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Introduction: Hypomagnesemia (hypoMg) has not yet been extensively studied in alcohol use disorder (AUD) . We hypothesize that chronic, excessive alcohol consumption favors oxidative stress and pro-inflammatory alterations that may be exacerbated by hypoMg. The objective of this study was to analyze the prevalence and associations of hypoMg in AUD.Patients and Methods: Cross-sectional study in patients admitted for a first treatment of AUD in six tertiary centers between 2013 and 2020. Socio-demographic, alcohol use characteristics, and blood parameters were ascertained at admission.Results: 753 patients (71% men) were eligible; age at admission was 48 years [IQR, 41-56 years]. Prevalence of hypoMg was 11.2%, higher than that observed for hypocalcemia (9.3%), hyponatremia (5.6%), and hypokalemia (2.8%). HypoMg was associated with older age, longer duration of AUD, anemia, higher erythrocyte sedimen-tation rate, gamma-glutamyl transpeptidase, glucose levels, advanced liver fibrosis (FIB-4 >= 3.25) and estimated glomerular filtration rate (eGFR) < 60 mL/min. In multivariate analysis, advanced liver fibrosis (OR, 8.91; 95% CI, 3.3-23.9) and eGFR < 60 mL (OR, 5.2; 95% CI, 1.0-26.2) were the only factors associated with hypoMg.Conclusions: Mg deficiency in AUD is associated with liver damage and glomerular dysfunction suggesting that both comorbidities should be assessed in the course of serum hypoMg.

Chemsex is a term applicable to the use of drugs related to sex among men who have sex with men (MSM). Because it is a recent trend, there is little information about its management and consequences. The aim of the study was to describe the clinical profile of a sample of chemsex users who consulted for treatment.This is a longitudinal and retrospective study of 53 patients who consulted for chemsex in an addiction unit of a general hospital in Barcelona, from January 2017 to June 2019. Data was collected from electronic medical records and a descriptive analysis was performed by calculating proportions and means.The most common drug used in chemsex was methamphetamine (81.1%; n=43) and 67.4% (n=29) of these used at least other two drugs. The prevalence of HIV infection was high (71.2%; n=37) and 72.1% (n=41) had psychiatric comorbidity, being the most common psychosis (37.2%; n=16).Methamphetamine was the most common drug chemsex user's seeked for treatment. Furthermore, there is a high prevalence of HIV diagnosis in this population. Both conditions can enhance the risk of suffering from psychosis and may explain why psychiatric comorbidity is so high in the sample.El fenómenoSe realizó un estudio longitudinal retrospectivo de una muestra de 53 sujetos que consultaron en la unidad de adicciones de un hospital de Barcelona en el período entre enero de 2017 y junio de 2019 por consumo de drogas en contexto deLa metanfetamina fue la droga principal por la que más frecuentemente se solicitaba tratamiento (81,1%; n=43). De éstos, el 67,4% (n=29) consumía además, como mínimo, otras dos sustancias. El 71,2% (n=37) presentaba infección por VIH. El 72,1% (n=41) de los sujetos presentó comorbilidad psiquiátrica, siendo lo más frecuente la sintomatología psicótica (37,2%; n=16).Un porcentaje elevado de usuarios de chemsex presentan diagnóstico de VIH y la droga principal más utilizada y por la que más consultaron fue la metanfetamina. Ambas condiciones podrían estar relacionadas con la elevada prevalencia de sintomatología psicótica.

Background and importance SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed encouraging results, with more than a 20% greater reduction of at-risk drinking in the intervention group and more than double of successful referrals to specialized treatment. Objective We aimed to evaluate the mid and long-term efficacy of an SBIRT program conducted by psychiatrist specialists in addictive disorders and motivational interviewing in the ED of a tertiary hospital. Design, settings and participants We conducted a secondary analysis of a previously published randomized controlled trial of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the AUDIT-C scale. Intervention or exposure Patients were randomized into two groups, with the control group receiving two leaflets: one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. Outcomes measure and analysis Long-term assessment primary outcome was the proportion of at-risk alcohol use measured by AUDIT-C scale. The main effectiveness analysis at 18 weeks and 12 months' follow-up was conducted with multilevel logistic regression analyses. Missing values were imputed with the last observation carried forward. Main results Of 200 patients included in the study, 133 (66.5%) and 131 (65.5%) completed 18 weeks and 1-year follow-up respectively. Although the proportion of risky drinkers was substantially lower in the intervention group (38.5 vs. 57.4% at 4.5 months and 58.5 vs 68.2% at 1 year), these results did not reach statistical significance (OR = 2.15; CI, 0.87-5.33). Conclusions In this secondary analysis for mid- and long-term effects of a specialized SBIRT program, there was no significant difference in the reduction of risky drinkers at 18 weeks and 1 year. The small size of the studied sample and the low retention rate precluded any significant conclusion, although point estimates suggest a positive effect. Overall, SBIRT programs are an effective tool to reduce alcohol use at short time and to refer patients to specialized treatment; however, its effects seem to decay over time.

