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  1. Article ; Online: Pregabalin use in forensic hospitals and prisons in German speaking countries-a survey study of physicians.

    Novotny, Michal / Bulla, Jan / Hubl, Daniela / Fischer, Sebastian Karl Maximilian / Grosshans, Martin / Gutzeit, Andreas / Bilke-Hentsch, Oliver / Seifritz, Erich / Mutschler, Jochen

    Frontiers in public health

    2024  Volume 11, Page(s) 1309654

    Abstract: Background: Pregabalin is a gamma-aminobutyric acid (GABA) analog that was approved in the EU in 2004 for the treatment of neuropathic pain, generalized anxiety disorder and epilepsy. Since its introduction, pregabalin abuse and misuse has increased ... ...

    Abstract Background: Pregabalin is a gamma-aminobutyric acid (GABA) analog that was approved in the EU in 2004 for the treatment of neuropathic pain, generalized anxiety disorder and epilepsy. Since its introduction, pregabalin abuse and misuse has increased significantly. In Switzerland, clinical reports suggest that pregabalin misuse is common among patients in forensic hospitals and prisons. However, data on pregabalin use is scarce, especially in these settings. Therefore, we conducted a study to explore patterns of pregabalin use among prison and forensic patients.
    Methods: We used a questionnaire to survey physicians working in prison and forensic medicine in German-speaking countries. A total of 131 responses were received.
    Results: According to the physicians' subjective assessment, 82.5% of them had observed a recent increase in pregabalin use by their patients and 89.1% of them reported that their patients requested pregabalin without a clear medical indication. Patients misusing pregabalin in combination with other illicit substances were observed by 93.3% of the physicians surveyed. According to 73.5% of the physicians surveyed, they had already encountered patients on pregabalin doses of more than 600 mg/day (the maximum recommended daily dose); the highest dose reported was 4,200 mg/day. According to 85.0% of physicians surveyed, they have observed patients experiencing withdrawal symptoms from pregabalin, with the most commonly reported symptoms being displeasure and high aggression. Regarding the nationality of pregabalin-misusing patients, 58.3% of the interviewed physicians reported to be rather in contact with foreign patients, mainly from Northwest Africa (Maghreb). Only 45.0% of the surveyed physicians prescribe pregabalin. Among patients who developed behavioral problems while taking pregabalin, none of the physicians (0.0%) showed a tendency to continue pregabalin at the same dose; all respondents chose to reduce/substitute/discontinue.
    Conclusion: Our study has provided confirmatory evidence that the use of pregabalin presents a significant issue in forensic and prison medicine across German-speaking countries. Prescribing pregabalin in this field can compound use disorder problems and exacerbate challenges in daily life for those in forensic institutions or prisons. It is necessary that all physicians who prescribe pregabalin are clearly informed about the management (including the risks) of this drug.
    MeSH term(s) Humans ; Prisons ; Pregabalin/therapeutic use ; gamma-Aminobutyric Acid ; Hospitals ; Physicians
    Chemical Substances Pregabalin (55JG375S6M) ; gamma-Aminobutyric Acid (56-12-2)
    Language English
    Publishing date 2024-01-08
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2023.1309654
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Concomitant Drug Use among Opioid-Dependent Patients with and without Attention Deficit Hyperactivity Disorder: Does Methylphenidate Merit a Trial?

    Tschudi, Letizia / Fischer, Sebastian Karl Maximilian / Perlov, Evgeniy / Baumgartner, Markus R / Soyka, Michael / Müller, Thomas Jörg / Seifritz, Erich / Mutschler, Jochen

    European addiction research

    2023  Volume 29, Issue 5, Page(s) 305–312

    Abstract: Introduction: Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. ... ...

    Abstract Introduction: Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups.
    Methods: This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis.
    Results: We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group.
    Conclusion: Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.
    MeSH term(s) Humans ; Amphetamine ; Analgesics, Opioid/therapeutic use ; Attention Deficit Disorder with Hyperactivity/complications ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Central Nervous System Stimulants/therapeutic use ; Cocaine ; Cocaine-Related Disorders/complications ; Cross-Sectional Studies ; Heroin/therapeutic use ; Methylphenidate/therapeutic use ; N-Methyl-3,4-methylenedioxyamphetamine/therapeutic use ; Substance-Related Disorders/complications ; Treatment Outcome
    Chemical Substances Amphetamine (CK833KGX7E) ; Analgesics, Opioid ; Central Nervous System Stimulants ; Cocaine (I5Y540LHVR) ; Heroin (70D95007SX) ; Methylphenidate (207ZZ9QZ49) ; N-Methyl-3,4-methylenedioxyamphetamine (KE1SEN21RM)
    Language English
    Publishing date 2023-07-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1215786-7
    ISSN 1421-9891 ; 1022-6877
    ISSN (online) 1421-9891
    ISSN 1022-6877
    DOI 10.1159/000531008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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