Suchergebnisse

In § 11 des Glücksspielstaatsvertrages heißt es, dass die Bundesländer die wissenschaftliche Forschung zur Vermeidung und Abwehr von Suchtgefahren durch Glücksspiele sicherzustellen haben. Diese Regelung der Forschungsförderung hat seit dem Jahr 2008 vielfältige Projekte auf den Weg gebracht. Sie reichen von der Grundlagenforschung über epidemiologische Erhebungen bis hin zur Evaluation konkreter Präventionsmaßnahmen. Die Mehrzahl dieser ländergeförderten Studien ist auf einer Fachtagung im Februar 2012 in Hamburg vorgestellt und in Form von Beiträgen für den vorliegenden Tagungsband beschrieben worden. In ihrer Gesamtheit liefern sie eine theoretisch wie empirisch fundierte Grundlage für die zukünftige Gestaltung von glücksspielbezogener Prävention, Hilfe und Politik in Deutschland. M.A. Sven Buth und Dr. Jens Kalke sind wissenschaftliche Mitarbeiter am Institut für interdisziplinäre Sucht- und Drogenforschung (ISD) in Hamburg. Prof. Dr. Jens Reimer ist Direktor des Zentrums für Interdisziplinäre Suchtforschung der Universität Hamburg.

Introduction: After rapidly opening up a low-threshold clinic to support heavily opioid-dependent persons at the beginning of the COVID-19 pandemic in April 2020 in Hamburg (Germany), this non-interventional study evaluated the feasibility and short-term effects of opioid substitution treatment (OST). The low-threshold concept was customized for the pandemic situation and is the first of its kind in Germany. Methods: Patients who had already begun treatment were questioned in two assessments, at T1 shortly after beginning treatment and at T2 6 months later. The primary outcome criterion was their quality of life using the OSTQOL. Secondary criteria included retention rate, their mental and physical health (measured by the BSI-18 and the OTI Health Scale), social situation, drug use, COVID-19 status, and satisfaction with treatment. Results: Out of 84 patients included in the study, 51 participated in both assessments, resulting in a 6-month retention rate of 60.7%. 27.5% were females, and 72.5% were males. The feasibility question of the low-threshold OST clinic can clearly be answered positively. During the course of the study over 6 months, the situation mainly remained stable regarding quality of life, physical and mental health, and days of drug consumption. Patients significantly reduced the time they spent on the drug scene from 8.5 (SD = 7.56) to 6.1 (SD = 6.71) hours a day between the beginning of OST and T2 (p = 0.020). While 56.9% answered to be homeless at the beginning of OST, only 33.3% answered not to have found an accommodation by T2 (p = 0.012). The number of patients having contact to social workers increased from 51.0% to 74.5% (p = 0.004). Almost 2 fifths of the patients took part in PCR testing for COVID-19 (that only being done if they had symptoms), and none of the tests were positive. Discussion/Conclusions: Overall, the low-threshold OST clinic has been successfully implemented in order to help a vulnerable group of people navigate through a global pandemic and support the public health sector. Further conclusions on effects are limited by the short study period and the small number of patients, which calls for further research studies in a larger setting.

<b><i>Aims:</i></b> The aim of the study was to characterize e-cigarette users in terms of their consumption patterns, motives, and the perceived health benefits they experience from using e-cigarettes. <b><i>Design:</i></b> The study was a cross-sectional online survey in 2015. A total of 3,320 German e-cigarette users were enrolled. A total of 91.5% were former tobacco smokers, 7.5% used both e-cigarettes and tobacco products, 1.0% were never-smokers. <b><i>Results:</i></b> No differences were found between ex-smokers and dual users with regard to sociodemographic and smoking history (mean age 40.8 years, 81% men, 45% with a high school degree or above). Both groups had smoked 26.4 tobacco cigarettes a day for 22 years, had unsuccessfully tried to quit smoking using various other nicotine replacement products, and had used e-cigarettes for an average of 2 years. Ex-smokers consumed lower nicotine strength and more liquid per month, experienced more positive health changes, and had made vaping their hobby. Never-smokers were about 5 years younger, used liquid without nicotine and without tobacco flavor, and had no physical dependency. <b><i>Conclusions:</i></b> E-cigarettes were primarily used as an alternative to smoking and a substitute for nicotine. More dual users than ex-smokers used e-cigarettes in places where smoking is forbidden. Positive health changes were more pronounced in ex-smokers than dual users.

