Estimating the Prevalence of Using Suspected Counterfeit Medications in the General Population.

INTRODUCTION: Counterfeit medications, sometimes referred to as "fake" or falsified drugs or pills, are drugs that are illicitly manufactured but designed to look like legitimate pharmaceuticals. Counterfeit medications are a growing public health concern. This study estimated the prevalence of self-reported use of suspected counterfeit medications by adults in the US and to assess what ingredients these individuals suspected were in the counterfeit medications. METHODS: This general population survey, drawn from an online panel, was administered across 2 waves in 2022 (15 April 3 June and 9 September 21 October) to 59,041 adults aged 18 and older. Statistical calibration weighting was used to calculate estimates representative of the national adult population. RESULTS: An estimated 1.8% (95% CI 1.7%-1.9%) of respondents, corresponding to approximately 4.6 million adults, suspected past 12-month use of counterfeit medications. Fentanyl was the most commonly suspected ingredient in the counterfeit product (16.1%, 95% CI 12.8%-19.3%). The next most prevalent response was "I don't know" (15.0%, 95% CI 11.0%-18.9%) followed by methamphetamine (14.9%, 95% CI 11.4%-18.4%). CONCLUSIONS: These data show the scale of the issue in relation to other well established drug use data points in the US. System-level methods, such as drug scanning software, should be implemented to reduce the likelihood that counterfeit drugs end up in the hands of individuals.

Trends in Characteristics of Prescription Opioid-related Poisonings among Older Adults in the United States, 2015-2021.

OBJECTIVES: Few studies have considered how trends in opioid poisonings have changed among older adults. The objective of this study was to examine trends in fatal and nonfatal opioid-related poisonings ("exposures") among older adults. METHODS: National poison center data were used to examine trends in characteristics of reported exposures to commonly prescribed opioids between 2015 and 2021 among adults 60 years or older. We estimated the proportion of opioid exposures by demographic characteristics, the specific opioid(s) involved, exposure type, route of administration, other substances co-used, and medical outcomes for each calendar year. We estimated whether there were linear changes in prevalence by year using logistic regression. RESULTS: Although there was a decrease in the number of opioid exposures within the study population from 7706 in 2015 to 7337 in 2021 (a 4.8% decrease, P = 0.04), exposures increased for adults aged 70 to 79 years (a 14.0% increase, P < 0.001). The proportion classified as "abuse" increased by 63.3% ( P < 0.001). There were significant decreases in the proportion involving hydromorphone (a 23.3% decrease, P < 0.001) and morphine (a 22.0% decrease, P < 0.001), with an increase involving buprenorphine (a 216.0% increase, P < 0.001). The proportion increased for co-use of cocaine (a 488.9% increase, P < 0.001) and methamphetamine (a 220.0% increase, P = 0.02), with a decrease in co-use of benzodiazepines (a 25.5% decrease, P < 0.001). The proportion of major medical outcomes increased by 93.9% ( P < 0.001). CONCLUSIONS: National patterns of opioid-related poisonings are shifting among older adults, including the types of opioids involved and co-use of other drugs. These results can inform prevention and harm reduction efforts aimed at older adults.

Characteristics of poisonings involving ketamine in the United States, 2019-2021.

BACKGROUND: The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression. AIMS: We examined recent trends in adverse effects related to ketamine use. METHODS: US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (n = 758). We examined quarterly trends in exposure and delineated correlates of patients experiencing a major adverse effect or death. RESULTS: The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (p = 0.018). The majority of patients were male (57.1%), and the plurality of cases involved intentional misuse or "abuse" (39.5%), followed by suspected suicide attempt (19.7%) and unintentional exposure (18.9%). A fifth (19.6%) experienced a major adverse effect or death. A third (33.4%) co-used other drugs; the drugs most commonly co-used were benzodiazepines (14.6%), alcohol (10.3%), and opioids (8.7%). Co-use of gamma-hydroxybutyrate (GHB; adjusted prevalence ratio (aPR) = 3.43, 95% confidence interval (CI): 1.57-7.46) and opioids (aPR = 2.44, 95% CI: 1.46-4.08) was associated with increased risk for a major adverse effect or death, as was injection-only administration (aPR = 2.68, 95% CI: 1.21-5.92). CONCLUSIONS: Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use-particularly with opioids or GHB-appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed.

