Analytical reliability of four oral fluid point-of-collection testing devices for drug detection in drivers.

BACKGROUND: Point-of-collection testing (POCT) devices for psychoactive substance detection through oral fluid samples are used in several countries for traffic enforcement. However, the reported reliability of such devices is quite heterogeneous among studies, and evaluating and comparing their analytical performance is of paramount importance to guide enforcement policies. AIM: To evaluate the analytical reliability of four POCT devices for the detection of cocaine and cannabinoids using oral fluid samples of Brazilian drivers. METHOD: A total of 168 drivers were recruited during standard roadblockfI procedures in Southern Brazil. Subjects were screened using one of the following POCT devices: the DDS2™, the DOA MultiScreen™, the Dräger Drug Test 5000™ and the Multi-Drug Multi-Line Twist Screen Device™ (MDML). Results of the screening tests were compared with chromatographic analyses in order to obtain the reliability parameters. RESULTS: The prevalence of confirmed positive samples for cocaine and cannabinoids were 9 % and 4.4 %, respectively. For cocaine, three POCT devices (MDML™, Dräger DrugTest 5000™, DOA MultiScreen™) showed good reliability, greater than 80 % of performance measures, using guidelines for research on drugged driving published by Walsh et al. (cutoff 10ng/mL). However, for cannabinoids, the devices had low reliability-only Dräger DrugTest 5000™ had good performance using cut-offs proposed by Walsh et al. (cutoff 2ng/mL). CONCLUSION: We observed a high prevalence of drivers testing positive for cocaine and cannabinoids. Most devices achieved good reliability performance for cocaine detection using cutoffs proposed by Walsh et al. or using the device's own cutoff. Instead, the reliability for cannabinoid detection obtained the desired parameters in just one device using cut-offs proposed by Walsh et al. and its own cutoff. Difficulties in detecting cannabinoids at the roadside should be better evaluated before the implementation of such tests.

Mental disorders and delivery motorcycle drivers (motoboys): a dangerous association.

OBJECTIVE: Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers ("motoboys") are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets. METHOD: A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews. RESULTS: A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p=0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p=0.007). CONCLUSIONS: The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.

Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: need for data and structure.

OBJECTIVES: Few studies of comorbidity among cocaine users have been undertaken in Brazil, despite the fact that cocaine is one of the most commonly used illegal drugs in the country. The aim of this paper is to review existing data on psychiatric evaluations of cocaine users, and present data from two studies that have addressed this issue as it pertains to the Brazilian public health system. STUDY DESIGN: Review and results from two studies (cross-sectional and matched control). METHODS: The Brazilian literature on PubMed, Lilacs, Psychinfo and DATASUS was searched using the key words: 'psychiatric symptoms', 'diagnosis', 'evaluation', 'assessment', 'cocaine disorders' and others related to this issue. Intake data from two studies of male and female cocaine users were also analysed with regard to psychiatric symptoms as measured by the Symptom Check List - 90 Revised (SCL-90). RESULTS: The literature review found no specific studies regarding psychiatric evaluation of cocaine users in Brazil. Analyses from the two studies presented showed high levels of psychiatric symptoms in this population. In the first study, psychiatric symptoms were measured at treatment entry and their prevalence was high, ranging from 27.4% to 53.4%. In the second study, SCL-90R scores at programme admission were higher in cocaine users than normal controls, with effect sizes ranging from moderate to high. CONCLUSIONS: To the authors' knowledge, this is the first article to discuss psychiatric evaluations of comorbidity among cocaine users in Brazil. The results indicate a need to: pay more attention to the evaluation of psychiatric symptoms in cocaine users; emphasize the importance of standardized data collection in this area; and evaluate the course of these symptoms, their impact on outcome, and how they are best addressed in treatment.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder.

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100%) and cocaine users (N = 7; 43.8%). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100 percent) and cocaine users (N = 7; 43.8 percent). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.

