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Association between solar insolation and a history of suicide attempts in bipolar I disorder

Bauer M, Glenn T, Alda M, Andreassen OA, Angelopoulos E, Ardau R, et al.

J Psychiatr Res, 2019 06;113:1-9.
PMID: 30878786 DOI: 10.1016/j.jpsychires.2019.03.001

In many international studies, rates of completed suicide and suicide attempts have a seasonal pattern that peaks in spring or summer. This exploratory study investigated the association between solar insolation and a history of suicide attempt in patients with bipolar I disorder. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area on Earth. Data were collected previously from 5536 patients with bipolar I disorder at 50 collection sites in 32 countries at a wide range of latitudes in both hemispheres. Suicide related data were available for 3365 patients from 310 onset locations in 51 countries. 1047 (31.1%) had a history of suicide attempt. There was a significant inverse association between a history of suicide attempt and the ratio of mean winter solar insolation/mean summer solar insolation. This ratio is smallest near the poles where the winter insolation is very small compared to the summer insolation. This ratio is largest near the equator where there is relatively little variation in the insolation over the year. Other variables in the model that were positively associated with suicide attempt were being female, a history of alcohol or substance abuse, and being in a younger birth cohort. Living in a country with a state-sponsored religion decreased the association. (All estimated coefficients p 

Matched MeSH terms: Substance-Related Disorders/complications
Severity of Kratom (Mitragyna speciosa Korth.) Psychological Withdrawal Symptoms

Singh D, Narayanan S, Müller CP, Swogger MT, Rahim AA, Leong Bin Abdullah MFI, et al.

J Psychoactive Drugs, 2018 08 28;50(5):445-450.
PMID: 30152738 DOI: 10.1080/02791072.2018.1511879

Kratom leaves (Mitragyna speciosa Korth.) are traditionally used in Southeast Asia for their medicinal value. Self-report studies suggest that cessation from chronic kratom tea consumption (freshly brewed kratom tea) was associated with unpleasant psychological symptoms. This study sought to assess the severity of anxiety and depression during kratom cessation. Regular kratom users (N = 150) were recruited from the northern state of Penang (Malaysia) for this retrospective study. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scales were used to assess the severity of the symptoms of anxiety and depression. Most respondents (70%) experienced symptoms of mild anxiety, while 81% experienced symptoms of mild depression during kratom cessation. Those who consumed higher quantities of kratom tea daily (≥4 glasses) had higher odds of reporting longer duration of kratom use history (OR = 4.8, 95% CI 2.3 -10.1, p

Matched MeSH terms: Substance-Related Disorders/complications*
Fulltext Pain, instability, and familial discord: a qualitative study into women who use drugs in Malaysia

Rahman F, Lall P, Iqbal S, Vicknasingam B

Harm Reduct J, 2015 Nov 05;12:52.
PMID: 26542117 DOI: 10.1186/s12954-015-0086-6

BACKGROUND: Out of 20,887 persons who use drugs that came into contact with the National Anti-Drugs Agency (NADA) officials in the year 2013, 3.2% were women. Because women who use drugs (WWUD) are often a hidden population, this may be an underestimate. International literature shows that women who use drugs face increased risk of HIV, intimate partner violence, and mental health issues. Similar literature in Malaysia is lacking, and thus, the objective of our study was exploratory in nature.
METHODS: Thirty-eight women who use drugs were interviewed using a semi-structured topic guide in Kelantan, Penang, Johor, Kuala Lumpur, and Selangor. Locations were chosen purposively. Nineteen women were interviewed individually and the remaining 19 were in focus group discussions (FGDs). All interviews were transcribed verbatim, translated to English, and analyzed with NVivo.
RESULTS: Median age of respondents was 35.5 years old, 89.5% ethnic Malays, majority having married below the age of 20, and were of low socioeconomic backgrounds. Youngest age of initiation into drug use was 9 years old. Most reported is inhalation of amphetamine-type substances. Seven reported ever injecting. Three themes emerged: (a) repeating patterns of fluid family structures and instability; (b) "pain" and "difficulty" as features of home life; and (c) seeking marriage as a source of stabilization and practices of power within those marriages. Respondents often came from very fluid family environments and married to find stability, only to be drawn into a similar cycle. None of the women who had been separated from their children either institutionally, by family members, or by third parties, had accessed legal recourse for the loss of their parental rights.
CONCLUSION: Unstable familial relationships or environments contributed to earlier initiation of drug use which raised questions about support services for WWUD and children who use drugs. Respondents were drawn into unstable and/or abusive relationships, perpetuating social inequalities that marked their own familial environments during childhood. These findings support the need for additional services to support the unique needs of WWUD, including domestic violence services, financial and life skills, parental rights assistance, and empowerment programs.

