Atul Ambekar

• MD (Psychiatry)
• Professor at All India Institute of Medical Sciences

Introduction and aims: Injecting pharmaceutical opioids for non-medical purposes is a major concern globally. Though pharmaceutical opioids injection is reported in India, the exact proportion of people who inject drugs (PWID) using pharmaceutical opioids is unknown. The objectives of this study were to describe the various types of drugs that are...

Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs. We did a systematic search of peer-reviewed (Medline, B...

Background: Brain-derived neurotrophic factor (BDNF) plays an important role in neuronal plasticity and survival. The BDNF gene Val66Met polymorphism is hypothesized to be linked with alcohol dependence syndrome (ADS). We studied the relationship between the BDNF Val66Met polymorphism and the clinical features of ADS, including severity, craving, a...

Background Buprenorphine maintenance treatment is an effective long-term treatment for opioid dependence. Indian experience with Buprenorphine-based treatment is more than 2 decades old now. No study has reported the outcome of maintenance treatment among Indian women with opioid dependence till date. Aims The current study aims to assess the outc...

Background Indian guidelines mention the use of buprenorphine in opioid withdrawal in both outpatient and inpatient setting. Aim This is the first study aiming at assessing the feasibility aspects of outpatient-based buprenorphine-assisted opioid withdrawal treatment for opioid dependence. Methods In this prospective observational study, 30 men w...

Background: Naltrexone is a Food and Drug Administration (FDA)-approved anti-craving agent for the long-term treatment of alcohol dependence syndrome (ADS). However, it may not be equally effective in all patients. This study aims to assess naltrexone treatment response over four weeks in a national-level tertiary care setting. Methods: Male patien...

Opioid prescriptions for chronic non-cancer pain raise concerns of addiction risks. Understanding the nuanced intersection of chronic pain and opioid use is crucial in clinical settings. We present four case studies from two tertiary care hospitals illustrating the phenomenon of “pseudoaddiction” in CNCP referred to addiction specialists for manage...

Background and Objectives Risky behaviors are common among patients with substance use disorders. Knowing the determinants of risky sexual behaviors can identify individuals who may benefit from targeted interventions. The primary aim of the study was to assess unprotected risky sexual behavior and its sociodemographic and clinical correlates in tr...

Background About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Background Methadone take-home doses for opioid dependence treatment are strictly regulated due to diversion and overdose concerns, so patients must visit the clinic daily for dispensing. This was also done in India until the COVID-19 pandemic, when lockdown restriction compelled take- home dispensing of methadone. This study examined experience of...

Background Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of De...

Aims To study the implications of proposed changes in guidelines in ICD-11 in Alcohol and Opioid Use Disorder patients. To evaluate the concordance of ICD-11 with ICD-10 and DSM-5. To compare endorsement of various criteria for dependence between ICD 11 and other systems. To examine the agreement between ICD-11 and other systems with regard to the...

Background: Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking. Aim: To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroi...

Background: The menace of substance abuse is not only socially unacceptable but also emerging as a major public health challenge in many States of India, including Rajasthan. Aims: The aim of this study is to study the sociodemographic profile, pattern of use, availability of opioids, and process of seeking treatment services for opioid dependence....

Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients wit...

Background: Opioid-dependent patients undergoing opioid substitution therapy (OST) consume alcohol in a hazardous pattern which adversely affects their treatment outcome. This study aims to measure alcohol biomarkers to screen for secondary alcohol use in OST patients. Methods: A pilot study was planned to measure alcohol biomarkers (AST, ALT, G...

Background People who Inject Drugs (PWID) show higher rates of comorbid psychiatric illnesses than the general population. We aimed to assess the rates of different psychiatric disorders and substance dependence among PWID in the state of Delhi, India. Methods We conducted a community-based, cross-sectional study interviewing 104 adult male partic...

Background Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program “Alcohol e-Health.” Objective We aimed to test the effectiveness of the Alcohol e-Health program in a randomized...

Background A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. Methods Using all accessible data from multiple sources, we estimated the prevalence or...