Introduction: Opioid prescription (OP) is a widespread practice, which raises concerns for the risks involved. In the present study, we aimed to retrospectively evaluate risk factors for prescription opioid (PO) addiction in a sample of patients attended in a pain clinic in a big urban hospital. Methods: We conducted a case–control study to evaluate risk factors for OP addiction. We selected 20 patients referred to an addictions unit from the pain clinic for opioid use disorder and matched with 40 controls attending to the pain clinic who were not. Results: High dosage (OR = 1,023, P = 0,046) and long-lasting (OR = 1,023, P = 0,046) use of opioids are among the most important risk factors for a future referral to an addictions unit. Every 10 mg of equivalent dose of morphine escalation increases the probability for a future referral by 23%. Each month appears to increase the risk for a future referral to the addiction unit by 2.4%. Depressive and anxious symptomatology and concomitant benzodiazepi...

RESUMEN Fundamentos: El consumo excesivo de alcohol es uno de los factores de riesgo de morbimortalidad más importantes en nuestro entorno, por lo que en los últimos años se han desarrollado múltiples programas para la detección e intervención sobre los consumidores de riesgo en los centros de atención primaria y de Urgencias. El objetivo de este estudio fue analizar la tasa de detección y registro del consumo excesivo de los pacientes atendidos en un servicio de Urgencias. Métodos: Se incluyeron todos los pacientes con un consumo de riesgo de alcohol, mayores de 18 años, atendidos en un servicio de Urgencias del Hospital Clínic de Barcelona. Se realizó un análisis descriptivo de los datos, tras evaluar los informes de alta de los pacientes. Resultados: Se evaluaron 2.047 pacientes mediante la escala AUDIT, detectándose 247 consumidores de riesgo, de lo que 200 aceptaron participar. De estos, solamente se realizó una adecuada detección y registro en el 32,5%. En 122 historias clínicas no había ninguna referencia sobre el consumo de alcohol, y en 13 la referencia era inexacta y no informaba sobre si la cantidad de alcohol consumida era excesiva. Conclusiones: El consumo de riesgo de alcohol se registra de manera adecuada en menos del 35% de los pacientes. Es necesario evaluar las barreras que están obstaculizando la detección y registro para una mejor identificación de estos pacientes.

Due to the high economic and morbimortality burden associated to alcohol use, in the last decades, public health services have developed several programs to detect and to intervene on at risk drinkers in primary care settings and emergency departments (ED). The aim of this study is to determine the proportion of detected and registered risky drinkers in an ED of Hospital Clínic de Barcelona.All patients over 18 years old, presenting to the ED and reporting risky drinking, were asked to participate. We did a descriptive analysis of the data after revising clinical records.We detected 247 risky drinkers after assessing more than 2,047 patients with AUDIT-C scale. From these, 200 accepted to participate. Only 65 (32.5%) of these patients were properly detected and registered as risky drinkers, while the majority of them (122, 61%) had no record about their alcohol use in their clinical records.Risky drinkers are properly detected and registered in less than 35% of the patients. It is necessary to evaluate which barriers are restricting the implementation of screening programs to detect at risk drinkers.El consumo excesivo de alcohol es uno de los factores de riesgo de morbimortalidad más importantes en nuestro entorno, por lo que en los últimos años se han desarrollado múltiples programas para la detección e intervención sobre los consumidores de riesgo en los centros de atención primaria y de Urgencias. El objetivo de este estudio fue analizar la tasa de detección y registro del consumo excesivo de los pacientes atendidos en un servicio de Urgencias.Se incluyeron todos los pacientes con un consumo de riesgo de alcohol, mayores de 18 años, atendidos en un servicio de Urgencias del Hospital Clínic de Barcelona. Se realizó un análisis descriptivo de los datos, tras evaluar los informes de alta de los pacientes.Se evaluaron 2.047 pacientes mediante la escala AUDIT, detectándose 247 consumidores de riesgo, de lo que 200 aceptaron participar. De estos, solamente se realizó una adecuada detección y registro en el 32,5%. En 122 historias clínicas no había ninguna referencia sobre el consumo de alcohol, y en 13 la referencia era inexacta y no informaba sobre si la cantidad de alcohol consumida era excesiva.El consumo de riesgo de alcohol se registra de manera adecuada en menos del 35% de los pacientes. Es necesario evaluar las barreras que están obstaculizando la detección y registro para una mejor identificación de estos pacientes.

