Estimulantes de tipo anfetamínico en estudiantes de medicina latinoamericanos: una revisión / Amphetamine-type stimulants in Latin American medicine students: a review

Introducción: el consumo de estimulantes de tipo anfetamínico (ETA) y sus derivados está cada vez más presente en los estudiantes universitarios y, en particular, en los programas de medicina. El objetivo principal de este estudio fue revisar la literatura sobre el uso de ETA y sus derivados en estudiantes de medicina latinoamericanos. Materiales y método: se realizó una revisión de la literatura disponible, utilizando las bases de datos PubMed, SciELO y LILACS. Se encontraron un total de 1.054 artículos, de los cuales 17 fueron seleccionados para esta revisión. Resultados: la revisión muestra, en general, una mayor frecuencia de uso de ETA en estudiantes de medicina de América Latina en comparación con la población general y estudiantes de otras carreras universitarias. También existe una tendencia a un mayor uso en hombres, de mayor nivel socioeconómico y en cursos posteriores del programa. La razón más informada para usar ETA fue aumentar el rendimiento académico. Como factor protector se destacaron los deportes, el tiempo en familia y la profesión de alguna creencia religiosa. De los artículos seleccionados, no se encontraron estudios sobre las consecuencias a largo plazo del uso de ETA en estudiantes de medicina. Discusión: en resumen, los estudiantes de medicina latinoamericanos tienen un alto consumo de ETA, por lo que es evidente la necesidad de nuevos estudios para mejorar la precisión estadística, determinar factores de riesgo específicos, estudiar las consecuencias a largo plazo y establecer políticas de prevención y tratamiento.

Introduction: the consumption of amphetamine-type stimulants (ATS) and their derivatives are increasingly present in university students and in particular in medical programs. The main objective of this study was to review the literature on the use of ATS and their derivatives in Latin American medical students. Materials and method: a review of the literature available was performed, using PubMed, SciELO, and LILACS databases. A total of 1054 articles were found, of which 17 were selected for this review. Results: the review generally shows a higher frequency of use of ATS in medical students of Latin America compared to the general population and students from other university degrees. There is also a tendency of a higher use in men, from higher socioeconomic status, and in later courses of the program. The most reported reason for using ATS was to increase the academic performance. As a protective factor, sports, family time and professing some religious belief stood out. Of the selected articles, no studies were found on the long-term consequences of the use of ATS in medical students. Discussion: in summary, Latin American medical students have a high consumption of ATS, and therefore there is an evident need for new studies to improve statistical precision, to determine specific risk factors, to study long-term consequences, and to stablish prevention policies and treatment.

Current Situation of Methamphetamine Abuse and Related Research Progress / 法医学杂志

Drug problem is a major social and public security problem in the world. Drug abuse poses a great threat to economic development, social stability and public health. In recent years, synthetic drugs represented by methamphetamine have surpassed traditional drugs such as morphine, heroin, ketamine and become one of the most abused drugs in the world. In order to solve the problem of drug abuse, it is of great theoretical value and practical significance to carry out all-round and multi-level scientific research on drug-related issues. Based on the current situation of drug abuse, this article reviews research progresses on the epidemiology of methamphetamine abuse, the monitoring technology, the basic researches on toxicity damage, the withdrawal drug screening, the related clinical comorbidity and the testing technologies, comprehensively presenting the development trend of methamphetamine abuse related issues.

Amphetamine-type stimulant use and conditional paths of consumption: data from the Second Brazilian National Alcohol and Drugs Survey

Objective: The aim of this study was to estimate nationally representative prevalence rates of amphetamine-type stimulant (ATS) use and to identify consumption-associated factors, proposing a conditional model of direct and indirect consumption paths. Method: Using data from the Second Brazilian National Alcohol and Drugs Survey, this cross-sectional study analyzed a subsample of 3,828 participants between 15 and 64 years old, gathering information on the use of psychoactive substances in a probabilistic sample of the Brazilian household population. Results: Rates of lifetime and last-year ATS use were, respectively, 4.1 and 1.6%. Economically privileged individuals and users of other substances were more at risk for using ATS. The results suggest that higher education decreases the chances of ATS consumption. The conditional model showed that higher income increased ATS use, higher education lowered the odds of such an increase, and cocaine use cancelled that associative effect. Conclusion: Brazil presents high rates of ATS use. Prevention and treatment strategies should focus on the protective effect of higher education levels and should target polydrug use. Knowledge of ATS-associated factors and user profiles is the starting point for developing effective treatments and tailored prevention strategies.

