Patterns of multiple substance abuse during pregnancy: implications for mother and fetus

This paper describes patterns of drug use such as choice of drug, other substances abused, and route of administration in 174 women who reported methamphetamine, cocaine, heroin, or "Ts and blues" abuse during pregnancy. Seventy-five percent (130/174) reported using more than one drug. Other than tobacco, alcohol and cocaine were the drugs most frequently used in combination with other drugs (7% to 53% and 12% to 54% of the time, respectively). The extent of polydrug use observed in this study emphasizes (1) the difficulty in ascribing adverse maternal or fetal health effects to single substances, and (2) the potential for interaction effects due to multiple substance abuse.     

'Designer drugs'. Recognizing and managing their toxic effects.

"Adam," "Eve," "ecstasy," "China white." Illicit street drugs such as these are called designer drugs because they are designed to elicit certain effects and to bypass legal classification. Unfortunately, use and abuse of such substances can lead to serious medical problems and even death. Drs Sternbach and Varon describe the best-known compounds and discuss clinical characteristics and management of designer drug intoxication.     

“Designer drugs” — A current perspective

Since the late 1970s, in an effort to quench the ever burgeoning appetite for pharmacological substances of abuse and to satiate their own need for profit, unscrupulous chemists have set up clandestine laboratories to produce and market new drugs for street sale. Using fairly common industrial chemicals, they have altered or modified preexisting controlled substances such as fentanyl, meperidine, mescaline, amphetamine, and phencyclidine, producing derivatives of these parent compounds that, up until 1986, were able to temporarily elude the guidelines of the Federal Controlled Substances Act due to their new and unique chemical structures. Unsuspecting users continue to use the drugs recreationally. This article will present a comprehensive review of these “Designer Drugs” looking at historical data, pharmacokinetics, treatment, abuse trends, and some of the more recent additions to the social pharmacopoeia.     

New Synthetic Drugs in Addictovigilance

New substances, also known as "designer drugs" or "legal highs" are increasingly available to drug users. Two hundred and fifteen hitherto unlisted substances have been notified by European Union member states since 2005. These synthetic drugs, which have been developed to side-step the legislation on drugs, are analogues or derivatives of existing drugs and medications. The availability of these "legal highs", sold on Internet under various denominations such as bath salt, plant fertilizer, chemical not intended for human use, or spice, is unlimited. The effects felt by users vary, and the substances may be stimulant, entactogenic, hallucinogenic, psychedelic or dissociative. The pharmacological targets also vary, and may be either the increase of extracellular levels of neurotransmitters via different mechanisms (reuptake inhibition, stimulation of intracellular release) or else fixation on specific receptors. Several chemical classes, themselves divided into sub-classes, are involved: phenethylamines, tryptamines, piperazines, cathinones, cannabinoids etc. The toxicity of the main members of these categories is increasingly well known, the most deleterious being behavioural effects, physical manifestations, and cardiovascular consequences. However, small variations in their chemical structure can generate effects that are quantitatively different, thus enhancing their toxicity or addictive potential, and much remains to be achieved in terms of knowledge about these new drugs. These substances are indeed present on the French territory, as shown by data provided by the Observatoire Français des Drogues et Toxicomanies, and notifications by the French Addictovigilance network. Screening in clinical toxicology laboratories is not widespread, since these molecules are not detected by the standard screening tests, so that there is probably an under-estimation of the use of these new drugs. The legislation on these substances changes regularly, with more and more countries classifying them as "narcotics" or illegal psychotropic drugs so as to restrict their use, applying a generic classification when possible.     

Drug Abuse Monitoring: Which Pharmacoepidemiological Resources at the European Level?

Monitoring the potential for abuse and dependence of psychoactive substances falls within the scope of international conventions on narcotic drugs. At the European level, this monitoring is based on activities controlled by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) for substance abuse in general and by the European Medicines Agency (EMA) for marketed drugs, in the context of pharmacovigilance. If France has set up in the early 1990s an original system to assess potential for abuse of psychoactive substances, with specific tools combining both the evaluation of the use of these substances (illicit substances or diverted drugs), and the consequences of that use in terms of morbidity and mortality, there is no equivalent in other European countries. Indeed, unlike the USA, who, for several decades, organized this type of surveillance, with a multisource approach (sentinel systems, databases, medical and administrative data, databases for seeking care in relation abuse), we have not found in other European countries integrated system for identifying a signal of drug abuse, or to assess the impact of measures for minimizing the risk of abuse. However, some recent examples show a growing concern about drug addiction, based on a pharmacoepidemiological approach using pharmacovigilance databases or medical administrative data. These examples illustrate the interest of these approaches in the field of drug of abuse.     

Adolescent drug and alcohol use. Strategies for assessment,intervention, and prevention

Adolescent alcohol and other drug use continue to elude prevention efforts and fall short of the Healthy People 2010 targets. How is a clinician to know when an adolescent is experimenting with alcohol or other drugs, and when there is a potential problem? Beginning with an overview of the prevalence and clinical significance of various substances used by adolescents, this article considers the family, peer, and community context within which substance abuse develops. Indicators of problematic use patterns and some of the factors that protect adolescents are explored. Prevention and treatment strategies are outlined, including suggestions for counseling parents how to protect their teens from substance abuse.     