Bevedors de risc; Intervencions breus; Serveis d'urgències; Implementació Bebedores de riesgo; Intervenciones breves; Servicios de urgencias; Implementación Risk drinkers; Brief interventions; Emergency services; Implementation Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have been developed, evaluated, and shown to be effective, particularly in primary care and general practice. Nevertheless, effectiveness of SBIRT in emergency departments (EDs) has not been clearly established. Objective: We aimed to evaluate the feasibility and efficacy of an SBIRT program conducted by highly specialized professionals in the ED of a tertiary hospital. Methods: We conducted a randomized controlled trial to study the feasibility and efficacy of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the three-item version of the Alcohol Use Disorder Identification Test (AUDIT-C). Patients were randomized to two groups, with the control group receiving two leaflets-one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. The primary outcomes were the proportion of at-risk alcohol use measured by AUDIT-C scale and the proportion of patients attending specialized treatment at 1.5 months. Results: Of 3,027 patients presenting to the ED, 2,044 (67%) were potentially eligible to participate, 247 (12%) screened positive for at-risk drinking, and 200 agreed to participate. Seventy-two percent of the participating sample were men, and the mean (±SD) age was 43 (±16.7) years. Follow-up rates were 76.5%. At 1.5 months, the intervention group showed greater reductions in alcohol consumption and fewer patients continuing with at-risk alcohol use (27.8% vs. 48.1%; p = 0.01). The SBIRT program also increased the probability of attending specialized treatment, compared to the control condition (23% vs. 9.8%, p = 0.0119) CONCLUSION: The SBIRT program in the ED was found to be feasible and effective in identifying at-risk drinkers, reducing at-risk alcohol use, and increasing treatment for alcohol problems. This work was supported by the Hospital Cl ınic (Grant“Premifide resid encia Emili Letang) and the CERCA Programme/Generalitat de Catalunya.

Aims: To test the screening performance of urinary ethyl glucuronide (EtG) under routine clinical conditions in a sample of alcohol-dependent outpatients, comparing it against urinary ethanol, self reports and clinical judgment. Methods: A cross-sectional study under routine conditions was conducted in February 2015, where 613 consecutive urinary samples, provided by 188 outpatients with alcohol use disorders, were analyzed for ethanol and EtG (cut-off level = 500 ng/ml). Clinical variables such as the presence of aversive medication, comorbidities and clinician judgment were also collected. The discrepancy between the number of alcohol and EtG positives was recorded. A logistic regression analysis including clinical variables was conducted to assess for predictors of EtG positivity. Results: Urinary alcohol yielded 9 positives (1.5% of all urine samples) belonging to 8 patients. EtG yielded 136 positives (22% of all urine samples) belonging to 74 patients. Of these, 93.4% (127 of 136) were negative for alcohol. All urinary alcohol positives resulted in EtG positives. The clinician judged 48 samples from 26 patients as belonging to not abstinent patients and 550 samples from 178 patients as belonging to abstinent patients. She was unsure in 15 samples from 15 patients. When comparing it against EtG as the gold standard, the area under the curve was 0.592. Self reports were extremely unreliable in this study, with only 5 patients reporting drinking in a total of 6 urine samples. In the logistic regression model, only aversive medications (OR 2.1, 95% CI 1.3-3.3) and clinician judgment (OR 2, 95% CI 1.4-2.9) resulted in significant effects. Conclusions: EtG performed largely better than ethanol for urine screening in alcohol outpatients, detecting an extra 20.4% (125 out of 613) of positives. It means that for each alcohol-positive sample, there were 15 EtG-positive samples. Although better than ethanol, clinician judgment was also not performed efficiently. If routinely implemented in the screening of alcohol outpatients, EtG might bring relevant changes that merit further research.

