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Introduction: Nicotine dependence is one of the main causes of preventable diseases in the United States. Nicotine-seeking and avoidance behavioral assays in larval zebrafish could be used for identifying potential new pharmacotherapeutics in an early phase of drug discovery and could facilitate the identification of genes and genomic variations associated with nicotine-seeking and avoidance behavior. Methods: A new three-choice behavioral assay has been developed for the identification of nicotine-seeking and avoiding larval zebrafish. The three choices are represented by three compartments of a gradient maze. Video-recording and subsequent quantitative analysis of the swimming track was carried out using EthovisionXT (Noldus). Results: Three behavioral phenotypes could be identified. Nicotine-seeking larval zebrafish occupied nicotine compartments for longer periods and entered the nicotine-containing compartments most frequently. Nicotine-avoiders spent most of the cumulative time in the water compartment or entered the water compartment most frequently. Non-seekers remained in the center compartment for most of the time. In the gradient maze, about 20-30% of larval zebrafish had a preference for low nicotine concentrations whereas nicotine avoidance was stronger at higher nicotine concentrations. Lower concentrations of nicotine (0.63 µM, 6.3 µM) resulted in higher percentages of nicotine seekers whereas high nicotine concentrations (63 µM, 630 µM) resulted in higher percentages of nicotine avoiders. Pre-treatment of larval zebrafish with nicotine slightly increased the percentage of nicotine avoiders at lower nicotine concentrations. Treatment with varenicline strongly increased the percentage of nicotine avoiders at lower nicotine concentrations. Conclusion: The results show that larval zebrafish have individual preferences for nicotine that could change with drug treatment. The three-choice gradient maze assay for larval zebrafish provides a new testing paradigm for studying the molecular and cellular mechanisms of nicotine action and the discovery of potential new pharmacotherapeutics for the treatment of smoking cessation. [ABSTRACT FROM AUTHOR]

Purpose: This paper reports a review of couple-based behavioral HIV interventions conducted by the Social Intervention Group (SIG); and addresses gaps, future directions, and implications for couple-based HIV interventions. Method: We performed a literature review for SIG research on intervention and prevention studies involving couples/partners. Results: We identified nine couple-based interventions. Outcomes included reduced sexual and substance use-related risk behaviors and improved use of anti-retroviral treatment. We conducted these studies in diverse venues, including needle/syringe exchange programs, primary care clinics, and criminal justice settings. Conclusions: The findings of this review provide strong evidence for the efficacy of couple-based HIV interventions in reducing sexual HIV risks and linkage to HIV and substance-use treatment. SIG has advanced couple-based HIV intervention research science by improving study design, intervention core components, conceptual models, and implementation strategies; which have informed scientific directions and transformed couple-based HIV prevention research. [ABSTRACT FROM AUTHOR]

IntroductionNicotine dependence is one of the main causes of preventable diseases in the United States. Nicotine-seeking and avoidance behavioral assays in larval zebrafish could be used for identifying potential new pharmacotherapeutics in an early phase of drug discovery and could facilitate the identification of genes and genomic variations associated with nicotine-seeking and avoidance behavior.MethodsA new three-choice behavioral assay has been developed for the identification of nicotine-seeking and avoiding larval zebrafish. The three choices are represented by three compartments of a gradient maze. Video-recording and subsequent quantitative analysis of the swimming track was carried out using EthovisionXT (Noldus).ResultsThree behavioral phenotypes could be identified. Nicotine-seeking larval zebrafish occupied nicotine compartments for longer periods and entered the nicotine-containing compartments most frequently. Nicotine-avoiders spent most of the cumulative time in the water compartment or entered the water compartment most frequently. Non-seekers remained in the center compartment for most of the time. In the gradient maze, about 20–30% of larval zebrafish had a preference for low nicotine concentrations whereas nicotine avoidance was stronger at higher nicotine concentrations. Lower concentrations of nicotine (0.63 μM, 6.3 μM) resulted in higher percentages of nicotine seekers whereas high nicotine concentrations (63 μM, 630 µM) resulted in higher percentages of nicotine avoiders. Pre-treatment of larval zebrafish with nicotine slightly increased the percentage of nicotine avoiders at lower nicotine concentrations. Treatment with varenicline strongly increased the percentage of nicotine avoiders at lower nicotine concentrations.ConclusionThe results show that larval zebrafish have individual preferences for nicotine that could change with drug treatment. The three-choice gradient maze assay for larval zebrafish provides a new testing paradigm for studying the molecular and cellular mechanisms of nicotine action and the discovery of potential new pharmacotherapeutics for the treatment of smoking cessation.