Substance abuse and the kidney

Substance abuse has been increasing steadily in the UK and some other countries. Recent evidence suggests more than 40% of young people have tried illicit drugs at some time. There are numerous medical consequences to recreational drug use, and a physician should always consider substance abuse in any unexplained illness. The renal complications of drug abuse are also becoming more frequent, and may encompass a spectrum of glomerular, interstitial and vascular diseases. Although some substances are directly nephrotoxic, a number of other mechanisms are also involved. These effects are often chronic and irreversible, but occasionally acute with possible recovery. The rapid growth of illicit drug use is clearly a major public health problem. We review the commonly used substances of abuse and their associations with renal disease.     

Current “Legal Highs”

Background

A growing number of novel substances have been abused as recreational drugs by young people in the United States (US), Europe, and Australia. Called “legal highs,” these substances range from plant-based to completely synthetic compounds. Spice, Salvia, mephedrone, methylenedioxypyrovalerone (MDPV), and other cathinone derivatives have psychotropic effects and are marketed for recreational use through exploitation of inadequacies in existing controlled substance laws.

Objectives

This article reviews available literature on the most common “legal highs” as well as discussing the scientific basis for the legal difficulties in controlling trafficking in these novel substances.

Conclusions

“Legal highs” continue to increase in use in the US, Europe, and Australia. These substances are powerful, can mimic effects of more traditional drugs of abuse, and are intentionally manufactured to circumvent existing controlled substance laws. As controlled substance legislation may be inadequate in the face of the quickly evolving legal highs, physicians are likely to see an increase in the prevalence of legal highs.     

Importance of creatinine analyses of urine when screening for abused drugs

We report here a simple method involving urine creatine measurements for testing authenticity and reducing false-negative results in urine testing for drugs of abuse. Urinary creatinine in consecutive patient samples (n = 176) ranged between 0.1 and 31.9 mmol/L (mean 9.8 +/- SD 6.2) and the osmolality in these urines ranged between 49 and 1183 mOsm/kg (mean 595 +/- SD 276). With other consecutive samples in which creatinine was (arbitrarily chosen) less than 4.3 mmol/L (n = 85), the correlation with osmolality was lower. In 10 randomly selected urine samples from different patients, all "clean" for all drugs of abuse in initial immunological drug testing with approved methodology (in which creatinine was less than 4.3 mmol/L and osmolality was less than 200 mOsm/kg), five patients turned out to be drug positive after a simple concentration by volume. In a formerly heavy smoker of cannabis, the excretion of cannabinoids and creatinine was monitored for 93 days. The substances showed very good correlation throughout this period (r = 0.93, P less than 0.001), whereas simple measurements of cannabinoid concentrations would have falsely indicated several relapses of cannabis abuse. Urine samples used in drug-abuse testing should be tested for creatinine; if creatinine is less than 4.0 mmol/L, negative results for drugs may not be valid.     

Substance abuse among nurses: types of drugs

Substance abuse among nurses can have significant ramifications for patient care, productivity, and personal well-being. Existing evidence suggests that critical care nurses are especially vulnerable to pressures that induce substance abuse. Consequently, critical care leaders and nurses need to be prepared to help their impaired colleagues. This paper provides several valuable guidelines for addressing substance abuse based on an exploratory study of the types of drugs or substances most frequently abused among nurses.     

Rhabdomyolysis and drugs of abuse

Rhabdomyolysis is a disorder in which injury to muscle results in leakage of myocyte intracellular contents into the plasma. It has been associated with a tremendous number and diversity of clinical conditions and substances. Several physiological and biochemical mechanisms for this syndrome have been described. The most likely etiology of rhabdomyolysis in patients presenting to the emergency department is ingestion of drugs of abuse, most commonly ethanol, heroin, amphetamines, cocaine, and other sedatives or stimulants. In this article, the association between rhabdomyolysis and drugs of abuse is explored, as well as its diagnosis and treatment.     

Emerging drugs of abuse

Several new and emerging substances are being diverted for abuse. Most of these emerging abused substances do not cause traditional drug screens to turn positive. The health effects of these substances have not yet been fully elucidated. Health care providers should be aware of the existence of these new abused substances.     

Romania: changing the regulatory environment

Access to the necessary medications for palliative care, especially opioids, is an essential part in the development of a national palliative care program. In November 2005, Romania's Parliament adopted new legislation concerning the medical use of opioids and psychotropic substances to replace the old and restrictive legislation of 1969. The new law and regulations are the result of a four-year project in which governmental authorities collaborated with health care professionals and international experts. The World Health Organization "Achieving Balance in National Opioids Control Policy--Guidelines for Assessment" was used to propose balanced legislation that would facilitate modern pain management and provide adequate control of these substances with the potential for abuse. A national education program to facilitate the implementation of the new legislation has been organized. The training started in November 2006 and will continue throughout 2007. It is anticipated that at least 3,000 doctors and 500 pharmacists will attend these courses.     

