Understanding and preventing the advertisement and sale of illicit drugs to young people through social media: A multidisciplinary scoping review

ISSUES

The sale of illicit drugs online has expanded to mainstream social media apps. These platforms provide access to a wide audience, especially children and adolescents. Research is in its infancy and scattered due to the multidisciplinary aspects of the phenomena.

APPROACH

We present a multidisciplinary systematic scoping review on the advertisement and sale of illicit drugs to young people. Peer-reviewed studies written in English, Spanish and French were searched for the period 2015 to 2022. We extracted data on users, drugs studied, rate of posts, terminology used and study methodology.

KEY FINDINGS

A total of 56 peer-reviewed papers were included. The analysis of these highlights the variety of drugs advertised and platforms used to do so. Various methodological designs were considered. Approaches to detecting illicit content were the focus of many studies as algorithms move from detecting drug-related keywords to drug selling behaviour. We found that on average, for the studies reviewed, 13 in 100 social media posts advertise illicit drugs. However, popular platforms used by adolescents are rarely studied.

IMPLICATIONS

Promotional content is increasing in sophistication to appeal to young people, shifting towards healthy, glamourous and seemingly legal depictions of drugs. Greater inter-disciplinary collaboration between computational and qualitative approaches are needed to comprehensively study the sale and advertisement of illegal drugs on social media across different platforms. This requires coordinated action from researchers, policy makers and service providers.

Analysis of the Methylation Level of the DAT1 Dopamine Transporter Gene in Patients Addicted to Stimulants, Taking into Account an Analysis of Personality Traits

Drug addiction is a chronic biochemical drug use disorder that affects the human brain and behavior and leads to the uncontrolled use of legal or illicit drugs. It has been shown that three factors are involved in the development of addiction: genetic factors, a diverse environment, and the effect of medication on gene expression. The comprehensive approach and holistic analysis of the problem are due to the multigenic and multifactorial nature of addiction. Dopamine, one of the major neurotransmitters in the brain, is believed to be the "culprit" that leads to a drug abuse-induced "high". That is why, in our research, we focused mainly on the genes related to dopaminergic reuptake. In the present study, we chose methylation of the DAT1 dopamine transporter gene based on molecular reasons related to the dopaminergic theory of addiction. This study included two groups: 226 stimulant-dependent and 290 non-stimulant-dependent subjects. The analysis consisted of a case-control comparison of people addicted to psychostimulants compared to a control group of healthy and non-addicted people. There were differences in the levels of statistical significance between the groups. Our research shows lower methylation of islands 1, 9, and 14 in addicted people and greater methylation of islands 32 and 33. The difference in individual CpG methylation islands of the gene under study provides valuable information about the DNA methylation process in patients addicted to psychostimulants. Pearson's linear correlation analysis in stimulant dependence showed a negative correlation between total methylation island levels and the NEO-FFI Neuroticism scale. In subjects with neuroticism, the methylation level was statistically significantly lower. Pearson's linear correlation analysis of stimulant-dependent subjects showed a positive correlation between total methylation island levels and the NEO-FFI Openness scale and the NEO-FFI Conscientiousness scale.

Utilizing Different Diffusion Mechanisms for Thin Film Fluorescence-Based Detection and Discrimination of Illicit Drug Vapors

Film-based fluorescence sensors have been demonstrated to be powerful tools for real-time detection of trace chemical vapors. While explosive vapor detection via fluorescence quenching has been widely explored, fluorescence-based real-time detection and identification of illicit drug vapors remains a challenge. Here, we report two perylene diimide-based sensing materials, P1 and P2, incorporating 2,2-dihexyloctanyl chains and 4-[tris(4-{tert-butyl}phenyl)methyl]phenyl moieties at the imide positions, respectively. Quartz crystal microbalance with in situ photoluminescence measurements showed that N-methylphenethylamine, a simulant of methamphetamine (MA), diffused into films of P1 and P2 via Fickian and case-II mechanisms, respectively. The difference in the analyte diffusion mechanism led to P2 showing significantly faster luminescence quenching but slower luminescence recovery compared to P1. Finally, the different diffusion mechanisms were used as the basis for developing a simple sensor array based on P1 and P2 that could selectively detect free-base illicit drugs (MA, cocaine, and tetrahydrocannabinol) from potential interferants (organic amines, alcohol, and cosmetics) within 40 s.

