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Background: The present study aimed to identify sociodemographic characteristics, risky behaviors, type of drug use, and service use variables associated with emergency department (ED) use and hospitalization among people who inject drugs (PWID). Methods: Studies in English published from January 1, 1995, to December 15, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on ED use and hospitalization among PWID. Results: After a detailed assessment of 17,348 outputs, a total of 19 studies met the eligibility criteria for inclusion in the analysis. Greater risks of ED use and hospitalization among PWID were associated with (i) a history of homelessness, (ii) HIV-positive status, and (iii) injecting drugs more than four times per day. Individuals were more likely to use the ED if they (i) had a history of physical abuse, (ii) were using cocaine and methamphetamine, and (iii) had used primary care services. Women and individuals with chronic physical illnesses were more likely to be hospitalized. Conclusions: The present study is the first to integrate determinants related to ED use and hospitalization based on sociodemographic characteristics, risky behaviors, type of drug, and service use determinants among PWID. To reduce ED use and hospitalization among PWID, the paper also recommends various strategies could be implemented. [ABSTRACT FROM AUTHOR]

Objective: Warfarin is a widely prescribed narrow therapeutic index anticoagulant. Determining proper warfarin dosage remains problematic due to its narrow therapeutic index and genetic variations from individual to individual. The administration of incorrect doses of warfarin can catastrophic adverse events. Observational studies have demonstrated single nucleotide polymorphisms in CYP2C9 and VK0RC1 significantly affect warfarin dose requirements. The present study aimed to examine the influences of various genotypes on warfarin dose requirements among Iranian patients. Methods: Blood samples were taken from 117 patients and stored in tubes containing EDTA. DNA extraction was performed on the blood samples and the different alleles and genotypes of the studied SNPs were identified and recorded by the PCR-RFLP technique. Results: Of the 117 patients, no significant differences in the mean daily warfarin dose requirement were found among the genotypes of polymorphism CYP2C9 * 3 (1075A> C). However, there were significant differences among the genotypes of CYP2C9 * 2 (430C> T). The mean daily warfarin dose requirements were significantly different among wild genotypes, heterozygotes and mutants in the two polymorphisms of VKORC1 (1173C> T) and VKORC1(1639G> A). Conclusion: The results of our study demonstrated that CYP2C9 and VKORC1 polymorphisms have significant effect on warfarin maintenance dose requirements in iranian patients which would help improve the prediction of warfarin dose requirements and minimize the chance of over-anticoagulation or under-anticoagulation. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore HIV risk perceptions and to examine the factors associated with the perceptions of HIV risk among people who inject drugs in Saveh, Iran. In this cross-sectional survey, 272 people who inject drugs in Saveh were recruited using a convenience snowball sampling method between April 2020 and May 2021. Two classes of HIV risk perception (high versus low) were identified using logistic regression to determine factors associated with individual HIV risk perception. Study participants were categorized as having a low (n = 181, 66.5%) or high (n = 91, 33.5%) risk perception for becoming infected with HIV. The odds of categorizing as high risk for HIV was significantly greater in participants who reported: injecting their drugs more than 2 times per day (AOR = 2.4, p <.05); receptive syringe sharing (AOR = 3.1, p <.05) and as HIV positive (AOR = 3.9, p <.05). Participants who smoked heroin (AOR = 0.4, p <.05) and who had received any psychosocial intervention in the previous 3 months (AOR = 0.3, p <.05) were less likely to perceive being at high for HIV risk. Interventional programs should focus on improving the perceptions of people who inject drugs toward HIV risk and reducing their HIV risk behaviors through increased HIV self-assessments. [ABSTRACT FROM AUTHOR]

Suicidal behaviors including ideations and attempts may ultimately lead to suicide especially among intravenous drug users (IVDUs). The present study assessed the prevalence, sociodemographic characteristics, risky behaviors, mental health conditions, and type of drug use associated with suicidal behaviors among IVDUs. Studies in English published from January 1, 1995 to February 1, 2022 were searched on PubMed, Scopus, Cochrane, and Web of Science to identify papers on variables associated with suicidal behaviors (ideation and attempts) among IVDUs. Out of 10,795 papers, 21 studies met the eligibility criteria. Among IVDUs, the findings indicated a past-year pooled prevalence rate of 35% for suicide ideations (95% CI, 22%–48%) and 25% for suicide attempts (95% CI, 13%–36%). Generally, suicide ideations were associated with being homeless, having a previous history of physical and sexual abuse, and depression. Suicide attempts were associated with being female, having a previous history of physical and sexual abuse, having depression or other mental health disorders (e.g., anxiety, stress, and serious mental health disorders), and having cocaine, methamphetamine, sedative-hypnotic, and polysubstance use disorders. Integrated treatment and assertive community treatment approaches may be promoted to prevent suicidal behaviors. Such programs can be implemented for referring individuals to receive suicide attempt-concerned interventions and motivational therapy. [ABSTRACT FROM AUTHOR]