The aim of the current study is to understand the pathways to drug use and early school dropout in relation to adverse childhood experiences. The study focuses in exploring the meaning that participants themselves give to their experiences through the analysis of their biographies. The current study focuses on the analysis of the biographies that therapeutic community members in a Greek drug-free treatment organization, KETHEA, write upon their entrance in the treatment setting. The study wishes to understand how participants perceive their childhood experiences and especially adverse childhood experiences, in relation to their initiation to drug use and school dropout. Biographies were written by members themselves in a private and quite space and researchers requested access through KETHEA paying particular attention to the issues of confidentiality and ethics. Through the analysis, it was revealed that school dropout and initiation to drug use coincide and are both related with several adverse childhood experiences. These include, neglect and abuse, even sexual abuse by a family member, dysfunctional familial relationships, and several learning and behavioural problems at school. Biographies are analysed per developmental age, that include pre-school years, childhood, early adolescence, middle adolescence, and late adolescence. The study concludes that by middle and late adolescence many behavioural patterns linked to adverse early childhood experiences already develop. The analysis reveals that already in preschool years children experience loneliness, because of neglect and the loss of a loved one. In school years, abuse is often perceived as ‘normal’ given that children do not have positive life experiences of what is like to grow in a caring environment and problems in relation to school attendance and acceptance already surface. In early adolescence, the realization comes that family and life conditions are adverse and many feel rejected from the school environment. In middle adolescence drug and alcohol use are already initiated and school dropout seems a plausible option. In late adolescence drug use is present and other phenomena such as early engagement with sexual behaviour and victimization of others make their appearance. Therefore, the study suggests the significance of the development of early prevention and intervention programmes much earlier than high school. [ABSTRACT FROM AUTHOR]

Abstract Background Off- label drug use refers to the use of medicines outside of their marketing authorization with respect to dose, dosage form, route of administration, indication or age. Off-label/unlicensed drug use significantly associated with adverse drug reactions and medication errors in neonates and critically ill neonates are more vulnerable to these problems. Objective To assess the prevalence and associated factors with off-label and unlicensed drug use in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. Methods A cross-sectional study was conducted from March 01,2019 to April 30, 2019 in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. Neonates admitted for 24 h and took at least one medicine were included in the study. Data was collected from prescription and medical charts. The off-label and license status of the medicine was verified based on European medicine Agency electronic medicine compendium. Data was analyzed by SPSS version 21.0. Binary and multivariate logistic regression was done to assess the predictors of off-label/unlicensed medicine use at p-value ≤0.05 significance level. Result A total of 364 medicines prescribed for 122 neonates were analyzed. The prevalence of off-label and unlicensed drug use was 246 (67.58%), and 86 (23.63%) respectively. Of the total 122 neonates, 114(93.44%), and 57(46.72%) of them were exposed to at least one off-label and unlicensed drug respectively. Antibiotics were the most commonly prescribed off-label and unlicensed drugs. No statistically significant association was found between demographic as well as health related variables with off-label/unlicensed medicine use at p-value of ≤0.05 significance level. Conclusion Off-label and unlicensed medicine use was high among neonates admitted to intensive care unit of the hospital. Selecting the safest medicines for such vulnerable patients is crucial to promote rational prescribing and better therapeutic benefit.