Tailoring an HIV-prevention intervention for cocaine injectors and crack users in Porto Alegre, Brazil.

Brazil has the second largest number of reported AIDS cases in the world. Porto Alegre, like most other large urban centres in Brazil, has been greatly impacted by an AIDS epidemic driven by high rates of drug use and risky sexual behaviours. While epidemiologic surveillance of HIV/AIDS and treatment initiatives for HIV-infected individuals are well developed in Brazil, comparatively little attention has focused on developing interventions directed toward high-risk populations. Intervention programmes, particularly those tailored for chronic drug users, are lacking. This pilot project successfully adapted and tailored a cognitive behavioural HIV intervention developed in the US to the cultural setting in Porto Alegre. The project established feasibility and acceptability of the approach for targeting risky drug and sexual behaviours among a group of male Brazilian drug users. A sample of 120 male cocaine users was recruited from a public health clinic serving the target population in the city of Porto Alegre. The average age of the participants was 29; they averaged less than 8 years of formal education; and less than half (41%) were married. Lifetime self-reported drug use was high with 93% reporting cocaine use, 87% reporting crack use, and 100% reporting marijuana use. 43% of the sample reported ever injecting drugs. Reports of risky sexual behaviours were similarly elevated. Almost half (45%) tested positive for HIV. Preliminary evidence suggests that intervention acceptability was high among participants. Given the reported high risk sexual and drug use behaviours among these men, HIV interventions must be evaluated and expanded to include this population as well as their sexual partners.

Uso de drogas y riesgos relacionados con el VIH/sida en diferentes muestras / Drug use and related risks associated with HIV/AIDS in different samples of Porto Alegre, Brasil

Objetivos: Elaborar un panorama de sida/VIH (virus de la inmunodeficiencia humana) y uso de cocaína en Porto Alegre (Brasil), proporcionar una breve descripción de estudios conducidos por nuestro grupo de investigación y comentar los resultados especulando en un modelo parcial de exposición al VIH fundamentado en los datos encontrados. Material y método: Se presentan datos de corte transversal de 6 muestras con el propósito de comparar las tasas de prevalencia del VIH, así como características demográficas y uso de drogas. En estas 6 muestras se incluyeron los más variados tipos de usuarios de drogas, y las técnicas de muestreo utilizadas según el estudio muestra albo, fueron referenciales en cadena y procedimientos de bola de nieve. Los individuos fueron sometidos a test de seropositividad para VIH en los centros públicos de información y prevención hacia el VIH o en el Laboratorio del Hospital de Clínicas de Porto Alegre. La variable independiente fue el uso de drogas, con énfasis en la cocaína, que se midió con el uso de la tercera versión de la Risk Assessment Battery. Se analizaron cada una de las muestras por separado y luego se compararon las seroprevalencias con el test de la χ² y pruebas de comparaciones múltiples. Resultados: Puede observarse un dramático aumento («dosis-respuesta») en la prevalencia encontrada en estos estudios, en lo que se refiere a la seropositividad VIH, directamente relacionado con el modo de utilización de la sustancia; en las muestras en que predominan usuarios de cocaína inyectable y crack las seroprevalencias fueron claramente mayores que las muestras de usuarios recreacionales o no usuarios de drogas inyectables. Un resultado paralelo impactante fue la fuerte asociación entre una baja escolaridad, bajo salario y trabajo irregular con la alta seroprevalencia. Conclusiones: Hacemos comentarios por una perspectiva histórica, una vez que todos los estudios fueron conducidos entre 1995 y 2004, período en el que en la epidemia de sida empezó a observarse una clara disminución en el número de casos debidos al uso de droga inyectable, y un aumento en las infecciones por transmisión heterosexual, sobre todo en mujeres. Existe una gran demanda de intervenciones preventivas, especialmente para los medios más pobres, con usuarios con un nivel de educación más bajo, y en centros urbanos grandes como Porto Alegre que enfrentan diferentes riesgos asociados con la combinación de estas variables y la posibilidad de adquirir o diseminar el VIH

