BACKGROUND: Propofol has been widely used for an induction and/or maintenance of general anesthesia, or for sedation for various procedures. Although it has many ideal aspects, there have been several cases of drug abuse and addiction. The authors investigated whether there are abuse liable groups among the general population. METHODS: We surveyed 169 patients after gastric endoscopic examination, which used propofol as a sedative, with the Addiction Research Center Inventory (ARCI) questionnaire. Other characteristics of the patients, such as past history, smoking habits, depression, anxiety, alcohol abuse liability and sleep disturbance, were recorded by history taking and several questionnaires before the exam. RESULTS: Propofol had a high Morphine-Benzedrine Group (MBG) score (representative value for euphoria) of 6.3, which is higher than marijuana, and a Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score (representative value of sedation) of 8.1, which is lower than most opioids. The MBG score showed no statistically significant correlation between any of the characteristics of the groups. In females, the PCAG score showed a correlation with age, and in males, it showed a correlation with a sleeping problem. CONCLUSIONS: Propofol had relatively high euphoria and low residual sedative effects. It had a more potent sedative effect in the female group who were young, and in the male group who had a low sleep quality index. There were differences in the abuse liability from a single exposure to propofol in the general population. Further study is needed to evaluate the abuse liability of repeated exposure.
Alcoholism ; Analgesics, Opioid ; Anesthesia, General ; Anxiety ; Behavior, Addictive ; Cannabis ; Depression ; Endoscopy* ; Euphoria ; Female ; Humans ; Hypnotics and Sedatives ; Male ; Propofol* ; Surveys and Questionnaires ; Smoke ; Smoking ; Substance Abuse, Intravenous ; Substance-Related Disorders

Tramadol is a centrally acting analgesic with a dual mode of action. Its analgesic efficacy is attributed to its partial affinity for the mu-opiate receptor and its inhibition of norepinephrine and serotonin reuptake. Acting in a synergistic manner and being more efficacious, tramadol is used worldwide for the treatment of moderate to severe acute or chronic pain. Abuse and dependence of tramadol as well as tramadol-related deaths have been increasingly reported, either ingested alone or taken in combination with other potentially interacting drugs. The possible toxic effect of tramadol was reviewed from aspects of its analgesic mechanisms, adverse effect, dependence, and abuse.
Analgesics, Opioid/poisoning* ; Forensic Toxicology ; Humans ; Substance-Related Disorders/prevention & control* ; Tramadol/poisoning*

Background: The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge. Objective: To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre. Methods: A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed. Results: The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11–20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%). Conclusion: A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.
Substance-Related Disorders ; Heroin Dependence ; Social Problems ; India

Salsolinol, a dopamine-derived tetrahydroisoquinoline, is one of the endogenous alkaloids structurally related to morphine. It has been implicated in the pathophysiology of alcohol dependence and Parkinson's disease since it's first discovery in 1970's. Salsolinol is involved in many neurophysiological processes, including modulation of dopamine activity, facilitation of prolactin release and reinforcement of additive substance craving. In addition, salsolinol exerts highly neurotoxic effects on dopaminergic neurons ultimately leading to apoptosis, which is mediated by inhibition of endogenous antioxidants and, thereby, production of reactive oxygen species (ROS). These properties are considerably based in alcohol dependence and several neurodegenerative disorders including Parkinson's disease. Salsolinol is synthesized by the condensation of dopamine with acetaldehyde or pyruvate through enzymatic or non-enzymatic processes in the dopamine-rich neurons. Acute alcohol ingestion increase the level of acetaldehyde and salsolinol is structurally related to endogenous opioids. Therefore, it has been suggested that salsolinol may be the missing link between alcohol ingestion and the activation of reward pathway in the mesolimbic brain. The reinforcing effect of both alcohol and salsolinol in self-administration setting also strongly supports this hypothesis. N-methylsalsolinol, the major metabolite of salsolinol, is highly neurotoxic and responsible for the selective destruction of dopaminergic neurons in Parkinson's disease. In contrast to this, several structural analogs of salsolinol act as endogenous anti-parkinsonism substances. Delicate structural differences may underlie this peculiar properties. It may become possible to introduce fine structural modifications, even stereo-specific manipulations, to develop entirely newer kinds of antiparkinsonism drugs. Although the implication of salsolinol in the pathophysiology of alcohol dependence had been suggested long ago, the progression of the related research was at most very limited up to now. Even now, this important chemical, deeply involved in a wide range of essential neurophysiological processes, still is relatively neglected by psychiatric researchers. However, it is expected that the accumulating knowledge of salsolinol's neuromodulatory and neurotoxic effects will give new insights into the many dopamine related psychiatric disorders including substance dependence, parkinsonism and schizophrenia. We expect that many psychiatrists will give proper attention to this highly promising research subject.
Acetaldehyde ; Alcoholism ; Alkaloids ; Aluminum Hydroxide ; Analgesics, Opioid ; Antioxidants ; Apoptosis ; Brain ; Carbonates ; Dopamine ; Dopaminergic Neurons ; Eating ; Humans ; Isoquinolines ; Morphine ; Neurodegenerative Diseases ; Neurons ; Parkinson Disease ; Parkinsonian Disorders ; Prolactin ; Psychiatry ; Pyruvic Acid ; Reactive Oxygen Species ; Reinforcement (Psychology) ; Research Subjects ; Reward ; Schizophrenia ; Substance-Related Disorders