Systemic opioid and chronic pain

Opioid analgesic drugs currently represent the most powerful choice in pain therapy. They elicit their effects by mimicking endogenous substances – opioid peptides – the natural ligands of the opioid receptors. These analgesic drugs interact with specific receptors physiologically present in the central nervous system (CNS) and in the periphery, where they serve different functions. The opioid receptors modulate well-known functions related to nociceptive transmission, but this system is also involved in the regulation of gastrointestinal, endocrine, and autonomic functions. Opioids are being prescribed more frequently for treating pain, and physicians should be able to control pain before it becomes intractable. Recent research on new endogenous opioid pathways, the development of several administration routes, and the development of new drugs with reduced ability for abuse, will allow a deeper scientific understanding, better targeted therapy, and safer use of opiate drugs for the pharmacological control of pain. The goals in this field of research are important and future knowledge will help physicians to use all analgesic drugs correctly and effectively in the treatment of pain.     

Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens

Urine drug testing is frequently used in clinical, employment, educational, and legal settings and misinterpretation of test results can result in significant adverse consequences for the individual who is being tested. Advances in drug testing technology combined with a rise in the number of novel misused substances present challenges to clinicians to appropriately interpret urine drug test results. Authors searched PubMed and Google Scholar to identify published literature written in English between 1946 and 2016, using urine drug test, screen, false-positive, false-negative, abuse, and individual drugs of abuse as key words. Cited references were also used to identify the relevant literature. In this report, we review technical information related to detection methods of urine drug tests that are commonly used and provide an overview of false-positive/false-negative data for commonly misused substances in the following categories: cannabinoids, central nervous system (CNS) depressants, CNS stimulants, hallucinogens, designer drugs, and herbal drugs of abuse. We also present brief discussions of alcohol and tricyclic antidepressants as related to urine drug tests, for completeness. The goal of this review was to provide a useful tool for clinicians when interpreting urine drug test results and making appropriate clinical decisions on the basis of the information presented.     

Signal Identification in Addictovigilance: the Functioning of the French System

The French addictovigilance network (addictovigilance: surveillance of addiction), composed of 13 Addictovigilance Centres, was set up in 1990 in order to achieve reliable surveillance and evaluation of abuse and dependence cases due to psychoactive substances (alcohol and tobacco excepted). The detection of safety signals is one of the roles of the addictovigilance centres. Signals from spontaneous reports need to be analyzed before further communication. In addictovigilance, signals may be linked to adverse effects (deaths, pathological signs), to products (new psychoactive substances with potentially dangerous effects) or to practices (new administration routes, new contexts of use). These signals are provided by numerous partners among whom the addictovigilance network has to raise awareness about information that may possibly be an alert signal. The watchful attitude of all partners will make it possible that signals will be, after analyze, considered as true alerts. The addictovigilance network collects data, assess the potential for addiction of psychoactive drugs to provide information on the risk of addiction and give opinions for public health decisions (harm reduction or prevention programs, psychoactive substances control, health alerts).     

Abuse of licit and illicit psychoactive substances in children and teenagers in the PACA Region (Southeastern France)

INTRODUCTION: The abuse of licit and illicit psychoactive substances in children and teenagers represents a public health problem. MATERIALS AND METHODS: The aim of this study was to evaluate the extent of this phenomenon and its growth in the PACA (Provence-Alpes-C?te d'Azur) region (Southeastern France). The cases identified during the 10-year period 1992-2002 by the CEIP (Centre d'Evaluation et d'Information sur la Pharmacodépendance) were studied retrospectively. RESULTS: One hundred and ninety-one cases were identified. In most instances, abuse involved a first experience or was sporadic. The users were often boys (70%). The substances were solvents (48.7%) used collectively (33%) during recreational activities (74%). Illicit drugs accounted for 28.2% of the cases involving a first experience (89%), with polyconsumption accounting for 50%, cannabis 57.6%, ecstasy 25.9%, and LSD (lysergic acid diethylamide) 12.1% of cases. Medicines were also used (16%), the most frequent being benzodiazepines (51.6%). CONCLUSION: The study confirms the abuse of licit and illicit psychoactive substances in children and teenagers and provides information regarding the substances available in this region of France.     

Identifying the substance abuser in clinical practice.

Illicit drugs are used regularly by 14.5 million Americans. By identifying patients who abuse substances, the nurse will be better able to provide for the treatment interventions needed and omit ineffective treatment interventions. The patient will benefit by receiving timely and appropriate care. To identify substance abusers, the nurse must know effects of commonly abused drugs, their routes of administration, withdrawal signs, and the physical assessments that should be performed. The most common drugs abused are narcotics, depressants, antidepressants, anti-anxiety drugs, stimulants, hallucinogens, and marijuana.