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Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16–40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.

Background: Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years. Methods: We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia. Results: Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis. Conclusion: Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.

Introduction: Hypomagnesemia (hypoMg) has not yet been extensively studied in alcohol use disorder (AUD) . We hypothesize that chronic, excessive alcohol consumption favors oxidative stress and pro-inflammatory alterations that may be exacerbated by hypoMg. The objective of this study was to analyze the prevalence and associations of hypoMg in AUD.Patients and Methods: Cross-sectional study in patients admitted for a first treatment of AUD in six tertiary centers between 2013 and 2020. Socio-demographic, alcohol use characteristics, and blood parameters were ascertained at admission.Results: 753 patients (71% men) were eligible; age at admission was 48 years [IQR, 41-56 years]. Prevalence of hypoMg was 11.2%, higher than that observed for hypocalcemia (9.3%), hyponatremia (5.6%), and hypokalemia (2.8%). HypoMg was associated with older age, longer duration of AUD, anemia, higher erythrocyte sedimen-tation rate, gamma-glutamyl transpeptidase, glucose levels, advanced liver fibrosis (FIB-4 >= 3.25) and estimated glomerular filtration rate (eGFR) < 60 mL/min. In multivariate analysis, advanced liver fibrosis (OR, 8.91; 95% CI, 3.3-23.9) and eGFR < 60 mL (OR, 5.2; 95% CI, 1.0-26.2) were the only factors associated with hypoMg.Conclusions: Mg deficiency in AUD is associated with liver damage and glomerular dysfunction suggesting that both comorbidities should be assessed in the course of serum hypoMg.

Purpose of review: Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research. Recent findings: The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences. Summary: Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders.

Introduction: New synthetic opioids (NSO), a class of new psychoactive substances (NPS), have recently emerged and pose an upcoming global public health challenge. The effects produced by NSO are similar to those from morphine, but they present greater pharmacological potency and abuse potential. Due to the increasing number of fatal overdoses and seizures in which NSO have been detected as heroin substitutes or adulterants, individuals with Opioid Use Disorder (OUD) represent a vulnerable population. The aim of our study was to describe and characterize from a gender perspective a Spanish cohort of potential conscious or unconscious NSO users. Methods: A cross-sectional study was conducted in a cohort of OUD participants under treatment in addiction care services in Barcelona and Badalona, Spain. Clinical evaluation was performed through an ad hoc survey, a scale to evaluate reasons to use an opioid without prescription (range 0–4) and the Wellbeing Index (WHO-5) (range 0–100). Objective consumption of NSO was assessed by urinalysis carried out by two validated methods: high-sensitivity gas chromatography-mass spectrometry (MS) and ultra-high-performance liquid chromatography-high-resolution MS. Results: A total of 154 participants with OUD were enrolled. They were mainly men (72.7%), mean age 47.8 years. Methadone was the predominant medication for opioid agonist treatment (mean dose 61.25 mg/day). A total of 32 (20.8%) participants reported having consumed some opioid to become “high” in the previous 3 months. The principal reasons for consuming illicit opioids were Replacing other drugs (mean 2.03) and Availability (mean 1.62), although Low price, was more highly valued by men (p = 0.045) and Shorter effect duration, most highly rated by women (p = Conclusion: A non-negligible consumption of NSO-fentanyl’s (positive detection in 6.1% of biological samples) was detected. The reasons for using these substances and also the well-being differed between the genders. There is therefore both voluntary and involuntary NSO consumption in our country which highlights the importance of approaching this potential public health problem.

People who inject drugs (PWID) experience more gaps at each stage of the HIV care continuum than others living with HIV. The study aimed to describe the effectiveness of an integrated care model to reach the UNAIDS 90–90–90 target. This cross-sectional study included PWID who met the criteria for DSM-5 substance use disorder. They received a multidisciplinary comprehensive program, including medical HIV care, substance use treatment, and psychosocial support, at a drug-use treatment outpatient facility during 2019. The percentage of patients reaching the 90–90–90 UNAIDS target was the main study variable. Two hundred and twenty-one PWID were monitored at the facility during a median follow-up of 98 months (IQR: 61–143). Current HIV status was established in all PWID, of whom 84/221 (38.0%) tested HIV-positive. All the 84 patients (100%) received antiretroviral therapy, and 76(90.5%) had RNA HIV-1

BackgroundIn March 2020, the World Health Organization declared COVID-19 a global pandemic. In the following weeks, most European countries implemented national lockdowns to mitigate viral spread. Services for people who use drugs had to quickly revise their operating procedures to rearrange service provision while adhering to lockdown requirements. Given the scarcity of literature published on overdose prevention during COVID-19 in Europe, we aimed to examine how these changes to service provision affected take-home naloxone (THN) programmes and naloxone availability across Europe.MethodsBetween November 2020 and January 2021, we conducted a rapid assessment with country experts from European countries that provide THN. We sent country experts a template to report monthly THN distribution data (January 1, 2019-October 31, 2020) and a structured 6-item survey for completion.ResultsResponses were received from 14 of the 15 European countries with THN provision of which 11 participated in the rapid assessment: Austria, Denmark, England, Estonia, Lithuania, Northern Ireland, Norway, Scotland, Spain (Catalonia only), Sweden, and Wales. All reported reduced organisational capacity during COVID-19, and some put into place a range of novel approaches to manage the restrictions on face-to-face service provision. In six countries, the introduction of programme innovation occurred alongside the publication of government guidelines recommending increased THN provision during COVID-19. Eight of the eleven participating countries managed to maintain 2019-level monthly THN distribution rates or even increase provision during the pandemic.ConclusionThrough programme innovation supported by public guidelines, many European THN programmes managed to ensure stable or even increased THN provision during the pandemic, despite social distancing and stay-at-home orders affecting client mobility.

