Buying 'legal' recreational drugs does not mean that you are not breaking the law

BACKGROUND

Recreational drug use in the UK is common; sources of recreational drugs are changing, with increasing purchase of legal highs from the Internet. Previous studies have shown that there is not consistency of active ingredient(s) in legal highs purchased from the Internet.

AIM

The aim of this study was to determine the impact of the 16 April 2010 change to the Misuse of Drugs Act (1971) on the content of 'legal highs' purchased over the Internet and supplied within the UK.

METHODS

Legal highs were purchased from a number of different Internet suppliers and the active ingredients determined by analysis undertaken within a Home Office approved and licensed laboratory set in a UK academic institution. The active ingredient(s) detected on screening were then compared to the UK legislation in force at the time of purchase to determine whether each individual 'legal' high was in fact legal or not.

RESULTS

All 18 products purchased prior to the change in the UK legislation contained active ingredients that were legal under the Misuse of Drugs Act (1971) in force at that time. Six products were purchased and analysed after the changes to the UK Misuse of Drugs Act (1971) on the 16 April 2010. Five of the products contained information, either on the Internet site or the packaging, stating that the product contained legal substances; the final product did not specify the active ingredient and so purchasers would be unable to determine if this was truly a legal product. Five of the six products contained an active ingredient that is a Class B drug under the Misuse of Drugs Act (1971); the other product contained an unlicensed medicine not controlled under the Misuse of Drugs Act (1971).

CONCLUSION

We have shown in this study that some drugs sold as 'legal' highs contain drugs that are controlled under the Misuse of Drugs Act (1971). Under current UK legislation, individuals purchasing legal highs that contained controlled drugs would be subject to the same penalties as if they had knowingly purchased a controlled drug. Dissemination of information on the harm associated with the use of legal highs should also inform individuals that they may be purchasing controlled substances and the potential legal consequences of this.

Purchasing 'legal highs' on the Internet--is there consistency in what you get?

BACKGROUND

The supply of recreational drugs has changed and users increasingly buy 'legal highs' over the Internet. Use of these is common and there is a potential for significant toxicity associated with their use.

AIM

To determine the content of legal highs available for purchase in the UK and whether the content of these remains consistent.

METHODS

Twenty-six legal highs were purchased monthly from five different Internet sites over 6 months. These were analysed to determine the drugs in the products and whether there were any changes in their content over this time period.

RESULTS

All products were supplied initially, but there was a decline in supply of products month by month. The following drug classes were detected: piperazines, cathinones, caffeine/ephedrine or products in which no psychoactive drugs were detected. Of the products supplied on more than one occasion, 15 (75%) contained the same compounds on each occasion. In three products there was a change in the piperazine detected, with 1-benzylpiperazine being substituted for 1-methyl-4-benzylpiperazine or vice versa. In two other products there was a cathinone [4-fluorophenylpiperazine (pFPP) or 3-fluromethcathinone (3FMC)] detected in products purchased in Month 1 that was not present in the products purchased in subsequent months.

CONCLUSION

Whilst there was no variation in the composition of most legal highs supplied over 6 month, there was significant variation in the piperazine or cathinone content of one quarter of the products. This variation could be of clinical significance as the cathinone and piperazine products can be associated with significant toxicity.

What evidence is there that the UK should tackle the potential emerging threat of methamphetamine toxicity rather than established recreational drugs such as MDMA ('ecstasy')?

BACKGROUND

There is increasing interest in whether methamphetamine is an emerging recreational drug in the UK.

AIM

To determine what evidence is there that methamphetamine use is an emerging drug in the UK compared to established recreational drugs such as MDMA.

DESIGN AND METHODS

We undertook a retrospective study collating data on the number of enquiries to both our poisons centre and the UK National Poisons Information Service (NPIS) relating to all recreational drugs, methamphetamine and MDMA; presentations to our Emergency Department (ED) with acute methamphetamine toxicity and the frequency of positive urine tests for methamphetamine and MDMA in workplace drug screening programmes.

