Interpersonal Violence & Traumatic Brain Injuries among Native Americans & Women

OBJECTIVES:

This study aimed to assess the odds of experiencing a traumatic brain injury (TBI) as a result of interpersonal violence (IPV) among Native Americans compared to other races controlling for gender, age, socioeconomic status, rurality and intoxication at the time of the injury.

METHODS:

A secondary data analysis of the Arizona Trauma Database consisting of 18 944 cases of TBI between 2008-2010 throughout the state of Arizona was conducted. There were 312 patients who experienced injuries caused by IPV in the sample. Descriptive statistics, cross-tabulations, bivariate analyses and a logistic regression model were used for analyses.

RESULTS:

The logistic regression model found that Native Americans (OR = 1.15), patients from the other race category (OR = 1.18), females (OR = 1.35) and those who were insured (OR = 1.26) had higher odds of experiencing a TBI as a result of IPV. Rurality and intoxication were mediators of the correlation between Native American race and TBI as a result of IPV.

CONCLUSIONS:

Native Americans are more likely than Whites and females are more likely than males to experience TBIs as a result of IPV.

Purchase full article at:   http://goo.gl/PFHf8V

By:  Linton KF1.

• 1School of Social Work, University of Hawaii at Manoa , Honolulu, HI , USA. 
• Brain Inj. 2015;29(5):639-43. doi: 10.3109/02699052.2014.989406. Epub 2014 Dec 17.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Booze, Bars, and Bystander Behavior: People Who Consumed Alcohol Help Faster in the Presence of Others

People help each other less often and less quickly when bystanders are present. In this paper, we propose that alcohol consumption could attenuate or reverse this so-called bystander effect. Alcohol impairs people cognitively and perceptually, leading them to think less about the presence of others and behave less inhibited. Moreover, alcohol makes people more prone to see the benefits of helping and not the costs. 

To provide an initial test of these lines of reasoning, we invited visitors of bars in Amsterdam to join our study at a secluded spot at the bar. We manipulated bystander presence, and at the end of the study, we measured alcohol consumption. When participants took their seats, the experimenter dropped some items. We measured how many items were picked up and how quickly participants engaged in helping. 

Results revealed that alcohol did not influence the bystander effect in terms of the amount of help given. But importantly, it did influence the bystander effect in terms of response times: people who consumed alcohol actually came to aid faster in the presence of others.

…The foremost finding from the current contribution is that alcohol does not simply attenuate the entire bystander effect, but only increases response speeds. This could imply that the influences that seriously undermine helping and intervention (such as audience inhibition, confusion and diffusion of responsibility, and pluralistic ignorance) may slow down the decision process but do not actually change it. Indeed, people under the influence of alcohol in the presence of others were at least as fast as sober people who were alone. It seems that the complications caused by the presence of bystanders in the five-step model (Latané and Darley, 1970) may simply be ignored by them. Under the influence of alcohol, people may not notice that no-one is helping and thus do not experience pluralistic ignorance before step 2. They may not think that someone else will provide help and thus may not experience diffusion of responsibility before step 3, and they may not worry about how to implement the help in step 4. Because the amount of help given remains the same, it may imply that people make their decision to act rather quickly based on the immediate situation, and then contemplate and search (in each step) for information that confirms the correctness of the decision. As drunk people are often cognitively impaired, they may be less likely to go through this process of “false deliberation” (see also Waroquier et al., 2010)…

Full article at:  http://goo.gl/jNLZQD

By:  Marco van Bommel,1,2,3,* Jan-Willem van Prooijen,1,2 Henk Elffers,2 and Paul A. M. Van Lange1

¹Department of Experimental and Applied Psychology, VU University Amsterdam, Amsterdam, Netherlands

²Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, Netherlands

³Department Psychology of Conflict, Risk, and Safety, University of Twente, Enschede, Netherlands

Edited by: Jacob B. Hirsh, University of Toronto, Canada

Reviewed by: Andrew K. Littlefield, Texas Tech University, USA; Ronald Friedman, University at Albany, SUNY, USA