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.Esta revisión resume las intervenciones farmacológicos y psicosociales que han sido llevadas a cabo en trastornos de ansiedad con un diagnóstico comórbido de trastorno por uso de sustancias y además proporciona recomendaciones clínicas respecto de cuáles elementos de intervención son útiles para hacer frente a los síntomas del uso de sustancias y los síntomas de ansiedad en pacientes con estas afecciones concurrentes. Se utilizó la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describió mediante el enfoque GRADE. Hay ensayos clínicos disponibles únicamente para el trastorno por estrés postraumático (TEPT) y para el trastorno de ansiedad. En cuanto al diagnóstico comórbido de trastorno por uso de sustancias, todos los estudios han incluido pacientes con consumo de alcohol, ninguno de ellos ha abordado el consumo de cocaína, cannabis o nicotina. Aunque algunos tratamientos han mostrado beneficios para los síntomas de ansiedad sin beneficios para el consumo de alcohol u otras sustancias, solo se han ensayado enfoques farmacológicos limitados (sertralina, desipramina, paroxetina, buspirona, naltrexona y disulfiram). Nuestros resultados sugieren que 1) podemos (débilmente) recomendar el uso de desipramina sobre la paroxetina para aliviar los síntomas de ansiedad en pacientes con un TEPT y consumo de alcohol; 2) en estos pacientes, el uso de naltrexona para reducir los síntomas de ansiedad es también recomendable (fuerza débil); y 3) se pueden recomendar antidepresivos ISRS frente a placebo para reducir el consumo de alcohol (recomendación débil). Nuestra revisión pone de relieve la necesidad de realizar más investigaciones en esta área y de estudios más grandes, multisitio con muestras generalizables para proporcionar evidencia más definitiva para la práctica clínica.

Justificación: Existe una asociación entre tabaquismo y TUS, especialmente con alcohol y cannabis. Sin embargo, las intervenciones sanitarias parecen no ir encaminadas a su enfoque.Objetivo: Evaluar el grado de motivación para el abandono tabáquico tras realizar una intervención psicoeducativa breve sobre abordaje del tabaquismo.Metodología: Se trata de una investigación cuantitativa de tipo analítico cuasiexperimental que se lleva a cabo mediante dos cohortes experimentales, del tipo pre- y post-intervención. Se aplica una intervención breve educativa y se evalúan las diferencias en la motivación para el abandono tabáquico en un grupo antes de la intervención y en otro grupo después de la misma. Resultados: Existe una diferencia de 1,27 puntos en el grado de motivación encontrado en los individuos respecto a los grupos experimentales. Conclusiones: Las personas drogodependientes son fumadoras con altos grados de dependencia nicotínica por lo que es preciso diseñar estrategias de cesación adecuadas. Justification: There is a connection between smoking and substances use disorder, especially alcohol and cannabis. Nevertheless, health interventions seem not to be addressed to this approach. Objective: Evaluation of the motivation degree for the smoking quit after developing a brief psycho-educational intervention on smoking.Methodology: It is a quantitative research of analytical type, almost experimental, developed by means of two experimental series, of the types pre- and post- intervention. A brief educational intervention is applied and there is an evaluation of the differences in the motivation for the smoking quit in a group before the intervention and in another one after the intervention. Results: There is a difference of 1,27 points in the degree of motivation found in the individuals regarding the experimental groups. Conclusions: Drug addict people are smokers with a high degree of nicotinic dependence, so it is necessary to design suitable strategies of quitting. .

HIV-infected people with substance use disorders (HIV-SUDs) are at increased risk of leaving hospital against medical advice (LHAMA). The aim of this study was to evaluate the incidence of LHAMA in HIV-SUDs admitted to a patient-centered hospital where they receive integrated care, including healthcare, substance use treatment, and social support. Observational study was conducted at an urban acute-care university teaching hospital. Integrated care included a specialist in addiction medicine and a social worker incorporated into the medical staff. LHAMA was defined as participants leaving the hospital without the physician's permission and not returning within 6 h. Two hundred and ninety-nine HIV-SUDs were hospitalized, and 79 (26.4%) patients were readmitted, generating a total of 517 admissions during 2010-2016. Over the study period, 45 LHAMA were registered, yielding an incidence of 8.7%. On multiple logistic regression analysis, admission for malignancies (OR:4.2

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.La concurrencia de depresión y un trastorno por uso de sustancias (TUS) en pacientes que presentan patología dual ha sido reconocida desde hace mucho tiempo como una consideración importante en la práctica clínica. Esta revisión sintetiza la evidencia de intervenciones farmacológicas y psicosociales para trastornos comórbidos de depresión y uso de sustancias y además proporciona recomendaciones clínicas respecto de las mejores intervenciones para tratar a estos pacientes. Se utilizó la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describió mediante el enfoque GRADE. Nuestros resultados sugieren que: 1) en pacientes con depresión y consumo de alcohol, se recomienda la administración de antidepresivos inhibidores de la recaptación de serotonina (ISRS) no selectivos en lugar de los ISRS para mejorar los síntomas depresivos (recomendación fuerte). No se recomiendan antidepresivos ISRS (recomendación fuerte) ni antidepresivos no ISRS (recomendación débil) para reducir el consumo de alcohol; 2) en pacientes con depresión y consumo de cannabis, no se recomienda el uso de venlafaxina (recomendación débil); 3) en pacientes con depresión y consumo de cocaína, no se recomienda el uso de antidepresivos ISRS para mejorar los síntomas depresivos (recomendación débil) o para reducir el consumo de cocaína (recomendación fuerte). El uso de antidepresivos no ISRS solo se recomienda para mejorar los síntomas depresivos (recomendación fuerte); 4) no se recomienda la administración de bupropión para reducir el consumo de nicotina (recomendación fuerte), y 5) en cuanto al tratamiento psicológico, en pacientes con depresión y trastorno de alcohol concurrente, tanto la farmacoterapia como la terapia cognitivo-conductual tienen efectos positivos en la internalización de los síntomas y en la reducción del consumo de alcohol (recomendación débil). Nuestra revisión sugiere la necesidad de realizar más investigaciones en esta área y de estudios aleatorizados, multisitio y más grandes para proporcionar más evidencia definitiva.

Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).Aunque el correcto diagnóstico y manejo de los pacientes con esquizofrenia y un diagnóstico comórbido de trastorno por uso de sustancias (TUS) determinaría una disminución de la morbilidad y mortalidad en estos pacientes, el desarrollo de estrategias terapéuticas eficientes es todavía una asignatura pendiente. Presentamos recomendaciones sobre el manejo farmacológico y psicológico de estos pacientes siguiendo la estructura PICO (Paciente-Intervención-Comparación-Outcome/resultados). Realizamos una evaluación de la calidad de los estudios y un resumen de la evidencia para cada pregunta siguiendo las recomendaciones del grupo de trabajo GRADE («Grading of Recommendations, Assessment, Development and Evaluation»). Nuestros resultados sugieren: 1) En pacientes con esquizofrenia y trastorno por consumo de cannabis, no es posible recomendar un fármaco antipsicótico sobre otro (entre olanzapina, risperidona o haloperidol) para mejorar los síntomas psicóticos, reducir el consumo de cannabis o mejorar las variables pragmáticas (recomendación débil). No se puede recomendar la clozapina para reducir el consumo de cannabis (recomendación débil). 2) En pacientes con esquizofrenia y trastorno por consumo de cocaína, recomendamos haloperidol sobre olanzapina para reducir el craving (recomendación moderada) y olanzapina sobre haloperidol para mejorar los efectos secundarios motores en estos pacientes (recomendación moderada). 3) En pacientes con esquizofrenia y trastorno por consumo de alcohol, mientras que se recomienda naltrexona para reducir el consumo de alcohol (en términos de reducción del craving de alcohol) (recomendación débil), no hay evidencia suficiente para hacer ninguna recomendación sobre el uso de acamprosato como adyuvante (recomendación débil). 4) En pacientes con esquizofrenia y trastorno por consumo de nicotina, se recomiendan bupropión y vareniclina adyuvantes para reducir el consumo y la abstinencia de nicotina (recomendación fuerte/moderada). 5) En pacientes con esquizofrenia y trastorno por policonsumo, se recomiendan antipsicóticos de segunda generación sobre los de primera generación y olanzapina sobre otros antipsicóticos de segunda generación para mejorar los síntomas psicóticos (recomendación moderada/débil).

Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).

Opioid use disorder continues to be an important public health concern, reaching epidemic ranges in some countries as well as the consequences associated with consumption. A review of the pharmacology of different opioid drugs available is presented. Also, a current state of the art in the treatment of opioid-related disorders is reviewed. Opioid overdose is a potentially fatal medical emergency that can be reversed with naloxone, an antagonist of opioid receptors, in different doses and routes depending on the opioid that caused the intoxication. For opioid use disorders, the main pharmacological approach is substitution treatment (methadone, buprenorphine, slow-release oral morphine) with the objective of neurochemical stabilization, avoiding the reinforcing effect, and decreasing withdrawal symptoms and craving; there is also a naltrexone depot formulation approved for relapse prevention, associated with psychosocial interventions that seek to restore functionality and prevent relapse. In this chapter, the authors review the current state of knowledge in the field focused on clinical practice.

Hallucinogenic drugs have as their primary effect the production of disturbances of perception. Hallucinogens can be classified according to their chemical structure as indoleamines (similar to serotonin), phenethylamines (similar to catecholamines), dissociatives (phencyclidines) and others (including salvinorin, dextromethorphan, muscarinic antagonists and cannabinoids). The hallucinogenic effects appear to be related to the agonistic action on 5-HT2A receptors in the cortex. These actions seem to cause a functional imbalance at various levels (cortical areas, limbic system, which is a group of brain structures involved in emotional regulation), contributing to distort the integrative action. Hallucinogens produce substance use disorder, induce acute tolerance to its effects and do not present withdrawal syndrome. The novel psychoactive substances (NPS) can induce substance use disorder, intoxication and in some cases withdrawal syndrome (for those with psychostimulant properties). Depending on the substance and pharmacological effects, the DSM-5 diagnostic criteria for hallucinogens or stimulants can be applied. The therapeutic aim in these cases is to reduce consumption and achieve the abstinence. There are no specific drugs for treating the addiction caused by these substances. Some hallucinogens are under evaluation for its therapeutic use in different mental disorders.

To investigate the prevalence of non-medical use (NMU) of codeine in Germany, Italy, Spain and the UK and whether availability of OTC codeine has any association with NMU of the drug.Data collected in the online Survey of Non-Medical Use of Prescription Drugs, in surveys launched in the second half of 2018 from (Germany (n = 14,969), Italy, (n = 9974), Spain (n = 9912) and the UK (n = 9819) were analysed. For each survey, the estimated prevalence and 95% confidence interval (CI) of respondents reporting NMU of prescription and/or OTC codeine within the last 12 months were calculated and compared.The prevalence of last 12-month NMU in Spain was 12.6% (95% CI 11.7-13.6) for prescription codeine, 6.3% (5.6-7.0) for OTC codeine and 16.1% (15.1-17.3) for any codeine (prescription and/or OTC). The prevalence of last 12-month NMU in the UK was 5.4% (4.9-5.8) for prescription codeine, 4.5% (4.1-5.0) for OTC codeine and 8.3% (7.8-8.9) for any codeine (prescription and/or OTC). The prevalence of last 12-month NMU for prescription codeine was 2.1% (1.9-2.4) in Germany and 1.9% (1.7-2.2) in Italy.The prevalence of last 12-month NMU of any codeine product is approximately eight times greater in Spain and four times greater in the UK compared to Germany and Italy where the drug is only available by prescription. While other factors may contribute, these findings suggest that availability of codeine OTC is associated with greater NMU.

Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients.Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD.Men represented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion "Changes in weight or appetite" was more prevalent (57.1%) in P-MDD group.We found differences in the criterion "Changes in weight or appetite". Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients.Antecedentes: El consumo de cocaína es un creciente problema de salud en todo el mundo. Además, los pacientes con trastorno por consumo de cocaína (TCC) presentan una alta comorbilidad con el trastorno depresivo mayor (TDM). Estos pacientes pueden presentar dos tipos de TDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio es evaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDM- IC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Se llevó a cabo un análisis secundario en una muestra transversal de 160 pacientes que presentaban TCC y algún TDM. La evaluación clínica, así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizó utilizando la entrevista PRISM. Resultados: Los hombres representaron el 80% de la muestra con una edad media de 38,61 años y el 64,5% sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fue más frecuente que el de TDM-P (38,7%). Los pacientes con TDM-IC mostraron una edad de aparición más temprana para el TCC. El 79,4% de los pacientes cumplían criterios para otro trastorno por consumo de sustancias. Únicamente el criterio “Cambios en el peso o en el apetito” fue estadísticamente más prevalente (57,1%) en los pacientes con TDM-P. Conclusiones: Existen diferencias en el criterio “Cambios en el peso o en el apetito” entre TDM-P y TDM-IC. Se necesita más investigación a fin de obtener un diagnóstico diferencial entre los dos tipos de depresión y proporcionar un mejor tratamiento para los pacientes con TCC.

1 Describir las diferencias de género observadas en la muestra de pacientes de la interconsulta de Adicciones atendiendo a variables clínicas y sociodemográficas. 2 Estudio descriptivo de tipo transversal en el que se incluyeron un total de 3027 pacientes en un período de tiempo desde Enero de 2014 hasta Enero de 2020 reclutados en el Servicio de interconsulta de Adicciones del Hospital del Mar de Barcelona. Se realizó un análisis comparativo de variables sociodemográficas y clínicas respecto al género de los pacientes.Se utilizaron como métodos estadísticos Chi cuadrado, R de Pearson y Correlación de Spearman. 3 Nuestra muestra está constituída en su mayor parte por hombres (N= 2389 (79%), con un 21% de mujeres (N=638). Se valida en nuestra muestra lo recogido en la literatura, puesto que hemos observado que las mujeres presentan mayor proporción de infecciones: Ac VIH + (30,3% frente a un 20%), Ac. VHC (37% frente a 31,3%) y comorbilidad psiquiátrica en TUS+ eje I (21% frente a 17%), TUS + eje II (15,4% frente a 11%) respecto a los hombres (ver tabla)*. Se recoge que en nuestra muestra las mujeres presentaban consumos mayores de Heroína (18% vs 15%) y Cocaína (7,5% vs 6,7%)), frente a Alcohol, la sustancia que los hombres consumen con mayor proporción (63% frente a un 48% en mujeres). En lo referente a lo social hemos encontrado mayor proporción de viudedad y divorcios en la mujeres. No encontramos grandes diferencias en la situación laboral de los dos grupos. Concluimos que se deberían realizar más estudios que permitan analizar, con perspectiva de género, las circunstancias por las que se observa que las mujeres presentan mayor comorbilidad orgánica y psiquiátrica que los hombres, como hemos podido corroborar en nuestra muestra.

OBJETIVOS/INTRODUCCIÓN ChemSex es el término usado en la comunidad científica para referirse al uso intencionado de drogas psicoactivas (CHEM) para mantener relaciones sexuales (SEX), entre hombres (HSH), durante largos periodos de tiempo, con múltiples parejas, y uso de apps para buscar contactos y drogas. Se asocia a riesgos con el consumo, salud sexual e integridad física, psicológica y social, siendo prioridad de salud pública estudiar este fenómeno y el desarrollo de programas de tratamiento eficaces. Nuestro objetivo es profundizar en el conocimiento y mejora de la intervención en pacientes que acuden a un dispositivo de atención a las adicciones (CAS) con práctica de Chemsex. MATERIAL Y MÉTODOS Estudio de caso clínico y revisión bibliográfica RESULTADOS Y CONCLUSIONES Derivación al CAS desde el Servicio de Enfermedades Infecciosas hospitalario de paciente de 48 años, VIH positivo, y otras ITS, inmigrado, activo laboralmente con alta especialización. Refiere trayectoria de psicopatología de larga evolución con dos periodos de agudización, el primero coincidiendo con la llegada a Barcelona y el segundo hace 2 años en contexto de ruptura de pareja e inicio de la práctica de Chemsex, con policonsumo (OH, cocaína, speed, MDMA, poppers, GHB i MA) y uso de apps. Destaca el malestar subjetivo agudo, sentimiento de culpabilidad y conductas autodestructivas, incluyendo alteración de la conducta alimentaria y de la sexualidad. Se observa disociación de varios aspectos de la personalidad, no integrados. Se establece plan de tratamiento individualizado. Destacamos la importancia de ofrecer un programa de tratamiento que identifique e intervenga en los determinantes multifactoriales del inicio y mantenimiento del uso problemático del Chemsex, y en el abordaje de las repercusiones derivadas de la práctica y psicopatología concomitante.

