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Knowledge of drug composition consumed on the streets and the identification and quantification of their adulterants is essential for understanding unexpected side effects, tracking routes, and drug profiling. Therefore, this work aimed to determine the purity and to identify and quantify the main adulterants found in personal doses of cocaine (perico) and coca paste (bazuco) in Cartagena de Indias (Colombia). The data collected in this study describe a first attempt to introduce the qualitative and quantitative analyses of adulterants present in street drugs in Cartagena de Indias to improve surveillance. Through gas chromatography coupled to mass spectrometry (GC-MS), the purity and adulterants were quantified in 45 personal doses of cocaine powder and coca paste. 100% of the personal doses in the city were adulterated; caffeine, phenacetin, and levamisole were the main adulterants identified in cocaine. Besides the above, lidocaine was also found in coca paste. The purity of cocaine varied from 8% to almost 70%, with caffeine ranging from 6% to 42%. In the case of coca paste, the maximum content of cocaine found was 60%, while some samples contained as little as 14%. The results are consistent with other research in terms of the widespread use of caffeine as an adulterant, but they also follow the growing trend of the use of levamisole and phenacetin. The wide range of cocaine content in samples sold in the illicit market could cause undesirable effects on cocaine users who do not know the exact intended dose for consumption; so, this study intends to make these results available not only to academic, public health, and national security agencies but also to tourists entering Cartagena de Indias, so that they are aware of what they are consuming and the risks to which they are exposed.

Purpose of the review To assess the current state of the opioid overdose crisis along three major axes: drug markets and patterns of use, the effectiveness of systems of care, and international developments. Recent findings Overdose is a major contributor to mortality and disability among people who use drugs. The increasing number of opioid overdoses in North America especially is an indication of changing drug markets and failing regional systems of care. Globally, we see three clusters of overdose prevalence: (1) a group of countries led by the United States with historically high rates of opioid overdose, (2) a group of countries with increasing rates within a concerning range, (3) a group with very low rates. The contamination of street drugs, the quality and accessibility of treatment, and the overall system of care all contribute to the prevalence of overdose. Summary Drug markets and pattern of consumption in parts of the world are shifting towards contamination and opioids like fentanyl as the drug of choice, which dismantles insufficient and largely ineffective systems of care. Furthermore, outside of North America, more countries like Estonia, Lithuania, Sweden, Finland, and Norway show very concerning numbers. Without a consistent system response, effects will be devastating.

Cocaine-related emergency department admissions are increasing, and cocaine seizures are at an all-time high in Europe. Our aim was to investigate the trends in purity and adulterants over time in cocaine available to cocaine users at street level in Denmark. We used a representative sample of cocaine seized at street level and analyzed by the national departments of forensic medicine between 2006 and 2019 (n = 1460). Latent profile analysis was used to classify the samples based on cocaine, levamisole, and phenacetin content. Low purity cocaine comprised most of the cocaine seizures in early years, but its share began to decline in 2013, and from 2016 to 2019, the high purity profile was dominant. While the total number of samples containing adulterants decreased, levamisole remained a common and dangerous adulterant. The findings underline the need to inform the public, medical doctors, and service providers for people with drug use disorders about the higher potency of street cocaine.

Objectives:We reviewed the literature for preventive programs against illicit drug use that specifically target adults aged 18–25 (i.e. emerging adults).Methods:Narrative review of preventive programs that have a high strength of recommendation according to the US Preventive Services Task Force (USPSTF) grading system.Results:Prevention programs that met the criteria are school and college based, family-based, community based, peer-led, workplace-based, and technology-based interventions. They target the known modifiable risk factors associated with illicit drug use among adolescents and young adults.Conclusion:The preventive programs we reviewed are utilizing evidence-based strategies for the prevention of illicit drug use. Further research is needed to formulate new and effective preventive strategies for the reduction of illicit drug use by emerging adults.

Fentanyl and related psychoactive substances are at the forefront of the opioid overdose crisis, for which a complete solution is not immediately obvious. Drug testing for harm reduction may be an effective approach to both reduce overdoses and importantly, engage people who use drugs (PWUD) with the medical system. Paper spray mass spectrometry (PS-MS) is an ambient ionization strategy that is uniquely suited to address this complicated analytical task. This perspectives article presents the merits of PS-MS, with a focus upon the current state of its use as a candidate drug checking strategy for harm reduction. PS-MS is inherently sensitive and selective, with detection limits in the picogram range. It requires small drug samples (~1 mg) for quantitative drug testing, critical to encourage pre-consumption measurements by PWUD in the context of a harm reduction strategy. Calibrations obtained in surrogate drug matrices containing highly concentrated primary drugs demonstrate comparable sensitivities, a wide calibration range, and minimal matrix effects. PS-MS can be interfaced with high-resolution MS for non-targeted analysis, allowing the identification of novel psychoactive substances as they appear in street drugs. Individual quantitative PS-MS measurements for drug testing can be done in 1 minute or less, resulting in high sample throughput. Significant advancement in mass spectrometer miniaturization and mobilization has concomitant benefits for direct, on-site drug checking, such as reduced cost, simplified maintenance and ease of use by less skilled operators. While PS-MS technology continues to rapidly advance, it is our opinion that PS-MS can be utilized as an effective tool for harm reduction in the opioid overdose crisis.

Multiple classes of environmental contaminants have been found in aquatic environments, globally. Understanding internalised concentrations in the organism could further improve the risk assessment process. The present study is concerned with the determination of several contaminant classes (107 compounds) in Gammarus pulex collected from 15 sites covering 5 river catchments across Suffolk, UK. Quantitative method performance was acceptable for 67 compounds including pharmaceuticals, pesticides, illicit drugs and drugs of abuse. A total of 56 compounds were detectable and ranged from, Graphical abstract Unlabelled Image, Highlights • A method is presented to quantify pesticides, pharmaceuticals and drugs of abuse. • Cocaine was the most frequently determined compound found in 100% of samples. • Several pesticides no longer approved for use in the EU were determined. • Estimates of toxic pressure for detected pesticides was low. • Effect pressure of drugs showed good potential to prioritise compounds of concern.

Background Efficacy of medical student substance use interventions in the emergency department (ED) setting remains unstudied. Objective In this pilot study, we set out to determine whether medical students could perform a brief motivational interview for substance use in the ED. Methods At two hospitals, medical students utilized motivational interviewing skills taught by their medical school curriculum and administered a substance use intervention to ED patients who met the study definition of unhealthy substance use. Results In 6 weeks, medical students gave a brief intervention to 102 subjects. The mean age of the subjects was 46.9 (standard deviation 15.6) years. The majority, 86 (86.3%) identified as white. Fifty-four (52.9%) identified as male. Eighty of 102 (78.4%) participants completed a phone follow-up assessment. Of the 69 smokers, 11 (15.9%) reported attempting to quit or quitting completely. Of the 33 with high-risk alcohol use, 11 (33.3%) were abstaining completely from alcohol use and an additional 12 (36.4%) reported a decrease in alcohol daily consumption (measured in drinks per day). Warm hand-off success for street drugs or at-risk alcohol use was 13.6% for those who received an intervention. Conclusions It is feasible for medical students to perform a substance use intervention in the ED setting. Medical student contributions as a part of the team response to this public health crisis provide an opportunity for further discussion and research.