Matched MeSH terms: Substance-Related Disorders/complications
Delta hepatitis in Malaysia

Sinniah M, Dimitrakakis M, Tan DS

Southeast Asian J. Trop. Med. Public Health, 1986 Jun;17(2):229-33.
PMID: 3787309

Sera from one hundred and fifty nine Malaysian individuals were screened for the prevalence of delta markers. These included 15 HBsAg positive homosexuals, 16 acute hepatitis B cases, 9 chronic hepatitis B patients, 13 healthy HBsAg carriers and 106 intravenous (i.v.) drug abusers, of whom 27 were positive for HBsAg only and the rest were anti-HBc IgG positive but HBsAg negative. The prevalence of delta markers in the homosexuals was found to be 6.7%, in the HBsAg positive drug abusers 17.8%, in acute hepatitis B cases 12.5%. No evidence of delta infection was detected in healthy HBsAg carriers, chronic hepatitis B cases and HBsAg negative i.v. drug abusers. With reference to i.v. drug abusers, the prevalence of delta markers was higher in Malays (23%) than in Chinese (7%) although the latter had a higher HBsAg carrier rate. Although the HBsAg carrier rate in the homosexuals was high, their delta prevalence rate was low as compared to drug abusers. In Malaysia, as in other non-endemic regions, hepatitis delta virus transmission appeared to occur mainly via the parenteral and sexual routes. This is the first time in Malaysia that a reservoir of delta infection has been demonstrated in certain groups of the population at high risk for hepatitis B.

Matched MeSH terms: Substance-Related Disorders/complications
Fulltext Prevalence of sexually transmitted diseases among female drug abusers in Malaysia

Isa AR, Sivakumaran S

Med J Malaysia, 1993 Jun;48(2):124-8.
PMID: 8350786

The prevalence of sexually transmitted diseases (STD) among female drug abusers was determined by screening 130 new inmates of a rehabilitation centre. The majority of the subjects (77.7%) were self-confessed sex workers. A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%) and trichomoniasis (19.2%) were noted. Gonorrhoea vaginitis was seen in 8.5%, which was low compared to previous studies. Six subjects were seropositive for human immunodeficiency virus (HIV), with 5 of them admitting to needle sharing and working as prostitutes. More than half of them harboured 2 or more STD. A rich reservoir of STD was seen among the drug abusers. With more evidence now available concerning the ease of HIV transmission associated with ulcerative STD, a stage could be set for greater heterosexual HIV transmission. As part of the rehabilitation process, female drug abusers need a thorough screening for STD followed by aggressive treatment regimens.

Matched MeSH terms: Substance-Related Disorders/complications*
Psychiatric morbidity in the first-degree relatives of schizophrenic patients

Varma SL, Sharma I

Br J Psychiatry, 1993 May;162:672-8.
PMID: 8149120

First-degree relatives (FDRs) of 162 schizophrenic and 106 control probands were investigated [corrected]. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.

Matched MeSH terms: Substance-Related Disorders/complications
Fulltext Material security and adherence to antiretroviral therapy among HIV-positive people who use illicit drugs

Mohd Salleh NA, Van Draanen J, Nosova E, Barrios R, Milloy MJ, Richardson L

AIDS, 2020 06 01;34(7):1037-1045.
PMID: 32073444 DOI: 10.1097/QAD.0000000000002501

OBJECTIVE: To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care.
DESIGN: We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 to 2017.
METHODS: We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving at least 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three-factor structure, employed in the current analyses, were factor 1 (basic needs); factor 2 (housing-related variables) and factor 3 (economic resources).
RESULTS: Recent incarceration [β-coefficient (β) = -0.176, 95% confidence interval (95% CI): -0.288 to -0.063], unmet health needs [β = -0.110, 95% CI: -0.178 to -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336 to -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586 to -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, or for each factor individually.
CONCLUSION: Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.