Objetivo: Evaluar la influencia de las percepciones, actitudes y prácticas del personal asistencial que trabaja en unidades de hospitalización de salud mental de adultos respecto a intervenciones sobre el consumo de tabaco en pacientes ingresados. Material y métodos: Estudio transversal. Se incluyen unidades de hospitalización de Agudos (UA), Patología Dual (UPD) y Unidades Hospitalarias de Desintoxicación (UHD). La evaluación de la intervención sobre el tabaco en los pacientes se ha realizado a través de la revisión del informe de alta y un breve cuestionario al paciente. Posteriormente, se ha administrado un cuestionario ad-hoc sobre actitudes y conocimientos a una muestra multidisciplinar de profesionales directamente relacionados con la intervención en pacientes. Resultados: Se han incluido 7 centros (Hospital Clínic de Barcelona, Hospital de Sant Pau, Hospital Mútua Terrassa, Hospital de Mataró, Institut Pere Mata, Hospital Vall Hebron y Parc Salut Mar), con un total de 118 pacientes (61% varones, edad:44+14), 133 informes de alta y 237 profesionales (26% varones, edad:38+11; 29% fumadores). En la muestra de profesionales el 75% consideraba disponer de suficientes conocimientos para abordar la adicción al tabaco, si bien sólo el 50% se consideraba capacitado para realizar intervención breve; el 60% consideraba que tratar el tabaco forma parte de su responsabilidad profesional; alrededor del 30% consideraba el tabaco como una herramienta de refuerzo y que dejar de fumar podría desestabilizar la enfermedad psiquiátrica. El 80% de los profesionales estaba de acuerdo con la prohibición de fumar en estas unidades, pero un 50% consideraba que la prohibición genera altas voluntarias y conflictos. Conclusiones: El personal de las unidades de hospitalización en Salud Mental se muestra de acuerdo con la prohibición de fumar, si bien todavía se considera una fuente de conflictos. Más de la mitad considera que el abordaje del tabaco forma parte de su responsabilidad.

Introducción: El consumo de psicoestimulantes como la cocaina y los derivados anfetamínicos se asocia frecuentemente a comorbilidad psiquiátrica. A pesar de que la cocaína y los derivados anfetamínicos comparten muchos efectos agudos y crónicos, existen algunas diferencias importantes entre el tipo de consumidor y las consecuencias de su consumo. Objetivos: Estudiar de forma prospectiva las características diferenciales entre los pacientes ingresados en una unidad de patología dual con consumo de cocaína y de derivados anfetamínicos. Material y métodos: Durante 3 años recopilamos datos demográficos, sociofamiliares y clínicos de aquellos pacientes ingresados en la unidad de patología dual del Parc de Salut Mar que cumplían criterios de trastorno por consumo de psicoestimulantes. Estos pacientes fueron divididos en dos categorías: trastorno por consumo de derivados anfetamínicos o trastorno por consumo de cocaína según los criterios del DSM-IV. Resultados: Se incluyeron 498 pacientes (70,9% hombres; edad media 36,8 ± 7,8 años). La razón principal del ingreso fueron las alucinaciones y/o delirios (36,5%), seguidos de los trastornos de conducta (25,3%). El diagnóstico psiquiátrico más frecuente fue el trastorno psicótico (41,8%). Los sujetos del grupo de anfetaminas eran con más frecuencia varones solteros, con un nivel educativo más elevado y con una mayor prevalencia de antecedentes familiares de enfermedad mental. Requirieron de ingresos de mayor duración y presentaron mayor prevalencia de trastornos por consumo de cannabis y de policonsumo de sustancias psicoactivas así como una menor gravedad clínica en el momento del ingreso. Cabe destacar que los sujetos del grupo de anfetaminas tuvieron un inicio más precoz del consumo de cocaína, cannabis y alcohol. Conclusiones: Nuestros datos muestran que los consumidores de anfetaminas presentan un mayor policonsumo de sustancias y un inicio más precoz del consumo de otras sustancias aunque al inicio del ingreso presentan una menor gravedad clínica.

Introducción: El alcohol es la sustancia más consumida en España y la que motiva más consultas en centros de adicciones. En 2017, el 91,2% de la población consumió alcohol alguna vez en la vida y el 62.7% en el último mes. El 7,4% de la población consume alcohol diariamente(1). Para mejorar la asistencia de estos pacientes es prioritario un estudio sociodemográfico de la muestra poblacional. Objetivo: Describir la población de pacientes con TUS alcohol que acuden a un centro de adicciones en Barcelona. Metodología: Análisis descriptivo de variables sociodemográficas, clínicas y de tratamiento de pacientes que consultan por uso de alcohol en un centro de adicciones ambulatorio en Barcelona. Resultados: 224pacientes participaron en el estudio (176hombres; 51.6 años). En los últimos 6 meses ha habido10 abandonos de tratamiento, 3altas médicas y 22nuevas incorporaciones. El 44.2% han tenido buena evolución frente al 55,8% si se tienen como referencia los controles de orina. Las sustancias consumidas con el alcohol: nicotina 34,82%, cocaína 18,75%, cannabis14,29%, hipnosedantes 3,12% y opiáceos 0,89%. El 58,93% padecían patología dual: trastornos del estado de ánimo 25,45%, trastornos de ansiedad 6,25%, trastornos adaptativos 16,52%, trastornos de la esfera psicótica 6,25%, TBP 3,57%, TDAH 2,67%, TCA 2,67%, ludopatía 1,34%, deterioro cognitivo y/o discapacidad intelectual 1,78% y trastornos de la personalidad 6,25%. Conclusiones: El policonsumo de sustancias es lo más frecuente. Más de la mitad de los pacientes que acuden a tratamiento por TUS OH padecen además otro trastorno psiquiátrico comórbido, siendo los más prevalentes los trastornos del estado de ánimo, los trastornos adaptativos y los trastornos de ansiedad. Cabe destacar la baja prevalencia comórbida de ludopatía, lo que puede atribuirse a un infradiagnóstico de los profesionales. Bibliografía: 1. Ministerio de Sanidad, Consumo y Bienestar social. (2019). Observatorio Español de las Drogas y las Adicciones. Informe EDADES 2019. Recuperado de: http://www.pnsd.mscbs.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2019_Informe_EDADES.pdf

Objetivos: Caracterizar los pacientes visitados desde la Interconsulta de adicciones de un hospital general en relación a la vinculación previa a la red de adicciones. Métodos: Planteamos un estudio descriptivo que incluye los pacientes ingresados en el Hospital del Mar de Barcelona por enfermedades somáticas atendidos por la unidad de Interconsulta de Adicciones entre Septiembre 2014 y Diciembre 2019. La muestra fue dividida en dos grupos (con y sin vinculación previa). Se comparan variables sociodemográficas (edad, género), clínicas (diagnóstico dual) y la sustancia psicoactiva principal. Se usa Chi-cuadrado para variables cuantitativas; Wilcoxon para comparación de medias. Resultados: La muestra total se compuso de 2057 y un 51% no tenía vinculación previa. Estos pacientes presentaron una media de edad significativamente mayor (53 vs 46 años; p

