scholarly journals Prescription Opioid Related Misuse, Harms, Diversion and Interventions in Canada: A Review

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES191-ES203 ◽  
Author(s):  
Benedikt Fischer
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Grey Literature ◽  
The United States ◽  
Health Concern ◽  
Substance Use Treatment ◽  
Prescription Opioid ◽  
Polysubstance Use ◽  
The Us ◽  
Related Mortality

Background: The non-medical use of and harms related to prescription opioid (PO) analgesics – key medications to treat severe and chronic pain - are an emerging public health concern globally. PO use is proportionally highest in North America, where, consequently, nonmedical PO use (NMPOU) and morbidity/mortality are high and well documented for the United States. Canada is the country with the second highest PO consumption rate in the world – with steeper recent increases in PO use than the US - mainly driven by substantial increases in the use of strong opioids (e.g., oxycodone). Indications and select data of NMPOU and PO-related morbidity and mortality have emerged in recent years, yet a systematic and comprehensive collection of relevant data to characterize the phenomenon in Canada does not exist. Objectives: This paper comprehensively reviews the available data in Canada regarding NMPOU, and PO-related harms, diversion, and interventions, and discusses implications for interventions and policy. Study Design: Narrative literature/data review. Setting: Canada. Methods: Publicly available data and information – either from journal publications, “grey literature” (e.g., government/technical reports) or Web sites reporting relevant data on Canada - were searched and narratively reviewed. Results: Indicators on NMPOU and PO-related harms in Canada are highly fragmented, and not nearly as systematic and comprehensive as they are in the US; virtually no national statistics/data are collected. Available –largely provincial/local - data indicate that PO misuse is increasingly common in key populations, including general adult and student populations, street-drug users, First Nations/Aboriginal Peoples, and correctional populations. Co-morbidities – e.g., pain, mental health problems, polysubstance use – among people reporting NMPOU appear to be high. Substance use treatment admissions for those with problematic PO use have risen substantially where reported. Opioid-related mortality (and oxycodone-related mortality, specifically) have increased considerably in Ontario where relevant data from the mid-1990s onward have been examined. In Canadian populations reporting NMPOU, sourcing of POs occurs through various diversion routes, including from family/friends, “double-doctoring,” or street drug markets. In addition, losses and theft/robberies from pharmacies and licensed medications dealers appear to be on the rise. Finally, interventions (i.e., provincial PO guidelines, prescription monitoring programs, substance use treatment services) are fragmented and inconsistently applied throughout the country, and currently fail to effectively address the growing problem of NMPOU and PO-related harms across Canada. Limitations: This review did not rely on systematic review methodologies. Conclusion: Corresponding to its increasing and high overall PO consumption levels, NMPOU and POrelated harms in Canada are high based on available data, and likely now constitute the third highest level of substance use burden of disease (after alcohol and tobacco). The data and monitoring situation in Canada regarding NMPOU and PO-related harms are fragmented, un-systematic, and insufficient. While major and concerted policy initiatives – primarily from the federal level - are absent to date, these urgently require vastly improved national data indicators and monitoring in order to allow for and evaluate evidence-based interventions on this urgent and extensive public health problem. Key words: Prescription opioids, pain, non-medical use, epidemiology, public health, morbidity, mortality, treatment, policy, Canada

scholarly journals Therapeutic options and challenges for substances of abuse

2007 ◽  
Vol 9 (4) ◽  
pp. 431-445 ◽  
Keyword(s):  
Public Health ◽  
United States ◽  
Substance Use ◽  
The United States ◽  
Health Concern ◽  
Pharmacological Treatments ◽  
Public Health Concern ◽  
Significant Public Health Concern ◽  
Significant Public Health ◽  
Substances Of Abuse

Addiction to substances continues to be a significant public health concern in the United States. The following review of current pharmacological treatments discusses a range of substances: nicotine, alcohol, cocaine, and opioids. The goal is to provide an overview of currently available and new pharmacological treatments for substance use disorders, while also addressing the pharmacotherapeutic challenges remaining. The significant advances in pharmacotherapy have had limited utilization, however. For example, naltrexone for alcoholism is infrequently prescribed, buprenorphine for opiates still has relatively few qualified prescribers, and stimulants have no Food and Drug Administration-approved pharmacotherapy. These pharmacotherapies are needed, with the rate of even the relatively uncommon abuse of opiates now rising sharply.

scholarly journals Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study

10.2196/16191 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e16191 ◽  
Author(s):  
Robin C Stevens ◽  
Bridgette M Brawner ◽  
Elissa Kranzler ◽  
Salvatore Giorgi ◽  
Elizabeth Lazarus ◽  
...  
Keyword(s):  
Social Media ◽  
Substance Use ◽  
Mixed Methods ◽  
Drug Use ◽  
Prescription Drugs ◽  
The United States ◽  
Health Concern ◽  
Polysubstance Use ◽  
Keywords And Phrases ◽  
And Behaviors

Background Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use–related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. Objective This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths’ drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. Methods We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). Results We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one’s life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). Conclusions Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population.

