Prevalence & Correlates of Transactional Sex among an Urban Emergency Department Sample: Exploring Substance Use & HIV Risk

Men and women involved in transactional sex (TS) report increased rates of HIV risk behaviors and substance use problems as compared with the general population. When people engaged in TS seek health care, they may be more likely to utilize the emergency department (ED) rather than primary care services. 

Our goal was to examine the prevalence and correlates of TS involvement among an ED sample of men and women. Adults ages 18-60 were recruited from an urban ED, as part of a larger randomized control trial. Participants (n = 4,575; 3,045 women, 1,530 men) self-administered a screening survey that assessed past 3-month substance use (including alcohol, marijuana, illicit drugs, and prescription drugs) and HIV risk behaviors, including TS (i.e., being paid in exchange of a sexual behavior), inconsistent condom use, multiple partners, and anal sex. 

Of the sample, 13.3% (n = 610) reported TS within the past 3 months (64.4% were female). Bivariate analysis showed TS was significantly positively associated with alcohol use severity, marijuana use, and both illicit and prescription drug use, and multiple HIV risk behaviors. These variables (except marijuana) remained significantly positively associated with TS in a binary logistic regression analysis. 

The prevalence of recent TS involvement among both male and female ED patients is substantial. These individuals were more likely to report higher levels of alcohol/drug use and HIV risk behaviors. 

The ED may be a prime location to engage both men and women who are involved in TS in behavioral interventions for substance use and sexual risk reduction.

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

By:  Patton R1, Blow FC2, Bohnert AS2, Bonar EE2, Barry KL2, Walton MA2.

• 1The Substance Abuse Research Center, University of Michigan.
• 2Department of Psychiatry, University of Michigan. 
• Psychol Addict Behav. 2014 Jun;28(2):625-30. doi: 10.1037/a0035417.

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Social Media Mining for Toxicovigilance: Automatic Monitoring of Prescription Medication Abuse from Twitter

Introduction

Prescription medication overdose is the fastest growing drug-related problem in the USA. The growing nature of this problem necessitates the implementation of improved monitoring strategies for investigating the prevalence and patterns of abuse of specific medications.

Objectives

Our primary aims were to assess the possibility of utilizing social media as a resource for automatic monitoring of prescription medication abuse and to devise an automatic classification technique that can identify potentially abuse-indicating user posts.

Methods

We collected Twitter user posts (tweets) associated with three commonly abused medications (Adderall^®, oxycodone, and quetiapine). We manually annotated 6400 tweets mentioning these three medications and a control medication (metformin) that is not the subject of abuse due to its mechanism of action. We performed quantitative and qualitative analyses of the annotated data to determine whether posts on Twitter contain signals of prescription medication abuse. Finally, we designed an automatic supervised classification technique to distinguish posts containing signals of medication abuse from those that do not and assessed the utility of Twitter in investigating patterns of abuse over time.

Results

Our analyses show that clear signals of medication abuse can be drawn from Twitter posts and the percentage of tweets containing abuse signals are significantly higher for the three case medications (Adderall^®: 23 %, quetiapine: 5.0 %, oxycodone: 12 %) than the proportion for the control medication (metformin: 0.3 %). Our automatic classification approach achieves 82 % accuracy overall (medication abuse class recall: 0.51, precision: 0.41, F measure: 0.46). To illustrate the utility of automatic classification, we show how the classification data can be used to analyze abuse patterns over time.

Conclusion

Our study indicates that social media can be a crucial resource for obtaining abuse-related information for medications, and that automatic approaches involving supervised classification and natural language processing hold promises for essential future monitoring and intervention tasks.

Below:  Distributions of abuse/non-abuse tweets for the four drugs. The numbers and percentages of abuse-indicating tweets for each drug are also shown

Below:  a Distributions of all collected tweets and automatically detected abuse-indicating tweets for Adderall® and oxycodone and b the proportions of abuse-indicating tweets over the same time periods

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

By:  Abeed Sarker, Karen O’Connor, Rachel Ginn, Matthew Scotch, Karen Smith, Dan Malone, and Graciela Gonzalez

Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ USA

Center for Environmental Security, Biodesign Institute, Arizona State University, Tempe, AZ USA

Rueckert-Hartman College for Health Professions, Regis University, Denver, CO USA

Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ USA

Abeed Sarker, Phone: +1-480-884-0349, Email: ude.usa@rekras.deeba.

