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Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box.

ABSTRACT: As defined by the World Health Organization, the Eastern Mediterranean Region (EMR), given its special geopolitical situation and internal/external conflicts, faces an increase in illegal activities such as drug production and trafficking, highlighting the need for a comprehensive understanding of the substance use situation. On the basis of a review of published papers between 2015 and 2021 we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this region, namely tramadol, captagon and khat.

SUBMITTER: Mohaddes Ardabili H

PROVIDER: S-EPMC9540563 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box.

Mohaddes Ardabili Hossein H Akbari Abolfazl A Rafei Parnian P Butner J L JL Khan Riaz R Khazaal Yasser Y Arab Abdulmalik Zuhair AZ Qazizada Mohammed Rafiq MR Al-Ansari Basma B Baldacchino Alexander Mario AM

BJPsych international 20220801 3

As defined by the World Health Organization, the Eastern Mediterranean Region (EMR), given its special geopolitical situation and internal/external conflicts, faces an increase in illegal activities such as drug production and trafficking, highlighting the need for a comprehensive understanding of the substance use situation. On the basis of a review of published papers between 2015 and 2021 we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this reg ...[more]

PMID: 36287793

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Project description:BackgroundChildhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change.MethodsHub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change.ResultsFifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora's box. Following analysis, key drivers of practice change were 'social influence', 'belief in capability', 'knowledge' and 'behaviour regulation' while barriers to practice change were 'environmental context and resources' and 'emotion'.ConclusionsPractitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora's box.

Dataset Information

Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box.

Publications

Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box.

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