Bruxismo secundario al consumo recreacional de éxtasis: revisión de la literatura / Secondary bruxism after recreational ecstasy consumption: a review

El Metilendioximetanfetamina (MDMA) o éxtasis, es una droga sintética que fue accidentalmente aislada en 1914, sin encontrarse en ella una utilidad médica. La OMS la considera una droga psicotrópica y es ilegal en diversos países, incluyendo a Chile. De acuerdo al Estudio Global de Drogas Sintéticas, el consumo de éxtasis ha aumentado considerablemente en Latinoamérica entre el 2008 y 2014, estudios en Chile la muestran con una "nueva droga" cuyo consumo está aumentando en personas de 19­25 años de edad. El concepto de bruxismo en odontología ha cambiado con el paso del tiempo. Actualmente se reconoce su naturaleza multifactorial, en dónde los factores centrales (patofisiología) juegan un rol principal. Diversos autores han reportado bruxismo como un efecto secundario al consumo recreacional de éxtasis, con frecuencias que van entre el 50 a 89%. Esto puede explicarse debido al efecto de desbalance a nivel de las vías serotoninérgicas y/o domaminérgicas que produce el MDMA, tal como parece ocurrir en el bruxismo. Debido a que la Oficina de las Naciones Unidas contra la Droga y el Delito (UNODOC) advierte del aumento progresivo y significativo del consumo de éxtasis en la población joven chilena, es importante conocer las implicancias orales con la finalidad de lograr un mejor manejo odontológico, siendo necesarios mayores estudios para determinar la real asociación entre el consumo de éxtasis recreacional y bruxismo secundario.

Methylenedioxymethamphetamine (MDMA) or Ecstasy is a synthetic drug accidentally isolated in 1914, finding in it no specific medical use. The WHO considers it as a psychotropic drug and it is illegal in several countries, including Chile. According to the Global Synthetic Drugs Assessment, the use of ecstasy has increased steadily in Latin-America between the years 2008 and 2012, and studies in Chile show ecstasy as a "new drug", with an increased consumption in the 19-25 year-old age group. The concept of bruxism in dentistry has changed over time, moving to a multifactorial etiology where central factors, such as pathophysiology have a major role. Several authors report bruxism as a side effect of ecstasy consumption, at a rate of between 50 and 89%. This can be explained by the fact that MDMA acts centrally inducing imbalance at the level of serotonergic and/or dopaminergic pathways, as it occurs in bruxism. Since the United Nations Office on Drugs and Crime warns of a significant and progressive increase in the consumption of recreational ecstasy in young Chilean adult population, it is important to know there are oral implications in order to have better dental management, and further studies are necessary in order to determine an actual association between ecstasy consumption and secondary bruxism.

Occupational conditions and the risk of the use of amphetamines by truck drivers / Condições ocupacionais e o risco de uso de anfetaminas entre motoristas de caminhão

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act ("Lei do Descanso"); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

