Buy Heroin online in Linz

__________________________

📍 Verified store!

📍 Guarantees! Quality! Reviews!

__________________________

▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼

▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲

Buy Heroin online in Linz

Official websites use. Share sensitive information only on official, secure websites. Edited by: Catherine M. Ashwin Karanam , Pfizer, United States. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Introduction: Acquired QT interval prolongations due to drug side effects can result in detrimental arrhythmia. Maternal use of placenta-permeable drugs may lead to fetal exposure, thus leading to an increased risk of neonatal QT prolongation and arrhythmia. Objectives: This study aimed to evaluate the influence of maternal QT-prolonging medication on the neonatal QT interval. Methods: In the prospective KUNO-Kids health study, an ongoing population-based birth cohort, we classified maternal medications according to the known risk of QT interval prolongation. Effects on the neonatal QT interval were tested by linear regression analyses, correcting for perinatal confounders birth weight, gestational age, birth mode, and age at ECG recording. Subgroup analyses were performed for selective serotonin reuptake inhibitors, proton pump inhibitors, and antihistamine dimenhydrinate. Logistic regression analysis was performed using a QTc of ms as the cut-off value. Results: A total of 2, pregnant women received a total of 3, medications, of which were known to increase the risk of QT prolongation, resulting in 4. Overall, the mean age of the neonates at ECG was 1. Logistic regression analysis showed no association of exposure to maternal medication with an increased risk of neonatal QT interval prolongation OR odds ratio 0. Conclusion: The currently used maternal medication results in a relevant number of fetuses exposed to QT interval-prolonging drugs. In our cohort, exposure was found to have no effect on the neonatal QT interval. A severely prolonged QT interval is associated with life-threatening complications, such as stillbirth and sudden infant death syndrome SIDS in infants, and detrimental arrhythmia and sudden unexplained death SUD in children and adults Schwartz et al. Through various interactions with cardiac ion channels, these drugs can prolong the QT interval and thus increase the risk for critical arrhythmia. Furthermore, genetic variants are known to influence individual susceptibility to drug-induced QT interval prolongation Kallergis et al. QT interval prolongation has been described for several drugs commonly taken by pregnant women, including selective serotonin reuptake inhibitors SSRIs Funk and Bostwick, , proton pump inhibitors PPIs Moore et al. Maternal drug use during pregnancy may result in fetal exposure if drugs pass the placenta. In the case of pro-arrhythmogenic drugs, this may lead to an increased risk of arrhythmia in the fetus and neonate. However, data on the influence of potential QT interval-prolonging maternal medication on the postnatal neonatal QT interval are very limited. There are some case reports on neonates with markedly prolonged postnatal QT intervals that were possibly related to exposure to maternal medication. One of these patients needed therapy for life-threatening arrhythmia and torsade de pointes, occurring after maternal intake of tricyclic antidepressants Dubnov, ; Fukushima et al. For SSRIs, two case—control studies addressed the issue of neonatal QT interval prolongation after intrauterine exposure with inflicting results Dubnov-Raz et al. Apart from a possible influence of maternal medication on the neonatal electrocardiogram ECG , there are other neonatal and maternal factors that may affect the neonatal QT interval. For example, studies have reported a variable effect of gestational age on neonatal repolarization Marcellino et al. The interpretation in newborns is methodologically challenging as the QT interval varies with age and may change within days Schwartz et al. Therefore, the aim of this study was to evaluate the influence of peripartum maternal QT interval-prolonging medication on the QT interval in the neonatal ECG, taking peripartum confounders into account. In the presented study, we analyzed parental and neonatal demographics, maternal medication, and postnatal ECGs recorded from 3, participants. Written informed consent was obtained for each case. The study was approved by the Ethics Committee of the University of Regensburg We included neonates with a postnatal ECG and a complete documentation of the maternal medication during pregnancy. Exclusion criteria were as follows: outpatient childbirth, stillbirth, maternal age less than 18 years, or maternal German language skills inadequate to achieve informed consent. Maternal medication during pregnancy was recorded in an interview conducted postnatally by the study team and verified by checking the maternity pass. For each drug, the month of gestation and the frequency of intake were recorded. Participants with maternal drugs that could not be classified due to insufficient specifications were excluded from the analysis. Data on maternal demographics age and migration background , neonatal characteristics gestational age, birth weight, and sex , and the mode of birth spontaneous delivery and caesarian section were collected from patient records and a postpartum interview. ECGs were recorded in the first week of life, as described by Simma et al. The QT interval was measured manually from the onset of the Q-wave to the end of the T-wave using the tangent method. Parental and neonatal demographics, perinatal characteristics, and ECG parameters were entered in an electronic case report form eCRF , and extensive plausibility checks were