Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention

Objectives: The objective of the study was to longitudinally assess the outcomes and correlates of suicidal ideation and behavior (SIB) among heroin users who attended inpatient detoxification and psychosocial rehabilitation. SIB was assessed in 300 heroin users upon entry into inpatient detoxification (baseline) as well as 3-months (t1) (n = 252; 84%) and 9-months (t2) (n = 225; 75%) post treatment. Multivariable logistic regression was used to determine the demographic, clinical and treatment related factors that increased the risk for a high SIB score. Results: From baseline to t1 there was a significant decrease in the proportion of those who endorsed SIB (68.7 vs. 38.9%, p \u3c 0.0001). There was an increase in the proportion of those who endorsed SIB from t1 to t2 (38,9 vs. 47.1%, p = 0.047). There was a significant increase in the proportion of those reporting suicide likely in the near future from baseline to t1 (8.7 vs. 16.3%: p \u3c 0.0049) and this was repeated from t1 to t2 (22.7%) (t1 vs. t2: p = 0.031). After controlling for all other variables, a comorbid mental illness (MI) at baseline was a significant independent risk factor for a high SIB score at t1(RR 1.63; 95% CL 1.30–2.03) (p \u3c 0.0001) and a comorbid MI at t1 increased the risk for a high SIB score at t2 (RR 2.73; 95% CL 1.78–4.19) (p \u3c 0.0001). A poorer general health score and poorer social functioning score at baseline were associated with a high SIB score at baseline (RR 1.02; 95% CL 1.01–1.04) (p = 0.001) and t2, respectively (RR 1.07; 95% CL 1.04–1.11) (p \u3c 0.0001). Conclusions: Among heroin users, a comorbid mental illness, poorer physical health and poorer social functioning are important factors to consider in suicide risk assessment. Although there were decreases in overall SIB 3 months after detoxification, this trend was not sustained at 9-month follow-up. After detoxification there were significant increases in the proportion of those reporting a likelihood of suicide in the following 3 months. The results suggests that the treatment exposure did not adequately mitigate suicide risk. There is a need for review of the treatment as well as targeted screening and management of SIB in heroin users attending treatment services

Responding to COVID-19 : emerging practices in addiction medicine in 17 countries

Following the classification of the Coronavirus disease (COVID-19) as a pandemic by the World Health Organization (WHO), countries were encouraged to implement urgent and aggressive actions to change the course of the disease spread while also protecting the physical and mental health and well-being of all people. The challenges and solutions of providing prevention, treatment, and care for those affected with issues related to substance use and addictive behaviors are still being discussed by the global community. Several international documents have been developed for service providers and public health professionals working in the field of addiction medicine in the context of the pandemic (1–3), however, less is known about country-level responses. In the current paper we, as individual members of the Network of Early Career Professionals working in Addiction Medicine (NECPAM), discuss emerging country-level guidelines developed in the 6 months following the outbreak.The South African Medical Research Councilhttp://www.frontiersin.org/Psychiatryam2022Family Medicin

Factors associated with recidivism at a South African forensic psychiatric hospital

Aims: This study examines common factors associated with recidivism among state patients at a South African forensic psychiatric hospital. More specifically, demographic, clinical and criminological factors of a recidivist group are compared to a non-recidivist group with the intention of understanding to what extent these factors might determine the likelihood of re-offending. Method: A retrospective case file review of 293 inpatients and a random selection of 120 outpatients was conducted. For the purpose of the study, a patient was classified as a recidivist if an additional charge or act of violence was added to the file while the patient was on leave of absence in the community. Of the inpatients, only those who met the criteria for recidivism were included in the study. All 120 randomly selected outpatients were included. Demographic, clinical and criminological data were captured for all patients. Results: Eighty recidivists were compared with 100 non-recidivists. Using the × 2 and Fischer’s exact test, substance-use disorder, antisocial personality disorder, an index offence of assault and in-ward adverse events were found to be associated with recidivism (p < 0.05). Using logistic regression analysis, the odds of recidivism in a patient with an index offence of assault was 8.4 times of those who did not commit assault as an index offence (95.0% CI 1.6–43.1). The odds of recidivism for patients with cannabis use was 2.8 (95.0% CI 1.3–6.0) and for patients with in-ward adverse sexual behaviour was 17.2 (95.0% CI 2.0–150). Conclusion: Substance-use disorder and antisocial personality disorder are associated with higher risk for recidivism. This study also highlights that a less serious offence such as assault had a higher association with recidivism. Patients noted to display adverse sexual behaviour in the ward pose a potentially high risk for re-offence. Important criminal history factors and certain clinical factors could not be interpreted because of large amounts of missing data in patients’ files

