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Section 8. Medical science
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-130-131
Tursunhodzhaeva Lyudmila Alexandrovna, Head of the Department of Addiction and adolescent psychopathology of the Tashkent Institute of Postgraduate Education, Republic of Uzbekistan
E-mail: evovision@bk.ru Bakhramov Furkat Shuhratovich, Assistant Department of Addiction and adolescent psychopathology of the Tashkent Institute of Postgraduate Education, Republic of Uzbekistan
Аnalysis of medical and social consequences of drug dependence according to a long catamnesis
Abstract: Complete rejection of the drug, followed by long-term remission is most likely with a small (up to 5 years) experience of drug use, and the occurrence of adverse social impacts, particularly single conviction for offenses related to drugs for some patients, apparently, plays the role of a factor contributing to the formation of motivation to stop drug addiction. Keywords: addiction, medical social consequences, remission, death.
The urgency of the problem. The severity of the medical social consequences of drug dependence is emphasized by many researchers. The authors note the low level of employment of drug addicts, a high risk of violent and criminal behavior, violation of intrafamily relations [1; 5]. In the families of drug addicts frequent problems of emotional deprivation, low material level, alienation [3; 6]. More than 90% of patients, at least one commit a criminal offense and brought to trial almost one in three of them. According to experts of the World Health Organization, injecting drug users are at risk for tuberculosis, HIV/AIDS, sexually transmitted diseases [2]. There is an acute problem ofdrug users mortality [7], and its most common causes are considered accidents, poisonings and injuries, as well as diseases of the internal organs [8; 10]. The average life expectancy of opium drug users on average 7-10 years since the start of the reception.
It is believed that severe health and social consequences of opioid dependence determine its poor prognosis [4].
After analyzing the numerous studies of opioid abuse, carried out over the last 25 years, J. Parsons [11] reported that approximately one-third of drug users dying prematurely, about one-third continued anesthesia ofvarying intensity, and one-third of overcoming dependence with access to the persistent long-term remission.
In general, the study of long Catamnesis suggests that a typical manifestation of the dynamics of opioid dependence in a large proportion of cases are either giving up using drugs or opiate substitution by other psychoactive substances. In this connection it is maintained interest in studying the trends, outcomes and medical social consequences of drug addiction.
Purpose ofthe study. the study ofhealth and social consequences and outcomes of drug addiction according to 15-year-old catamnesis.
Material and Methods. The object of the study were 484 people (414 men and 70 women) with a diagnosis of drug addiction, registered Tashkent city narcological clinic on January 1, 2001. To analyze the health and social consequences and outcomes of drug dependence undertaken continuous study of medical records (outpatient cards, stories hospital illness, archival materials, excerpts from psychiatric hospitals, acts ofjudicial Addiction expert), which made it possible to trace the fate of the patients according to the regular dynamic observation on over the next 15 years.
Results of the study. Analysis of the data of 15-year-old catamnesis showed that 47 patients (9.7%) in different periods of observation have stopped attending drug treatment clinic, 60 patients (12.4%) went outside the city of Tashkent and the Republic of Uz-
bekistan in connection with what their fate It could not be traced in recent years. At the same time it found that 43.4% of migrants to the moment of departure has been ascertained state of stable remission lasting more than three years. Depending on the nature of the medical and social consequences of the remaining 377 patients were divided into three groups. The largest group (199 patients, 52.8%) were drug addicts convicted in 2001-2015 GG for offenses related to drugs. This group consisted of 181 men and 18 women.
Depending on the nature of the medical and social consequences of the remaining 377 patients were divided into three groups. The largest group (199 patients, 52.8%) were drug addicts convicted in 2001-2015 GG for offenses related to drugs. This group consisted of181 men and 18 women.
In studying the history of convictions, their frequency was distributed data is not evenly. The largest part (91.5%) were convicted of drug addicts in the period from 2001 to 2005, and 56.3% of them — in 2001, when the spread of drug abuse in the Republic of Uzbekistan was of epidemic. Over the next 5 years (2007 to 2010) to 3.5% held criminally liable, from 2010 to 2015-2.5% of drug addicts, included in this group.
The majority (96.5%) of drug users, convicted of the offense, abused drugs opium, heroin in particular (83.4%), 3.5% were cannabis users. The vast majority (81.4%) had experience of drug use no more than five years: 17.6% of patients — up to 1 year, 42.7% —
2-3 years, 21.1% — 4-5 years. In 18.6% of drug addicts duration of disease was more than 5 years, and in 10.0% of patients it exceeded 10 years. In the early stages of drug use 19.6% of drug users have attempted on their own or after treatment to stop the anesthesia, but the duration of abstinence periods, usually no more than
3-6 months. Persons convicted of offenses in the period 2001-2005, to 80.4% of drug addiction different course without remission. In 29.4% of persons convicted in the following years, marked remissions lasting more than 1 year in the course of the disease.