*Correspondence: Marco van Bommel, ln.etnewtu@lemmobnav.m

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Verbal Memory Impairment in Polydrug Ecstasy Users: A Clinical Perspective

Background

Ecstasy use has been associated with short-term and long-term memory deficits on a standard Word Learning Task (WLT). The clinical relevance of this has been debated and is currently unknown. The present study aimed at evaluating the clinical relevance of verbal memory impairment in Ecstasy users. To that end, clinical memory impairment was defined as decrement in memory performance that exceeded the cut-off value of 1.5 times the standard deviation of the average score in the healthy control sample. The primary question was whether being an Ecstasy user (E-user) was predictive of having clinically deficient memory performance compared to a healthy control group.

Methods

WLT data were pooled from four experimental MDMA studies that compared memory performance during placebo and MDMA intoxication. Control data were taken from healthy volunteers with no drug use history who completed the WLT as part of a placebo-controlled clinical trial. This resulted in a sample size of 65 E-users and 65 age- and gender-matched healthy drug-naïve controls. All participants were recruited by similar means and were tested at the same testing facilities using identical standard operating procedures. Data were analyzed using linear mixed-effects models, Bayes factor, and logistic regressions.

Results

Findings were that verbal memory performance of placebo-treated E-users did not differ from that of controls, and there was substantial evidence in favor of the null hypothesis. History of use was not predictive of memory impairment. During MDMA intoxication of E-users, verbal memory was impaired.

Conclusion

The combination of the acute and long-term findings demonstrates that, while clinically relevant memory impairment is present during intoxication, it is absent during abstinence. This suggests that use of Ecstasy/MDMA does not lead to clinically deficient memory performance in the long term. Additionally, it has to be investigated whether the current findings apply to more complex cognitive measures in diverse ‘user categories’ using a combination of genetics, imaging techniques and neuropsychological assessments.

Below:  Frequency distribution of the raw IR (left panel) and DR (right panel) scores in the Ecstasy users during MDMA intoxication and placebo, and healthy controls

Full article at:   http://goo.gl/KprKVF

By:  Kim P. C. Kuypers, Eef L. Theunissen, Janelle H. P. van Wel, Elizabeth B. de Sousa Fernandes Perna, Anke Linssen, Anke Sambeth, Benjamin G. Schultz, Johannes G. Ramaekers

Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Where do College Drinkers Draw the Line? A Qualitative Study

Alcohol use among college students has received nationwide recognition as a public health concern. The primary aim of this study was to explore students’ opinions of when drinking “crosses the line” from acceptable to unacceptable. This study used qualitative methods to: (a) examine unappealing aspects of drinking by relationship type (potential dating partner, friend, self), and (b) determine whether this differs by gender. Seventy-eight interviews were conducted with college students who violated campus-alcohol policy. The semi-structured interview included open-ended questions related to reactions to other’s excessive drinking. Qualitative analyses revealed that college males and females find lack of control as unappealing, including lack of physical, verbal, and sexual control. More females than males indicated negative perceptions of same-sex friends and self who displayed poor sexual control. Future research might also consider integration of themes in measures of negative expectancies and consequences to more accurately capture unappealing aspects of college drinking behavior.

…This study revealed three primary themes regarding college students’ negative reactions to excessive drinking. These included (a) negative reactions to a lack of control, (b) female participant’s dislike of uncontrolled sexual behavior by self and others, and (c) alcohol-induced aggression. First, the majority of male and female participants found behaviors that indicated a lack of general control (e.g., being “sloppy,” stumbling, impaired consciousness, etc.) as unappealing in a potential dating partner, in same-sex friends, and in oneself...

A second theme emerging from these qualitative interviews related to how females in the sample viewed a lack of sexual control by same-sex friends or themselves such as engaging unplanned sexual behavior, and/or betraying a friend by having relations with his/her romantic partner. Negative perceptions of casual or spontaneous sexual encounters are consistent with data exploring perceptions of casual sexual encounters. Research examining gender differences in sex or “hook-ups” among young adults suggests that females are less likely to report the experience as positive compared to men (Owen, Rhoades, Stanley, & Fincham, 2010). Qualitative data suggest that women are aware of a double standard and believe that other women who engage in casual sex are disrespected and stigmatized (Bradshaw, Kahn, & Saville, 2010; Paul, 2006)...

