Background and Aims
People who have recently injected drugs are a priority population in efforts to achieve hepatitis C virus (HCV) elimination. This study estimated the prevalence and number of ...people with recent injecting drug use living with HCV, and the proportion of people with recent injecting drug use among all people living with HCV infection at global, regional and country‐levels.
Methods
Data from a global systematic review of injecting drug use and HCV antibody prevalence among people with recent (previous year) injecting drug use were used to estimate the prevalence and number of people with recent injecting drug use living with HCV. These data were combined with a systematic review of global HCV prevalence to estimate the proportion of people with recent injecting drug use among all people living with HCV.
Results
There are an estimated 6.1 million 95% uncertainty interval (UI) = 3.4–9.2 people with recent injecting drug use aged 15–64 years living with HCV globally (39.2% viraemic prevalence; UI = 31.6–47.0), with the greatest numbers in East and Southeast Asia (1.5 million, UI = 1.0–2.1), eastern Europe (1.5 million, UI = 0.7–2.4) and North America (1.0 million, UI = 0.4–1.7). People with recent injecting drug use comprise an estimated 8.5% (UI = 4.6–13.1) of all HCV infections globally, with the greatest proportions in North America (30.5%, UI = 11.7–56.7), Latin America (22.0%, UI = 15.3–30.4) and eastern Europe (17.9%, UI = 8.2–30.9).
Conclusions
Although, globally, 39.2% of people with recent injecting drug use are living with hepatitis C virus (HCV) and 8.5% of all HCV infections occur globally among people with recent injecting drug use, there is wide variation among countries and regions.
Background
The aim of this study was to assess the relative effects of alcohol mixed with energy drink (AmED) versus alcohol alone on cognitive performance across the ascending and descending breath ...alcohol concentration (BrAC) limb using doses similar to real‐world intake.
Methods
Using a single‐blind, placebo‐controlled, crossover design, 19 participants completed 4 sessions where they received: (i) placebo, (ii) alcohol, (iii) AmED 500 ml energy drink (ED), and (iii) AmED 750 ml ED. Performance on measures of psychomotor function (Compensatory Tracking Task CTT), information processing (Digit Symbol Substitution Task DSST; Inspection Time Task ITT), and response inhibition (Brief Stop‐Signal Task Brief SST) was assessed at ~0.05% ascending BrAC, ~0.08% peak BrAC, and ~0.05% descending BrAC.
Results
The ITT and Brief SST showed no differential effect of AmED versus alcohol (gs < 0.30 and gs < 0.36, respectively). Moderate magnitude improvements in alcohol‐induced impairment of CTT and DSST performance were observed after AmED versus alcohol on the descending BrAC limb (gs > 0.45 and gs > 0.37, respectively). A moderate magnitude decrease in DSST errors was also observed after AmED relative to alcohol at 0.050% ascending target BrAC (gs > 0.43).
Conclusions
Changes in cognitive function after AmED administration were dependent on the degree of intoxication, BrAC curve limb, and ED volume. Co‐administration of ED doses which matched (500 ml) and exceeded (500 ml) maximum daily intake guidelines with alcohol decreased impairment of psychomotor function and global information processing after alcohol consumption. These results cannot be necessarily interpreted to suggest that people are less impaired after AmED, as behavior is the result of coordination of multiple cognitive functions, and reduced impairment on one aspect of cognition may not translate into global improvements.
Introduction
Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths ...related to tapentadol.
Methods
All cases in which tapentadol use was coded contributory to death (n = 159) were retrieved from the National Coronial Information System (1 July 2000–31 December 2020).
Results
The mean age was 48.5 (18–81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre‐existing disease was co‐contributory. The median peripheral blood tapentadol concentration was 1.00 mg L−1 (0.02–47.00), and the median aortic concentration was 2.05 mg L−1 (0.10–30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common.
Discussion and Conclusions
The typical tapentadol‐related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self‐harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.
