Substance use and its determinants: a cross-sectional study among students

Contexte : Bien que la consommation de substances psychoactives chez les étudiants éveille l’intérêt depuis quelques années, nous ne disposons pas à ce jour de données épidémiologiques sur les déterminants associés à la consommation de substances psychoactives chez les étudiants. Objectif : L’objectif de cette étude était d’identifier les déterminants associés à la consommation de substances psychoactives chez les étudiants. Méthode : La population d’étude comprenait les étudiants inclus dans la cohorte i-Share entre le 01 janvier 2015 et le 31 décembre 2017. Toutes les variables ont été extraites du questionnaire d’inclusion. La variable d’intérêt était la consommation au cours de la vie de substances psychoactives (cannabis, amphétamines, MDMA, cocaïne, protoxyde d’azote et poppers). Nous avons recherché les déterminants significativement associés à la consommation de substances psychoactives par des modèles de régression logistique multivariée en testant de nombreuses variables relatives aux autres consommations des étudiants, à leurs caractéristiques générales, au contexte de leur vie antérieure aux études, à leur cursus universitaire, à la vie actuelle, à leur santé physique et mentale, à leur bien être moral, et à leur vie sexuelle. Résultats : La population d’étude comprenait 11 046 étudiants, dont 9 922 étudiants ayant répondu aux questions permettant de caractériser leurs consommations de substances psychoactives. Le modèle de régression final comprenait 6218 étudiants. Les déterminants associés à la consommation de substances psychoactives chez les étudiants étaient le genre masculin (RC = 1,83 IC95% = [1,54-2,17]), viser un doctorat quand on est bachelier depuis plus de 4 ans (RC = 2,64 IC95% = [1,04-4,24]), une situation économique familiale difficile (RC = 0,73 IC95% = [0,57-0,94]), le mésusage de l’alcool (RC = 5,10 IC95% = [3,33-7,73]), la dépendance à l’alcool (RC = 9,09 IC95% = [1,13-71,99]), le tabagisme actif (RC = 28 IC95% = [22,60-34,94]) et ancien (RC = 7,87 IC95% = [6,75-9,19]), être très souvent incapable de répondre aux obligations (RC = 1,58 IC95% = [1,03-2,41]), ne jamais se protéger pendant les rapports sexuels (RC = 1,83 IC95% = [1,54-2,17]) et avoir eu au moins 5 partenaires sexuels les 6 derniers mois (RC = 1,83 IC95% = [1,54-2,17]). Discussion : Cette étude transversale permet de mettre en avant des associations sans présumer d’un lien de causalité. Ainsi, les hypothèses soulevées nécessitent d’être approfondies par d’autres schémas d’étude permettant de caractériser ces associations.Background: If use of psychoactive substance in students awake more and more interest the last few years, to date no epidemiologic data are available about determinants associated to this consumption. Aim: The objective of this study was to identify determinants associated to psychoactive substance use in students. Method: The study population was all students enrolees in the i-Share cohort included between January 2015 and December 2017. All variables were extracted from the inclusion questionnaire. The variable of interest was psychoactive substance (cannabis, amphetamine, MDMA, cocaine, nitrous oxide and poppers) use during life. Multivariate logistic regression models were performed to identify determinants significantly associated to psychoactive substance use. Many variables concerning others consumption, global characteristics, life context before studying, university degree, current life, physical and mental health, wellbeing, sex life. Results: the study population included 11 046 students, whose 9 922 students answered questions allowing a characterization of psychoactive substance use. The final multivariate regression logistic model included 6 218 students. Determinants significantly associated to psychoactive substance use in students was male gender (OR= 1.83 IC95%= [1.54-2.17]), aspiration to doctoral degree when you have been a bachelor for more than 4 years (OR= 2.64 IC95%= [1.04-4.24]), difficult economic situation in family (OR= 0.73 IC95%= [0.57-0.94]), alcohol misuse (OR= 5.10 IC95%= [3.33-7.73]), alcohol dependence (OR= 9.09 IC95% = [1.13-71.99]), smoking tobacco (OR= 28 IC95%= [22.60-34.94]) and old smoking tobacco (OR= 7.87 IC95% = [6.75-9.19]), being very frequently enable to meet obligations (OR= 1.58 IC95%= [1.03-2.41]), have unprotected intercourse (OR= 1.83 IC95%= [1.54-2.17]) and have more than 5 sexual partner during the past 6 months (OR= 1.83 IC95%= [1.54-2.17]). DI! SCUSSION: This transversal study highlights associations with psychoac tive substance use but does not allow to conclude to causal links. Thus raised hypothesis need other studies with adapted shape to characterize these associations

Second-degree burn induced by high-concentration topical capsaicin with mobility sequelae: a case report

International audienceHigh-concentration topical capsaicin is used as a second line treatment for neuropathic pain. Transient, mild burning sensation and erythema are expected adverse drug reactions. Here, we report the first case of second degree burn after the application of a high-concentration topical capsaicin patch with secondary mobility sequelae. Nine months after the application, neuropathic pain still remained and the patient described mobility difficulties in daily activities, preventing her from returning to work. This report aims to raise the question of the benefit/risk ratio of high concentration topical capsaicin

Int J Drug Policy

The Covid-19 pandemic offered a unique opportunity to investigate trends in hospitalizations related to psychoactive substance intoxication, since the usual health burden of social use at parties and gatherings was likely to be decreased during lockdowns and curfew periods. Since young adults are the main users of psychoactive substances for experimental and recreational purposes, this study identified and compared hospitalization trends in young adults and adults over 30 years old. This national cohort study was conducted using the French hospital discharge database. An interrupted time-series analysis for the period between 2014 and 2020 was performed in two groups: young (age 18-29) and other adults (30+) to ascertain the trends in the monthly incidence of hospitalization related to psychoactive substance intoxication (opiates, cocaine, benzodiazepines, psychostimulants, alcohol and cannabis). Hospitalization characteristics during the first and second lockdown and the period between them were compared to the reference period (from 01/01/2014 to 29/02/2020). Among 1,358,007 stays associated with psychoactive substance intoxication, 215,430 concerned young adults. Compared with adults 30+, hospitalization trends in young adults showed a greater decrease in the number of stays during lockdown, with a maximum decrease of -39% during the first lockdown (1,566 vs. 2,576; CI95%: 2,285-2,868) versus -20% (10,212 vs. 12,894; CI95%: 12,001-13,787) in the second lockdown. Presentations for alcohol intoxication decreased throughout the pandemic, particularly during the second lockdown, while admissions for benzodiazepine intoxication increased during both lockdowns. Admissions for cannabis intoxication increased throughout the entire period. Lockdowns were associated with fewer hospitalizations related to psychoactive substance intoxication in both age groups, especially among young adults, which might reflect a decrease in social use. Recreational use might therefore be an important target for prevention and risk minimization

Pharmacol Res

Context Ticagrelor was related to bradycardia in DISPERSE-II trial. This risk has been integrated into the European risk-management plan, and its use is warned in at-risk patients. Nevertheless, this risk was not systematically assessed nor measured. Objectives To estimate the risk of bradyarrhythmia associated with ticagrelor. Study design Systematic review and meta-analysis. Data-source MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ISI web of Science, clinicaltrial.gov, clinicaltrialsregister.eu. Study selection Randomized controlled trials (RCTs) and observational studies in patients treated with ticagrelor or comparator(s). Meta-analysis Risk of bias in each RCT was assessed using Cochrane tool. Relative Risks (RR) with 95 % confidence intervals (95 %CI) were calculated for each RCT, and pooled using fixed-effect or random-effects models, when appropriate. Subgroup and sensitivity analyses were performed. A potential publication bias was searched. Results Among 82 eligible studies, event data were missing for 56 studies, due to detected reporting bias (i.e. inability to confirm zero events). Fifteen RCTs were selected and the combined RR of bradyarrhythmia was 1.15 (95 %CI 1.05−1.26), and 1.29 (1.02−1.65) for severe bradyarrhythmia. The risk appeared to be dose dependent. Restricting the analysis only to RCTs performed in patients without previous bradyarrhythmia resulted in a non-increased risk. Conclusion This meta-analysis confirmed the risk of bradyarrhythmia or severe bradyarrhythmia related to ticagrelor, and its use in patients without previous bradycardia was effective in preventing it. The evidence coming from this meta-analysis was low to moderate due to missing outcome in 2/3 of eligible studies. Waiting for access to these data, the use of ticagrelor in patients with risk factors of bradycardias should be avoided