Third, both male and female students noted that alcohol-induced aggression was a behavior that “crossed the line.” Females identified that dating partners who were sexual aggressive or “pushy” were unattractive, and males indicated that they would lose respect for a same-sex friend who acted in a sexually aggressive way. Acts of sexual aggression and assault are most prevalent among women ages 16–24 years, with an estimated 38% of women reporting some form of sexual violence during the previous academic year (Nasta, et al., 2005). Furthermore, an estimated 39–50% sexual assault victims and 50% of perpetrators report using alcohol at the time of the assault (Abbey, Zawacki, Buck, Clinton, & McAuslan, 2001; Gross, Winslett, Roberts, & Gohm, 2006). More recent estimates have suggested that 96% of drug-related assaults involved use of alcohol prior to assault (Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010). Alcohol use and sexual assault often occur in conjunction with each other; both genders reported prohibitions related to alcohol-induced aggression. Reinforcing these prohibitions may aid in prevention efforts that target early warning signs and ways to avoid situations likely to lead to aggressive behavior…

Full article at: http://goo.gl/Xnpcyc

By:  Danielle L. Terry, M.S., Lorra Garey, B.A., and Kate B. Carey, Ph.D.

Center for Health and Behavior, Syracuse University

Please Address Correspondence To: Danielle K. Seigers or Kate B. Carey, Department of Psychology, Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340, Email: ude.rys@regieskd, Email: ude.rys@yeracbk, Phone: 315-443-2877, Fax: 315-443-4123

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Studying Ritual & Individual Orientations to Alcohol Use: Drinking Motives & Their Connection to Intoxication in Finland in the 2000s

Background

Finland was an agricultural country until the 1960s. Thereafter, Finland modernized rapidly. Studies have postulated that as Finland becomes modernized, intoxication-oriented drinking would gradually decrease. Current studies, however, show that heavy episodic drinking has lately become more common among men and women. Simultaneously, drinking is seldom motivated by the purpose of getting drunk. The article tackles this conundrum by approaching drinking motives from a ritual and an individual perspective. We study what kinds of drinking motives currently exist in Finland, their prevalence among different population groups, how they vary by social background, and their association with intoxication.

Methods

The data were collected as part of the nationally representative Drinking Habit Survey in 2008. It consists of verbal descriptions on the most recent drinking occasion (N = 521), estimations of its blood alcohol content, and responses to pre-defined standardized motive questions related to the latest drinking occasions (N = 8732).

Results

Besides the motive ‘to get drunk’, also the motives of drinking as a ‘time-out’ ritual, ‘to get into the mood’ and ‘I drunk to brighten up’ predict a “wet” drinking occasion. Overall, Finns highlight drinking motives of sociability, relaxation, meal drinking and situational factors. The more educated orientate to their drinking more with motives that express mastery of cultural capital and individuality. The less educated and the young, again, orientate to their drinking more with motives that imply intoxication and external expectations.

Conclusions

Whereas the ritual perspective discloses what kinds of situations predict intoxication, the individual perspective reveals what kinds of individualistic orientations are associated with drunkenness. These perspectives partly speak past each other and are difficult to combine. The article proposes that situational perspective would serve as a bridge between them and enable the incorporation of results from different research traditions.

Purchase full article at:   http://goo.gl/efzLim

By:  Jukka Törrönen, Janne Härkönen

Affiliations

SoRAD/Centre for Social Research on Alcohol and Drugs Stockholm University, SE-10691, Stockholm, Sweden

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Women's Sex-Related Dissociation: The Effects of Alcohol Intoxication, Attentional Control Instructions, and History of Childhood Sexual Abuse

This study examined influences of alcohol intoxication, attentional control, and CSA severity on sex-related dissociation. Sex-related dissociation is defined here as dissociation (e.g., feeling as if the world is unreal and feeling disconnected from one's body) during sexual activity or in the presence of sexual stimuli. 

