Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Abstract Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.

Capacidad de los Centros de Atención Psicosocial de Alcohol y Drogas para manejar situaciones de crisis / The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises / Capacidade de manejo de situações de crise por Centros de Atenção Psicossocial Álcool e Drogas

Objetivo: evaluar la capacidad de los Centros de Atención Psicosocial de Alcohol y Otras Drogas 24 horas para manejar situaciones de crisis de las personas que consumen AOD en la atención integral. Método: estudio cuantitativo, evaluativo y longitudinal, realizado de febrero a noviembre de 2019. La muestra inicial estuvo compuesta por 121 personas que consumen AOD, que recibieron atención integral en situaciones de crisis en dos Centros de Atención Psicosocial para Alcohol y Otras Drogas 24 horas en el centro de São Paulo. Los mismos fueron reevaluados después de 14 días de atención. La capacidad para manejar la crisis se evaluó mediante un indicador validado. Los datos se analizaron utilizando estadísticas descriptivas y modelos de regresión de efectos mixtos. Resultados: sesenta y siete personas que consumen AOD completaron el follow-up (54,9%). Durante la atención de las situaciones de crisis, nueve personas que consumen AOD (13,4%; p=0,470) fueron derivadas a otros servicios de la red de salud: siete por complicaciones clínicas, una por intento de suicidio y una por hospitalización psiquiátrica. La capacidad de los servicios para manejar situaciones de crisis fue del 86,6%, fue considerada positiva. Conclusión: los dos servicios evaluados fueron capaces de manejar situaciones de crisis en su área de influencia, evitando internaciones y contando con el apoyo de la red cuando fue necesario, logrando así los objetivos de desinstitucionalización.

Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Objetivo: avaliar a capacidade dos Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas em manejar situações de crise dos usuários no acolhimento integral. Método: estudo quantitativo, avaliativo e longitudinal, realizado de fevereiro a novembro de 2019. A amostra inicial foi composta por 121 usuários, acolhidos integralmente em situações de crise por dois Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas do centro de São Paulo. Estes foram reavaliados após 14 dias de acolhimento. A capacidade de manejar a crise foi avaliada por um indicador validado. Os dados foram analisados por estatística descritiva e por regressão de modelos de efeitos mistos. Resultados: sessenta e sete usuários concluíram o follow-up (54,9%). Durante o acolhimento às situações de crise, nove usuários (13,4%; p=0,470) foram encaminhados para outros serviços da rede de saúde: sete por complicações clínicas, um por tentativa de suicídio e um para internação psiquiátrica. A capacidade de manejo das situações de crise pelos serviços foi de 86,6%, avaliada como positiva. Conclusão: os dois serviços avaliados foram capazes de manejar situações de crise no próprio território, evitando internações e tendo apoio da rede quando necessário, atingindo assim, os objetivos da desinstitucionalização.

The Socio-Demographic Factors and Causes of Substance Abuse Relapse: 36 Cases

Background: Relapse is frequent among substance abusers all across the world, and Bangladesh is no exception. Drug-related issues are gradually becoming a hot topic in Bangladesh, from a social, economic, and medical standpoint. The present study aimed to find out sociodemographic factors associated with relapse amongst substance abuser. Material & Methods: This descriptive type of observational study conducted in the Combined Military Hospital and other Government/Private Hospital/Institute especially Central Drug Addict Treatment Center, Dhaka with a total sample size of 36 participants. Detailed information was obtained in each case according to protocol through complete history from patients or their accompanying attendants using a data collection sheet which was read out to them in Bangla. All the information was recorded in the pre fixed protocol. Collected data was classified, edited, coded and entered into the computer for statistical analysis by using SPSS-23. Results: The study found that yaba was the most commonly abused drug among 36 participants, with 27.78% reporting abuse. 27.78% of participants had a psychiatric illness, with the majority being male (97.22%) and Muslim (88.89%). The largest group of participants were aged 31-40 (47.22%) and most were unemployed (83.33%) and married (94.44%). Peer pressure and family problems were the most commonly reported causes of relapse (91.67% and 83.33%, respectively). Other factors such as unemployment, depression, and failure in life also contributed to relapse. Conclusion: Yaba was the most prevalent substance of abuse and the majority of participants were male, had a psychiatric illness, and were unemployed. Peer pressure and family problems were the main causes of relapse.

Atitudes de profissionais sobre o uso de drogas por gestantes / Health professional attitudes towards drug use for pregnant women / Actitudes de profesionales sobre el consumo de drogas en mujeres embarazadas

O uso de drogas é um dos fatores associados a gestações de alto risco. As crenças e atitudes dos profissionais configuram possíveis dificultadores dos cuidados em saúde. O presente estudo buscou verificar as atitudes profissionais em relação a gestantes usuárias de drogas. Realizou-se a busca bibliográfica de publicações entre 2000 e junho de 2022, nas bases de dados Scielo, Lilacs, Medline/Pubmed, Scopus e PsycINFO. Ao final foram analisados 27 artigos, todos de língua inglesa. Foram identificadas atitudes negativas em 33,3% dos artigos, e atitudes positivas em 44,5%; também foram encontradas atitudes ambivalentes (22,2%). Além disso, alguns dos estudos apontaram algumas barreiras quanto às intervenções. Atitudes negativas e moralizantes denotam um cunho individualizante. Em relação às atitudes positivas, essas podem ter um papel fundamental na atuação profissional e na saúde materna e do feto.

