| Abstract | Cilj: Utvrditi prevalenciju i distribuciju sredstava ovisnosti u pacijenata čiji su biološki uzorci krvi i urina testirani u Zavodu za medicinsku laboratorijsku dijagnostiku Kliničkoga bolničkog centra Split u od 1. 1. 2015. do 31. 12. 2022. godine.
Metode: Rezultati probirnih testova na kokain, kanabinoide, opijate, benzodiazepine, amfetamine i metadon iz uzoraka urina te rezultati analize koncentracije alkohola u uzorku seruma/plazme retrospektivno su prikupljeni iz baze laboratorijskoga informatizacijskog sustava BioNet u Zavodu za medicinsko laboratorijsku dijagnostiku KBC-a Split. Podatci su uključivali rezultate testova svih punoljetnih pacijenata testiranih od 2015. do 2022. godine, vrijeme testiranje te spol i dob pacijenata. Analiziran je ukupni broj testova u odnosu na vrstu sredstava ovisnosti te u odnosu na svaku godinu. Izračunan je udio pojedinih sredstava ovisnosti u odnosu na ukupni broj pozitivnih testova te je za svako sredstvo ovisnosti izračunan udio pozitivnih testova ukupno i ovisno o spolu i dobi ispitanika, kao i deskriptivni statistički pokazatelji demografskih obilježja testiranih i pozitivnih osoba. Koncentracija alkohola razmatrana je u odnosu na kategorije djelovanja alkohola ovisno o unesenoj količini. Logističkom regresijom analiziran je utjecaj spola i dobi kao prediktora za pozitivni rezultat probirnih testova, dok je za koncentraciju alkohola primijenjena linearna regresija.
Rezultati: U razmatanome razdoblju provedene je 33 584 analiza, pri čemu se najviše analiza odnosilo na alkohol (n = 9503, 28 %), dok su ostala sredstva ovisnosti imala udio u prosjeku od oko 12 %. Od 2015. do 2022. godine ukupni broj analiza po godini porastao je s 3251 na 5612, odnosno za 73 %. Alkohol (n = 5 096; 58,5 %) i benzodiazepini (n = 1859; 21,3 %) imali su najveći udio u ukupnome broju pozitivnih testova, dok su kanabinoidi bili najčešće nedopušteno sredstvo ovisnosti (n = 771; 8,9 %). Amfetamini su činili udio od 3,8 %, a opijati, metadon i kokain imali su udio od po 2,5 %. Gledajući udio pozitivne testove unutar svake kategorije sredstva ovisnosti, najviše je bilo pozitivnih pacijenata na benzodiazepine (44,7 %) i kanabinoide (19,1 %), dok je manji udio pozitivnih zabilježen za amfetamine (8,4 %), kokain (5,6 %), metadon (5,6 %) i opijate (5,2 %). Ukupno je 53,6 % osoba bilo pozitivno na alkohol, pri čemu su pozitivne osobe bili u prosjeku u pijanome stanju s koncentracijom alkohola od 1,97 g/kg (SD = 1,15). Logistička regresija pokazala je da spol i dob imaju statistički značajan učinak na rezultate testiranja (P < 0,001). Za sva razmatrana sredstva ovisnosti izgledi za
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pozitivan rezultat testa bili su manji u žena (od oko 2,3 % za opijate do čak 71 % za metadon). Veći izgledi za pozitivan rezultat s porastom dobi zabilježeni su samo za benzodiazepine (oko2,5 %), dok su se za ostala sredstva ovisnosti izgledi za pozitivan rezultat testa smanjivali s porastom dobi (od oko 49,3 % za amfetamine do oko 96,7 % za metadon). Linearna regresija pokazala je da je koncentracija alkohola manja u žena (β = -4,415) te da opada s povećanjem dobi (β = -0,051).
