National Drugs Strategy 2009 - 2016

National Drugs Strategy 2009 – 2016 Click here to download PDF 2.6mb

Newer antiepileptic drugs in the treatment of status epilepticus: impact on prognosis

Background: Newer antiepileptic drugs (AED) are increasingly prescribed, and seem to have a comparable efficacy as the classical AED, but are better tolerated. Very scarce data exist regarding their prognostic impact in patients with status epilepticus (SE). We therefore analyzed the evolution of prescription of newer AED between 2006-2010 in our prospective SE database, and assessed their impact on SE prognosis.¦Methods: We found 327 SE episodes occurring in 271 adults. The use of older versus newer AED (levetiracetam, pregabalin, topiramate, lacosamide) and its relationship to outcome (return to clinical baseline conditions, new handicap, or death) were analyzed. Logistic regression models were applied to adjust for known SE outcome predictors.¦Results: We observed an increasing prescription of newer AED over time (30% of patients received them at the study beginning, vs. 42% towards the end). In univariate analyses, patients treated with newer AED had worse outcome than those treated with classical AED only (19% vs 9% for mortality; 33% vs 64% for return to baseline, p<0.001). After adjustment for etiology and SE severity, use of newer AED was independently related to a reduced likelihood of return to baseline (p<0.001), but not to increased mortality.¦Conclusion: This retrospective study shows an increase of the use of newer AED for SE treatment, but does not suggest an improved prognosis following their prescription. Also in view of their higher price, well-designed, prospective assessments analyzing their impact on efficacy and tolerability should be conducted before a widespread use in SE.

Steering Group Report on a National Substance Misuse Strategy February 2012

Alcohol plays a complex role in Irish society. It is associated with many aspects of Irish social and cultural life and is generally consumed for enjoyment, relaxation and sociability. The pub often plays an important role in community life and is an attraction for tourists. More broadly, alcohol plays a signifi cant role in the Irish economy by generating employment, tax income and export income.However, alcohol is no ordinary commodity. It has major public health implications and it is responsible for a considerable burden of health and social harm at individual, family and societal levels. Steering Group Report on a National Substance Misuse Strategy February 2012 Click here to download PDF 2.7mb

Staying safe

This leaflet provides advice and information on drugs and clubbing, on planning ahead for a night out, dancing and drugs, looking after your friends, drugs and the law and first aid information.

Evaluation of indirect susceptibility testing of Mycobacterium tuberculosis to the first- and second-line, and alternative drugs by the newer MB/BacT system

In order to evaluate the Organon Teknika MB/BacT system used for testing indirect susceptibility to the alternative drugs ofloxacin (OFLO), amikacin (AMI), and rifabutin (RIF), and to the usual drugs of standard treatment regimes such as rifampin (RMP), isoniazid (INH), pyrazinamide (PZA), streptomycin (SM), ethambutol (EMB), and ethionamide (ETH), cultures of clinical specimens from 117 patients with pulmonary tuberculosis under multidrug-resistant investigation, admitted sequentially for examination from 2001 to 2002, were studied. Fifty of the Mycobacterium tuberculosis cultures were inoculated into the gold-standard BACTEC 460 TB (Becton Dickinson) for studying resistance to AMI, RIF, and OFLO, and the remaining 67 were inoculated into Lowenstein Jensen (LJ) medium (the gold standard currently used in Brazil) for studying resistance to RMP, INH, PZA, SM, EMB, and ETH. We observed 100% sensitivity for AMI (80.8-100), RIF (80.8-100), and OFLO (78.1-100); and 100% specificity for AMI (85.4-100), RIF (85.4-100), and OFLO (86.7-100) compared to the BACTEC system. Comparing the results obtained in LJ we observed 100% sensitivity for RMP (80-100), followed by INH - 95% (81.8-99.1), EMB - 94.7% (71.9-99.7), and 100% specificity for all drugs tested except for PZA - 98.3 (89.5-99.9) at 95% confidence interval. The results showed a high level of accuracy and demonstrated that the fully automated, non-radiometric MB/BacT system is indicated for routine use in susceptibility testing in public health laboratories.