Objetivo: Describir los factores sociodemográficos y clínicos asociados a la finalización de una desintoxicación hospitalaria versus los que no completan la hospitalización. Material y métodos: Estudio descriptivo en el que se incluyen todos los pacientes que ingresaron en la unidad de desintoxicación del Hospital de Mar de Barcelona entre Enero del 2015 y Enero del 2020 (n=585). La muestra se separó en 5 grupos (finalización de desintoxicación, alta voluntaria, alteración de contrato terapéutico, fuga y otros), se realiza un análisis comparativo de variables sociodemográficas (Edad y genero) y clínicas (Sustancia principal de consumo, diagnóstico dual y diagnóstico de VIH). Para las comparaciones estadísticas se utilizó la prueba de Xi-cuadrado para proporciones y Wilcoxon para diferencia de medias. Resultados: La muestra estuvo constituida mayoritariamente por hombres (n=452; 77%). Los hombres solicitaron alta voluntaria en mayor proporción que las mujeres (25% y 11% respect; p=0,001). El alcohol fue la sustancia que estuvo significativamente más asociada a finalizar la desintoxicación y la cocaína la que más asociada estuvo a solicitar alta voluntaria, a altas por fuga y por alteración del contrato terapéutico (p

Sáiz PA, Flórez G, Arrojo M, Bernardo M, González-Pinto A, Goikolea JM, Zorrilla I, Cunill R, Castells X, Becoña E, López A, Torrens M, Fonseca F, Tirado-Muñoz J, Arranz B, Garriga M, San L.

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.

Altres ajuts: This work was supported by grants from Ministerio de Sanidad, Política Social e Igualdad (Plan Nacional Sobre Drogas, PNSD 2015I054 and 2016I024). Soy beans contain isoflavones, including daidzein and genistein, with biological activities related to therapeutic effects in reducing osteoporosis, decreasing adverse menopausal manifestations, providing protection from cardiovascular diseases, and reducing hormone-dependent cancers and age-related cognitive-decline. Daidzein has been described as inhibiting the aldehyde-dehydrogenase-2 enzyme (ALDH2), and reducing alcohol use in clinical pilot studies. Our aim was to evaluate the possible interactions between a soy extract product and alcohol in a crossover, single blind, randomized study. Ten healthy male volunteers participated in two experimental sessions: one with a single dose of alcohol (0.5 g/kg, Vodka Absolut, Sweden), and the other with four capsules of a soy extract product (Super-Absorbable Soy Isoflavones, Life-Extension, United States) and, 2 h later, the same dose of alcohol. Results showed no differences in vital signs except a slightly higher significative reduction in diastolic blood pressure at 2, 3, 4, and 8 h after administration with alcohol alone in comparison with soy extract+alcohol. Ethanol-induced subjective and adverse effects were similar for both conditions with the exception of headache (higher at 8 h after alcohol alone). Our results demonstrate that a single dose of a soy isoflavone extract did not influence alcohol pharmacokinetics and pharmacological effects and did not induce any disulfiram-reaction symptoms. Soy extract and alcohol did not interact and can be administered safely.

Fentanyl, fentanyl analogs, and other new synthetic opioids (NSO) have burst onto the illegal drug market as new psychoactive substances (NPS). They are often sold as heroin to unsuspecting users and produce euphoria through their agonist action on μ- opioid receptors. Their high consumption, often combined with other substances, has led to multiple intoxications during recent years. In some countries, such as the United States, the consumption of opioids, whether for medical or recreational purposes, has become epidemic and is considered a public health problem. Fentanyl analogs are more potent than fentanyl which in turn is 50 times more potent than morphine. Furthermore, some fentanyl analogs have longer duration of action and therefore interactions with other substances and medicines can be more serious. This review is focused on the potentially most frequent interactions of opioid NPS taking into account the drugs present in the reported cases of poly-intoxication, including other illegal drugs of abuse and medication. Substances involved are mainly antidepressants, antihistamines, antipsychotics, benzodiazepines, analgesics, anesthetics, psychostimulants, other opioids, alcohol, and illegal drugs of abuse. The interactions can be produced due to pharmacokinetic and pharmacodynamic mechanisms. Naloxone can be used as an antidote, although required doses might be higher than for traditional opioid intoxications. It is crucial that doctors who habitually prescribe opioids, which are often misused by patients and NPS users, be aware of designer opioids’ potentially life-threatening drug-drug interactions in order to prevent new cases of intoxication.

La concurrencia de depresión y un trastorno por uso de sustancias (TUS) en pacientes que presentan patología dual ha sido reconocida desde hace mucho tiempo como una consideración importante en la práctica clínica. Esta revisión sintetiza la evidencia de intervenciones farmacológicas y psicosociales para trastornos comórbidos de depresión y uso de sustancias y además proporciona recomendaciones clínicas respecto de las mejores intervenciones para tratar a estos pacientes. Se utilizó la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describió mediante el enfoque GRADE. Nuestros resultados sugieren que: 1) en pacientes con depresión y consumo de alcohol, se recomienda la administración de antidepresivos inhibidores de la recaptación de serotonina (ISRS) no selectivos en lugar de los ISRS para mejorar los síntomas depresivos (recomendación fuerte). No se recomiendan antidepresivos ISRS (recomendación fuerte) ni antidepresivos no ISRS (recomendación débil) para reducir el consumo de alcohol; 2) en pacientes con depresión y consumo de cannabis, no se recomienda el uso de venlafaxina (recomendación débil); 3) en pacientes con depresión y consumo de cocaína, no se recomienda el uso de antidepresivos ISRS para mejorar los síntomas depresivos (recomendación débil) o para reducir el consumo de cocaína (recomendación fuerte). El uso de antidepresivos no ISRS solo se recomienda para mejorar los síntomas depresivos (recomendación fuerte); 4) no se recomienda la administración de bupropión para reducir el consumo de nicotina (recomendación fuerte), y 5) en cuanto al tratamiento psicológico, en pacientes con depresión y trastorno de alcohol concurrente, tanto la farmacoterapia como la terapia cognitivo-conductual tienen efectos positivos en la internalización de los síntomas y en la reducción del consumo de alcohol (recomendación débil). Nuestra revisión sugiere la necesidad de realizar más investigaciones en esta área y de estudios aleatorizados, multisitio y más grandes para proporcionar más evidencia definitiva. Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.