scholarly journals Prevalence of Pain Among Nonmedical Prescription Opioid Users in Substance Use Treatment Populations: Systematic Review and Meta-analyses

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. E671-E684
Author(s):  
Benedikt Fischer
Keyword(s):  
Systematic Review ◽  
Substance Use ◽  
Health Concern ◽  
Substance Use Treatment ◽  
Prescription Opioid ◽  
Pooled Prevalence ◽  
Prevalence Of Pain ◽  
Pain Symptoms ◽  
Meta Analyses ◽  
Primary Drug

Background: Prescription opioid analgesics (POA) are widely used in the pharmacotherapeutic treatment of acute and chronic pain in North America, where nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in recent years. Existing epidemiological data suggest an association between NMPOU and pain problem symptoms in different populations, including samples in substance use treatment, although the extent of these correlations has not been systematically assessed. Objective: To systematically review and meta-analyze the prevalence of pain symptoms or problems among populations reporting NMPOU in substance use treatment. Study Design: Systematic review and meta-analyses. Methods: A systematic review and meta-analyses were conducted for pain symptoms in substance use treatment samples reporting NMPOU within the last 30 days or at admission to treatment. Overall, 8 unique epidemiological studies were identified and included in the meta-analyses; in 7 of these samples POAs were the primary drug and/or POA dependence was reported. Results: The pooled prevalence of pain in all NMPOU samples in substance use treatment was 58% (95% confidence interval [CI]: 53%–64%). The pooled prevalence of pain in the studies with POAs as the primary drug and/or POA dependence was 60% (95% CI: 52%–67%), and the prevalence of pain with “any” POA abuse (n = 2 studies) was 50% (95% CI: 40%–60%). Limitations: A small number of studies were available and included in the review; these were restricted to cross-sectional datasets only. Statistical heterogeneity was found in the metaanalytical results. Conclusions: Pain symptoms are disproportionately elevated in substance use treatment samples reporting NMPOU. Effective measures to prevent and treat NMPOU are urgently needed, although a substantive extent of NMPOU observed in this specific context may relate directly or indirectly to the presence of pain, e.g., either as an expression of ineffective pain care or as a consequence of previous POA-based interventions. At the same time, effective ways to treat and address ongoing pain issues in NMPOU samples need to be implemented, which may require ongoing opioid-based pharmacotherapeutic care aimed at both pain and dependence. Key words: Prescription opioids, nonmedical use, dependence, pain, comorbidity, substance use treatment, prevention, systematic review, meta-analyses.

scholarly journals Dietary Relationship with 24 h Urinary Iodine Concentrations of Young Adults in the Mountain West Region of the United States

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 121 ◽  
Author(s):  
Demetre E. Gostas ◽  
D. Enette Larson-Meyer ◽  
Hillary A. Yoder ◽  
Ainsley E. Huffman ◽  
Evan C. Johnson
Keyword(s):  
Public Health ◽  
Thyroid Function ◽  
Dietary Habits ◽  
Urinary Iodine ◽  
The United States ◽  
Iodine Intake ◽  
Iodized Salt ◽  
Health Concern ◽  
Iodine Status ◽  
The Us

Background: Iodine deficiency is not seen as a public health concern in the US. However certain subpopulations may be vulnerable due to inadequate dietary sources. The purpose of the present study was to determine the dietary habits that influence iodine status in young adult men and women, and to evaluate the relationship between iodine status and thyroid function. Methods: 111 participants (31.6 ± 0.8 years, 173.2 ± 1.0 cm, 74.9 ± 1.7 kg) provided 24 h urine samples and completed an iodine-specific Food Frequency Questionnaire (FFQ) for assessment of urinary iodine content (UIC) as a marker of iodine status and habitual iodine intake, respectively. Serum Thyroid Stimulating Hormone (TSH) concentration was evaluated as a marker of thyroid function. Spearman correlational and regression analysis were performed to analyze the associations between iodine intake and iodine status, and iodine status and thyroid function. Results: 50.4% of participants had a 24 h UIC < 100 µg/L). Dairy (r = 0.391, p < 0.000) and egg intake (r = 0.192, p = 0.044) were the best predictors of UIC, accounting for 19.7% of the variance (p ≤ 0.0001). There was a significant correlation between UIC and serum TSH (r = 0.194, p < 0.05) but TSH did not vary by iodine status category (F = 1.087, p = 0.372). Discussion: Total dairy and egg intake were the primary predictors of estimated iodine intake, as well as UIC. Iodized salt use was not a significant predictor, raising questions about the reliability of iodized salt recall. These data will be useful in directing public health and clinical assessment efforts in the US and other countries.

State Intervention During Public Health Emergencies: Is the United States Prepared for an Ebola Outbreak?