OBJETIVO Testar se as condições ocupacionais de motoristas profissionais de caminhão estariam associadas ao uso de anfetaminas após o controle do efeito de características demográficas, de saúde mental e uso de drogas.MÉTODOS Estudo transversal, com amostra não-probabilística de 684 motoristas de caminhão, do sexo masculino, recrutada em três rodovias do estado de São Paulo, durante os anos de 2012 e 2013. Foram coletadas informações demográficas, ocupacionais, sobre uso de drogas e sobre saúde mental (qualidade de sono, estresse emocional e transtornos psiquiátricos). Foi desenvolvido um modelo de regressão logística para identificar os fatores associados ao uso de anfetaminas. A razão de chances (OR; IC95%) foi definida como a medida de associação e o nível de significância considerado foi p < 0,05.RESULTADOS A amostra estudada apresentou idade média de 36,7 (DP = 7,8) anos e baixa escolaridade (8,6 [DP = 2,3] anos). O uso de anfetaminas nos doze meses prévios à entrevista foi autorrelatado por 29,0% dos motoristas. Após o controle do efeito de variáveis demográficas e ocupacionais, os fatores preditores do uso de anfetaminas entre os motoristas de caminhão foram: ter menos de 38 anos (OR = 3,69), menos de nove anos de escolaridade (OR = 1,76), ser autônomo (OR = 1,65), trabalhar em turno noturno ou turno irregular (OR = 2,05), trabalhar mais de 12 horas diárias (OR = 2,14) e usar álcool (OR = 1,74).CONCLUSÕES Os aspectos ocupacionais estão intimamente associados ao uso de anfetaminas entre motoristas de caminhão, reforçando a importância da fiscalização da lei (Lei do Descanso; Lei 12.619/2012) que regulamenta a carga horária de trabalho desses profissionais. Os resultados mostram a necessidade de haver maior rigor sobre a comercialização e prescrição das anfetaminas no Brasil.

Manter-se acordado: a vulnerabilidade dos caminhoneiros no Rio Grande do Sul / Staying awake: truck drivers' vulnerability in Rio Grande do Sul, Southern Brazil / Mantenerse despierto: la vulnerabilidad de los camioneros en Rio Grande do Sul, Sur de Brasil

OBJETIVO: Analisar os fatores associados ao uso de substâncias estimulantes por caminhoneiros para se manterem acordados. MÉTODOS: Survey com 854 motoristas em oito locais de concentração de caminhoneiros (sete postos de gasolina e um posto aduaneiro em região de fronteira) em cinco municípios do Rio Grande do Sul, em 2006. O desfecho "uso de rebite" foi categorizado em "sim" ou "não". Foi realizada análise de regressão de Poisson com variância robusta para a seleção de variáveis do modelo, que foi composto por níveis socioeconômicos, demográficos, de informações sobre a profissão e sobre o consumo de álcool. RESULTADOS: O consumo de rebite para se manter acordado foi declarado por 12,4% dos caminhoneiros de forma isolada ou em combinação com outras substâncias (café, guaraná em pó, energéticos, cocaína aspirada). O rebite foi a substância mais citada por aqueles que consumiam algo para ficar acordados. A ingestão de bebidas alcoólicas foi prática de mais de 70% dos entrevistados, dos quais 45,1% relataram consumo pelo menos uma vez por semana. O uso de rebite esteve associado às faixas etárias mais jovens, ao aumento da renda, à maior duração das viagens e ao consumo de álcool. DISCUSSÃO: O aumento da remuneração dos caminhoneiros implica aumento da carga de trabalho. Isso produz desgaste físico e emocional, levando-os a buscar solução temporária no consumo de substâncias estimulantes. A redução do consumo abusivo de álcool e do uso ilícito de substâncias como anfetaminas por motoristas profissionais depende não só de políticas voltadas para a prevenção e tratamento de drogas, mas de políticas intersetoriais articuladas que garantam melhores condições de trabalho e de saúde aos caminhoneiros.