Drug use is one of the factors related to high-risk pregnancy. The health professional beliefs and attitudes regarding this issue constitute possible difficulties in the health care. The present study sought to verify the health professional attitudes towards pregnant women who use drugs. A literature review for studies published between 2000 and june 2022 was carried out in the Scielo, Lilacs, Medline/Pubmed, Scopus, and PsycINFO databases. In the end, 27 articles were analyzed, all of them written in English. Negative attitudes were identified in 33,3% of the articles, and positive attitudes in 44,5%; ambivalent attitudes were also found in 22,2% of the studies. Additionally, some studies pointed out barriers to interventions. The negative and moralizing attitudes denote an individualizing nature. Concerning the positive attitudes, they can play a fundamental role on professional performance and, consequently, on the maternal and fetal health.

El uso de drogas es uno de los factores asociados a los embarazos de alto riesgo. Las creencias y actitudes de los profesionales se configuran como posibles obstáculos al cuidado en salud. El presente estudio buscó verificar las actitudes de los profesionales en relación a embarazadas usuarias de drogas. Se realizó una búsqueda bibliográfica de publicaciones entre 2000 y junio de 2022, en las bases de datos Scielo, Lilacs, Medline/Pubmed, Scopus y PsycINFO. Finalmente, fueron analizados 27 artículos, todos en idioma inglés. Se identificaron actitudes negativas en el 33,3% de los artículos, y actitudes positivas en el 44,5%; así también se encontraron actitudes ambivalentes (22,2%). Además, algunos de los estudios señalaron algunas barreras con respecto a las intervenciones. Las actitudes negativas y moralizantes denotan una impronta individualizadora. En relación con las actitudes positivas, estas pueden tener un papel fundamental en la actuación profesional y en la salud materna y del feto.

The relationship between anxiety and depression mood and substance abuse history in male prisoners / 中华行为医学与脑科学杂志

Objective:To explore the influence of substance abuse history on anxiety and depression of male prisoners during their imprisonment, and its relationship with violent behavior.Methods:A questionnaire survey was conducted among 1 455 prisoners from October to November 2019.Self-administered personal substance abuse history questionnaires were used to collect the information on substance abuse (alcohol, tobacco, and drug use). The generalized anxiety scale (GAD-7) and patient health questionnaire (PHQ-9) were used to investigate anxiety and depression.All subjects were divided into substance abuse group ( n=871) and non substance abuse group ( n=584) according to whether they had a history of substance abuse or not.SPSS 21.0 software was used for statistical analysis.The statistical methods were t-test, chi square test and Logistic regression analysis. Results:(1)The scores of GAD-7 ((4.95±5.88) vs (3.35±5.33), t=-5.407, P<0.01) and PHQ-9 ((6.69±6.50) vs (4.48±5.73), t=-6.821, P<0.01) scales in the substance abuse group were higher than those in the no-substance abuse group.(2)Somatic disease( β=0.700, OR=2.014, 95% CI=1.599-2.538, P<0.05), history of alcohol abuse( β=0.434, OR=1.543, 95% CI=1.176-2.025, P<0.05), history of tobacco abuse( β=0.387, OR=1.473, 95% CI=1.154-1.880, P<0.05), age ≤ 45( β=0.372, OR=1.450, 95% CI=1.118-1.881, P<0.05) were the risk factors of anxiety among prisoners.Somatic disease( β=0.686, OR=1.986, 95% CI=1.581-2.496, P<0.05), history of tobacco abuse( β=0.488, OR=1.629, 95% CI=1.286-2.063, P<0.05), age ≤ 45( β=0.484, OR=1.622, 95% CI=1.260-2.089, P<0.05), history of alcohol abuse( β=0.344, OR=1.410, 95% CI=1.073-1.854, P<0.05) were the risk factors of depression among prisoners.(3) Years of education ≤ 9 years( β=0.900, OR=2.459, 95% CI=1.855-3.261, P<0.05), age ≤ 45( β=0.788, OR=2.199, 95% CI=1.690~2.860, P<0.05), unmarried( β=0.683, OR=1.980, 95% CI=1.421-2.759, P<0.05), history of alcohol abuse( β=0.308, OR=1.361, 95% CI=1.053-1.758, P<0.05), history of drug abuse( β=0.557, OR=1.745, 95% CI=1.055-2.885, P<0.05) were risk factors for violent behavior of prisoners. Conclusion:The history of substance abuse may be a risk factor for anxiety and depression of prisoners during their imprisonment.Alcohol and drug abuse are both factors influencing the occurrence of violent behavior.

