ADOLESCENTES USUÁRIAS DE SUBSTÂNCIAS PSICOATIVAS

Esta pesquisa estudou adolescentes internadas para tratamento de dependência de drogas no Centro de Recuperação Álcool e Drogas Desafio Jovem. Objetivou descrever as características psicossociais e a psicodinâmica dessas adolescentes, além de identificar comportamentos de riscos e de proteção à saúde das participantes. Para coleta de dados, foram utilizados o Questionário de Identificação Sócio-Demográfico e Consumo de Substâncias Psicoativas, o teste projetivo H.T.P. (House-Tree-Person) e o Inventário de Triagem do Uso de Drogas (DUSI) . Fizeram parte do estudo 14 adolescentes na faixa de 12 a 17 anos. A maioria das adolescentes (78,57%) são filhas de pais separados. A primeira substância usada, na faixa de idade de 9 a 14 anos, foi o cigarro (42,86%), a segunda foi a maconha (35,71%), a terceira, na faixa de 9 a 15 anos foi o álcool (21,43%) e a quarta substância, na faixa de 9 a 16 anos foi o crack (35,71%). A droga predileta das adolescentes é o crack (42,9%). A carência afetiva é vista como reflexo da própria história de vida, com o desamparo, com ausência de afeto, falta de confiança, isolamento, falta de contatos sociais seguros, descontentamento com o ambiente familiar que se apresenta restritivo, apresentando vulnerabilidade que se faz presente em relação às pressões vividas no ambiente familiar. O pai se constitui quase sempre ausente na elaboração das adolescentes. Situações, como negligência, violência e abandono paterno, bem como o envolvimento com drogas lícitas e ilícitas pelos pais e outros familiares, devem ser objeto de medidas de proteção de políticas públicas de promoção de saúde familiar e comunitária e de redução de danos relacionados ao uso de substâncias psicoativas.

Pharmacist professionals in the prevention of drug abuse: updating roles, and opportunities

The objective of this paper was to prepare and provide resources to pharmacists and other healthcare professionals, enabling them to carry out a critical analysis on drug abuse, acquiring knowledge in several areas that effectively contribute to their personal development in this professional field. Professionals play a crucial role in the reduction and prevention of substances abuse, since they are able to advise patient about illicit drugs, psychotropic medicines and alcohol abuse. There is an urgent need to specialize pharmacists to act in the national public health service and contribute to actions aimed at the surrounding community.

Untargeted profiling of urinary steroid metabolites after testosterone ingestion: opening new perspectives for antidoping testing.

AIM: Antidoping procedures are expected to greatly benefit from untargeted metabolomic approaches through the discovery of new biomarkers of prohibited substances abuse. RESULTS: Endogenous steroid metabolites were monitored in urine samples from a controlled elimination study of testosterone undecanoate after ingestion. A platform coupling ultra-high pressure LC with high-resolution quadrupole TOF MS was used and high between-subject metabolic variability was successfully handled using a multiblock data analysis strategy. Links between specific subsets of metabolites and influential genetic polymorphisms of the UGT2B17 enzyme were highlighted. CONCLUSION: This exploratory metabolomic strategy constitutes a first step toward a better understanding of the underlying patterns driving the high interindividual variability of steroid metabolism. Promising biomarkers were selected for further targeted study.

HIV infection, viral hepatitis and liver fibrosis among prison inmates in West Africa.