Exploring the Decision-Making Process behind Illicit Drug Use at Music Festivals

Background: Illicit substance use is common at music festivals. One could question whether festival attendees deliberately plan to take drugs at such events or whether their illicit (poly)drug use is provoked by specific circumstances, such as the presence of peers or a general belief that others are using drugs at the festival. Objectives: The present study implemented the prototype willingness model, which is a model that assesses whether illicit drug use at music festivals is rather a rational or a more spontaneous decision-making process. Results: A three-wave panel survey was conducted, questioning festival attendees before (n = 304, 60.86% males), during, and after music festival visits. In total, 186 people (59.68% males) between 18 and 55 years (M = 27.80 years; SD = 8.19) completed all three surveys, of which 62.9% had taken one or more different illicit substances at the festival. Positive attitudes toward illicit drug consumption were most firmly related to attendees' intentions to take drugs at festivals. Additionally, the more festival visitors identified themselves with the prototype of an attendee using drugs, the more likely they were to be willing to use them. The perceived presence of illicit substances at such events was also strongly related to the actual behavior. Conclusion: The findings suggest that illicit drug use at music festivals relates to both a rational choice and an unplanned one.

[A cohort study of HIV infection in club drug abusers among men who have sex with men in Qingdao]

Objective: To understand and analyze the incidence of HIV infection in club drug abusers among men who have sex with men (MSM) in Qingdao and provide a reference for the prevention and intervention of this population. Methods: From March 2017 to July 2022, club drug abusers among MSM who are HIV-negative were recruited by snowball sampling of MSM social organizations in Qingdao, a prospective cohort was established, and a follow-up survey was conducted every six months, with the sample size estimated to be 436. The survey contents included demographic characteristics, sexual characteristics, AIDS knowledge awareness, club drug abuse, HIV testing, and other information. HIV infection was the outcome-dependent variable, and the interval between the recruitment into the cohort and the HIV infection was the time-dependent variable. Cox proportional hazards regression analysis was conducted to identify the related factors for HIV infection. Results: A total of 987 participants of club drug abusers among MSM were recruited during the baseline survey and 826 eligible participants were enrolled in this cohort. A total of 46 HIV infection cases were found, and the cumulative follow-up time was 1 960.68 person-years. The incidence of HIV infection was 2.35/100 person-years. The multivariate Cox regression analysis showed that <30 (aHR=3.04, 95%CI: 1.62-5.71) non-Shandong residents (aHR=2.29,95%CI:1.20-4.39) found their partners through offline (aHR=4.62,95%CI:2.05-10.41), homosexual sexual partners >4 (aHR=3.06,95%CI:1.59-5.88), condom broken during sex (aHR=2.24,95%CI:1.21-4.17) and hemorrhage sexual intercourse (aHR=2.56,95%CI:1.31-5.03) were significantly associated with HIV infection in this cohort. Conclusions: The incidence of HIV infection in club drug abusers among MSM in Qingdao is generally low, but knowledge and practice have separated, and the risk of HIV infection is high. The related factors of HIV infection included younger age, non-Shandong residents, finding their partners offline, multiple sexual partners, condom break during sex, and hemorrhage sexual intercourse; HIV-related behavioral intervention should be strengthened.