Corresponding author.

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Nonmedical Use of Prescription Medication among Adolescents Using Drugs in Quebec

OBJECTIVE:

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec.

METHOD:

Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors.

RESULTS:

Among adolescents who had used drugs in the previous 12 months, 5.4% reported NMUPM. Based on multivariate analyses, having an ADD, anxiety disorder, low self-esteem, low self-control, low parental supervision, regular alcohol use, and polysubstance use were associated with increased odds of reporting NMUPM.

CONCLUSIONS:

The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

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By:   Roy É1, Nolin MA2, Traoré I3, Leclerc P4, Vasiliadis HM5.

• 1Full Professor, Faculty of Medicine, Université de Sherbrooke (http://www.usherbrooke.ca/), Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec.
• 2Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec.
• 3Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec.
• 4Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec.
• 5Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec.
• Can J Psychiatry. 2015 Dec 1;60(12):556-63.
• 
  
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Chasing the Bean: Prescription Drug Smoking among Socially Active Youth

PURPOSE:

Alternative consumption practices of prescription drug misuse have been less well monitored than general prevalence. We describe prescription drug smoking among socially active youth and highlight correlates of this practice. We also examine its association with drug problems, drug dependence, and mental health.

METHODS:

We surveyed 404 young adults recruited from nightlife venues in New York via time-space sampling. We use linear and logistic regression models to examine the probability of smoking prescription drugs and its association with drug problems, dependence, and mental health. Qualitative findings supplement the survey data.

RESULTS:

Males have higher odds than females (odds ratio [OR] = 3.4), and heterosexuals have higher odds than sexual minority youth (OR = 2.3) of smoking prescription drugs. Those involved in electronic dance music nightlife have higher odds (OR = 2.1) than those who do not participate in that scene, whereas those in college bar scenes have lower odds (OR = .4) of having smoked prescription drugs. Prescription drug smokers report more drug problems (β = .322) and greater symptoms of dependence net (β = .298) of the frequency of misuse and other characteristics. Prescription drug smokers do not report greater mental health problems. Qualitative interview data support these survey findings.

CONCLUSIONS:

Prescription drug smoking is a significant drug trend among socially active youth. It is associated with drug problems and symptoms of dependence net of frequency of misuse. Prevention and intervention efforts for youth who misuse prescription drugs should address the issue of prescription drug smoking, and this may be an area for clinicians to address with their adolescent patients.

...In terms of escalation to smoking prescription drugs, our results demonstrate that this mode of administration was more likely among males. Although studies have suggested that the lifetime prevalence of illicit drug use is converging between males and females [30], studies have shown that males often use a wider range of drugs [31] and have heavier patterns of substance use [32]. These findings on escalation to smoking pills cohere with this broader literature. Recent pain killer misusers also reported higher odds of smoking prescription pills.

In terms of subcultural participation, those involved in EDM scenes were much more likely to report smoking pills. This may relate to the misuse of prescription drugs to moderate the effects of “club drugs” popular in such scenes [33]. Further examinations of the role of prescription drug smoking in polydrug combinations are necessary. By contrast, those involved in the college bar scene were less likely to have smoked prescription drugs. This is somewhat surprising given that studies have regularly highlighted the high prevalence of prescription drug misuse among college students [4]; yet, college students may misuse prescription drugs primarily for functional reasons and thus may be less inclined to smoke pills.