Matched MeSH terms: Substance-Related Disorders/complications*
Priapism: ecstasy related?

DubinN N, Razack AH

Urology, 2000 Dec 20;56(6):1057.
PMID: 11113767

Priapism, an uncommon urological emergency, is commonly drug-induced. We present a previously unreported case of a young man with priapism probably related to Ecstasy.

Matched MeSH terms: Substance-Related Disorders/complications*
Analgesic use and chronic renal disease in patients with headache

Rahman A, Segasothy M, Samad SA, Zulfiqar A, Rani M

Headache, 1993 Sep;33(8):442-5.
PMID: 8262786

The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.

Matched MeSH terms: Substance-Related Disorders/complications
Fulltext Infective endocarditis amongst intravenous drug abusers seen at the University Hospital, Kuala Lumpur

Jayamalar R, Parasakthi N, Puthucheary SD

Med J Malaysia, 1987 Dec;42(4):264-8.
PMID: 3136302

Drug abuse is a major problem in Malaysia. Serious complications of intravenous drug addiction include septicaemia and infective endocarditis. We present nine cases of endocarditis occuring amongst drug abusers. The tricuspid valve was most frequently involved and the common aetiological organisms were S. aureus and Str. faecalis. There was a high mortality rate of 67% in our study, inspite of appropriate therapy. Early recognition of the disease and aggressive treatment is required to improve the associated mortality.

Matched MeSH terms: Substance-Related Disorders/complications*
Computed tomography and ultrasonography: a comparative study in the diagnosis of analgesic nephropathy

Segasothy M, Abdul Samad S, Zulfiqar A, Shaariah W, Morad Z, Prasad Menon S

Nephron, 1994;66(1):62-6.
PMID: 8107955

Computed tomography (CT) and ultrasonography (US) were performed in 40 patients who had consumed excessive quantities of analgesics (> 1 kg) to compare their value in the diagnosis of analgesic nephropathy (AN). The computed tomography and sonographic features were renal papillary calcifications. Renal papillary necrosis (RPN) was documented in 20 of 40 patients by US and in 14 of 40 patients by CT. In 11 patients, both US and CT were positive. In 9 patients, US was positive whilst CT was negative. In 3 patients, CT was positive whilst US was negative. Prevalence of RPN was 50% using US and 35% using CT. Using US as a gold standard, sensitivity of CT was 55%, specificity 85%, positive predictive value 78.6% and negative predictive value 34.6%. Percent agreement with CT and US was 70%. Cohen's kappa statistic adjusting for chance agreement was 40%. Based on these results, it is found that US yielded a higher percentage of positive cases of RPN.

Matched MeSH terms: Substance-Related Disorders/complications
Drug injecting and HIV infection among the population of drug abusers in Asia

Poshyachinda V

Bull Narc, 1993;45(1):77-90.
PMID: 8305908

Opium has been produced and consumed since the nineteenth century in the areas of Asia currently referred to as the Golden Crescent and the Golden Triangle. In the 1970s and 1980s, most countries from Afghanistan to Japan experienced a heroin epidemic of varying degrees of severity. Opium and heroin abuse appeared to be more severe in countries and areas where those drugs were produced, an exception being Hong Kong, which has had a large population of heroin abusers for more than two decades. Drug injecting was far more common in countries of the Golden Triangle than in those of the Golden Crescent. In Myanmar and Thailand, for example, up to 90 per cent of chronic heroin abusers practised intravenous injection, which appeared to spread to heroin abusers in nearby territories such as the State of Manipur in India. Yunnan province in China, as well as Malaysia and Viet Nam. Amphetamine abuse was more frequent in Japan and the Republic of Korea for a number of years, while illicit production and consumption in the Philippines have recently shown significant increases. The injection of amphetamines was common only in the Republic of Korea. The prevalence of injecting among institutionalized methamphetamine abusers was reported at about 90 per cent. Most countries in Asia first reported cases of infection with the human immunodeficiency virus (HIV) in the mid-1980s. An extremely rapid spead of the epidemic and high prevalence, at rates of from 30 to 90 per cent, of HIV infection among the sample of intravenous heroin abusers were observed in a few countries with a high prevalence of intravenous injecting, such as India (in the State of Manipur), Myanmar and Thailand. The rest had either few reported cases or none at all, even though needle-sharing was found to be common. Great caution should be exercised in interpreting prevalence because of vast differences in methods of assessment. Given the vulnerability of intravenous drug abusers to rapid transmission of HIV infection, the prevention of drug injecting is of paramount importance in arresting the spread of the epidemic. Efforts to contain drug abuse, though difficult, are a principal means of achieving that end.

