While this supports provider concerns over an increase in antibiotic utilization, hospital CDI rates actually decreased by a mean of 5.5 nosocomial infections per 10,000 patient hours during the study period. Although some practitioners may feel some relief knowing that this study failed to find a CDI epidemic as the result of an overall protocol change, these results may be only one small piece in an overall concerning trend. Instead, it is important to recognize that there are more risks than just CDI with antibiotic exposure, risks that were not measured in this study. Subsequent studies should focus on rate of antibiotic use and the other risks that are involved with these mandated prescribing practices.Some of these include protonpump inhibitor exposure and poor compliance with the use of personal protective equipment.Healthcare facilities frequently implement new practices and staff educational procedures, which may have had an impact on the results and CDI rates.Although this study showed that rates of antibiotic administration increased explained by practice improvements and staff education. While the study was not designed to look at these effects, it provides hope that ongoing facility practices may be mitigating CDI risk despite increased antibiotic exposure. The use and abuse of stimulants has been increasing across the United States.Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt ,pots for cannabis plants in order to prioritize them in preventive and risk mitigation programs. Methods: We used the California State Emergency Department Database to obtain discharge information for 2011.
The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes. Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American and Black , followed by non-Hispanic White patients. The prevalence of SAT was 2.0% for ED visits by patients with a history of stimulant abuse, and 0.3% for ED visits without a history of stimulant abuse . The SATs were directly associated with stimulant abuse, younger age , and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients. Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention. [West J Emerg Med. 2022;23X–X.] cocaine use along with medical and non-medical amphetamine consumption. The risk, severity, and type of stimulant abuse have been shown to vary across different populations.1Various trends have been established in regard to different population demographics. For example, it has been shown that methampheta-mine is more prevalent in the western US, although this has been trending eastward.Cocaine and amphetamines have different mechanisms of action but similarly affect monoamine transporters.
Cocaine blocks the reuptake of neurotransmitters, while amphetamine releases more into the synapse.Therefore, when comparing the two drugs, methamphetamine affects dopamine balance in the brain for a longer period of time. This is one of the many factors that have led to the differential effects of these stimulants.In recent years, there has been an increase in overall prescriptions to college students, especially to those in academically stressful situations.Misuse of stimulants has been shown to cause multiple issues including tissue ischemia and long-term neurological changes. An apparent correlation has been observed between the increase in overall stimulant prescription to patients of varying ages and demographics and misuse of these stimulants, resulting in both physiological and neurological changes that could be prevented.Particularly, the neurological changes that result from stimulant abuse may increase their risk of suicide. Globally, suicide is the third leading cause of death in the 15-44 age group.6 Although a strong correlation between stimulant abuse induced neurological changes and suicide exists, various other factors contribute to the onset of suicidal thoughts. The rising concern with regard to impulsive suicidal thoughts, and their potential to claim lives, has spurred public health intervention efforts to provide support to these most vulnerable and at risk populations. Public health interventions in populations suffering from stimulant abuse can facilitate a reduction of suicide attempts in this demographic.Specific, targeted preventive efforts may reduce SAT in at-risk populations and help maintain mental and physiological health. An association between stimulant abuse and SAT has already been reported.We expanded on this work, accessing the 2011 State Emergency Department Database to determine which subgroups, if any, of stimulant-abuse populations are at increased risk of SAT. This subgroup analysis may inform targeted public health efforts focused on the most at-risk individuals. Analysis of over 10 million ED visits in California gave us insight into the relation between SAT and stimulant abuse in different patient populations.