OBJECTIVE: To analyze factors associated with the use of stimulants by truck drivers to stay awake. METHODS: A survey with 854 drivers was carried out at eight truck stops (seven gas stations and one border patrol post) located at five cities in the State of Rio Grande do Sul (Southern Brazil) in 2006. The outcome "amphetamine use" was categorized as "yes" or "no". Poisson regression analysis with robust variance was conducted in order to select the variables that would be included in the model, which was composed of variables regarding socioeconomic and demographic characteristics, information on the profession and on alcohol consumption. RESULTS: Amphetamine use to stay awake was reported by 12.4% of the truck drivers, either in isolation or in combination with other substances (coffee, guaraná powder, energy drinks, snorted cocaine). Amphetamine was the most cited substance by those who consumed something to stay awake. The consumption of alcoholic drinks was mentioned by more than 70% of the interviewees; among those who drink, 45.1% reported that they use alcohol at least once a week. Amphetamine use was associated with younger age groups, wage increase, longer trips, and alcohol use. CONCLUSIONS: The increase in the truck drivers' wages implies increased workloads. This produces physical and emotional stress, which makes the truck drivers search for a temporary solution in the consumption of stimulants. The reduction in the abusive consumption of alcohol and in the illicit use of substances like amphetamines by professional drivers depends not only on policies addressing prevention and treatment for drug abuse, but also on integrated policies ensuring better working and health conditions to the truck drivers.

OBJETIVO: Analizar los factores asociados al uso de sustancias estimulantes por camioneros para mantenerse despiertos. MÉTODOS: Sondeo con 854 en ocho locales de concentración de camioneros (siete puestos de gasolina y un puesto de aduana en región de frontera) en cinco municipios de Rio Grande do Sul, Sur de Brasil, en 2006. El desenlace, uso de la anfetamina rebite, fue categorizado en "si" o "no". Se realizó análisis de regresión de Poisson con varianza robusta para la selección de variables del modelo, que fue compuesto por variables socioeconómicas, demográficas, de informaciones sobre la profesión y sobre el consumo de alcohol. RESULTADOS: El consumo de rebite para mantenerse despierto fue declarado por 12,4% de los camioneros de forma aislada o en combinación con otras sustancias (café, guaraná en polvo, energéticos, cocaína aspirada). El rebite fue la sustancia más citada por aquellos que consumían algo para permanecer despiertos. La ingestión de bebidas alcohólicas fue práctica de más del 70% de los entrevistados, de los cuales 45,1% relataron consumo por al menos una vez por semana. El uso de rebite estuvo asociado a los grupos etarios más jóvenes, al aumento de la renta, a la mayor duración de los viajes y al consumo de alcohol. DISCUSIÓN: El aumento de la remuneración de los camioneros implica aumento de la carga de trabajo. Esto produce desgaste físico y emocional, llevando a los camioneros a buscar solución temporal en el consumo de sustancias estimulantes. La reducción del consumo abusivo de alcohol y del uso ilícito de sustancias como anfetaminas por choferes profesionales depende no sólo de políticas direccionadas hacia la prevención y tratamiento de drogas, sino también de políticas intersectoriales articuladas que garanticen mejores condiciones de trabajo y de salud a los camioneros.

Descripción del consumo de drogas lícitas e ilícitas por género a través de la metodología de pares / A gender comparison of legal and illicit drug consumption

Background: It is possible that men consume a higher amount of legal and illegal drugs than women. This can be assessed using the peer methodology, that is an adaptation of the privileged access interviewers (PAI) method and allows to identify populations in which there may be a tendency to under state a phenomenon (hidden populations) Aim: To compare the consumption of legal and illegal drugs by gender. Material and methods: Drug consumption was assessed using a peer methodology in university students between 18 and 26 years of age. Results: A random sample of 56 women (mean age 21.6 years) and 86 men (mean age 21.5 years), was studied. Women tended to report a higher proportion of tobacco consumption than men. Both genders had a similar consumption behavior of alcohol, total legal drugs, marihuana, cocaine, ecstasies and total illegal drugs. Among subjects that recognized the consumption of legal drugs, men have a higher proportion of illicit drug use and women have a higher proportion of smoking. Men have a higher awareness of the damages caused by drug consumption. Conclusions: The results in these small population sample do not support the hypothesis that men have a higher frequency and proportion of illicit drug consumption.