End-of-life care in illicit drug users: mapping medication use

BACKGROUND

While clinical wisdom has long provided suggested guidance around caring for people who use illicit drugs (referred to as PWUD) at the end of life, there is striking paucity of empirical evidence underpinning these practices. Understanding medications and doses required to manage symptoms at the end of life is essential to provide effective end-of-life care for these patients. This study aimed to examine the type and dose of medications prescribed to hospitalised patients who use illicit drugs at the end of life, compared with patients without previous or current illicit drug use.

METHOD

A retrospective medical record review was conducted on consecutive patient deaths between 2012 and 2017 at a metropolitan hospital. PWUD were identified using the International Classification of Diseases 10th Revision codes for illicit drug use. Daily dosage of opioids, benzodiazepines and antipsychotics was documented for the last 3 days of life and compared with a matched comparator group.

RESULTS

PWUD patients (n=55) received higher doses of opioids, midazolam and antipsychotics than comparator patients (n=55) for each day, significant for opioids in the last 24 hours (p=0.01). PWUD patients received a significantly higher total opioid dose (median=480.0 mg vs 255.0 mg) and midazolam (median=15.0 mg vs 5.0 mg) (both p<0.05). Rates of dose escalation did not differ.

CONCLUSIONS

Results suggest that PWUD require greater doses of symptom-controlling medications, particularly opioids and midazolam, at the end of life but that rates of dose escalation do not differ greatly. This study provides a foundation for future research to inform clinical guidelines for this cohort of palliative care patients.

Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022

INTRODUCTION

The emergence of benzodiazepine-type new psychoactive substances (NPSs) are a growing international public health concern, with increasing detections in drug seizures and clinical and coronial casework. This study describes the patterns and nature of benzodiazepine-type NPS detections extracted from the Emerging Drugs Network of Australia - Victoria (EDNAV) project, to better characterise benzodiazepine-type NPS exposures within an Australian context.

METHODS

EDNAV is a state-wide illicit drug toxicosurveillance project collecting data from patients presenting to an emergency department with illicit drug-related toxicity. Patient blood samples were screened for illicit, pharmaceutical and NPSs utilising liquid chromatography-tandem mass spectrometry. Demographic, clinical, and analytical data was extracted from the centralised registry for cases with an analytical confirmation of a benzodiazepine-type NPS(s) between September 2020-August 2022.

RESULTS

A benzodiazepine-type NPS was detected in 16.5 % of the EDNAV cohort (n = 183/1112). Benzodiazepine-type NPS positive patients were predominately male (69.4 %, n = 127), with a median age of 24 (range 16-68) years. Twelve different benzodiazepine-type NPSs were detected over the two-year period, most commonly clonazolam (n = 82, 44.8 %), etizolam (n = 62, 33.9 %), clobromazolam (n = 43, 23.5 %), flualprazolam (n = 42, 23.0 %), and phenazepam (n = 31, 16.9 %). Two or more benzodiazepine-type NPSs were detected in 47.0 % of benzodiazepine-type NPS positive patients. No patient referenced the use of a benzodiazepine-type NPS by name or reported the possibility of heterogenous product content.

CONCLUSION

Non-prescription benzodiazepine use may be an emerging concern in Australia, particularly amongst young males. The large variety of benzodiazepine-type NPS combinations suggest that consumers may not be aware of product heterogeneity upon purchase or use. Continued monitoring efforts are paramount to inform harm reduction opportunities.

Examining the Association between Medical Marijuana Legalization and Criminal Behaviors: Evidence from a U.S. Representative Sample

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015-2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015-2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted.

Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS)

Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.

Restrictive measures and substance use reporting: New evidence from the COVID-19 pandemic

BACKGROUND

Since the beginning of the COVID-19 pandemic, several studies have been conducted on the impact of lockdown and containment measures on various aspects of individual and social behaviour, including substance use. The increasing body of literature investigating this phenomenon emphasizes the need for additional studies at the local level. We investigate changes in reported illicit drug consumption following changes in public measures limiting individual mobility in the province of Bergamo, one of the regions that faced the most severe consequences in terms of number of cases and death toll in the early stages of the pandemic.

