Dublin's homeless crisis – is this reflected in emergency department psychiatry referrals?

AimsThis study seeks to explore the prevalence and impact of homelessness in an adult sample of psychiatry referrals over a one-month period via the Emergency Department at St. James's Hospital.BackgroundHomelessness has now reached a crisis point in Ireland. In July 2019, there were 10,275 people documented as homeless nationwide, with the number of homeless families increasing by 178% since June 2015. The majority of individuals registered as homeless are located in Dublin. St. James's Hospital (SJH) provides psychiatric care to a population of 136,704 people across Dublin South-City within areas of significant deprivation according to the most recent social deprivation index.MethodAll Emergency Department psychiatry referrals over a one-month period were recorded. Month of study was randomly generated. Data were collected from electronic records. Socio-demographic information was analysed. Data were anonymised and recorded using Microsoft Excel. Current homelessness statistics were accessed from the Department of Housing, Planning, and Local Government and compared to the data collected.ResultDuring the month of the Study (March 2019), 4315 adults accessed emergency homeless accommodation in Dublin. Of the 109 psychiatry referrals received through the Emergency Department at SJH during this time, over a quarter (28%) of those referred reported themselves to be homeless or living in temporary accommodation. An additional 5% were documented as living in residential or sheltered care at time of assessment. All of the referred homeless patients were unemployed (n = 30). 50% of homeless patients were referred to psychiatry following expressed thoughts or acts of self-harm. Illicit drug abuse was associated with 73% of referrals. Alcohol abuse was associated with 47%. Of those who were referred, under a quarter (23%) were assessed as having a major mental illness, and in the majority of these cases, illicit drug and alcohol abuse were compounding factors in exacerbating symptomatology. Of those referred, 66% had previously been reviewed by psychiatry during prior ED presentations and 60% of homeless presenters reported that they had previously been, or were currently linked in with community mental health teams.ConclusionFrequently, vulnerable patients most in need of social and psychiatric care, such as homeless people with addiction issues, are eclipsed from accessing supports. The high proportion of patients reporting to be homeless is cause for concern and suggests the need for tailored and integrated multi-disciplinary assessments and interventions at an Emergency Department level.

772 Examining sleep difficulties and suicide ideation among those reporting abuse and dependence on illicit drugs and alcohol

Introduction Sleep disturbance is associated with poor mental health and may contribute to initiating or continuing use/abuse of alcohol and drugs. Using data from a nationwide survey, we examined the relationship between sleep disturbance and suicide behaviors among youth and adults, including those who report drug/alcohol use and abuse. Methods We analyzed data from the 2018 National Survey on Drug Use and Health (NSDUH), an annual survey collecting information about the use of illicit drugs and alcohol among non-institutionalized U.S. youth (age 12–17) and adults (age>17). The 2018 survey included 9,398 youth and 43,026 adult respondents. Depression was assessed in adults with the Kessler-6 and in youth with several questions assessing psychological distress. Those who scored at risk for psychological distress were also asked about sleep disturbance and suicidal behaviors (i.e., ideation, planning, attempt). All were asked to report their drug/alcohol use and/or abuse. Our study population included those who reported psychological distress. We conducted binary logistic regression to examine the relationship between suicidal behavior and sleep disturbance in this population. We also conducted sub-analyses to explore the relationship between suicidal behavior and sleep disturbance among those reporting drug/alcohol use and abuse. Results Youth were 29% male and 71% female, adults were 36% male and 64% female. Adult participants, 39% were 18 to 25, 22% were 26 to 34, and 39% were age 35 and older. Among those with psychological distress, suicidal behavior was more likely among those who reported sleep disturbance (youth: OR=2.7, 95%CI:1.8–4.0; adults: OR=1.3, 95%CI:1.2–1.5). Also, among those with psychological distress, suicidal behavior was more likely among those who reported concomitant sleep disturbance and either alcohol abuse/alcoholism (youth: OR:3.3, 95%CI:1.6–7.0; adults: OR=1.4, 95%CI:1.1–1.7); illicit drug abuse (youth: OR=3.5, 95%CI:1.6–7.4; adults: OR=1.3, 95%CI:1.0–1.6); or alcohol and illicit drug abuse (youth: OR=3.2, 95%CI:1.5–6.9; adults: OR=1.4, 95%CI:1.1–1.7). Conclusion Youth and adults with psychological distress and sleep disturbance are more likely to also report suicidal behaviors. Alcohol and drug use or abuse increase their risk for suicidal behavior compared to those who do not report sleep disturbance. Future work should include examination of causality and of interventions. Support (if any) NIH K24-HL105664, P01-AG009975, T32-HL007901, K01HL150339, 1R56HL151637

Opioid Dependence And Methadone Maintenance Treatment (MMT) Programme In Nepal In Three Different Decades: An Exploratory/Comparative Study