Targeting of under-75 years for the optimization of medication reconciliation with an approach based on medication risks: An observational study

PURPOSE: To date, how medication reconciliation (MR) could be prioritized in younger patients remains poorly evaluated. This study aimed at assessing whether a MR prioritization strategy based on the identification of high-risk medication at patients' admission treatment could be of interest in non-elderly patients. METHOD: This prospective study was conducted between July and September 2017 in an internal medicine unit at Bordeaux teaching hospital. All patients aged 16 to 74 years and receiving at least two long-term treatments at admission were considered eligible. High-risk medications were defined on the basis of a pharmacovigilance study, which identified the drugs most involved in serious adverse effects reported in the Nouvelle-Aquitaine region in non-elderly adults. They included antithrombotics, analgesics, antipsychotics and cardiac therapies. MR-induced treatment changes were compared according to the existence of high-risk medications at admission in study participants. RESULTS: Among the 92 study participants, 46 presented with high-risk medications at admission (median age 66 years, IQR 58-70) and 46 without such (median age 54 years, IQR 47-64). High risk-medications (HRM) existing at admission were antithrombotics (52.2%) and antipsychotics (22.4%). MR resulted in treatment changes in 37% of patients admitted with at-risk medications vs. 8.7% of those admitted without such (P=0.001). Overall, the mean number of treatment changes performed after MR was of 1 (95%CI 0.4-1.6) in patients with high-risk medication at admission and of 0.2 (95%CI 0-0.4) in patients without such. MR-induced treatment changes assessed as clinically major at least once by pharmacists or clinicians was greater in HRM group (43.5%) than in non-HRM group (31.6%). However, the consistency was low between clinicians and pharmacists, especially to distinguish the clinical importance of significant and minor interventions. CONCLUSION: Targeting high-risk medications at admission appeared efficient for the prioritization of MR in non-elderly patients hospitalised in internal medicine

Therapie

INTRODUCTION: Incidence of hospitalisations related to psychoactive substance (H-PS) intoxication has been strongly decreased during the coronavirus disease 2019 (COVID-19) pandemic especially in young adult and French region of Nouvelle-Aquitaine was mostly concerned. This study aimed to describe (i) the incidence of H-PS in Bordeaux teaching hospital during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. MATERIAL AND METHODS: This historical cohort study was conducted in adults admitted to the Bordeaux teaching hospital with main or associated diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-PS were described according to patients' age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). RESULTS: Among the 5,824 stays included over the study period, PS most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-PS's incidence was more important in young adults (-40%; n(baseline)=450) in comparison to those aged 30+ (-18%; n(baseline)=1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%; n(2017)=145 vs. -35%; n(2017)=166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalisation indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides attempts increased during lockdown compared to the baseline period (almost 50% vs. 29%) and the period after lockdown was associated with 1.7 more-time road accident increased and 3 more-time fights compared with pre-lockdown period. DISCUSSION/CONCLUSION: The period following lockdown should be considered at risk H-PS due to accident. Recreational use of alcohol and ecstasy could be a target for minimize serious consequences associated to PS use in young adult

Hospitalisations related to psychoactive substance intoxication in young adults during and after the first lockdown in Bordeaux Teaching Hospital