Effectiveness of psychosocial interventions for alcohol use disorder:a systematic review and meta-analysis update

Background: Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO's Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD). Objective: To estimate the effects of psychosocial interventions on drinking and related outcomes. Methods: We included randomized controlled trials published between January 2015 and June 2022 on adults with alcohol dependence (ICD 10/DSM-IV) and moderate to severe AUD (DSM-5), and those examined psychosocial interventions against treatment-as-usual (TAU) and active controls. Eight databases and registries were searched. Relative Risk (RR) and standardized mean difference (SMD) were used for dichotomous and continuous outcomes. We used Cochrane's risk of bias assessment (RoB2). Results: Of 873 screened records, 14 and 13 studies in the narrative synthesis and meta-analysis. Of the 2,575 participants, 71.5% were men. Thirteen studies used ICD 10/DSM IV diagnosis. Compared to TAU, any psychosocial intervention increased the relative risk of abstinence by 28% [ N  = 7, RR = 1.28, 95% CI: 1.07 to 1.53, p  = .01, NNT = 9]. There were minimal heterogeneity and no evidence of publication bias. Psychosocial interventions were not effective in reducing the drinking frequency ( n  = 2, Hedge's g = -0.10, 95% CI: -0.46 to 0.26, p  = .57) and drinks/drinking days ( N  = 5, g = -0.10, 95% CI: -0.37 to 0.16, p  = .43). Treatment discontinuation did not differ between intervention and control groups [RR = 1.09, 95% CI: 0.66 to 1.80]. Conclusion: Psychosocial interventions are effective in improving abstinence but not in reducing drinking frequency or amount. Policymakers must consider this evidence to generate AUD treatment guidelines. Registration: PROSPERO 2022 CRD42022342608. </p

Fronto-temporal cortical atrophy in ‘nyaope’ combination heroin and cannabis use disorder

Sub-Saharan Africa is one of the top three regions with the highest rates of opioid-related premature mortality. Nyaope is the street name for what is believed to be a drug cocktail in South Africa although recent research suggests that it is predominantly heroin. Nyaope powder is most commonly smoked together with cannabis, a drug-use pattern unique to the region. Due to the increasing burden of this drug in low-income communities and the absence of human structural neuroimaging data of combination heroin and cannabis use disorder, we initiated an important cohort study in order to identify neuroanatomical sequelae. Twenty-eight male nyaope users and thirty healthy, matched controls were recruited from drug rehabilitation centers and the community, respectively. T1-weighted MRI images were obtained using a 3 T General Electric Discovery and cortical thickness was examined and compared. Nyaope users displayed extensive grey matter atrophy in the right hemispheric medial orbitofrontal, rostral middle frontal, superior temporal, superior frontal, and supramarginal gyri (two-sided t-test, p < 0.05, corrected for multiple comparisons). Our findings indicate cortical abnormality in nyaope users in regions involved in impulse control, decision making, social- and self-perception, and working memory. Importantly, affected brain regions show large overlap with the pattern of cortical abnormalities shown in heroin use disorder

The Impact of stigma on treatment services for people with substance use disorders during the COVID-19 pandemic-perspectives of NECPAM members.

Stigma is a mark of shame, disgrace, or disapproval which results in an individual being rejected, discriminated against, and excluded from society. Stigma toward individuals with substance use disorders (SUDs) affects the emotional, mental, and physical health of individuals. People with SUD are often viewed as unpredictable, dangerous, and morally responsible for their condition. These prejudiced and discriminatory views of the community may lead to reduced access to care, inability to make decisions regarding treatment, and forced or coerced treatment. Further, stigma negatively affects the policies and programs intended for the management of substance use and other addictive disorders....

Responding to COVID-19: emerging practices in addiction medicine in 17 countries.

Contains fulltext : 232789.pdf (Publisher’s version ) (Open Access)6 p

Optimizing digital tools for the field of substance use and substance use disorders:backcasting exercise

Background: Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities.Objective: This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030.Methods: A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders’ collaborative engagement during the 2022 Lisbon Addiction Conference.Results: The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis.Conclusions: The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones