Maconha como preditor para uso de crack e suas repercussões na pandemia de COVID-19

A Cannabis é a terceira substância mais utilizada em todo o mundo depois do álcool e do tabaco. O uso crônico de Cannabis está associado a alterações no sistema nervoso central (SNC) e no sistema endocanabinóide endógeno (SEE), comprometimento cognitivo e alterações motivacionais, principalmente quando o início de consumo ocorre na infância e adolescência quando há maior vulnerabilidade aos seus efeitos. No que tange aos usuários de crack, em sua grande maioria, relatam o uso de mais de uma substância, sendo a cannabis uma das drogas mais utilizadas por essa população. Neste sentido, artigo 1 avaliou a precocidade do uso de cannabis para desfechos acerca da progressão do uso de outras SPAS em usuários de crack, em 312 usuários de SPAs, tendo como droga principal o uso de crack. Os resultados apontam que a idade de início do uso de cannabis, álcool e nicotina são semelhantes, seguidas da cocaína aos 17 anos e finalmente do crack aos 21 anos. A idade do primeiro uso de cannabis esteve associada à idade do primeiro uso do crack (p <0,001) e também aos anos de uso regular desta SPA (p <0,01). O número de tratamentos (-0,114 IC 95% -0,603; -0,005 p = 0,046) e a idade do primeiro tratamento (0,13 IC 95% 0,040; 0,608 p = 0,026) apresentaram coeficientes mais baixos, assim como o escore de gravidade do instrumento ASI6 ( -0,017 IC 95% -0,244; -0,177 p = 0,756). Nossos resultados sugerem que a idade do primeiro uso de cannabis foi semelhante à das substâncias lícitas, sendo um preditor para o consumo prematuro e prolongado de outras SPAs, o que pode estar relacionado à gravidade da dependência e menor adesão terapêutica. Nesse contexto, estratégias preventivas psicoeducativas e com terapêuticas mais comportamentais talvez possam promover maior efetividade na melhora clínica, visto estudos anteriores reformulados, essa amostra como se apresenta mais deficitária em questões cognitivas como flexibilidade e controle inibitório. Houve um aumento do consumo de substâncias durante a pandemia de COVID-19. Entretanto, o uso abusivo pode acarretar na perpetuação do sofrimento psicológico, além de desencadear sintomas e transtornos psiquiátricos. O artigo 2 desta dissertação buscou realizar uma revisão breve a partir da literatura científica em relação a população que faz uso de cannabis e seu comportamento durante a 9 pandemia de COVID-19 e demonstrou também os riscos ao organismo decorrentes de seu consumo, além do possível aumento de morbimortalidade, em caso de comorbidade com essa grave infecção viral. Os resultados desse estudo demonstraram que, embora não incluídos como grupo de risco nas recomendações globais de saúde, os usuários de cannabis podem ser mais vulneráveis ao contágio e a piora do seu quadro clínico devido à infecção por covid-19, o que pode ser explicado tanto pela ação da SPA sobre o SNC e sistema imunológico, bem como devido ao método de uso que essa substância é utilizada. Além disso, o comportamento dos usuários de cannabis pode torná-los ainda mais vulneráveis à infecção por SAR-CoV-2.Cannabis is the third most used substance worldwide after alcohol and tobacco. Chronic cannabis use is associated with changes in the central nervous system (CNS) and in the endogenous endocannabinoid system (ESS), cognitive impairment and motivational changes, especially when consumption begins in childhood and adolescence, when there is greater vulnerability to its effects. With regard to crack users, the vast majority report the use of more than one substance, with cannabis being one of the most used drugs by this population. In this sense, article 1 evaluated the precocity of cannabis use for outcomes about the progression of the use of other SPAS in crack users, in 312 SPAs users, with the use of crack as the main drug. The results show that the age of onset of cannabis, alcohol and nicotine use are similar, followed by cocaine at 17 years of age and finally by crack at 21 years of age. Age of first cannabis use was associated with age of first crack use (p <0.001) and also with years of regular use of this SPA (p <0.01). The number of treatments (-0.114 95% CI -0.603; -0.005 p = 0.046) and the age of the first treatment (0.13 95% CI 0.040; 0.608 p = 0.026) had lower coefficients, as well as the severity score of the ASI6 instrument (-0.017 95% CI -0.244; -0.177 p = 0.756). Our results suggest that the age of first cannabis use was similar to that of licit substances, being a predictor for premature and prolonged use of other PASs, which may be related to the severity of dependence and lower therapeutic adherence. In this context, preventive psychoeducational strategies and more behavioral therapies may perhaps promote greater effectiveness in clinical improvement, as seen in previous studies reformulated, this sample appears to be more deficient in cognitive issues such as flexibility and inhibitory control. There has been an increase in substance use during the COVID-19 pandemic. However, abusive use can lead to the perpetuation of psychological suffering, in addition to triggering psychiatric symptoms and disorders. Article 2 of this dissertation sought to carry out a brief review based on the scientific literature in relation to the population that uses cannabis and their behavior during the COVID-19 pandemic and also demonstrated the risks to the organism resulting from its consumption, in addition to the possible increase of morbidity and mortality, in case of comorbidity with this serious viral infection. The results of this study 11 showed that, although not included as a risk group in the global health recommendations, cannabis users may be more vulnerable to contagion and the worsening of their clinical condition due to infection by covid-19, which can be explained both by the action of SPA on the CNS and immune system, as well as due to the method of use that this substance is used. Furthermore, the behavior of cannabis users can make them even more vulnerable to SAR-CoV-2 infection