METHODS

The empirical analysis is based on a unique dataset covering all people recorded by police forces as drug users between January 2019 and December 2021 in the province of Bergamo. Data relate to reports for illicit drug consumption and not criminal activities.

RESULTS

Estimates show that, during periods when individual mobility was severely limited, the probability of reported cannabis consumption decreased by 8-9%, while that of reported cocaine use increased by 6-12%. No significant changes emerge in the reported consumption of heroin or polysubstance. Furthermore, while reported cannabis use returned to pre-pandemic levels once the restrictive measures were eased, the increased likelihood of reported cocaine use appears to have been more long-lasting. These findings are robust to alternative estimation strategies and different model specifications. Our study also reveals significant gender, age and housing status disparities in reported drug use.

CONCLUSION

We provide a novel and distinctive perspective on the topic by using previously unexploited administrative data sources. We show that the relationship between restrictions and reported drug use varies by type of substance. Our methodology and findings can support the design of targeted policies for better resource allocation and improved public health outcomes.

Comparing police use of drug detection dogs amongst injecting and non-injecting groups of people who regularly use drugs in Australia

INTRODUCTION

Drug detection dogs are utilised across multiple settings, however existing literature focuses predominantly on festival-based encounters. We compare drug dog encounters in non-festival settings among two samples of people who regularly use drugs, and investigate factors associated with witness only versus stop and/or search encounters.

METHODS

Australians who regularly (i.e., ≥monthly) use ecstasy and/or other illegal stimulants (n = 777; Ecstasy and Related Drugs Reporting System (EDRS)) or inject illegal drugs (n = 862; Illicit Drugs Reporting System (IDRS)) were surveyed between April-June, 2019. Univariable regression analyses were used to test for differences in drug dog encounters between samples, and to identify factors associated with a more intensive drug dog encounter (namely those that involved a stop and/or search).

RESULTS

People who inject drugs were less likely to witness drug dogs than those who regularly use ecstasy and/or other illegal stimulants (odds ratio (OR) 0.46; 95 % CI 0.30-0.69). They were significantly more likely than EDRS participants to report being stopped and searched (3.29; 1.68-6.44) however. Among those carrying drugs at their last stop and/or search encounter, the majority of both samples reported that their drugs were not detected by police. IDRS participants aged 35-49 were more likely to report a stop and/or search encounter than those aged 17-34; no significant associations were found among the EDRS sample.

CONCLUSIONS

Despite participants who use ecstasy and/other stimulants being more likely than those who regularly inject drugs to report encountering drug dogs in non-festival settings, participants who inject drugs were more likely to report an intensive or invasive drug dog encounter and/or receiving a formal criminal justice consequence. This study reinforces questions about the efficacy and appropriateness of drug dog operations.

Bombé, an undetermined substance that caused an outbreak of illicit drug use in Kinshasa, Democratic Republic of the Congo

BACKGROUND

Illegal drugs are becoming a public health problem in African cities. In 2021, Bombé, a new drug of unknown composition, caused an outbreak of neuro-psychiatric symptoms in Kinshasa. Bombé was rumored to be based on ground catalytic exhausts stolen from cars.

METHODS

The chemical composition of six samples of Bombé obtained from different neighborhoods in Kinshasa was determined by triple quad liquid chromatography-mass spectrometry/mass spectrometry with confirmation by quadrupole time-of-flight mass spectrometry. Metals were determined by inductively coupled plasma-mass spectrometry, and polycyclic aromatic hydrocarbons were measured by gas chromatography-mass spectrometry.

