Regulatory Pathways to Promote Treatment for Substance Use Disorder or Other Under-Treated Conditions Using Risk Adjustment

2018 ◽  
Vol 46 (4) ◽  
pp. 935-939
Author(s):  
Matthew J.B. Lawrence
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Risk Adjustment ◽  
Legal Analysis ◽  
Regulatory Pathways ◽  
Administrative Process ◽  
Part C ◽  
Federal Laws ◽  
The Individual ◽  
Almost All

This commentary provides a legal analysis of the extent to which changes proposed by scholars to promote care for substance use disorder or other under-treated illnesses through risk adjustment could be implemented administratively, without legislation, in federal risk adjustment systems: Medicare's privatized component, Medicare's pharmaceutical component, and the individual and small group market. As the article explains, federal laws governing risk adjustment provide broad discretion to regulators and can reasonably be interpreted to permit (or in the case of Part C even compel) full and final implementation through the administrative process of almost all of the changes that scholars have proposed.

ADHD and substance misuse

2018 ◽  
Author(s):  
Timothy Wilens ◽  
Nicholas Carrellas ◽  
Joseph Biederman
Keyword(s):  
Substance Use ◽  
Cigarette Smoking ◽  
Substance Use Disorder ◽  
Extended Release ◽  
Substance Misuse ◽  
Genetic Factors ◽  
Elevated Risk ◽  
Adhd Treatment ◽  
Stimulant Medications ◽  
The Individual

There has been great interest in the overlap between ADHD and substance use disorder (SUD). ADHD is a common neurobehavioural disorder of childhood that places the individual at elevated risk for later SUD. Studies have shown that 25–40% of adults and adolescents with SUD have ADHD. Although the exact link between the two disorders is still unclear, it appears their connection is complex, and involves the interplay between various biological, behavioural, and genetic factors. Early pharmacotherapy of ADHD does not increase SUD, and, in fact, appears to reduce cigarette smoking and SUD. In individuals with ADHD and SUD, stabilization of SUD is recommended initially, with consideration of adjunct non-stimulant and extended release stimulant medications. More research on the mechanisms of overlap between the disorders, preventative effects of early ADHD treatment on SUD, and concurrent treatments for ADHD and SUD are necessary.

scholarly journals Simulated Legal Phenomena in the System of Principles of the Administrative Process

2021 ◽  
Vol 18 (2) ◽  
pp. 175-191
Author(s):  
D. A. Kirillov
Keyword(s):  
Russian Federation ◽  
Criminal Responsibility ◽  
Presumption Of Innocence ◽  
Legal Analysis ◽  
Negative Consequences ◽  
Administrative Process ◽  
The Russian Federation ◽  
The Individual ◽  
The Right ◽  
Principle Of Legality

With the inclusion of the category “simulation” in the Code of the Russian Federation on Administrative Offences an interest arose in studying “simulation” in the system of principles of the administrative process. The purpose of the study is to formulate general recommendations for neutralizing the negative consequences of manifestations of feign in the system of principles of the administrative process. The methodological basis of the research is materialistic dialectics and elements of conceptual analysis. The methods of analogy and generalization allow us to justify the use of the construction of “simulated legal phenomenon” for the study of the principles of the administrative process. The survey revealed obstacles to the implementation of certain aspects of the presumption of innocence. The comparative legal analysis allows us to establish the comparability of the volumes of state repression in the measures of administrative and criminal responsibility, a clearly negative assessment of simulation in administrative law compared to its neutral assessment in civil law, to identify a number of obstacles to the functioning of the principles of the administrative process. Other standard research methods are also used. The expediency of analyzing the simulation of the system of principles of the administrative process is justified; a simplified model of the system of principles of the administrative process is used for the analysis; from the standpoint of assessing legal simulation, the analysis of the principle of legality, the principle of procedural equality, the principle of guilt, the principle of presumption of innocence, as well as the principle of respect for the honor and dignity of the individual was carried out. In order to reduce the level of obvious simulation in the system of principles of the administrative process, in particular, it is recommended: in the doctrine of the administrative process to consider the principle of legality not as a reality, but as a goal; in the laws, replace the term “legality” with the term “lawfulness”; in the laws, the wording “the principle of equality before the law” and the like should be replaced with “the principle of equality of rights”; part 1 of Article 1.5 of the Code of the Russian Federation on Administrative Offences should be amended as follows: “a person is subject to administrative responsibility only for those socially harmful actions (acts of inaction) in respect of which his guilt is established”; part 3 of Article 1.5 of the Code of the Russian Federation on Administrative Offences after the words: “...is not obliged to prove his innocence” should be supplemented with the words “but has the right to disagree with all or part of the arguments confirming his guilt, or to refute them”. It is also recommended to amend the legislation in order to unify the approach to the differentiation of administrative offenses and crimes.

