The role of an anesthesiologist in the pandemic of uncontrolled use of psychotropic drugs

In the modern world, the number of people using various psychotropic drugs increases every day. The situation that has been described in recent decades associated with the use of narcotic and not criminalized substances in international literature as the OPIOID + (plus) crisis. According to statistics, over the past few years, officially registered deaths from drug overdose have exceeded 70,000 in the United States. Leading causes were synthetic opioids, psychostimulants, and cocaine. This includes prescription opioids, opiates, benzodiazepines, and antidepressants. All aforementioned drugs are used in combination with each other, with alcohol or psychotropic marijuana. For humans, biological, social, and psychological factors are cause the initiation of psychoactive drugs. Due to the lack of a well-functioning medical care system for patients with chronic pain, doctors of all specialties treat pain. In this article, we consider the current situation with mind-altering drugs and apply the role of the anesthesiologist in reducing the growth rate of the opioid pandemic.

Shifting Pathways of Stimulant Use Among Individuals With Opioid Use Disorder: A Retrospective Analysis of the Last Thirty Years

Background: Stimulant use among individuals with opioid use disorder has recently increased, driven by changes in drug distribution channels. However, our understanding of polysubstance use is often limited by a need to provide targeted treatment to a primary drug of addiction. Yet there is a crucial need to better understand pathways to addiction, and how the use of multiple substances may differ between populations, as well as time periods.Methods: Using a national opioid surveillance system, we analyzed survey data from new entrants to 124 opioid use disorder treatment centers from 2017 to 2020. Age of first use was collected for prescription opioids, illicit opioids, prescription stimulants, crack/cocaine, and methamphetamines. Year of initial use of an opioid or stimulant was calculated and grouped by 5 year blocs, inclusive of initial use starting from 1991 and ending in 2020 (n = 6,048).Results: Lifetime exposure to stimulants was 82.5% among individuals with opioid use disorder. Mean age of initiation increased for all drugs in 2016–2020, in particular prescription opioids (22.3 to 31.8). Stimulants were initiating drugs for a substantial proportion of individuals with opioid use throughout the analyzed time period. Those initiating opioid/stimulant use from 1991 to 1995 had a mean average of 6.8 years between first and second drug exposure, which steadily decreased to 1.5 years between exposures in 2016–2020. Sankey plots depict significantly more drug transitions in those initiating use from 1991 to 2000 (65.1% had at least two drug transitions) compared to 2010–2020 (16.0%). Opioid-stimulant use increased over time among racial/ethnic minorities, sexual minorities, and those with an educational attainment of high school or less.Conclusion: These data highlight not only the substantial prevalence of stimulant use among individuals who develop opioid use disorder, but also the variability through which pathways of use occur. Prevention and intervention efforts need to take into account increasing ages of initial drug exposures, demographic shifts in stimulant-using populations, and more rapid drug transitions between opioid and stimulants. But at a broader level, prevention, harm reduction ideology, and addiction medicine needs to take into account the ubiquity of polysubstance use among individuals with substance use disorders.

Declines and pronounced regional disparities in prescription opioid use in the United States

BackgroundThe United States (US) opioid epidemic is a persistent and pervasive public health emergency as it continues to claim the lives of Americans through addiction and overdose. There have been sustained efforts to reverse this iatrogenic crisis over the past decade. This study analyzed the changes in prescription opioid distribution for pain and identified regional differences between 2010 and 2019.Methods and FindingsOpioid production data was obtained from the DEA’s annual production quotas. Total opioid production has decreased 41.5% from 2013 (87.6 morphine mg equivalent metric tons) to 2019 (51.3). Opioid distribution from 2010 to 2019 was collected for ten prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) from the US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System. Regional variance was expressed as the ratio of the 95th to 5th percentiles of opioid distribution per state, corrected for population. The peak year for all ten prescription opioids was identified, individually, as between 2010 and 2013, except for codeine (2015). There was a 51.96% overall decrease in opioid distribution per capita with the largest decrease in Florida (−61.61%) and smallest in Texas (−18.64%). The largest quantities of opioid distribution were observed in Tennessee (520.70 morphine mg equivalent or MME per person) and Delaware (251.45) in 2011 and 2019. The smallest was Nebraska (153.39) in 2011 and Minnesota (90.49) in 2019. The highest to lowest state ratio of total opioid use, corrected for population, was sizable in 2011 (5.25) and 2019 (2.78). Similarly, the mean 95th/5th ratio was relatively stable in from 2011 (4.78 +0.70) and 2019 (5.64+0.98). The 95th/5th ratio in 2019 was greatest for methadone (10.23) and oxymorphone (10.09) and smallest for morphine (2.20) and fentanyl (2.12). Southern states (e.g MS, TN, AL, AK, DE, and NC) had the highest per capita distribution for eight of the ten opioids in 2019. The strength of the correlation between per capita hydrocodone and codeine, and hydromorphone and codeine increased significantly from 2011 to 2019ConclusionsThis study found a decline in total production and distribution for ten prescription opioids during the last half-decade. However, distribution was non-homogeneous at a state level. Analysis of regional differences revealed a three-fold difference in the 95th:5th percentile ratio between states which was unchanged over the past decade. Future research focused on identifying factors contributing to the observed regional variability could prove valuable to understanding, and potentially remediating, the pronounced disparities in prescription opioid use in the US.

The Cannabis and Older Persons Study: Has Science Caught Up With Practice Yet?