Uso de álcool e anfetaminas entre caminhoneiros de estrada / Alcohol and amphetamines use among long-distance truck drivers

O objetivo do estudo foi analisar a incidência do uso de álcool e anfetaminas entre caminhoneiros de estrada. Foram estudados 91 sujeitos, abordados em um posto de combustíveis em Passos, MG, em novembro de 2005. Os dados dos participantes foram obtidos por meio de um questionário contendo 19 questões de múltipla escolha. Utilizou-se para a análise dos dados estatística descritiva, teste do qui-quadrado e o coeficiente de correlação de Cramér. Os resultados indicaram que 66 por cento dos caminhoneiros usavam anfetaminas durante os percursos de viagens, principalmente em postos de combustíveis (54 por cento) à beira das rodovias. O álcool era utilizado por 91 por cento deles, dos quais 43 por cento consumiam a bebida nos postos de combustíveis. Concluiu-se que há a necessidade de campanhas preventivas e informativas voltadas para esta categoria profissional nos postos de combustíveis e empresas de transportes, alertando sobre os riscos de ingestão dessas substâncias no período de trabalho.

The purpose of the study was to assess the incidence of alcohol and amphetamine use among long-distance truck drivers. There were studied 91 truck drivers at the gas station in Passos, Southeastern Brazil, in November 2005. Data was collected using a questionnaire comprising 19 multiple choice questions. Descriptive statistics, Chi-square test and Cramér's correlation coefficient were used for data analysis. The results indicated that 66 percent of the long-distance truck drivers used amphetamines during their travels, mainly at gas stations along the highways (54 percent). Alcohol was consumed by 91 percent of them and 43 percent of them consumed it at gas stations. It is concluded that there is a need of preventive and education campaigns targeting this occupation category at gas stations and transportation companies, focusing on the risks of these substances use during working hours.

Consumo de drogas en población escolar de Chile en alumnos de 8° básico a 4° medio, 2003 / Drug use in chilean school population ranging from 8th grade basic education to 4th year middle school, 2003

Se describe el consumo de drogas en población escolar chilena que en 2003 cursaba entre el 8° básico y el 4° año medio. Los datos corresponden al Quinto Estudio Nacional de Drogas en Población Escolar de Chile, 2003. Se determinó que la tasa de consumo reciente de cualquier droga ilícita para el grupo de estudio es de 13,66 por ciento, donde el 94 por ciento se concentra en estudiantes que usan marihuana. La tasa de consumo reciente de alcohol y cigarrillos alcanza a 61,15 por ciento y 51,54 por ciento, respectivamente. Los hombres presentan consumos recientes de drogas ilícitas más altos que las mujeres, aunque sólo las superan en 3 puntos porcentuales en marihuana; sin embargo, los usos recientes de pasta base y de cocaína se encuentran en una razón de 2:1. La tendencia del consumo en el bienio 2001-2003, de acuerdo a la prevalencia de último año, registra una disminución del consumo de marihuana y cigarrillos. La disponibilidad de drogas y la baja percepción de riesgo favorece el uso de estas sustancias.

The validity of peer responses as a tool for screening at-risk students: a preliminary analysis.

Students are becoming the majority of new amphetamine users in Thailand. This study compared urinalysis results with peer responses to individual characteristics related to substance use with the aim of identifying "at-risk" students. A randomly selected group of students from a public high school in northern Thailand was asked to fill out the names of classmates they viewed as having any of forty-three risk behaviors set out in a questionnaire. A total of 564 students were included, from whom urine specimens were collected on the first two days following the school break. An immunoassay test was used to screen the specimens and positive results were confirmed using thin-layer chromatography. About 4% of urinalysis results were methamphetamine-positive. Using urine test results as the standard, the sensitivity of peer responses to alienated behavior was 81.8%, while frequent class/school absenteeism and low concentration levels were somewhat lower, at 77% and 68%, respectively. Delinquency showed the least sensitivity at 50%. The McNemar chi2 test showed significant differences between urine test results and each peer response subscale (p < 0.001). This preliminary analysis has shown that peer responses with regard to substance-related behavior compare well with urine test results.

Increasing trend of illicit drug abuse in Thai parturient at Siriraj Hospital.