performed. We tested the hypothesis that fetal exposure to maternal QT-prolonging medication is associated with a prolonged neonatal QT interval using linear regression analysis. Potentially confounding variables birth weight, gestational age, birth mode, and age at ECG were included using a multivariate model. In a sensitivity analysis, we tested whether maternal medication is associated with a QTc interval larger than ms using logistic regression analysis. The same set of confounder variables was included. Out of a total of 3, participants in the KUNO-Kids health study, were excluded because of incomplete or unclassifiable documentation of maternal medication or a lack of ECG recording. Therefore 2, participants were included in this analysis. A total of 22 additional participants had to be excluded in the multivariate analysis due to the incomplete dataset on perinatal demographics. A total of 2, participants were included in the multivariate analysis. An immigration background was present in The proportion of caesarean delivery was An estimate of The mean age of the neonates at the time of ECG was 1. The mean heart rate was The cohort characteristics are summarized in Table 1. A total of 3, entries for maternal medication were reported and classified. In total, drugs were classified as representing a known risk for QT interval prolongation. A total of 2, participants were assigned to the non-exposure group. Drugs assigned to the group with the known risk of QT interval prolongation and the number of participants with peripartum fetal exposure. Using ms as the cut-off, the QTc interval was prolonged in 4. To control the possible influence of confounding variables, we performed a multivariate analysis, including birth weight, gestational age, birth mode, and age of the neonate at the time of the ECG recording. Each variable considered as a confounder showed a statistically significant association with the postnatal QT interval using the multivariate model. An increase in birth weight was associated with a longer QT interval regression coefficient 0. A caesarean section was associated with a significantly longer postnatal QT interval regression coefficient 3. Due to limitations to the sample size, subgroup analyses were performed for PPIs, SSRIs, and dimenhydrinate only, with 26, 29, and 16 exposed participants, respectively. Compared with unexposed neonates, no subgroup showed significantly prolonged QT intervals in the neonatal ECG. In multivariate analysis, these differences were also not significant for any subgroup Table 4. Increased genetic susceptibility to drugs that induce QT interval prolongation in some individuals at risk could lead to an increased rate of QT prolongation without significantly affecting the QT interval of the whole group of exposed neonates. To test whether exposure to maternal QT prolonging medication is associated with an increased rate of prolonged neonatal QT interval, a logistic regression analysis was additionally performed using a QTc of ms as the cut-off value. In this analysis, controlling gestational age, birth weight, birth mode, and age at ECG as confounders, exposure to maternal medication was not associated with an increased chance of neonatal QTc prolongation above ms OR odds ratio 0. Through various pathophysiological mechanisms, drugs can lead to QT interval prolongation and subsequently to an increased risk of critical arrhythmias, mostly through interactions with cardiac ion channels. Maternal drug use during pregnancy may result in fetal exposure via the placenta. The aim of this prospective birth cohort study was to investigate the influence of the peripartum maternal use of potential QT interval-prolonging medication on the neonatal ECG. As a main finding, there was no significant effect on the mean neonatal QT interval and on the rate of infants with QT prolongation. Most frequent was the maternal use of SSRIs, PPIs, beta-agonist inhalation, and dimenhydrinate, some of which are common over-the-counter medications in Germany. Despite heterogeneous exposure due to the use of a variety of different drugs in our cohort, in a first general approach, we tested the effect of all potential QT interval-prolonging drugs in a combined analysis. No significant change in the mean neonatal QT interval after exposure to maternal potential QT interval prolonging-drugs was found. The rate of neonates with a QTc interval greater than ms was also not significantly higher in the exposed group than that in the unexposed neonates. This cut-off value has been recommended by Saul et al. Therefore, we cannot exclude that possible effects on the neonatal QT interval may already have disappeared over time due to decreasing drug levels in the neonate. In our institution, most neonates are discharged from the maternity ward on the third day of birth. Thus, our study indicates that at this time point, there was no increased risk of arrhythmia or need for further diagnostic evaluation due to drug-induced QT prolongation for the infants. Second, since numerous additional factors may have an influence on the neonatal QT interval, we performed a multivariate analysis to correct for confounding factors. This analysis also showed no significant influence of maternal QT interval-prolonging medication on the neonatal QT interval. In contrast, there was a significant association between the confounding factors of gestational age, birth weight, birth mode, and timing of the ECG with neonatal QT intervals in our setting. Transient postnatal QT interval prolongation and high dynamics in the first few days with normalization over the course of days have been described Schwartz et al. The study of Marcellino et al. In our study, neonates from 33 to 43 weeks of gestation were included, and in the multivariate