Neuropsychological Measurement of Drug Effects: Polydrug Research

Abstract

This study examined the impact of treatment intensity on cocaine use. Seventy-seven cocaine-using methadone patients were enrolled in a six-month, structured, manual-driven, cognitive behavioral treatment program. Sessions consisted of five individual and/or group sessions per week. At intake subjects showed extensive polydrug abuse, psychiatric comorbidity, criminal histories, and HIV risk behaviors. Treatment intensity was measured by dividing number of sessions attended into quartiles. Paired comparisons, within treatment quartiles, were made between subjects' intake and six-month self-reports of cocaine use. Subjects in quartiles two through four showed significant reductions in frequency of cocaine use at follow-up, with subjects who received the most treatment showing the greatest reductions in cocaine use. Bivariate and multivariate analyses showed that treatment sessions attended remained a strong predictor of reduction in cocaine use at follow-up, even after controlling for drug use at intake and background variables. The results indicate that there is a substantial treatment dose-response relationship.     

住院医嘱不合理药物联用案例分析

目的为临床合理联用药物提供参考。方法随机抽查住院病例医嘱,查找不合理用药问题并进行汇总分析。结果 2406份住院医嘱中,共发现不合理药物联用问题44例。结论临床药师应开展以药物相互作用为主线的药学服务,确保安全有效的药物联用。     

Polydrug use (the use of drugs in combination): A brief review

This brief review provides an overview of this topic; it is not a critical review. Polydrug use is a poorly defined concept; it is taken here to mean the simultaneous use of more than one drug. Data on polydrug use is seldom systematically collected, and the use of alcohol and tobacco in combination with illegal drugs is frequently overlooked. If alcohol and tobacco are included, most users are polydrug users, since these drugs are used by most users of illegal drugs, and many people with alcohol problems also use illegal drugs. Polydrug use has increased; drug availability, cultural context and the 'normalization' of drug use are important factors. Gender and racial differences are observed in the prevalence of polydrug use. Implications for drug prevention include the importance of targeting multiple substance use rather than single substances. Aiming prevention campaigns at younger people and focusing on 'gateway' drugs might be more effective. But polydrug users are diverse, and a variety of strategies (aimed at different types of polydrug users) are necessary. Implications for treatment include the evidence of the greater difficulty that polydrug users have in quitting; they may therefore require additional help. A fuller, systematic, review is required; it is expected that this would recommend the commissioning of additional research on this poorly understood phenomenon.     

Polydrug use (the use of drugs in combination): A brief review

This brief review provides an overview of this topic; it is not a critical review. Polydrug use is a poorly defined concept; it is taken here to mean the simultaneous use of more than one drug. Data on polydrug use is seldom systematically collected, and the use of alcohol and tobacco in combination with illegal drugs is frequently overlooked. If alcohol and tobacco are included, most users are polydrug users, since these drugs are used by most users of illegal drugs, and many people with alcohol problems also use illegal drugs. Polydrug use has increased; drug availability, cultural context and the ‘normalization’ of drug use are important factors. Gender and racial differences are observed in the prevalence of polydrug use. Implications for drug prevention include the importance of targeting multiple substance use rather than single substances. Aiming prevention campaigns at younger people and focusing on ‘gateway’ drugs might be more effective. But polydrug users are diverse, and a variety of strategies (aimed at different types of polydrug users) are necessary. Implications for treatment include the evidence of the greater difficulty that polydrug users have in quitting; they may therefore require additional help. A fuller, systematic, review is required; it is expected that this would recommend the commissioning of additional research on this poorly understood phenomenon.     