Matched MeSH terms: Substance-Related Disorders/complications*
Fulltext Dilated common bile duct in opium addicts with and without biliary symptoms --implication for research in AIDS cholangiopathy

Chuah SY, Leong CK, Pang CW

Singapore Med J, 2003 May;44(5):261-7.
PMID: 13677363

Opium addicts (OA) with no biliary symptoms have been shown to have dilated common bile duct (CBD). Endoscopic retrograde cholangio-pancreatography (ERCP) without biliary drainage in such asymptomatic OA is hazardous. Hence it is not indicated unless there are clear clinical and laboratory evidences of biliary stasis.

Matched MeSH terms: Substance-Related Disorders/complications*
Fulltext The HIV-associated risk behaviour among male drug abusers in Malaysia

Juita G, Osman A

Med J Malaysia, 1995 Dec;50(4):320-5.
PMID: 8668050

To examine the risk factors of HIV type-I infection among male drug addicts in Malaysia, a case-control study was conducted on inmates, aged 20-40 years, at a drug rehabilitation centre in January, 1994. Stratified random sampling was performed. A total of 87 cases and 261 controls, chosen by frequency matching for age and ethnicity, answered self-administered questionnaires. About 59.8% of the subjects administered drugs intravenously and of these, 71.2% shared needles. Practices significantly associated with HIV infection were needle-sharing (OR = 8.53; 95% CI = 3.36-5.52), sexual relationship with prostitutes (OR = 3.70; 95% CI = 2.10-6.56), homosexuality (OR = 4.05; 95% CI = 1.49-11.11) and non-condom use while having sex with prostitutes (OR = 2.27; 95% CI = 1.05-4.97).

Matched MeSH terms: Substance-Related Disorders/complications*
Prevalence rates and risk factors for hepatitis C among drug users not in treatment in Malaysia

Vicknasingam B, Narayanan S, Navaratnam V

Drug Alcohol Rev, 2009 Jul;28(4):447-54.
PMID: 19594801 DOI: 10.1111/j.1465-3362.2009.00087.x

The prevalence of hepatitis C virus (HCV) among heroin dependants in treatment was estimated at 89.9%; however, virtually no information exists on the prevalence or risk behaviour among the larger population of drug users not in treatment. This study assessed the prevalence of HCV and associated risk factors among this group with a view to designing more effective intervention programs.

Matched MeSH terms: Substance-Related Disorders/complications*
Erectile Dysfunction among People Who Use Ketamine and Poly-Drugs

Suppiah B, Vicknasingam B, Singh D, Narayanan S

J Psychoactive Drugs, 2016 Apr-Jun;48(2):86-92.
PMID: 27014841 DOI: 10.1080/02791072.2016.1156790

Despite the rise in recreational use of ketamine in Malaysia, there have been no studies of users or of the health-related consequences they face. This study was initiated to examine ketamine use and its health consequences. A structured questionnaire was used to elicit information. A final sample of 127 males was divided into persons who used only ketamine and those who were poly-drug users. Each group was further divided into long-period and short-period users. Urine toxicology screening for ketamine and other illicit drugs commonly used in Malaysia was also done. Our findings corroborate those of earlier studies that link ketamine use to urological problems such as frequent urination, dysuria, incontinence, painful bladder, nocturia, and urinary urgency. A new finding in this study is the significant association between ketamine use and erectile dysfunction, such that higher odds of reporting erectile dysfunction were linked to long-period users. Our findings strengthen the case for early intervention, as ketamine users are drawn from young and unmarried male participants. The association of ketamine use with erectile dysfunction, if substantiated, will help physicians in their diagnosis of erectile dysfunction, particularly among youths.