RESULTS

Analysis of the Bombé samples revealed that it contained heroin (2-12% of the total area under the curve of the samples) and opioid derivatives, plus paracetamol (33-72%), caffeine (17-26%), and also benzodiazepines (5/6 samples) and cyproheptadine (2/6 samples). The concentrations of neurotoxic metals were unremarkable. The median (range) concentrations of manganese and lead were 9.4 µg/g (range 3-334 μg/g) and 0.36 µg/g (range 0.1-3.12 μg/g ), respectively. All polycyclic aromatic hydrocarbons were below the level of detection (<0.10 µg/g).

CONCLUSION

Thanks to international collaboration, Bombé was documented to be a heroin-based drug and its alleged origin from catalytic exhausts was not substantiated. The local human expertise and technical capacity for undertaking toxicological analyses should be increased in Africa.

Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan

BACKGROUND

Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention.

METHODS

Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca' Granda Policlinico in Milan.

RESULTS

A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users' group; p = 0.0021.

CONCLUSIONS

Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.

Are behavioural risk factors clusters associated with self-reported health complaints? University students in Finland

OBJECTIVES

No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task.

METHODS

Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health.

RESULTS

Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor.

CONCLUSIONS

Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.

Psychoactive substances and previous hospital admissions, triage and length of stay in rural injuries: a prospective observational study

BACKGROUND

Patients admitted to hospital after an injury are often found to have used psychoactive substances prior to the injury. The aim of this study was to investigate the associations between psychoactive substances (alcohol, psychoactive medicinal drugs and illicit drugs) and previous hospital admissions, triage and length of stay in the arctic Norwegian county of Finnmark.

METHODS

Patients ≥ 18 years admitted due to injury to trauma hospitals in Finnmark from January 2015 to August 2016 were approached. Parameters regarding admittance and hospital stay were collected from 684 patients and blood was analysed for psychoactive substances. Using a prospective, observational design, time, triage, length of stay in hospital, use of intensive care unit (ICU), injury severity, Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) and number of previous admittances were investigated by bivariable testing and logistical regression analysis.

RESULTS

Of 943 patients approached, 81% consented and 684 were included in the study. During the weekend, 51.5% tested positive for any substance versus 27.1% Monday-Friday. No associations were identified between testing positive and either triage or injury severity for any substance group although triage level was lower in patients with AUDIT-C ≥ 5. Short length of stay was associated with alcohol use prior to injury [odds ratio (OR) 0.48 for staying > 12 h, confidence interval (CI) 0.25-0.90]. The OR for staying > 24 h in the ICU when positive for an illicit substance was 6.33 (CI 1.79-22.32) while negatively associated with an AUDIT-C ≥ 5 (OR 0.30, CI 0.10-0.92). Patients testing positive for a substance had more often previously been admitted with the strongest association for illicit drugs (OR 6.43 (CI 1.47-28.08), compared to patients in whom no substances were detected.

CONCLUSIONS

Triage level and injury severity were not associated with psychoactive substance use. Patients using alcohol are more often discharged early, but illicit substances were associated with longer ICU stays. All psychoactive substance groups were associated with having been previously admitted.

Energetics of high temperature degradation of fentanyl into primary and secondary products

Fentanyl is a synthetic opioid used for managing chronic pain. Due to its higher potency (50-100×) than morphine, fentanyl is also an abused drug. A sensor that could detect illicit fentanyl by identifying its thermally degraded fragments would be helpful to law enforcement. While experimental studies have probed the thermal degradation of fentanyl, little theoretical work has been done to understand the mechanism. Here, we studied the thermal degradation pathways of fentanyl using extensive ab initio molecular dynamics simulations combined with enhanced sampling via multiple-walker metadynamics. We calculated the free energy profile for each bond suggested earlier as a potential degradation point to map the thermodynamic driving forces. We also estimated the forward attempt rate of each bond degradation reaction to gain information about degradation kinetics.