People who inject drugs are often the target of stigma that puts this already at-risk group at greater risk of harm. Past research has shown that holding stigmatizing views of people who inject drugs increases risky behaviors and is a barrier to their engagement in important medical and public health interventions. One explanation is that the negativity surrounding the group causes increased levels of anticipated emotional exhaustion, discouraging positive engagement. However, there has been minimal research focused on addressing this negativity to reduce levels of held stigma against people who inject drugs. We hypothesized that giving people an imagined positive contact exercise about people who inject would lead to a reduction in stigma, since exposure to positive empathy may create new mental associations between stigmatized groups and more positive emotions and experiences. Secondarily, we hypothesized that positive empathy strategies would be more effective than traditional informational or learning based techniques, and that the latter would be more effective than a control condition. Our sample consisted of 375 participants recruited online. Participants were assigned to one of three study conditions: a positive empathy condition, an informational learning condition, or a control condition, and completed a posttest social distance measure. Results demonstrated that subjects exposed to the positive empathy stigma reduction condition experienced a significant reduction in held stigma while participants exposed to traditional informational learning techniques showed no significant reduction in held stigma. Positive empathy-based stigma interventions should be further researched as a promising avenue to reduce the effects of drug-related stigma.

People who inject drugs are often the target of stigma that puts this already at-risk group at greater risk of harm. Past research has shown that holding stigmatizing views of people who inject drugs increases risky behaviors and is a barrier to their engagement in important medical and public health interventions. One explanation is that the negativity surrounding the group causes increased levels of anticipated emotional exhaustion, discouraging positive engagement. However, there has been minimal research focused on addressing this negativity to reduce levels of held stigma against people who inject drugs. We hypothesized that giving people an imagined positive contact exercise about people who inject would lead to a reduction in stigma, since exposure to positive empathy may create new mental associations between stigmatized groups and more positive emotions and experiences. Secondarily, we hypothesized that positive empathy strategies would be more effective than traditional informational or learning based techniques, and that the latter would be more effective than a control condition. Our sample consisted of 375 participants recruited online. Participants were assigned to one of three study conditions: a positive empathy condition, an informational learning condition, or a control condition, and completed a posttest social distance measure. Results demonstrated that subjects exposed to the positive empathy stigma reduction condition experienced a significant reduction in held stigma while participants exposed to traditional informational learning techniques showed no significant reduction in held stigma. Positive empathy-based stigma interventions should be further researched as a promising avenue to reduce the effects of drug-related stigma. [ABSTRACT FROM AUTHOR]

People who use illicit drugs frequently become targets for welfare intervention, often positioned both as complicit in the reproduction of intergenerational poverty and marginalisation, and as sources of hope for interrupting such patterns. This article draws on empirical research exploring the experiences of highly marginalised people with histories of illicit drug‐use to investigate how they negotiate service encounters in the context of the participants' previous experiences with welfare interventions. In doing so, the article seeks to texture the conception of the support and control nexus, drawing out the systemic and service level factors of welfare services which inhibit people who use drugs from benefitting from available support. We conducted 12 in‐depth interviews with participants subject to interventions by health, social or legal services between July and September 2018. All interviews were audio‐recorded, transcribed verbatim and coded in NVivo. Transcripts were analysed using a grounded theory approach where data were subject to an iterative process of constant comparisons to identify emergent themes and theoretical concepts. The findings suggest that the blending of welfare services and systems of control has unintended and often negative consequences for highly marginalised people. In effect, the drug treatment programme's aims of assisting people to reduce harm and increase stability are significantly undermined by control mechanisms such as mandatory reporting policies. A better understanding of the ways in which welfare service processes alienate marginalised people from seeking support, as well as from benefitting from the support available, might provide a way to address these concerns. [ABSTRACT FROM AUTHOR]