Aims
Alcohol mixed with energy drinks (AmED) is a relatively new consumption trend generating increasing concern regarding potential adverse effects. Despite the political and health imperative, ...there has been no systematic and independent synthesis of the literature to determine whether or not AmED offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co‐consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes; (ii) hazardous drinking practices; and (iii) risk‐taking behaviour.
Methods
Pubmed, PsycInfo and Embase databases were searched until May 2013 for papers outlining descriptive, observational analytical and human experimental studies which compared target outcomes for AmED versus alcohol consumers (between‐subjects), or AmED versus alcohol consumption (within‐subjects). Odds ratios were calculated for target outcomes following screening, data extraction and quality assessment.
Results
Data were extracted from 19 papers. Analyses typically revealed increased odds of self‐reported stimulation‐based outcomes and decreased odds of sedation‐based physiological and psychological outcomes relative to when alcohol was consumed alone, as indicated by rigorous cross‐sectional descriptive research. These findings typically have not been reflected in experimental research, due possibly to the low doses administered relative to typical self‐reported ‘real‐life’ intake. AmED consumers generally report more hazardous alcohol consumption patterns and greater engagement in risk‐taking behaviour than alcohol consumers. While most studies had equivocal findings, two studies showed lower odds of risk‐taking behaviour for AmED relative to alcohol drinking sessions but limitations with respect to the outcome measures used restrict conclusions with regard to the behavioural outcomes of AmED use.
Conclusions
Mixing alcohol with energy drinks may exert a dual effect, increasing stimulation‐based effects and reducing sedation‐based outcomes; the clinical severity and dose threshold has not been established. At this stage it is unclear whether these changes in the nature of intoxication translate into greater alcohol intake and risk‐taking behaviour.
Alcohol intoxication is associated with transient increases in risk-taking behaviors which can lead to harm. Certain assessment and intervention evaluation approaches require measurement of risk ...behaviors and associated harms at the event-level (i.e., within a single drinking session). This systematic review aimed to identify measures solely assessing risk-taking behaviors and harms while intoxicated and identify evidence of their reliability and validity. EMBASE, Medline, PsycINFO, and PsycTESTs were searched for articles published between 1997 and 2019. Articles were selected based on use of a scale with one or more items measuring risk-taking behaviors and harms (to the individual or others around them) occurring while intoxicated. Additional searches were run to identify studies reporting estimates of reliability and validity for identified measures. Nineteen measures were identified containing at least one relevant item. Most measures indexed both acute and chronic risk behaviors and consequences, mainly with the intent of screening for established patterns of problematic use. No individual measure was identified exclusively quantifying risk-taking behavior and harms which had occurred within a drinking session (with the exception of one scale measuring tendency to engage in risk behaviors), yet three measures had a subscale meeting this criterion. These measures demonstrated good validity and reliability. This gap represents an opportunity for scale development, designed for use in ecological momentary assessment and evaluation of structural interventions targeting risk behaviors and harms whilst intoxicated.
•Systematic review of scales measuring behaviors and consequences while intoxicated.•Nineteen scales were identified with at least one relevant item.•No one scale met criteria; three measures with relevant subscales were identified.•Opportunity to develop measures for ecological momentary assessment whilst intoxicated.
Identifying differences in unintentional versus intentional drug poisoning deaths can inform targeted prevention. This study aimed to: compare unintentional versus intentional drug poisoning deaths ...by drug involvement, age and sex; describe patterns of drug involvement by intent; and describe common drug patterns by age and sex.
Cases comprised deaths among Australians aged ≥15 where drug poisoning was the underlying cause (Cause of Death Unit Record File 2012–2016). Sex, age, and drug involvement were analysed by intent using logistic regression.