Regarding consequences, we found no effect for smoking prescription drugs on mental health outcomes, but strong effects for the CIDI and SIP-AD measures of problem drug use. Thus, our findings provide further support to previous research identifying that transitions to non-oral modes of consumption (mostly sniffing) increase prescription drug abuse related problems [15]. Attesting to the strength of the effect, we observed increased symptoms of dependence associated with smoking prescription drugs even net of the effect of frequency of prescription drug misuse. Thus, smoking is associated with higher dependence and problems above and beyond greater recent misuse. Although the effect of frequency of misuse on drug problems is perhaps unsurprising, the effect of smoking provides clinicians and practitioners with another indicator of increased likelihood of dependence and problems associated with prescription drug misuse... 

Full article at:  http://goo.gl/4zM2dE

By:   Kelly BC¹, Vuolo M², Pawson M³, Wells BE⁴, Parsons JT⁴.

¹Department of Sociology, Purdue University (https://www.cla.purdue.edu/sociology/), West Lafayette, Indiana; Center for HIV Educational Studies & Training, New York, New York. Electronic address: bckelly@purdue.edu.

²Department of Sociology, Purdue University, West Lafayette, Indiana.

³Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York.

⁴Center for HIV Educational Studies & Training, New York, New York; The Graduate Center, City University of New York, New York, New York; Department of Psychology, Hunter College, City University of New York, New York, New York.

J Adolesc Health. 2015 Jun;56(6):632-8. doi: 10.1016/j.jadohealth.2015.02.008.

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Prescription Stimulants and PTSD among US Military Service Members

Posttraumatic stress disorder (PTSD) is a prevalent condition among military service members and civilians who have experienced traumatic events. Stimulant use has been postulated to increase the risk of incident PTSD; however, research in this area is lacking. 

In this study, the association between receipt of prescription stimulants and PTSD was examined in a secondary analysis among active duty U.S. military members (n = 25,971), participating in the Millennium Cohort Study, who completed a baseline (2001–2003) and two follow-up surveys (between 2004–2008). Prescription stimulant data were obtained from the military Pharmacy Data Transaction Service. PTSD was assessed using the PTSD Checklist–Civilian Version and incident PTSD was defined as meeting the criteria at follow-up among those who did not have a history of PTSD at baseline. Overall, 1,215 (4.7%) persons developed new-onset PTSD during follow-up. 

Receipt of prescription stimulants were significantly associated with incident PTSD, hazard ratio = 5.09, 95% confidence interval [3.05, 8.50], after adjusting for sociodemographic factors, military characteristics, attention-deficit/hyperactivity disorder, baseline mental and physical health status, deployment experiences, and physical/sexual trauma. 

Findings suggested that prescription stimulants are associated with incident PTSD among military personnel; these data may inform the underlying pathogenesis of and preventive strategies for PTSD.

Spanish Abstracts by the Asociacion Chilena de Estres Traumatico

TEPT y Prescripción de Estimulantes en Militares

El Trastorno por Estrés Postraumático (TEPT) es una condición prevalente entre los miembros del servicio militar y civiles que han experimentado eventos traumáticos. Se ha postulado que el uso de estimulantes incrementa el riesgo de incidencia de TEPT, sin embargo, la investigación en esta área es escasa. En este estudio, la asociación entre prescripción de estimulantes y TEPT fue evaluada en un análisis secundario entre militares estadounidenses en servicio activo (n: 25.971), participando en el Estudio de Cohorte Milenium, quienes completaron encuestas a nivel basal (2001-2003) y al seguimiento a 2 años (entre 2004–2008). La información de prescripción de estimulantes se obtuvo del Servicio de Información de Farmacia militar. El TEPT fue evaluado usando Checklist para TEPT-versión civiles y la incidencia de TEPT se definió al cumplir criterios en el seguimiento de quienes no tenían historia de TEPT a nivel basal. En conjunto, 1.215 (4,7%) personas desarrollaron TEPT durante el seguimiento. La prescripción de estimulantes se asoció significativamente con la incidencia de TEPT (cociente de riesgo HR 5.09; 95% CI: 3.05, 8.50) después de ajustar por factores sociodemográficos, características militares, trastorno por déficit atencional (TDAH), nivel basal del estado de salud mental y físico, experiencias en el destacamento, y trauma físico/sexual. Los hallazgos sugirieron que la prescripción de estimulantes está asociada con la incidencia de TEPT en el personal militar; estos datos podrían informar de la patogénesis subyacente y estrategias preventivas para TEPT.