Matched MeSH terms: Substance-Related Disorders/complications*
Chronic mitragynine (kratom) enhances punishment resistance in natural reward seeking and impairs place learning in mice

Ismail NIW, Jayabalan N, Mansor SM, Müller CP, Muzaimi M

Addict Biol, 2017 Jul;22(4):967-976.
PMID: 26990882 DOI: 10.1111/adb.12385

Kratom (Mitragyna speciosa) is a widely abused herbal drug preparation in Southeast Asia. It is often consumed as a substitute for heroin, but imposing itself unknown harms and addictive burdens. Mitragynine is the major psychostimulant constituent of kratom that has recently been reported to induce morphine-like behavioural and cognitive effects in rodents. The effects of chronic consumption on non-drug related behaviours are still unclear. In the present study, we investigated the effects of chronic mitragynine treatment on spontaneous activity, reward-related behaviour and cognition in mice in an IntelliCage® system, and compared them with those of morphine and Δ-9-tetrahydrocannabinol (THC). We found that chronic mitragynine treatment significantly potentiated horizontal exploratory activity. It enhanced spontaneous sucrose preference and also its persistence when the preference had aversive consequences. Furthermore, mitragynine impaired place learning and its reversal. Thereby, mitragynine effects closely resembled that of morphine and THC sensitisation. These findings suggest that chronic mitragynine exposure enhances spontaneous locomotor activity and the preference for natural rewards, but impairs learning and memory. These findings confirm pleiotropic effects of mitragynine (kratom) on human lifestyle, but may also support the recognition of the drug's harm potential.

Matched MeSH terms: Substance-Related Disorders/complications*
Does substance abuse contribute to further risk of falls in dementia

Eshkoor SA, Hamid TA, Nudin SS, Mun CY

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 2014;21(3):317-24.
PMID: 23883099 DOI: 10.1080/13825585.2013.819067

This study aimed to predict the risk of falls by focusing on substance abuse in the elderly with dementia. Our national cross-sectional survey included 1210 elderly Malaysian demented subjects. The study identified the effects of age, ethnicity, sex differences, marital status, educational level, and substance abuse on the likelihood of falls in the elderly with dementia. The multivariate logistic regression model was used to analyze data collected from samples. The prevalence of falls was about 17% among subjects and significantly increased with age (p = .006). Furthermore, the results showed that age (OR = 1.03), ethnicity (OR = 1.69), substance abuse (OR = 1.68), and female sex (OR = 1.45) significantly enhanced the risk of falls in respondents (p < .05). Educational level and marital status had no significant effects on the likelihood of falls (p > .05). However, the findings provided evidence of an additional effect of substance abuse on further risk of falls in older adults with dementia.

Matched MeSH terms: Substance-Related Disorders/complications*
Fulltext Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study

Bórquez A, Rich K, Farrell M, Degenhardt L, McKetin R, Tran LT, et al.

J Int AIDS Soc, 2020 Jun;23 Suppl 1(Suppl 1):e25495.
PMID: 32562365 DOI: 10.1002/jia2.25495

INTRODUCTION: Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre-exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants.
METHODS: We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01-2020/01-2021). We also investigated the 10-year impact (01-2020/01-2030) of: (1) PrEP prioritization for stimulant-using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant-associated risk.
RESULTS: MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant-associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade.
CONCLUSIONS: MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed.

Matched MeSH terms: Substance-Related Disorders/complications*
Fulltext Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations

Lee CH, Ko AM, Yang FM, Hung CC, Warnakulasuriya S, Ibrahim SO, et al.

JAMA Psychiatry, 2018 03 01;75(3):261-269.
PMID: 29417149 DOI: 10.1001/jamapsychiatry.2017.4307

Importance: Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences.
Objective: To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations.
Design, Setting, and Participants: In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016.
Main Outcomes and Measures: Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD.
Results: Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P

Matched MeSH terms: Substance-Related Disorders/complications*

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