Of 7994 deaths, 71% were unintentional and 24% intentional. Compared with unintentional deaths, intentional deaths were more likely among females (OR 1.31 95% CI 1.16–1.48) and those aged 55+ (1.50 1.25–1.81 for 55–64 years; 3.79 3.07–4.66 for 65+ years, compared to 35–44 years), and were more likely to involve hypnosedatives (2.11 1.87–2.39), other psychotropic medicines (1.58 1.39–1.78), non-opioid analgesics and anaesthetics (1.48 1.25–1.73). Common unintentional profiles comprised: opioids (excluding heroin); heroin; alcohol; opioids with hypnosedatives; opioids with hypnosedatives and other psychotropic medicines; stimulants; other psychotropic medicines; and opioids with other psychotropic medicines. Unintentional deaths involving heroin or stimulants only had a greater proportion of males (79.0% and 83.4%, respectively) and younger individuals aged 15–34 (30.3% and 39.5%, respectively). Common intentional profiles comprised: hypnosedatives; other psychotropic medicines; opioids (excluding heroin); hypnosedatives with other psychotropic medicines; opioids with hypnosedatives; and opioids with hypnosedatives and other psychotropic medicines.
The demographic and drug involvement profile of intentional and unintentional deaths were distinct, suggesting different approaches to prevention are necessary.
•More than two-thirds of drug poisoning deaths were deemed unintentional.•Unintentional deaths often involved middle-aged males using alcohol and opioids.•Intentional deaths commonly involved older females using psychotropics.•Unintentional heroin and stimulant deaths were mostly young to middle-aged males.•Intentional deaths from other opioids and hypnosedatives were mostly among age 55+.
Introduction
This paper examines the acquisition and dissemination of harm reduction information among people who inject drugs, as well as preferred sources of information.
Methods
Data were obtained ...from 862 people who inject drugs, recruited from Australian capital cities for the 2021 Illicit Drug Reporting System. Multivariable regression analyses were performed to assess potential factors associated with knowledge sharing.
Results
Almost two‐fifths (37%) reported that they had received information about how to keep themselves safe when using drugs within the past 6 months. Reporting on their last occasion of receiving information, participants stated that it was commonly about injecting practices (56%), overdose prevention (26%) and injection‐related injuries (22%), and was mostly received from an alcohol and other drug worker (54%), followed by other health professional (24%) and social network (18%). Among those who reported receiving information, 50% shared this information with other people, predominantly with their social network: no factors were found to be significantly associated with sharing information. The majority reported that peer workers and/or people with lived experience would be the first person they would talk to for information about a range of topics (e.g., injecting/harm reduction practices, overdose prevention).
Discussion and Conclusions
Two in five participants had recently obtained information about how to keep themselves safe while using drugs, with half sharing this information with their social network. Peer workers were the preferred source of information, suggesting that the peer educator workforce should be expanded to embrace the capacities and expertise of people who inject drugs.
People who inject drugs (PWID) are at an elevated risk of fatal overdose in the first year after experiencing a non-fatal event. Such non-fatal events may also result in overdose-related sequelae, ...ranging from physical injury to paralysis. Given variation in drug markets and treatment availability across countries and regions, we may see similar variations in non-fatal overdose prevalence. Monitoring non-fatal overdose prevalence among PWID is essential for informing treatment intervention efforts, and thus our review aims to estimate the global, regional, and national prevalence of non-fatal overdose, and determine characteristics associated with experiencing such an event.
We conducted a systematic review and meta-analyses to estimate country, regional, and global estimates of recent and lifetime non-fatal overdose prevalence among PWID. Using meta-regression analyses we also determined associations between sample characteristics and non-fatal overdose prevalence.
An estimated 3.2 (1.8–5.2) million PWID have experienced at least one overdose in the previous year. Among PWID, 20.5% (15.0–26.1%) and 41.5% (34.6–48.4%) had experienced a non-fatal event in the previous 12 months and lifetime respectively. Frequent injecting was strongly associated with PWID reporting recent and lifetime non-fatal overdose. Estimates of recent non-fatal overdose were particularly high in Asia and North America.
Around one in five PWID are at an elevated risk of fatally overdosing every year, however there is substantial geographical variation. In countries with higher rates of non-fatal overdose there is need to introduce or mainstream overdose prevention strategies such as opioid agonist treatment and naloxone administration training programs.
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