Background Driving under the influence of drugs (DUID) increases the risk of serious injury or death in traffic accidents. The aim of this study was to provide information about DUID in Spanish drivers. Methods 10,064 oral fluid samples were collected from Spanish drivers that tested positive on the roadside using the Drager DrugTest 5000 (DDT5000) between 2013 and 2015. Samples were collected using Quantisal™ and analysed by LC–MS/MS at the Toxicology Laboratory of the Institute of Forensic Science of the University of Santiago de Compostela. Results Drivers were mainly young men (85.1% male, 29.7 ± 8.1 years old). In 98.5% of cases, LC–MS/MS results confirmed at least one of the positive results detected on the roadside. Cannabis (82.4%) and cocaine (42.1%) were the most commonly detected drugs. Poly-drug use was observed in 42.7% of drivers, mostly for all illicit drugs (>80%) except for cannabis (42.6%). Illicit drug and single-drug use was more frequent among drivers under 35 years old, and medicines and poly-drug use more common among drivers older than 35 years old. The on-site device performance was calculated using both the DDT5000 cut-offs and the LC–MS/MS method LOQs. Sensitivity (>73% vs >58%), specificity [>94% for all the compounds regardless the cut-offs used, except for cannabis (71%)] and accuracy (>87.5% with both cut-offs) fulfilled the DRUID Project requirements in all cases. Conclusion LC–MS/MS confirmation result was negative in only 1.5% of the cases. The DUID driver profile was a young man, consuming cannabis or a combination of cannabis and cocaine.

Background The smoking of illicit drugs presents a serious social and economic burden in Canada. People who smoke drugs (PWSD) are at increased risk of contracting multiple infections through risky drug practices. Peer-led harm reduction activities, and the resulting social networks that form around them, can potentially minimize the dangers associated with the smoking illicit drugs. Goal The goals of this study were to pilot test the combined approaches of respondent driven sampling with community based participatory action research in these settings and compare the attributes and social networks of PWSD in two British Columbia cities with different harm reduction programs. Methods Using community-based participatory action research (CBPAR) and respondent-driven sampling (RDS), individuals with lived drug experiences were employed from communities in Abbotsford and Vancouver as peer researchers to interview ten contacts from their social networks. Contacts completed a questionnaire about their harm reduction behaviours and interactions. Results We found that PWSD residing in Abbotsford were more likely to report engaging in harm-promoting behaviours, such as sharing, reusing, or borrowing crack pipes. However, PWSD in the Downtown East side Community of Vancouver were more likely to report engaging in harm-reducing activities, such as being trained in naloxone use and CPR. We found no differences in network sizes between the two communities, despite the population differences and harm reduction programs Conclusion The high participation rates and interactions between researchers, and peer researchers enriched the study implementation and successfully informed our results. The fact that there were no differences in network size suggests that people have similar support in Vancouver as in Abbotsford, and that drug use practices differ mainly due to availability of harm reduction programming and resources.

Heroin addiction is currently a significant health problem, and information on the electrocardiographic effects of heroin is limited.The aim of the present study is to investigate effects of heroin addiction on electrocardiographic parameters.A total of 136 individuals, including 66 individuals who smoke heroin as the study group and 70 healthy individuals with no drug addiction as the control group, were included in the study. Individuals who inject heroin were excluded. Electrocardiographic (ECG) evaluation of those using heroin was performed and compared with those of the control group. In addition, pre-treatment and post-treatment ECG of the heroin group were compared. A p-value of0.05 was accepted as statistically significant.Heart rate (77.2±12.8 versus 71.4±11.2; p=0.02) were found to be higher in the heroin group compared to the control group. QT (341.50±25.80 versus 379.11±45.23; p=0.01), QTc intervals (385.12±29.11 versus 411.3±51.70; p0.01), and T peak to end time (Tpe) (65.41±10.82 versus 73.3±10.13; p0.01) were significantly shorter in the heroin group. No difference was observed between the groups with regard to Tpe/QT and Tpe/QTc ratios. In the subgroup analysis of the heroin group, QT (356.81±37.49 versus 381.18±40.03; p0.01) and QTc (382.06±26.41 versus 396.06±29.80; p0.01) intervals were significantly shorter in the pre-treatment period.Heroin addiction significantly affects the QT, QTc, and Tpe time intervals. The arrhythmia effects of these parameters are well known. More attention to the electrocardiographic parameters of these individuals should be given. (Arq Bras Cardiol. 2020; 115(6):1135-1141).Atualmente, o vício em heroína é um problema de saúde preocupante, e as informações sobre os efeitos eletrocardiográficos da heroína são limitadas.O objetivo do presente estudo é investigar os efeitos da dependência de heroína em parâmetros eletrocardiográficos.Um total de 136 indivíduos, incluindo 66 indivíduos que fumam heroína como grupo de estudo e 70 indivíduos saudáveis sem dependência de drogas como grupo de controle, foram incluídos no estudo. Indivíduos que injetam heroína foram excluídos. A avaliação eletrocardiográfica (ECG) dos usuários de heroína foi realizada e comparada com as do grupo controle. Além disso, os ECGs pré e pós-tratamento do grupo usuário de heroína foram comparados. Um valor de p0,05 foi aceito como estatisticamente significativo.A frequência cardíaca (77,2±12,8 versus 71,4±11,2; p=0,02) foi maior no grupo usuário de heroína em comparação com o grupo controle. Os intervalos QT (341,50±25,80 versus 379,11±45,23; p=0,01), QTc (385,12±29,11 versus 411,3±51,70; p0,01) e o intervalo do pico ao fim da onda T (Tpe) (65,41±10,82 versus 73,3±10,13; p0,01) foram significativamente menores no grupo usuário de heroína. Nenhuma diferença foi observada entre os grupos com respeito às razões Tpe/QT e Tpe/QTc. Na análise de subgrupo do grupo usuário de heroína, os intervalos QT (356,81±37,49 versus 381,18±40,03; p0,01) e QTc (382,06±26,41 versus 396,06±29,80; p0,01) foram significativamente mais curtos no período pré-tratamento.O vício em heroína afeta significativamente os intervalos de tempo QT, QTc e Tpe. Os efeitos de arritmia desses parâmetros já são conhecidos. Os parâmetros eletrocardiográficos desses indivíduos merecem mais atenção. (Arq Bras Cardiol. 2020; 115(6):1135-1141).