Definition and conceptualization of collaboration in drug rehabilitation: Systematic synthesis and comparison using a scoping review approach

Objective@#Although interagency collaboration in drug treatment and rehabilitation has been substantially studied, a lack of consensus on the nomenclature and definition of collaboration remains an unresolved issue in public health policy and practice. To facilitate further consensus, this review analyses previously used definition, conceptualization, and theorization on interagency collaboration in the field of drug rehabilitation.@*Methods@#We conducted evidence synthesis using a scoping review approach. This review is based on searches using the MEDLINE, CINAHL Complete, Embase, and PsychINFO databases and used the protocol proposed by Arksey and O’Malley.@*Results@#A total of 6,259 papers were retrieved from database and citation searches, 33 of which were eligible for inclusion in the analysis after screening and evaluation. Although the definitions varied, the common elements included (a) the presence of at least two entities, which were either services, programs or organizations; (b) these entities collaborated or shared resources; (c) partnership went through a development process; and (d) the intent of collaboration was to achieve a common purpose. There were five means of conceptualizing collaboration: (a) degrees, or level of intensity and formality; (b) elements, or the constitutive structure and activities; (c) stages, or the development of partnership over time; (d) levels, or the focus of the collaborative; and (e) type, or a distinction between collaboration on in policy and practice.@*Conclusion@#Scholarship in this field can benefit from studies that conceptualize collaboration not only crosssectionally through the description of degrees, elements, levels, and type, but also by considering the stages dimension of collaboration (i.e., evolution of collaboration initiative over time). Countries or jurisdictions may need to formalize a term and definition for collaboration as it applies to initiatives within their territories.

Tratamento para mulheres que usam drogas: uma crítica sob a perspectiva do feminismo decolonial / Tratamiento para mujeres que usan drogas: una crítica desde la perspectiva del feminismo descolonial / Treatment for women who use drugs: a critique from the perspective of decolonial feminism

Resumo Este artigo realiza revisão sistemática sobre o tratamento para o uso de drogas por mulheres e aponta lacunas nessa literatura a partir de uma perspectiva feminista decolonial. Foram coletados trabalhos escritos em inglês, português e espanhol publicados entre os anos de 2010 e 2019. Os resultados apontam para a influência dos estigmas sociais, de atitudes julgadoras dos profissionais e da família e a importância de considerar as necessidades sociais e de saúde através de um cuidado singularizado. No entanto, poucos trabalhos sinalizam o fato de que essas mulheres vivem em sociedades sexistas e para o modo como gênero, raça e classe influenciam nos usos de drogas e no tratamento. Por fim, destacamos contribuições do feminismo decolonial para a leitura do fenômeno do uso de drogas e como essa articulação pode fundamentar uma atenção psicossocial nos moldes de uma Reforma Psiquiátrica Antimanicomial feminista e antirracista.

Resumen Este artículo realiza una revisión sistemática sobre el tratamiento del consumo de drogas por parte de mujeres y señala vacíos en esta literatura desde una perspectiva feminista descolonial. Se recogieron artículos escritos en inglés, portugués y español publicados entre 2010 y 2019. Los resultados apuntan a la influencia de los estigmas sociales, las actitudes críticas de los profesionales y familiares y la importancia de considerar las necesidades sociales y de salud a través de una atención singular. Sin embargo, pocos estudios señalan el hecho de que estas mujeres viven en sociedades sexistas y cómo el género, la raza y la clase influyen en el uso y el tratamiento de las drogas. Finalmente, destacamos los aportes del feminismo descolonial a la lectura del fenómeno del consumo de drogas y cómo esta articulación puede apoyar la atención psicosocial en la línea de una Reforma Psiquiátrica Anti-asilo feminista y antirracista.

Abstract This article performs a systematic review on treatment for drug use by women and points out gaps in this literature from a decolonial feminist perspective. Papers written in English, Portuguese and Spanish published between the years 2010 and 2019 were collected. The results point to the influence of social stigmas, judgmental attitudes of professionals and family and the importance of considering social and health needs through a personalized care. However, few studies will point to the fact that these women live in sexist societies and how gender, race and class influence drug use and treatment. Finally, we highlight contributions from decolonial feminism to the reading of the phenomenon of drug use and how this articulation can support psychosocial care along the lines of a feminist and anti-racist Anti-asylum Psychiatric Reform.

