Drug dependence and its risk factors in emergency department patients:A retrospective cross-sectional study

Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1,2019 and March 1,2020.The demographic and baseline information were recorded.All the prescibed DAP,the reasons to use these drugs,secondary drug dependence,the department where DAP were first prescribed,types of doctors who preferred to prescribed DAP,and the risk factors for the development of drug dependence were determined.Results:A total of 3000 patients were screened from medical records,and among them,80 patients developed drug dependence.Drug dependence only developed for tramadol(n=57,71.3%),diazepam(n=11,13.8%),and biperiden(n=12,15.0%).Tramadol was the most frequently prescribed drug(n=57,71.3%).The most common reason for drug dependence was psychiatric disorders(n=29,36.3%).Drug dependence developed in renal colic patients due to the administration of tramadol(n=7,100%).On the contrary,dependence to biperiden were mainly developed in patients with psychiatric complaints(n=12,41.4%).The rate of secondary drug dependence was 15%(n=12).Of the Biperiden users,41.7%developed secondary drug dependence on diazepam.Most DAP were first prescribed in the ED(n=52,65%),and the specialist preferred to prescribe DAP(n=43,53.8%).For the development of dependence,the presence of renal colic(OR:3.387,95%confidence interval(CI):1.473-7.788,P=0.004)and low back pain(OR:5.778,95%CI:2.779-12.014,P<0.001)were the risk factors.Conclusions:Most DAP were first prescribed in the ED compared to other departments,and specialist are preferred to use DAP.Tramadol is the most commonly used drugs caused drug dependence.Psychiatric disorder patients are easier to develope drug dependence.Furthermore,renal colic and low back pain patients needs more attention to avert drug dependence.

Reliability and Validity of Addiction Severity Index in Drug Users with Methadone Maintenance Treatment in Guizhou Province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Substance use and substance use disorders in Africa:An epidemiological approach to the review of existing literature

The relationship between man and substances that have abuse potentials,and whose use has been associated with the development or progression of substance use disorders has continued to evolve in terms of geography,economic implications,and time.History shows that local plants with psychoactive constituents can get exported worldwide through global travel,commerce,or even conquest.Time and globalization also change people’s relationship with substances of abuse;hence,an area that was initially alien to certain substances might evolve to becoming a trafficking hub,and then a destination.A case in point is Africa where a rapidly increasing prevalence of substance use/abuse and substance use disorder among adolescents and young adults is putting enormous strain on the economy,healthcare system,and society at large.However,there appears to be a paucity of scientific literature and data on the epidemiology,risk assessment,and contributing factors to substance use and the development of substance use disorders across Africa.In this narrative review,we examine extant literature(PubMed,Google scholar,Medline)for information on the prevalence,trends,and influencers of substance use and the development of substance use disorders.This is with a view of understanding the determinants of substance use and factors that influence the development of substance use disorders in the region,and how this information can be channeled towards developing a comprehensive intervention and treatment program.

Primary studies on heroin abuse and injury induced by oxidation and lipoperoxidation

Objective To further reveal serious risks of heroin abuse to human body and clarify grave injuries of oxidation, peroxidation and lipoperoxidation induced by nitric oxide and other free radicals to heroin abusers Methods Determined and compared plasma levels of nitric oxide (P NO), vitamin C (P VC), vitamin E (P VE), β carotene (P β CAR), lipoperoxides (P LPO) and erythrocyte activities of superoxide dismutase (E SOD), catalase (E CAT), glutathione peroxidase (E GSH Px) and erythrocyte level of lipoperoxides (E LPO) in 137 cases of heroin abusers (HAs) and 100 cases of healthy volunteers (HVs), used linear regression and correlation, stepwise regression and correlation to analyze correlation among heroin abusing duration (HAD), daily heroin abusing quantity (DHAQ) with above determination values in the HAs Results Compared with the above average values in the HVs group, the average values of P NO, P LPO, E LPO in the HAs group were significantly increased ( P <0 0001), the average values of P VC, P VE, P β CAR, E SOD, E CAT and E GSH Px were significantly decreased ( P <0 0001); the analysis of linear regression and correlation showed that with ascending of the HAD and DHAQ in the HAs, the values of P NO, P LPO, E LPO were gradually increased ( P <0 0001), the values of P VC, P VE, P β CAR, E SOD, E CAT, E GSH Px were gradually decreased ( P <0 0001); the analysis of stepwise regression and correlation suggested that the correlation among the HAD, DHAQ with the values of P NO, P VC, P VE was the closest Conclusion The balance between oxidation and antioxidation in the HAs was seriously destroyed, and the injuries induced by nitric oxide and other free radicals, oxidation, peroxidation and lipoperoxidation reactions to the body of HAs gravely exacerbated In the abstaining from heroin dependence, therefore, it should consider that sufficient quantum antioxidants such as VC, VE and β CAR are dosed to the HAs so as to abate the injuries to their bodies