Objectives: to analyze characteristics of homeless people and factors associated with living on the streets. Methods: a census-type sectional survey carried out between 2015 and 2018, in the municipality of Maringá-Paraná. A total of 701 homeless answered a structured questionnaire with sociodemographic data, living conditions, and drug use. We used Pearson’s correlation test for the association analysis of the variables at a 95% confidence level. Results: men (90.7%) the average age of 37.7 years had been homeless for an average of 5.39 years. Most had little education (54.2%), and homelessness was due to drug use (47.2%) and family disagreements (38.9%). Conclusions: drug use and family disagreements were the main reasons for homelessness. Time on the street, gender, and drugs were associated with a negative correlation to be homeless; and age, mean daily income, the number of daily meals, having been in prison, and having an income source were associated with positive correlation. RESUMEN Objetivos: analizar las características de las personas en situación de calle y factores asociados a la vida en las calles. Métodos: investigación seccional del tipo censal, realizada entre 2015 y 2018, en el municipio de Maringá-Paraná. Un total de 701 personas en situación de calle ha respondido a un cuestionario estructurado con datos sociodemográficos y condiciones de vida y uso de drogas. El test de correlación de Pearson ha sido utilizado para el análisis de asociación de las variables con nivel de confianza de 95%. Resultados: hombres (90,7%), con edad media de 37,7 años, estaban en situación de calle hace 5,39 años. La mayoría tenía escasa escolaridad (54,2%), y la situación de calle se debía al uso de drogas (47,2%) y a los desentendimientos familiares (38,9%). Conclusiones: el uso de drogas y los desentendimientos familiares han sido los principales motivos para la situación de calle. El tiempo en la calle, sexo y drogas han sido asociados a una correlación negativa para la situación de calle; y edad, renta media diaria, número de comidas diarias, tener sido preso y tener una fuente de renta han sido asociados a la correlación positiva. RESUMO Objetivos: analisar características das pessoas em situação de rua e fatores associados à vida nas ruas. Métodos: pesquisa seccional do tipo censitário, realizada entre 2015 e 2018, no município de Maringá-Paraná. Um total de 701 pessoas em situação de rua respondeu a um questionário estruturado com dados sociodemográficos e condições de vida e uso de drogas. O teste de correlação de Pearson foi utilizado para a análise de associação das variáveis com nível de confiança de 95%. Resultados: homens (90,7%), com idade média de 37,7 anos, estavam em situação de rua há 5,39 anos. A maioria possuía pouca escolaridade (54,2%), e a situação de rua se devia ao uso de drogas (47,2%) e a desentendimentos familiares (38,9%). Conclusões: o uso de drogas e os desentendimentos familiares foram os principais motivos para a situação de rua. O tempo na rua, sexo e drogas foram associados a uma correlação negativa para a situação de rua; e idade, renda média diária, número de refeições diárias, ter sido preso e ter uma fonte de renda foram associados a correlação positiva.

Introduction:les avortements clandestins augmentent la morbi-mortalité maternelle en Afrique sub-Saharienne et sont favorisés par les législations restrictives et la faiblesse prévalence contraceptive. A Brazzaville l´automédication par les « médicaments de la rue » semble être un procédé abortif fréquent. L´étude visait à déterminer la proportion des « médicaments de la rue » et le profil sociodémographique des patientes impliquées. Méthodes:nous avons réalisé une étude longitudinale de Juillet à Décembre 2018, 67 patientes admises pour complications d´avortement provoqués ont été recrutées à l´hôpital de Talangaï. Leurs (i) caractéristiques socio démographiques, (ii) obstétricales et (iii) les caractéristiques de l´avortement (procédé, implication du manganguiste, rang et coût de l´avortement) ont été collecltées et analysées avec le logiciel Epi info 7. Nous avons comparé les moyennes avec le test de student, les proportions avec le CHI-2, p était fixé à

Objective: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. Method: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. Results: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). Conclusion: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men. Objetivo: avaliar risco relacionado ao uso de drogas em homens internados em hospital psiquiátrico e identificar associações com variáveis sociodemográficas, socioeconômicas e condições de risco. Método: estudo transversal com aplicação de teste de rastreamento em 209 participantes internados por transtornos mentais e comportamentais, devido ao uso de substâncias psicoativas. A análise estatística foi realizada através de estatísticas descritivas e ajuste de modelo de regressão logística binária para o risco moderado ou elevado relacionado ao uso de drogas. A força de associação foi medida pela razão de chances. Resultados: observou-se elevado uso na vida, com início de experimentação de álcool e tabaco ainda na adolescência. Maiores prevalências de risco relacionado observadas para álcool, tabaco, cocaína fumada e inalada, e maconha. Riscos moderados e elevados foram encontrados para tabaco (22,5 e 62,5%, respectivamente), álcool (13,5 e 73%), maconha (16 e 32,5%), cocaína fumada (3 e 41%) e inalada (9 e 19,5%). Conclusão: os resultados apontaram elevado uso na vida, com idade de experimentação precoce. O tabaco e o álcool são as principais drogas utilizadas pelos homens internados. Objetivo: evaluar riesgo relacionado al uso de drogas en hombres internados en hospital siquiátrico e identificar asociaciones con variables sociodemográficas, socioeconómicas y condiciones de riesgo. Método: estudio transversal con aplicación de test de rastreo en 209 participantes internados por trastornos mentales y conductuales debido al uso de sustancias psicoactivas. El análisis estadístico fue realizado a través de la estadística descriptiva y ajuste del modelo de regresión logística binaria, para el riesgo moderado o elevado de tipo uso drogas. La fuerza de asociación fue medida por la razón de chances. Resultados: se observó elevado uso en la vida, con inicio de experimentación de alcohol y tabaco en la adolescencia. Fueron observadas mayores prevalencias de riesgo relacionado para alcohol, tabaco, cocaína fumada e inhalada, y mariguana. Riesgos moderados y elevados fueron encontrados para tabaco (22,5% y 62,5%, respectivamente), alcohol (13,5% y 73%), mariguana (16% y 32,5%), cocaína fumada (3% y 41%) e inhalada (9% y 19,5%). Conclusión: los resultados apuntaron elevado uso en la vida, con edad de experimentación precoz. El tabaco y el alcohol son las principales drogas utilizadas por los hombres internados.

Background. Malaria remains a public health issue in the world especially in resource-limited countries, where it has a negative impact on their economy. There is a body of recent reports outlining the crucial role of enterprises in control of malaria. The present study aimed at determining the knowledge, attitudes, and practices (KAP) towards malaria among employees from enterprises in the town of Douala, Cameroon. Methods. A cross-sectional descriptive study took place between February 2015 and June 2017 in 14 enterprises of Douala. A pretested structured questionnaire was used to document sociodemographic parameters and KAP of employees. Results. A total of 2705 employees, mainly consisted of males (83.1%), were included in the study. The mean age of respondents was 37.33±9.78 years (range 19-87). Over 90% of respondents knew at least one sign/symptom (94.1%) and associated malaria transmission with mosquito bites (91%). Artemether-Lumefantrine (36.2%), under commercial name “Coartem,” was the most cited antimalarial drug. Nearly 98.2% considered malaria as a dangerous disease. Misconceptions on malaria transmission, causative agent, prevention, and treatment were recorded. More than 77% of employees declared to use mosquito bed nets to prevent malaria. About 63% employees declared going to the hospital when they were feel having malaria while 12.9% were seeking care through street drugs. Educational level, socioprofessional category, area of residence, and enterprise were significantly associated with the level of knowledge on malaria transmission, causative agent, and preventive and treatment practices. Conclusion. This study showed a good level of knowledge, attitudes, and practices of employees even though some misconceptions and bad behaviors are still present especially in people with a low level of education. Hence, there is a need to develop strategies for sensitization especially in this fraction of employees. In addition, enterprises could be an interesting approach in order to control malaria in Cameroon.

