Journal of addiction medicine
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Comparative Study
Assessment of alcohol withdrawal in Native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised Scale.
The Clinical Institute Withdrawal Assessment of Alcohol Revised (CIWA-Ar) is a commonly used scale for assessing the severity of alcohol withdrawal syndrome in the acute setting. Despite validation of this scale in the general population, the effect of ethnicity on CIWA-Ar scoring does not appear in the literature. The purpose of our study was to investigate the validity of the CIWA-Ar scale among Native American patients evaluated for acute alcohol detoxification. ⋯ The CIWA-Ar scale may underestimate the severity of alcohol withdrawal syndrome in certain ethnic group such as Native Americans. Further prospective studies should be undertaken to determine the validity of the CIWA-Ar scale in assessing alcohol withdrawal across different ethnic populations.
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Promethazine has been reported to be misused in conjunction with opioids in several settings. Promethazine misuse by itself or in conjunction with opioids may have serious adverse health effects. To date, no prevalence data for the nonmedical use of promethazine have been reported. This study examines the prevalence and correlates of promethazine use in 2 different populations in San Francisco, California: methadone maintenance clinic patients and community-based injection drug users (IDUs). ⋯ The finding that one-quarter of methadone maintenance patients in a clinic or recruited in community settings have recently used promethazine provides compelling evidence of significant nonmedical use of promethazine in this patient population. Further research is needed to establish the extent and nature of nonmedical use of promethazine.
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Case Reports
Concerns about pregabalin: further experience with its potential of causing addictive behaviors.
Pregabalin (PRG) is approved for the treatment of neuropathic pain, partial seizures, and generalized anxiety disorder in many countries. Supported by case reports and a few studies there is an ongoing debate on PRG's potential to cause addictive behaviors. Considering that PRG is currently under investigation for the treatment of benzodiazepine dependence and withdrawal as well as relapse prevention in alcohol dependence, assessment of PRG's abuse and dependence potential is indispensable. ⋯ During reduction of PRG, the patient developed a moderate withdrawal syndrome with vegetative symptoms. Because of the early detection of the developing PRG abuse (4 months after first application of PRG), the development of PRG dependence was prevented. This case illustrates the possibility of PRG to trigger the development of addictive behaviors and should encourage physicians to be very careful when administering PRG to patients with current or past substance-related disorders.
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To estimate the prevalence of self-reported substance use and psychiatric disorders in a highly select chronic nonmalignant pain population within a nonprimary care tertiary referral-only pain clinic. ⋯ Certain populations of patients with complex nocioceptive, neuropathic, and myofascial pain syndromes may have a lower prevalence of substance use disorders than the general population. They also may have concurrent psychiatric disorders, which should be evaluated and treated concomitantly as part of their chronic pain treatment. Rates reported for possible obsessive-compulsive personality disorder may be reflective of patients' expected preoccupation with pain complaints. The low prevalence of substance use disorders may be attributable to the severity of their illness, the patients' inability to achieve pain relief and obtain pain medications easily, as well as their persistence in pursuing accurate diagnoses and treatment. Roughly one-third were not currently prescribed opioids at the time of the study, perhaps undercutting risk for opioid use disorder rates. Additionally, due to the tertiary referral nature of this clinic, patients with behaviors believed to be a manifestation of opioid use disorder may have already been selected out prior to referral to this clinic. A major limitation of this study was that it relied on a self-report assessment instrument and there were no drug screen findings to report. Such unique clinic characteristics and study limitations may narrow generalizability of results. Despite the low prevalence of substance use disorders observed for this clinic population, these patients must be continuously monitored for abuse, misuse, and diversion of their medication.
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Recent work offers evidence that nonmedical use of prescription medications (NUPM) may precipitate the development and recurrence of psychopathology. This work further explores this relationship by examining the dose-related effects of past year opioid and pooled tranquilizer/sedative NUPM on incidence and recurrence of psychopathology. ⋯ Any opioid or tranquilizer/sedative NUPM may increase risk for alcohol use disorder and non-NUPM substance use disorder, with weekly/daily opioid or tranquilizer/sedative nonmedical users appearing to be most vulnerable to the incidence and recurrence of depressive, bipolar, and anxiety disorders. This work highlights the importance of screening for the NUPM by clinicians, and it highlights the need for further research to better understand the psychopathology-NUPM interaction.