Full article at:  http://goo.gl/3yaoOo

By:  

Nancy F. Crum-Cianflone¹, 

Melissa A. Frasco¹, 

Richard F. Armenta^1,2,

Christopher J. Phillips^1,2,*, 

Jaime Horton¹,

Margaret A. K. Ryan⁴, 

Dale W. Russell³and

Cynthia LeardMann^1,2

1. 1
   Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
2. 2
   The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
3. 3
   Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
4. 4
   Occupational Medicine Department, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA

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When Cure Becomes an Illness—Abuse of Addictive Prescription Medicines - Serbia

Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population (Babor et al., 2007). The illegal market turnover of the controlled substances is very difficult to trace and intervene timely among the young in the early stage of illness (Inciardi et al., 2007). Contrary to this one, legally regulated pharmaceuticals pose another dangerous threat that is more accessible to the authorities. In order to combat substance dependence the national strategies should specially emphasize prescription medicines with proven potential of abuse and addiction (Compton and Volkow, 2006).

Serbia as the largest Western Balkans market and a typical Eastern European transitional health system might serve as an appropriate example of medicines abuse in the EU borderlands (Jakovljevic, 2013). The results of local research in 2008, showed that 15.1% of first grade high school students, at least once had used, some psychoactive substance (excluding nicotine and alcohol), while 7.6% of them used sedatives, which was the most common [European School Survey Project on Alcohol and Other Drugs (ESSPAD), 2008]. The national survey on life styles of citizens in Serbia in 2014 about substance use and gambling addiction reported that in the past 12 months 22.4% of the respondents used sedatives, anxiolytics or hypnotics drugs (13.9% of males and 30.9% of females) and in the last 30 days 14.6% of respondents (8% of males and 21.2% of females) used these drugs with higher preponderance among older population. In the last 12 months 5.1% of the respondents used opioids for pain treatment (4.1% of males and 6.1% of females) and in the last 30 days 2.2% of respondents (1.6% of males and 2.8% of females) used these drugs. A large number of respondents said that they had purchased these drugs in the pharmacies prescribed by their physicians –85.3% of the population 18–64 years of age used hypnotics and sedatives, and 70.3% of the population used opioid drugs (Kilibarda et al., 2014).

Various studies have shown that drug addiction disorders are related to personality disorders, anxiety disorders and a considerably higher suicide rate (Regier et al., 1990). Further consequences of drug addiction are: education (Yamada et al., 1993) and employment underachievement, reduced work productivity, poor health, higher rates of human immunodeficiency virus (HIV) and hepatitis B and C infections (Jakovljevic et al., 2013a), social dysfunction, higher rate of violence and incarceration among that population, poverty, homelessness, a lower probability of recovery, poor treatment outcomes, and poor quality of life. The treatment system for substance use disorders is accompanied by high public and private expenses (Jovanovic and Jakovljevic, 2011).

Table 1

National level dispensing (Defined Daily Doses per 1000 population/day) and consumption (€) of major potentially addictive medicines and those used to treat substance addiction in 2004 and 2013 in Serbia.

