Alcohol, cannabis, ecstasy and cocaine: drugs of reasoned choice amongst young adult recreational drug users in England

This paper describes the current drugs consumption patterns of a cohort of English young adults who have been tracked, longitudinally, since they were fourteen. It compares their tobacco, alcohol and illicit drugs consumption at 22 years (n=465) with when they were 18 years (n=529) using self-report questionnaires and in-depth interviews (n=86). It further explores whether, as a very drugwise/experienced sample of adolescents, this cohort are now beginning to settle down and reduce their substance use. The results suggest that any reductions in recreational drug use are likely to be delayed beyond traditional markers. The cohort have largely maintained their consumption habits with rates for current tobacco smoking (35.5%), regular drinking (82.3%), on-going drug involvement (past year, any drug, 52.1%) and more regular use (past month, any drug, 31.2%) being almost identical to their rates at 18 years. Current drug involvement is increasingly dominated by cannabis however. A minority continue to use ecstasy. LSD and amphetamine use have declined but cocaine trying (lifetime prevalence 5.9% at 18 years up to 24.6%) and use have increased dramatically. Mixing and combining substances is commonplace. Hedonistic motives for these substance use patterns remain but are now joined by the need to use psycho-active repertoires ‘sensibly’ to relax and reduce the stresses of the working week. This style of recreational drug use by generally conforming adults offers a severe challenge to current national drugs strategy.     

The effect of medical cannabis laws on juvenile cannabis use

BackgroundA number of states in the United States legally allow the use of cannabis as a medical therapy to treat an illness or to alleviate symptoms. Concern persists as to whether these types of laws are increasing juvenile recreational cannabis use. It is also plausible that medical cannabis laws engender an escalation of illicit non-cannabis drug use among juveniles because cannabis is frequently considered to be a gateway drug.MethodsThis study uses longitudinal data drawn from the National Survey on Drug Use and Health for the 50 U.S. states and a cross-sectional pooled-time series research design to investigate the effect of medical cannabis laws on juvenile cannabis use and on juvenile non-cannabis illicit drug use. Our study period encompasses five measurement periods calibrated in two-year intervals (2002–2003 to 2010–2011). This research design is advantageous in that it affords us the ability not only to assess the effect of the implementation of medical cannabis laws on juvenile drug use, but also to consider other state-specific factors that may explain variation in drug use that cannot be accounted for using a single time series.ResultsFindings show that medical cannabis laws amplify recreational juvenile cannabis use. Other salient predictors of juvenile cannabis use at the state-level of analysis include perceived availability of cannabis, percent of juveniles skipping school, severity of perceived punishment for cannabis possession, alcohol consumption, percent of respondents with a father residing in household, and percent of families in the state receiving public assistance. There is little empirical evidence to support the view that medical cannabis laws affect juveniles’ use of illicit non-cannabis drugs.ConclusionBased on our findings, it seems reasonable to speculate that medical cannabis laws amplify juveniles’ use of cannabis by allaying the social stigma associated with recreational cannabis use and by placating the fear that cannabis use could potentially result in a negative health outcome.     

Secondary cannabis use among London drug treatment service clients

Background: Cannabis is the second most commonly used substance after alcohol among people seeking treatment for other drug use, but no statistics are available regarding secondary cannabis use among drug treatment clients.

Objectives: To investigate levels of secondary cannabis use among drug treatment clients and perceived need for support addressing this use among clients and staff.

Methods: Cross-sectional surveys of clients (N?=?295) and staff (N?=?33) were conducted in 2015 at four London drug and alcohol treatment services. Client measures included recent drug use, type of cannabis used, Severity of Dependence Scale for cannabis, and views on secondary cannabis use treatment. Staff measures included definition of problem cannabis use, importance and timing for addressing secondary cannabis use.

Results: Among clients, 39.7% reported recent secondary cannabis use, with 30.8% of these clients meeting criteria for problem use. Problem users were more likely to be interested in receiving treatment for cannabis use than non-problem users (51.4% versus 10.8%, p?<?.001). Nearly half of staff (48.5%) thought secondary cannabis use should be addressed early in treatment.