Group interventions in psychosocial care centers for alcohol and drugs: challenges of care practice / Intervenciones grupales en centros de atención psicosocial alcohol y drogas: desafíos de la práctica de atención / Intervenções grupais em centros de atenção psicossocial álcool e drogas: desafios da prática assistencial

ABSTRACT Objective: to understand the challenges of care practice with group interventions Psychosocial Care Centers for Alcohol and Drugs. Method: qualitative intervention research developed with 30 professionals from four Alcohol and Psychosocial Drug Care Centers in a municipality in central Brazil from March to April 2019. We used a professional characterization instrument and conversation wheels to collect data that were submitted to the thematic modality of content analysis. Results: some challenges that permeate the practice with group interventions in CAPSad were evidenced, from the professionals' perspective, such as inadequate physical structure and scarcity of material resources; issues related to aspects of users such as difficulty in adhesion and commitment to groups, incompatible work schedules and lack of financial resources for travel to the centers; factors related to the competence of professionals as not having affinity to work with groups, absence of specific training, prioritization of other practices, demotivation, absence of care records and difficulty in performing the patient discharge and; aspects of work processes such as outpatient organizational culture, very high demand, insufficient human resources, lack of external supervision, few offers of therapeutic groups and lack of criteria for the definition of group coordinators. Conclusion: the challenges experienced include issues of inadequate physical structure and deficient material resources, difficulties related to the life contexts of users, competence of professionals and factors of the work processes of the services.

RESUMEN Objetivo comprender los desafíos de la práctica asistencial con intervenciones grupales en Centros de Atención Psicosocial de Alcohol y Drogas. Método investigación de intervención desarrollada con 30 profesionales de cuatro Centros de Atención Psicosocial de Alcohol y Drogas de un municipio del centro de Brasil de marzo a abril de 2019. Utilizamos un instrumento de caracterización profesional y ruedas de conversación para recolectar datos que fueron sometidos a la modalidad temática de análisis de contenido. Resultados: se evidenciaron algunos desafíos que permean la práctica con intervenciones grupales en CAPSad, desde la perspectiva de los profesionales, como estructura física inadecuada y escasez de recursos materiales; cuestiones relacionadas con aspectos de los usuarios como dificultad para incorporar y compromiso de grupos, jornada laboral incompatible y falta de recursos económicos para desplazamiento al servicio; factores d la competencia de los profesionales como no tener afinidad para trabajar con grupos, ausencia de formación específica, priorización de otras prácticas, desmotivación, ausencia de registros de atención y dificultad en la realización del alta de los usuarios y; aspectos de los procesos de trabajo como cultura organizacional ambulatoria, demanda muy grande, recursos humanos insuficientes, falta de supervisión externa, pocas ofertas de grupos terapéuticos y falta de criterio para la definición de coordinadores de grupo. Conclusión: lo vivido incluye cuestiones de estructura física inadecuada y recursos materiales deficientes, desafíos relacionados con los contextos de vida de los usuarios, competencia de los profesionales y factores de los procesos de trabajo de los servicios.

RESUMO Objetivo: compreender os desafios da prática assistencial com intervenções grupais em Centros de Atenção Psicossocial Álcool e Drogas. Método: pesquisa-intervenção de abordagem qualitativa desenvolvida com 30 profissionais de quatro Centros de Atenção Psicossocial Álcool e Drogas de um município da região central do Brasil de março e abril de 2019. Utilizou-se instrumento de caracterização profissiográfica e rodas de conversa para coleta de dados que foram submetidos à análise de conteúdo, modalidade temática. Resultados: evidenciou-se alguns desafios que permeiam a prática com intervenções grupais em CAPSad, sob a ótica dos profissionais, como estrutura física inadequada e escassez de recursos materiais; questões ligadas a aspectos dos usuários como a dificuldade de adesão e comprometimento com os grupos, agenda de trabalho incompatível e falta de recursos financeiros para deslocamento ao serviço; fatores da competência dos profissionais como não ter afinidade de trabalhar com grupos, ausência de formação específica, priorização de outras práticas, desmotivação, ausência de registros dos atendimentos e dificuldade de realizar a alta dos usuários e; aspectos dos processos de trabalho como cultura organizacional ambulatorial, demanda muito grande, recursos humanos insuficientes, falta de supervisão externa, poucas ofertas de grupos terapêuticos e ausência de critérios para a definição de coordenadores de grupos. Conclusão: os desafios vivenciados englobam questões de estrutura física inadequada e recursos materiais deficitários, dificuldades ligadas aos contextos de vida dos usuários, competência dos profissionais e fatores dos processos de trabalho dos serviços.

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

Adolescents' lived experiences of substance abuse in the Greater Giyani Municipality

Background: Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives: To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results: Five themes were identified: substance abuse behaviour among adolescents, adolescents' motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents' discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion: The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution: The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Prevalencia de VIH y sus factores asociados en personas que se inyectan drogas atendidos en una institución prestadora de servicios de salud de Medellín-Colombia / HIV prevalence and associated factors in people who inject drugs attended in an institution that provides health services from Medellín-Colombia

