One study was excluded from the depression meta-analysis because it assessed aggregate data on crashes, crash deaths, and depression. Effect estimates showed some heterogeneity , hence a random effects model was used. A funnel plot from the six studies did not indicate any major publication bias. Pooled data from the six studies indicate that depression nearly doubles the risk of involvement in a car crash .Two studies , Rapoport et. al were excluded from the antidepressant use meta-analysis because event data could not be extracted. Effect estimates showed some heterogeneity , hence a random effects model was used. The random effects and the fixed effects model estimates were close.Pooled data from the eight studies show that antidepressant use may increase the risk of car crash involvement by 40% .Depression and antidepressants have mental and physical effects with the potential to adversely affect the ability to operate a motor vehicle. Depression, in addition to psychomotor retardation, is often associated with suicidal ideation and intent, increasing the potential for both unintentional and self-harm related motor vehicle crashes . The studies reviewed, conducted mainly in developed countries, found associations between depression and crashes. Though estimates are hampered by the variation in study population and study design, depression was generally found to approximately double the risk of crash risk. Antidepressants have numerous side effects that include drowsiness, hypotension, suicidal ideation, dizziness,rolling benches canada decreased seizure threshold, nausea, and anxiety. These may individually and combined have the potential to interfere with driving abilities. Studies of the effects of antidepressants as a class and driving found a modest increase in crash risk, with OR ranging from 1.19 to 1.90 for crashes, and 3.19 for fatal crashes.
The effect varied by type of antidepressant, with significant variation between studies, but averaged about 1.4 times the crash risk in meta-analysis. Antidepressants have potentially conflicting contributions to motor vehicle crashes in relieving the effects of depression and suicide while posing side effects that may affect driving. While the benefits of antidepressants outweigh their potential risks, prospective studies are needed to better understand the risk of antidepressants and depression on motor vehicle crashes. Of the seven studies included in this analysis assessing the effects of depression, only three included information on antidepressants. However, no comparison of depression scores, medications use, and crash risk in given individuals was reported. Equally, the studies of the effects of antidepressants did not assess the current or past levels of depression. Future studies are needed to control for these interactions. In addition to the effects of the drugs when taken alone, antidepressants can interact with numerous classes of medications primarily due to their inhibition of metablism of other drugs that are cleared through the cytochrome P-450 system of enzymes. Drug interactions may be especially important in impairing attention and cognition when antidepressants are combined with drugs that also have sedative properties, such as benzodiazepines and tricyclic antidepressants . Among antidepressants and their active metabolites, norfluoxetine and fluvoxamine have significant inhibitory effects on CYP 3A4 isoenzyme, which is the most abundant CYP enzyme found in the human body . Fluoxetine and fluvoxamine have been reported to reduce metabolism of multiple drugs, specifically the triazolobenzodiazepines . By blocking the metabolism of these benzodiazepines, the serum concentrations of the benzodiazepines may increase and have increased side effects . It should be recognized that although in vitro affinities of antidepressants for the respective isoenzymes can be very helpful for predicting potentially dangerous drug combinations, there is wide variability between patients and their susceptibility for these interactions. Much of this variability can be attributed to genetic polymorphisms. The strengths of this review include that 17 of the studies reported used large population-based databases, and 14 included detailed crash analysis, increasing the validity of their findings. Also included were studies from across a number of developed countries, with well designed studies that met the inclusion criteria.
The studies included in this review have several limitations. The criteria for determination of depression ranged from self-report to claims-based diagnostic codes. In determining the effects of depression and antidepressants, it is difficult to distinguish effects of depression from effects of drugs. The distinction is hampered by the retrospective methodology of the majority of the studies. Additionally, antidepressants are often prescribed with other psychotropic medications, increasing the potential for crashes due to both drugs, as has been demonstrated in several studies . Due to the limitation of these studies, the extent to which antidepressants mitigate the effects of depression remains unknown. However, the larger association of depression with crash risk, vs. the use of antidepressants, suggests that treatment of depression is likely to reduce the risk. In the management of depression the risk-benefit ratio fo treatment should be considered, as well as the side effect profile when medications are being considered.Cocaine popularity in the United States has rebounded in the past 5 years after many years of decline. Annual deaths by cocaine increased 200% from 2012 to 2017, making cocaine the leading non-opioid cause of drug overdose death in the US. At the same time, cocaine’s user base has expanded with more people trying cocaine for the first time. From 2012 to 2017, the number of people using cocaine for the first time in the past year increased by 57%. In 2017, 6.2% of people in the US aged 18–25 reported using cocaine in the past year, compared to 0.6% for heroin. Historically, patterns of cocaine use differed from those of other illicit drugs in that cocaine has been used almost exclusively in social settings, especially to indicate high social status. Cocaine possesses the unique reputation of being the “rich man’s speed,” a symbol of affluence flouted by celebrities and artists and the object of aspiration for others. The glamorization of cocaine’s bodily effects and an underestimation of its dangers likely also influenced public perception of cocaine. A 1977 Newsweek story on cocaine reported “Among hostesses in the smart sets of Los Angeles and New York, a little cocaine, like Dom Perignon and Beluga caviar, is now de rigueur at dinners”. Although the impression of cocaine is that it gives the user strength and vigor, its actual use is harmful.