Conclusions: Two out of five drug treatment clients used cannabis and a third experienced cannabis-related problems. Many are willing to address cannabis use, but defined treatment pathways are needed.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.     

我院门诊处方点评及用药分析

目的：根据《医院处方点评管理规范》的基本指标要求,研究我院门诊处方特点,并采取干预措施减少不合理用药,促进临床合理用药。方法：随机抽取我院2013年1～12月每月门诊处方300张,总计3600张进行统计点评,对不合理处方及用药进行分析整理。结果：在随机抽取的处方中抗菌药物使用率为15．09％,基本药物使用率47．3％,平均用药2．60种,合格处方率92．17％。经过一年的持续点评干预,不合格处方率下降到7．83％。结论：处方点评和干预措施改善了我院处方质量。加强门诊审核药师药学知识学习会对降低不合格处方率具有很好的作用。     

Adolescent stigma towards drug addiction: Effects of age and drug use behaviour

The objective of this study was to examine adolescent age and experience with drug use on stigmatizing attitudes toward drug addiction. Data were derived from the  2005 cycle of the Ontario Student Drug Use Survey. In total, 4078, 7- to 12-graders completed self-administered questionnaires that included a measure of drug abuse stigma. Results indicated that stigma scores were higher among younger than older adolescents, and the decline across age was robust, occurring among both males and females and those from rural and non-rural areas. The decline, however, was stronger among non-drug users and among those who had no close friends that use drugs. Despite the age-related decline, the level of stigma in general suggested that drug abuse stigma may continue into adulthood. Findings highlight that individual attitudes toward drug use and drug abusers are salient factors for personal drug use. Given that stigma is a barrier to treatment, but reduced stigma may encourage greater adolescent use, this study highlights the need for more in-depth studies of drug stigma.     

北京安贞医院2010年度用药咨询记录分析

目的:通过对我院用药咨询情况进行整理分析,就热点问题进行讨论,总结工作经验,以提高合理用药的水平。方法:将2010年度用药咨询记录共计5 213份作为统计对象,按咨询方式,咨询者身份、性别、年龄情况,咨询完成情况、咨询内容以及咨询药物品种分布情况进行统计分析。列举一些特殊案例,提出合理性建议。结果:咨询者以老年患者居多,占总咨询数的96.1%,且女性多于男性。咨询内容中一般性问题占总咨询数的76.1%,专业性问题总体上涉及较少,但个别患者提出的问题又非常专业,反映了患者对药品知识的了解情况不一。结论:提高药物咨询工作质量对促进合理用药有非常重要的意义,有利于进一步树立药师的公众形象。     

基层医院临床不合理用药分析

目的分析不合理用药情况及原因,提高基层医院合理用药水平,确保患者用药安全。方法随机抽取本院2009年1月-2010年1月门诊西药处方960张,根据有关药学理论,统计其不合理用药处方进行分类和统计分析。结果不合理用药处方合计90张（占9．38％）,不合理用药主要表现在四个方面,根据处方数所占的比例依次为：联合用药不合理29张（32．22％）、重复用药25张（27．78％）、选药不当20张（22．22％）、用法不合理16张（17．78％）。结论合理用药任重道远,特别是在抗生素的用药中,一方面需要临床医生科学用药,另一方面需要加强多方面的监督和制约。     

Multiple routes of drug administration and HIV risk among injecting drug users

This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25-0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01-3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02-5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.     