5th International Congress of Technology Addiction will be held by the Turkish Green Crescent Society on June 2 – June 3, 2021 from 09:00 AM to 6:30 PM (GMT +3) as a virtual conference. It will be o ered through Zoom and the Green Crescent Society’s online platform. Click here for more info: https://kongre.yesilay.org.tr/en/

Objectives To assess the cognitive functions in participants maintained on buprenorphine for opioid dependence at peak and trough buprenorphine levels. Methods This was a double-blind, randomized, experimental study. Sixty participants maintained on buprenorphine were matched for age and education and randomly allocated to “peak” group or “trough”...

Background: The co-occurrence of alcohol and tobacco dependence is frequently witnessed in treatment settings. It is a challenge for clinicians to treat such patients due to their powerful biological association. Aim: The study is aimed to assess the relationship of Catechol-O-methyltransferase (COMT) Val158Met polymorphism with substance intake...

Background and aims Following the recognition of ‘internet gaming disorder’ (IGD) as a condition requiring further study by the DSM‐5, ‘gaming disorder’ (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the eleventh revision of the International Classification of Diseases (ICD‐11). However, the proposed d...

Heroin use, a prevalent and disabling condition, affects sexual functioning and the sexual quality of life. While there is adequate literature on sexual dysfunction with heroin use, the literature is scarce on the emotional aspects of sex, like the perception of sexual relationship, self-esteem, and satisfaction amongst heroin users. The study asse...

The need and the importance of telemedicine has been brought to the forefront during the ongoing pandemic of COVID-19. It has created another viable option for treatment delivery while reducing risks. However, there are major concerns regarding the delivery of services for treatment of substance use disorders using telepsychiatry. We discuss the va...

Drug dependence associated with increased dopamine neurotransmission and neuroplastic changes is influenced by Dopamine transporters (DAT) which are modulated by genetic and epigenetic factors. This study assesses DAT availability in relation to the 40bp DAT1 VNTR (genetic) and DAT1 promoter methylation (epigenetic) changes in patients with alcohol...

Purpose The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects an...

BACKGROUND Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program “Alcohol e-Health.” OBJECTIVE We aimed to test the effectiveness of the Alcohol e-Health program in a randomized...

Mephentermine is an α-adrenergic agonist, indicated for treatment of hypotensive states. It is not a common drug used for recreational purposes; rather for its performance enhancing properties. However, there are few case reports which highlight its dependence potential or its effect on induction of psychotic symptoms. In this case series, we inten...

The prevalence of unipolar depression among adolescents in India is high. Cognitive behavior therapies (CBTs) are considered the current gold standard treatment for depression in adolescents; however, their access is limited in India. Given the ubiquity of technology including smartphones and computers, technology can be leveraged to improve access...

Exposure to alcohol in popular movies during adolescence is associated with higher rates of alcohol use. We aimed to assess the extent and pattern of depiction of alcohol in Bollywood movies, and to analyze the trends in portrayal of alcohol over three decades selected for the study. We selected the top five grossing movies for each year of the thr...

Introduction: Most studies on opioid agonist treatment (OAT) from South Asia have assessed retention over short term. The aim of this study was to assess retention rates on buprenorphine-based OAT in a community clinic at 6 years, and to assess factors associated with long-term retention. Methods: Retrospective cohort study. Consecutive case record...

Introduction and aims: We aimed to evaluate and compare the effect of different intravenous doses of naloxone on reinforcing effect of intravenous buprenorphine (2 mg) in patients stabilised on sublingual buprenorphine. Design and methods: This is a double-blind, within-subject, randomised, crossover study. Opioid-dependent patients, with histor...

Background: Pattern of drinking has a strong bearing on alcohol-related negative consequences. Very few studies from India have assessed this relationship using any standardized instrument. Aim: The current study aims to assess the relationship between pattern of alcohol use and negative consequences among problem alcohol users using a standardi...

Aims: The primary aim of the current study was to assess the sexual history and behavior among treatment-naïve male patients of heroin dependence presenting to outpatient services; their knowledge and attitude about high-risk sexual behavior; and their sexual quality of life. Methods: A cross-sectional exploratory study was done on treatment-naïve...