OBJECTIVE: To describe drug consumption and the co-occurrence use of more than one illegal drug as well as associated factors in freshmen at a public university in Southern Brazil. METHODS: Cross-sectional study with census of students entering undergraduate courses in 2017. A total of 1,788 university students answered questions about illicit drug use. For analysis, ordinal logistic regression was used. RESULTS: Marijuana was the most consumed drug (lifetime: 42.1%; 30-day use: 22.7%), followed by hallucinogens (lifetime: 13.1%, 30-day use: 2.8%). Rates for lifetime use of 0, 1 and 2 or more drugs were 56.2%, 23.3% and 20.4%, respectively, and were associated with men (OR = 2.2; 95%CI:1.4–3.5), being at least 23 years old (OR = 2.7; 95%CI: 1.4–5.1), under 18 years old first experimentation with drugs (OR = 2.3; 95%CI: 1.3–3.9) and living with friends (OR = 2.0; 95%CI: 1.2–3.4). Rates for 30-day use of 0, 1 and 2 or more drugs were 76.8%; 18.1% and 5.1%, respectively, and were associated with being single, separated or widowed (OR = 3.2; 95%CI: 1.4–7.0), lower socioeconomic classes (OR = 0.3; 95%CI: 0.1–1.1; p = 0.001), under 18 years old first experimentation with drugs (OR = 1.8; 95%CI: 1.1–2.9) and living with friends (OR = 1.8 95%CI: 1.2–2.8). CONCLUSION: Results indicate that students are at greater risk of illicit drug-related health problems. Thus, a better understanding of this consumption should be pursued, as well as the development of a prevention plan.

Urine has been a biological matrix of choice for drug screening, but recent advances in technology and the introduction of commercial oral fluid assays have effectively established oral fluid as a viable alternative matrix. This systematic review aimed to evaluate the sensitivity of oral fluid in detecting some illicit drugs compared to urine, and to compare the initial and final detection times of these drugs in both fluids. The electronic search in MEDLINE, Cochrane Library, Scopus, and Web of Science was carried out covering studies published from January 2003 and June 2019, in order to find all valid studies that detected drugs in oral fluid and urine in the same patient. Studies about illicit drugs, such as tetrahydrocannabinol, cocaine, amphetamines and illicit opioids, with fluids collection at the same day, controlled drug administration during the study, reported administration interval and time of collection were favored. Out of 2598 studies identified by electronic search, 7 studies were selected for qualitative analysis. Five were clinical trials and 2 were crossover trials. In total, 74 patients aged 20-52 years underwent a diagnostic examination (4 studies with tetrahydrocannabinol, 1 with methamphetamine, and 2 with cocaine) after drug administration. Illicit drug detection in oral fluid is similar to urine but oral fluid has a strong potential for the immediate detection of recent marijuana use compared to urine. In relation to cocaine and methamphetamine, the largest drugs detection window is obtained through urine analysis. Oral fluids cannot replace urine for most of the purposes of drug testing.

Objective: to analyze the relationship between alcohol and other drug use, and mental distress among women. Method: an analytical cross-sectional study conducted with 369 women in Piauí State. Alcohol Use Disorders Identification Test, Non-Student Drugs Use Questionnaire and Self-Reporting Questionnaire and inferential statistics were used. Results: women with heavy alcohol consumption (zone IV - possible dependence) are 2.1 times more likely to have mental distress. Consuming tobacco increases the odds of distress 3.5%, tranquilizers 2.6 times and cannabis 4.5 times. There is a statistically significant and positive correlation between the Alcohol Use Disorders Identification Test score and the Self-Reporting Questionnaire (p = 0.000; r = 0.250). Conclusion: alcohol, tobacco, tranquilizers and cannabis use is associated with mental distress. The more intense the alcohol consumption, the more intense the mental distress. Therefore, it is necessary to track alcohol and other drug consumption, and mental distress in the routine care of women. RESUMEN Objetivo: analizar la relación entre consumo de alcohol, otras drogas y trastornos mentales entre las mujeres. Método: estudio transversal analítico realizado con 369 mujeres en Piauí. Se utilizaron lo Alcohol Use Disorders Identification Test, lo Non-Student Drugs Use Questionnaire y el Self-Reporting Questionnaire y las estadísticas inferenciales. Resultados: las mujeres con alto consumo de alcohol (zona IV - posible dependencia) tienen 2,1 veces más probabilidades de tener problemas mentales. El consumo de tabaco aumenta las probabilidades de este sufrimiento en 3,5 veces, los tranquilizantes en 2,6 veces y el cannabis en 4,5 veces. Existe una correlación estadísticamente significativa y positiva entre la puntuación de lo Alcohol Use Disorders Identification Test y de lo Self-Reporting Questionnaire (p = 0,000; r = 0,250). Conclusión: el consumo de alcohol, tabaco, tranquilizantes y cannabis se asocia con trastornos mentales. Cuanto más intenso es el consumo de alcohol, más intenso es el sufrimiento mental. Por lo tanto, es necesario hacer un seguimiento del consumo de alcohol, otras drogas y trastornos mentales en el cuidado de rutina de las mujeres. RESUMO Objetivo: analisar a relação entre uso de álcool, outras drogas e sofrimento mental entre mulheres. Método: estudo analítico, transversal, realizado com 369 mulheres no Piauí. Utilizou-se Alcohol Use Disorders Identification Test, Non-Student Drugs Use Questionnaire e Self-Reporting Questionnaire e estatística inferencial. Resultados: mulheres com padrão de consumo de álcool intenso (zona IV – possível dependência) possuem 2,1 vezes mais chance de ter sofrimento mental. Consumir tabaco aumenta em 3,5 vezes as chances desse sofrimento, tranquilizantes em 2,6 vezes e cannabis em 4,5 vezes. Há correlação estatisticamente significativa e positiva entre o escore do Alcohol Use Disorders Identification Test e do Self-Reporting Questionnaire (p = 0,000; r = 0,250). Conclusão: uso de álcool, tabaco, tranquilizantes e cannabis está associado ao sofrimento mental. Quanto mais intenso o consumo de álcool, mais intenso o sofrimento mental. Portanto, faz-se necessário o rastreamento do consumo de álcool, outras drogas e sofrimento mental na rotina de atendimento à mulher.

