The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the ...early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia.
Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation.
The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25-40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine (n = 201, 77.9%) and gamma-hydroxybutyrate (n = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (n = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (n = 100, 26.1%) and clonazepam (n = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, P < 0.001).
Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations via the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments.
Objective
To estimate the associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among a large, diverse sample of college students.
...Method
We analyzed data from the national (United States), cross‐sectional 2018–2019 Healthy Minds Study (HMS; n = 42,618; response rate: 16%). HMS collects information on the physical, mental, and social health of college students. Multiple logistic regression analyses were used to estimate the association between a positive eating disorder screen (measured using the SCOFF) and any self‐reported lifetime eating disorder diagnosis and self‐reported illicit drug use in the past 30 days (any illicit drug use and use of marijuana, cocaine, heroin, methamphetamines, stimulants, ecstasy, opioids, benzodiazepines), while adjusting for potential confounders.
Results
Among the sample, 54.34% (n = 28,608) were female and the mean age of participants was 23.30 (SE ± 0.05) years. Logistic regression analyses revealed unique associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among the sample of college student participants. A positive eating disorder screen was most strongly associated with methamphetamine use (adjusted odds ratio AOR 3.93, 95% confidence interval CI 1.43–10.78), and any lifetime eating disorder diagnosis was most strongly associated with benzodiazepine use (AOR 3.42, 95% CI 2.28–5.13).
Discussion
Illicit drug use is common among college students who screen positive for an eating disorder and report any lifetime eating disorder diagnosis. The co‐occurring nature of eating disorders and illicit drug use may complicate treatment and lead to compounded adverse health outcomes.
Objective
To investigate associations between reported eating disorder (ED) diagnosis and substance use disorder (SUD) diagnosis, substance misuse, and illicit drug use among US college students.
...Method
Data consisting of n = 414,299 students' responses to the National College Health Assessment survey conducted by the American College Health Association between fall 2015 and spring 2019 were utilized for this study. Unadjusted and adjusted odds ratios were used to determine the association of reported ED diagnosis with reported SUD diagnosis, misuse of cigarettes, e‐cigarettes, alcohol, marijuana, cocaine/methamphetamine, sedatives, hallucinogens, opiates, inhalants, MDMA, and other club drugs, as well as illicit use of prescription pain killers, prescription sedatives, and prescription stimulants. A sensitivity analysis investigating associations between reported anorexia nervosa (AN), bulimia nervosa (BN), and each substance use outcome was also conducted.
Results
Among all in our analytic cohort, 7.15% reported receiving an ED diagnosis or being treated for an ED in the last 12 months. Students with ED indications were significantly more likely to report each of the substance use outcomes investigated in this study, including SUD diagnosis (aOR: 7.43; 95% CI: 6.98, 7.92; p < .0001), opiate misuse (aOR: 8.35; 95% CI: 7.38, 9.45; p < .0001), and misuse of other club drugs (aOR: 10.37; 95% CI: 9.10, 11.81; p < .0001) than peers without reported EDs. Both AN and BN were associated with an increased likelihood of SUD diagnosis.
Discussion
These findings demonstrate strong associations between EDs and the most extensive list of substance use outcomes explored in the context of college setting ED research to date.
We used structured and unstructured electronic health record (EHR) data to develop and validate an approach to identify moderate/severe opioid use disorder (OUD) that includes individuals without ...prescription opioid use or chronic pain, an underrepresented population.
Using electronic diagnosis grouper text from EHRs of ~1 million patients (2012–2020), we created indicators of OUD—with “tiers” indicating OUD likelihood—combined with OUD medication (MOUD) orders. We developed six sub-algorithms with varying criteria (multiple vs single MOUD orders, multiple vs single tier 1 indicators, tier 2 indicators, tier 3 and 4 indicators). Positive predictive values (PPVs) were calculated based on chart review to determine OUD status and severity. We compared demographic and clinical characteristics of cases identified by the sub-algorithms.
In total, 14,852 patients met criteria for one of the sub-algorithms. Five sub-algorithms had PPVs ≥0.90 for any severity OUD; four had PPVs ≥0.90 for moderate/severe OUD. Demographic and clinical characteristics differed substantially between groups. Of identified OUD cases, 31.3% had no past opioid analgesic orders, 79.7% lacked evidence of chronic prescription opioid use, and 43.5% lacked a chronic pain diagnosis.
Incorporating unstructured data with MOUD orders yielded an approach that adequately identified moderate/severe OUD, identified unique demographic and clinical sub-groups, and included individuals without prescription opioid use or chronic pain, whose OUD may stem from illicit opioids. Findings show that incorporating unstructured data strengthens EHR algorithms for identifying OUD and suggests approaches limited to populations with prescription opioid use or chronic pain exclude many individuals with OUD.