scholarly journals Clinical Audit of Gabapentin use in a Mental Health Hospital in Qatar

2018 ◽  
Author(s):  
Nervana Elbakary ◽  
Hazem Hashem
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Drug Users ◽  
Off Label ◽  
Wide Range ◽  
Potential Abuse ◽  
History Of ◽  
Almost All ◽  
To Receive ◽  
Mental Health Hospital

Bakground: Gabapentin was approved by FDA for the treatment of epilepsy, and as an analgesic for post-herpetic neuralgia (PHN). Gabapentin has been prescribed off-label for a wide range of disorders. Off-label use of gabapentin has been estimated to range from 83 to 95% of all its use. In the last few years, gabapentin has been becoming dispensed extensively for appropriate and inappropriate uses; meanwhile, drug-monitoring agencies have warned for potential abuse liabilities associated with gabapentin. The principal population at risk for addiction consists of patients with history of substance use disorders (SUD), mostly pregabalin and opioids. Purpose: To audit the appropriate use of gabapentin among a cohort of drug users, followed by subgroup analysis to determine the likelihood of drug abuse, misuse and/or diversion. Results: A total of 76 patients were included in the study. 99% of candidates used Gabapentin for off label indications, 30% for managing of behavioral symptoms related to dementia (BPSD). 27%, of the cohort used the medication had a confirmed history of substance-use disorder (SUD). One patient found to receive an inappropriate dose with regard to Creatine clearance Crcl. Conclusion: The data analysis has revealed that almost all gabapentin use in this setting was for off-label indications. Without placing limitations on the prescribing of this medication, it is expected that misuse of it by patients will continue to upsurge. This study highlights the need to standardize a hospital protocol for Gabapentin use within this facility, especially among patients with a history of substance- use disorder.

Substance Use Disorder Related to Kratom (Mitragyna speciosa) Use in Malaysia

2019 ◽  
Vol 8 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Darshan Singh ◽  
Mohammad F.I.L. Abdullah ◽  
Balasingam K. Vicknasingam ◽  
Christian P. Müller
Keyword(s):  
Substance Use ◽  
Secondary Education ◽  
Substance Use Disorder ◽  
Withdrawal Symptoms ◽  
Chi Square ◽  
Mini International Neuropsychiatric Interview ◽  
Mitragyna Speciosa ◽  
Dependence Scale ◽  
Chi Square Analysis ◽  
Almost All

Background: Kratom is a traditional medicinal herb with mild addictive properties. Nevertheless, current available data on substance use disorder related to kratom use is scarce. This study aims to clinically evaluate and identify factors that are associated with kratom use disorder among regular kratom tea/juice users in traditional settings in Malaysia. </P><P> Method: 150 regular kratom users were recruited through convenient sampling for this crosssectional study. They were interviewed with Mini International Neuropsychiatric Interview (M.I.N.I.) to diagnose substance use disorder related to kratom use, while the Ketum Dependence Scale (KDS) and Clinical Opioid Withdrawal Scale (COWS) were administered to evaluate kratom dependence and withdrawal severity. Results: All subjects were males with the majority being Malays (99%, n=148/150). More than half were single (n=84/150), had secondary education (91%, n=136/150), and were employed (93%, n=139/150). Almost all (99%) fulfilled the criteria for substance use disorder related to kratom use, 95% reported withdrawal symptoms on abstinence, 87% reported tolerance, and 93% craving for kratom. Results from Chi-square analysis indicated that higher quantity (>3 glasses) of daily kratom tea/juice consumption was significantly associated with severe kratom dependence (OR: 2.1: 1.0-4.5: p<.041) and moderate withdrawal (OR: 3.1: 1.5-6.3: p<.002). Similarly, those who consumed >3 glasses of brewed kratom tea daily had higher odds of reporting longer kratom use history (>7 years) (OR: 4.4: 2.2-8.8: p<.001) and higher frequency of daily kratom use (>5 times) (p<.001), compared to those who consumed less than three glasses of kratom daily. Conclusion: Our findings indicated that regular and chronic (>3 glasses daily) kratom tea/juice consumption was associated with kratom use disorder, severe kratom dependence and moderate withdrawal.

