Access to health services for problematic use of illegal psychoactive substances in the metropolitan area of Bologna

AbstractAim. To estimate access to health services among subjects with problems due to the use of psychoactive substances among people born abroad (non-natives) and to draw comparisonswith those born in Italy (natives) using several data sources.Design. Analysis of the new accesses for problematic use of illegal substances in the health services (hospital, emergency unit) and in the services dedicated to drug addicts (SERT) in the metropolitan area of Bologna in the period 2004/2011.Results. No significant differences are recorded in regard to the substances used and the standardized incidence rate per 10 000 (natives males 10.72, females 3.93; non-native males 10.39, females 3.23). Among the non-natives, younger and with a higher percentage of females as compared with the Italians, there is a lower likelihood of access to the SERT.Conclusions. The data reported describe the complexity of a problem that ought to be carefully monitored in the territory

Ketamine abusers referring to Emergency Departments in Northern Italy: a cross- sectional study

Introduction. Ketamine is an essential medicine used as an anesthetic in low andmiddle-income countries and in veterinary medicine. Recreational use is widespreadthroughout the world, especially owing to its lower price compared to other substances.In Western countries its use has been mainly linked to subpopulations of young peoplewho use drugs recreationally. Ketamine misuse is associated with amnesia, dependence,dissociation, lower urinary tract dysfunction and poor impulse control. Regular ketamineuse is associated with abdominal pains.Aims. The aims of this study are to analyze characteristics and main symptoms of ketamineabusers attending emergency departments (EDs) in the metropolitan area of Bologna,Emilia-Romagna Region, northern Italy.Methods. We identified 74 records of ketamine-related visits: 30% female; 22% nonnatives;mean age 25.6 years. Forty-two percent reported ketamine use alone, 46% reportedthe use of other illegal substance (cocaine 19%, heroin 18%), 26% alcohol misuse.Results. The most common reported symptoms were neurological (soporous state 18%,agitation 14%, confusion 7%, panic attacks 7%, mydriasis 7%, tremors 7%), gastro-intestinal(abdominal pain 15%, vomiting 11%), urological (6.8%) and cardiac (palpitations5%, chest pain 5%). Complications secondary to falls and cuts (7%) were the mostfrequent trauma complications. We highlight a significant number of visits regardingsuicide attempts (10%) and overdose (4%).Conclusions. The results highlight a particular population of problematic ketamine usersidentified using the hospital’s ICT system. In particular, poly-drug users who consumeketamine in combination with heroin or cocaine presenting to the ED representa specific target for targeted prevention projects on non-lethal overdoses and suicideattempts

Estimate of the prevalence of subjects with gambling-related problems requiring treatment: a study in Northern Italy

The aims of this study, which analyzes the data related to subjects who for the first time turned to a hospital or to a Public Service Dedicated to Drug Addicts or to a Community Mental Health Center for problems related to pathological gambling in the metropolitan area of Bologna (Northern Italy) in the period  2000/2015, were: to describe characteristics and problems of pathological gamblers (PGs); to estimate the prevalence of PGs using the capture-recapture method. 495 residents were identified, with an estimate of 1570 PGs and a prevalence of 1.78 per 1000. We highlight a high number of new cases in the period after 2010. Most patients are males, aged from 40 to 50 years, 12% was born abroad, one in three suffers from other mental disorders, 9% has alcohol dependence, 8% drug dependence. We should point out the low level of education and the high presence of unemployed subjects. 

Alcohol Misuse Among Young Adults in Northern Italy

Purpose: To estimate the prevalence of heavy episodic drinking (HED), consumption patterns, protective and risk behaviours and motivations in a sample of young Italians with recent alcohol use. Design: Cross-sectional study. The target population was young people (18−29 years) living in the metropolitan area of Bologna (Northern Italy). A mixed study design with quantitative and qualitative instruments was used. Findings: Four focus groups were held; 500 young people were interviewed. The results show ample alcohol misuse among youths and highlight a process of normalization of excess-oriented practices. Following single episodes of HED, almost all the interviewees experienced health problems or negative consequences in the fields of relations and social commitments. A particular group of habitual alcohol drinkers (frequent and repeated misuse) were identified with a high likelihood of encountering problematic situations and stated that their motivation for their last episode of HED was boredom and the search for psychoactive effects. From the current focus, it can be seen that those who take large quantities of alcoholic beverages do so to reach a state of inebriation. Young adults seem to be well-informed as to the psychoactive properties of alcoholic beverages and are aware of the related risks. Originality/value: A gradual loss of traditional references in the alcohol culture emerges among Italian youths. Future studies targeted at the cultural aspects of alcohol misuse are needed

Early Adolescents and Substance Use

1300 students (54.3% girls) 13–16 years old were interviewed in the urban area of Bologna during 2010. Random effect multiple logistic regression models were used. Results show a reciprocal relationship between alcohol use, tobacco, and cannabis. Most users were offered cannabis, began using at 14 years of age, and do not believe using is very dangerous. They live with only one parent, have more than 50 euros of spending money per month, and abuse alcohol, abuse that increases relative to the intensity of cigarette smoking. Legal/illegal dichotomy seems to overturn, where alcohol becomes a “drug” and the use of tobacco, similar to other drugs, is motivated as a solution to reduce anxiety, combat boredom, relax, and to ease loneliness

Women between normality and dependence: a study of problematic consumption and dependence in women aged 30–50 years

Introduction: In the field of dependence, there have been few studies on populations of \u201cnormal\u201d women. Aims: To quantify the prevalence of problematic consumption of legal and illegal psychoactive substances, pathological gambling and compulsive buying in a sample of 433 Italian women aged between 30 and 50 years. Methods: Selection per quota in various shopping malls in Tuscany and Emilia Romagna. Results: About 13.9% have risk-level alcohol consumption, 9.2% have a medium\u2013high level of tobacco addiction, 7.2% tested positive for compulsive shopping, 1.6% have cannabis dependence and 0.5% are pathological gamblers. Multivariate analysis reveals a relationship between high-risk alcohol consumption and cannabis dependence, and between tobacco addiction and compulsive shopping. Conclusions: The research reveals various consumption profiles and \u201cminor dependences\u201d which appear to be functional to the ways in which this specific target-group faces ordinary everyday life

Emergency Department Presentation and Mortality Rate Due to Overdose: A Retrospective Cohort Study on Non-Fatal Overdoses.