Introduction: First Methadone Maintenance Programme (MMTP) in Nepal was started in the year 1994. This study was done to study and explore/compare findings of the present study with that of studies published in Nepal in the new millennium. Material and Method: Study was conducted at the Mental Hospital, Lalitpur, Kathmandu, Nepal from 1994 to 2002. Data was collected for the initial 5 years from 1994 to 1998. These patients were followed up for the next five years till 2002. Data thus obtained are presented in a tabulated form, in terms of frequencies and percentages. Results: A total of 204 patients were put on Methadone Maintenance Treatment Programme (MMTP) during the scheduled period. One-hundred-and-twenty-two (60%) of them were abusing buprenorphine. Severity of buprenorphine abuse was between 1-6 ampoules (2 ml per ampoule) per day. Approximately 40% (81) of them were sharing the injecting equipment. Seventy-seven (38%) of them had been in police custody in the past, for various reasons like theft, cheating, possessing, trafficking, violence and other antisocial behaviours. Forty-five percent (92) clients were retained at the end of 5 years. Sixty-nine family members (spouses, mothers, brothers) from these 92 regular methadone clients were interviewed. Eighty-six percent (79) of the interviewed family members reported significant improvement in clients’ health. Eighty-one percent (75) of the family members reported significant improvement among the methadone users’ family in financial responsibilities and interest in work. Overall, MMTP was found to have reduced the amount of illicit drug abuse significantly in these patients. These results are compared with the data of the subsequent published data on MMTP from Nepal in the new millennium. Conclusion: Though the present study data may appear to be of historical value, we are presenting these data, in the light of the findings of the newer studies published of late from Nepal. Till date, our study remained the largest MMT Programme in Nepal, in terms of number of patients studied, number of years of study and number of years of follow up of these patients.

Long Term Immunologic Consequences of Illicit Drug Abuse

This decreased immune responsiveness in illicit drug abusers is believed to be responsible for the increased susceptibility to viral infections. Therefore, beyond the prevalence of illicit drug use and dependence, medical practitioners and illicit drug users should be aware of the flipsides associated with this disorder, particularly the immunologic downsides.

Maternal Substance Abuse and the Later Risk of Fractures in Offspring: L’abus maternel de substances et le risque ultérieur de fractures chez les enfants

Objective: To assess the association of maternal illicit drug abuse before or during pregnancy with future fractures in offspring. Methods: We performed a longitudinal cohort study of 792,022 infants born in hospitals of Quebec, Canada, between 2006 and 2016, with 5,457,634 person-years of follow-up. The main exposure was maternal substance abuse before or during pregnancy, including cocaine, opioid, cannabis, and other illicit drugs. The main outcome measure was hospitalization for traumatic fracture in offspring up to 12 years of age. We used adjusted Cox regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal drug abuse with the subsequent risk of fracture in children. Results: The incidence of child fractures was higher for maternal illicit drug abuse than no drug abuse (21.2 vs. 15.4 per 10,000 person-years). Maternal drug abuse before or during pregnancy was associated with 2.35 times the risk of assault-related fractures (95% CI, 1.29 to 4.27) and 2.21 times the risk of transport accident-related fractures (95% CI, 1.34 to 3.66), compared with no drug abuse. Associations were strongest before 6 months of age for assault-related fractures (HR = 2.14; 95% CI, 0.97 to 4.72) and after 6 years for transport-related fractures (HR = 2.86; 95% CI, 1.35 to 6.05). Compared with no drug abuse, associations with assault and transport-related fractures were elevated for all drugs including cocaine, opioids, and cannabis. Conclusions: Maternal illicit drug abuse is associated with future child fractures due to assault and transport accidents.

Medical Waste Proper Disposal and Techniques - A Review of Multiple Devices

Every year municipal solid waste continues to grow as the US population expands. Municipal solid waste includes substances that pose a harmful risk for the environment such as medical waste or pharmaceutical agents. Health-care related waste increases annually by 15% and thus concerns for proper disposal of hazardous agents such as medical waste or pharmaceutical agents increases. It is important that these agents are disposed of properly to mitigate the chances of toxins and hazardous materials from tampering with the environment, and ultimately the US’s water supply. Additionally, medical waste can contribute to illicit drug abuse and potential overdoses. Methods such as flushing and disposing of these wastes in regular garbage are most common. However, medical waste disposal devices have been marketed to help reduce the risk of potential toxicities to the environment. These medical devices can be broken up into three categories: storage, sequestering agents, and immediate destruction devices. Sequestering agents are the most common devices within this review. The objective of this review is to highlight these different devices as well as describe what each can or cannot do.

New Drug Situation in Russia

The paper explores the rapidly changing drug situation and provides insights into the emergence of various ways of shift to the “new” models of drug abuse, defines the role of “controlled” drug use among different ages and gender groups. It reviews the situation in hand, reveals positive changes: fewer total number of registered addicts, less opioid addiction, fewer injecting drug users. However, the author highlights the onset of massively veiled (illicit) drug abuse, describes the growth of public interest in various psychostimulants. A whole category of new drugs has emerged. Their availability and, in some cases, low cost prompt various drug experiments among both regular and occasional consumers and those prone to first trials. This triggered a change in the methods of drug abuse towards multiple drug abuse. Among certain groups of the population, such models as “status”, “recreational”, and “club” drug abuse have become widespread. The author identifies and shows real practices of controlled drug abuse. Such “controlled” consumption is most often an intermediate stage in the formation of drug addiction with a delayed period, which requires special forms of social control.