High Rates of Midazolam Injection and Associated Harms in Bangkok, Thailand.
High Rates of Midazolam Injection and Associated Harms in Bangkok, Thailand.
Filed under: Addiction Rehab
Addiction. 2012 Dec 24;
Hayashi K, Suwannawong P, Ti L, Kaplan K, Wood E, Kerr T
AIMS: To identify the prevalence and correlates of midazolam injection among injecting drug users in Thailand. DESIGN: Serial cross-sectional mixed-methods study. SETTING: Bangkok, Thailand. PARTICIPANTS: 435 adults who had injected drug(s) in the past six months were recruited through peer outreach and word-of-mouth in Bangkok in 2011. MEASUREMENTS: Multivariable logistic regression was used to analyze self-reported data collected through an interviewer-administered survey in July-October 2011 (n=435). Additionally, qualitative data were collected in June-July 2009 (n=10) and analyzed to explore the health problems attributable to midazolam injection. FINDINGS: Among 435 survey participants, the prevalence of daily midazolam injection in the past six months was 37.0% (95% Confidence Interval: 32-42). While 75.8% of the daily midazolam injectors identified heroin as their drug of choice, 91.8% of these individuals reported substituting heroin with midazolam when heroin was unavailable. In multivariable analyses, daily midazolam injection was associated with femoral vein injection (Adjusted Odds Ratio [AOR] = 4.48), polydrug use (AOR = 4.94), daily heroin injection (AOR = 3.25), binge use (AOR = 1.75), and perceived increase in policing pressure (AOR = 1.95) (all p < 0.05). Qualitative accounts indicated severe health problems associated with midazolam injection, including nerve and vascular injuries. CONCLUSION: Midazolam misuse is increasing among injecting drug users in Bangkok and appears to be used primarily as a substitute for heroin. Midazolam injection was independently associated with various risk factors for injection-related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are urgently needed. HubMed – addiction
A randomized study of cell phone technology to reinforce alcohol abstinence in the natural environment.
Filed under: Addiction Rehab
Addiction. 2012 Dec 20;
Alessi SM, Petry NM
AIMS: Contingency management (CM) uses tangible incentives to systematically reinforce abstinence and is among the most efficacious psychosocial substance abuse treatments. This study assessed the feasibility and initial efficacy of a portable CM procedure designed to address technical limitations for detecting drinking that have prevented using CM for alcohol problems. DESIGN: Participants received a cell phone, breathalyzer, and training on video-recording alcohol breath tests (BrACs) and texting results. For 4 weeks, staff texted participants 1-3 times daily indicating a BrAC was due within the hour. Participants were randomized to (1) modest compensation for submitting dated time-stamped BrAC videos regardless of results or (2) the same plus CM with escalating vouchers for on-time alcohol-negative tests (n-BrAC; <02 g/dL). Thank you texts were sent, with CM patients also informed of results-based earnings. SETTING: Participants' natural environment. PARTICIPANTS: Adults (N=30; ?21 years) who drank frequently but not physiologically dependent. MEASUREMENTS: Drinking and related problems were assessed at Intake and Week 4. BrACs and self-reports of drinking were collected throughout. The primary outcome was percent of n-BrACs. Other outcomes were longest duration of consecutive n-BrACs (LDA) and self-reports of drinking. FINDINGS: On average, 88.6% (10.4%) of BrACs were submitted on time, without group differences (p>.5). Percent of n-BrACs and LDA were greater with CM, and there was an interaction effect on drinking frequency and negative consequences, with decreases over time with CM (p=.00; effect sizes d=.52 to.62). CONCLUSION: Cell phone technology may be useful for extending contingency management to treatment for alcohol problems.
HubMed – addiction
Acute coronary events during alcohol withdrawal.
Filed under: Addiction Rehab
Addiction. 2013 Jan; 108(1): 222-3
Rodrigo C, Fernando T, Samarakoon L, Dandeniya C, Wattegama M, Wanniarachchi N, Jayananda G, Rajapakse S
Commentary on Nonnemaker et?al. (2013): Banning menthol cigarettes – is it time to conduct the experiment?
Filed under: Addiction Rehab
Addiction. 2013 Jan; 108(1): 179-80
Carter L
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