Ampakine CX546 bolsters energetic response of astrocytes: a novel target for cognitive-enhancing drugs acting as alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor modulators.

Glutamate was previously shown to enhance aerobic glycolysis i.e. increase glucose utilization and lactate production with no change in oxygen levels, in mouse cortical astrocytes by a mechanism involving glutamate uptake. It is reported here that a similar response is produced in both hippocampal and cerebellar astrocytes. Application of the cognitive-enhancing drug CX546 promoted further enhancement of glucose utilization by astrocytes from each brain area following glutamate exposure. alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors represent the purported molecular target of cognitive-enhancing drugs such as CX546, and the presence of AMPA receptor subunits GluR1-4 was evidenced in astrocytes from all three regions by immunocytochemistry. AMPA itself did not stimulate aerobic glycolysis, but in the presence of CX546, a strong enhancement of glucose utilization and lactate production was obtained in cortical, hippocampal and cerebellar astrocytes. The effect of CX546 was concentration-dependent, with an EC(50) of 93.2 microm in cortical astrocytes. AMPA-induced glucose utilization in the presence of CX546 was prevented by the AMPA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) and the negative modulator GYKI 52466. In addition, the metabolic effect of CX546 in the presence of AMPA was mimicked by the AMPA receptor modulator cyclothiazide. Our data suggest that astrocyte energetics represents a novel target for cognitive-enhancing drugs acting as AMPA receptor modulators.

Your body, your life, your choice

This booklet provides information about different drugs, their effects, their risks and how to deal with problems, whether they happen to you or a friend.

Hypertension artérielle réfractaire au traitement due au syndrome d'apnées du sommeil et à la prise de médicaments [Obstructive sleep apnea and drugs as causes of treatment-resistant hypertension].

Treatment-resistant hypertension is still common despite the availability of several types of antihypertensive agents acting by different mechanisms. The existence of refractory hypertension should lead to rule out "white-coat hypertension", poor adherence to prescribed drugs as well as classical causes of secondary hypertension such as renal artery stenosis, primary aldosteronism, pheochromocytoma and renal disease. It is also important to consider the possible existence of obstructive sleep apnea or the regular intake of vasopressive drugs or substances.

Effects of immunosuppressive drugs on T helper cells subsets and potential to promote tolerance in a stringent experimental transplantation model.

To achieve the goal of sustained donor-specifi c transplantation (Tx) tolerance, research efforts are now focusing on therapies based on specifi c cell subsets with regulatory properties. We and others have previously highlighted the therapeutic potential of naturally occurring CD4+CD25+Foxp3+ regulatory T cells (nTreg) in promoting long-term graft acceptance. Using more stringent experimental Tx models, we were however confronted to limitations. Indeed, while the transfer of antigenspecifi c nTreg promoted long-term MHC-mismatched skin allograft acceptance in lymphopenic mice in the absence of any immunosuppressive drug, allograft survival was only slightly prolonged when nTreg were transferred alone into non-lymphopenic mice. This suggested that in more stringent conditions, adjuvant therapies may be needed to effectively control alloreactive T cells (Teff). Whether and how the expansion of the Treg pool could be best combined with current immunosuppressive regimens in clinical settings remains to be defi ned. In this study, we have used in vitro assays and an in vivo skin Tx model to investigate the effects of various immunosuppressive drugs on the survival, proliferation and effector function of Teff and nTreg in response to alloantigens. Teff proliferation was inhibited in a dose-dependent manner by rapamycin and cyclosporine A, while anti-CD154 mAb only marginally affected Teff survival, proliferation and effector fucntion in vitro. Rapamycin promoted apoptosis of Teff as compared to nTreg that were more resistant in the presence of IL-2. In vivo, the transfer and/or expansion of Treg could be advantageously combined with rapamycin and anti-CD154 mAb treatment to signifi cantly prolong MHC-mismatched skin allografts survival in non-lymphopenic recipients. Taken together our data indicate that immunosuppressive drugs differentially target T-cell subsets and that some regimens could promote Treg expansion while controlling the Teff pool in response to alloantigens.