Objectives: Literature on this issue has shown a high prevalence of alcohol and other drug use in the prison population. Although many risk factors have been linked to this behavior in prison, it is not common to find research that analyses the influence of family/social contact in prison. Material and method: A cross-sectional study was carried out on 2,709 inmates (2,484 men and 225 women) in 9 prisons in Spain, data was collected through self-report questionnaires, including information at socio-demographic level, family-social contact and use of alcohol and other drugs in the last month in prison. Results: Inmates with no family contact in prison show a higher prevalence of use for all the substances analyzed, binary logistic regression analysis shows statistically significant associations with the use of cannabis (OR: 1.86, p ≤0.001) or cocaine (OR: 3.40, p ≤0.001) in prison. Discussion: More knowledge about this public health problem amongst social workers in the prison environment could be an effective diagnostic and preventive tool for reducing the use of alcohol and other drugs during imprisonment.

Objectives: to analyze the exposure to violence and distressful experiences lived by adolescents in institutional shelters in the city of Rio de Janeiro (previous to their admittance). Methods: a cross-sectional study carried out in public institutional shelter units, with a sample of 72 adolescents aged between 12 and 18 years. Data on sociodemographic aspects, family relationships and distressful experiences were obtained by means of the Parcours Amoureux des Jeunes instrument, validated for use in Brazil. Statistical analysis included estimates of prevalence and 95% confidence intervals. Results: high magnitudes of distressful experiences and overlapping abuses lived by adolescents were observed, especially violent events (72.2%), social exclusion (59.1%), and sexual harassment (48.6%). Conclusions: the study shows that adolescents under institutional sheltering come from a background of severe and frequent distressful experiences. These took place in multiple environments: family (prior to their institutional reception), community, and group. RESUMEN Objetivos: analizar la exposición a la violencia y las experiencias difíciles vividas por adolescentes en situación de acogida institucional en la ciudad de Río de Janeiro. Métodos: estudio transversal realizado en unidades públicas de acogida institucional, con una muestra de 72 adolescentes entre 12 y 18 años de edad. La medición de los aspectos sociodemográficos, de las relaciones familiares y de las experiencias difíciles se realizó mediante el instrumento Parcours Amoureux des Jeunes, validado suuso en Brasil. El análisis estadístico contó con estimaciones de prevalencias e intervalos de confianza al 95%. Resultados: se observaron altas magnitudes de experiencias difíciles, con superposición de abusos vividos por los adolescentes, en particular los eventos violentos (72,2%), la exclusión social (59,1%) y el acoso sexual (48,6%). Conclusiones: el estudio reveló altas y múltiples magnitudes de experiencias difíciles experimentadas por los adolescentes en acogida institucional tanto en el ámbito familiar, en momentos anteriores a la acogida, como en el ámbito comunitario y grupal. RESUMO Objetivos: analisar a exposição à violência e experiências difíceis vivenciadas por adolescentes em situação de acolhimento institucional no município do Rio de Janeiro. Métodos: estudo transversal realizado nas unidades públicas de acolhimento institucional, com amostra de 72 adolescentes entre 12 e 18 anos. A aferição dos aspectos sociodemográficos, das relações familiares e das difíceis experiências foi realizada por meio do instrumento Parcours Amoureux des Jeunes, validado para uso no Brasil. A análise estatística contou com estimações de prevalências e intervalos de confiança a 95%. Resultados: foram observadas elevadas magnitudes de experiências difíceis e com sobreposição de abusos vividos pelos adolescentes, com destaque para os eventos violentos (72,2%), a exclusão social (59,1%) e o assédio sexual (48,6%). Conclusões: o estudo revelou elevadas e múltiplas magnitudes de experiências difíceis experenciadas pelos adolescentes em acolhimento institucional, tanto no âmbito familiar, em momentos prévios ao acolhimento, como em âmbito comunitário e grupal.

Objectives: to evaluate the impact of training on brief interventions for use of substances on the attitudes; and, face validity and internal consistency of Brazilian versions of the Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br) and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) for use among teachers. Methods: methodological (N=122) and quasi-experimental study (n=27). A sociodemographic questionnaire, the DDPPQ-br and the SAAPPQ were applied before and three months after the training. For analysis, were applied the Mann-Whitney and Wilcoxon tests. Results: the DDPQ-br and SAAPPQ were considered valid by experts. The training improved teachers’ attitudes towards accountability on the approach to substance use at schools and on the readiness to perform this role. In relation to drugs, it increased the perception of support. Conclusions: teachers’ training can improve their attitudes and strengthen the school in the function of preventing substance-related harm. RESUMEN Objetivos: evaluar el impacto de la capacitación en intervenciones breves para el uso de sustancias en las actitudes; y, la validez nominal y la consistencia interna de las versiones brasileñas del Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br) y del Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) entre los maestros. Métodos: investigación metodológica (N=122) y cuasi experimental (n=27). Se aplicó un cuestionario sociodemográfico, el DDPPQ-br y el SAAPPQ, antes y tres meses después de la capacitación. Para el análisis, se utilizaron las pruebas de Mann-Whitney y Wilcoxon. Resultados: El DDPQ-br y el SAAPPQ fueron considerados válidos por los especialistas. La capacitación pudo mejorar las actitudes con respecto a la responsabilidad del enfoque del uso de sustancias en la escuela y la disposición para realizar esta función. En relación a las drogas, aumentó la percepción de apoyo. Conclusiones: capacitar a los maestros puede mejorar sus actitudes y fortalecer la escuela en la función de prevenir daños relacionados con el uso de sustancias. RESUMO Objetivos: avaliar o impacto de uma capacitação em intervenções breves para o uso de substâncias sobre as atitudes e validade de face e consistência interna das versões brasileiras Drug and Drug Problems Perceptions Questionnaire (DDPPQ-br) e Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) entre professores. Métodos: estudo metodológico (N=122) e quase-experimental (n=27). Foram aplicados o questionário sociodemográfico, o DDPPQ-br e o SAAPPQ antes e três meses após a capacitação. Para análise, foram utilizados os testes de Mann-Whitney e de Wilcoxon. Resultados: O DDPQ-br e o SAAPPQ foram considerados válidos pelos especialistas. Através da capacitação, foi possível melhorar as atitudes frente a responsabilização sobre a abordagem do uso de substâncias na escola e o preparo para exercer tal função. Em relação às drogas, a percepção de suporte foi potencializada. Conclusões: Capacitar professores pode melhorar suas atitudes e fortalecer a escola na função de prevenir danos relacionados ao uso substâncias.