approach similar to the latter study, there seemed to be a decrease in the postnatal QT interval with increasing gestational age. Furthermore, in our analysis, increasing birth weight was associated with an increasing QT interval, but this effect was rather small, with an average of a 3-ms increase in the QT interval per kilogram of weight. One possible explanation for the effect in our data might be that we did not correct for gestational diabetes of the mother. After this complication of pregnancy, prolonged QT and QT dispersion have been described and neonates also tend to be heavier Al-Biltagi et al. Interestingly, our analysis seemed to show a difference in the neonatal QT interval with respect to the mode of delivery, spontaneous delivery vs. In the logistic regression analysis, the rate of neonates with a QTc interval above ms was also significantly increased in children born by cesarean section compared to spontaneous delivery odds ratio 1. Several underlying causes are conceivable due to complex interactions, such as perinatal stress and corresponding neurohumoral activation, maternal medication during anesthesia, and an increased risk of neonatal respiratory distress. Further analyses including these factors and differentiating between primary and secondary cesarean sections are needed to evaluate whether the birth mode indeed has an impact on the neonatal QT interval and what mechanisms might cause such an impact. To the best of our knowledge, no data have been published on this topic. As gestational age, birth weight, birth mode, and timing of the ECG were not the primary exposure variables in this analysis, these findings need to be verified in further studies. Due to the heterogeneity of maternal drugs and the sample size of the respective medication groups, we performed a subgroup analysis for SSRIs, PPIs, and dimenhydrinate only. Although Dubnov-Raz et al. The results in our cohort go in line with the latter study, showing no significant effect of SSRI exposure. No cases of neonatal QT interval prolongation after the maternal use of PPIs or dimenhydrinate have been described, and to the best of our knowledge, no studies addressing the effect of intrauterine exposure to these agents on the neonatal QT time have been conducted so far. In our analysis, there was no significant effect of intrauterine exposure on the neonatal QT interval in these two subgroups. Limiting in our setting, despite the considerably large cohort, the number of exposed infants in the respective subgroups was small. This is, to the best of our knowledge, the first cohort study to investigate the possible effect of maternal medication with the known risk of QT interval prolongation in a multivariate analysis, taking important perinatal confounding factors into account. In summary, in our cohort, there was no significant effect on the neonatal QT interval, either in the overall or in the subgroup analyses, which adds important data on possible effects of maternal therapy with regard to this scarcely investigated neonatal adverse effect. Further studies with larger case numbers are necessary in order to have a more substantial database on the safety of these therapies and to clarify some of the contradictory previous study results. In this analysis, the maternal medication use more than 4 weeks before delivery was defined as non-exposure Med-. Although it is unlikely, it cannot be excluded that substances with a very long half-life still have residual activity and thus lead to fetal exposure at the time of birth. In addition, the prolonged use of long-acting drugs and subsequent accumulation can lead to increased fetal exposure. As genetic variants are known to influence susceptibility for acquired QT interval prolongation Kallergis et al. Furthermore, our results might be biased because of the single-center study design as maternal diseases and medication intake in our cohort may not match those of the general population. Future studies will need to take these factors into account when discussing individual aspects of medication safety. A relevant number of women take potential QT-interval prolonging drugs during pregnancy and until delivery. In our cohort, intrauterine exposure showed no effect on the neonatal QT interval and on the rate of infants with QT prolongation. Further studies with larger case numbers are needed in order to have a more substantial database on the safety of these therapies. Several perinatal confounders might have an influence on the neonatal QT interval. More data are needed to consider them appropriately in future studies or interpretation of neonatal ECGs in the clinical setting. The authors would like to thank all families who participated in the KUNO-Kids birth cohort study and all medical students, nurses, midwives, physicians, and researchers who facilitated the recruitment of participants and data assessment. Hedwig of the Order of St. John, Regensburg, Germany. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by the Ethics Committee of the University of Regensburg, Regensburg, Germany. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Pharmacol. Find articles by Holger Michel. Find articles by Antonia Potapow. Find articles by Markus-Johann Dechant. Find articles by Susanne Brandstetter. Find articles by Sven Wellmann. Hedwig, University of Regensburg, Regensburg, Germany. Find articles by Michael Melter. Find articles by Christian Apfelbacher. Find articles by Michael Kabesch. Find articles by Stephan Gerling. Received Mar 24; Accepted Jul 18; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Citalopram, escitalopram, fluoxetine, paroxetine, and sertraline. Amitriptyline, opipramol, clomipramine, doxepine, imipramine, nortriptyline, and trimipramine. Peripartum exposure proton pump inhibitor.