Resumen Introducción: En Colombia, la investigación sobre el VIH en Personas que se Inyectan Drogas (PID) es escaso, pese a ser un grupo clave para el control de la infección. Objetivo: Determinar la prevalencia de VIH y sus factores asociados en PID atendidos en una Institución Prestadora de Servicios de salud (IPS) de Medellín-Colombia. Métodos: Estudio de prevalencia en 293 PID en una IPS especializada en la atención de enfermedades infecciosas. Se aplicó una encuesta para recolectar datos sociodemográficos y de salud, una inmunocromatografía para la tamización de la infección y los casos positivos se confirmaron con Western blot. Los análisis se realizaron en SPSS 27.0. Resultados: La edad mediana 29 años, 84% hombres, 52% sin escolaridad y alta frecuencia de factores de riesgo sexual. La prevalencia del VIH fue de 5,5%, de estos 87,5% coinfectados con virus de la hepatitis C y 53,6% con la B. La prevalencia de VIH fue estadísticamente más elevada en sujetos mayores de 29 años de edad (10,4%), quienes viven en condición de calle (25,5%), sin escolaridad (9,9%) y quienes reciben dinero o drogas a cambio de sexo (11,6%). Conclusión: Se obtuvo una prevalencia de VIH mayor a la reportada en estudios previos de la ciudad, alta proporción de coinfección con virus de las hepatitis B y C, y se identificaron grupos con mayor ocurrencia de VIH. Estos resultados, además de permitir disponer de una línea base para evaluar intervenciones posteriores en este grupo, demuestra la interseccionalidad en el riesgo de VIH, consumo de drogas inyectables, hepatitis virales, baja escolaridad, condición de calle, y otros que muestran la complejidad clínica, epidemiológica y social para impactar el VIH en este grupo.

Abstract Introduction: In Colombia, research on HIV in people who inject drugs (PID) is scarce, despite being a key group for infection control. Objective: To determine the prevalence of HIV and its associated factors in PID treated in a health service provider institution (IPS) in Medellín-Colombia. Methods: Prevalence study in 293 PID from an IPS specialized in the care of infectious diseases. A survey was applied to collect sociodemographic and health data, immunochromatography for infection screening, and positive cases were confirmed with Western blot. Analyzes were performed in SPSS 27.0. Results: The median age was 29 years, 84% men, 52% without schooling and high frequency of sexual risk factors. HIV prevalence was 5.5%, of these 87.5% co-infected with hepatitis C virus and 53.6% with hepatitis B virus. HIV prevalence was statistically higher in subjects older than 29 years of age (10.4%), those who live on the streets (25.5%), without schooling (9.9%) and those who receive money or drugs in exchange for sex (11.6%). Conclusion: A higher prevalence of HIV was obtained in comparison with previous studies of the city; a high proportion of co-infection with hepatitis B and C viruses, and groups with a higher occurrence of HIV were identified. These results, in addition to providing a baseline to evaluate subsequent interventions in this group, demonstrate the intersectionality in the risk of HIV, injecting drug use, viral hepatitis, low schooling, homelessness, and others social and health conditions, that show the clinical, epidemiological and social complexity to impacting HIV in this group.

Social Factors Contributing to Substance Abuse: A Narrative Analysis

Background: India has seen a rise in the use of substance abuse. A national survey in 2019 showed that around 2.1% of the country’s population uses opioids and 2.8% of Indians between the ages 10-75 use cannabis. In order to prevent substance related disorders it is necessary to get in-depth understanding of the various social factors leading to the use of substance use. Methodology: The researcher used Narrative Analysis to gather data from 4 individuals through the use of semi-structured interview. The participants were undergoing treatment at a rehabilitation center in Mumbai. Results: Through narrative analysis 3 common themes namely, friends (peer pressure), curiosity and parental neglect were identified. There were 3 unique themes identified- stamina/booster, bad neighbourhood and resentment towards family. Conclusions: This research identifies some common themes that can help those working in the field of mental health to focus on those areas while working with young children and their families. This research shows the importance of teaching assertiveness training to young children to prevent them from trying substances. The parents need to be trained and informed about various parenting styles and how to develop secure attachment styles with children. This research also paves the way for further research by identifying which other parental styles leads substance abuse

Prevalence and Pattern of Substance Abuse among 18 to 60 years Male in a Rural Area of District Etawah, Uttar Pradesh

Abstract: Adolescent and young people’s behavior is of major concern due to Substance abuse. According to WHO, Substance abuse is consistently or sporadic drug use inconsistent with or unrelated to acceptable medical practice. Globally, alcohol and tobacco as a risk factors cause 4.0% and 4.1% of the overall burden of disability respectively. Objective: To determine the prevalence of substance abuse among 18 to 60 years’ male in rural Etawah and to identify type and pattern of substance abuse. Material and Methods: It was a community based cross sectional study carried out in five block of district Etawah for a period of one and half year. 1500 participants were interviewed using pre designed pre-tested questionnaire and data regarding socio demographic profile and pattern of abuse were collected. Data was entered in Microsoft excel sheet and analyzed by SPSS version 24 using appropriate statistical test. Result: Among 1500 participants, majority were below 30 years of age (i.e. 42.8%). In this study prevalence of Substance use among was 47% [707/1500]. Among all the other substance use, smokeless tobacco showed highest prevalence. Conclusion: Substance use is common in both urban as well as in rural area. So there is a need to educate and aware people regarding bad effects of drug abuse.