Cannabis is the most commonly used illicit drug among adolescents and young adults, including pregnant women. There is substantial evidence for a significant association between prenatal cannabis exposure and lower birth weight in offspring, and mixed results regarding later behavioural outcomes in the offspring. Adolescent cannabis use, especially heavy use, has been associated with altered executive function, depression, psychosis and use of other drugs later in life. Human studies have limitations due to several confounding factors and have provided scarce information about sex differences. In general, animal studies support behavioural alterations reported in humans and have revealed diverse sex differences and potential underlying mechanisms (altered mesolimbic dopaminergic and hippocampal glutamatergic systems and interference with prefrontal cortex maturation). More studies are needed that analyse sex and gender influences on cannabis-induced effects with great clinical relevance such as psychosis, cannabis use disorder and associated comorbidities, to achieve more personalized and accurate treatments.

PURPOSE OF REVIEW Cannabis is globally the most commonly cultivated, trafficked and consumed illicit drug of abuse. The current article provides an updated overview of existing comprehensive interventions for preventing and reducing cannabis use. RECENT FINDINGS The PubMed database was searched for evidence regarding comprehensive interventions for preventing and reducing cannabis use from June 2016 to January 2018. The search resulted in 274 articles. Twenty-one studies were selected for assessment and 13 fulfilled the inclusion criteria. Six systematic reviews regarding preventive, psychosocial, pharmacological and risk reduction interventions were identified. Psychosocial interventions included therapist-assisted and computerized interventions. Four therapist-assisted, one computerized and two pharmacological clinical trials were published over the review period. Overall, considering the three different approaches (preventive, psychosocial or pharmacological) promising results have been found in certain interventions in reducing cannabis use among different types of users. In addition, recommendations to reduce adverse health outcomes related to cannabis use have also been reviewed. SUMMARY Although relevant findings have been found so far, further research with adequately powered trials assessing comprehensive interventions for reducing cannabis use remains a need before definitive treatment recommendations can be established.

New psychoactive tryptamines may be a public health risk since they intend to mimic the hallucinogenic effects of regulated psychoactive drugs. Few studies describe uses and clinical effects of unregulated new psychoactive tryptamines. This study aims (1) to explore the presence of tryptamines classified as NPS among the substances delivered for analysis to a harm-reduction organization; (2) to describe the substances found in the samples after analysis; and (3) to compare analytical results of regulated vs. non-regulated tryptamines. Samples delivered and analyzed by gas chromatography-mass spectrometry from 2006 to 2015 were included. A descriptive study of results was conducted. From 25,296 samples that were delivered, 436 were tryptamines; from these 232 (53.21%) were non-regulated. The most delivered non-regulated tryptamine was 4-AcO-DMT. A search of the PubMed database in July 2016 revealed that no studies in humans have ever been carried out with 4-AcO-DMT. Unregulated tryptamines likely contained one unadulterated substance (p ≤ 0.001). The number of samples submitted which contained tryptamines increased during the course of the study, with significant differences in client expectations vs. analysis results between the controlled and uncontrolled groups. There is a need for further research in order to prevent the potential health risks associated with their use.

Since its introduction in the 1960s by Dole and Nywswander [1], methadone maintenance treatment (MMT) is the most widely used therapy to treat opioid dependence and is considered its first-line treatment. Its efficacy has been proven in terms of decrease of heroin use and retaining patients in treatment; also, it reduces the risk behaviors associated with HIV infection, decreases criminal behavior related with drug use, reduces the risk of fatal overdose and improves health-related quality of life [2]. However, between 30 and 80% of treated patients relapse in heroin use or drop out from MMT [3]. Besides moral concepts and prejudices that hinder legislation and interfere with the implementation of MMT programs based in the scientific evidence to improve their effectiveness [4], in the last decade there has been an increasing interest in the study of the influence of pharmacogenetics in order to develop individualized therapies in response to interindividual variability in MMT response.

