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1.
Int J Environ Res Public Health ; 19(12)2022 06 16.
Article in English | MEDLINE | ID: covidwho-1896866

ABSTRACT

(1) Background: During the SARS-CoV-2 (COVID-19) pandemic, cannabis use increased relative to pre-pandemic levels, while forced home confinement frequently caused sleep/wake cycle disruptions, psychological distress, and maladaptive coping strategies with the consequent appearance of anxiety symptoms and their potential impact on substance use problems. (2) Aim: Long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. The present work aims to investigate the effectiveness of trazodone in optimizing the condition of people with cannabis dependence under pandemic conditions. (3) Methods: All cases with cannabis use disorder were uniformly treated with long-acting trazodone 150 mg or 300 mg/day; their craving and clinical status were monitored through appropriate psychometric scales. Side effects were recorded as they were reported by patients. We described the cases of three young patients-one man and two women-who were affected by chronic cannabis use disorder and who experienced lockdown-related psychological distress and sought psychiatric help. (4) Results: The described cases highlight that the once-a-day formulation of trazodone seems to have a therapeutic role in patients with cannabis use disorder and to guarantee tolerability and efficacy over time. No significant side effects emerged. (5) Conclusions: The use of long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. Trazodone deserves to be studied in terms of its efficacy for cannabis use disorder.


Subject(s)
COVID-19 , Cannabis , Hallucinogens , Marijuana Abuse , Substance-Related Disorders , Trazodone , COVID-19/drug therapy , COVID-19/epidemiology , Communicable Disease Control , Female , Humans , Male , Marijuana Abuse/drug therapy , Pandemics , SARS-CoV-2 , Substance-Related Disorders/drug therapy , Trazodone/adverse effects , Trazodone/therapeutic use
2.
Int J Environ Res Public Health ; 19(6)2022 03 11.
Article in English | MEDLINE | ID: covidwho-1765710

ABSTRACT

This article examines the relaxation of state marijuana laws, changes in adolescent use of marijuana, and implications for drug education. Under federal law, use of marijuana remains illegal. In spite of this federal legislation, as of 1 June 2021, 36 states, four territories and the District of Columbia have enacted medical marijuana laws. There are 17 states, two territories and the District of Columbia that have also passed recreational marijuana laws. One of the concerns regarding the enactment of legislation that has increased access to marijuana is the possibility of increased adolescent use of marijuana. While there are documented benefits of marijuana use for certain medical conditions, we know that marijuana use by young people can interfere with brain development, so increased marijuana use by adolescents raises legitimate health concerns. A review of results from national survey data, including CDC's YRBS, Monitoring the Future, and the National Household Survey on Drug Use, allows us to document changes in marijuana use over time. Increased legal access to marijuana also has implications for educational programming. A "Reefer Madness" type educational approach no longer works (if it ever did). We explore various strategies, including prevention programs for education about marijuana, and make recommendations for health educators.


Subject(s)
Cannabis , Hallucinogens , Medical Marijuana , Substance-Related Disorders , Adolescent , Evidence-Based Medicine , Humans , Legislation, Drug , Medical Marijuana/therapeutic use , Public Health , Substance-Related Disorders/drug therapy , United States
3.
Adv Pharmacol ; 93: 403-441, 2022.
Article in English | MEDLINE | ID: covidwho-1650856

ABSTRACT

The number of people who suffer from a substance abuse disorder has continued to rise over the last decade; particularly, the number of drug-related overdose deaths has sharply increased during the COVID-19 pandemic. Converging lines of clinical observations, supported by imaging and neuropsychological performance testing, have demonstrated that substance abuse-induced dysregulation of neurotransmissions in the brain is critical for development and expression of the addictive properties of abused substances. Recent scientific advances have allowed for better understanding of the neurobiological processes that mediates drugs of abuse and addiction. This chapter presents the past classic concepts and the recent advances in our knowledge about how cocaine, amphetamines, opioids, alcohol, and nicotine alter multiple neurotransmitter systems, which contribute to the behaviors associated with each drug. Additionally, we discuss the interactive effects of HIV-1 or COVID-19 and substance abuse on neurotransmission and neurobiological pathways. Finally, we introduce therapeutic strategies for development of pharmacotherapies for substance abuse disorders.