© 2018 Elsevier B.V. Technology provides new ways to access customers and suppliers while enhancing the security of off-line criminal activity. Since the first cryptomarket, Silk Road, in 2011, cryptomarkets have transformed the traditional drug sale by facilitating the creation of a global network of vendors and buyers. Due to the fragmented nature of traces that result from illegal activities, combining the results of concurrent processes based on traces of different nature should provide supplementary benefit to understand the drug market. This article compares the data of the Australian virtual market (in particular data extracted from cryptomarkets) to the data related to traditional market descriptors, namely national seizures and arrests, prevalence data, shipping countries of seized post shipments as well as outcomes of specific surveys targeting users’ behaviour online. Results revealed the domestic nature of the online illicit drug trade in Australia which is dominated by amphetamine-type substances (ATS), in particular methylamphetamine and cannabis. These illicit drugs were also the most seized drugs on the physical market. This article shows that the combination of different information offers a broader perspective of the illicit drug market in Australia and thus provides stronger arguments for policy makers. It also highlights the links between the virtual and physical markets.

Background Synthetic opioids are compounds that were created to act on the opioid receptors. Novel synthetic opioids include various analogs of fentanyl (e.g., acetylfentanyl, acryloylfentanyl, carfentanil, furanylfentanyl, 4-fluorobutyrylfentanyl or ocfentanil) and newly emerging non-fentanyl compounds with different chemical structures, such as AH-7921, MT-45, and U-47700. In the last years, these drugs have rapidly emerged on the recreational drug market, and their abuse has been increasing worldwide. Due to the high potency and the low dose required to produce desired effects, the risk of overdose for these compounds including severe health implications, is quite high. Several fatal intoxication cases related to the abuse of synthetic opioids have recently been reported in the literature. Conclusion As a consequence, the detection of these compounds in biological samples is crucial in order to get a better understanding of their concentration and distribution in body fluids. We overviewed the analytical approaches for the investigation of synthetic opioids in postmortem samples reported in the literature, with special emphasis given to cases of lethal intoxication.

Objective To describe current trends in nonopioid substance exposures and associated outcomes among teenagers nationwide. Study design In this cross-sectional study, we used 2010-2015 data from the American Association of Poison Control Centers' National Poison Data System and Poisson tests to document trends in the rate of calls to poison control centers involving adolescents stratified by sex, exposures by substance category, proportion of intentional exposures, and severity of exposures. Results The number of calls per 1000 persons increased from 5.7 to 6.8 for teenage girls and decreased from 4.7 to 4.3 for boys. Reported exposures to prescription and over-the-counter medications and illicit street drugs increased between 24% and 73%, and reported opioid exposures decreased by 16%. Among teenage girls, intentional exposures increased from 57% to 68%, with cases increasingly managed in health care facilities and more likely to result in worse health outcomes. Conclusions The increase in intentional nonopioid substance exposures among teenage girls, with serious and potentially life-threatening consequences, is a matter of serious concern. Similar trends were not observed among teenage boys.

To explore the association between illicit drug use and traumatic dental injuries (TDI) among adolescents. Method: We used data from 618 adolescents who participated in Phases I and III of Research with East Adolescents Community Health Survey (RELACHS), a longitudinal school-based study of adolescents in East London. Illicit drug use was collected when participants were 11–12 and 15–16 years old (Phases I and III, respectively). Clinical examinations for TDI were conducted in Phase III only. The association of lifetime prevalence of illicit drug use at ages 11–12 and 15–16 years with TDI was evaluated in crude and adjusted binary logistic regression models. Results: Overall, 6.3% and 25.4% of adolescents reported having ever used illicit drugs at ages 11–12 (Phase I) and 15–16 years (Phase III), respectively. Also, 8.7% of adolescents were found to have TDI at age 15–16 years. There was no significant association between lifetime prevalence of illicit drug use reported at age 11–12 years (Odds Ratio: 1.07; 95% Confidence Interval: 0.45–2.54) or age 15–16 years (OR: 1.19; 95%CI: 0.74–1.93) and TDI. Conclusion: This study found no support for an association between illicit drug use and TDI among adolescents from East London.

Background and objective: The prevalence of mental illness and illicit substance use has increased markedly in South Africa’s Western Cape Province, over the last 2 decades; potentially increasing demand for psychiatric care. This paper describes the demographic and substance use profile of patients admitted to Lentegeur (LGH), the largest of the four psychiatric hospitals in the Province.Methods: Medical records, patient interviews and other clinical notes were used to collect data on demographics, illicit substance use, violent behaviour and utilization of rehabilitative services for patients (n=535) admitted to LGH between 1 August 2012 and 31 January 2013.Results: Majority of admissions were male (65.6%) and younger (69.8% < 35 years) compared to females (62.6% >35 years). Overall, 255 (49%) used an illicit substance, (24% females and 63% males). Majority of substance users were youth (18–35 years) in both males (83.1%) and females (73.8%). Cannabis and methamphetamine were the most popular drugs in males (56.3% and 34.9%) and females (17.9% and 16.2%) with the highest rates being among the youth. Violence was common among both men (60.7%) and women (40.8%); among the violent, 67% of males and 35.6% of female used substances. Only 5.5% of drug users utilized formal drug rehabilitation services.Conclusion: Substance use and violence were high, yet only a small proportion of the patients utilised available drug rehabilitation services. This may have implications on psychotic relapses, morbidity and subsequent pressure on financial resources within the health care system. Efforts are needed to maximise utilisation of existing rehabilitative resources for these patients.Keywords: Illicit drug use, violence, acute psychosis, psychiatric hospital.

Clandestine heroin laboratories have been a feature of the Malaysian illicit drug scene since soon after the abuse of heroin emerged in 1972. The first few clandestine heroin laboratories which synthesised heroin via the acetylation of imported morphine were uncovered in 1973 and 1977. By the mid-1980s, this type of laboratory was replaced by heroin-cutting laboratories whereby imported high-grade heroin was cut to street heroin. This was to meet the rising demand for the drug owing to the rapid escalation of the number of drug users. Over the years, the most significant change in the composition of the street heroin is the decrease in its purity from 30%-50% to 3%-5%. Caffeine has remained the major adulterant and chloroquine is detected in virtually all recent seizures.

BACKGROUND: Attitudes and beliefs about drug use have been shown to be robust correlates of use of drugs such as alcohol, marijuana, and cocaine; however, little is known regarding attitudes or beliefs about new psychoactive substances (NPS). We sought to examine attitudes and beliefs about NPS and how they relate to self-reported use in a high-risk population—electronic dance music (EDM) party attendees. METHOD: 1,048 individuals (age 18–40) were surveyed entering EDM parties in New York City in 2016. We queried lifetime use and attitudes and beliefs specific to NBOMe, 2C series drugs, “bath salts” (synthetic cathinones), tryptamines, dissociative NPS, and synthetic cannabinoids. RESULTS: More than half the sample reported being unfamiliar with NPS other than “bath salts” and synthetic cannabinoids. “Bath salts” received the highest ratings of strong disapproval (34.3%), followed by synthetic cannabinoids (23.3%), compared to other NPS (10–14%). “Bath salts” were perceived to be a great risk by 43.1% of the sample, followed by synthetic cannabinoids (27.0%), and other NPS (12–16%). “Bath salts” were reportedly least likely to be used if offered (2.9%). In multivariable models, reporting no disapproval towards use was associated with increased odds of reporting use of 2C drugs, “bath salts”, and tryptamines. Having friends who use and reporting intent to use or willingness to use if offered were also associated with use of various NPS classes. CONCLUSIONS: This study delineated attitudinal and belief-related correlates of use of various NPS classes. Results can inform prevention effects as NPS continue to emerge.