Cannabinoid hyperemesis syndrome (CHS) is a recently described condition associated with chronic marijuana use. CHS is defined by the triad of chronic marijuana consumption cyclic bouts of nausea and vomiting, plus frequent hot showering. Its etiology, pathogenesis, and epidemiology remain obscure. We interviewed all patients over the age of 18 years attended between February and April 2014 in an outpatient marijuana rehabilitation center. A questionnaire was used to collect sociodemographic and clinical data as well as information related to a diagnosis of CHS. Of 22 patients who met the inclusion criteria, 4 (18.2%) reported symptoms suggestive of CHS; 2 (9.1%) had all symptoms, and 2 (9.1%) had some. CHS is common. We recommend asking about symptoms that might indicate this diagnosis given that CHS generates a high level of discomfort as well as diagnostic errors and many referrals to specialists.El síndrome de hiperémesis cannábica (SHC) es una triada consistente en uso crónico de cánnabis, náuseas y vómitos, y duchas de agua caliente de presentación cíclica asociada al consumo crónico de cánnabis. Es una patología descrita recientemente con una etiopatogenia y epidemiología desconocidas. Se entrevistó todos los pacientes mayores de 18 años atendidos desde febrero a abril de 2014 en una consulta ambulatoria para deshabituación del cánnabis. Se diseñó un cuestionario para recoger datos sociodemográficos, clínicos y criterios diagnósticos de SHC. De los 22 pacientes que cumplieron los criterios de inclusión, un 18,2% (n = 4) refirieron haber presentado síntomas sugestivos de SHC, de una forma parcial [9,1% (n = 2)] o completa [9,1% (n = 2)]. El SHC es una entidad frecuente, por lo que recomendamos preguntar por la presencia de clínica sugestiva dado que genera un el elevado grado de disconfort, errores diagnósticos y múltiples consultas a especialistas.

The relationship between economic downturns and substance use has been studied in numerous economic crises occurring worldwide, but the precise relationship between the two remains unclear.The aim of the present study was to undertake a survey on behaviour and perspectives related to the latest European economic crisis among illegal drug users attending substance treatment services.We conducted a questionnaire-based survey in drug dependence treatment settings, in three geographically different jurisdictions (England, Catalonia and Poland), including 180 drug users.Most of the participants of the survey (58.3%) reported an increase in drug use during the crisis, compared with only 25.6% of the sample who reported a decrease in drug use. The main reason given for increasing drug use was greater amount of free time available. Other important reasons were greater substance availability during this period, more stress at work and seeking comfort in response to the loss of a stable source of income, social status and/or family. Those who reported cutting down on the amount of drug use during the economic recession, reported economic difficulties as the main reason. Other important factors were family and friends' economic problems and the fear of losing their job. Illegal drug use reduction was compensated by increased smoking in 46.3% of the patients, and increased alcohol use in 39.4%.While this result has potential interest for those developing policies and interventions to reduce drug-related harm, longitudinal studies and future research involving a broader population of drug-users (including those not in treatment) could shed further light on these behavioural mechanisms linking changes in drug use with economic recessions.

Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.La adicción a opioides de prescripción médica (OPM) está ahasta la fecha sobre su tratamiento se basan principalmente en el uso de buprenorfina. Sin embargo, la metadona puede considerarse como otra opción. El objetivo de nuestro estudio fue revisar las historias clínicas de todos los pacientes ingresados en una unidad de psiquiatría para la desintoxicación de OPM usando metadona entre el 2010 y el 2013. El periodo de evaluación finaliza a los 3 meses desde el alta médico. Pese a ser una revisión de historia clínicas, se evaluaron las características sociodemográficas de la muestra, así como las variables relacionadas con el tratamiento y la tasa de abstinencia durante el estudio. Se incluyeron 11 pacientes, mayoritariamente mujeres (81,8%), con una mediana de edad de 50 años. La mediana de duración de la dependencia fue de 8 años. Hubo una alta prevalencia de adicción a otras sustancias así como de comorbilidades psiquiátricas. Ocho pacientes fueron seguidos durante al menos 3 meses. De estos, 7 (87,5%) estuvieron abstinentes hasta el final del periodo evaluado por el estudio. Los resultados sugieren la necesidad de estudios de mayor rigor metodológico para la correcta evaluación de la metadona como un tratamiento potencialmente eficaz para la dependencia de los OPM.

Nalmefene is the first available drug approved in the E.U. to reduce alcohol use in alcohol-dependent patients. Reduction in alcohol use in heavy drinkers diminishes mortality risk and socio-economic burden. Nalmefene has shown efficacy at 6 months in alcohol-dependent patients with high or very high drinking risk levels in reducing total alcohol consumption (-7.6 g/day [95% confidence interval (CI): -11.6 to -3.5]; P = 0.0003), heavy drinking days (-2.00 days/month [95% CI: -3.00 to -1.00]; P ⟨ 0.00001) and other secondary outcome measures such as γ-glutamyl transferase, alanine aminotransferase, drinking risk level and Clinical Global Impression. It is generally well tolerated and has limited contraindications and interactions. As-needed dosage is a novel concept in the addictions field, which may overcome limitations of traditional regimens. In the pivotal trials, nalmefene was taken 52% of the days and compliance with the as-needed treatment regimen was good (above 80% of the days) in 68% of the nalmefene-treated patients. A new pharmacological approach combined with a brief psychosocial intervention for alcoholism is available and appears to be feasible, safe and efficacious.

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Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.