Needs of Spouses of Patients with Substance Use Disorder: A Qualitative Study

2021 ◽  
Author(s):  
Shiva Soraya ◽  
Mandana Haghshenas ◽  
Hamid Reza Ahmadkhaniha ◽  
Somayeh Azarnik ◽  
Hossein MansourKiaei ◽  
...  
Keyword(s):  
Substance Use ◽  
Qualitative Study ◽  
Social Services ◽  
Substance Use Disorder ◽  
Substance Dependence ◽  
Wide Spectrum ◽  
Family Members ◽  
Purposeful Sampling ◽  
The Individual ◽  
Initial Interviews

Background: The skill of adjusting and regulating the needs and adaptation are the most fundamental abilities of family members. Since substance use related disorders create serious health threats and cost burdens for family, it is important to investigate the needs of spouses of these patients. Regarding the wide spectrum of needs based on previous researches, the psychiatric needs were the focus in this study. By evaluating the needs, the executives of social services can better determine the basic needs of patients and their family members. Methods: This is a qualitative study applying a content analysis approach. Based on the objectives of this research, purposeful sampling was done and continued until information saturation. In total, 16 spouses of patients using substance were interviewed. Initial interviews began with guiding questions and the probing questions were applied in the following interviews. Participants’ emotions were coded and codes with similar concepts were placed together in one category and subcategories were created. Results: After conducting 16 in-depth interviews, 38 initial codes were obtained and categorized into 6 key concepts (Neglecting the reciprocal roles and rights, lack of responsibility, lack of motivation, psychiatric changes due to substance use, feelings of insecurity, and defective communication). Conclusion: The present study paves the way in better understanding of the needs of the spouses of patients with substance use disorder, and enables the specialists in this area to adjust the treatment according to each individual patient and evaluate emerging patient related issues and challenges as well. Substance dependence, in addition to making problems for the individual and the society, leads to unsatisfied needs of close family members and acquaintances. In other words, treatment will be more effective if each patient is recognized individually, the family is educated, and family-level interventions are provided.

scholarly journals Lateral Preoptic Area Neurons Signal Cocaine Self-Administration Behaviors

2021 ◽  
Author(s):  
Kevin R Coffey ◽  
Vaishnavi Venkat ◽  
Mark West ◽  
David Barker
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Preoptic Area ◽  
Operant Response ◽  
Discrete Elements ◽  
Self Administration ◽  
Drug Seeking ◽  
The Face ◽  
Highly Correlated ◽  
The Individual

The lateral preoptic area is implicated in numerous aspects of substance use disorder. In particular, the lateral preoptic area is highly sensitive to the pharmacological properties of psychomotor stimulants, and its activity promotes drug-seeking in the face of punishment and reinstatement during abstinence. Despite the lateral preoptic areas complicity in substance use disorder, how precisely lateral preoptic area neurons encode the individual components of drug self-administration has not been ascertained. To bridge this gap, we examined how the firing of single lateral preoptic area neurons correlates with three discrete elements of cocaine self-administration: 1) drug-seeking (pre-response), 2) drug-taking (response), and 3) receipt of the cocaine infusion. A significant subset of lateral preoptic area neurons responded to each component with a mix of increases and decreases in firing-rate. A majority of these neurons encoded the operant response with increases in spiking, though responses during the drug-seeking, taking, and reciept windows were highly correlated.

scholarly journals Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Lauren A. Magee ◽  
J. Dennis Fortenberry ◽  
Marc Rosenman ◽  
Matthew C. Aalsma ◽  
Sami Gharbi ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Justice System ◽  
Clinical Care ◽  
Data Systems ◽  
Individual Level ◽  
Clinical Diagnoses ◽  
The Individual ◽  
Health Diagnosis

Abstract Background Individuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention. Methods We linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes. Results Of those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest. Conclusions Our findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.

scholarly journals "I can't live like that": The experience of caregiver stress of caring for a relative with substance use disorder

2021 ◽  
Author(s):  
Geoffrey Maina ◽  
Marcella Ogenchuk ◽  
Taryn Phaneuf ◽  
Abukari Kwame
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Behavioral Problems ◽  
Self Care ◽  
Health Impact ◽  
Physical And Mental Health ◽  
Individual Interviews ◽  
Specific Care ◽  
The Individual ◽  
The Impact

Abstract Background: The impact of addiction extends beyond the individual using a substance. Caring for an individual with addiction creates persistent stressful circumstances that cause worry, anger, depression, shame, guilt, anxiety, and behavioral problems within the family unit.The aim of the study: The paper aims to explore the experiences of caring for a relative with a substance use disorder (SUD) and self-care strategies caregivers employ.Methods: The study adopted an exploratory qualitative design. To be included in the study, participants were required to have a relative with a (SUD) disorder and not be actively using the substance themselves. Individual interviews were conducted to gather their experiences, meanings, and how they made sense of caring for a relative with a SUD.Results: 21 Participants were involved in the study, of which 17 were women, and four were men of which there had a sister, four had a brother, eight had a parent, six had a dependent, and one participant had a grandparent with a SUD. Four themes, whose overarching focus is the pains of living and caring for a family with a SUD, caused the participants and how the participants mitigated these experiences.Conclusion: The stress associated with caring for individuals with a SUD impacts the caregiver's physical and mental health. Specific care modalities targeting caregivers need to be developed to address the health impact and to support self-care.

Sign in / Sign up

Export Citation Format

Share Document