Parents' Mental Health Experiences during the Perinatal Transition: A Qualitative Study.

Capturing the voices of both parents regarding perinatal mental health is imperative. This qualitative study employed a purposive sampling technique to interview 23 individuals, including mothers, partners, and perinatal practitioners/educators. Qualitative data analysis utilized an inductive, data-driven approach. Four themes emerged. First, mothers' perception of risk of postpartum depression (PPD) changed over time and with subsequent children. Theme two focused on identity loss. Third, the stay-at-home parent often feels unrecognized by their partner. Fourth, a PPD prevention class for parents should include certain key elements. These themes can aid practitioners in prioritizing the needs of parents during the perinatal period.

Women's Mental Health and Wellbeing in the Interconception Period.

PURPOSE: Promoting women's health during the interconception period is critical for the health of future pregnancies. METHODS: This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey. RESULTS: Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period. CLINICAL IMPLICATIONS: Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted.

Exploring Predictors of Social Distancing Compliance in the United States during the COVID-19 Pandemic.

OBJECTIVE: Through the application of the Health Belief Model, this study sought to explore how relationships between perceived susceptibility, severity, and benefits of social distancing recommendations, as well as psychological factors, may impact compliance with COVID-19 social distancing recommendations in the United States. METHODS: Between October and November 2020, a convenience sample of English-speaking adults in the United States completed an online, cross-sectional survey which included items assessing beliefs around threats (e.g., perceived susceptibility and severity), response efficacy (e.g., perceived benefits), psychological factors (e.g., stress and COVID-specific anxiety), and compliance with social distancing measures (e.g., avoiding social gatherings). RESULTS: Social distancing compliance was positively associated with perceived susceptibility of COVID-19 (b = 0.42, P < 0.05) and perceived benefits of social distancing recommendations (b = 0.81, P < 0.01). No significant associations were found between perceived severity of COVID-19 (P = 0.38), general stress (P = 0.28), COVID-19-related anxiety (P = 0.12), and compliance. CONCLUSIONS: Findings suggest that perceived susceptibility to COVID-19 and perceived benefits of social distancing measures significantly increased compliance with social distancing recommendations in this convenience sample of U.S. adults.

Mental Health During the COVID-19 Pandemic in the United States: Online Survey.

BACKGROUND: The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. OBJECTIVE: This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. METHODS: Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19-specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19-specific concerns, and mental health and well-being outcomes. RESULTS: Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (-0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). CONCLUSIONS: Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media.

The effect of exercise on mental health.

Including exercise for the prevention and treatment of mental disorders is a promising area of research for exercise scientists since data indicate that many of these disorders are not treated at all, and there is a significant delay in treatment. This review provides an appraisal of the recent use of exercise to prevent and treat specific mental disorders and provides a recommended framework for future progress of this research. More research is needed to overcome methodological issues to demonstrate the efficacy and effectiveness of exercise and to integrate mental and physical healthcare for widespread dissemination.

Prevalence of self-reported postpartum depression specific to season and latitude of birth: evaluating the PRAMS data.

To determine whether season of infant birth or amount of daylight at time and location of birth is a risk factor for self-reported postpartum depression (PPD). The primary hypothesis was that the prevalence of PPD will peak during the darkest winter months. A cross-sectional analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 5 (2004-2006) data set (N = 67,079). Self-reported PPD was established using a modified version of the Patient Health Questionnaire-2 (PHQ-2) included in the PRAMS questionnaire. Logistic regression for complex survey design was used to determine odds ratios and 95% confidence intervals. No significant relationship was found between mild or moderate PPD and either season of birth or length of daylight at birth. By analyzing a large, multi-state sample, this study adds to the equivocal preexisting literature suggesting that there is no significant relationship between the season of birth or length of daylight at birth and PPD.