In a study ranking the danger of drugs, cocaine received the highest harm ratings and notably scored highest in the “social harm” category. Furthermore, epidemiological evidence on cocaine has shown it to be a highly addictive and widely abused drug specifically among young people .Its attractiveness among the public has been arbitrated by popular media, including coverage of celebrity drug activities associating the drug with high society. In these ways, references to cocaine in the media and popular culture portrayed real-world behaviors of cocaine use. There is reason to believe that popular culture today is again capturing real-world trends around a renewed interest in cocaine. Although cocaine’s reputation waned during the 1980s War on Drugs government crackdown, other forms of popular media such as the music industry continue to relay information about cocaine. Major artists today frequently mention cocaine and other drugs extensively in their songs,flood table particularly in the context of glamour, wealth, and sociability. For instance, studies analyzing popular music and videos have found drugs to be a dominant theme with one study reporting that 33.3% of top-charting songs portrayed substance use with an average of 32.5 drug references per hour. Considering that 90 percent of Americans regularly listen to music with an average listening time of 32.1 h per week, this means Americans on average are exposed to 54 explicit references to drugs every day. A growing body of research supports that drug mentions in popular media may be linked with substance use, including for smoking, alcohol, and cannabis. A qualitative study found that an underground form of hip-hop music called “screw” is a strong reinforcer of codeine syrup use; respondents named “media modeling” as the foremost reason for the popularity for syrup usage. A content analysis of another genre of music, popular country music, found that lyrics were more likely to describe women in association with alcohol use and sex in the 2010’s compared to earlier decades, confirming the known association between alcohol use and sexual assault in this genre. However, the majority of these studies on substance use in song lyrics have been descriptive and limited in the scope of songs analyzed. For instance, Primack et al.conducted a content analysis of 279 songs for drug-related content in the single year of 2005 to determine degree of drug exposure for music listeners. Hall, West, and Neeley analyzed time trends of alcohol, tobacco, and other drugs in 1100 songs over 50 years, an average of only 22 songs per year. Herd performed a qualitative analysis of the social context surrounding 341 rap songs. While these studies describe important findings regarding drug exposure in song lyrics, trends over time, and qualitative content analysis, none were specific to cocaine nor quantified the effect size of drug exposure in song lyrics with drug use behavior. Additionally, all studies compiled song titles from ranked lists, most commonly the Billboard Top-100, thereby skipping over thousands of popular songs that did not make the list.
Given cocaine’s fashionable reputation and highly social patterns of use, descriptions of cocaine in music are potentially an indication of increased cocaine initiation and use. However, the epidemiological trends between popular media and cocaine have yet to be studied empirically. This study investigated the relationship between prevalence of drug mentions in music lyrics and epidemiological trends for cocaine. We sought to offer insights on the recent rise in cocaine use incidence and cocaine overdose mortality observed during the first decades of the 21st century with respect to the influence of contemporary music trends on population-based health behaviors.Our study explores the ability of song lyrics to signal epidemiological trends in incidence and mortality of cocaine use. specifically, our results found that an increase in cocaine mentions in song lyrics is associated with increased incidence of cocaine use in the same year and death by cocaine 2 years later. The temporal relationship between cocaine lyrics and incidence of cocaine use and related deaths was confirmed with significant cross correlation in the same year for cocaine use and 2 years for cocaine overdose mortality. The lead time period of 2 years found in this study between lyrics mentioning cocaine and incidence of cocaine and cocaine overdose mortality is supported by epidemiological evidence that the time between initiation of cocaine use and seeking help for addiction is between 1 and 3 years. Musical trends that depict cocaine in lyrics may be an early signal of a rising interest and use of cocaine in the same year. The lag-time period of 2 years between cocaine lyrics and cocaine mortality may indicate that there is an incubation period of 2 years between addiction and fatality. Treatment intervention is critical in this time period to prevent the onset of drug dependence and death. Our results also provide insights into the pathways by which media may influence cocaine use behaviors. In addition to being a measurement tool to estimate cocaine epidemiology, media itself can influence public perceptions of drug use and lead to increased drug use at the population level. Therefore, music about cocaine may not only provide an early signal of cocaine-related behaviors, but it could also act as an exposure that encourages the use of cocaine. Our study did not test the potential dynamic and cyclical relationship between cocaine lyrics and patterns of cocaine use. While cocaine mortality did not appear to estimate future cocaine mentions in song lyrics, further investigation into the influence of cocaine use on song lyrics is warranted. Our study showed growth in slang terminology such as “kilo”, “yayo”, “coco”, and “baking soda” instead of more explicit terms for cocaine such as “coke” and “cocaine” used in older song lyrics. These results may indicate that the current generation has inherited an attachment to cocaine expressed through the development of new slang terms for cocaine. Evidence of this shifting use of cocaine by younger generations is provided by a 2018 United Nations study reporting that settings of cocaine use have branched out from exclusive clubs to include more accessible environments including college parties, concerts, and bars. Furthermore, in the past decade, first time users of cocaine have moved from high income areas to lower income and under resourced neighborhoods.