Trypanosoma cruzi: establishment of permeable cells for RNA processing analysis with drugs

Pre-mRNA maturation in trypanosomatids occurs through a process called trans-splicing which involves excision of introns and union of exons in two independent transcripts. For the first time, we present the standardization of Trypanosoma cruzi permeable cells (Y strain) as a model for trans-splicing study of mRNAs in trypanosomes, following by RNase protection reaction, which localizes the SL exon and intron. This trans-splicing reaction in vitro was also used to analyze the influence of NFOH-121, a nitrofurazone-derivative, on this mechanism. The results suggested that the prodrug affects the RNA processing in these parasites, but the trans-splicing reaction still occurred.

Report Against Drugs- an action plan to combat substance abuse in Longford.

The Forum for Longford was started in 1997 to provide a co-ordinated inter-agency approach to identify and help tackle social problems in Longford. A survey was carried out with 1,331 post-primary students to ascertain attitudes and behaviours towards alcohol, smoking and drug use. Of the pupils interviewed, 64% had taken an alcoholic drink at age 15 or younger; of these 73% had their first drink between the ages of 12 to 15. Of those that had experience of alcohol, 51% drank several times a week or daily. For smoking, 67% had smoked a cigarette; of these 8% smoked 5 or more daily. Of those that smoked, 47% began between the ages of 11 to 14. With regard to illegal drugs 27% had used cannabis, 20% had used inhalants, 10% hallucinogens, 9% amphetamines and 7.4% had used ecstasy. Following on form these findings, the report makes several recommendations, including the formation of a community task force, Garda/ neighbourhood watch response, schools prevention and information. Also among these key areas are the role of parents, the needs of young people and facilities for young people.This resource was contributed by The National Documentation Centre on Drug Use.

2006 Drugs estimate refuels debate on governance, Issue 17, Spring 2006

In November 2005 €34.027 million was voted for the Drugs Initiative, which funds the local and regional drugs task forces, and the Young People’s Facilities and Services Fund (YPFSF), in 2006 – an 8 per cent increase on the allocation for 2005 and ‘well in excess of inflation’ according to the government. The community sector strongly criticised this estimate, calling for an additional €8 million to €15 million, to fund the projects identified following the creation of the Emerging Needs Fund in January 2005. In February 2006, the government revised its drugs estimate upwards by a further €8.979 million. As well as criticising the 2006 drugs estimate, the community sector raised a series of concerns with regard to governance – the rules, processes and behaviour that affect the way in which powers are exercised4 – or, in short, decision-making with regard to drugs policy in Ireland.This resource was contributed by The National Documentation Centre on Drug Use.

A guide to working in partnership: employability provision for drug users.

The aim of this guide is to identify the key principles of partnership working and to provide case study examples of how partnership works in practice in employability provision for drug users. Developing and sustaining new and valuable relationships with the world beyond drugs is a key factor in sustainable recovery for drug users. This includes the worlds of employment, training and education. Research suggests that employment can aid the process of recovery. A qualitative study of drug users in Scotland highlighted the importance of employment and other activities to fill the ‘void’ left by drug useThis resource was contributed by The National Documentation Centre on Drug Use.

A manual in quality standards in substance use education.

A Manual in Quality Standards in Substance Use Education is published by The Drug Education Workers Forum (DEWF). The manual looks at different areas of substance use education, such as schools, youth work and community settings, and provides clear information on the best practice for delivering such education.This resource was contributed by The National Documentation Centre on Drug Use.

A Report on Drug Abuse in Dublin

This report consists of a number of case histories and taped interviews with drug users in which they speak about their reasons for taking drugs. The author also analyses the drug trafficking scene, which is based on the importation of drugs from London, Northern Ireland, robbery of chemists' shops and forged prescriptions. The author concludes that adequately equipped drug clinics, advisory services and better police precautions all have an important part to play in dealing with the drugs problem. He also concludes the Drug Squad needs to be strengthened and educational programmes about the dangers of drugs need to be introduced into schools.This resource was contributed by The National Documentation Centre on Drug Use.