Reconciling incongruous qualitative and quantitative findings in mixed methods research: exemplars from research with drug using populations

Mixed methods research is increasingly being promoted in the health sciences as a way to gain more comprehensive understandings of how social processes and individual behaviours shape human health. Mixed methods research most commonly combines qualitative and quantitative data collection and analysis strategies. Often, integrating findings from multiple methods is assumed to confirm or validate the findings from one method with the findings from another, seeking convergence or agreement between methods. Cases in which findings from different methods are congruous are generally thought of as ideal, whilst conflicting findings may, at first glance, appear problematic. However, the latter situation provides the opportunity for a process through which apparently discordant results are reconciled, potentially leading to new emergent understandings of complex social phenomena. This paper presents three case studies drawn from the authors’ research on HIV risk amongst injection drug users in which mixed methods studies yielded apparently discrepant results. We use these case studies (involving injection drug users [IDUs] using a Needle/Syringe Exchange Program in Los Angeles, CA, USA; IDUs seeking to purchase needle/syringes at pharmacies in Tijuana, Mexico; and young street-based IDUs in San Francisco, CA, USA) to identify challenges associated with integrating findings from mixed methods projects, summarize lessons learned, and make recommendations for how to more successfully anticipate and manage the integration of findings. Despite the challenges inherent in reconciling apparently conflicting findings from qualitative and quantitative approaches, in keeping with others who have argued in favour of integrating mixed methods findings, we contend that such an undertaking has the potential to yield benefits that emerge only through the struggle to reconcile discrepant results and may provide a sum that is greater than the individual qualitative and quantitative parts.     

Adverse effects on birth weight of parental illegal drug use during pregnancy and within two years before pregnancy

This study investigates possible links between maternal illegal drug use during pregnancy and up to two years before pregnancy with birth weight (BW), and explores the potential role of paternal illegal drug use on low birth weight. A population-based retrospective cohort study was conducted that linked four national databases in Taiwan. A total of 1,698 subjects with a criminal record of schedule I or II illegal drug use within two years before pregnancy were enrolled as the drug-exposed group, and 16,980 matched subjects were enrolled as the unexposed group. Multivariate analysis of BW found a decrease of 108.63 g (95% CI: −172.29, −44.96), 79.67 g (95% CI: −116.91, −42.43), and 69.78 g (95% CI: −106.71, −32.84) in newborns whose mothers used illegal drugs only during pregnancy (period I), only within one year before pregnancy (period II), and only within the second year before pregnancy (period III), respectively. Paternal use of illegal drugs before maternal pregnancy was significantly associated with low birth weight. The paternal effect on low birth weight was opposite the maternal effect. The adverse effect of illegal drug use on birth weight existed even if the mother did not use drugs during pregnancy but had ever used drugs during the two years before pregnancy. Paternal factors’ contribution to low birth weight persisted, and the decrement of BW was even greater than the maternal effect within one or two years before pregnancy. Maternal and paternal illegal drug use may have a lasting effect on their offspring’s birth weight.     

我院住院患者抗菌药物应用分析

目的：了解抗菌药物的应用状况，指导临床合理应用抗菌药物。方法：对2006年11月～2007年11月我院2130份出院病历抗菌药物的使用情况编制调查表进行统计分析。结果：住院患者抗菌药物使用率为63．28％，单联、二联、三联用药率分别为81．56％、31．69％、5．25％。预防性用药占69．76％，经验用药占94．31％，抗菌药物应用频率最多的种类是头孢菌素类，其次为氟喹诺酮类，新型、昂贵抗菌药物所占比率大，主要存在的问题有预防性使用抗菌药物过宽、预防用药不规范、经验用药和选用高档抗菌药物较多、病原学送栓率低。结论：我院抗菌药物应用率偏高，不舍理应用仍占相当比例。     

The Ethnographic Accessing,Sampling and Screening of Hidden Populations: Heroin Sniffers in New York City

This article discusses various ways in which ethnographic methods were employed in a cohort study of HIV risk and transitions to injecting among non-injecting heroin users (NIUs), or ‘sniffers’, in New York City. In preparation for and in conjunction with an epidemiologic questionnaire survey and biological specimen collection, ethnographic methods were used to explore the meaning of non-injecting and injecting routes of heroin administration for NIUs, how non-injecting heroin use was imbedded in the everyday life of the user, and the relationship of users to the retail markets for heroin. The study utilised different ethnographic techniques to access, sample, and screen heroin ‘sniffers’ for the epidemiologic survey. These techniques included ethnographic accessing, targeted canvassing, and interactive screening. The article concludes that ethnographic methods can be fruitfully integrated with epidemiologic survey research and are necessary for conducting research among non-institutionalised, ‘hidden’ populations of drug users.     