BACKGROUND Prisoners represent a vulnerable population for blood-borne and sexually transmitted infections which can potentially lead to liver fibrosis and ultimately cirrhosis. However, little is known about the prevalence of liver fibrosis and associated risk factors among inmates in sub-Saharan Africa. METHODS Screening of liver fibrosis was undertaken in a randomly selected sample of male inmates incarcerated in Lome, Togo and in Dakar, Senegal using transient elastography. A liver stiffness measurement ≥9.5 KPa was retained to define the presence of a severe liver fibrosis. All included inmates were also screened for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Substances abuse including alcohol, tobacco and cannabis use were assessed during face-to-face interviews. Odds Ratio (OR) estimates were computed with their 95 % Confidence Interval (CI) to identify factors associated with severe liver fibrosis. RESULTS Overall, 680 inmates were included with a median age of 30 years [interquartile range: 24-35]. The prevalence of severe fibrosis was 3.1 % (4.9 % in Lome and 1.2 % in Dakar). Infections with HIV, HBV and HCV were identified in 2.6 %, 12.5 % and 0.5 % of inmates, respectively. Factors associated with a severe liver fibrosis were HIV infection (OR = 7.6; CI 1.8-32.1), HBV infection (OR = 4.8; CI 1.8-12.8), HCV infection (OR = 52.6; CI 4.1-673.8), use of traditional medicines (OR = 3.7; CI 1.4-10.1) and being incarcerated in Lome (OR = 3.3; CI 1.1-9.8) compared to Dakar. CONCLUSIONS HIV infection and viral hepatitis infections were identified as important and independent determinants of severe liver fibrosis. While access to active antiviral therapies against HIV and viral hepatitis expands in Africa, adapted strategies for the monitoring of liver disease need to be explored, especially in vulnerable populations such as inmates.

Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders

Objective: This study examined the pattern of criminal convictions in persons with schizophrenia over a 25-year period marked by both radical deinstitutionalization and increasing rates of substance abuse problems among persons with schizophrenia in the community. Method: The criminal records of 2,861 patients (1,689 of whom were male) who had a first admission for schizophrenia in the Australian state of Victoria in 1975, 1980, 1985, 1990, and 1995 were compared for the period from 1975 to 2000 with those of an equal number of community comparison subjects matched for age, gender, and neighborhood of residence. Results: Relative to the comparison subjects, the patients with schizophrenia accumulated a greater total number of criminal convictions (8,791 versus 1,119) and were significantly more likely to have been convicted of a criminal offense (21.6% versus 7.8%) and of an offense involving violence (8.2% versus 1.8%). The proportion of patients who had a conviction increased from 14.8% of the 1975 cohort to 25.0% of the 1995 cohort, but a proportionately similar increase from 5.1% to 9.6% occurred among the comparison subjects. Rates of known substance abuse problems among the schizophrenia patients increased from 8.3% in 1975 to 26.1% in 1995. Significantly higher rates of criminal conviction were found for patients with substances abuse problems than for those without substance abuse problems (68.1% versus 11.7%). Conclusions: A significant association was demonstrated between having schizophrenia and a higher rate of criminal convictions, particularly for violent offenses. However, the rate of increase in the frequency of convictions over the 25-year study period was similar among schizophrenia patients and comparison subjects, despite a change from predominantly institutional to community care and a dramatic escalation in the frequency of substance abuse problems among persons with schizophrenia. The results do not support theories that attempt to explain the mediation of offending behaviors in schizophrenia by single factors, such as substance abuse, active symptoms, or characteristics of systems of care, but suggest that offending reflects a range of factors that are operative before, during, and after periods of active illness.