Intimate partner violence (IPV) is a public health problem worldwide. Several factors have been found to be associated with an increased prevalence of IPV, such as substance use. A cross-sectional study was conducted with the aim of determining the prevalence of IPV among women entering Hospital del Mar (Barcelona) for any medical/surgical reason, and who had a diagnosis of substance use disorder. Secondly, it was intended to psychometrically validate the Spanish version of the Hurt, Insulted, Threatened with Harm, Screamed (HITS) questionnaire. All patients were assessed by two IPV questionnaires, the Composite Abuse Scale (CAS) and HITS. Out of 52 patients interviewed, 46 answered both questionnaires. According to the CAS questionnaire, 23 patients (50%) experienced IPV at some point in their lives and 11 (23.9%) in the last year. Cannabis consumption was also associated with an increased severity of IPV (95% CI 3.5-28.9, p = .013).According to the HITS questionnaire, there was a prevalence of 39.1% (18 patients) in the last 12 months. HITS had a specificity of 100% and a sensitivity of 78% relative to the CAS questionnaire. A cut-off score x∈ [6.7], derived through ROC analysis, correctly discriminated 91% of the victims and 100% of the non-victims. The results obtained showed that the prevalence of IPV was very high among women who suffered from more than one substance use disorder. Therefore, it is highly recommended to systematically screen for IPV victimization by putting the HITS questionnaire into practice.La violencia de género (VG) es un problema de salud pública a escala mundial. Existen determinados factores asociados a un aumento de la prevalencia, como el consumo de sustancias. Se realizó un estudio transversal con el objetivo de determinar la prevalencia de VG en las mujeres que ingresaron en el Hospital del Mar (Barcelona) por cualquier motivo médico/quirúrgico y con el diagnóstico de trastorno por consumo de sustancias. Secundariamente, se pretendió validar la versión en español del cuestionario Hurt, Insulted, Threatened with Harm, Screamed (HITS). Se evaluaron a todas las pacientes mediante dos cuestionarios de detección de VG, el Composite Abuse Scale (CAS) y el HITS. De las 52 pacientes entrevistadas durante el período de estudio, 46 respondieron ambos cuestionarios. Según el cuestionario CAS, 23 pacientes (50%) presentaron VG alguna vez en la vida y 11 (23,9%) en el último año. El consumo de cannabis se asoció a una mayor gravedad de la VG (IC95% 3,5-28,9, p = .013). La prevalencia de VG, según el HITS, fue de 39,1% (18 pacientes) en los últimos 12 meses. El HITS mostró en relación al CAS una especificidad del 100% y una sensibilidad del 78%. Un punto de corte x∈ [6,7], obtenido mediante el análisis ROC, fue el que mejor discriminó al 91% de las víctimas y al 100% de las no-víctimas. Los resultados obtenidos demostraron una elevada prevalencia de VG entre las mujeres consumidoras de más de una sustancia de abuso. Por ese motivo, se recomienda incorporar el cribado sistemático mediante el cuestionario HITS.

Background Concern regarding the QTc interval in human immunodeficiency virus (HIV)-infected patients has been growing in recent years, and cases of prolonged QTc interval and torsades de pointes have been described in HIV-infected patients on methadone therapy. This study aimed to determine the prevalence and factors associated with long QTc interval in a cohort of opioid-dependent HIV-infected patients on methadone maintenance therapy. Methods A cross-sectional study was conducted in opioid-dependent HIV-infected patients on methadone maintenance therapy at a drug abuse outpatient center. Patients with any cardiac disease, drug-positive urine test, electrolyte abnormalities, and changes in their antiretroviral therapy (ART) or methadone doses in the last 2 months were excluded. Heart rate and QT interval in lead II were measured using the Bazett formula. Results Ninety-one patients were included: 58 (63.7%) were men with a median age of 44.5 years and 68 of 91 (74.7%) were on ART. Median methadone dose was 70 mg/day (range 15-250 mg/day) and mean QTc interval was 438 ± 34 ms. Prolonged QTc interval (>450 ms) was documented in 33 of 91(36.3%) patients, and 3 of 91 (3.2%) had QTc >500 ms. On multiple linear regression analysis, methadone doses (P = .005), chronic hepatitis C-induced cirrhosis (P = .008), and being ART-naive (P = .036) were predictive of prolonged QTc. Conclusions The prevalence of prolonged QTc interval in opioid-dependent HIV-infected patients on methadone maintenance therapy is high. Risk factors for prolongation of the QTc interval are chronic hepatitis C-induced cirrhosis, higher methadone doses, and being ART-naive. Thus, electrocardiographic monitoring is required to minimize cardiovascular morbidity and mortality in this specific HIV group.

Cocaine addiction is characterized by persistent decision-making deficits, which are linked to structural and functional abnormalities in frontolimbic systems. Moral judgment is as a special instance of decision making, in which both cognitive and emotional signals must be adequately integrated to decide how to resolve moral dilemmas. Here, we employed a moral dilemmas functional magnetic resonance imaging (fMRI) task to explore possible alterations of frontolimbic systems in cocaine-dependent subjects. We also explored if these alterations relate to more basic deficits in functional connectivity within these systems during spontaneous resting-state activation. Ten cocaine-dependent subjects and 14 non-drug-using controls participated in the study. Cocaine-dependent subjects were carefully selected to discard potentially confounding co-morbidities, and they underwent a uniform supervised abstinence period of 10 days. Both groups were scanned, and fMRI maps were generated to identify (1) brain response to moral dilemmas; and (2) the strength of functional connectivity within frontolimbic systems during resting-state. During the moral dilemmas task, cocaine-dependent subjects showed reduced activation involving frontolimbic structures as the anterior cingulate cortex (ACC), left insula and brain stem. Connectivity analyses showed that cocaine users had less resting-state functional connectivity between ACC, thalamus, insula and brain stem. These results demonstrate that cocaine-dependent subjects have functional alterations in the frontolimbic systems that support moral judgment and social decision making.

PurposeImprovement in Access to Treatment for People with Alcohol and Drug Related Problems (IATPAD) was a European study that detected barriers and facilitators to accessing treatment for patients with alcohol and drug‐related problems. This article seeks to compare the findings from a qualitative study with patients and staff in Catalunya (Spain).Design/methodology/approachThe paper describes a multi‐centre, qualitative study. A purposive sample of 47 staff, from a randomly selected sample of the three main entrance points to treatment for patients with alcohol and drug problems in Catalunya, were recruited from: Out‐patient General Psychiatry Centres (CSMA); Out‐patient Addiction Centres (CAS); and Primary Care Centres (CAP). In addition, open‐ended responses were collated from 142 additional staff on barriers and facilitators to accessing treatment for patients with alcohol and drug problems and how these barriers could be improved. A total of 25 patients from two CAS were interviewed in‐depth. The framework approach was used to interpret qualitative interviews.FindingsThe main barriers and facilitators to accessing treatment identified by staff and patients were patients' motivation, centres' opening hours, staff attitudes, the provision of information about services, and the co‐ordination and integration of different services – mainly the mental health and addiction sectors.Originality/valueThis paper describes and compares the main barriers and facilitators to accessing treatment from both staff and patients' point of view. Recommendations are made in order to improve service accessibility for patients with addiction problems and those with a dual diagnosis.