2015 ◽  
Vol 12 (2) ◽  
Author(s):  
Marie-Helen Maras ◽  
Michelle D. Miranda
Keyword(s):  
Public Health ◽  
State Intervention ◽  
The United States ◽  
International Travel ◽  
American Government ◽  
Training And Education ◽  
Public Health Emergencies ◽  
The Us ◽  
Bioterrorism Agent ◽  
Legal Guidelines

AbstractIn the fall of 2014, the US was faced with the reality that a deadly, foreign virus had entered its borders. Ebola, a disease thought to be of little threat to the US yet classified as a major bioterrorism agent, became a reality for the American government and its citizens. The introduction of Ebola unveiled many deficiencies in the country’s health care system, international travel policies, and ability to control or restrict the movement of exposed individuals in order to protect the larger population. The need to review and establish legal guidelines and policies to deal with these deficiencies is paramount: the inherent lack of training and education; weaknesses in monitoring, maintenance, and treatment; and the lack of uniform guidelines to isolate international travelers have all demonstrated that the country may not be able to control a larger-scale threat in the future.

scholarly journals Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature

2021 ◽  
Vol 18 (8) ◽  
pp. 4167
Author(s):  
Amal Chakraborty ◽  
Mark Daniel ◽  
Natasha J. Howard ◽  
Alwin Chong ◽  
Nicola Slavin ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Diseases ◽  
Scoping Review ◽  
Classification System ◽  
Grey Literature ◽  
Indigenous Communities ◽  
Environmental Indicators ◽  
Health Concern ◽  
Environmental Determinants ◽  
Health And Wellbeing

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the “community infrastructure” domain within the built environment, and the “community capacity” domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

A Preliminary Report on Alcohol-Associated DNA Methylation Changes and Suicidal Behavior: Evidence Using Mendelian Randomization

2021 ◽  
pp. 105413732095224
Author(s):  
Charleen D. Adams
Keyword(s):  
Public Health ◽  
Dna Methylation ◽  
Suicidal Behavior ◽  
Genome Wide Association Study ◽  
Mendelian Randomization ◽  
Causal Effect ◽  
Economic Stress ◽  
Self Report ◽  
Health Concern ◽  
The Us

Suicide is a major public health concern. In 2015, it was the 10th leading cause of death in the US. The number of suicides increased by 30% in the US from 1999 to 2016, and a greater uptick in suicides is predicted to occur as a result of the COVID-19 crisis, for which the primary public-health strategy is physical distancing and during which alcohol sales have soared. Thus, current strategies for identifying at-risk individuals and preventing suicides, such as relying on self-reported suicidal ideation, are insufficient, especially under conditions of physical distancing, which exacerbate isolation, loneliness, economic stress, and possibly alcohol consumption. New strategies are urgent now and into the future. To that aim, here, a two-sample Mendelian randomization (an instrumental variables technique using public genome-wide association study data as data sources) was performed to determine whether alcohol-associated changes in DNA methylation mediate risk for suicidal behavior. The results suggest that higher alcohol-associated DNA methylation levels at cg18120259 confer a weak causal effect. Replication and triangulation of the results, both experimentally and with designs other than Mendelian randomization, are needed. If the findings replicate, the information might be utilized to raise awareness about the biological links between alcohol and suicide and possibly explored as a biomarker of risk, perhaps especially for early detection of those who may not self-report suicidal intent.

Otitis media in Indigenous Australian children: review of epidemiology and risk factors

2013 ◽  
Vol 128 (S1) ◽  
pp. S16-S27 ◽  
Author(s):  
Jake Jervis-Bardy ◽  
L Sanchez ◽  
A S Carney
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Otitis Media ◽  
Bacterial Load ◽  
Grey Literature ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Health Concern ◽  
Indigenous Australian ◽  
Indigenous Children

AbstractBackground:Otitis media represents a major health concern in Australian Indigenous children (‘Indigenous children’), which has persisted, despite public health measures, for over 30 years.Methods:Global searches were performed to retrieve peer-reviewed and ‘grey’ literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012.Results:In Indigenous children, the prevalence of otitis media subtypes is 7.1–12.8 per cent for acute otitis media, 10.5–30.3 per cent for active chronic otitis media and 31–50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media.Conclusion:Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.

Where Is the Fairness in Canadian Cannabis Legalization? Lessons to be Learned from the American Experience

2021 ◽  
Vol 55 (2) ◽  
pp. 395-418
Author(s):  
Akwasi Owusu-Bempah
Keyword(s):  
Public Health ◽  
Law Enforcement ◽  
The United States ◽  
Systemic Racism ◽  
American Experience ◽  
Drug Law ◽  
Drug Law Enforcement ◽  
The Us ◽  
International Attention ◽  
Drug Prohibition

Canada has received praise and international attention for its departure from strict cannabis prohibition and the introduction of a legal regulatory framework for adult use. In addition to the perceived public health and public safety benefits associated with legalization, reducing the burden placed on the individuals criminalized for cannabis use served as an impetus for change. In comparison to many jurisdictions in the United States, however, Canadian legalization efforts have done less to address the harms that drug law enforcement has inflicted on individuals and communities. This article documents the racialized nature of drug prohibition in Canada and the US and compares the stated aims of legalization in in both jurisdictions. The article outlines the various reparative measures being proposed and implemented in America and contrasts those with the situation in Canada, arguing, furthermore that the absence of social justice measures in Canadian legalization is an extension of the systemic racism perpetuated under prohibition.

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