•Electronic health records (EHRs) facilitate opioid use disorder (OUD) research.•EHR OUD studies often have a limited focus on chronic pain and prescription opioids.•Approaches are needed to identify OUD from EHRs that do not rely only on diagnoses.•We developed and validated a method to identify OUD using multiple data elements.•Our method included a population with illicit opioid use and lacking OUD diagnoses..
Abstract
Objectives
The aim of this study is to understand how early cigarette use might predict subsequent illicit drug use, especially among individuals with attention-deficit hyperactivity ...disorder (ADHD) symptoms during childhood.
Methods
Data were drawn from the National Longitudinal Study of Adolescent Health (Waves I–IV). The analysis sample involves participants who had not used illicit drugs at Wave I, with no missing responses for studied predictors (N = 7,332).
Results
Smoking status at Wave I (ever regular vs. never regular) and childhood ADHD symptoms predicted subsequent illicit drug use at Waves II to IV. No interaction effect of smoking status at Wave I and childhood ADHD symptoms was found. However, an indirect effect from childhood ADHD symptoms on illicit drug use was identified, through smoking status at Wave I. Similar results were observed for predicting illicit drug dependence.
Conclusions
The findings support the notion that smoking status during early adolescence may mediate the association between childhood ADHD symptoms and risk of later adult drug use. Interventions to prevent smoking among adolescents may be particularly effective at decreasing subsequent drug use, especially among children with ADHD symptoms.
Oral manifestations of illicit drug use Teoh, L; Moses, G; McCullough, MJ
Australian dental journal,
September 2019, 2019-09-00, 20190901, Letnik:
64, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The use of illicit and misuse of licit drugs is a global public health problem, with illicit drug use being responsible for 1.8% of the total disease burden in Australia in 2011. Oral adverse effects ...associated with illicit drug use are well‐established, with aggressive caries, periodontitis, bruxism, poor oral hygiene and general neglect documented. Other factors such as a high cariogenic diet and lifestyle, social and psychological factors compound the poorer oral health in illicit drug users. Literature has shown that the oral health‐related quality of life among injecting drug users is poorer compared with the Australian general population and the overall quality of life of addicted people correlates with caries experience. Thus, the role of the dentist is imperative in managing the oral health of these individuals. Given their widespread recreational use, it is likely that dental practitioners will encounter patients who are regular or past users of illicit drugs. The aim of this article is to describe the prevalence and mechanism of action of commonly used illicit drugs in Australia, including cannabis, methamphetamine, cocaine and heroin and to inform dentists about the common orofacial presentations of their side effects to help with patient management.
•Family structure is associated with youth drug use.•Family structure’s association with youth drug use varies by drug types.•Youth drug users’ risks of use disorders vary by drug types.
The study ...aimed to examine family structure’s relation to youth illicit drug use, use disorders, and treatment services utilization.
Using pooled data from the 2015 to 2017 National Survey on Drug Use and Health, we examined the prevalence of youth (12–17 years old) past-year and lifetime illicit drug use (N = 41,579), drug use disorders among each type of drug users (n = 149–5,445), and treatment service utilization among youth with drug use disorders (n = 1,335) across two-parent, one-parent, and no-parent families. Bivariate analyses and logistic regression models were used to compare differences across family structure.
On average about 25% youth ever used illicit drugs, 20% of the past-year users had a drug use disorder, and less than 10% of the past-year users with disorders received treatment services. Family structure was associated with drug use prevalence, in particular, the use of marijuana, heroin/cocaine/methamphetamine, and hallucinogens, but was not related to the rate of drug use disorders and treatment service utilization, even after adjusting for covariates.
The findings suggest that family structure is associated with youth drug use initiation but not drug use disorders or treatment service utilization. Youth in single and non-parent families are especially vulnerable to drug use initiation and should be specifically targeted by prevention programs.
Illicit drug use and oral health Rossow, Ingeborg
Addiction (Abingdon, England),
November 2021, Letnik:
116, Številka:
11
Journal Article
Recenzirano
ABSTRACT
People with drug use disorders (PWDUD) have elevated prevalence of oral diseases, in particular dental caries (tooth decay), periodontal (gum) disease and xerostomia (dry mouth). When left ...untreated, these oral health conditions may progress and lead to tooth ache, abscesses and tooth loss, and in turn, to poor chewing functioning and digestion, dental aesthetic problems and reduced wellbeing. Illicit drug use may, per se, cause xerostomia, which in turn increases vulnerability for dental caries. However, the other main drivers of oral diseases and their progression—poor oral hygiene, frequent sugar intake and infrequent dental visits—can mainly be ascribed to the irregular lifestyle, poor economy and mental health problems that often accompany illicit drug use. Establishment of good oral health habits is essential in the dental care for PWDUD. Dental treatment is often comprehensive and challenging; because the patients may have extensive treatment needs but also difficulties adhering to preventive measures and dental appointments. An integrated care approach for PWDUD would likely benefit both their oral and general health.
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