探析儿科不合理用药现状及合理用药原则

合理用药是现代医学必须遵守的一个最基本原则,现代药物机制的复杂性及疾病的多样性要求医生在诊疗过程中要仔细研究病情,科学合理用药。经过长期的发展,现代医学对疾病的认识以及治疗,建立了一套相对完善的理论体系,特别是在治疗对象上的细分,这为治疗的具体实施提供了便利。儿科作为一个重要的医学分支,在用药上有自己独特的特点,儿科的合理用药体现在给药过程的每一个环节(科学选择药物,合理使用药物及正确的剂量、用法等)。由于种种原因,实际诊疗过程中儿科用药存在一些不合理情况,不利于患儿疾病的康复。临床药师、医生应谨遵儿科用药特点及药物使用原则纠正这些不合理现象。     

门诊处方点评和用药分析

目的对处方进行点评,促进合理用药。方法 2010年3～11月,每月随机抽取处方150张,总计1350张,进行统计点评。结果抗菌药物使用率为38.2%,注射剂使用率为18.1%,不合格处方率为10.7%。结论处方点评实施了药师对临床的用药监控,使不合格处方率呈下降趋势,提高医生用药水平,保障用药安全。     

我院静脉用药调配中心不合理用药分析

目的分析本院静脉用药调配中心的不合理用药情况,并提出改善建议,以确保患者的静脉用药安全。方法对2021年1~6月本院静脉用药调配中心的不合理用药医嘱的审核结果进行统计分析。结果 126份不合理处方中,配伍禁忌46份(36.5%),溶媒选择不当23份(18.3%),给药剂量不当19份(15.1%),药物浓度不合理18份(14.3%),重复用药12份(9.5%),给药途径不合理8份(6.3%)。结论通过药师对静脉用药调配中心用药医嘱进行审核与干预,同时以药品说明书及相关资料为依据,及时纠正临床静脉用药问题,减少或避免临床的不合理用药,保障患者静脉药物治疗安全。     

Routes of cannabis administration among adolescents during criminal prohibition of cannabis in Canada

Abstract

This report assesses sociodemographic correlates of cannabis routes of administration (ROAs) among adolescents in 2017, one year prior to legalization of cannabis in Canada. We analyze a subsample of 809 students (Grades 9–12) from the Ontario Student Drug Use and Health Survey (OSDUHS) who used cannabis in the previous year. Pipes/bongs/waterpipes (81.8%) are the most prevalent ROA, followed by joints (73.8%) and edibles (42%). Approximately 70% of students report 2+ ROAs. Alcohol use in the previous year is associated with 2.28 (1.3–5.58 OR; 95% CI) times the odds of food/drink ROA and 2.91 (1.10–3.89; 95% CI) times the odds of joint ROA. Tobacco use is associated with 1.60 (1.07–2.41 OR; 95% CI) times the odds of blunt ROA, 2.07 (1.10–3.89; 95% CI) times the odds of pipe/bong/waterpipe ROA, and 1.75 (1.03–2.95 OR; 95% CI) times the odds of e-cigarette/vape pen/vaporizer ROA. Students who used alcohol have a rate 1.59 (1.08–2.36 IRR; 95% CI) times greater for total ROA count, and students who used tobacco have a rate 1.24 (1.09–1.40 IRR; 95% CI) times greater. Given young people’s vulnerability to adverse outcomes associated with cannabis use, it is important to track ROA trends to inform harm reduction and educational programing and to evaluate impacts of policy changes.     

2011年本院儿科住院患者用药现状与分析

目的：了解本院儿科住院患者用药特点,促进儿科合理用药。方法：对本院儿科住院患者用药采用金额排序法进行回顾性统计和分析,并随机抽取2011年儿科住院病历100份进行合理用药分析。结果：按金额排序,儿科住院患者用药种类前5位依次是中药制剂、抗感染药、呼吸系统用药、心血管系统用药和解热镇痛药。抗菌药物使用率较高,在用药中存在一定的不合理用药情况。结论：本院儿科住院患者用药基本合理,但应加强抗菌药的使用管理,儿童使用中药制剂应加强规范,并应提高儿童合理用药水平。     

治疗药物监测在丙戊酸临床应用中的研究进展

近年来,丙戊酸有关的治疗药物监测研究报道较多。在临床实践中治疗药物监测作为丙戊酸剂型选择和治疗方案调整的参考依据,可以提高丙戊酸临床疗效、减少药物不良反应,考察患者的服药依从性。丙戊酸在临床使用时进行治疗药物监测对丙戊酸的临床个体化、合理用药有着重要的指导意义。