Patterns of Cocaine and Opioid Co-Use and Polyroutes of Administration Among Street-Based Cocaine Users in Montréal, Canada.

Patterns of cocaine and opioid co-use and polyroutes of administration among street-based cocaine users in Montréal, Canada.

Filed under: Addiction Rehab

Int J Drug Policy. 2012 Nov 22;
Roy E, Richer I, Arruda N, Vandermeerschen J, Bruneau J

BACKGROUND: Effective public health programs aimed at problematic cocaine users are challenged by the fact that they can have complex patterns of drug use with respect to polysubstance use and routes of drug administration. This study was carried out to explore the presence of subgroups of cocaine users on the basis of their concurrent use of opioids and their routes of cocaine and opioid administration, and to determine if subgroups could be differentiated in terms of sociodemographic factors and risk behaviours. METHODS: Regular cocaine users (?1 per week) were recruited in low-threshold services located in the Montréal downtown area. The following variables were examined: demographic characteristics, types of drug used, routes of drug administration, and condom use with occasional or commercial sexual partners. Latent class analysis and multinomial logistic regression modeling were carried out. RESULTS: 886 cocaine users were recruited (83.5% male: mean age 35.38 years). A 5-class model was identified: (1) “cocaine smokers” (CSs) (n=161; membership probability (MP)=0.183); (2) “cocaine smokers/sniffers” (CSSs) (n=201; MP=0.218); (3) “cocaine injectors” (CIs) (n=207; MP=0.231); (4) “cocaine-opioid injectors” (COIs) (n=277; MP=0.291); (5) “cocaine-opioid polyroute users” (COPs) (n=40; MP=0.077). Compared with COIs, other subtypes were significantly different in terms of either age, duration of cocaine use, ethnic background, homelessness, polydrug use or condom use. CONCLUSION: The heterogeneity of consumption patterns supports the importance of offering an array of interventions aimed at problematic cocaine users. These should include the provision of clean injecting and smoking material, the promotion of safe sexual behaviours and the prevention of initiation to drug injection. In the absence of specific treatment, cocaine users should have access to primary health care services and addiction treatment based on innovative behavioural and pharmacological approaches.
HubMed – addiction

 

Irreversible alopecia universalis during treatment with pegylated interferon-ribavirin for chronic hepatitis C virus infection: Case report and published work review.

Filed under: Addiction Rehab

Hepatol Res. 2012 Dec; 42(12): 1248-51
Omazzi B, Prada A, Borroni G, Sacrini F

Hair disorders that have been described in association with pegylated interferon-ribavirin combination treatment include canities, hypertrichosis, telogen effluvium, and the most common cutaneous side-effect by far, alopecia. Alopecia is a heterogeneous disease characterized by hair loss on the scalp or any hair-bearing surface with a wide range of clinical presentations, from a single patch of hair loss to complete loss of hair on the entire body (alopecia universalis). Although some cases of reversible alopecia universalis associated with pegylated interferon-ribavirin combination therapy have been reported in the published work, irreversible alopecia universalis has not yet been reported in relation to pegylated interferon and ribavirin combination treatment. For the first time, we report a case of irreversible alopecia universalis during pegylated interferon-ribavirin combination therapy in a man infected with hepatitis C virus in the absence of clinical or biochemical evidence of immunological disorders or thyroid dysfunction at any time before, during or after antiviral therapy.
HubMed – addiction

 

Clozapine and therapeutic drug monitoring: is there sufficient evidence for an upper threshold?

Filed under: Addiction Rehab

Psychopharmacology (Berl). 2012 Nov 22;
Remington G, Agid O, Foussias G, Ferguson L, McDonald K, Powell V

RATIONALE: Clozapine levels are advocated in the monitoring of patients on this drug and have now been used for a number of years. A safety-related threshold has also been proposed, as well as therapeutic lower and upper thresholds. While there has been reasonable consensus regarding a lower therapeutic threshold, this is not the case for the upper thresholds. OBJECTIVES: Our aim was to review available evidence related to upper thresholds. METHODS: We carried out an electronic search of different databases and a manual search of articles between 1960 and 2011, cross-referencing the following terms with clozapine-interactions, monitoring, pharmacokinetics, plasma levels, serum levels, and toxicity. RESULTS: Sixty-nine articles met our search criteria and these could be divided into reviews (11), studies (24), and case reports (35). Study quality was evaluated, and none met criteria for a prospective, randomized controlled trial specifically addressing higher plasma levels, e.g., >500 ng/ml. Case reports emphasize in particular the impact of interactions, e.g., antidepressants and smoking. There is clear evidence indicating a dose-related increased risk of seizures, at least to 500-600 mg/day, but a lack of data to suggest such a relationship between plasma levels, dose, and side effects linked to safety, e.g., seizures, myocarditis, and agranulocytosis. The very limited evidence addressing an upper threshold related to clinical response suggests a “ceiling effect” in the range of 600-838 ng/ml. CONCLUSIONS: It appears that the current safety-related threshold is not supported by evidence. There may be an upper threshold for clinical response, beyond which chance of response falls off, although further studies are warranted.
HubMed – addiction

 

The Associations Between Personality Characteristics and Absenteeism: A Cross-Sectional Study in Workers With and Without Depressive and Anxiety Disorders.

Filed under: Addiction Rehab

J Occup Rehabil. 2012 Nov 21;
Vlasveld MC, van der Feltz-Cornelis CM, Anema JR, van Mechelen W, Beekman AT, van Marwijk HW, Penninx BW

Purpose Although numerous studies have identified risk factors for sickness absence, few studies have addressed the role of personality characteristics in absenteeism. The aim of this study was to examine the associations of the Big 5 personality characteristics (neuroticism, extraversion, openness, agreeableness and conscientiousness) and locus of control with absenteeism, taking the presence of depressive and anxiety disorders into account. Methods Cross-sectional data from the baseline measurement of the Netherlands Study of Depression and Anxiety (NESDA) were examined. NESDA includes persons with current or remitted depressive and anxiety disorders and healthy controls, of which 1883 working participants were selected. Personality characteristics were included as predictor variables, short-term (0-2 weeks) and long-term (>2 weeks) absenteeism as outcome measure. The presence of depressive and anxiety disorders was considered as modifying covariate. Results In healthy workers, high neuroticism, external locus of control, low extraversion, low agreeableness and low conscientiousness were associated with short-term absenteeism. In addition, high neuroticism, low extraversion and low openness were related to long-term absenteeism in healthy workers. In workers with psychopathology, similar associations were found for persons with this profile (high neuroticism, external locus of control, low extraversion and low conscientiousness) with long-term absenteeism, but no associations of these characteristics were found with short-term absenteeism. Conclusions Personality characteristics were significantly associated with work absenteeism in both workers with and without anxiety or depression. Interventions aimed at preventing sickness absence may focus on reducing neuroticism and strengthening extraversion, conscientiousness and locus of control.
HubMed – addiction

 

Find More Addiction Rehab Information…