Developments in Drug Addiction During COVID-19—An Austrian Perspective Based on a Clinical Sample

Buy Heroin online in Linz

Official websites use. Share sensitive information only on official, secure websites. Reviewed by: Dan P. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Concerns about the negative consequences of the COVID pandemic on people with substance use disorder SUD were raised by experts in the field around the world. Here we provide an Austrian perspective, discussing the impact of the pandemic on help-seeking patient with drug use disorder during the initial stage of the pandemic. The viewpoints and related descriptive data include the perceived individual impact of COVID, as well as various aspects of drug use behavior and the Austrian drug market before and after the onset of the pandemic. Surprisingly and in contrast to anticipated developments, we had the impression of a rather stable situation in Austria, at least at this early stage of the pandemic. The immediate impact of COVID on these help-seeking patients with high levels of drug dependency seemed less severe than anticipated so far. Importantly, this observation might be a short-term effect for this already fragile group and careful monitoring of further developments as well as preparation of long-term strategies are advised. In general, problematic drug use is associated with many health risk factors and finding appropriate long-term health care strategies has to remain a top priority facing the pandemic. Our perspectives are restricted to observations from help-seeking patients at our clinic, and no conclusions for the general population can be directly drawn. Experts around the world have clearly articulated their concerns about the impact and consequences of the COVID pandemic on the mental health. The reciprocal impact between Covid and SUD have been described, categorized in spread of disease, risk of infection, increased severity of COVID symptoms, psychological stress, and reduced access to addiction treatment services 3. Reports from different countries suggest reduced availability of illicit and prescribed drugs, altered consumption patterns, higher probability of relapse, and even elevated risk of deadly overdose without opportunity for rescue due to social distancing and isolation 4 — 8. All this is seen as a result of government control strategies and border closures, leading to interruptions in illegal drug supply, self-manufacturing of substances, changes in quality and strength of those substances, poor access to health services, psychological stress due to isolation, worries about employment, and personal financial situation and even suicide 9 — Preexisting conditions regarding the respiratory system from inhalation drugs, damaging effects of drugs on the cardiovascular system and an overall worse health condition further increase the risk of mortality associated with COVID In fact, mortality in the population with OUD appears to be higher than in the general population 6. From a psychological perspective, recent literature indicate a serious impact of COVID on the feelings, thoughts and behavior of patients with substance addiction 14 , The current pandemic can lead to indirect consequences on PWUD, as additional stressors on mental health conditions could trigger relapses 5. Direct and indirect consequences can even grow more acute for PWUD given the poor access to health services 9. For patients in opioid substitution treatment OST , misuse and diversion of OST medicine can result in many negative effects on health, including risks from injecting behavior and overdose, and these problems have been discussed long before the COVID crisis Furthermore, progress in recovery might be at risk and the indirect impact on the whole society ranges from economic costs of untreated opioid dependence to drug-related criminal behavior In the context of COVID, experts warn about fatal opioid poisoning due to increased medication diversion People in OST already experience vulnerabilities in their medical, mental, and social health 13 , making the COVID pandemic as potential source of additional distress especially challenging. Providing stable OST services for this clinical population is therefore advised to remain a priority Government measures for health care systems included reduction of face-to-face contacts, postponement of non-urgent procedures and major restrictions for outpatient clinics. For most patients in OST, less strict regulations were applied for medication prescription extension from 1—2 months and dispensation from daily to weekly. In sum, Austria adopted early and aggressive control strategies COVID in Austria between mid of March and mid of June confirmed cases per day and related government measures during the shutdown and re-opening phases. Closely looking at the situation reported by health care systems of other countries, we feared a major impact on our drug addicted patients, whether in OST or not. As the largest addiction care facility in our province Upper Austria we prepared for different scenarios including an onrush of patients suffering from withdrawal due to reduced availability of illicit drugs or relapse of former patients, loss of contact in ongoing OST due to restricted access to our outpatient clinic, severe intoxications due to altered consumption patterns, etc. As an attempt to quantify the impact of COVID pandemic on our patients, we added specific questions to our routine anamneses for later analysis. Data is presented in a descriptive manner additionally to our perspectives in the following sections for more details see tables in the Supplementary Material. Data collection was conducted in accordance to the Declaration of Helsinki and approved by the local ethics