Legal highs is a popular name for psychoactive substances with a potentially harmful effect on human health (Mazurkiewicz et al., 2013). These substances are highly synthesized and modified usually...

Given the current opioid crisis around the world, harm reduction agencies are seeking to help people who use drugs to do so more safely. Many harm reduction agencies are exploring techniques to test illicit drugs to identify and, where possible, quantify their constituents allowing their users to make informed decisions. While these technologies have been used for years in Europe (Nightlife Empowerment & Well-being Implementation Project, Drug Checking Service: Good Practice Standards; Trans European Drugs Information (TEDI) Workgroup, Factsheet on Drug Checking in Europe, 2011; European Monitoring Centre for Drugs and Drug Addiction, An Inventory of On-site Pill-Testing Interventions in the EU: Fact Files, 2001), they are only now starting to be utilized in this context in North America. The goal of this paper is to describe the most common methods for testing illicit substances and then, based on this broad, encompassing review, recommend the most appropriate methods for testing at point of care. Based on our review, the best methods for point-of-care drug testing are handheld infrared spectroscopy, Raman spectroscopy, and ion mobility spectrometry; mass spectrometry is the current gold standard in forensic drug analysis. It would be prudent for agencies or clinics that can obtain the funding to contact the companies who produce these devices to discuss possible usage in a harm reduction setting. Lower tech options, such as spot/color tests and immunoassays, are limited in their use but affordable and easy to use.

Methamphetamine (MA) tablet production confers chemical and physical properties. This study developed a simple and effective physical characteristic profiling method for MA tablets with capital letter "WY" logos, which realized the discrimination between linked and unlinked seizures. Seventeen signature distances extracted from the "WY" logo were explored as factors for multivariate analysis and demonstrated to be effective to represent the features of tablets in the drug intelligence perspective. Receiver operating characteristic (ROC) curve was used to evaluate efficiency of different pretreatments and distance/correlation metrics, while "Standardization + Euclidean" and "Logarithm + Euclidean" algorithms outperformed the rest. Finally, hierarchical cluster analysis (HCA) was applied to the data set of 200 MA tablet seizures randomly selected from cases all around China in 2015, and 76% of them were classified into a group named after "WY-001." Moreover, the "WY-001" tablets occupied 51-80% tablet seizures from 2011 to 2015 in China, indicating the existence of a huge clandestine factory incessantly manufacturing MA tablets.

Attention deficit hyperactivity disorder and stimulant use disorder commonly co-exist, and appropriate treatments have not been well established.To provide guidance for treatment of co-existing attention deficit hyperactivity disorder and stimulant use disorder.A systematic review of published English articles using MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane, utilising consistent search terms.Randomised controlled trials, comparing any treatment arm with a control group, for participants meeting Diagnostic and Statistical Manual of Mental Disorders or equivalent criteria for both attention deficit hyperactivity disorder and stimulant use disorder.Eight trials were identified for inclusion in this review. Four of eight studies showed improvement in attention deficit hyperactivity disorder outcome measures compared with placebo. Two of six studies that reported substance use outcomes showed improvement in treatment arms compared with placebo. Studies to show effect tended to be those with the highest treatment dosage.Evidence for the efficacy of treatment of patients with comorbid stimulant use disorder and attention deficit hyperactivity disorder is limited. Promising outcomes need replication in further studies utilising higher treatment dosage.

The current practice in securing the contact traces of chemical substances taken from clothes belonging to a person suspected of manual handling explosives is focused on pockets and cuffs. The outerwear worn by people who had contact with fluorescent powders that simulate explosives and drugs was the subject of this study. Clothes were first exposed to the test substance for a period of time and then analyzed by fluorescence methods to determine the location of the highest quantity of traces. The results obtained from the study confirm that the areas with the highest concentration of powdery traces are different from those suggested by current forensic practice. They appear to be promising for a more efficient identification of the suspects involved in illegal manufacturing of drugs of abuse or explosives. Moreover, they may be helpful for developing the methodology for handling the evidence material in the forensic clothing examination process.

Background The exact nature of treatment and management recommendations made, and received, for mood and anxiety disorders in a community population is unclear. In addition, there is limited evidence on the impact of recommendations on actual receipt of treatment or implementation of management strategies. We aim to describe the frequency with which specific recommendations were made and implemented; and thus assess the size of any gap between the recommendation and implementation of treatments and management strategies. Methods We used the Survey ‘Living with a Chronic Condition in Canada - Mood and Anxiety Disorders (SLCDC-MA), a unique crossectional survey of a large (N = 3358) and representative sample of Canadians with a diagnosed mood or anxiety disorder, which was conducted by Statistics Canada. The survey collected information on recommendations for medication, counselling, exercise, reduction of alcohol consumption, smoking cessation and reduction of street drug use. We also estimate the frequency that recommendations are made and followed, as well the impact of the prior on the latter. We consulted people with lived experience of the disorders to help interpret our results. Results The results generally showed that most people would receive recommendations, almost all for antidepressant medications (94.6%), with lower proportions for the other treatment and management strategies (e.g. 62.1 and 66% for counselling and exercise). Most recommendations were implemented and had an impact on behaviour. The exception to this was smoking reduction/cessation, which was often not recommended or followed through. Other than with medication, at least 20% of the population, for each recommendation, would not have their recommendation implemented. A substantive group also exists who access treatments, and employ various management strategies, without a recommendation. Conclusions The results indicate that there is a gap between recommendations made and the implementation of treatments. However, its size varies substantially across treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1316-0) contains supplementary material, which is available to authorized users.

Author(s): Kazemi, Donna M; Borsari, Brian; Levine, Maureen J; Dooley, Beau | Abstract: BackgroundThe use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed.MethodsA search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies.ResultsSelected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items.ConclusionIllicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs.

The rapidly evolving demographic base of our communities intensifies the need for an awareness which in the past seemed beyond the traditional concerns of pediatric dentists; in this case, substance abuse by teenagers. A review was carried out regarding evolving demographics, the proportion of teenagers involved with substance abuse, the rationale for the use of varying elicit substances and the associated symptoms. A series of options for action are considered given the potential for pediatric dentists to be involved in the care of teenagers using elicit substances.