Background: Off- label drug use refers to the use of medicines outside of their marketing authorization with respect to dose, dosage form, route of administration, indication or age. Off-label/unlicensed drug use significantly associated with adverse drug reactions and medication errors in neonates and critically ill neonates are more vulnerable to these problems. Objective: To assess the prevalence and associated factors with off-label and unlicensed drug use in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. Methods: A cross-sectional study was conducted from March 01,2019 to April 30, 2019 in neonatal intensive care unit of Ayder Comprehensive Specialized Hospital. Neonates admitted for 24 h and took at least one medicine were included in the study. Data was collected from prescription and medical charts. The off-label and license status of the medicine was verified based on European medicine Agency electronic medicine compendium. Data was analyzed by SPSS version 21.0. Binary and multivariate logistic regression was done to assess the predictors of off-label/unlicensed medicine use at p-value ≤0.05 significance level. Result: A total of 364 medicines prescribed for 122 neonates were analyzed. The prevalence of off-label and unlicensed drug use was 246 (67.58%), and 86 (23.63%) respectively. Of the total 122 neonates, 114(93.44%), and 57(46.72%) of them were exposed to at least one off-label and unlicensed drug respectively. Antibiotics were the most commonly prescribed off-label and unlicensed drugs. No statistically significant association was found between demographic as well as health related variables with off-label/unlicensed medicine use at p-value of ≤0.05 significance level. Conclusion: Off-label and unlicensed medicine use was high among neonates admitted to intensive care unit of the hospital. Selecting the safest medicines for such vulnerable patients is crucial to promote rational prescribing and better therapeutic benefit. [ABSTRACT FROM AUTHOR]

Objective: As our society ages, the incidence of acute and chronic diseases increases, and so does chronic drug use and polypharmacy. This study was intended to examine the medication behaviors of the elderly who lived in the nursing homes in the Elazig and Malatya provinces, located in eastern Turkey, and in the Kayseri province located in Central Anatolia. Materials and methods: The population of this cross-sectional study included people over the age of 60 years (n=310) who lived in the nursing homes in the Elazig, Malatya, and Kayseri provinces. The entire population was included in the research without sampling, of which 255 (82.2%) people participated. Data were collected using a survey form, and the survey was conducted through face-to-face interviews. The data were reported in numbers, percentages, and averages. Results: Of the studied population, 87.8% were treated through polypharmacy, using various drugs. The most commonly used drugs were antihypertensives (52.2%). Females over 60 years used more polypharmacy than men (p,0.05). Of the elderly studied, 97.3% used drugs as recommended, 95.3% did not know about the side effects of the drugs they used, and 93.7% did not read the prospectuses of the drugs. Also, 82.7% stated that their drugs did not have any side effects and 70.2% said that the health care personnel did not educate them about their drugs. Of the elderly who were informed about their drugs, 55.3% obtained the information from the nurse and 44.7% from the physician. Of the elderly, 51.3% received education on the duration they would need to take the drug, 30.3% were educated on the intended use of the drugs, 7.9% received education on their drug dose, and 6.6% were educated on the side effects of the drugs. Conclusion: The results of this study showed that the majority of the elderly studied used more than one drug (polypharmacy) and the most used drug group was antihypertensives. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to propose a methodology for classifying prisons into distinct drug-use risk categories based on prisoners’ use of specified prescription and illegal drugs. The categories of prisons thus defined have particular relevance for the planning of drug-related interventions, education and services in Irish prisons. The methodology may be transferable to, and of value in, prison systems elsewhere.Methods: From the 14 prisons in Ireland, 824 randomly selected prisoners completed a self-administered questionnaire on lifetime, last year and last month use of specified prescription and non-prescription drugs. Questions were derived from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and other sources. Oral fluid samples were collected for verification of recent drug use. The EMCDDA definition of “recent problematic drug use” was used inpost hochierarchical cluster analysis to define categories of prisons with similar drug-use patterns.Findings: Four categories of prisons, designated “low”, “medium”, “high” and “very high” drug use, were identified. While the prisons comprising each category were known, drug use patterns in individual prisons were not disclosed because of concerns about prisoner confidentiality in a small jurisdiction. The clusters identified were used to contextualise subsequent analyses of drug use, the availability and use of harm-reduction services and differential service requirements by prison category.Conclusions: The methodology described allows for identification of prison categories by drug-use patterns. With restrictions on disclosure of information by individual prison, it provides more valuable information than would derive from data on all prisons combined. [ABSTRACT FROM PUBLISHER]