Since 2016, the Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old. Our current work dives into particular groups of cannabis users and explores outcomes related to medical conditions and symptoms. This symposium also features a range of methodological approaches from an analysis of the BRFSS caregiving and cannabis modules, a convenience sample of more than 4,000 older cannabis users enrolled in the Illinois Medical Cannabis Program and qualitative interviews conducted with aging veterans. Kanika Arora examines the association between informal caregiving and marijuana use and whether this association varies by age. Julie Bobitt shares findings from 32 interviews with older Veteran cannabis users. Alton Croker examines cannabis use as a complement or alternative to palliative care. HyoJung Kang clusters negative outcomes experienced by older persons who use cannabis. Brian Kaskie compares cannabis use among persons with Multiple Sclerosis (N=135) and persons diagnosed with arthritis (N=582) or cancer (N=622). While we certainly find reason to remain concerned that cannabis use alone and co-occurring use with prescription opioids may contribute to increased rates of substance misuse and other undesirable outcomes among older adults, we find it increasingly difficult to overlook the benefits many persons derive when taking cannabis as a method to manage pain or address other medical conditions. At this point, public policy officials and program administrator should strive to strike a balance between addressing cannabis harms relative to promoting benefits such as opioid reduction and diversion.

Psychoactive Substance Use Among Middle-Aged and Older Adults With Visual Impairment

Older adults with visual impairment may be at risk for developing substance use disorder (SUD) as psychoactive substance use is often used to cope with the stressors of vision loss. This study estimates the national prevalence and risk of psychoactive substance use among older adults with visual impairment. We analyzed data of respondents age ≥50 from the 2015-2019 National Survey on Drug Use and Health, an annual cross-sectional survey of a nationally representative sample of non-institutionalized individuals in the U.S. (N=43,886). We estimated and compared prevalence of past-year use of cannabis, cocaine, misuse of prescription opioids, sedatives, stimulants/tranquilizers, alcohol use disorder (AUD), any SUD, and nicotine dependence between adults with visual impairment to those without. Comparisons were conducted using chi-square and we used multivariable generalized linear models using Poisson and log link to estimate adjusted prevalence ratios (aPRs) for adults with visual impairment relative to those without, controlling for demographics and diagnosis of ≥2 chronic diseases. An estimated 6.1% experienced visual impairment. Those with visual impairment had higher prevalence of AUD, nicotine dependence, misuse of prescription opioids, tranquilizers, and stimulants, and SUDs. In adjusted analyses, vision-impaired adults had higher risk of AUD (aPR=1.71, 95% CI: 1.40-2.09), nicotine dependence (aPR =1.53, 95% CI:1.35-1.73), opioid misuse (aPR =1.54, 95% CI:1.26-1.90), and SUD (aPR=1.67, 95% CI:1.40-2.01). Psychoactive substance use adds unique health risks for older adults with vision loss, who may suffer significant psychological stress and loss of independence. Screening for substance use among all older adults with visual impairment should be considered.

Drug Use Changes at the Individual Level: Results from a Longitudinal, Multisite Survey in Young Europeans Frequenting the Nightlife Scene

<b><i>Background:</i></b> Monitoring emerging trends in the increasingly dynamic European drug market is vital; however, information on change at the individual level is scarce. In the current study, we investigated changes in drug use over 12 months in European nightlife attendees. <b><i>Method:</i></b> In this longitudinal online survey, changes in substances used, use frequency in continued users, and relative initiation of use at follow-up were assessed for 20 different substances. To take part, participants had to be aged 18–34 years; be from Belgium, Italy, the Netherlands, Sweden, or the UK; and have attended at least 6 electronic music events in the past 12 months at baseline. Of 8,045 volunteers at baseline, 2,897 completed the survey at both time points (36% follow-up rate), in 2017 and 2018. <b><i>Results:</i></b> The number of people using ketamine increased by 21% (<i>p</i> &#x3c; 0.001), and logarithmized frequency of use in those continuing use increased by 15% (<i>p</i> &#x3c; 0.001; 95% CI: 0.07–0.23). 4-Fluoroamphetamine use decreased by 27% (<i>p</i> &#x3c; 0.001), and logarithmized frequency of use in continuing users decreased by 15% (<i>p</i> &#x3c; 0.001, 95% CI: −0.48 to −0.23). The drugs with the greatest proportion of relative initiation at follow-up were synthetic cannabinoids (73%, <i>N</i> = 30), mephedrone (44%, <i>N</i> = 18), alkyl nitrites (42%, <i>N</i> = 147), synthetic dissociatives (41%, <i>N</i> = 15), and prescription opioids (40%, <i>N</i> = 48). <b><i>Conclusions:</i></b> In this European nightlife sample, ketamine was found to have the biggest increase in the past 12 months, which occurred alongside an increase in frequency of use in continuing users. The patterns of uptake and discontinuation of alkyl nitrates, novel psychoactive substances, and prescription opioids provide new information that has not been captured by existing cross-sectional surveys. These findings demonstrate the importance of longitudinal assessments of drug use and highlight the dynamic nature of the European drug landscape.

Patient Knowledge of Opioid Usage and Side Effects Prior to Surgery

BackgroundGiven the increasing morbidity and mortality related to prescription opioids in the United States, it is critical for patients to understand the risks and proper usage of opioid analgesics.MethodsWe surveyed 166 patients undergoing elective surgery at a single tertiary care facility preoperatively. We queried patients regarding aspects of prescription opioid use, side effects and adverse effects, and storage and disposal behaviors.ResultsOverall knowledge regarding prescription opioids was high (mean score = 8.05/12, range 0–12). The average number of questions answered correctly was not significantly different based on opioid use at the time of the survey (65% vs 67.5%, p = 0.52). Characteristics significantly associated with higher knowledge included young age (p = 0.01), female gender (p &lt; 0.01), and white race (p = 0.01).ConclusionsPatient knowledge regarding prescription opioids is high preceding surgery, but gaps remain regarding side effects and adverse effects. Knowledge did not differ by prior or current opioid use, and these findings may help target important knowledge gaps to improve patient education regarding opioids during the preoperative period.