BACKGROUND: There is a lack of studies on methamphetamine (MA) exposure and morbidity in children beyond the perinatal period. OBJECTIVES: We compared morbidity in children (0-3 years) with prenatal MA exposure to opioid-exposed and to non-exposed children. METHODS: We used data from a Czech nationwide, registry-based cohort study (2000-2014). Children, who reached 3 years of age, of mothers hospitalized with (i) MA use disorder during pregnancy (MA; n = 194), (ii) opioid use disorder during pregnancy (opioids; n = 166), and (iii) general population (GP; n = 1,294,349) with no recorded history of substance use disorder (SUD). Information on inpatient contacts, length of stay, and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10]) were assessed. Crude and adjusted odds ratios (aOR), 95% confidence interval (CI) for the risk of hospitalization, and for getting diagnosis from the ICD-10 diagnosis chapters were calculated using binary logistic regression. A stratified analysis on hospitalizations with SUD of mothers was performed. RESULTS: No significant differences were found in the measures of hospitalization between the MA and opioid groups. Children prenatally exposed to MA and opioids had higher numbers of hospitalizations and diagnoses and longer stays in hospital than children in the GP. Increased risks of certain infectious and parasitic diseases were found in both MA (aOR = 1.6; CI: 1.1-2.3) and opioid (aOR = 1.9; 1.3-2.8) groups as compared to the GP group. The most pronounced difference in stratified analysis on maternal hospitalizations related to SUD after birth was observed for injury, poisoning, and certain other consequences of external causes in the strata of the MA group who had hospitalized mothers (aOR 6.3, 1.6-24.6) compared to the strata without maternal hospitalizations (aOR 1.4, 0.9-2.3). CONCLUSION: This study suggests that children born to mothers using MA during pregnancy have similar morbidity during the first 3 years of life but higher than the GP. The excess of risk was primarily due to infections and injuries in the MA group.
- MeSH
- dítě MeSH
- kohortové studie MeSH
- lidé MeSH
- methamfetamin * škodlivé účinky MeSH
- morbidita MeSH
- opioidní analgetika terapeutické užití MeSH
- poruchy spojené s užíváním opiátů * epidemiologie farmakoterapie MeSH
- registrace MeSH
- těhotenství MeSH
- zpožděný efekt prenatální expozice * epidemiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. METHODS: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. RESULTS: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). CONCLUSION: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.
- MeSH
- kohortové studie MeSH
- lidé MeSH
- poruchy spojené s užíváním opiátů * MeSH
- předávkování léky * MeSH
- příčina smrti MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Amphetamine-type stimulants (ATSs) are the second most commonly consumed class of illicit drugs globally, but there is limited understanding of the precise factors associated with problematic versus controlled ATS consumption. This exploratory study aimed to identify which individual, social, and environmental factors are associated with different patterns of ATS use over time. METHODS: Cross-sectional surveys were conducted in Germany, England, The Netherlands, Poland, and the Czech Republic via face-to-face computer-assisted personal interviews to collect data on different user groups. 1,458 adults (18+) reported exposure to but no ATS use (n = 339); former rare/moderate ATS use (n = 242); current rare/moderate ATS use (n = 273); former frequent/dependent ATS use (n = 201); current frequent/dependent ATS use (n = 403). Extent of ATS/other substance use was assessed by number of consumption days (lifetime, past year, past month) and Severity of Dependence Scale. To identify factors associated with group membership, data were also collected on previous injecting drug use (IDU) and consumption setting/rules. Psychological distress was measured using the Brief Symptom Inventory, with additional data collected on self-reported adverse life events and physical/mental health. RESULTS: Currently, using frequent/dependent ATS users experienced more frequent unstable living conditions (27.5%) and psychological distress (59.8%) compared to other groups. A multinomial logistic regression showed that currently abstinent rare/moderate users were more likely to abstain from methamphetamine use {odds ratio (OR) = 2.48 (confidence interval [CI] = 1.32-4.68)} and from IDU (OR = 6.33 [CI = 2.21-18.14]), to avoid ATS use during working hours (OR = 6.67 [CI = 3.85-11.11]), and not to use ATS for coping reasons (OR = 4.55 [CI = 2.50-6.67]) compared to the reference group of currently using frequent/dependent users. CONCLUSIONS: People who use ATS frequently and/or at dependent levels are more likely to have experienced social and economic adversity compared to infrequent ATS users. On the other hand, there is a substantial share of users, which show a controlled use pattern and are able to integrate ATS use into their lives without severe consequences.
BACKGROUND: With recent changes in legislation regulating recreational and medical cannabis use around the globe, increased use in pregnancy is to be expected. OBJECTIVES: To investigate the association between cannabis use during pregnancy and birth outcomes. METHOD: Data from the Norwegian Mother and Child Cohort Study (MoBa), a prospective pregnancy cohort, were used. Participants were recruited from all over Norway between 1999 and 2008: 9,312 women with 10,373 pregnancies who reported use of cannabis before or in pregnancy. Women reported on their illegal drug use before pregnancy and at pregnancy weeks 17/18 and 30 and at 6 months postpartum. Linear regression was used to estimate crude and adjusted effects of prenatal cannabis exposure on birth outcomes. RESULTS: In 10,101 pregnancies, women had used cannabis before pregnancy but not during pregnancy. In 272 pregnancies, women had used cannabis during pregnancy, and among these, in 63 pregnancies, women had used cannabis in at least 2 periods. In adjusted analyses for potential confounders, only cannabis use during at least 2 periods of pregnancy showed statistically significant effects on birth weight. The effect was observed in the complete cohort (B = -228 g, 95% CI = -354 to -102, p < 0.001) and for the subgroup where information about the child's father was available (B = -225 g, 95% CI = -387 to -63, p = 0.01). Our results may indicate that prolonged use causes more harm, whereas short-term use did not indicate adverse effects on birth outcomes. CONCLUSIONS: There was a statistically significant and clinically relevant association between the use of cannabis during pregnancy and reduced birth weight. Clinicians should screen not only for cannabis use but also for the length and intensity of use as part of a comprehensive substance use screening.