Drug abuse by healthcare providers is a serious public problem affecting not only the providers themselves but also their families, colleagues, and patients. It is not a new problem, but the medical community has historically been unwilling to accept and publicly acknowledge the problem, particularly a problem of its own members. Therefore, drug abuse by healthcare providers has either gone unnoticed or has been treated punitively, which has led to high prevalence and mortality. In South Korea, drug-abusing healthcare providers are considered criminals rather than patients. However, many studies have reported that punitive action alone is ineffective. This article describes the treatment principles, prognosis, and possibilities of returning to practice for drug-abusing healthcare providers. Early detection of drug abuse is key to subsequent treatment and prognosis. Furthermore, why relapse prevention as well as treatment is significant and which factors intensify the risk of relapse will be discussed. The use of opioids, coexisting psychiatric illness, and a family history of drug abuse are statistically significant factors. Finally, continuous and close monitoring is effective for relapse prevention, so it is considered another kind of therapy. An organized system for treating drug abuse is currently lacking in South Korea, not only for the general population but also for healthcare providers. In the future, a systematic approach and management by the medical community is necessary to resolve drug abuse by healthcare providers.
Analgesics, Opioid ; Criminals ; Delivery of Health Care ; Health Personnel ; Humans ; Prevalence ; Prognosis ; Recurrence ; Republic of Korea ; Substance-Related Disorders

Currently, the number of reports of propofol abuse in the general population and among physicians has increased, arousing public concerns about drug abuse. It is especially easy for physicians to access various drugs, and thus they are prone to abuse drugs. However, the data on physicians' drug abuse in the Republic of Korea remains insufficient. In this article, we estimated the state of current drug abuse among the Korean general population and the assumed rate and tendency toward drug abuse among physicians based on published data. The current prevalence of drug abuse in Korea is around 4%, and the physicians' rate may not differ from that of the general population. According to the data on drug-related crime in Korea, 1% of such crimes are associated with medical personnel. Opioids are used more frequently by medical personnel than the general population (6.2% vs. 18.1%). Even though drug abuse is commonly related to personality problems and comorbid psychological disorders, social and environmental factors are also important. Burnout problems due to the stresses of a heavy workload in the hospital with sleep deprivation, rapidly expanding medical knowledge, and increasing government regulations are additional important causes of drug abuse among physicians. However, few studies on drug abuse and physician burnout have been performed in Korea. Although the rate of physicians' drug abuse is similar to that in the general population, the prevalence is disturbing because physicians are responsible for the health and well-being of the general population. Therefore, detailed research about physicians' drug abuse and burnout is needed, and proper solutions to prevent and treat drug abuse should be established.
Analgesics, Opioid ; Burnout, Professional ; Crime ; Government Regulation ; Korea ; Prevalence ; Propofol ; Republic of Korea ; Sleep Deprivation ; Street Drugs ; Substance-Related Disorders

OBJECTIVE: To explore the change and influence factors of quality of life QOL for drug abusers who accepted methadone maintenance treatment (MMT). METHODS: The questionnaire of QOL-BRIEF was used to measure the level of QQL when patients just entered the study and 6 months after the treatment respectively. The effect of therapy and characteristic of patients on change of QOL was analyzed. RESULTS: The scores in physiological domain, psychological domain, and the total score obviously increased after the treatment. There was no significant difference in the change of QOL between the patients of different dose groups. The QOLs of males and patients with long-time drug use improved significantly after the treatment. CONCLUSION MMT can raise the QOL of drug abusers. Gender and time of drug use may be the risk factors of QOL improvement.
Female ; Humans ; Male ; Methadone ; administration & dosage ; Opioid-Related Disorders ; drug therapy ; Quality of Life ; Substance Withdrawal Syndrome ; drug therapy ; Surveys and Questionnaires