Why MBBS Students are Taking to Substance Abuse ? — A Retrospective Study on the Pattern and Causes of Substance Abuse among the MBBS Students of West Bengal

Background : Substance abuse is an important health hazard and also a major preventable cause of morbidity and mortality. This habit not only affects health, education and occupational career, but also incurs huge financial and social burden to the society specially when the doctors are involved in it. Aims and objectives : To estimate the prevalence of substance abuse, its pattern and causes among the MBBS students of West Bengal. Methods : A questionnaire based cross-sectional retrospective study was designed to collect data from the Medical Officers of the State to record their experience of substance abuse during their MBBS course. Results : The prevalence of substance abuse was 22% among the study participants. Smoking Tobacco was most common (16.67%). 76% of the subjects with substance abuse spend Rs1000 or less per month. The prevalence was 25% in upper class and 22.22% among those who belonged to lower class of socio-economic status as per BG Prasad Classification. Curiosity was the reason as per 34.5% of the subjects followed by depression (23.25%), peer pressure (13%) study pressure by 15%; media influence by 11%; to cope with home problems by 10.75% and parental influence by 2.25% of the study subjects. Conclusion : The institution should keep a Psychological Counselor who can guide the students who suffer from problems related to Depression, Peer pressure, Study pressure that may lead to substance abuse. Allotting, hobbies, sports and recreation would help in keeping away from substance abuse

Burden and determinants of substance abuse among urban adolescents of Shimla city: How vulnerable are our future citizens

Background: Substance abuse is a major but neglected public health problem across the globe. Most of the time it starts during adolescence, which is also considered a critical risk period for the initiation of substance use. Materials and Methods: We conducted a cross-sectional analytical study to estimate the prevalence and determine the association of socio-demographic and other risk factors with substance abuse among adolescents in an urban area of Himachal Pradesh. A multi-stage cluster with probability proportional to size sampling technique was followed and a semi-structured, pretested questionnaire was used as the study tool. Results: We studied a total of 728 participants and 39.6% were females. The mean age was 15.6 ± 1.3 years. Out of these, 12.1% reported any substance abuse earlier in their lifetime. Among ever users, most commonly abused substance was alcohol (8.9%), followed by smoked tobacco (7.1%), bhang (3.7%), hard liquor (2.8%), charas/ganja (1.4%), chewing tobacco (1.4%), inhalants (fluid/eraser) 0.82%, prescription drugs (cough syrup/tablets 0.69% and injecting drugs 0.27%), Chitta (0.27%), opium and heroin with 0.14% each. On multiple logistic regression analysis, male gender (AOR=1.82), among friend’s tobacco smoking (AOR=2.33), alcohol abuse (AOR=4.52), and cannabis abuse (AOR=2.99) were found to be associated with an increased likelihood of substance abuse. High socio-economic status (AOR=0.59) and tobacco chewing among friends (AOR=0.49) had a protective effect on indulgence in substance abuse. Conclusion: The influence of peers played the most significant predictor while the presence of substance abuse in the family was also associated with an increased likelihood of abuse by adolescents.

Acolhimento integral em Centros de Atenção Psicossocial Álcool e Drogas na perspectiva da proteção dos direitos humanos / Integrated embracement in Psychosocial Care Centers for Alcohol and Drugs in the perspective of the protection of human rights

Resumo Este artigo tem por objetivo avaliar se os resultados do acolhimento integral em Centros de Atenção Psicossocial Álcool e Drogas III (CAPS AD III) atendem aos padrões de qualidade para proteção e respeito dos direitos humanos dos usuários. Desenvolvemos um estudo avaliativo, quantitativo e de desenho longitudinal com 122 usuários acolhidos integralmente em dois CAPS AD III, com follow-up após 14 e 90 dias. Os resultados dos indicadores qualidade de vida, consequências da dependência de substâncias e reabilitação psicossocial, foram posteriormente analisados à luz do referencial QualityRights. Três temas e nove padrões foram avaliados. Quatro padrões foram classificados como alcance total, quatro como alcance parcial e um como alcance iniciado. O direito a usufruir do padrão mais elevado possível de saúde física e mental foi o padrão mais atingido pelo acolhimento integral (tema 2). O direito a exercer a capacidade legal e o direito à liberdade pessoal e segurança foi atendido com algumas fragilidades (tema 3). O direito de viver de forma independente e ser incluído na comunidade, necessita de outros recursos sociais, além do cuidado especializado em saúde mental, para ser melhorado (tema 5).

Abstract This article aims to assess whether or not the results of integrated embracement in Psychosocial Care Centers for Alcohol and Drugs III (CAPS AD III) meet the quality standards necessary for the protection of and respect for users' human rights. An evaluative, quantitative, and longitudinal design was developed through a study with 122 users, embraced in two CAPS AD III follow-ups after 14 and 90 days. This study analyzed the quality of life indicators, consequences of substance abuse, and psychosocial rehabilitation in the light of the QualityRights framework. Three themes and nine patterns were evaluated. In this study, four patterns were classified as total reach, four as partial reach, and one as initiated reach. The right to enjoy the highest possible standard of physical and mental health was the standard most achieved by integrated embracement (theme 2). The right to exercise legal capacity and the right to personal freedom and security were achieved, but with some weaknesses (theme 3). The right to live independently and be included in the community requires other social resources, in addition to specialized mental health care in order to be improved (theme 5).