Zaključci: Porast broja provedenih testova vjerojatno je posljedica prepoznavanja važnosti ovih analiza u kliničara. Najviše pozitivnih rezultata zabilježeno je za najdostupnija i legalna sredstva – alkohol i benzodiazepine, no razmjerno velik udio pozitivnih na benzodiazepine upućuje na potrebu strožega praćenja propisivanja i konzumiranja takvih lijekova. Među nedopuštenim sredstvima ovisnosti prevladavaju kanabinoidi, vjerojatno zbog najšire dostupnosti, kao i percepcije o manjoj štetnosti navedenih sredstava. Manji udio stimulansa vjerojatno je posljedica činjenice da se češće rabe kao rekreativne droge te u kontekstu društvenih događanja. Udio pozitivnih testova, kao i dobna razdioba rezultata, upućuju na to da je potrebno kontinuirano praćenje upotrebe sredstava ovisnosti prikupljanjem i analizom podataka dobivenih koristeći se različitim metodologijama te objavljivanje sveobuhvatnih izvješća o konzumaciji među različitim dobnim skupinama. To bi trebalo pridonijeti poboljšanju i usmjeravanju javnozdravstvenih akcija na najizloženije skupine, a sve radi postizanja smanjenja štetnih učinaka konzumacije sredstava ovisnosti. |
| Abstract (english) | Aim:
To examine the prevalence and distribution of drugs of abuse in patients whose biological
samples of blood and urine were tested at the Medical Laboratory Diagnostic Division of the
University Hospital Center Split Split, Croatia ) from January 1, 2015, to December 31,
Methods:
We retrospectively collected screening test results for cocaine, cannabinoid, opiate,
benzodiazepine, amphetamine and methadone from urine samples and the results of the
analysis of alcohol concentration in the serum/plasma sample s from the BioNet laboratory
database of the Medical Laboratory Diagnostic Division (UHC Split ). The data inclu ded the
test ing results of all adult patients tested from 2015 to 2022, the testing date , and the sex and
age of the patients. The total number of tests was analyzed according to the type of drug of
abuse and year. We calculated the proportions of drugs of abuse considering the total number
of positive tests and the proportion of positive tests in each drug category ( in total and
depending on the sex and age of the patients). We also calculated descriptive statistics of
demographic characteristics for teste d and positive patients. The concentration of alcohol was
considered according to the categories of alcohol effects depending on the amount ingested.
Logistic regression was used to analyze the effect of sex and age as predictors for a positive
screening test result, while linear regression was used for alcohol concentration.Results
: During the considered period, a total of 33,584 analyses were conducted, with most
analyses being related to alcohol (n = 9,503, 28%), while other addictive substances had an
average proportion of about 12%. From 2015 to 2022, the total number of analyses per year
increased from 3,251 to 5,612 73% increase)increase). Alcohol (n = 5,096; 5 8.5 %) and benzodiazepines
(n = 1,859; 21.3 %) had the highest share in the total number of positive tests, while
cannabinoids were the most frequently detected illicit substance (n = 771; 8.8 The
proportion of a mphetamines in positive test results was 3.8 %, while the proportion of opioids,
methadone, and cocaine was 2.5% each . Considering the proportion of positive test results
within each category of substances, the highest number of positive patients were detected for
benzodiazepines (44.7%) and cannabinoids (19.1%), with a lower proportion of positives
observed for amphetamines (8.4%), cocaine (5.6%), methadone (5.6%), and op ioids (5.2%). In
total, 53.6% of individuals tested positive for alcohol, with positive individuals being on
average in an intoxicated state with an alcohol concentration of 1.97 g/kg (SD = 1.15). Logistic
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regression revealed that
regression revealed that sexsex and age and age statisticalstatistically impactly impact the testing results (the testing results (PP < 0.001). For all < 0.001). For all considered substances, the odds of a positive test result were lower in females (ranging from considered substances, the odds of a positive test result were lower in females (ranging from about 2.3% for opioids to as high as 71% for methadone). Higher odds of a positive result with about 2.3% for opioids to as high as 71% for methadone). Higher odds of a positive result with increasing age wincreasing age were only observed for benzodiazepines (around 2.5%), while for other addictive ere only observed for benzodiazepines (around 2.5%), while for other addictive substances, the odds of a positive test result decreased with age (from approximately 49.3% for substances, the odds of a positive test result decreased with age (from approximately 49.3% for amphetamines to about 96.7% for methadonamphetamines to about 96.7% for methadonee). Linear regression indicated that alco). Linear regression indicated that alcohol hol concentration is lower in females (concentration is lower in females (β = β = --4.415) 4.415) and decreases with increasing age (and decreases with increasing age (β = β = --0.051).0.051).Conclusions:
The increase d number of conducted tests was likely a result of clinicians
recognizing the importance of these analyses. The highest number of po sitive results was
recorded for the most accessible and legal substances alcohol and benzodiazepines. However,
a relatively high proportion of positive results for benzodiazepines indicates the need for stricter
monitoring of prescribing and consumption of such medications. Cannabinoids were dominant
among illicit substances , likely due to their widespread availability and the perception of lower
harm associated with these substances. The lower prevalence of stimulants probably stems from
the more frequen t recreational use of such drugs and use in social events . The distribution of
positive test results, as well as age related patterns, suggests the necessity for continuous
monitoring of substance use through data collection and analysis using various meth odologies.
Comprehensive reports on consumption across different age groups should be published to
enhance and direct public health efforts toward the most vulnerable populations, all to reduce
the harmful effects of substance mis use. |