Subject(s)
Behavior, Addictive , COVID-19 , Substance-Related Disorders , Behavior, Addictive/drug therapy , Humans , Pandemics , Substance-Related Disorders/drug therapy , Synaptic Transmission
4.
Eur J Pharmacol ; 904: 174143, 2021 Aug 05.
Article in English | MEDLINE | ID: covidwho-1487708

ABSTRACT

Disulfiram (DSF) is a well-known anti-alcohol agent that inhibits aldehyde dehydrogenase and results in extreme 'hangover' symptoms when consumed with alcohol. This drug, however, has been suggested as useful in other forms of drug addiction due to its beneficial potential in both drug abuse reduction and withdrawal. However, among other drugs used in alcohol dependence, it carries the greatest risk of pharmacological interactions. Concomitant use of DSF and central nervous system stimulants usually leads to harmful, undesirable effects. To date, there is still limited data regarding the detailed safety profile of DSF as a concomitant drug. In this review article, we outline the current state of knowledge about DSF, its broad pharmacological action, as well as therapeutic effects, with a particular emphasis on the molecular understanding of its potential pharmacodynamic interactions with common addictive substances (e.g., alcohol, cocaine, cannabinoids, opioids) supported by relevant examples.


Subject(s)
Acetaldehyde Dehydrogenase Inhibitors/pharmacology , Acetaldehyde Dehydrogenase Inhibitors/therapeutic use , Disulfiram/pharmacology , Disulfiram/therapeutic use , Substance-Related Disorders/drug therapy , Alcohol Drinking/prevention & control , Alcoholism/drug therapy , Animals , Disulfiram/adverse effects , Drug Interactions , Humans
5.
Drug Alcohol Depend ; 221: 108617, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1082129

ABSTRACT

BACKGROUND: The COVID-19 pandemic significantly altered treatment delivery for opioid treatment programs (OTPs) dispensing medications for opioid use disorder (MOUD). We aimed to identify patterns of substance use among MOUD patients and examine whether COVID-19-related impacts on access to healthcare varied across subgroups. METHODS: This analysis was embedded within a type 3 hybrid trial that enrolled patients across eight OTPs at the start of the pandemic. Enrolled patients reported on past-30 day use of multiple substances during their baseline assessment. Participants re-contacted in May-July 2020 completed a survey about COVID-19-related impacts on various life domains. Using latent class analysis we identified patient subgroups, and then examined group differences on a set of negative and positive COVID-19 impacts related to healthcare access. RESULTS: Of the 188 trial participants, 135 (72 %) completed the survey. Latent class analysis identified three MOUD patient subgroups: minimal use (class probability: 0.25); opioid use (class probability: 0.34); and polysubstance use (class probability: 0.41). Compared to the minimal use group, the polysubstance use group reported increased substance use and difficulty accessing sterile needles, naloxone, and preferred substance. The opioid use group reported increased substance use and difficulty accessing their preferred substance. There were no significant group differences related to accessing routine or specialized healthcare or medication; or paying attention to their health. CONCLUSIONS: During COVID-19, many MOUD patients reported challenges accessing care, particularly harm reduction services for patients with polysubstance use. Additional efforts, like providing wraparound support, may be necessary to serve the needs of MOUD patients.


Subject(s)
Health Services Accessibility/statistics & numerical data , Latent Class Analysis , Opiate Substitution Treatment/statistics & numerical data , Substance-Related Disorders/drug therapy , Adult , Buprenorphine/therapeutic use , COVID-19/epidemiology , Clinical Trials as Topic , Cross-Sectional Studies , Female , Harm Reduction , Health Services Accessibility/trends , Humans , Male , Methadone/therapeutic use , Naloxone/therapeutic use , New England/epidemiology , Opiate Substitution Treatment/trends
6.
J Subst Abuse Treat ; 121: 108181, 2021 02.
Article in English | MEDLINE | ID: covidwho-885359

ABSTRACT

Syringe exchange patients in Los Angeles' Skid Row endure conditions such as deep poverty, polysubstance use, underlying health problems, and living on the streets or in homeless encampments/shelters that make them uniquely vulnerable to acquiring and dying from COVID-19. In this commentary, we discuss two essential changes that Homeless Health Care Los Angeles (HHCLA) made to modify existing medication for addiction treatment (MAT) services to address the specific treatment needs of this high-risk population during COVID-19. First, HHCLA implemented a novel "telephone booth" model that allowed socially distanced on-site "face-to-face" treatment of syringe exchange patients; this model helped us to overcome the inherent challenges of using traditional telemedicine approaches (e.g., video, mobile telephone) with this disadvantaged patient population. Second, HHCLA transitioned from on-site direct dispensing of MAT medications in our providers' offices to a less contact- and time-intensive "coordinated pharmacy" model that allowed patients the freedom to obtain MAT medications off-site from participating pharmacies. Our data indicate that implementing these COVID-19-related changes effectively maintained patient enrollment and engagement in MAT-illuminating new, potentially effective models for delivering MAT that meet the critical health and safety needs of syringe exchange patients following COVID-19.


Subject(s)
COVID-19 , Homeless Persons , Needle-Exchange Programs , Pharmacies , Substance-Related Disorders/drug therapy , Telemedicine , Humans , Los Angeles , Vulnerable Populations
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