committee. Additionally, various aspects of drug consumption patterns and drug supply e. Data collection started 1 month after the onset of the COVID crisis in Austria, determined by the first official Austrian government measures mid of March Data was collected for 2 months mid of April until mid of June Please note that this original data supports our personal perspectives, but that our views are based on our general perception of the situation in a clinical setting at the beginning of the pandemic. Our overall impression at our clinical facility was that patients were less affected by the pandemic than anticipated. The impact of COVID on personal life was categorized into physiological, psychological, economic, social, and other aspects, and indicated by the patients as either absent or present see Table 1. At the beginning of the pandemic, especially psychological and social aspects seemed to affect the personal life. Among our sample, struggling with anxiety, fear, and isolation was reported, but no direct association with factors due to COVID could be observed for levels of craving or drug dependency. From our point of view, drug consumption patterns seemed hardly affected by the COVID pandemic among the patients in Austria at the initial stage. Preferred drugs and consumption forms appeared to be unaltered by COVID, which was also reflected in our sample. None of our patients indicated a change in their preferred drug, nor how they consumed it i. Related government measures like physical distancing resulted in reduced contact only for the minority of our participants, in terms of consuming alone instead of in groups or only in private spaces. Furthermore, we found a wide range of consumed illicit drugs in our sample, with many reporting regular consumption of more than one substance or drug. The unaltered pattern of consumption is also tightly connected to a stable drug availability at the illicit drug market. Our impression is that this group of patients was struggling with many aspects brought along by the pandemic. These aspects include high levels of unemployment, financial instability, health problems, social isolation, and psychological stress. This might be a reason why the observed direct impact of COVID on drug use behavior seems less severe at this initial stage, but can result in fatal long-term effects, if no specific treatment for this group is provided. Therefore, a special emphasis on this already deprived population is of utmost importance to avoid a further downward spiral, and enabling access to psychological support and therapy is essential during the next phases of the pandemic. Developments of the illegal drug market were deflected by participants' information regarding source, pricing and quality of illicit drugs, as well as other aspects of drug supply and potential changes due to COVID see Supplementary Table 2. The way of receiving drugs active: having to leave the house; passive: getting drugs delivered did not change for any of our participants, even though government measures included movement restrictions. Stockpiling of drugs due to concerns about future availability was not observed in our study, and expected disruption in drug availability 21 could rarely be observed. According to this report, this stability on the drug market could also be observed for Czechia, Hungary, Netherlands, and Sweden, whereas changes were perceived for countries heavily impacted by COVID like France or Spain In contrast, the EMCDDA expected a decline in drug use during the first 3 months of the pandemic as summarized in their related trendspotter briefing While this might be true for other countries or in other populations with lower levels of drug dependency like recreational drug users or social substance use, our results did not confirm this anticipation. This observation is restricted to the initial stage of the pandemic, but we do not expect a long-term diminution for this specific population due to lack of drug availability or increase in pricing. In other words, drug addiction will not disappear due to outer circumstances, and again, stability in treatment and therapy is strongly advised. Misuse and concomitant use among patients in OST appeared to be a prevalent problem, even before the pandemic. We anticipated that the less restricted access to substitution medicine might lead more patients to use OST medication divergent from its purpose. From our point of view, it would also have been possible that disruption in illicit drug supply might lead patients to less concomitant use of other drugs. Another expectation was that new patients were prone to start OST due to a potential lack of availability in opioids at the illicit drug markets. All of these anticipations were not confirmed by our observations. Among our sample of patients in OST misuse and diversion were found to be very common. Misuse e. In respect to diversion, In Austria, access to health care providers 1 was less affected than the situation required in heavily impacted countries like Italy, Spain, or France. Essentially, regulations regarding prescriptions for OST medication were temporarily eased to ensure maintenance of therapy despite the lock down. It is widely acknowledged that misuse and regular concomitant use of illicit drugs in addition to prescribed OST medication is highly prevalent among these patients In our opinion, the impression that the less rigid OST supply policies had no direct impact on these problematic topics, could only be a short-term effect and the situation can get out of hand rapidly. From our perspective, during lock-down only the main pharmacological supply of these patients was enabled, while long-term treatment including psychological and psychiatric support was nearly impossible due to