1. Medical Drugs, Intoxication Substances, and Somatic Diseases Evgeniya Koshkina Deputy Director for Science Moscow Research and Practical Centre on Addictions Department of Healthcare of Moscow Warsaw, 19.04.2016 1 Moscow Research and Practical Centre on Addictions Department of Healthcare of Moscow

2. Rationale Alcohol is one of the five dominant risk factors of disease, injury and death A study conducted by Norwegian scientists has shown that 50% patients admitted with injuries from accidents or with poisonings, revealed the presence of alcohol, narcotic drugs or medications (Bogstrand, S.T., et al., 2011.) Problem alcohol use over a long period of time can deteriorate the course of several diseases, cause complications, induce or contribute to various diseases, including several forms of cancer, coronary heart disease, liver diseases, pancreatitis, and such infections as HIV, tuberculosis and pneumonia. 2

3. The study is planned within the framework of cooperation between Norwegian Institute of Public Health (NIPH) and Moscow Research and Practical Centre on Addictions, Department of Health of Moscow (MRPCA)  The aim of this study is to investigate relationship between the cases of patients hospitalized to somatic departments due to internal diseases and problem use of alcohol and other intoxicating substances (including medications).  The study will be carried out by means of analyzing questionnaires, combined with analysis of biological markers in blood, as well as analysis of medical documentation data (registers). 3

4. Working hypothesis Currently knowledge of how specialized medical institutions deal with patients with problem substance use remains limited.  Does alcohol abuse (laboratory-confirmed) affect duration of stay at a hospital and frequency of hospital admissions sue to physical illness and whether it affects the cost of treatment.  Do somatic patients with alcohol abuse get outpatient care at home, and how such care is controlled.  Compare prevalence of alcohol or other intoxication detection in patients admitted to emergency departments in Norway, with relevant data from Russia. Comparative analysis of all the results will be carried out anonymously. 4

5. Objectives 1.Find out the extent to which risky alcohol, narcotic drugs and other intoxicating substances use practices are associated with acute somatic conditions. 2.Find out if patients with problem alcohol and other intoxicating substance use are more resource-intensive. 3.Investigate the use of medications prescribed for health reasons, and to compare them to blood tests results. 4.Find out if patient return to work one year after hospitalization, and whether this is related to alcohol and other intoxicating substances. 5.Find out if after discharge patients are forwarded to drug or alcohol addiction treatment, and to what extent the course of treatment is controlled. 6.Find out, how problem use of alcohol and other intoxicating substances is reflected in medical records (registers). 5

6. Study Design  Project implementation is planned as a cross-sectional study, focused on patients with acute medical conditions and poisonings, admitted to somatic hospital. Estimated project duration: 1 year.  To assure a wide range of data and fulfill all objectives, the study will use four data sources:  blood samples  questionnaire  data from patients’ records  data from registers (Norway) 6

7. Sampling  It is planned to collect blood samples and questionnaires during 1 year.  The study will include about 3,000 patients.  Patients should be selected during the whole year, to identify possible seasonal fluctuations, as well as in all the times of a day and all the days of a week, as time-related fluctuations in the use of intoxicants are significant. 7

8. Patient selection and consent obtaining All patients older than 18 years, admitted to emergency room of a somatic hospital, seeking medical care due to acute somatic condition – all such patients would be invited to participate in the study. The study will also include patients receiving treatment due to poisoning or an overdose of intoxicating substances or medical drugs. 8

9. Material. Blood samples will be analyzed for the following intoxicants : Alcohol : concentration and alcohol metabolites Alcohol biological markers of problem and non-problem alcohol consumption Benzodiazepines Opioids Illegal drugs such as: – Stimulating substances: of amphetamine and cocaine origin – Cannabis – Other intoxicating and psychoactive substances 9

10. Questionnaires will be filled in case of informed consent. Questionnaires will be filled in by health professionals.  Information about own alcohol use collected using AUDIT-4 screening test "Alcohol Use Disorder Identification Test-4".  To fill in the information about own use of intoxicant substances other than alcohol, two questions from the modified test "Drug Use Disorders Identification Test" (DUDIT) are used.  The questionnaire includes five questions related to anxiety and depression Symptomatic questionnaire "Symptom Check List - 5" (SCL-5). 10

11. More complete research material requires access to medical records data, due to the following reasons: Misunderstandings during completing questionnaires Gaps in registration Registration of exact date and time of admission and discharge Registration of medical sorting data (triage) Obtaining diagnostic codes Control for patients who can not express consent during admission Figuring out, what medical drugs patients received after admission Contact information for further control Other information needed to clarify aspects related to the course of the disease, and important to achieve the aims of the study. 11