Background: This study describes the case of a 57 year old gentleman with a previous severe brain injury who developed a severe psychotic disorder 19 years after the injury. This appears to have been precipitated by heavy psychedelic substance use, including cannabis, salvia divinorum, ketamine, LSD, cocaine and DMT amongst others. The psychosis remained in the absence of drug intoxication and was associated with prominent apathy, lack of concern and abulia. Case study: This study discusses the heavy psychedelic substance misuse possibly potentiating a transition to psychosis in this individual. Little work has been undertaken in this area as substance misuse has traditionally been an exclusion criteria for investigating psychosis in this patient group. Conclusions: It is suggested that psychedelic substance misuse should be investigated as a risk factor for psychotic illness in patients with brain injury, as this case clearly suggests. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) and risky sexual behaviors are serious and overlapping public health problems that disproportionately affect drug-involved women. Despite the fact that drug-using women experience extensive IPV, to date, no studies have investigated the association of IPV and risky sexual behaviors among drug-using women in Iran. Methods: Drug-using women (N =120) were recruited from a rehabilitation center in Tehran from March to October, 2009. The Revised Conflict Tactics Scale (CTS2), a standardized questionnaire, was used to collect data regarding violence. We used t-test and logistic regression models to explore the relationship between IPV domains and specific sexual risk behavior outcomes using SPSS 21. Results: The means (sd) for CTS2 domains were as follows: negotiation 4.29 (1.55), psychological violence 2.55 (1.51), sexual violence 0.37 (1.00), physical abuse 1.17 (1.49), injury 2.18 (1.97), and the mean total score was 1.69 (0.96). We found significantly higher injury scores, but lower sexual abuse scores among women with sexually-transmitted infection (STI) compared to women without STI (p-values 0.030 and <0.0001, respectively). In addition, we found that psychological abuse was positively associated with STI (p-value 0.03) and increased condom use (p = 0.010), possibly mediated through an increased likelihood of having multiple partners. Conclusion: The findings revealed that in Iran drug-involved women experience high rates of IPV and that IPV is associated with increased risky sexual behavior. Implication: Preventive interventions for violence that are integrated within drug treatment programs, as well as harm reduction programs are highly recommended. [ABSTRACT FROM AUTHOR]

Prison substance use is a major concern for prison authorities and the wider community. Australia has responded to this problem by implementing the National Corrections Drug Strategy. Across Australia, the true extent of prison substance use cannot be determined. As a result, the effectiveness of the interventions employed as part of this strategy cannot be properly assessed. This has important implications for the allocation of corrective services resources and future policy development. This article explores the benefits and limitations, as well as the ethical and practical issues in using wastewater analysis (WWA) to measure levels of substance use in prisons. It reports results from the first application of WWA to an Australian prison, which supports the use of WWA in this context. Given the increasing concern for prescription misuse in prisons, we also highlight the novel use of WWA to measure the extent of prescription misuse by prisoners. The article concludes that as a result of its objectivity, sensitivity and cost-effectiveness, the use of WWA in prisons warrants further consideration in Australia. [ABSTRACT FROM AUTHOR]