restricted access to all outpatient clinics. For the future, it is important to provide patients suffering from addictive disorders with all possible resources in order to maintain a high standard in addiction care practice, including use of telehealth and adopting proactive policies 3. Many factors that are brought along by the predominant COVID crisis lead to an anticipated increase in overdoses and fatal outcomes, including disruption in drug supply and social distancing In Austria these risk factors seem to play a minor role so far, which can only be indirectly deduced from our study. At least for now, drug availability is not a major concern as indicated by our participants. This lack of awareness of possible overdoses in our sample is also a cause for concern, as the majority of our participants usually consumed alone, even before the onset of the pandemic. This bears the danger that no help can be administered in case of an overdose as discussed earlier 7. Crucially, our observations are restricted to patients in treatment. We can therefore not assure that drug users, who are not seeking help, might be at greater risk of overdose during the pandemic. Therefore, emphasizing the increase of potential overdoses for persons who use drugs due to many factors brought along by COVID should be implemented in current health care strategies. At the initial stage of the pandemic, the impact of the COVID pandemic in terms of incidents and mortality has been less severe in Austria compared to other countries in Europe and worldwide. From our point of view as a clinical facility treating patients with drug use disorder, drug use behavior, and the drug market seemed also less directly affected by COVID than anticipated in Austria, at least at the initial stage of the pandemic. This is also reflected in our data collected from a small clinical population of patients with a high level of drug dependency. Although this group clearly indicated an impact of the pandemic on many aspects of their personal life, individual drug use patterns seemed less affected at this initial stage. Furthermore, the Austrian drug market in terms of pricing and availability appeared also rather stable, which is in line with other expert opinions and our overall observations at our clinical facility. The overall maintenance of the Austrian health system due to the less severe impact of COVID so far could be hypothesized as possible reasons for the stable drug situation. We urge to not misinterpret this surprising lack of direct massive impact of COVID on this clinical group as an all-clear. In fact, close monitoring of the development of this clinical population is of great importance, since long-term effects have yet to be investigated. For instance, the already difficult job situation for patients struggling with addiction might result in long-term negative consequences given the general increase in unemployment due to COVID in the general population. Furthermore, existing psychological problems might deteriorate resulting in higher numbers of comorbidities and co-addictions. Finally, pushing this clinical group further to the edge of society can have severe consequences for their well-being. In this still ongoing pandemic it cannot be foreseen, when the impact on this already deprived population struggling with many problems reaches its peak and the situation starts getting out of control. Therefore, stability in access to addiction treatment should be emphasized with regard to the COVID pandemic and resulting government measures. Prevalent misuse and concomitant use in OST are particularly alarming and need to be addressed rapidly, while maintaining a high standard in care. This is especially challenging during the COVID pandemic, with many resources of the health care system fully occupied with controlling the disease and its impact on other mental health issues. With COVID on the rise again and the multiple known risk factors for people with drug addiction, development of long-term strategies to improve the outlook for this vulnerable group cannot be neglected. In conclusion, the immediate impact of COVID on highly addicted patients with drug use disorder in treatment, was less severe than expected. We emphasize, that our perspectives are based on observations at a clinical facility and restricted to the described clinical sample. As a major health care provider in our region Upper Austria , a wide range of consequences on our patients can directly be observed and developments on the Austrian drug market can be deflected from our patients' reports. However, we emphasize that no direct conclusions for the general population can be drawn from our impressions and our small sample. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by Ethics Commission of the Medical Faculty of the Johannes Kepler University Linz. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. IF-L: conceptualization, formal analysis, methodology, and writing—original draft preparation. KY: supervision, data curation, resources, and writing—review. NG: conceptualization, data curation, and writing—review. All authors: contributed to and have approved the final manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We are very grateful to the medical staff at the Department of Psychiatry - Specialization Addiction Medicine of the Kepler University Hospital for their valuable help with data collection. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Isabella Fuchs-Leitner. Find articles by Kurosch Yazdi. Find articles by Nikolas W Gerstgrasser. Find articles by Jan Rosenleitner. Received Sep 2; Accepted Nov 5; Collection date Open in a new tab. Click here for additional data file. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Buy Heroin online in Linz