ANSIEDADE E CONSUMO DE SUBSTÂNCIAS PSICOATIVAS EM ADOLESCENTES

Os objetivos deste estudo foram: relacionar o consumo de substâncias psicoativas e ansiedade, verificar os níveis de ansiedade e as substâncias psicoativas mais consumidas, e associar consumo de substâncias psicoativas e ansiedade entre estudantes do ensino médio de escolas públicas e particulares da cidade de Maceió. Os estudantes e as instituições que participaram da pesquisa foram selecionados por meio de amostragem não-probabilística por conveniência. Tratou-se de um estudo de delineamento correlacional. A amostra foi de 407 estudantes, com idade de 14 a 18 anos. A pesquisa foi realizada em sete escolas, sendo quatro da rede pública estadual e três da rede particular. Os participantes responderam a um questionário sóciodemográfico; à Escala de Ansiedade do Adolescente (EAA); e a um questionário sobre o consumo de substâncias psicoativas. Foi feita a análise das relações entre consumo de substâncias psicoativas e ansiedade por meio do teste qui-quadrado e exato de Fisher. O álcool foi a substância lícita mais consumida pelos estudantes, enquanto o solvente, a substância ilícita mais consumida por esse grupo. Os participantes apresentaram maior percentual no nível moderado: 28%. Verificou-se diferença estatisticamente significativa entre o consumo de substâncias psicoativas e ansiedade nos adolescentes. O uso na vida de solventes (p=0,037) e energéticos (p=0,023); uso no ano de cigarro (p=0,043) e bebidas alcoólicas (p=0,007); e uso freqüente de bebidas alcoólicas (p<0,001) relacionou-se com ansiedade moderada. Houve diferença significativa entre consumo de substâncias psicoativas e ansiedade nos tipos de escola: Na escola pública, houve relação entre estudantes que disseram consumir cigarro na vida e no ano, e entre os que fizeram uso na vida de solventes e energéticos com ansiedade grave (p=0,022; p=0,003; p=0,010;p=0=0,44, respectivamente); e entre estudantes que afirmaram ter feito consumo freqüente de bebidas alcoólicas com ansiedade moderada (p=0,007). Na escola particular, houve relação entre estudantes consumiram bebidas alcoólicas no ano com ansiedade moderada (p=0,011). A pesquisa verificou a necessidade de se realizarem projetos de prevenção de drogas e promoção de saúde que visem aumentar a reflexão sobre o estilo de vida e ansiedade.

Etapas de cambio comportamental frente al consumo de drogas ilegales, tabaco y alcohol en escolares de 9 a 17 años de Bogotá – Colombia

Objetivo: El propósito del estudio fue describir estadísticamente las etapas de cambio comportamental frente al consumo de sustancias psicoactivas –SPA– (alcohol, tabaco y drogas ilegales) en escolares entre 9 y 17 años de Bogotá- Colombia, pertenecientes al estudio FUPRECOL. Método: Se trata de un estudio descriptivo y transversal en 6.965 niños y adolescentes entre 9 y 17 años, pertenecientes a 24 instituciones educativas oficiales de Bogotá - Colombia. La medición de los procesos de cambio propuestos por el Modelo Transteórico (MTT), aplicados al consumo de drogas, tabaco y alcohol se aplicaron de manera auto-diligenciada mediante un cuestionario estructurado. Resultados: De la muestra evaluada, el 58,4% fueron mujeres con un promedio de edad 12,74 ± 2.38 años. En la población en general, frente al consumo de drogas, el 6% de los escolares se encontraban en etapa de pre-contemplación, 44 % en contemplación; 30% en preparación/acción, 20% en mantenimiento. Con relación al consumo de alcohol, el 5% de los niños y adolescentes se encontraban en etapa de pre-contemplación, 36 % en contemplación; 12% en preparación/acción, 46% en mantenimiento. Frente al tabaco, el 4% de los niños y adolescentes se encontraban en etapa de pre-contemplación, 33 % en contemplación; 12% en preparación/acción, 51% en mantenimiento. Conclusiones: En los escolares evaluados, un importante porcentaje se ubica en la etapa de mantenimiento frente a la intención de consumo de tabaco y alcohol. Frente al consumo de drogas ilegales los niños y adolescentes están en la etapa de contemplación. Se requieren esfuerzos mayores para fomentar programas preventivos que enseñen sobre el riesgo del abuso/dependencia de este tipo de sustancias psicoactiva sobre la salud; dándole prioridad en las agendas y políticas públicas dentro del ámbito escolar.