1600份住院病历用药合理性分析

目的：调查我院住院患者病历记录,对医生给药方案进行分析,为临床合理用药提供参考。方法：对我院2007年6月-2008年6月归档的1600份住院病历进行审核,并对其中不合理用药现象进行总结和分析。结果：245份（15．3％）病历中存在着不舍理用药现象,包括用药时间不合理（137份）、药物选择不合理（151份）、药物用法不合理（64份）、用药剂量不合理（46份）、用药途径不舍理（16份）。结论：应重视加强用药时间、药物选择的合理性宣传,提高医生用药水平,保障用药安全。     

A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment

Aims: Privileged access interviewing (PAI) has traditionally been used to reach illicit drug users and other ‘hidden’ populations. How PAI data compare to other self-reported data have seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions.

Methods: Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ² test, Fisher’s exact test, t-test and logistic regression analysis.

Results: PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p?<?0.001 and p?=?0.001, respectively). Furthermore, the PAI group reported selling medication (p?<?0.001 last month, p?<?0.001 during treatment episode) and snorting buprenorphine (p?=?0.010 last month, p?=?0.001 during treatment episode) more frequently.

Conclusions: PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a data-gathering method also when studying other, more easily accessible populations.     

Research methods for studying injecting drug users in a rural centre

Targeted sampling, multiple data collection methods and peer interviewers have been used with success for studies of injecting drug users (IDUs) in main cities. This paper reports the success of a trial of these research methods with IDUs in a rural centre. Recruitment via outreach (for individual interviews and for focus groups), street intercept and service-based surveys (methadone clinic and prison based surveys) were found to be viable and to vary in their success in recruiting subgroups of IDUs. Their use in combination is recommended so that the largest possible range of IDUs can be recruited. The close involvement of peer interviewers and of an advisory group in planning and implementing these data collections was essential. Advertising was not found to be successful for recruiting to a phone-in, for focus groups nor to a community forum. Concerns about anonymity, 'paranoia' and a general lack of a cohesive IDU community were barriers to recruitment.     

不合理用药典型案例分析

目的：对临床药物治疗中不合理用药的典型案例进行分析和评价,为临床合理用药提供借鉴和参考。方法：通过参与临床用药实践及对住院病历医嘱合理性进行点评,对典型不合理用药案例进行分析和评价。结果：临床不合理用药主要表现在4个方面：①特殊人群用药不合理;②药物使用方法不合理;③联合用药不合理;④药物配伍禁忌。结论：通过积极参与临床用药实践,及时发现和分析临床不合理用药问题,并为个体化治疗提出相应解决方案,避免不合理用药的发生,保证患者用药安全有效。     

我院120份住院病历不合理用药分析

目的：了解住院病人不合理用药情况。方法：随机抽查2004～2006年我院120份住院病历j结果：120份病历中有768组方，其中有实际意义药物相互作用的27组，占3、52％，给药方案不妥的15组，占1．95％。结论：重视合理用药，才能够提高临床医疗质量。     

我院320例住院患者抗菌药物使用调查分析

目的：了解住院患者抗菌药物的应用情况,为临床合理用药提供参考。方法：采用回顾性调查分析的方法,随机抽取我院2006年6月部分出院患者病例320份,其中使用抗菌药物病例135份,对其抗菌药物使用情况进行统计分析。结果：共涉及6大类36个品种抗菌药物,排在前3位的分别为β-内酰胺类、氟喹诺酮类和硝基咪唑类。结论：我院抗菌药物使用基本合理,但仍存在一些问题,应进一步提高合理用药水平。     