RESULTS

There was a small increase in the number of methamphetamine-related calls to our poisons centre, but it remained uncommon (0.1% of all recreational drugs cases in 2000 to 1.23% in 2006) compared to MDMA (17.3-42.7% of all recreational drugs cases). The number of 2005/6 enquiries to the UK NPIS for methamphetamine was 12, compared to 455 MDMA enquiries (0.014 and 0.52% of all enquiries, respectively). There were five presentations to our ED relating to methamphetamine over a 15-month period compared to 171 for MDMA. Of the 254 440 urine samples screened for the presence of drugs in the workplace (2000-06), three were positive for methamphetamine and 147 for MDMA.

CONCLUSION

There is no evidence of increasing use of methamphetamine or that acute methamphetamine poisoning is a significant clinical problem compared to established recreational drugs such as MDMA. In our opinion, healthcare, educational and law enforcement resources should be proportionally directed towards tackling drugs that pose an immediate and continuing healthcare risk to the population rather than emerging recreational drugs.

Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)

BACKGROUND

Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects.

AIM

The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs.

DESIGN AND METHODS

Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present.

RESULTS

In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions.

CONCLUSION

Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.

Unreduced gametes and neopolyploids in natural populations of Achillea borealis (Asteraceae)

Polyploidy is a major mechanism of speciation and adaptation, yet little is known about the origins of polyploids in natural species. I investigated gametic nonreduction and neopolyploid formation in natural tetraploid populations of Achillea borealis (Asteraceae), an autopolyploid complex consisting of tetraploid and hexaploid cytotypes. Cytological analyses of tetraploid populations revealed the occurrence of reduced (n=2x) as well as unreduced 'big' (2n=4x) and 'jumbo' (4n=8x) pollen grains, which were clearly distinguished by size. Production of unreduced pollen was monitored in two tetraploid populations in 1997 and 1998. Mean population-level frequencies of unreduced pollen ranged from 0.030 to 0.538%, with as few as one-third and as many as one-half of sampled plants producing unreduced grains. Eight individuals were found to produce >1% unreduced pollen, with highest observed frequencies of 7.0, 13.2 and 15.8%. Experimental crosses using high unreduced pollen producers as male parents generated viable seeds. However, the frequency of neohexaploids in the progeny of experimental crosses (0.388%) was similar to that observed in progeny of randomly selected, open-pollinated control parents (0.465%). These results suggest that unreduced eggs are the most likely source of new polyploids. In spite of the inefficiency of unreduced pollen in unilateral sexual polyploidization, the overall rate of neohexaploid formation (one in 233) was several orders of magnitude greater than estimates of genic mutation rates.

Chromosomal variation and genome size support existence of cryptic species of Triatoma dimidiata with different epidemiological importance as Chagas disease vectors

The wide geographical distribution of Triatoma dimidiata, one of the three major vectors of Chagas disease, ranges from Mexico to northern Peru. Since this species occupies a great diversity of artificial and natural ecotopes, its eradication is extremely difficult. In order to assist control efforts, we used chromosome analyses and DNA amount as taxonomic markers to study genetic variability in populations of T. dimidiata from Mexico, Guatemala, El Salvador and Colombia. We differentiated three groups or cytotypes defined by characteristic chromosome C-banding patterns and genome size measured by flow cytometry. The three cytotypes are restricted to different geographic locations. Cytotype 1 occurs in Mexico (excluding Yucatán), Guatemala (excluding Petén), El Salvador and Colombia. Cytotype 2 occurs in Yucatán and cytotype 3 occurs in Petén. Cytotype 1, commonly associated with domestic and peridomestic environments but also inhabiting sylvatic ecotopes, is the most widespread and with major epidemiological significance. In contrast, the Yucatán cytotype inhabits wild ecotopes but increasingly enters houses, while the Petén cytotype appears exclusively sylvatic. We suggest that these cytotypes represent cryptic species of T. dimidiata with different epidemiological relevance as Chagas disease vectors. Poor ability to colonize human dwellings, together with their restricted geographic distribution, indicate that the Yucatán and Petén putative species probably have much less epidemiological significance than cytotype 1. Thus, the genetic markers we describe are powerful tools to differentiate cryptic species in T. dimidiata with different epidemiological significance, contributing to planning the most effective control measures.

