2012-2014年我国复方地芬诺酯滥用的时空分布

目的:了解我国药物滥用人群中复方地芬诺酯的滥用现状及对周边地区的影响。方法:基于2012-2014年国家药物滥用监测的复方地芬诺酯滥用数据,利用Moran I和Get G*等空间统计分析模型,探索复方地芬诺酯滥用的时空分布规律和热点地区。结果:2012-2014三年复方地芬诺酯滥用平均上报率2.73%,其中,滥用者的平均年龄38.08岁左右,以男性(87.60%),汉族(79.30%),初中文化水平(52.6%)的滥用者为主。空间分析提示,2012-2014年,大部分省市复方地芬诺酯的滥用率呈下降趋势,滥用热点稳定在青海、甘肃、宁夏三个省。结论:我国复方地芬诺酯的滥用热点稳定分布在西北三省,提示有必要进一步研究这些地区的地芬诺酯滥用情况。     

昆明地区复方地芬诺酯片滥用情况分析

目的:了解昆明地区复方地芬诺酯片的滥用情况。方法:自行设计调查表,对2006年1月-2006年5月入所发现的复方地芬诺酯片滥用者进行调查。结果:在2152例海洛因滥用者中共发现复方地芬诺酯片滥用者208例,占9.67%。在208例复方地芬诺酯片滥用者中,男162例,占77.88%,女46例,占22.12%;年龄17-50(33.5±s6.2)a;婚姻状况:未婚134例,占64.42%,同居24例,占11.54%,已婚29例,占13.94%,离异21例,占10.10%;文化程度:小学84例,占40.38%,初中105例,占50.48%,高中及以上19例,占9.13%;职业:无业174例,占83.65%,个体15例,占7.21%,驾驶员8例,占3.85%,服务人员5例,占2.40%,其他6例,占2.88%。滥用复方地芬诺酯片的主要方式:口服(100%);初始滥用的主要原因:"戒毒"(49.04%),目前滥用的主要原因:"替代海洛因"(46.63%);主要来源:药店(83.66%)和小诊所(47.52%);有19例(9.13%)曾发生过滥用复方地芬诺酯片急性中毒。结论:昆明地区药物滥用者中出现复方地芬诺酯片滥用情况;复方地芬诺酯片容易获得;滥用的主要原因与海洛因滥用有关;希望有关部门予以重视。     

大剂量使用易造成滥用部分特殊药实施电子监管

昨天,国家食品药品监督管理局宣布,将对含麻黄碱类复方制剂(不包括含麻黄的中成药)、含可待因复方口服溶液、含地芬诺酯复方制剂等含特殊药品复方制剂实施电子监管,以进一步加强药品管理,防止从药用渠道流失和滥用。含可待因复方口服溶液是市民常用的镇咳药品,一旦大剂量使用,极易造成滥用成瘾,含麻黄碱类复方制剂、含地芬诺酯复方     

五省市吸毒人群中复方地芬诺酯使用情况调查

目的:调查吸毒人群使用复方地芬诺酯的现况、一般用药情况、用药目的及药物滥用潜力。方法:自行设计调查表,于2008年3月-7月,在北京、上海、广东、广西、山西等五个地区的戒毒所或社区美沙酮维持治疗门诊对戒毒人员或参加美沙酮维持治疗人员进行调查。采用视觉类比量表(VAS)评分评价使用复方地芬诺酯所产生的欣快效应。结果:在1147例有效被调查者中,有使用复方地芬诺酯经历者343例(占29.9%),全部为海洛因成瘾者,以31-40 a(占44.0%)、男性(占75.2%)、无业和个体经商(分别占30.1%和31.3%)、初中文化程度(占55.9%)以及已婚者(47.9%)为主。复方地芬诺酯的平均用量为8片.次-1,2次.d-1;75.5%为超常规大剂量用药者;98.8%以口服方式用药;73.6%从药店购买;20.8%同时合并使用其他药物;使用复方地芬诺酯的主要目的是"自行戒毒"(占88.0%)。VAS评分显示,滥用海洛因时产生的欣快感平均为6.2 cm,单独使用复方地芬诺酯时产生的欣快感平均为0.1 cm,两者比较有统计学差异(P<0.001)。根据每日用药剂量分组比较,超常规大剂量使用者产生的欣快感大于常规剂量用药者(P<0.05);且经Spearman等级相关分析显示,复方地芬诺酯的用量与欣快感之间存在正相关(P<0.05)。合并其他药物使用的欣快感大于单独使用(P<0.001)。结论:本调查人群中使用复方地芬诺酯主要目的是自行戒毒,大部分人属于非常规的大剂量用药。虽然该药的精神依赖性潜力不强,但大剂量使用或合并用药后会增加其滥用潜力。     