Background and Objectives: Some opioid-dependent injecting buprenorphine (BPN) users can continue to inject BPN even while using dextropropoxyphene as a treatment or as a drug of abuse. With this rationale, this study was aimed to assess the effect of injection BPN on psychomotor and cognitive functioning in opioid-dependent patients receiving oral...

Street children as a population sub-group exist in significant numbers in the developing world and have been reported to be vulnerable to adverse health and risk behaviours that include physical and sexual risk behaviour. However, the estimation of prevalence for various psychoactive substances among the street children in a representative sample h...

Introduction and aims: Non-fatal opioid overdose (NFOO) predicts future fatal opioid overdose and is associated with significant morbidity. There is limited literature on the rates and risk factors for NFOO in people who inject drugs (PWID) from India. We aimed to study the rates of NFOO and documented risk factors for NFOO, as well as knowledge-l...

Background: Harmful Alcohol use is frequent among opioid dependents patients undergoing agonist maintenance treatment. The objective assessment of harmful alcohol use can be done using laboratory measures of serum biomarkers. For community-based patients, there is often a requirement of an alternative method due to lack of onsite laboratory servic...

Prescription opioids’ use are very prevalent worldwide. Butorphanol, one of the prescription opioid, is frequently used as an opioid analgesic especially in the peri-operative period. However, there are few case reports which highlight about the dependence potential of butorphanol. The available literature on butorphanol dependence have mostly repo...

Background Most people who inject drugs (PWID) start their drug use careers by using non-injecting opioid drugs. A variety of interconnected factors may influence the risk of transition from non-injecting to injecting drug use (IDU). However, such factors have not been studied well in India. As almost all non-injecting opioid users (NIOU) are at po...

The Mental Healthcare Act (MHCA), 2017, is enacted with an aim to promote and protect the rights of and improve the care and treatment for people affected by mental illness in India. The Act purportedly includes substance use disorder (SUD) specifically in the definition of mental illness itself. However, some of the phrases used in the definition...

Introduction: Substance use among adolescents is on the rise across the globe along with a diminution of gender gap observed earlier posing a huge public health burden. Unfortunately, there is a paucity of literature on adolescent substance use. The literature is even sparse about substance use among adolescent girls. The current study aims to prov...

BACKGROUND In recent years, drug testing in body fluids has gained popularity for validating self-reported drug use. The storage and transportation of urine specimens is a major concern for remote areas where the facilities for performing drug abuse testing are lacking. AIMS AND OBJECTIVES The aim of the present study was to develop an efficient m...

Background Alcohol Dependence (AD), a chronic relapsing disorder, is a serious social and public health concern globally. Risk of AD is reportedly increased due to polymorphisms and methylation changes affecting transcription of the genes involved in various dopamine neurotransmitter gene pathways. The aim of this study was to identify polymorphism...

Objectives. Substance use among adolescent population is increasing across the world. However, there is little data on the substance use among female adolescents, more so from India. Hence, we aimed to assess socio-demographic and clinical profile of adolescent females seeking treatment at our tertiary care drug treatment centre. Methods. Study des...

Background: A systematic understanding of suicide mortality trends over time at the subnational level for India's 1·3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016. Methods: As...

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the...

Opioid dependence is a significant clinical and public health issue in India. Opioid substitution therapy (OST) is the most evidence-based treatment for opioid dependence. Although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far. We conducted a narrative review of In...

Background: Alcohol dependence (AD), characterized by profound disruptions in specific circuits of the brain is influenced by both environmental, which play a significant role in developing addiction and genetic factors, which make some individuals more susceptible to disruptions. Various polymorphisms in the neurotransmitter genes are reported to...

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the...

Engaging individuals in opioid dependence treatment is a challenge. Opioid substitution therapy (OST) is an effective opioid dependence treatment modality, and leads to improved retention, which, in turn, is associated with better outcomes. However, data on retention rates and factors association with retention among OST recipients from community d...

Background 18% of the world’s population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have no...

With almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While stat...