L'adolescent consommateur de substances face au réseau de soins [Substance abuse adolescents and the health care network]

Substance user adolescents were asked to report on each contact they had had with any type of care providers since they had begun to use alcohol or illegal drugs regularly. Primary care doctors and social workers represent the main access to the care network. In one out of two contacts substance use was not discussed.

Applications of a transportable Raman spectrometer for the in situ detection of controlled substances at border controls

A transportable Raman spectrometer was tested for the detection of illicit drugs seized during border controls. In a first step, the analysis methodology was optimized using reference substances such as diacetylmorphine (heroin), cocaine and amphetamine (as powder or liquid forms). Adequate focalisation distance and times of analysis, influence of daylight and artificial light sources, repeatability and limits of detection were studied. In a second step the applications and limitations of the technique to detect the illicit substances in different mixtures and containers was evaluated. Transportable Raman spectroscopy was found to be adequate for a rapid screen of liquids and powders for the detection and identification of controlled substances. Additionally, it had the advantage over other portable techniques, such as ion mobility spectrometry, of being non-destructive and capable of rapid analysis of large quantities of substances through containers such as plastic bags and glass bottles.

Addiction: l'égalité face aux substances [Addiction: are women and men equal?]

When illicit drugs are taken, men and women have a different biological response to drug used. Likewise, gender differences show more stigmas, more complex familial environment, and more history of sexual abuse for drug addicted women. The expression of psychiatric co-morbidities differs according to gender, with increased mood disorders, eating disorders, anxiety, and post traumatic disorders among drug addicted women.

Symptômes dépressifs et consommation problématique de substances psychoactives : effets modérateurs du contexte social

Seulement une minorité d’adolescents qui consomment des substances psychoactives développe des problèmes significatifs reliés à cette consommation. Il importe donc de connaître et de comprendre les processus par lesquels se développe la consommation problématique afin de pouvoir la prévenir. Cette étude examine le rôle des symptômes dépressifs et des relations sociales dans le développement de la consommation problématique à l’adolescence. Plus précisément, elle vise à déterminer, à l’aide d’un devis longitudinal corrélationnel prospectif, si le soutien des pairs, le soutien des parents et la qualité de la relation maître-élève ont des effets modérateurs protecteurs sur la relation entre les symptômes dépressifs et la consommation problématique. L’échantillon utilisé pour cette étude est tiré de la Stratégie d’Intervention Agir Autrement et comprend 4473 adolescents. Des régressions linéaires multiples ont été effectuées et ont démontré que les symptômes dépressifs et le soutien des parents augmentent le risque d’une consommation problématique, alors que le soutien des pairs le diminue. De plus, les résultats confirment le rôle protecteur du soutien des pairs, mais indiquent que le soutien des parents exacerbe le lien entre les symptômes dépressifs et la consommation problématique. Par ailleurs, la qualité de la relation maître-élève est associée à une consommation moins problématique uniquement chez les jeunes qui n’ont pas beaucoup de symptômes dépressifs. Les implications de ces résultats sont discutées.

La comorbidité de l'épuisement professionnel et de la consommation de substances psychoactives.