复方地芬诺酯片依赖11例临床分析

目的:探讨复方地芬诺酯片依赖的临床特点。方法:对11例复方地芬诺酯片依赖门诊患者的临床资料进行分析。结果:滥用原因主要是海洛因依赖者的自我脱瘾治疗或复方可待因溶液依赖者用作替代品。患者均从朋友处获知本药物有关作用的知识。药品来源于药店或诊所,易获得。滥用时间为3.1a±s1.6a,滥用剂量45.5片·d-1±s16.0片·d-1,滥用次数1.9次·d-1±s0.9次·d-1。滥用方式全部为口服。患者有躯体依赖和心理依赖的表现,VAS评分为4.1±s1.2。门诊治疗以逐渐减少药物剂量后小剂量维持治疗为主。结论:复方地芬诺酯片被滥用的剂量很大,其依赖综合征的表现与其他阿片类物质依赖的表现相似,依赖性呈中等强度。本药易被获得和滥用,应加强麻醉药品和精神药品的复方制剂的管理。     

地芬诺酯、曲马多滥用应引起重视

日前来宁波戒毒研究中心戒毒的病人从一些非法医疗机构或个人手中获得所谓的“戒毒药物”。根据病人主诉及我们实验室气相-质谱联用仪检测,发现为地芬诺酯、曲马多等,并存在较为严重的滥用趋势。基本情况如下:①一些海洛因依赖者在一些非法医疗机构或个人那里,采用大剂量的地芬诺酯、曲马多等进行脱毒治疗。②一些海洛因依赖者在得不到海洛因的情况下,用较低的价格购买“戒毒药物”,其主要由大剂量的地芬诺酯、曲马多、安定、消炎镇痛药等组成。③海洛因依赖者以此“戒毒药物”充当海洛因,从而形成有海洛因时滥用海洛因,得不到海洛因时便用…     

芬太尼的滥用及监测管理

目的:了解芬太尼的药理特性及滥用风险,分析其国内的滥用情况,为该药在临床的合理使用及科学监管提供参考。方法:检索国内外芬太尼滥用的文献报道,汇总近年来国内外药物滥用数据中有关芬太尼的数据并进行分析。结果:芬太尼由于其独特的药理特性存在被滥用的可能,文献报告和监测数据表明,自芬太尼上市以来欧美国家相继发生芬太尼滥用现象,北京市也存在芬太尼滥用的监测报告。结论:芬太尼类化合物的不合理使用会带来严重的安全隐患,临床医生、患者、药品监管部门都应当增强对其滥用风险的认识,积极避免不合理用药情况的出现。     

复方地芬诺酯滥用及监测数据分析

复方地芬诺酯是一种复方制剂处方药,主要成分为盐酸地芬诺酯和硫酸阿托品,临床上主要用于急、慢性功能性腹泻及慢性肠炎的治疗。由于地芬诺酯有与吗啡相似的基本结构,可替代阿片制剂,大剂量服用可有吗啡样欣快作用,被部分吸毒人员将其作为海洛因自行戒毒和替代品加以使用,     