<b><i>Objectives:</i></b> Buprenorphine (BUP) is used in opioid maintenance treatment (OMT) for opioid-dependent patients. Previous real-world evidence suggests that many patients receive lower BUP dosage than recommended, with 38% of patients receiving &#x3c;6 mg BUP per day. The goal of this research is to evaluate the impact of BUP dosage on the risk of relapses in the real world. <b><i>Methods:</i></b> This study was based on German claims data of 4 million patients. Patients identified by International Classification of Diseases, 10th Edition F11.2 (opioid dependence) between 2011 and 2012 and at least one BUP prescription were selected for this study (<i>n</i> = 364) and followed up over 4 years. Patients were assigned to 6 dosage groups, with &#x3c;6 mg/day serving as low dosage/reference category. The impact of dosage on the occurrence of relapses (indicated by treatment interruption of &#x3e;3 months without OMT prescription or hospital admissions) was examined using multivariate logistic regression. Age, gender, comorbidities, fixed/variable dosing, and up-dosing were used as covariates. <b><i>Results:</i></b> Results showed a protective effect of higher BUP as higher BUP dosages were significantly associated with a lower risk of relapse. Using low dosage (&#x3c;6 mg/day) as the reference category, ORs were 0.40 (95% CI 0.19–0.87) at 6–&#x3c;8 mg/day, 0.28 (0.15–0.56) at 8–&#x3c;10 mg/day, 0.26 (0.10–0.67) at 10–&#x3c;12 mg/day, 0.40 (0.18–0.92) at 12–&#x3c;16 mg/day, and 0.18 (0.09–0.37) at ≥16 mg/day. No covariate showed a significant effect on the probability of relapse. <b><i>Conclusions:</i></b> The present study used a large German health claims dataset to confirm that higher BUP dosages are a protective factor for avoiding relapses in opioid-dependent patients, thus highlighting the importance of adequate BUP dosing in relapse prevention.

<b><i>Background:</i></b> Many studies have examined factors associated with the first onset of cannabis use and abuse. Currently, there is relatively little research regarding conditions under which cannabis dependence is more likely to emerge. Although previous studies have examined different potential determinants of cannabis dependence, to our knowledge, a systematic review is lacking. <b><i>Aims:</i></b> The study aims to identify recent findings regarding psychosocial determinants of cannabis dependence and to summarize them systematically. <b><i>Methods:</i></b> A literature search in 4 databases - Embase, Medline, PsycINFO and PSYNDEX - was conducted. Searches were limited to publications between 2000 and April 2014, English and German as languages and humans as study subjects. <b><i>Results:</i></b> Our search detected a total of 10,568 studies. Twenty-six studies finally met inclusion criteria. Consumption patterns such as a regular cannabis use independent of social context and an early onset of use (11-15 years) were correlates of cannabis dependence. Moreover, early reactions to cannabis use and coping-oriented use motives explained additional variance. Stress factors and critical life events such as parental separation and early parental death as well as mental and social conflicts have also been linked with development of cannabis dependence. Additionally, comorbid mental disorders correlated with cannabis dependence. <b><i>Conclusion:</i></b> Numerous factors were shown to have an impact on transition to cannabis dependence. In particular, a wide range of mental disorders has been linked to an elevated risk of becoming dependent. The development of a dependence syndrome seems to be associated with diverse processes, in which social, biological and intra-individual factors interact in a complex manner. Nevertheless, the link between cannabis dependence and predisposing factors could not be resolved convincingly by most studies due to methodological weaknesses regarding dependence criteria.

