Drug and alcohol dependence
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Drug Alcohol Depend · Aug 2018
ReviewReview: Adjunctive pharmacologic approaches for benzodiazepine tapers.
Many patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints. ⋯ Studies were heterogeneous with respect to sample selection, sample size, and outcome measures. Medications targeting insomnia yielded mixed results. Similarly, studies of agents targeting anxiety symptoms demonstrated inconsistent findings in the reduction of anxiety, improvement in withdrawal symptoms, or enhancement of benzodiazepine completion rates. Anticonvulsants have supporting evidence from small case reports; carbamazepine shows some potential in assisting taper completion and reducing withdrawal severity. These conclusions should be considered in light of a number of inconsistencies across studies in the literature. The results of this review article highlight the need for additional research on optimal strategies for facilitating successful benzodiazepine tapers.
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Drug Alcohol Depend · Aug 2018
Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016.
A cascade of care framework has been proposed to identify and address implementation gaps in addiction medicine. Using this framework, we characterized temporal trends in engagement in care for opioid use disorder (OUD) in Vancouver, Canada. ⋯ Temporal improvements in OUD cascade of care indicators were observed. However, only a third of participants were retained in OAT in 2016. These findings suggest the need for novel approaches to improve engagement in care for OUD to address the escalating opioid-related overdose crisis.
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The primary objective of this pilot study was to describe the impact of e-cigarette liquid flavors on experienced e-cigarette users' vaping behavior. ⋯ Vaping behavior changes across e-liquids and influences nicotine intake. Research is needed to understand the mechanisms that underlie these behavioral changes, including e-liquid pH and related sensory effects, subjective liking, and nicotine effects.
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Drug Alcohol Depend · Aug 2018
Transitions in the use of multiple substances from adolescence to young adulthood.
Research indicates that many adolescents frequently use multiple substances. This study examines stability and transitions in the use and co-use of multiple substances (cigarette, alcohol, marijuana, illicit drugs) from adolescence to young adulthood. ⋯ Strong stability among adolescent substance use classes was found between waves. Transitions were typically to classes using more substances, although, transitions to use fewer substances was evident for some individuals. Distinguishing stable and transitioning classes of substance use and co-use provides opportunities for prevention and intervention to disrupt high-risk use classes.
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Drug Alcohol Depend · Aug 2018
Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults.
Prescription drug misuse (PDM) rates are highest in adolescents and young adults. Little research in these high-risk groups has examined PDM differences by educational status or attainment. This investigation attempted to further our understanding of adolescent and young adult prescription drug use and misuse through examining PDM type (i.e., nonmedical misuse, medical misuse and mixed misuse) and substance use disorder (SUD) symptoms from PDM by educational status/attainment. ⋯ These results further suggest the importance of assessing educational status in adolescent and educational attainment in young adult PDM investigations. Adolescents poorly engaged in school or not in school appear especially in need of interventions to limit PDM and associated SUD symptoms.