A lógica das redes, modos de atenção e práticas de cuidado em saúde com usuários de álcool e outras drogas / The logic of networks, modes of care and practices of care in health with users of alcohol and other drugs / La lógica de redes, modos de atención y prácticas de atención en salud con usuarios de alcohol y otras drogas

Sabe-se que foi a partir da Reforma Psiquiátrica e da constituição de políticas públicas sobre drogas que o uso de álcool e outras drogas passou a ser pensado como uma questão de saúde pública. Nesta perspectiva, o objetivo geral desta pesquisa foi o de mapear e compreender as práticas de cuidado desenvolvidas através das equipes que atuam nos serviços públicos voltados às pessoas que usam álcool e outras drogas na cidade de Santa Cruz do Sul. Para a construção dos dados da pesquisa foram utilizados os seguintes procedimentos: participação nas reuniões de equipe dos serviços; realização de uma roda de conversa com cada equipe; observação participante em grupos e atividades em cada um dos serviços. Os dados foram analisados a partir da análise temática de conteúdo, sendo construídas três categorias temáticas. A primeira categoria apresenta e discute as noções de rede que surgiram nos grupos. Na segunda categoria, identificam-se e (re)descobrem-se algumas práticas de cuidado no contexto dos serviços estudados. Por fim, a terceira categoria coloca em evidência e problematiza as perspectivas de trabalho das equipes. A pesquisa possibilitou o entendimento dos serviços que ofertam cuidados aos usuários de álcool e outras drogas em Santa Cruz do Sul, assim como desafios, articulações entre os serviços e quais perspectivas estão orientando este cuidado.(AU)

It is known that from the onset of the Psychiatric Reform and the constitution of public policies about drugs the use of alcohol and other drugs was thought as a public health issue. In this perspective, the main goal of this research was to map and understand the care practices developed by the staff workers of public health system that focus on people who are alcohol and drug users in the county of Santa Cruz do Sul. To gather data for the research the following procedures took place: participation in the staff meetings; conversation meetings with each staff team; participant observation in group activities at each one of the services. The data was analyzed using a content theme analysis, three theme categories were built. The first category shows and discusses the notion of network that came up in the groups. In the second category, it is identified and (re)discovered some care-taking practices within the context of the services being studied. At last, the third category highlights and problematizes the perspectives of the work of the teams. The research allowed for the understanding of the services that offer care to alcohol and drug users of Santa Cruz do Sul, as well as the challenges, articulations between the services and which perspectives are under this care-taking practice.(AU)

És sabido que fue a partir de la Reforma Psiquiátrica y de la constituición de las políticas públicas sobre drogas que el uso del álcohol y otras drogas empezó a ser piensado como una questión de salud pública. Con esa perspectiva, el objetivo general de esta investigación ha sido de mapear y comprender las prácticas de cuidado desarolladas a través de los equipos que trabajan en los servicios públicos para las personas que son usuários de álcohol y otras drogas en la ciudad de Santa Cruz do Sul. Para la construcción de los datos de la investigación ha sido utilizados los siguientes procedimientos: participación en las reuniónes del equipos de los servicios; realización de una rueda de charla con cada uno de los equipos; observación participante en los grupos y actividades en cada uno de los servícios. Los datos fueron analisados a partir de la análise temática de contenido, con tres categorias temáticas siendo constuidas. La primera categoria presenta y discute las nociones de red que surgiram en los grupos. En la segunda categoria, identificase y (re)descobrense algunas prácticas de cuidado en el contexto de los servícios investigados. Por fin, la tercera categoria pone en prueba y problematiza las perspectivas del trabajo de los equipos. La investigación hizo posible el entendimiento de los servícios que ofrecen cuidados a los usuários de álcohol y otras drogas en Santa Cruz do Sul, así como los desafíos, articulaciones entre los servícios y cuáles perspectivas están orientando este cuidado.(AU)

Consumo de drogas de abuso durante a gravidez pelo método de rastreamento oportunístico / Consumption of drugs of abuse during pregnancy analyzed by means of the opportunistic screening method / Consumo de drogas de abuso durante el embarazo analizado mediante el método de detección oportunista

RESUMO Objetivo: rastrear o consumo de drogas por gestantes em pré-natal de baixo risco, usuárias da atenção básica de saúde. Método: estudo transversal, desenvolvido em 2016, 2018 e 2020, em município do Paraná - Brasil. Rastreou-se o consumo de drogas de abuso com uso do ASSIST 3.1. Utilizou-se estatística descritiva, não paramétrica e coeficiente de correlação de Spearman. Resultados: entrevistou-se 588 gestantes. Verificou-se uso atual de álcool, tabaco, maconha e cocaína durante a gestação e aumento progressivo no consumo destas substâncias, constatou-se correlações significativas entre o risco relacionado ao consumo das drogas de abuso entre si, nível de escolaridade, renda familiar, cor e religião. Conclusão: o consumo atual de uma das drogas foi correlacionado com as demais, revelando um perfil de usuárias com poliuso de substâncias, jovens, primigestas, casadas, sem residência própria, nível educacional médio, renda familiar de até dois salários mínimo, de cor preta e/ou parda, e católicas.