<b><i>Background:</i></b> Opioid maintenance treatment is the option of choice to stabilize opioid-dependent patients. Whilst efficacy of methadone and buprenorphine has been studied extensively, fewer data on slow-release oral morphine are available. <b><i>Aims:</i></b> This study analyzes the effects of slow-release oral morphine compared to methadone with regard to self-reported mental symptoms, drug use and satisfaction with treatment. <b><i>Methods:</i></b> The study was carried out as an open-label randomized crossover trial in 14 treatment sites in Switzerland and Germany. It comprised 2 crossover periods of 11 weeks each. For measuring mental symptoms, the Symptom Checklist-27 (SCL-27) was used. Drug and alcohol use was assessed by the number of consumption days, and treatment satisfaction by a visual analogue scale. <b><i>Results:</i></b> A total of 157 patients were included for the analyses (per-protocol sample). Statistically significantly better outcomes for morphine as compared to methadone treatment were found for overall severity of mental symptoms (SCL-27 Global Severity Index), as well as 5 of the 6 syndrome groups of the SCL-27, and for treatment satisfaction. There were no statistically significant differences with regard to drug or alcohol use between groups. <b><i>Conclusions:</i></b> This study supports positive effects of slow-release oral morphine compared to methadone on patient-reported outcomes such as mental symptoms and treatment satisfaction with comparable effects on concomitant drug use. Slow-release oral morphine represents a meaningful alternative to methadone for treatment of opioid dependence.

<span class="fett">Fragestellung:</span> Ziel der Studie war zu zeigen, ob sich bei einem Wechsel der in der Substitutionsbehandlung Opiatabhängiger eingesetzten Substanzen Levomethadon und d,l-Methadon das psychische Befinden und das Verlangen nach Drogen ändern. </p><p> <span class="fett">Methodik:</span> Es wurde eine stratifizierte, randomisierte 2×2-Cross-over-Studie doppelblind über 8 Wochen durchgeführt. Zu Beginn und nach 4 Wochen wurde die Studienmedikation umgestellt. </p><p> <span class="fett">Untersuchungsgruppe:</span> 75 Patienten, die sich seit mindestens einem Jahr in Substitutionsbehandlung befanden, wurden in die Studie eingeschlossen. Von 68 Patienten liegen vollständige Ergebnisse vor. </p><p> <span class="fett">Ergebnisse:</span> In keinem der Merkmale – psychische Befindlichkeit, depressive Verstimmungen, Ängstlichkeit, Drogenverlangen und Drogenkonsum – konnte ein mit der Umstellung des Substitutionsmittels zusammenhängender Effekt beobachtet werden. Kurzfristige, vorübergehende Befindlichkeitsschwankungen regulierten sich wieder auf einen Zustand, der vor Cross-over zu beobachten war. </p><p> <span class="fett">Schlussfolgerungen:</span> Levomethadon und d,l-Methadon können im entsprechenden Dosisverhältnis gleichberechtigt eingesetzt werden.

<B>Fragestellung:</B> Russischsprachige Drogenabhängige sind in Deutschland im Suchthilfesystem unterrepräsentiert, jedoch ihr Anteil an den Drogentoten ist aus bisher unerklärten Gründen überproportional gestiegen.</P><P> <B>Methode:</B> In einer Expertenbefragung wurden Interviews mit 10 Mitarbeitern des Drogenhilfesystems in Hamburg durchgeführt, um über die Situation der russischsprachigen Drogenabhängigen Erkenntnisse zu gewinnen und daraus Verbesserungsvorschläge für das Suchthilfesystem abzuleiten. </P><P> <B>Ergebnisse:</B> Zum Konsumverhalten werden Beobachtungen beschrieben, die die Vermutungen eines exzessiven Konsums bestätigen. Dabei ist vor allem der frühe Einstieg in den intravenösen Konsum alarmierend. Weiterhin ist der gemeinsame Gebrauch von Spritzen und anderen Utensilien als hohes Risiko für Infektionskrankheiten zu werten. </P><P> <B>Schlussfolgerungen:</B> Aus Expertensicht müssen Maßnahmen erfolgen, die zu einer verbesserten Information der Betroffenen, einem kultursensibleren Umgang des Hilfesystems und zu einer Prävention durch verbesserte Integration führen.

Smoking cocaine hydrochloride in the form of cocarettes is a method of cocaine use that has not been described in the scientific literature so far. Nonetheless it seems to be a somewhat common method of cocaine use in order to avoid the nasal irritation. Three case reports are presented in order to discuss the possibility.