OBJECTIVE: To report the magnitude of the problem and to evaluate the outcome of maternal illicit drug use in Thai parturients. DESIGN: Retrospective case-control study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECT: The subjects were 44,640 parturients who had deliveries at Siriraj Hospital from January 1998 to December 2001 and were divided into two groups. The study group consisted of 66 parturients with a history of illicit drug use and the control group consisted of 44,574 parturients without a history of illicit drug use. INTERVENTION: Medical records of 66 parturients with a history of illicit drug use were reviewed. Obstetric statistics of the department were retrieved from the computerized database in the Division of Obstetric and Gynecologic Registry. The data were analyzed using descriptive statistics. MAIN OUTCOME MEASURE: Characteristics of parturients, pregnancy outcome, type and incidence of illicit drug. RESULTS: Within the study period, 66 cases of maternal illicit drug use were identifiable during the intrapartum period; 65 cases used amphetamine or derivatives and 1 case used an opioid derivative. The number had risen from 1 case in 1998 to 58 cases in 2001. Mean age of the patients was 23.30 +/- 6.04 years. Compared to the control group which included 44,574 parturients, the patients had a lower incidence of antenatal care (ANC rate = 21.21% vs 94.35%; RR = 0.23, 95% CI = 0.14-0.26), a higher incidence of HIV infection (10% vs 2%; RR = 6.09, 95% CI = 2.83-13.12), a higher incidence of birth before arrival (BBA rate = 9.09% vs 1.06%; RR = 8.59, 95% CI = 3.98-18.51), and a lower cesarean section rate (10.60% vs 26.36%; RR = 0.40, 95% CI = 0.20-0.81). There were no serious intrapartum, immediate postpartum and neonatal complication. Fetal outcome included a higher incidence of low birth weight infants (22.73% vs 10.23%; RR = 2.22, 95% CI = 1.42-3.46) and a smaller head circumference than the normal range of Thai fetal biometry (31.85 +/- 1.47 cm). CONCLUSION: There is an increasing trend of illicit drug use in Thai parturients. Although the present case series of drug abuse in Thai parturients cannot give the whole picture of maternal drug abuse in the Thai population, the dramatic increase in the identifiable cases during the past 4 years is very alarming. Currently, the outcome of pregnancy in case detected during intrapartum is not much different from that in the general population. However, there are potential risks for the patients and their babies. All medical staffs should be aware of this condition. Careful clinical data gathering and laboratory testing are suggested for prevention of complications and the potential hazards of this problem.

Substance abuse treatment policy implications derived from routine statistical reports.

Substance abuse poses both economic and social threats. Medical treatments for substance abusers are considered as one of the main strategies to tackle with the problems. For each episode of cases seeking medical treatments, data are routinely collected and reported to the Department of Medical Services and copies to the Office of Narcotics Control Board of Thailand. However, they are rarely analyzed and used. This paper demonstrates an example how a basic analysis, with occasional substantiation from other databases or basic knowledge, can lead to meaningful policy options for medical treatments of substance abuse in the near future.

Consumo de drogas en Chile: resultados del estudio nacional 1994 / Drug comsumption in Chile: national study results, 1994

Con el objeto de evaluar el consumo de drogas en Chile, se realizó un estudio descriptivo en la población de 12 a 64 años. La muestra está referida a la población de las ciudades de al menos 50.000 habitantes en las 12 regiones de Chile. El muestreo fue probabilístico trietápico. El 13.42 por ciento declaró haber consumido alguna droga ilícita en su vida. Este porcentaje está fuertemente marcado por el consumo de marihuana. Por otra parte, el 3.12 por ciento declaró haber iniciado el consumo durante el último año. El consumo de drogas ilícitas es bastante más frecuente en hombres que en mujeres, en razón de 3 a 1. Sin embargo, dicha razón baja a 2 a 1 en el caso de los jóvenes entre 12 y 18 años. El consumo de alcohol y tabaco muestra prevalencias, en el último mes, de aproximadamente 40 por ciento en cada caso