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      World Opioid and Substance Use Epidemic: A Latin American Perspective

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          Abstract

          The opioid crisis is a growing social and public health phenomenon, particularly in developed countries such as the United States. Since the 1990s, this crisis has shown a variety of causal processes and consequences and has affected quality of life for millions of individuals, families, and communities across the globe. Although abuse of opioid‐based painkillers appears to have triggered the epidemic in the United States, in this article, the problem is examined with a focus on Latin America, where drug‐associated problems constitute threats to the health and quality of life for large segments of the population. After a review of the history of opium consumption and its consequences in the world and in Latin America, the authors present epidemiological data and information about regional market differences, professional involvement, clinical practices, public health realities, and prevention efforts. Recommendations are made for collaborative efforts to promote prevention policies and measures to improve the situation.

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          Most cited references48

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          Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.

          Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
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            An international survey of sleeping problems in the general population.

            This international omnibus survey investigated the prevalence and characteristics of sleep problems, as well as strategies for resolving sleep problems, in the general population of the USA, France, Germany, Italy, Spain, the UK and Japan. A representative sample of the general population aged > or = 15 years was recruited from each country. Questions focused on the nature of sleeping problems, the impact of problems on daily functioning and behavior with regard to resolving sleeping problems. A total of 10 132 individuals were included in this survey. The prevalence of sleeping problems was 56% in the USA, 31% in Western Europe and 23% in Japan. Most individuals with sleeping problems considered these to have an impact on their daily functioning, with family life most affected in the Western European sample, personal activities in the US sample and professional activities in the Japanese sample. Almost half of individuals with sleep problems had never taken any steps to resolving them, and the majority of respondents had not spoken with a physician about their problems. Of those individuals who had consulted a physician, drug prescriptions had been given to approximately 50% in Western Europe and the USA and 90% in Japan. Sleeping problems continue to present a considerable burden across Western Europe, the USA and Japan. Despite this, they are under-reported and under-treated, with almost half of affected individuals not taking any steps to resolve their sleeping problems.
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              The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology.

              Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy, and the availability and accessibility of the required medications. In some countries, pain relief is hampered by the lack of availability or barriers to the accessibility of opioid analgesics. As the follow-up to a successful project to evaluate the availability and accessibility of opioids and regulatory barriers in Europe, the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) undertook to expand their research to those parts of the world where data were lacking regarding these aspects of care, in particular Africa, Asia, the Middle East, Latin America and the Caribbean, and the states of India. This project has been undertaken in collaboration with the Union for International Cancer Control (UICC), the Pain and Policy Studies Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), together with a consortium of 17 international oncology and palliative care societies. This article describes the study methodology.
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                Author and article information

                Contributors
                directorgeneral@cra.org.ec
                Journal
                Psychiatr Res Clin Pract
                Psychiatr Res Clin Pract
                10.1176/(ISSN)2575-5609
                RCP2
                Psychiatric Research and Clinical Practice
                American Psychiatric Association (Washington, DC )
                2575-5609
                24 January 2019
                April 2019
                : 1
                : 1 ( doiID: 10.1176/rcp2.v1.1 )
                : 32-38
                Affiliations
                [ 1 ] Addiction and Psychiatric Center Cuenca Ecuador
                [ 2 ] Department of Psychiatry Cuenca University School of Medicine Cuenca Ecuador
                [ 3 ] Department of Psychiatry Mayo Clinic College of Medicine Rochester MN
                [ 4 ] Academic Affairs School of Medicine Universidad Peruana Cayetano Heredia Lima Perú
                Author notes
                [*] [* ]Send correspondence to Dr. Pacurucu‐Castillo ( directorgeneral@ 123456cra.org.ec ).
                [†]

                The authors report no financial relationships with commercial interests.

                Article
                RCP20032
                10.1176/appi.prcp.20180009
                9175731
                36101564
                c44d9c82-de85-4c48-aa10-61c927d38278
                © 2019 American Psychiatric Association

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 October 2018
                : 19 July 2018
                : 31 October 2018
                Page count
                Figures: 0, Tables: 0, References: 54, Pages: 7, Words: 6002
                Categories
                Article
                Articles
                Custom metadata
                2.0
                01 April 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.6 mode:remove_FC converted:23.05.2022

                opioid epidemics,latin america,cocaine,addictions,epidemiology,dual diagnosis

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