<b><i>Background:</i></b> Quality of life (QOL) of patients in opioid substitution treatment (OST) is increasingly being addressed in research. However, no disease- or treatment-specific instrument is available to assess the QOL of this target population. The purpose of this project was to develop the first QOL instrument for OST patients. <b><i>Methods:</i></b> Focus groups with 60 OST patients were analyzed using thematic analysis to elicit key QOL themes as perceived by patients. Identified themes were developed into items and refined through pilot testing and cognitive debriefing. The resulting 82 items were tested in a large sample of OST patients (<i>n</i> = 577). Principal component analysis with varimax rotation was performed to explore a possible factor structure and reduce the number of items. Psychometric properties were assessed. <b><i>Results:</i></b> Factor analysis revealed 6 subscales accounting for 46.1% of the variance: Personal Development, Mental Distress, Social Contacts, Material Well-being, Opioid Substitution Treatment, and Discrimination. The 38-item instrument demonstrated good to acceptable internal consistency reliability for all subscales (Cronbach's alpha = 0.75–0.88), and good convergent and discriminant validity. <b><i>Conclusion:</i></b> The Opioid Substitution Treatment Quality of Life scale (OSTQOL) is a multidimensional instrument with low respondent and administrator burden. A thorough validation is needed to assess its validity.

Abstract Background Nonmedical prescription drug use (NMPDU) refers to the self-treatment of a medical condition using medication without a prescriber's authorization as well as use to achieve euphoric states. This article reports data from a cross-national investigation of NMPDU in five European Countries, with the aim to understand the prevalence and characteristics of those engaging in NMPDU across the EU. Methods A parallel series of self-administered, cross-sectional, general population surveys were conducted in 2014. Data were collected using multi-stage quota sampling and then weighted using General Exponential Model. A total of 22,070 non-institutionalized participants, aged 12 to 49 years, in 5 countries: Denmark, Germany, Great Britain, Spain, and Sweden. Lifetime and past-year nonmedical use of prescription medications such as stimulants, opioids, and sedatives were ascertained via a modified version of the World Health Organization's Composite International Diagnostic Interview. Information about how the medications were acquired for NMPDU were also collected from the respondent. Results Lifetime and past-year prevalence of nonmedical prescription drug use was estimated for opioids (13.5 and 5.0 %), sedatives (10.9 and 5.8 %), and stimulants (7.0 and 2.8 %). Germany exhibited the lowest levels of NMPDU, with Great Britain, Spain, and Sweden having the highest levels. Mental and sexual health risk factors were associated with an increased likelihood of past-year nonmedical prescription drug use. Among past-year users, about 32, 28, and 52 % of opioid, sedative, and stimulant nonmedical users, respectively, also consumed illicit drugs. Social sources (sharing by friends/family) were the most commonly endorsed methods of acquisition, ranging from 44 % (opioids) to 62 % (sedatives). Of interest is that Internet pharmacies were a common source of medications for opioids (4.1 %), stimulants (7.6 %), and sedatives (2.7 %). Conclusions Nonmedical prescription drug use was reported across the five EU countries we studied, with opioids and sedatives being the most prevalent classes of prescription psychotherapeutics. International collaborations are needed for continued monitoring and intervention efforts to target population subgroups at greatest risk for NMDU.

<span class="fett">Fragestellung:</span> Ziel dieser Studie war eine Bestätigung der Wirksamkeit einer diamorphingestützten Behandlung an einer größeren Stichprobe von Non-Responder in der Methadonsubstitution und unter Einbeziehungen einer zweiten Zielgruppe derzeit nicht in Behandlung befindlicher Opiatabhängiger (»Nicht-Erreichte«). </p><p> <span class="fett">Methodik:</span> In einer randomisierten Kontrollgruppenstudie wurden 1.015 Schwerstopiatabhängige – 487 Non-Responder aus der Methadonsubstitution (MS) und 528 Nicht-Erreichte (NE) – entweder mit Diamorphin (N=515) oder mit Methadon (N=500) über 12 Monate behandelt. </p><p> <span class="fett">Ergebnisse:</span> Die Haltequote war in der Diamorphingruppe (67,2 %) signifikant höher als in der Methadongruppe (40,0 %). In beiden Hauptzielkriterien erzielten Patienten in der Diamorphingruppe eine höhere Response als diejenigen in der Methadongruppe, ohne signifikanter Wechselwirkung mit den MS- und NE-Stratum. </p><p> <span class="fett">Schlussfolgerungen:</span> Die Ergebnisse dieser Studie bestätigen die Effektivität der diamorphingestützten Behandlung bei Non-Respondern der Methadonsubstitution. Die höhere Wirksamkeit bei nicht in Behandlung befindlichen Schwerstopiatabhängigen könnte genutzt werden, um diese Patienten in das Suchthilfesystem besser einzubinden.