ATC code group	Reimbursed value of dispensed medicines in 2004	Reimbursed value of dispensed medicines in 2013	DDD per 1000 inhabitants/hospital day in 2004	DDD per 1000 inhabitants/hospital day in 2013
POTENTIALLY ADDICTIVE MEDICINES
N01A Anesthetics, General	€1,283,128	€4,072,544	N/A	N/A
N01AF Barbiturates, plain	€21,465	€101,8422009	N/A	N/A
N02A Opioids	€1,472,459	€2,499,864	0.84	0.52
N02AA Natural opium alkaloids	€197,341	€611,410	0.04	0.08
N02AB Phenylpiperidine derivatives	€272,205	€1,341,574	0.03	0.11
N02AD Benzomorphan derivatives	€818	€5062006	0.00	N/A
N02AX Other opioids (mostly tramadol based preparations)	€1,002,095	€546,880	0.77	0.33
N03AA Barbiturates and derivatives	€427,676	€263,570	2.9	2.03
N03AE Benzodiazepine derivatives	€291,568	€1,288,405	0.63	2.48
N05AH Diazepines, oxazepines, thiazepines, and oxepines	€1,529,558	€4,925,668	0.37	1.53
N05B Anxiolytics	€9,450,094	€15,091,052	106.95	79.81
N05BA Benzodiazepine derivatives	€9,448,412	€15,091,052	106.95	79.81
N05C Hypnotics and sedatives	€1,197,390	€2,232,897	2.47	4.02
N05CD Benzodiazepine derivatives	€1,197,390	€1,459,522	2.47	1.98
N05CF Benzodiazepine related drugs	€0	€773,375	0.00	2.03
N06B Psychostimulants, agents used for ADHD and nootropics	€287,766	€3,138,433	0.35	6.61
R01AA Sympathomimetics, plain (mostly ephedrine based preparations)	€1,676,145	€4,328,551	132.14	14.83
R05DA Opium alkaloids and derivatives	€74,118	€28,649	0.05	0.03
R06AB Substituted alkylamines (mostly pheniramine derivatives)	€492,461	€2,764,304	0.56	0.08
MEDICINES USED TO TREAT SUBSTANCE ADDICTION
N07B Drugs used in addictive disorders	€236,734	€1,900,777	0.31	1.50
N07BA Drugs used in nicotine dependence	€138,139	€407,718	0.03	0.10
N07BB Drugs used in alcohol dependence	€35,123	€206,726	0.19	0.53
N07BC Drugs used in opioid dependence	€63,472	€1,286,332	0.09	0.88

Full article at: http://goo.gl/q0oRli

By: Mihajlo (Michael) Jakovljevic,1,* Marija Lazarevic,2 Milena Jurisevic,2 and Mirjana R. Jovanovic3,4

1Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

2Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

3Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

4Psychiatry Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia

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Substituting Cannabis for Prescription Drugs, Alcohol & Other Substances among Medical Cannabis Patients: The Impact of Contextual Factors

Recent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes.

The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis.

Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients.

The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. 

Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both.

Via:   http://ht.ly/SsTnn 

By: Lucas P1, Walsh Z2, Crosby K2, Callaway R3, Belle-Isle L1,4, Kay R5, Capler R6, Holtzman S7.

• 1Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada.
• 2Psychology, The University of British Columbia, Kelowna, Canada.
• 3Medical Cannabis Advocate, Vancouver, British Columbia, Canada.
• 4Canadian AIDS Society, Ottawa, Canada.
• 5GreenLeaf Technologies, Kelowna, British Columbia, Canada.
• 6Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
• 7Department of Psychology, University of British Columbia, Kelowna, Canada.

Prescription Pain Reliever Misuse Prevalence, Correlates, and Origin of Possession Throughout the Life Course

• Among respondents, 4.7% reported past-year prescription pain reliever misuse. 
• Prevalence for individuals aged 12 to 17 was 5.9%, 
• 18 to 25 was 10.2%, 
• 26-34 was 7.7%, 
• 35 to 49 was 4.3%, 
• 50 or older was 1.7%
• While many social and clinical correlates of pain reliever misuse emerged among younger respondents, these correlates diminished in significance among older adults. 
• Only past-year illicit drug use disorders (marijuana, cocaine, crack cocaine, heroin, and hallucinogen use) was a significant predictor of pain reliever misuse among all age groups. 
• Also, older adults were more likely to report pain reliever possession from multiple medical doctors,
• Whereas younger individuals were more likely to possess pain reliever from friends/relatives or through purchase from a drug dealer/stranger.

Increased efforts to better screen for illicit drug use and greater efforts to coordinate patient prescription records among medical care providers may be high priorities in developing interventions to reduce rates of misuse of prescription pain relievers, especially among older adults.

Via: http://ht.ly/SgzeL

By: Mowbray O1, Quinn A2.

• 1University of Georgia School of Social Work, United States.
• 2University of Georgia School of Social Work, United States.