Our findings cohere with previous findings and indicate that depressed or suicidal individuals are more likely to abuse stimulants and are increasingly susceptible to SAT. As the only modifiable risk factor in our study, stimulant abuse was more common in young and middle-aged, male, Native American, and Black patients with lower household income. We also found that stimulant abuse puts females at higher risk of SAT. The risk of SAT is prevalent across patient populations and increases with factors such as stimulant abuse.5 Not only does a SAT endanger the life of a vulnerable individual, it also psychologically affects the individual, families, communities, and society as a whole. The substantial impact that suicide has on the community necessitates public health intervention efforts to target high-risk populations. Young populations have been deemed increasingly at risk of suicide due to a variety of psychosocial stressors.Research stipulates that within these diverse, young populations,cannabis flood table females have proven to be the most vulnerable group.Suicide remains the second leading cause of death in individuals between the ages of 10- 34.Stimulant abuse contributes to the numerous stressors that young populations face.Public health prevention efforts within this demographic group may reduce the economic and human cost of suicide. The rising national trend in non-medical prescription stimulant abuse has allowed experts to discern the psychological factors that contribute to the start of recreational substance consumption.This work indicates that the initiation of abuse often follows discrete traumatic events.Therefore, the inefficiency of prescription medication as a coping mechanism may be attributed to these higher suicidal rates. A prominent correlation between lower median household income state quartile and increased stimulant abuse exists . Poor access to healthcare and high rates of depression in individuals of lower socioeconomic status contribute to psychological effects prompting non-medical stimulant abuse.Non-medical stimulant use has also been associated with other harmful habits including tobacco, alcohol, and other illicit drug use.Each of these habits has also been correlated to increased suicide risk, all of which may be contributing factors.Multi-variable analysis showed SAT is associated with stimulant abuse and younger age. One potential reason for this result may involve the absence of impulse control correlated with drug abuse.Meanwhile, the proportion of ED visits with associated stimulant abuse was higher in younger age groups. This pattern corroborates past research indicating increased non-medical stimulant use among college populations.Association of SAT with stimulant abuse , and higher prevalence of stimulant abuse in those who are younger in age indicates that young people should be targeted for active stimulant-abuse prevention and treatment interventions. We found a stronger association between SAT and stimulant abuse in females, in all age groups. Previous literature coheres with this finding. Gender differences in stimulants have been established both behaviorally and pharmacologically. Women have been known to undergo the telescoping effect, which stipulates that in the long term, females escalate from low-dose use to addiction faster than men.
The quicker increase in consumption rates has been attributed to hormonal fluctuations inherent with the menstrual cycle. This hormonal fluctuation has been shown to subject women to differential drug effects dependent on their menstrual phase.Women have been shown to be significantly more susceptible to physiological dependence, which is the most extreme classification of drug use in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. This is associated with an increase in extreme lifestyle changes attributable to drug administration and consumption.Suicide attempts are associated with Native American and White race. At the same time, stimulant abuse was more common in Native American, and to a lesser extent, White patients. This pattern indicates active stimulant-abuse prevention and treatment interventions could specifically reduce SAT in those racial groups. It has been well established in the literature that race plays a significant role in the type of substance being abused.The increased rate of cocaine abuse in Black populations has been attributed to distribution networks and the historic, structurally driven prevalence of cocaine in Black communities.White and Hispanic populations, on the other hand, have more commonly used amphetamines or are considered dual users of both stimulants.Interestingly, Asian/Pacific Islanders have also experienced a sharp increase in non-cocaine stimulant admissions to treatment centers.We were not able to differentiate the exact type of the stimulant in this study.During the research and writing of this paper, I had the opportunity to read and hear from other contributors to this volume reporting on other western states. I have been struck by the contrasts between the situation in Montana and that of other states, most notably New Mexico. The political situation in Montana is moving in the opposite direction of New Mexico. In November 2020, Montana experienced a political tsunami. After 16 years of mostly Republican controlled legislatures and a moderate Democratic governor, Republicans won solid control of both houses and the election of a “Make America Great Again” Republican Greg Gianforte. In sharp contrast to New Mexico, where at least in some instances progressive Ds defeated incumbent moderates in primaries, in Montana the trend curved in the opposite direction, with extreme right-wing candidates defeating a number of moderate Rs. The Rs swept all the races for statewide offices. At the national level, our one House member is a far-right Republican, and so is one of our senators. Trump carried the state by over 16 points. Montana has finally turned red and few if any seasoned hands anticipate this changing any time soon. Republicans hold 67 of 100 House seats and 31 of 50 Senate seats. This is the most lopsided Republican legislative majority since 1931.It is important to point out for readers not familiar with Montana politics of the significant changes in the state’s political landscape born of the 2020 electoral results. Montanans had grown accustomed to Republicans proposing far-right legislation but what legislation passed, or passed and survived the Democratic governor’s veto, was significantly tempered over the course of the previous 16 years. In the years previous to that, when Republicans held both the governor’s office and legislative majorities in one or both houses, the Montana Republican Party was different: it was much more heterodox. While it contained far-right voices, it also contained a number of moderate voices who often voted with Democrats to pass or stymy legislation favored by more right leaning Republicans. During the 2019 session, the “solutions caucus” was composed of 20 Republicans in the House and 10 in the Senate. We can get a view into the tone of Montana’s hard right turn from a story that garnered high media coverage in November 2021. Rep. Derek Skees, a prominent Republican, currently expected to run soon for the Public Service Commission, referred to the Montana State Constitution as a “socialist rag” that should be thrown out and replaced. The source of his ire was his accusation that state courts use it to defend a women’s right to choose, but I suspect the sources of his wrath run to other constitutional provisions as well. Journalist Eric Dietrich reported that “Spokespeople for the Legislature’s Republican majority leadership, Gov.