- MeSH
- Cannabis škodlivé účinky MeSH
- lidé MeSH
- longitudinální studie MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Norsko MeSH
BACKGROUND: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. OBJECTIVE: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. METHODS: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25-34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. RESULTS: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson's r's = 0.30-0.42, p's < 0.001) and the symptoms of hyperactivity disorder (r's = 0.24-0.30, p's < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). CONCLUSIONS: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.
- MeSH
- dospělí MeSH
- hyperkinetická porucha * epidemiologie MeSH
- kohortové studie MeSH
- komorbidita MeSH
- lidé MeSH
- poruchy spojené s užíváním psychoaktivních látek * epidemiologie MeSH
- prevalence MeSH
- terapeutická komunita MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. OBJECTIVES: To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). METHOD: A cohort study using nationwide registries in Czechia (2000-2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. RESULTS: MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0-218.5) and length (aMD b = 0.6 cm, 0.0-1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = -63.0 g, -123.0 to -3.1) and birth length (aMD b = -0.3 cm, -0.6 to 0.0). CONCLUSIONS: Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.
- MeSH
- kohortové studie MeSH
- komplikace těhotenství * MeSH
- lidé MeSH
- methamfetamin škodlivé účinky MeSH
- novorozenec MeSH
- předčasný porod MeSH
- těhotenství MeSH
- výsledek těhotenství * MeSH
- zpožděný efekt prenatální expozice * MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996-2012: 8,602 patients; Czech -Republic (CZ) 2000-2014: 4,377 patients; Netherlands (NL) 1994-2014: 33,235 patients, Zurich (ZU) 1992-2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a "nuisance" short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4-51.4%; CZ: 49.8-53.9%; NL: 52.3-54.0%; ZU: 46.4-49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059-0.343; NL: 0.710-0.751; ZU: 0.681-0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.
- MeSH
- databáze faktografické trendy MeSH
- dospělí MeSH
- emigranti a imigranti * MeSH
- lidé středního věku MeSH
- lidé MeSH
- opiátová substituční terapie metody trendy MeSH
- opioidní analgetika aplikace a dávkování MeSH
- poruchy spojené s užíváním opiátů diagnóza epidemiologie terapie MeSH
- rozvrh dávkování léků MeSH
- výsledek terapie MeSH
- zapojení pacienta metody trendy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Nizozemsko epidemiologie MeSH
- Španělsko epidemiologie MeSH
- Švýcarsko epidemiologie MeSH
AIM: The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia. METHOD: A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine. RESULTS: Pharmaceutical buprenorphine in the form of Subutex was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1-2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days. CONCLUSION: While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use.
- MeSH
- buprenorfin aplikace a dávkování MeSH
- dospělí MeSH
- intravenózní abúzus drog epidemiologie psychologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- programy výměny jehel a stříkaček trendy MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Gruzie MeSH
AIM: To determine the prevalence of, and factors associated with, hepatitis C virus (HCV) infection in the population of Czech injecting drug users (IDUs). DESIGN: Multicentric cross-sectional study. SETTING: A convenience sample of injecting drug users was recruited using the snowball sampling method. PARTICIPANTS: Sample of 760 IDUs from 9 different Czech regions. MEASUREMENT: We used one-drop instant blood tests to determine the anti-HCV antibodies status; a structured questionnaire was completed during the interview with the researcher. We calculated the ratio of positive findings and performed univariate analyses of correlations between predictors and independent variables. Finally, we created a logistic regression model that controlled for age, region of residence, reported sharing of injection paraphernalia, and length of injection drug use and for the interaction between length of injection use and imprisonment in order to assess the predictive value of imprisonment in an individual's history. FINDINGS: 226 participants (29.74% of the tested sample) were found to be anti-HCV positive. After adjusting for the sensitivity of the test, the 'true proportion' was 34.97% (95% CI: 31.56-38.35). Many correlated independent variables were found in the univariate analyses. In our logistic regression model, we have found that imprisonment increases the odds of being anti-HCV positive by a factor of 4.3. CONCLUSION: Anti-HCV seroprevalence remains relatively low in the Czech IDUs population compared to similar populations in the developed countries. Regional differences exist in anti-HCV prevalence within the Czech Republic. The strong association of anti-HCV prevalence with imprisonment history when controlled for other potentially clinically important factors suggests the need for more effective preventive measures in Czech prisons.
- MeSH
- financování organizované MeSH
- hepatitida C epidemiologie etiologie MeSH
- intravenózní abúzus drog komplikace MeSH
- lidé MeSH
- logistické modely MeSH
- prevalence MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- finanční podpora výzkumu jako téma MeSH
- heroin MeSH
- lidé MeSH
- methamfetamin MeSH
- poruchy spojené s užíváním psychoaktivních látek epidemiologie MeSH
- sociální změna MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