Effect of Electro-acupuncture on Relapse to Heroin-Seeking in the Heroin Self-administrating Rats

Objective： To observe the effect of electro-acupuncture on the relapse to heroin-seeking induced by heroin-related cues after withdrawal from heroin self-administration in rats. Methods： Sixty male Wistar rats were randomized into physiological saline group, withdrawal group A, withdrawal group B, electro-acupuncture （EA） treatment group A and EA treatment group B, with 12 rats in each group. The rats were trained by nose-poke response to self administer heroin （50μg/kg/per infusion） or saline with one daily 4-h session for 14 consecutive days, the session ended after 25 infusions were earned or 4 hours had passed, the reinforcement schedule was a progressive ratio. Then rats in withdrawal group A and withdrawal group B were withdrawn from heroin for 1 week and 2 weeks respectively, and then they were reintroduced to their training chambers for 4-h relapse testing which was induced by heroin-related environmental cues; And rats in EA treatment group A and EA treatment group B were also withdrawn from heroin for 1 week and 2 weeks respectively, during which they were given EA treatment for 20 min daily, then they received relapse testing; In the meantime, rats in saline group were trained with saline instead of heroin for 14 days as control, after 7 days of withdrawal from saline, they received relapse testing. Results： Following 7-8 days of drug training, the rats began to establish the stable intravenous heroin self-administration behavior; For the stable heroin self-administrating rats that received EA treatment, when they were reintroduced to their training chambers, their heroin-seeking behaviors were obviously inhibited, and this inhibitory effect related to the cumulativeness of EA stimulation. Conclusion： The results suggested that EA could prevent relapse to heroin-seeking to a certain extent.

Inhibition of the reinstatement of morphine-induced place preference in rats by high-frequency stimulation of the bilateral nucleus accumbens

Background Opiate addiction remains intractable in a large percentage of patients, and relapse is the biggest hurdle to recovery. Many studies have identified a central role of the nucleus accumbens （NAc） in addiction. Deep brain stimulation （DBS） has the advantages of being reversible, adjustable, and minimally invasive, and it has become a potential neurobiological intervention for addiction. The purpose of our study was to investigate whether high-frequency DBS in the NAc effectively attenuates the reinstatement of morphine seeking in morphine-primed rats. Methods A morphine-dependent group of rats was given increasing doses of morphine during conditioned place preference training. A control group of rats was given equal volumes of saline. After the establishment of this model, withdrawal syndromes were precipitated in these two groups by administering naloxone, and the differences in withdrawal symptoms between the groups were analyzed. Electrodes for DBS were implanted in the bilateral shell of the NAc in the experimental group. The rats were stimulated daily in the NAc for 5 hours per day over 30 days. Changes in the conditioned place preference test and withdrawal symptoms in the rats were investigated and place navigation studies were performed using the Morris water maze. The data were assessed statistically with one-way analysis of variance （ANOVA） followed by Tukey＇s tests for multiple post hoc comparisons. Results High-frequency stimulation of the bilateral NAc prevented the morphine-induced reinstatement of morphine seeking in the conditioned place preference test. The time spent in the white compartment by rats following 30 days of DBS （（268.25±25.07） seconds） was not significantly different compared with the time spent in the white compartment after relapse was induced by morphine administration （（303.29±34.22） seconds）. High-frequency stimulation of the bilateral NAc accelerated the innate decay of drug craving in morphine-dependent rats without significantly influencing learning and memory. Conclusion Bilateral high-frequency stimulation of the shell of the NAc may be useful as a novel therapeutic modality for the treatment of severe morphine addiction.