Multiple clinical risks for cannabis users during the COVID-19 pandemic

The pandemic caused by Sars-CoV-2 (COVID-19) has been a great concern for public and mental health systems worldwide. The identification of risk groups is essential for the establishment of preventive and therapeutic strategies, as for substance users. During COVID-19 pandemic, there was an increase in the use of psychoactive substances during the lockdown, including cannabis. This commentary reviews relevant findings and discusses scientific evidence on the risks of worse clinical and psychiatric complications due to coronavirus disease COVID-19 in subjects who use cannabis. Although they are not included as a risk group in the health recommendations for that disease, they may have a more vulnerable respiratory system to viral diseases. There are certain similarities between the harmful cardiovascular and respiratory effects of cannabis use and those of smoking. Due to the different modes of smoking, cannabis chemicals are retained in the body for longe and may also contain other toxic substances such as tar, a substance found in tobacco and which has been associated with the development of lung cancer, bronchitis and pulmonary emphysema. Therefore, we discuss if individuals who use cannabis regularly might be more vulnerable to COVID-19 infection. This population deserves more clinical attention worldwide and this manuscript can help clinicians become more aware of cannabis risks during pandemics and develop specific intervention strategies

High COVID-19 morbidity and mortality risk among smoked drug users in Brazil

In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic

A network analysis of early trauma and impulsive behavior in individuals with mono- and poly-dependence of alcohol and crack cocaine

Objective: To investigate the relationship between impulsivity and early trauma through a network analysis in individuals diagnosed with different substance use disorders (SUD). Methods: This cross-sectional study includes a sample of 556 men with SUD (195 with alcohol use, 157 with crack cocaine use and 214 with multiple substance use). The Childhood Trauma Questionnaire was applied to investigate early trauma and the Barratt Impulsiveness Scale to assess impulsive behavior. The connection between trauma and impulsivity was assessed using network analysis through Fused Graphical Lasso algorithm. Results: No connection was observed between impulsivity and trauma networks in individuals with alcohol use. In cocaine users, networks were linked through the motor domain and sexual abuse nodes. Inversely connections were observed between emotional neglect node and perseverance and not planning nodes. In poly-use, the connection between impulsivity and trauma networks was weak, with cognitive complexity being the node that connects to the trauma network through physical abuse. There were inversely proportional connections between motor domain and emotional neglect nodes, and cognitive instability and physical neglect. Conclusions: Our results suggest that the relationship between the type of early (childhood) trauma and the expression of impulsivity could lead to a different substance use profile