2007年度药物滥用预警信息分析

目的:了解2007年我国大陆地区流行性滥用药物的分布特征,为加强禁毒工作,有针对性地防治麻醉药品、精神药品流行滥用提供参考依据。方法:对《药物滥用监测网络信息管理系统》实时采集2007年度监测数据进行趋势性分析,通过产生的预警信息,报告可能发生流行性滥用的药物。全年预警报告信息集中提示各种类型药物滥用流行的地区分布与时间分布情况。本年度预警报告滥用药物不包括已经在我国大陆地区流行滥用的海洛因及阿片。结果:2007年《药物滥用监测网络信息管理系统》发布可能发生药物流行性滥用的预警信息320条,其中,主要涉及阿片类药物(曲马多、哌替啶、二氢埃托啡、吗啡、复方甘草片、复方地芬诺酯等)的预警信息120条,占37.5%,7-8月是其预警报告高发时段,华东地区是流行滥用的高发地区;涉及苯丙胺类物质("冰毒"、"摇头丸")和氯胺酮、"麻谷丸"的预警信息106条,占33.1%,11-12月是其预警报告高发时段,东北地区是流行滥用的高发地区;涉及苯二氮艹卓类药物(地西泮、艾司唑仑、阿普唑仑)的预警信息60条,占18.8%,7月是其预警报告高发时段,华东、西南地区是流行滥用的高发地区。结论:本年度预警的流行性滥用的药物涉及种类多,覆盖面广,7-8月、11-12月是预警信息的频发时段。建议各地结合本地区流行性滥用药物的分布特征,采取有针对性的药物滥用预防措施。     

复方地芬诺酯不良反应引起的儿童用药安全性问题并文献分析

复方地芬诺酯常用于治疗腹泻，该文通过检索国内外相关文献综述了复方地芬诺酯的药物特性及在儿童中的用药安全性问题，为复方地芬诺酯在儿童中的合理用药提供参考。     

In vitro adsorption of diphenoxylate hydrochloride on activated charcoal and its relationship to pharmacological effects of drug in vivo. I.

The adsorption of diphenoxylate hydrochloride, a potent antidiarrheal agent, on activated charcoal powder was studied in vitro. Langmuir adsorption isotherms were established at pH 4 and 7, and the maximum adsorption capacity of charcoal for this drug was estimated using these values. Activated charcoal modified the bioavailability of diphenoxylate hydrochloride in vivo. The antipropulsive action of diphenoxylate in the mouse was strongly inhibited in the presence of activated charcoal. A comparative evaluation of charcoal and chromium oxide used as inert, nonabsorbable markers revealed that chromium oxide may be the marker of choic in GI transit studies in laboratory animals since it does not influence the bioavailability of diphenoxylate hydrochloride.     

Stimulant use and symptoms of abuse/dependence: epidemiology and associations with cannabis use--a twin study

BACKGROUND: This paper explores the magnitude of--and extent of overlap between--additive genetic, shared environmental and non-shared environmental influences on lifetime stimulant use and on stimulant abuse/dependence symptoms; the associations between stimulant use and cannabis use and the extent to which these associations can be attributed to common or correlated genetic and environmental influences. METHODS: Self-report data on lifetime stimulant use, abuse/dependence symptoms and corresponding measures of cannabis involvement were collected from a sample of 6265 male and female Australian twins born 1964-1971. RESULTS: Approximately one in five study participants reported lifetime stimulant use while 5% reported experiencing at least one symptom of abuse/dependence. Multivariate genetic model fitting indicated moderate genetic influences on stimulant use (40%) and symptoms (65%) while there was no evidence of sex differences in the magnitude of these influences. Despite some overlap in genetic influences on these measures, approximately 60% of the genetic variance in symptoms was specific to this phenotype. There were also strong genetic and shared environmental correlations between the factors associated with stimulant use and those associated with cannabis use. CONCLUSIONS: There were moderate genetic influences on stimulant use and stimulant abuse/dependence with moderate overlap between the genetic factors associated with these outcomes. Additionally, there were strong associations between measures of lifetime stimulant use and analogous measures of cannabis use which, importantly, could be largely attributed to shared familial risk factors predisposing to both stimulant and cannabis use.     