Objectives: To generate a panorama of HIV/AIDS and its relationship with cocaine consumption in Porto Alegre, Brazil, with a brief overview of the studies conducted by our research group, as well as to discuss its results, by means of a partial model of exposure to HIV that is based on the data described. Materials and method: We present cross-sectional data from six samples, with the purpose of comparing the HIV prevalence rates, as well as demographics and drug use. We included in these samples different types of drug users, and the sampling techniques used were target sampling, chain referral and snowballing. Subjects had blood collected for HIV in public health and prevention centers, as well as the Laboratory of Hospital de Clinicas of Porto Alegre. The independent variable of analysis was drug use --with emphasis on cocaine--, measured via the third Brazilian version of the Risk Assessment Battery. All samples were independently analyzed, and their seroprevalences were compared, using the χ² test and tests of multiple comparisons. Results: We can observe a dramatic rise («dose-response») in the prevalence found in these studies, with regard to HIV seropositivity being directly related to the mode of drug use: in the samples were injecting drug users and crack users predominate, seroprevalence was clearly higher than in recreational samples or with no injection drug use. A parallel result of some impact was the strong association between low schooling, low income, irregular work and seroprevalence. Conclusions: We comment on the bias of a historical perspective, since all studies have been conducted between 1995 and 2004, when the AIDS epidemic started to show a clear decrease in the overall number of cases due to injection drug use, and an increase in the infections due to heterosexual transmission, particularly among women. There is a great demand for preventive interventions, particularly among the poor environments, with drug users of low school background, and in large urban centers such as Porto Alegre, which are facing different risks associated with the combination of those variables and the possibility of acquiring or transmitting the virus

Psychometric properties of the World Health Organization quality of life instrument (WHOQoL-BREF) in alcoholic males: a pilot study.

OBJECTIVE: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. METHODS: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). RESULTS: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. CONCLUSIONS: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.

[Limitations and alternatives to the implementation of a program for drug users at risk of HIV infection using the Social Network Approach]. / Limites e alternativas para a implementação de um programa para dependentes químicos em risco para infecção pelo HIV utilizando o conceito de Rede Social.

The authors describe the development of a preventive program focused on intravenous drug users at risk of HIV infection, using the Social Network Approach as the intervention model. The authors describe the project's steps in a large university hospital in southern Brazil, emphasizing the unique methods and techniques developed by the treatment staff. Problems encountered during the project development are discussed, aimed at identifying the reasons why the program only achieved partial success. The authors identify critical issues, such as the use of a new technique not previously tried in Brazil, difficulties in maintaining IV drug users in treatment, lack of infrastructure for walk-in treatment, and the challenge of motivating staff and patients to continue treatment. The authors conclude by listing suggestions aimed at facilitating the development of new projects based on the same conceptual model.

Patterns of alcohol use among adolescents living in Porto Alegre, Brazil.

A cross-sectional household survey was used to assess patterns of alcohol experimentation and consumption among Brazilian adolescents, stratified by age and sex. Trained interviewers administered a standardized questionnaire to 950 subjects, ages 10 to 18, which examined such things as age of first alcohol use, situational aspects of consumption, amounts ingested and use among peers. Lifetime prevalence of alcohol use was high (71.5%), especially in the older teens (94.4%). The mean age of first use was 10 years, and consumption of all types of alcohol, including hard liquor, was common. Alcohol use typically began in the home, at family celebrations and social occasions, and progressively evolved to street drinking with peers. This pattern was most evident in males, who reported a larger volume of alcohol consumption per episode, when compared to females. The total amount of alcohol consumption reported for all ages is very high and may be due to permissive cultural views of alcohol. Age and gender play an important role in the evolution of drinking, with male adolescents being exposed to higher concentrations of alcohol and at younger ages than females, who seem to have a more conservative attitude toward excessive drinking. Subjects considered these practices normal, with no concern about the illegality of such behaviors.