Cuticular hydrocarbon variability among Triatoma dimidiata (Hemiptera: Reduviidae) populations from Mexico and Guatemala

The geographic variation in the cuticular hydrocarbon pattern among 11 populations of Triatoma dimidiata Latreille (Hemiptera: Reduviidae: Triatominae) from different regions of Mexico and Guatemala, was studied using capillary gas chromatography. T. dimidiata populations were differentiated based on the relative amounts of 71 hydrocarbon components. Insect population classification was mostly in agreement with their geographical vicinity; Mexican populations from the Yucatan peninsula grouped together with those from northern Guatemala, insects from the Mexican Gulf coast states were closely related to those collected from northern Oaxaca, and to a lesser extent, to insects from Chiapas. Insects from southern Oaxaca were clustered together with those from southern Guatemala. All these populations were clearly separated from Guatemalan specimens collected in caves from Alta Verapaz.

The cost-effectiveness of a patient-sitter program in an acute care hospital: a test of the impact of sitters on the incidence of falls and patient satisfaction

This article analyzes the costs and benefits of a patient-sitter program in relation to patient falls and patient satisfaction. During these days of intense budgetary scrutiny, it is necessary to integrate methods of cost/benefit analysis into our loss prevention management programs, whether physical loss or loss patient base due to dissatisfied patients. This article presents the research we have conducted to analyze costs and benefits of our patient-sitter program in relation to patient falls and patient satisfaction.

Induction of therapeutic antitumor antiangiogenesis by intratumoral injection of genetically engineered endostatin-producing Semliki Forest virus

Antiangiogenic therapy using Semliki Forest virus (SFV) carrying Endostatin gene for malignant brain tumor was investigated to improve the therapeutic efficacy. The efficiency of SFV-mediated gene delivery was first evaluated for B 16 cells and compared with the efficiency in cells of endothelial origin (HMVECs). HMVECs are more susceptible to SFV infection than B 16 cells. For the in vivo treatment model, phosphate-buffered saline, SFV-LacZ, retrovirus vector GCsap-Endostatin, and SFV-Endostatin were injected to mice bearing B 16 brain tumors. A very significant inhibition of tumor growth was observed in the group that had been treated with SFV-Endostatin. A marked reduction of intratumoral vascularization was seen in the tumor sections from the SFV-Endostatin group compared with tumor sections from the SFV-LacZ or GCsap-Endostatin groups. Moreover, at day 7 after intravenous administration of SFV-Endostatin, the serum level of endostatin was augmented more than 3-fold compared to that after intravenous administration of GCsap-Endostatin. The results indicated that treatment with SFV-Endostatin inhibited the angiogenesis with established tumors. Gene therapy with Endostatin delivered via SFV may be a candidate for the development of new therapy for brain tumors.

Ecstasy pill testing: harm minimization gone too far?

Harm reduction has become the focus of public health initiatives and therapeutic intervention in the management of dependent drug use over the last 20 years. The last decade has seen such approaches being extended to recreational drug use. Most harm reduction initiatives have aimed to inform users about risks and ways of minimizing risk. The concept of providing illicit drug users with quality assessment of their chosen drug is one possible harm reduction intervention that until recently has received little attention. In response to well-publicized 'ecstasy'-related deaths organizations in some European countries and the United States have chosen to provide a 'pill testing service' for users. There are two broad categories of pill testing offered. Simple colour reagent test kits (Marquis Reagent and colour charts) form the most widely used on-site pill testing method. Less frequently, but more accurately, laboratory personnel with access to sophisticated chromatographic equipment (high performance liquid chromatography (HPLC) or gas chromatography-mass spectrometry (GC-MS)) may provide analysis of a pill. Pill testing kits have been advocated as a 'tool to protect yourself against the polluted XTC market'. We refute this line of reasoning. Of the different tests only techniques such as GC-MS can identify satisfactorily the psychoactive constituents present in ecstasy pills. Colour tests based on an interpretation of a colour response in the presence of a drug are, at best, subjective. Pill testing of any description does not guarantee safety, or protect the consumer against individual responses to pills. At best it gives an artificial 'shine of safety' to a group of diverse drugs that remain both illicit and potentially harmful. Other simpler harm reduction mechanisms are likely to be more effective.