Parental substance use disorder and the risk of adolescent drug abuse: an event history analysis

A common observation in the research literature is that children of drug-dependent parents are at significantly heightened risk of adolescent drug use, abuse, and dependence. Recent research indicates that several psychological and interpersonal factors may affect the association between parents' psychoactive substance use disorder (PSUD) and drug use risks among adolescents, yet studies have failed to examine explicitly whether these factors moderate the association between PSUD and adolescent substance abuse. This paper explores these potential relationships using longitudinal data from a study that has followed three cohorts of adolescents and their families over a 7-year period. The cohorts are defined by parental diagnoses of PSUD, affective disorders, or no diagnosable disorder. The results indicate that PSUD is positively associated with adolescent drug abuse, yet this association is attenuated by strong family cohesion. Affective disorders among parents are associated with a higher risk of alcohol, but not drug, abuse. The associations are stronger in the presence of lower stress and higher self-esteem. PSUD is also associated more strongly with offspring drug and alcohol abuse when levels of use are lower. Hence, some unobserved mechanism that may involve physiological sensitivities to drugs and alcohol appears to put children of parents with drug problems at particular risk of drug and alcohol abuse. Limitations of the data and analysis are discussed.     

Loperamide: a review of its pharmacological properties and therapeutic efficacy in diarrhoea.

Loperamide, a butyramide derivative is a new agent for use in symptomatic control of acute non-specific diarrhoea and chronic diarrhoea. Unlike diphenoxylate or codeine, loperamide does not appear to exert opiate activity in man at normal therapeutic doses. In acute diarrhoea, loperamide provides more rapid control of symptoms than diphenoxylate when given in a flexible dosage according to unformed bowel movements, and in single dose studies 4mg loperamide has a much longer duration of effect than 5mg diphenoxylate. Loperamide is probably superior to diphenoxylate in providing symptomatic control of chronic diarrhoea such as that associated with chronic inflammatory bowel disease or following gastrointestinal surgery. It has been used for up to 3 years in such conditions without evidence of tolerance. The possibility of once daily dosage of loperamide in chronic diarrhoea is an advantage. Side-effects have not proved a problem.     

在神经损伤疾病治疗中的用药分析

目的 探讨神经损伤患者治疗中出现的类似感染症状的药物治疗对策。方法 分析治疗过程中药物对疾病转归的影响。结果 神经损伤疾病患者在治疗过程中,出现发热及消化道症状,呈血清病样改变;胃肠道粘膜溃疡,肠道充血水肿,炎性细胞浸润,脓血便或粘液便等;有时合并肺片异常及浆膜腔炎等类似感染症状,一般使用抗菌药治疗,疗效不明显,但给予复方苯乙哌啶或同时联用免疫抑制剂治疗,有明显的疗效。结论 复方苯乙哌啶对神经损伤治疗过程中类似感染症有明显疗效。     

The Epidemiology of Alcohol and Drug Abuse Among Adolescents

The primary purpose of this paper was to review systematically some of the more salient findings from a decade of research on the epidemiology of alcohol and drug abuse among adolescents. Data from most of the on-going nationwide studies regarding lifetime, past year, and past month use of various drugs were examined. While there is evidence of a downturn for some of the indicators, it is still too early to know if this is a temporary shift in rates or the beginning of meaningful trends toward lower levels of drug use. The second purpose was to challenge the alcohol and drug fields to consider more seriously the problem of multiple drug use and abuse. This was accomplished by showing that the relative percentage of youth who have used "only marijuana" has gone down as the percentage of youth who have used marijuana, other illicit durgs, and cigarettes and alcohol as well, has increased. Regression and discriminant analyses of data from the 1980 Monitoring the Future study of high school seniors reveals that variables that previously have differentiated users from nonusers are also useful in differentiating types of multiple drug users. The most important conclusion from this paper is that person characterized as "daily" users of marijuana are better typed as multiple drug users.