Women (N = 70) were randomized to a 2 (alcohol condition: none, .10% peak breath alcohol concentration) x 2 (attentional control instructions: none, "relax and maximize" sexual arousal) experiment and exposed to sexual stimuli. 

Alcohol intoxication was positively associated with sex-related dissociation. CSA severity and sex-related dissociation were positively associated in the no instruction condition but not in the "relax and maximize" condition. 

For some women, efforts to relax and maximize sexual arousal may buffer the association between CSA and sex-related dissociation.

  

Purchase full article at:   http://goo.gl/1HdGCF

By:  Bird ER1, Gilmore AK2, Stappenbeck CA3, Heiman JR4, Davis KC5, Norris J6, George WH1.

• 1 University of Washington, Psychology , Seattle , United States.
• 2 Medical University of South Carolina , Department of Psychiatry & Behavioral Science , Charleston , United States.
• 3 University of Washington, Psychiatry , Seattle , United States.
• 4 Indiana University and the Kinsey Institute, Psychological & Brain Sciences , Bloomington , United States.
• 5 University of Washington, School of Social Work , Seattle , United States.
• 6 University of Washington, Alcohol and Drug Abuse Institute , Seattle , United States.
• J Sex Marital Ther. 2016 Jan 6:0.  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Association between Intoxication at Last Sexual Intercourse and Unprotected Sex among Men and Women in Uganda

This study examined the association between intoxication at last sexual intercourse and unprotected sex using data derived from a nationally representative survey conducted in Uganda in 2011. 

Multivariable logistic regression analyses were used to examine the intoxication-unprotected sex association separately among men and women, adjusted for sociodemographic and behavioral covariates that were also examined as moderators of the association. 

Among men, intoxication at last sexual intercourse was almost entirely attributed to their own drinking, while women most frequently reported intoxication among their partners only. 

Among women, there was a significant association between their partner’s intoxication and unprotected sex (adjusted odds ratio (AOR) = 1.36; 95% confidence interval (CI) = 1.07–1.73). Intoxication was associated with unprotected sex among unmarried men (AOR = 2.09; 95% CI = 1.45–2.84), an association not observed among married men. 

The results suggest that the alcohol-unprotected sex link should be incorporated within Ugandan National HIV Prevention Strategy. These interventions should be designed to target unmarried men. Programs that combine alcohol reduction and address structural factors that constrain women’s ability to negotiate condom use are also needed.

Full article at:   http://goo.gl/WXKpj2

By:   Bradley T. Kerridge,¹ Delivette Castor,² Phu Tran,³ Matthew Barnhart,² and Roger Pickering⁴

¹Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, 10032, USA, Phone: 1-301-990-8391

²Office of HIV/AIDS, Bureau for Global Health, United States Agency for International Development, Washington DC, 20004, USA

³St. George’s University, SGU Caribbean Medical School, True Blue, Grenada, West Indies

⁴Laboratory of Epidemiology and Biometry, Intramural Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5636 Fishers Lane, Rockville, Maryland, 20852, USA

Bradley T. Kerridge: moc.liamg@egdirrekyeldarb

Correspondence/Requests for Reprints to: Bradley Kerridge, 179 Sharpstead Lane, Gaithersburg, MD, 20878, USA, Email:moc.liamg@egdirrekyeldarb, P: 301-990-8391

J Infect Dev Ctries. 2014 Nov; 8(11): 1461–1469.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). 

In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.

Below:  Scatter plots of blood levels of vitamins. The lower lines represent lower-normal levels, and the upper lines, upper-normal levels.

Full article at:   http://goo.gl/6a3CF5

By:   Hui Jai Lee, Jonghwan Shin, Kijeong Hong, and Jin Hee Jung

Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

Corresponding author.

Address for Correspondence: Jonghwan Shin, MD. Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-2662, Fax: +82.2-831-2826, Email:moc.revan@renihsyks

J Korean Med Sci. 2015 Dec; 30(12): 1874–1880.