Only 34.2% of drug addicts were prosecuted for the first time in my life. In 65.8% of the patients already had a criminal record, including for offenses not related to the drug. Some of them (48.7%) were prosecuted by 2-3 times, 17.1% — more than 3 times. The majority (59.8%) of the patients were married or living in a civil union, 38.7% were single, divorced comprised only 1.5% ofpatients.
The second largest group (106 patients, 28.1%) were persons who have completely stopped taking any substance that allows you to diagnose the state of the counter (over three years) of remission,
Analysis of medical and social consequences of drug dependence according to a long catamnesis
which equates to recovery followed by the termination offollow-up. This group included 95 men and 11 women.
Compared with the previous group, among patients with persistent therapeutic remission significantly less dependence was detected only on opiates (78.3%; p<0.001) and increasing the frequency of the abuse of cannabinoids (16.0%; p<0.001). At 5.7% of the patients diagnosed as substance dependence.
The majority of drug addicts (77.4%, p>0.05), duration of drug abuse to counter the formation of remission did not exceed 5 years, with no statistically significant differences on the basis of the previous group was not found.
In 24.5% of patients, it was up to 1 year, at 28.4% — 2-3 years, 24.5% of patients — 4-5 years. Much less often (22.6%, p>0.05), drug abuse experience, mainly cannabinoids, over 5 years. At 6.6% of the patients it was 6-8 years, 5.7% — 9-10 years, at 7.5% — 11-15 years and 2.8% of patients — more than 15 years.
No significant between-group differences in terms of family adaptation of drug addicts. The majority ofpatients who discontinued use of narcotic substances, the previous family ties: 51.9% of the patients were married, 48.1% — lived in the parental home (P>0.05).
Many patients (77.4%) had a history of convictions for offenses related to drugs, but in most cases (47.2%; p<0.045) were prosecuted more than once. More than one previous conviction had a 30.2% (p<0.001). 22.6% of patients never prosecuted.
Third, the least numerous group (72 patients, 19.1%) accounted for addicts who cause the termination of the dynamic observation was fatal. This group included 58 men and 14 women. Studying the cause of death showed that 20.8% ofpatients died from drug overdose, 16.7% — from pulmonary tuberculosis complications, 9.7% — from AIDS, 9.7% — as a result of accidents, 8.3% — from cirrhosis of the liver. Suicide accounted for 5.6% of all cases of death, with the same frequency (5.6%) as the cause of death was revealed acute cardiovascular insufficiency (myocardial infarction). Other causes of death
(cancer, pathology of the gastrointestinal tract, kidneys, meningoencephalitis, etc.) Totaled 23.6% of the total number of deaths.
Comparative analysis of the severity of the clinical manifestations of drug addiction, prior to death, discovered the existence of certain differences from the previous group. Patients in this group was significantly more likely to be diagnosed with dependence on opiates (93.3%; p<000.1) with a smaller proportion of cannabinoid dependence (8.3%, p>0.05), and a lot of dependency on opiates and other substances (5, 6%, p>0.05).
As in the previous group, the majority of drug addicts (66.6%, p>0.05), duration of drug abuse before death did not exceed 5 years. In 20.8% of patients with lethal outcome was observed against the background of persistent (over 3 years) abstinence from substance use.
However, compared to the previous group with respect to increasing frequency of prolonged (more than 5 years) opioid drug abuse or cannabinoid group (33.4% of patients; p>0.05). Half (50.0%, p>0.05) of the patients were married, 47.2% (p>0.05) were living in the parental home, 2.8% — were widowed. Conviction for offenses related to drugs, had 19.4% of the patients (p>0.05), with respect to increasing frequency of convictions of more than one half (41.7%, p>0.05). We do not have a criminal record 19.4% (p>0.05) patients.
Thus, among the most frequent adverse health and social consequences of drug addiction can be isolated conviction for offenses related to drug and deaths as a result of overdoses and diseases of internal organs. However, long-term follow-up observation is quite a high probability of a complete cessation of substance use, followed by the formation of a stable long-term remission.
When opioid adverse health and social consequences occur in the early stages of the disease. Criminal liability is the case, especially in those patients who show no desire to stop drug receptions and is biased toward delinquent behavior is due to the anesthesia.
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