This study aimed to identify socio-demographic determinants, risky behaviors and type of drug use, and the association with visiting by general practitioners (GP) in the last 12 months or outpatient service use among people who inject drugs (PWID). Studies in English published before November 1 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with visiting by GP or outpatient service use among PWID. After a detailed assessment of over 17,348 papers, a total of 13 studies met the eligibility criteria. Greater odds of visits to the GP in the last 12 months or outpatient service use was associated with (i) being younger, (ii) being female, (iii) employment status, (iv) having public health insurance, (v) individuals who shared needles, (vi) individuals who were prescribed benzodiazepines, (vii) history of taking prescribed mental health medications, (viii) individuals who got methadone maintenance treatment (MMT) and (X) individuals who had used primary care services. The present research findings highlighted that a significant proportion of the study participants used GP or outpatient service use/outpatient psychiatrist, suggesting that the focus should not be restricted to PWID. [ABSTRACT FROM AUTHOR]

Introduction: Identifying determinants of emergency department (ED) use and hospitalization among patients with substance‐related disorders (SRDs) can improve health services to address unmet health needs. Aim: The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients with SRDs. Methods: Studies in English published from January 1, 1995, to December 1, 2022, were searched on PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies. Results: The pooled prevalence rates of ED use and hospitalization among patients with SRDs were 36% and 41%, respectively. Patients with SRDs who were the most at risk of being both ED users and hospitalized were those (i) having medical insurance, (ii) having other drug and alcohol use disorders, (iii) having mental health disorders, and (iv) having chronic physical illnesses. A lower level of education increased the risk of ED use only. Discussion: To decrease ED use and hospitalization, more comprehensive services may be offered to these vulnerable patients with diversified needs. Implications for Practice: Chronic care integrating outreach interventions could be more provided for patients with SRDs after discharge from acute care units or hospitals. [ABSTRACT FROM AUTHOR]

Background: Street-involved children and youth (SICY) who work and live on/of the streets are more likely to inject drugs and engage in psychoactive substance use. Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic determinants, and risk-taking associated with alcohol and drug use among SICY. Methods: Studies published in English related to alcohol and drug use among SICY were searched for from December 1 1985 to July 1 2022, on PubMed, Scopus, Cochrane, and Web of Science. Results: After full-text paper evaluation, 73 studies were included in the meta-analysis. Results indicated that lifetime prevalence rates were 44% (alcohol), 44% (crack), 33% (inhalants), 44% (solvents), 16% (tranquilizer/sedatives), 22% (opioids), and 62% (polysubstance use). The current prevalence rates were 40% (alcohol), 21% (crack), 20% (inhalants), 11% (tranquilizer/sedatives), and 1% (opioids). Also, life-time and current prevalence of alcohol and crack use, current prevalence of tranquilizer/sedative use, and life-time prevalence of polysubstance use were higher among older age groups. Life-time prevalence of tranquilizer/sedative use was lower among older age groups. Conclusions: The high prevalence of using alcohol, crack, and inhalants is a major issue because they are used extensively among different age groups, including minors. Such findings are beneficial for policymakers, health authorities, and professionals in developing programs aimed at minimizing inhalant use and other types of substance use harms among this group. It is important to accurately monitor this risk-exposed population to understand the mechanisms that might help protect them from high-risk substance use. [ABSTRACT FROM AUTHOR]

This study aimed to describe the quality of life (QoL) in patients with substance use disorder (SUD) and investigate factors associated with general QoL among patients with SUD. Studies in English published before December 1st, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with general QoL in patients with SUD. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PECO criteria. After a detailed assessment of over 10,230 papers, a total of 20 studies met the eligibility criteria. The current research analyzed various relationships between sociodemographic features, clinical, the type of used drug, service use utilizations, and general QoL in patients with SUD. The odds of having a good general QoL were reduced among patients with common and severe mental disorders, alcohol use disorders (AUD), and receiving inpatient care; however, a better general QoL was observed among those receiving methadone maintenance treatment (MMT). Healthcare staff are recommended to pay high attention to the general QoL of patients with SUD seeking interventions. In addition, it is suggested that policymakers address substance use disorders when designing national guidelines and programs. QoL: Quality of life; SUD: Substance Use Disorder; AUD: Alcohol use disorders; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PECO: Participants, Exposures, Comparison, Outcomes; ORs: Odds Ratios; NOS: Newcastle Ottawa scale; CI: Confidence intervals; MMT:Methadone maintenance treatment; DSM-IV: Diagnostic and statistical manual of mental disorders-fourth edition. [ABSTRACT FROM AUTHOR]

The present study aims to determine mental health conditions, service use determinants, and drug use behaviors associated with non-fatal overdose among people who use illicit drugs (PWUIDs). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIDs. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, and Outcomes (PICO) criteria. The present study applied OR to measure the effect size with 95% CI. For data analysis, R 3.5.1 with the "meta" package was used to conduct the meta-analysis. After a detailed assessment of more than 13,845 articles, a total of 60 studies met the eligibility criteria. We found that non-fatal overdose was independently and positively associated with various factors considered and was, as expected, most strongly associated with being male, needs help injecting, needle sharing, overdose experience in past 12 months, alcohol abuse, had mental health diagnosis, depression, and anxiety disorders, suicide (ideation or attempt), inpatient detoxification, benzodiazepine use, and emergency department visit or hospitalization. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management. Abbreviations: PWUIDs: People who use illicit drugs; WHO: World Health Organization; CI: Confidence intervals; NOS: Newcastle-Ottawa Scale; OR: Odds ratio; PICO: Population, Intervention, Comparator, Outcomes; PRISMA: Protocols of Systematic Reviews and Meta-Analyses; PWIDs: people who inject drugs; WHO: World Health Organization; SIF: Safer Injection Facility [ABSTRACT FROM AUTHOR]