Published online 2015 Nov 30. doi:  10.3346/jkms.2015.30.12.1874

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Shop Amazon - Kindle Book Deals 

Extended-Release Naltrexone: A Qualitative Analysis of Barriers to Routine Use

Highlights

• The Consolidated Framework for Implementation Research structured a qualitative analysis of features of extended-release naltrexone that inhibited use for the treatment of alcohol and opioid use disorders.
• The processes of ordering, storing, and using and the cost of extended-release naltrexone were characteristics of the intervention that reduced use.
• Features of the outer setting (environment) that inhibited use included requirements for patients with opioid use disorders to be opioid free for 7 to 10 days and health plan formulary, benefit management, and reimbursement policies.
• Program cultures, resistance to change, and weak linkages with primary care for ongoing injections also affected routine use of the medication.

The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics).

Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX.

Purchase full article at:   http://goo.gl/CHlchu

By:   Kelly Alanis-Hirsch, P.hD.,  Raina Croff, Ph.D., James H. Ford II, Ph.D., Kim Johnson, Ph.D., Mady Chalk, Ph.D., Laura Schmidt, Ph.D., Dennis McCarty, Ph.D.

Affiliations

OHSU-PSU School of Public Health, Oregon Health & Science University

Correspondence

Corresponding author at: OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. Tel.: +503 494 1177.

mccartyd@ohsu.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.10.003

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Shop Amazon - Kindle Book Deals

Opioid Prescribing After Nonfatal Overdose and Association with Repeated Overdose

BACKGROUND:

Nonfatal opioid overdose is an opportunity to identify and treat substance use disorders, but treatment patterns after the overdose are unknown.

OBJECTIVE:

To determine prescribed opioid dosage after an opioid overdose and its association with repeated overdose.

SETTING:

A large U.S. health insurer.

PARTICIPANTS:

2848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012.

MEASUREMENTS:

Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, codes from emergency department or inpatient claims. The primary outcome was daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. We categorized dosages as large (≥100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to repeated overdose stratified by daily dosage as a time-varying covariate.

RESULTS:

Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At 2 years, the cumulative incidence of repeated overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for those receiving no opioids.

LIMITATION:

The cohort was limited to commercially insured adults.

CONCLUSION:

Almost all patients continue to receive prescription opioids after an overdose. Opioid discontinuation after overdose is associated with lower risk for repeated overdose.

Purchase full article at:   http://goo.gl/SEQNPN

By:   Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF.

From Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts.

Ann Intern Med. 2015 Dec 29. doi: 10.7326/M15-0038. [Epub ahead of print]

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Illustration via:  http://goo.gl/k5I5L2

Focused Use of Drug Screening in Overdose Patients Increases Impact on Management

Abstract

Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management.

STUDY OBJECTIVES:

Measuring the impact on patient management, in a University Emergency Department with approximately 40,000 admissions annually, of a rapid urinary drug screening test using specifically focused indications. Drug screening was restricted to patients having a first psychotic episode or cases demonstrating respiratory failure, coma, seizures, a sympathomimetic toxidrome, severe opiate overdose necessitating naloxone, hypotension, ventricular arrhythmia, acquired long QT or QRS >100 ms, and high-degree heart block.

METHODS:

Retrospective analysis of Triage® TOX drug screen tests performed between September 2009 and November 2011, and between January 2013 and March 2014.

RESULTS:

A total of 262 patients were included, mean age 35 ± 14.6 (standard deviation) years, 63% men; 29% poisoning with alcohol, and 2.3% deaths. Indications for testing were as follows: 34% were first psychotic episodes; 20% had acute respiratory failure; 16% coma; 8% seizures; 8% sympathomimetic toxidromes; 7% severe opioid toxidromes; 4% hypotension; 3% ventricular arrhythmias or acquired long QT intervals on electrocardiogram. A total of 78% of the tests were positive (median two substances, maximum five). The test resulted in drug-specific therapy in 6.1%, drug specific diagnostic tests in 13.3 %, prolonged monitoring in 10.7% of methadone-positive tests, and psychiatric admission in 4.2%. Overall, 34.3% tests influenced patient management.