BACKGROUND: The aims of this retrospective cohort study are to describe the presentation characteristics for nonfatal overdose-related complaints at the emergency departments (EDs) of the metropolitan area of Bologna (northern Italy), to estimate the subsequent risk of mortality by overdose, and to identify the profiles of the subjects most at risk. METHODS: Records of patients admitted to 10 EDs for overdose between January 2004 and December 2012 were retrospectively evaluated. The International Classification of Diseases was used to ascertain the cause of death. RESULTS: A total of 294 episodes of overdose involving 218 individuals were identified. The total time at risk was 1048 person-years (PY). The mortality rate for all causes was 35.48 per 1000 PY for males and 20.61 per 1000 PY for females. The mortality rate for overdose was 16.6 per 1000 PY for males and 13.74 per 1000 PY for females. In the multivariate regression analysis, the time from first ED overdose access (less than 1 year risk ratio [RR]: 7.07, 95% confidence interval [CI]: 5.32-9.39) was significantly associated with death by overdose. Males, subjects aged >30 years at presentation, patients who refused ED treatment, and those having previously contacted mental health services showed an increased mortality risk due to overdose. CONCLUSIONS: Experiencing a nonfatal overdose within the past 12 months increases the risk of mortality compared with an overdose more than 12 months earlier. Nonfatal overdose patients presenting to an ED form a specific target for prevention projects

Let It “B”? The Role of Hepatitis B Universal Vaccination among Italian Problematic Drug Users

Hepatitis B virus (HBV) hepatitis is extremely common among problematic drug users (DUs). As of 2012, 47 of the 53 European countries had implemented a universal hepatitis B vaccination programme, a scenario that could radically change its spread. Even so, drug users are still one of the main groups at risk of being infected by HBV, exposing the fact that universal vaccination still has not managed to reach an optimal level of contagion protection. In order to evaluate the role of universal HBV vaccination in protecting against risk behaviour related to the use of illicit drugs, a group of 748 DUs, 511 male and 237 female, was tested for HBV markers, at their first access to public addiction clinics in the metropolitan area of Bologna, Italy. 487 were born after 1981, so they were eligible to have received HBV vaccination in adolescence or at birth; in these subjects antibodies against HBV core antigen had the significant prevalence of 6.2%. Universal HBV vaccination has shown evidence of protecting against infection in the general population. These results, amongst the first to evaluate actual protection in DUs vaccinated at birth or during adolescence, show that compulsory universal vaccination does not solve the problem of HBV transmission in the most at risk groups and that additional strategies must be studied and implemented to address this issue

Who Are the Subjects with Gambling-Related Problems Requiring Treatment? A Study in Northern Italy

Background: This study analyzes data related to Hospital (HOS), Public Treatment Service Dedicated to Drug Addicts (SERD), or Community Mental Health Center (CMHC) clients with a first diagnosis of Pathological Gambling (PG) in the period 2000/2016 in Northern Italy. The aims were to describe trends and characteristics of pathological gamblers (PGs) and to estimate the prevalence of other diagnoses before or after the diagnosis of PG. Methods: Participants aged over 17 years with an ICD-9 or ICD-10 PG diagnosis were selected. Results: 680 PGs were identified, mean age 47.4 years, 20% female, 13% non-natives, 30% had other mental disorders diagnoses, 9% had alcohol dependence syndrome, and 11% had drug dependence. Most participants with comorbid disorders were diagnosed before PG, with a more elevated prevalence regarding mental disorders. Almost seven years had elapsed on average between the first admission and the diagnosis of PG. Conclusions: The results of this study highlight a growing demand for PG treatment addressed not only to SERD, but also to psychiatric and hospital services, based on the increase in SERD attendance from 2013. Many of them had already been treated for mental health problems before, but their percentage remained costant over time

Epidemiology and Clinical-Demographic Characteristics of Suicide Attempts in Alcohol Use Disorders in an Italian Population

Suicide is a leading cause of morbidity worldwide. Among the known risk factors, alcohol use disorders (AUDs) are particularly relevant, but data on the epidemiology and characteristics of suicide attempts (SA) in this group are lacking. We used electronic health records of national health services to identify individuals who received a diagnosis of AUD in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for SA from 2009 to 2020. The Crude Suicide Rate (CSR) for 1,000 Person Years was 2.93, higher than the general population. The CSR was higher in females, within one year from receiving the diagnosis of AUD, in patients with psychiatric comorbidities, concomitant abuse of cannabis or benzodiazepines. As for Covid-19 pandemic, the risk ratio of SA was significantly higher in 2020 compared to 2019 in females. Our results are relevant to identify clinical risk factors for SA in patients with AUDs, which are strongly associated with suicide risk but with scarce data in the previous literature and paucity of evidence-based therapeutic interventions