Treatment for alcohol and other drug problems in Brazil: a puzzle with missing pieces.

This article describes the characteristics and problems of drug abuse treatment settings in Brazil, both for inpatient and outpatient modalities. Examples from the author's own clinical experience as consultant and researcher working in different parts of the country are used to illustrate the numerous disadvantages of the existing care system, with clear detriment to patients and to positive treatment outcome. In addition, the inadequacy and insufficiency of the training system for therapists and counselors is described, with particular emphasis on the distortions of the already existing models.

Consumo de benzodiazepínicos em Porto Alegre / Benzodiazepinics comsumption in Porto Alegre

Os benzodiazepínicos (BDZ) vêm sendo utilizados em larga escala para o controle da ansiedade e outras condiçöes clínicas desde que foi introduzida sua comercializaçäo na década de 60. Nos últimos anos, diversos estudos têm apontando seu uso indiscriminado, contribuindo para aumentar a morbidade associada, bem como a busca por outras substâncias calmamente de acesso mais fácil. OBJETIVO. Estimar a prevalência do uso de benzodiazepínicos e calmantes caseiros na populaçäo adulta de Porto Alegre, TS. MÉTODOS. 480 habitantes do município de Porto Alegre, RS, com idade igual ou superior a 18 anos, selecionados através de amostragem aleatória por conglomerados (setores censitários do IBGE), foram entrevistados em seus domicílios durante o mês de junho de 1991. RESULTADOS. As prevalências do uso de BDZ na vida, no último ano e no último mês, foram, respectivamente, 46,7 por cento, 21,3 por cento e 13,1 por cento. Entre as mulheres e os viúvos ou separados a prevalência foi significativamente maior. A maioria dos indivíduos que usaram BDZ no último mês o fizeram, no mínimo, 2 a 3 dias por semana. Mais de 40 por cento dos entrevistados relataram uso freqüente de substâncias caseiras para "acalmar", sendo 28,8 por cento a prevalência do uso no último mês. CONCLUSAO. O uso de substâncias químicas para aliviar a ansiedade e outros sintomas está difundido entre a populaçäo. A legislaçäo, nem sempre respeitada, tem sido insuficiente para disciplinar o uso. É necessário compreender a complexidade de razöes para que a situ-açäo se mantenha e investir em medidas para educar médicos e populaçäo quanto ao uso adequado dos BDZ, além de buscar reguladoras ao nível da lei que sejam mais eficientes

[Benzodiazepine consumption in Porto Alegre]. / Consumo de benzodiazepínicos em Porto Alegre.

Benzodiazepines has been largely used to control anxiety and other clinical pictures since it began to be traded in the 60's. In recent years, many studies have shown that they are used indiscriminately, contributing to increase associated morbidity, and to search for other more accessible tranquilizers. PURPOSE--To estimate the prevalence of benzoadiazepine and over-the-counter tranquilizers use in adults living in Porto Alergre-RS, Brazil. METHODS--480 inhabitants of Porto Alegre, aged 18 or older, selected through a random cluster sampling procedure (sectors of the Brazilian Census), were interviewed in their homes during June, 1991. RESULTS--The prevalence for BDZ use during life, in the past year and in the past month was, respectively, 46.7%, 21.3% and 13.11%. Prevalence was significantly higher among women and widowers or divorced. The majority of those who used BDZ during the past month did so at least 2 or 3 days per week. More than 40% reported frequent over-the-counter substances use to "tranquilize", with a 28.8% prevalence for past month use. CONCLUSION--Chemical substance use to alleviate anxiety and other symptoms is generally spread. Legislation, not always respected, has been insufficient to discipline its use. Understanding the complexity of reasons for the situation to be unchanged is needed. Also necessary is the investment in education on adequate use of BDZ, both for physicians and population, and the search for legal measures that should be more efficient.