ABSTRACT Objective: to screen drug consumption by pregnant women undergoing low-risk prenatal care and who use Primary Health Care services. Method: a cross-sectional study developed in 2016, 2018 and 2020 in a municipality from Paraná, Brazil. Consumption of drugs of abuse was screened using ASSIST 3.1. Descriptive and non-parametric statistics was used, as well as Spearman's correlation coefficient. Results: a total of 588 pregnant women were interviewed. Current use of alcohol, tobacco, marijuana and cocaine during pregnancy was verified, as well as a progressive increase in the consumption of these substances; significant correlations were found between the risk related to the consumption of drugs of abuse between them, schooling level, family income, skin color and religion. Conclusion: current consumption of one of the drugs was correlated with the others, revealing a profile of women with substance polyuse, young, primiparous, married, without their own house, medium schooling level, family income of up to two minimum wages, black- and/or brown-skinned, and catholic.

RESUMEN Objetivo: detectar el consumo de drogas en mujeres embarazadas que cursan atención prenatal de bajo riesgo y utilizan los servicios de Atención Primaria de la Salud. Método: estudio transversal desarrollado en los años 2016, 2018 y 2020 en un municipio de Paraná, Brasil. El consumo de drogas se detectó empleando ASSIST 3.1. Se utilizó estadística descriptiva y no paramétrica, además del coeficiente de Spearman. Resultados: se entrevistó a 588 mujeres embarazadas. Se verificó consumo actual de alcohol, tabaco, marihuana y cocaína durante el embarazo y un aumento progresivo en el uso de estas sustancias; se encontraron correlaciones significativas entre el riesgo relacionado con el consumo de drogas de abuso entre sí, nivel de estudios, ingreso familiar, color de piel y religión. Conclusión: se correlacionó el consumo actual de una de las drogas con las demás, revelando un perfil de usuarias con consumo de sustancias múltiples, jóvenes, primíparas, casadas, sin residencia propia, nivel de estudios medio, ingreso familiar de hasta dos salarios mínimos, de raza negra y/o morena, y católicas.

Relationship between levels of mindfulness and substance use pattern / Relação entre níveis de mindfulness e padrão do uso de substâncias

OBJECTIVE: Evaluate the association between levels of mindfulness and sociodemographic characteristics and pattern of drug use of individuals seeking treatment in a University Service Specialized in Substance Use Disorders. METHODS: This is a cross-sectional study with 164 individuals over 18 years of age seeking treatment for the use of psychoactive substances in the June 2018-December 2019 period, using a questionnaire for sociodemographic data, the Mindful Attention Awareness Scale (MAAS) self- -reporting instrument, and the Alcohol, Smoking, and Substance Involvement Screening Test. RESULTS: An association was found between low levels of mindfulness mainly with the individual risk of being a medium/high-risk user of sedative-hypnotic drugs (p = 0.020). A borderline association was also found between MAAS and the risk of the individual being a medium/high risk of alcohol (p = 0.053) and with a more severe pattern of substance use (p = 0.065). CONCLUSION: Individuals seeking treatment for substance use presented impairments in the attentional aspect of mindfulness and levels of mindfulness seem to protect against behaviors related to substance use, especially against the use of high/ moderate risk of sedative-hypnotics.

OBJETIVO: Avaliar a associação entre níveis de mindfulness e características sociodemográficas e padrão do uso de drogas de indivíduos que buscam tratamento em Serviço Universitário Especializado em Transtorno por Uso de Substâncias. MÉTODOS: Estudo de corte transversal de 164 indivíduos acima de 18 anos que buscavam tratamento para uso de substâncias psicoativas no período de junho de 2018 a dezembro de 2019, utilizando questionário para dados sociodemográficos, o instrumento de autorrelato Mindful Attention Awareness Scale (MAAS) e o Alcohol, Smoking and Substance Involvement Screening Test. RESULTADOS: Foi encontrada associação entre baixos níveis de mindfulness principalmente com o risco de o indivíduo ser usuário de médio/alto risco de sedativos-hipnóticos (p = 0,020). Também foi encontrada associação limítrofe entre MAAS com risco de o indivíduo ser usuário de médio/alto risco de álcool (p = 0,053) e com padrão mais grave de uso de substâncias (p = 0,065). CONCLUSÃO: Indivíduos que buscavam tratamento para uso de substâncias apresentaram prejuízos no aspecto atencional de mindfulness, e níveis de mindfulness parecem proteger contra comportamentos relacionados ao uso de substâncias, principalmente contra o uso de alto/moderado risco de sedativos-hipnóticos.