L’objectif principal du présent mémoire réside dans l’exploration des liens concomitants existant entre les trois dimensions de l’épuisement professionnel telles que définies par Maslach (1981) et la consommation de substances psychoactives, plus précisément au niveau de la consommation épisodique excessive et hebdomadaire à risque d’alcool et de la consommation de médicaments psychotropes. À partir d’un échantillon composé de 1809 travailleurs provenant de 83 milieux de travail québécois, des profils-types correspondant à des formes particulières de comorbidité de santé mentale au travail sont identifiés grâce à la méthode d’analyse en classes latentes. Ainsi quatre profils-types sont dégagés: un premier regroupant les individus dits «sains», dont les scores aux différentes dimensions de l’épuisement professionnel sont faibles et dont la consommation de substances psychoactives est modérée; deux autres correspondant à des formes intermédiaires de risques; et un quatrième rassemblant des travailleurs dits «fragiles» dont les scores pour chacune des dimensions de l’épuisement professionnel se situent dans le quintile le plus élevé et dont les probabilités de consommation de substances psychoactives sont grandes. De plus, cette recherche s’est penchée sur l’identification de facteurs de risque et de protection associés à chacun des profils-types. À cet effet, les résultats des analyses corroborent la plupart des associations retrouvées au sein de la littérature quant aux facteurs du travail (composantes des modèles du stress professionnel de Karasek et Theorell (1990) ainsi que de Siegrist (1990)), hors travail (statut matrimonial, obligations parentales, revenu du ménage) et certaines caractéristiques individuelles (âge et genre). De faibles récompenses et un fort degré de surinvestissement de la part de l’individu se révèlent être des facteurs de risque particulièrement significatifs pour les formes intermédiaires et à risque de comorbidité de la santé mentale au travail. Dans une moindre mesure, une faible utilisation des compétences, des demandes psychologiques élevées, un soutien social inadéquat et le jeune âge expliquent une part de la variation observée entre les différents profils-types. Enfin, les résultats soutiennent une conceptualisation tridimensionnelle de l’épuisement professionnel.

Mieux estimer la consommation de substances illicites dans une communauté ; comment allier analyses des eaux usées et données traditionnelles

Travail dirigé présenté à la Faculté des arts et sciences en vue de l'obtention du grade de Maîtrise en criminologie, option criminalistique et information.

Use of psychoactive substances in students at a public university

Introduction: The use of psychoactive substances by the student population has been the object of various studies in Brazil. Objective: To determine the prevalence of substance use among students. Methods: Quantitative study with a closed questionnaire based on standardized assessment instruments was developed. It consists of questions related to types of psychoactive substance use, abuse, frequency and duration of use, self-criticism regarding the use, consequences of use in relation to health, and misdemeanors committed under the influence of psychoactive substances. The sample included the participation of 268 students. A total of 183 (68.3%) questionnaires were analyzed, and only those with positive result for substance abuse at some point in life, the remainder, 85 (31%) questionnaires, had negative responses to psychoactive substances. Results: Students’ responses to the two years surveyed indicated that the first psychoactive substance used was alcohol (77.9%), followed by tobacco use (10.9%), and marijuana (7.6%). Of the students surveyed, 145 (79.2%) answered that still make use of psychoactive substances, and the current frequency of use varies from one or more times per week. When asked about the possibility of being or becoming drug addicts, 169 (92.3%) responded that they are not or will not become dependent. Conclusion: The results indicate the high rate of substance use among college students surveyed, and point to their contradiction to consider such psychoactive substances harmful to their health.

Development of Original Analytical Methods for the Determination of Drugs of Abuse in Biological Samples

Drug abuse is a major global problem which has a strong impact not only on the single individual but also on the entire society. Among the different strategies that can be used to address this issue an important role is played by identification of abusers and proper medical treatment. This kind of therapy should be carefully monitored in order to discourage improper use of the medication and to tailor the dose according to the specific needs of the patient. Hence, reliable analytical methods are needed to reveal drug intake and to support physicians in the pharmacological management of drug dependence. In the present Ph.D. thesis original analytical methods for the determination of drugs with a potential for abuse and of substances used in the pharmacological treatment of drug addiction are presented. In particular, the work has been focused on the analysis of ketamine, naloxone and long-acting opioids (buprenorphine and methadone), oxycodone, disulfiram and bupropion in human plasma and in dried blood spots. The developed methods are based on the use of high performance liquid chromatography (HPLC) coupled to various kinds of detectors (mass spectrometer, coulometric detector, diode array detector). For biological sample pre-treatment different techniques have been exploited, namely solid phase extraction and microextraction by packed sorbent. All the presented methods have been validated according to official guidelines with good results and some of these have been successfully applied to the therapeutic drug monitoring of patients under treatment for drug abuse.