Abuse of pharmaceutical drugs is a major public health and social problem worldwide. Mostly abused drugs mainly include opioids such as morphine, tramadol, methadone and fentanyl, sedative-hypnotics such as benzodiazepines and non-benzodiazepines, and central stimulants such as Ritalin (methylphenidate), Adderall (amphetamine and dextroamphetamine) and modafinil. Abuse of pharmaceutical drugs not only causes direct damage to multiple systems of the body, but also significantly increases risks of mental and physical diseases, imposing a heavy burden on individuals, families and society. Therefore, the prevention and control of pharmaceutical drug abuse are of vital importance. The Chinese government has taken strict administration measures for pharmaceutical drugs with abuse risk. However, confronting endless new drugs and changing abuse trends, it is necessary to further strengthen management and prevention of pharmaceutical drugs, monitor the trend of abuse, establish rapid response mechanisms, popularize relevant knowledge, and develop specific therapeutic drugs and intervention means, in order to promote prevention and treatment of pharmaceutical drug abuse.
Analgesics, Opioid/adverse effects* ; Central Nervous System Stimulants/adverse effects* ; Humans ; Illicit Drugs/adverse effects* ; Substance-Related Disorders/prevention & control*

OBJECTIVES: The relationship between substance dependence and poor decision making has received much attention in recent years. This study aimed to test the hypothesis that alcohol dependent subjects would demonstrate a more perseverative decision-making pattern, during ambiguous situations. METHODS: 15 alcohol dependent patients and 15 healthy normal controls performed a novel computerized decision-making task, which presented figures of coins. The subjects were instructed to guess whether the total number of coins was 'odd' or 'even'. Besides these two response, one could select a third alternative - 'pass' - in case the chances were assumed to be low. RESULTS: There was significant difference in performance between the two groups (F=4.339, p=0.008). The control group gained 15.4+/-14.4 points, whereas the alcohol dependent group lost 0.6+/-5.3 points. The normal control group demonstrated a tendency to make more pass responses as the trials were repeated. In contrast, the alcohol dependent group didn't make use of the alternative, but kept challenging between 'odd' and 'even', although they sensed that the chances were low. CONCLUSION: The alcohol dependent patients demonstrated a more rigid and perseverative response pattern and showed deficits in making use of compromise alternatives.
Alcoholism ; Decision Making ; Humans ; Numismatics ; Substance-Related Disorders

Objective: To investigate the prevalence of diphenoxylate abuse and related factors of forced drug abstainer in Gansu province. Methods: By using a self-designed questionnaire, an epidemiologic investigation was carried out among 2 108 forced drug abstainer selected from the compulsory isolation detoxification center of Gansu province. A case-control study was conducted to analyze the factors related with diphenoxylate abuse. Results: The diphenoxylate abuse rate among forced drug abstainer in Gansu was 19.8% (406/2 046), ranking first in medical drug abuse. Multiple logistic regression analysis showed that factors as relieving withdrawal symptoms (OR=2.08, 95%CI: 1.01- 4.32), ways to obtain diphenoxylate (other ways: OR=1.00; regular clinic: OR=27.67, 95%CI: 2.64-289.82; friend: OR=0.01, 95%CI: 0.01-0.03), degree of euphoria (high: OR=1.00; medium: OR =3.36, 95%CI: 1.18-9.55; low: OR=26.16, 95%CI: 10.30-66.42), years of drug abuse (<5 years: OR=1.00; 10-15 years: OR=2.48, 95%CI: 1.02-6.04), abuse at home or in friend's house (OR=3.04, 95%CI: 1.08-8.68), abuse in car (OR=0.05, 95%CI: 0.00-0.68) and detoxification for the first time (OR=0.61, 95%CI: 0.43-0.86) were the possible influencing factors for diphenoxylate abuse. Conclusions: The prevalence of diphenoxylate abuse in forced drug abstainer in Gansu was relatively high. Reasons of abusing, the way to obtain diphenoxylate, whether using drug together with friends, degree of euphoria, years of abuse, abuse place and times for detoxification were related factors influencing the abuse of diphenoxylate.
Analgesics, Opioid/supply & distribution* ; Case-Control Studies ; China ; Diphenoxylate/supply & distribution* ; Humans ; Substance Withdrawal Syndrome ; Substance-Related Disorders/psychology* ; Surveys and Questionnaires