Background and aim: Benzodiazepines (BZD) are widely prescribed to substance users. However, the nonmedical use of prescription BZD often leads to abuse and dependence. Therefore, it is important to detect BZD among substance users seeking treatment. The aim of the present study was to develop an efficient method for testing BZD on dried urine spo...

Introduction: Impact of alcohol on various adverse consequences is also determined by the pattern of consumption. Pattern of drinking from developing countries is an under-researched area. The present study aims to assess the pattern of drinking among nontreatment-seeking problem alcohol users from an urban slum in a metropolitan city of North Indi...

Background. Adverse consequences of injecting are greater among female injecting drug users (FIDUs), yet treatment-seeking is low because of stigma, poor social support, and unavailability of gender-specific services. FIDUs, despite being a distinct subpopulation of women substance users, are sparsely studied. Aims. We aimed to study the sociodemo...

Background and aims: Given the scarcity of alcohol prevention and alcohol use disorder treatments in many low and middle-income countries, the World Health Organization launched an e-health portal on alcohol and health that includes a Web-based self-help program. This paper presents the protocol for a multicenter randomised controlled trial (RCT) t...

Substance use disorder (SUD) is a major problem worldwide, including in India, and contributes significantly to morbidity and mortality. The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of "rehabilitation centers" run by nongovernmental...

Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown...

Drug misuse and dependence is an ever evolving field of study, which has exploded over recent years owing to the advent of the internet. Due to the ever-growing number of young people using drugs recreationally and the privatisation of drug screening and detection services, there is the need to disseminate evidence-based information concerning the...

span lang="en-GB">Carisoprodol, a centrally acting skeletal muscle relaxant, is not a controlled substance. Despite some evidence for its abuse, certain aspects, e.g. nature of effects, existence of withdrawals, remain unclear till date. We discuss the case of a middle-aged male who presented with carisoprodol use for 10 years. He reported remarkab...

Introduction: Among substance users, women represent a small, unique subpopulation. Studying their socio-demographic and substance-use profile helps us understand their concerns and formulate management strategies. Materials and Methods: In this retrospective chart review, all the available records of outpatient treatment seekers at National Drug D...

Background & objectives: The frequently encountered co-morbidity of alcohol dependence (AD) with nicotine dependence (ND) increases the risk for various diseases. Ankyrin repeats and kinase domain containing 1 (ANKK1) gene polymorphism is reported to be associated with both ND and AD. This study was undertaken to investigate the possible associatio...

H eroin dependence (HD) is a complex disorder leading to disruptions in particular circuits of the brain, influenced by both environmental and genetic factors. Heroin interacts with the different brain neurotransmitters affecting the normal functions including learning, memory, cognition etc. The presence of polymorphisms in the glutamate pathway h...

Statement of the Problem: Alcohol Dependence (AD) is a chronic relapsing disorder with detrimental health outcomes. Substantial evidence suggests both genetic and environmental factors to be involved in its etiology. While environmental factors are known to play significant roles in developing addiction, genetics makes some individuals more suscept...

A lcohol dependence (AD) a neuropsychiatric disorder involves complex interaction of genes and the environment leading to a negative impact on personal, social and economic status of life. Genes of the monoamine (dopamine and serotonin) pathways regulate the release of various neurotransmitters in the brain and studies report on an association of s...

Summary Background 18% of the world’s population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates...

Background/Objectives: To study the socio-demographics and substance use profile of the female patients attending National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), Ghaziabad. Methods: A cross-sectional, retrospective chart review design was employed. All the available medical records of patients re...

Introduction: Elderly women comprise of a unique subpopulation of people who use drugs. However, literature on the profile of elderly women seeking treatment is scarce. Materials and methods: This retrospective chart review included 16 elderly (>60 years of age) women subjects seeking outpatient treatment at a tertiary care substance use treatment...

AbstractAims In India, opioid substitution therapy (OST) has been scaled-up in the recent years for HIV prevention among injecting drug users. This study aimed to assess the change in knowledge and attitude of the OST staff who underwent a five-day training programme on OST. Methods Using a ?pre-test post-test? design, routine data collected from 2...