CONCLUSIONS:

In contrast to previous studies showing modest effects of toxicological testing, restricted use of rapid urinary drug testing increases the impact on management of suspected overdose patients in the ED.

Below:  Indications for urinary drug screening (n = 369) in 262 patients.

Arrhythmia or long QT = QT prolongation >480 ms, or ventricular tachycardia or flutter, or torsade de pointes tachycardia; Hypotension = systolic hypotension (<80 mm Hg); Opiate toxidrome = if requiring antagonist administration; Psychosis = first psychotic episode; Resp failure = acute respiratory failure (pCO₂ 45‑80 mm Hg or emergency intubation); Sympathomimetic = clinical signs of sympathomimetic toxicity

Below:  Spectrum of substances detected with the Triage^® TOX screen (204 positive urine samples with 348 substances detected). AMP = amphetamines; BAR = barbiturates; BZO = benzodiazepines; COC = cocaine; MAMP = metamphetamines; MTD = methadone; OPI = opiates; PAR = paracetamol; TCA = tricyclic antidepressants; THC = tetrahydrocannabinoids

Below:  Impact of test results on clinical decisions (in %, n = 90) consecutive to the detection of substances with the Triage^®TOX drug screen (n = 262 tests). Toxin-specific administration of naloxone, flumazenil or N-acetycysteine or other drug-specific treatments after test results.

Diagnostic tests = drug-related diagnostic tests ordered after test result; disposition = psychiatry transfer influenced by negative screening / somatic transfer if positive; prolonged monitoring = longer monitoring when methadone positive

Full article at:   http://goo.gl/MGRtlR

By:   Erdmann A1, Werner D2, Hugli O3, Yersin B3.

• 1Emergency Department, University Hospital (CHUV), Lausanne, Switzerland; Angiology Department, University Hospital (CHUV), Lausanne, Switzerland.
• 2Laboratory of clinical chemistry, University Hospital (CHUV), Lausanne, Switzerland.
• 3Emergency Department, University Hospital (CHUV), Lausanne, Switzerland.
• Swiss Med Wkly. 2015 Dec 28;145:w14242. doi: 10.4414/smw.2015.14242. eCollection 2015.
• 
  
• More at:  https://twitter.com/hiv insight
• And: http://twitter.com/Prison Health

Ritualistic Use of Ayahuasca versus Street Use of Similar Substances Seized by the Police: A Key Factor Involved in the Potential for Intoxications and Overdose?

The ritualistic use of ayahuasca is becoming a global phenomenon. This beverage contains a combination of monoamine oxidase inhibitors (harmine, harmaline, and tetrahydroharmine) and N,N-dimethyltryptamine, the main substance responsible for its visionary effect. The recreational use of similar alkaloids and N,N-dimethyltryptamine has increased in recent years, mainly because of their hallucinogenic effects. 

In the present study, the concentrations of psychoactive alkaloids in three powder samples seized by the São Paulo State Police and nine ayahuasca aqueous extracts were analyzed by HPLC-DAD in an attempt to distinguish between illicit drugs and the religious beverage. The alkaloids detected (μg/mL) in the ayahuasca aqueous extracts were N,N-dimethyltryptamine (402-2070.3), harmaline (27.5-181.3), harmine (294.5-2893.8), and tetrahydroharmine (849.5-2052.5), whereas, of the three powder samples, one contained only N,N-dimethyltryptamine (82% and 2% w/w, respectively) while the other contained only harmaline (16%, w/w) and harmine (12%, w/w). 

The ritualistic use of ayahuasca involves oral intake and the probability of overdose is minimized by serotonergic stimulation of vagal pathways, leading to vomiting and diarrhea. In contrast, the recreational use of N,N-dimethyltryptamine involves consumption mainly by smoking or inhalation, both of which markedly increase its bioavailability and the potential for intoxications.

Purchase full article at:   http://goo.gl/fjvpGq

By:   Lanaro R¹, Calemi DB, Togni LR, Costa JL, Yonamine M, Cazenave Sde O, Linardi A.

¹a Researcher, Poison Control Center, Faculty of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , SP , Brazil.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health