Exploring Prospective Predictors of Illicit Drug-Toxicity Deaths: Evidence From the General Social Survey

Background: This study was based on over 30,000 U.S. respondents who completed General Social Surveys between 1978 and 2002. Aims: We approached these respondents prospectively, comparing and contrasting the responses of those who subsequently died from drug-poisonings (N = 135) with all respondents who were still living, N = 23,559. Method: We employed cross-tabulation and logistic regression analyses to test for statistically significant differences between drug-poisoning death casualties and all living respondents. Results: Consistent with past research findings, younger males were over-represented among drug death casualties. Also consistent with past studies, drug casualties showed evidence of perceiving themselves as socially marginalized in comparison to living respondents: More reported themselves in poorer health, as having been sexual minority members during the last 5 years, as having spent their younger years in homes where parents’ marriages disrupted, with fewer owning homes and feeling less satisfied about their financial situations. Conclusions: These exploratory findings obtained from a general population survey reinforce findings from clinical studies and help advance clinical assessments of potential at-risk individuals who might be identified sooner, lest they succumb to future fatal drug poisonings.     

我院150例住院患者围术期抗菌药物应用分析

目的:调查我院住院患者围术期抗菌药物的应用情况,为进一步规范抗菌药物的合理使用提供依据。方法:以随机抽样法抽取我院2011年1—3月住院手术病历150份,对手术类别、抗菌药物种类、用药时间和持续时间、合并用药情况及其合理性进行统计分析。结果:150例手术全部预防性使用了抗菌药物,使用抗菌药物涉及7类37种;起始用药时间在术前0.5～2 h内或术中用药的共63例,占42%;持续用药时间平均为(8.5±4.3)d;联合用药48例,有11例不合理。结论:我院围术期预防性应用抗菌药物的适应证把握不严、用药时间把握不当、疗程过长和选药起点高等问题比较突出。     

Collective Empowerment While Creating Knowledge: A Description of a Community-Based Participatory Research Project With Drug Users in Bangkok,Thailand

In light of growing concerns regarding the ongoing drug war in Thailand and a lack of support for people who inject drugs in this setting, in 2008, we undertook a community-based participatory research project involving a community of active drug users at a peer-run drop-in center in Bangkok. This case study describes a unique research partnership developed between academic and active drug users and demonstrates that participatory approaches can help empower this vulnerable population while generating valid research. Further research is needed to explore ways of optimizing community-based participatory research methods when applied to drug-using populations.     

Drug treatment and the achievement of paid employment

The aim of this article is to identify which aspects of drug treatment are most closely associated with recovering drug users’ ability to obtain paid employment. Based on a cohort study of 1033 individuals, this article reports on a logistic regression analysis of the factors associated with the achievement of paid employment 33 months after the initiation of treatment for drug dependency. While the results show a close relationship between the cessation of illegal drug use and individuals’ ability to obtain paid employment, they also show that abstaining from drug use is unlikely to be successful on its own. The factor that showed the strongest independent association with the achievement of paid employment was the receipt of employment-related assistance. The study's findings are, therefore, strongly supportive of the provision of employment support programmes as the most important mechanism for helping recovering drug users to obtain employment.     

2010 年至 2011 年某医院老干部住院用药分 析简

目的分析军队医院老干部住院用药情况,为临床合理用药提供参考。方法采用分类排序、金额排序和用药频度（DDDs）排序等方法,对2010年至2011年医院老干部住院用药前50位药品类别、使用金额和用药频度情况进行统计、分析。结果老干部住院用药前50位主要以循环系统药物、抗菌药物为主,其次为呼吸系统和消化系统药物,2年来药品品种变化不大,但用药金额增长幅度较大。结论住院用药分析结果反映了老干部住院用药的特点,与国内老年人住院用药情况基本相符,符合老年病的疾病谱。