In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current status of the outcome of the NDP objectives in terms of the availability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh, including affordability by consumers. The study covered a random sample (n=30) of rural Upazila Health Complexes (UHCs) and a convenient sample (n=20) of urban clinics (UCs) in the Dhaka metropolitan area. Observations on prescribing and dispensing practices were made, and exit-interviews with patients and their attendants, and a mini-market survey were conducted to collect data on the core drug-use indicators of the World Health Organization from the health facilities. The findings revealed that the availability of essential drugs for common illnesses was poor, varying from 6% in the UHCs to 15% in the UCs. The number of drugs dispensed out of the total number of drugs prescribed was higher in the UHCs (76%) than in the UCs (44%). The dispensed drugs were not labelled properly, although >70% of patients/care-givers (n=1,496) reported to have understood the dosage schedule. The copy of the list of essential drugs was available in 55% and 47% of the UCs and UHCs respectively, with around two-thirds of the drugs being prescribed from the list. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of encounters (n=1,496), more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection, including pneumonia (10-20%). The prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of the poor people. Thus, the availability and rational use of drugs and the affordability of the poor people have remained to be achieved in Bangladesh even 27 years after approving the much-acclaimed NDP 1982. [ABSTRACT FROM AUTHOR]

The purpose of this article is four-fold. Firstly, it is meant to draw attention to Project Prevention, an American-based program funded largely by private donations used to offer people - mostly poor, racialized, drug-using women - up to $200 for limiting their reproductive abilities. Secondly, it highlights links between Project Prevention's mandate and prevailing discriminatory scientific-medical, legal, political, and media discourses which serve to constitute certain 'Truths' about the dangers of prenatal drug-use and parenthood, particularly for women. Thirdly, Project Prevention is framed and theorized within its neo-liberal context in order to underscore the ways that contemporary (pregnant) bodies often become governed through social initiatives which implode state/non-state agencies, public/private distinctions. Finally, to ensure readers are not left with overly simplistic readings of the issues at hand, the article concludes by considering the potential role of counterclaims in terms of who does and does not get constructed as a 'risky' reproductive agent. [ABSTRACT FROM AUTHOR]

Through an analysis of Dracula, this article will explore some of the hyperbolic rhetoric surrounding drug use and women's place in medical discourse that has, like the Count himself, risen again and again in our culture. It argues that Dracula attempts - through popular metaphors of addiction, shifting terminologies about drug use, and British anxieties about immigration - to make a clear but highly unstable distinction between licit and illicit drug use. In the process, Stoker's novel illuminates a complex relationship between middle-class women and the opiates that paradoxically serve as a site of patriarchal oppression and resistance to it. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the relationship between drug use and self-rated health in the elderly. Materials: An interview survey among all individuals aged 75 years or over in the Danish Twin Register took place. The survey comprised of 2171 persons who responded to questions on self-rated health and drug use. Results: The mean number of all drugs used increased from 1.3 in persons with “very good” health to 4.6 in persons with “very poor” self-rated health. For prescription drugs, the corresponding figures were 0.5 vs 1.8, respectively. Among persons using no drugs, 45.8% reported “very good” health, compared with only 6.4% of the persons using five or more drugs. Only 4% of persons using no drugs reported “poor” or “very poor” health. Further, the probability of having a poorer self-rated health increased with the number of drugs used, even though the tendencies were less clear for users of three or more drugs, particularly in the oldest persons. Users of opioids clearly had a poorer self-rated health compared with users of other drug groups. Conclusion: This study shows a relationship between self-rated health and drug use among elderly Danish twins, who have previously been shown to have health characteristics similar to those of the general population. This suggests that drug use is a good proxy for self-rated health and, in particular that limited drug use is a proxy for good health. This observation may point towards additional research potentials for automated drug databases. [ABSTRACT FROM AUTHOR]

The authors discuss a study by J. C. Lucke and W. D. Hall related to the ethical aspects of offering incentives to encourage women to use contraception or to be sterilized. They say that Lucke and Hall address the use of financial incentives to increase uptake of contraceptives among drug-using women. They mention that the use of incentives to change health behavior is not uncommon. Moreover, they highlight that Project Prevention increases the freedom of choice among women.