Meeting abstractIntroduction: Incidence of hospitalisations related to psychoactive substance intoxication (H-SPA) might have been differently impacted by the Covid-19 pandemic according to age-groups. This study aimed to describe (i) the incidence of H-SPA during and after the first 2020 lockdown in adults aged 18–29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017–2019 baseline period. Material and methods: This historical cohort study was conducted in adults admitted to the University Hospital of Bordeaux with main or secondary diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-SPA were described according to patients age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). Results: Among the 5824 stays included over the study period, SPA most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-SPA's incidence was more important in young adults (−40%; nbaseline = 450) in comparison to those aged 30+ (−18%; nbaseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (−59%; n2017 = 145 vs − 35%; n2017 = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalization indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides increased during lockdown compared to the baseline period (almost 50% vs 29%) and the proportion of accidents in context of intoxication (3.5 vs 0.7%) after lockdown. Discussion/Conclusion: The period following lockdown should be considered at risk for hospitalizations due to accident in context of SPA use. Strong decrease in the incidence of H-SPA in young adult during the lockdown highlights the health burden of recreational use of alcohol and ecstasy in this population and the need for prevention

Hospitalizations after substance use in a University Hospital during the COVID-19 pandemic

Meeting abstractIntroduction: As soon as the lockdown began, during the COVID-19 pandemic, first cases of overdoses were reported with opioids and cocaine to the French Addictovigilance Network [1]. However, little information was available on substance use-related hospitalizations (H-SPA). The objective of this study was to describe changes in the relative incidence of H-SPA before, during, and after the lockdown, and to describe the characteristics of hospitalizations and patients. Material and methods: This retrospective study was conducted on patients hospitalized at a University Hospital from January to July 2020 in the context of use of methadone, buprenorphine, benzodiazepines, heroin, morphine, codeine, cocaine, ecstasy, and alcohol, using the database of the Programme de medicalisation des systèmes d'information. Three time periods were defined for the analysis: before (01/01–16/03), during (17/03–10/05), and after the lockdown (11/05–31/07). These results were compared to the average of the data analyzed between 2017 and 2019 at the same three time periods. Results: In this study, 5,674 patients and 6,135 stays were included. H-SPA had decreased by 24% during the year of the pandemic, in particular during lockdown with a 57.6% decrease compared to previous years. In contrast, methadone was associated with a 233.3% increase in post-lockdown hospitalizations compared to 2017. Among patients hospitalized after methadone use, 4 had no known history of opiate use, 6 were known opiate/methadone users without methadone treatment, 7 were being treated with methadone. In 2020, H-SPA were more severe and involved drug-using patients with cardiovascular disease. Methadone/cocaine association was reported in 1/4 of deaths during the lockdown. Discussion/Conclusion: During the year of the pandemic and especially during the lockdown, H-SPA decreased but were more severe. Severe H-SPA were more likely to occur in drug-using patients with cardiovascular disease. This study highlights also a strong increase of hospitalizations related to methadone consumption (in opioid-naive subjects, or not) since the lockdown

Myocardial infarction associated with erenumab: a case report

International audienceBackground: Monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP-mabs) are novel drugs for resistant migraine prophylaxis. As CGRP-mabs cause inhibition of vasodilatation, their use is reserved to patients with no recent history of cardiovascular diseases. We report a case of myocardial infarction associated with erenumab.Case: A 57-year-old woman with a familial history of coronaropathy, was first treated with erenumab 70 mg for 6 months, then increased to 140 mg. Almost five months after, the patient presented chest pain, increased troponin and abnormal electrocardiogram. A myocardial infarction without coronarography abnormality was diagnosed through MRI.Conclusion: Further evidence is needed to assess the risk of myocardial infarction in patients treated with a CGRP-mab. In patients over 40 years of age, the risk of coronary or cardiovascular events should be assessed using risk tables or algorithms to take into account cardiovascular risk factors. This may be complemented by appropriate exams to measure the burden of coronary atherosclerosis, if necessary