Isoenzyme variability of five principal triatomine vector species of Chagas disease in Mexico

Triatoma barberi, T. dimidiata, T. longipennis, T. pallidipennis and T. picturata, all key Chagas disease vectors in Mexico, were analysed by multilocus enzyme electrophoresis (MLEE) at 17 putative loci. The majority of insect specimens studied were collected from domestic and peridomestic structures from multiple geographic locations while others were collected from sylvatic areas. T. barberi was the least polymorphic species (P(0.95)=0.18), with polymorphism rates of the other species ranging from 0.29 to 0.50. T. barberi, a member of the protracta complex, clustered apart from the other studied species by Nei's genetic distance with >1.36, and at least eight loci were found to be diagnostic for this species. T. dimidiata was more related to T. longipennis, T. pallidipennis and T. picturata (phyllosoma complex) than to T. barberi, with a genetic distance averaging 0.36 with the phyllosoma complex species. In contrast, the genetic distances between the three phyllosoma complex species were not significantly different from zero, and there were no species-specific loci differentiating among them. The results strongly support the grouping of these three species in one complex, separate from the two other species studied.

Induction of a therapeutic antitumor immunological response by intratumoral injection of genetically engineered Semliki Forest virus to produce interleukin-12

OBJECT

The authors investigated immunogene therapy for malignant glioma to determine whether its therapeutic efficacy could be improved.

METHODS

Four groups of 203-glioma-bearing mice were treated with injections of phosphate-buffered saline, Semliki Forest virus (SFV)-LacZ, retrovirus vector DFG-interleukin (IL)-12, and SFV-IL12, respectively. The results indicated that therapeutic immunization with SFV-IL12 prolonged the survival of mice with established tumors. Semliki Forest virus induces apoptotic death to glioma cells, which facilitates the uptake of apoptotic cells by dendritic cells, providing a potential mechanism for enhanced immunogenicity.

CONCLUSIONS

Immunogene therapy with IL-12 via SFV may be an excellent candidate for the development of new cancer vaccines.

Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy

PURPOSE

To report sloughing of corneal epithelium during laser in situ keratomileusis and subsequent wound healing complications in patients with epithelial basement membrane dystrophy.

METHODS

In a retrospective study, the surgical procedures, postoperative course, and visual acuities of 16 eyes of nine patients with epithelial basement membrane dystrophy who underwent laser in situ keratomileusis complicated with epithelial sloughing at three centers were reviewed. The mean follow-up period was 23 weeks (range, 4 to 52 weeks).

RESULTS

In 13 (81%) of 16 eyes with epithelial basement membrane dystrophy, epithelial sloughing occurred during laser in situ keratomileusis. In eight of the 13 eyes, epithelial growth beneath the flap was observed. The flap was lifted and the interface epithelium scraped in six eyes. Flap melt or keratolysis occurred in four eyes. At the last follow-up visit, 13 of 16 eyes had an uncorrected visual acuity of 20/30 or better, and all eyes had a best-corrected visual acuity of 20/30 or better.

CONCLUSIONS

Patients with epithelial basement membrane dystrophy have poorly adherent corneal epithelium and are predisposed to epithelial sloughing during the microkeratome pass of laser in situ keratomileusis. This may lead to flap distortion, interface epithelial growth, flap keratolysis, and corneal scarring. It is not recommended that laser in situ keratomileusis be performed in patients with classic, symptomatic epithelial basement membrane dystrophy. In patients who present with mild and asymptomatic epithelial basement membrane dystrophy, laser in situ keratomileusis should be performed with caution, or photorefractive keratectomy may be the preferred refractive procedure.

Venipuncture in the medical physiology laboratory

Medical physiology laboratories, traditionally devoted to animal experimentation, face unprecedented difficulties linked to cost, staffing, instrumentation, and the use of animals. At the same time, laboratory experiences with living creatures play a unique role in medical education. In this article we describe the use of venipuncture and subsequent blood analysis, with medical students serving as both subjects and experimenters, in a sequence of first-year physiology laboratories. These experiments are safe, robust, inexpensive, and time efficient, and they teach the principles of cardiovascular, respiratory, renal, nutritional, and gastrointestinal physiology. In addition, they enhance medical education in several other important dimensions. First, they teach safe venous blood collection and handling, a training appropriate for students at this level. Second, by serving each week as subjects as well as experimenters, students experience aspects of both sides of the doctor-patient relationship. Third, the laboratories can be used to teach fundamentals of research design and analysis. Finally, because blood analysis is central to medicine, and because the student's own blood data are discussed, students are enthusiastic and cooperative, and the clinical relevance of the data is clear.