Objectives To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis. Design and methods Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia. Results The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. Conclusions These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed. Practitioner points Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

Objective. To analyze the care strategies of the adolescent crack user under treatment. Methods. Study of qualitative approach of descriptive type. The participants were 20 professionals from the Centro de Atenção Psicossocial Álcool e Drogas (Center for Psychosocial Care Alcohol and Drugs) and 10 professionals from the Centro de Atenção Psicossocial Infanto-juvenil (Center for Child Psychosocial Care) in a municipality in the interior of Rio Grande do Sul (Brazil). Data collection occurred through semi-structured interviews and the data were submitted to Thematic Analysis. Results. It was identified the development of strategies in four scopes: attractive activities in specialized services, the building of bonds between the team and the adolescent, the inclusion of family in the care and the intersectoral work. Conclusion. Care strategies, directed to and that address the needs of adolescents, contribute to better adherence to treatment and social reintegration. Resumen Objetivo. Analizar las estrategias de cuidado del adolescente usuario de crack en tratamiento. Métodos. Estudio con abordaje cualitativo de tipo descriptivo. Los participantes fueron 20 profesionales de un Centro de Atención Psicosocial Alcohol y Drogas y 10 profesionales de un Centro de Atención Psicosocial Infanto-Juvenil de un municipio del interior de Rio Grande do Sul (Brasil). La recolección de la información se realizó mediante entrevistas semiestructuradas y los datos se sometieron a análisis temático. Resultados. Se identificó el desarrollo de estrategias en cuatro ámbitos: actividades atractivas en los servicios especializados, la construcción de vínculos entre el equipo de salud y el adolescente, la inclusión de la familia en el cuidado, y el trabajo intersectorial. Conclusión. Las estrategias de cuidado, direccionadas a cubrir las necesidades de los adolescentes, contribuyeron a una mejor adhesión al tratamiento y a la reinserción social. Resumo. Objetivo. Analisar as estratégias de cuidado do adolescente usuário de crack em tratamento. Métodos. Estudo com abordagem qualitativo de tipo descritivo. Os participantes foram 20 profissionais de um Centro de Atenção Psicossocial Álcool e Drogas e 10 profissionais de um Centro de Atenção Psicossocial Infanto-Juvenil de um município do interior do Rio Grande do Sul (Brasil). A recolecção da informação se realizou por meio de entrevistas semiestruturadas e os dados se submeteram a análise temática. Resultados. Se identificou o desenvolvimento de estratégias em quatro aspectos: atividades atrativas nos serviços especializados, a construção de vínculos entre a equipe de saúde e o adolescente, a inclusão da família no cuidado, e o trabalho inter-setorial. Conclusão. As estratégias de cuidado, direcionadas a cobrir as necessidades dos adolescentes, contribuíram a uma melhor adesão ao tratamento e à reinserção social.

Objective. This research sought to analyze the predictive effect of personal (personality traits), social (social support and social stigma) and community factors (characteristic of the neighborhood and exposure to consumption) on the transition of drug use in young adults. Methods. Case and control study. The cases were 70 individuals from 18 to 34 years of age who had already transitioned into illicit drug use and the controls were 210 legal drug usuers (tobacco or alcohol) in the same age range who had not had the transition. A data file was applied along with seven instruments that measured the transition and consumption variables. Results. Marihuana was the illicit drug of highest transition. It was shown that greater personality traits of neuroticism, extraversion, and openness to the experience meant higher probability of drug use transition; while greater personality traits of agreeableness and conscience meant lower probability for the transition. The characteristics of the neighborhood environment and exposure to the opportunity of consumption increase the probability of the drug use transition. Social support and social stigma influenced negatively upon the drug use transition. Conclusion. Personality traits, neighborhood characteristics, exposure to drug use, social support, and the social stigma of drug use are factors that intervene in the transition from legal to illicit drug use. Resumo Objetivo. Analisar o efeito preditivo de fatores pessoais (características de personalidade), sociais (apoio social e estigma social) e comunitários (características do bairro e exposição ao consumo) sobre a transição do consumo de drogas em jovens. Métodos. Estudo de casos e controles. Os casos foram 70 pessoas de 18 a 34 anos que haviam transitado ao consumo de drogas ilícitas e os controles foram 210 pessoas da mesma idade consumidores de alguma droga lícita (tabaco ou álcool) que não hão tido transição. Se aplicou uma cédula de dados e sete instrumentos que mediram as variáveis de transição e consumo. Resultados. . A droga ilegal de maior transição foi a maconha. Se mostrou que as de maiores características de personalidade de neuroticismo, extroversão e apertura à experiência foi mais alta a probabilidade da transição do consumo de drogas; enquanto que a maiores traços de personalidade amabilidade e consciência foi menor foi a probabilidade para a transição. As características do entorno de bairro e a exposição à oportunidade de consumo incrementam a probabilidade da transição do consumo de drogas. O apoio social e a estigma social influenciaram negativamente na transição do consumo de drogas. Conclusão. Os traços de personalidade, as características do bairro, a exposição ao consumo de drogas, o apoio social e a estigma social do consumo de drogas são fatores que intervém na transição do consumo de drogas legais a ilegais. Resumen Objetivo. Analizar el efecto predictivo de factores personales (rasgos de personalidad), sociales (apoyo social y estigma social) y comunitarios (características del barrio y exposición al consumo) sobre la transición del consumo de drogas en jóvenes. Métodos. Estudio de casos y controles. Los casos fueron 70 personas de 18 a 34 años que habían transitado al consumo de drogas ilícitas y los controles fueron 210 personas de la misma edad consumidores de alguna droga lícita (tabaco o alcohol) que no han tenido transición. Se aplicó una cédula de datos y siete instrumentos que midieron las variables de transición y consumo. Resultados. La droga ilegal de mayor transición fue la marihuana. Se mostró que a mayores rasgos de personalidad de neuroticismo, extraversión y apertura a la experiencia fue más alta la probabilidad de la transición del consumo de drogas, por el contrario, a mayores rasgos de personalidad amabilidad y conciencia fue menor fue la probabilidad para la transición. Las características del entorno de barrio y la exposición a la oportunidad de consumo incrementan la probabilidad de la transición del consumo de drogas. El apoyo social y el estigma social influyeron negativamente en la transición del consumo de drogas. Conclusión. Los rasgos de personalidad, las características del barrio, la exposición al consumo de drogas, el apoyo social y el estigma social del consumo de drogas son factores que intervienen en la transición del consumo de drogas legales a ilegales.

Alcohol and illicit drug use in the workplace is a relatively widespread but still insufficiently recognised phenomenon. The reliability of judgement and performance of workers especially undertaking safety-critical tasks must not be influenced by physical, mental and/or behavioural disturbances. It is the responsibility of a company to define and implement proper policy for managing safety risks related to the influence of alcohol, drugs and/or psychotropic medication. Occupational physicians are already involved in the process of prevention in these matters. Authors describe basic recommendations of two biggest international associations of occupational physicians in this field because workers may not perform safety-critical tasks under the influence of psychotropic substances such as alcohol, illicit drugs and psychotropic medication.

REVIEW QUESTION/OBJECTIVES The purpose of this scoping review is to systematically identify and describe literature that uses a health equity-oriented (HEO) approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids.The question of the review is: What is currently known about the use of an HEO approach for preventing the harms of stigma or overdose when people use illicit or street drugs, or use prescription opioids for other than their intended purposes?Specifically, the review objectives are.