RESUMO
PURPOSE: Substance use disorders (SUDs) increase the risk and severity of infectious diseases, including coronavirus disease 2019 (COVID-19). Adults with a co-occurring SUD and psychiatric disorder were studied to elucidate the association between SUD severity and (1) COVID-19 vaccination status, (2) receptivity to a one-session intervention with a pharmacist advocating the benefits of vaccination, and (3) acceptance of referral for vaccination following the intervention. METHODS: COVID-19 vaccination status was recorded in 460 adults with SUD (324 males and 136 females) upon entry into inpatient treatment. A 2-parameter item response theory (IRT) model quantified SUD severity. Pharmacist-delivered intervention, modeled after the screening, brief intervention, and referral to treatment (SBIRT) protocol, was offered to unvaccinated participants. RESULTS: Higher SUD severity was associated with a lower vaccination rate. Nicotine, opioid, and sedative use disorders were most frequently associated with unvaccinated status. SUD severity was not associated with receptivity to intervention advocating vaccination or subsequent acceptance of a referral for vaccination. The portion of the sample that received the intervention was over 7 times more likely to accept a referral for vaccination when compared to participants who rejected the intervention (20.8% vs 2.8%). CONCLUSION: Pharmacist-administered intervention produced motivation for vaccination in a number of recipients; however, receptivity to the intervention was not related to SUD severity.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Farmacêuticos , Transtornos Relacionados ao Uso de Substâncias , Hesitação Vacinal , Humanos , Masculino , Feminino , Adulto , COVID-19/prevenção & controle , COVID-19/epidemiologia , Farmacêuticos/organização & administração , Vacinas contra COVID-19/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Pessoa de Meia-Idade , Hesitação Vacinal/psicologia , Vacinação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To evaluate the accuracy of detecting 16-year-old male (n = 465) and female (n = 162) youths who subsequently manifest opioid use disorder (OUD) at 25 years of age. We hypothesized that the combined measures of 2 components of etiology, heritable risk, and substance use, accurately detect youths who develop OUD. STUDY DESIGN: Heritable risk was measured by the transmissible liability index (TLI). Severity of the prodrome presaging OUD was quantified by the revised Drug Use Screening Inventory containing the consumption frequency index (CFI) documenting substance use events during the past month and the overall problem density (OPD) score indicating co-occurring biopsychosocial problems. Diagnosis of OUD was formulated by a clinical committee based on results of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in conjunction with medical and social history records. RESULTS: Bivariate analysis shows that the TLI, CFI, and OPD scores at 16 years of age predict OUD at 25 years. Multivariate modeling indicates that the TLI combined with the CFI predict OUD with 86% accuracy (sensitivity = 87%; specificity = 62%). The TLI and CFI at 16 years of age mediate the association between parental substance use disorder and OUD in offspring at 25 years of age, indicating that these measures respectively evaluate risk and prodrome. CONCLUSIONS: These results demonstrate the feasibility of identifying youths requiring intervention to prevent OUD.
Assuntos
Diagnóstico Precoce , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Pais , Medição de Risco/métodos , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This longitudinal investigation examined the hypothesis that subjective experience during consumption of preferred drugs mediates the association of transmissible risk for substance use disorder (SUD) measured in childhood and adolescence, and SUD diagnosis in adulthood. Transmissible risk denotes the psychological characteristics having intergenerational continuity between parents and their biological children. METHODS: The transmissible liability index (TLI) was administered to four hundred eighty-three 10 to 12-year-old boys (baseline). Follow-up evaluations were conducted when the boys attained 12-14, 16, 19, and 22 years of age, using age-specific versions of the TLI. Frequency of consumption of the participants' three most preferred drugs, affect on an ordinary day, affect while under influence of the preferred substances, and presence/absence of current SUD were assessed at 22 years of age. RESULTS: Consumption frequency of preferred drugs among boys mediates the association of transmissible risk during childhood, and adolescence and SUD diagnosis in adulthood. Severity of negative affect on a drug-free day predicts frequency of consumption of preferred drugs, which, in turn, predicts severity of negative affect during the drug use event. Neither affect on a drug-free day nor affect during the drug use event mediates the association of transmissible risk and SUD. CONCLUSIONS: Affect on drug-free days, and while under influence of preferred substances, covary with consumption frequency; however, affect is not related to transmissible SUD risk or SUD outcome.
Assuntos
Afeto , Filho de Pais com Deficiência/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Criança , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
OBJECTIVES: This study tested screening feasibility and described the behavioral, mental, and physical health of patients filling prescriptions for opioid medications in the community pharmacy setting. METHODS: We conducted a cross-sectional survey in rural/urban community pharmacies with adult noncancer patients. The survey included validated measures for opioid medication misuse risk, drug and alcohol use, and physical and mental health problems. Descriptive statistics were calculated, and bivariate and multivariable logistic regression evaluated relationships between opioid medication misuse risk and patient demographics, behavioral, mental, and physical health. RESULTS: A total of 164 patients completed the survey (87% response rate), revealing positive screens for prescription opioid misuse risk (14.3%), illicit drug use (7.3%), hazardous alcohol use (21.4%), depression (25.8%), and posttraumatic stress disorder (PTSD; 17.1%). Bivariate analyses revealed increased odds of a positive opioid medication misuse risk score with a positive screen for illicit drug use in the previous year (odds ratioâ=â3.91; 95% confidence interval [CI], 1.05-14.63) and PTSD (odds ratioâ=â6.7; 95% CI, 2.54-17.69). In adjusted multivariable analyses, these relationships strengthened such that a positive screen for illicit drug use (adjusted odds ratioâ=â12.96; 95% CI, 2.18-76.9) and PTSD (adjusted odds ratioâ=â13.3; 95% CI, 3.48-50.66) increased odds for a positive opioid medication misuse risk score. CONCLUSIONS: Findings confirmed the feasibility of screening risk factors and positive opioid medication misuse risk among community pharmacy patients. Future research should validate these findings as a foundation to intervention development.
Assuntos
Analgésicos Opioides/efeitos adversos , Farmácias , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Detecção do Abuso de Substâncias , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Fatores de Risco , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
The revised Drug Use Screening Inventory (DUSI-R) is a self-report questionnaire designed to quantify the severity of problems that are commonly associated with consumption of alcohol and other drugs. This study extends research conducted on the US population to determine whether the DUSI-R's substance abuse scale discriminates Brazilian youths in treatment (n = 41) from a general population sample (n = 43). A Portuguese translation of the substance abuse scale was administered in paper and pencil format at the time of intake into treatment and to randomly selected youths in school. The mean score on the 15-item substance abuse scale in the treatment group was 6.7 compared to 1.9 in the comparison group (t = 6.78; p < .001). The optimal cut-off score of two positive endorsements has 85% sensitivity and 70% specificity. This study demonstrates that the DUSI-R's substance abuse scale is valid for screening Brazilian youths who require treatment.