Comprehensive detection of lysergic acid diethylamide (LSD) in forensic samples using carbon nanotube screen-printed electrodes

Lysergic acid diethylamide (LSD) is a prevalent psychoactive substance recognized for its hallucinogenic properties, often encountered in blotter papers for illicit consumption. Given that LSD ranks among the most widely abused illicit drugs globally, its prompt identification in seized samples is vital for forensic investigations. This study presents, for the first time, an electrochemical screening method for detecting LSD in forensic samples, utilizing a multi-wall carbon nanotube screen-printed electrode (SPE-MWCNT). The LSD detection process was optimized on SPE-MWCNT in a phosphate buffer solution (0.1 mol L-1, pH 12.0) using square wave voltammetry (SWV). The combined use of SPE-MWCNT with SWV displayed robust stability in electrochemical responses for both qualitative (peak potential) and quantitative (peak current) LSD assessment, with a relative standard deviation (RSD) of less than 5% across the same or different electrodes (N = 3). A linear detection range was established between 0.16 and 40.0 μmol L-1 (R2 = 0.998), featuring a low limit of detection (LOD) of 0.05 μmol L-1. Interference studies with twenty-three other substances, including groups of phenethylamines typically found in blotting papers (e.g., NBOHs and NBOMes) and traditional illicit drugs, were performed, revealing a highly selective response for LSD using the proposed method. Consequently, the integration of SPE-MWCNT with SWV offers a robust tool for qualitative and quantitative LSD analysis in forensic applications, providing rapid, sensitive, selective, reproducible, and straightforward preliminary identification in seized samples.

Understanding the dynamics of chemsex among men who have sex with men, male sex workers and transgender women in Dhaka, Bangladesh: a multiphase sequential mixed-method research protocol

INTRODUCTION

Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (hijra) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and hijra in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions.

METHODS AND ANALYSIS

This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and hijra to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops.

ETHICS AND DISSEMINATION

Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.

Blood-lead level in humans and drug addiction: a comprehensive study in Iran

Drug abuse has a high prevalence worldwide and causes many health-related disorders. There are limited human exposure studies on establishing lead exposure levels and their propensity for drug addiction. In the present study, blood samples were tested for lead (Pb) concentrations in illicit drug users together with the related symptoms in comparison with control group of non-drug users. The study was performed on 250 volunteers divided equally in four drug groups, namely, opioids, hashish, methadone, and methamphetamine, and one control group of non-drug users. Participants were recruited from drug addiction clinics and camps in Kashan city, Iran, who were using drugs continuously for more than 1 year. Control group was recruited from companions of the patients with no drug use history. In the investigated groups of drug users, the highest blood-lead level (BLL) concentrations were observed in the opioid group (mean 37.57 µg/dL) with almost 3.7 times higher than in the control group (mean 3.39 µg/dL). In the methamphetamine group, type of occupation had the significant association with BLL concentrations. The positive correlation was revealed in the opioid and methadone groups for BLL concentrations and the duration of drug usage. In the opioid group, the highest BLL concentrations were observed among users who used both methods of drug use: smoking and eating. Also, several behavioral and life-style factors were identified which influence the blood-lead concentration in the drug users. The results of our study revealed that the BLL concentrations in investigated drug users' groups were significantly higher than in the control group (P < 0.001). That can be related with the Pb contents in illicitly used drugs. Apart other adverse health effects, long-term illicit drug use might cause to lead poisoning.

Self-reported Xylazine Experiences: A Mixed-methods Study of Reddit Subscribers

OBJECTIVES

Xylazine is an α 2 -agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from people who use drugs (PWUDs). Specifically, we sought to answer the following: (1) What are the demographics of Reddit subscribers reporting exposure to xylazine? (2) Is xylazine a desired additive? And (3) what adverse effects of xylazine are PWUDs experiencing?

METHODS

Natural language processing (NLP) was used to identify mentions of "xylazine" from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022.

RESULTS

Seventy-six posts were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. Sixty-one participants completed the survey. Of those who disclosed their location, 25 of 50 participants (50%) reported locations in the Northeastern United States. The most common route of xylazine use was intranasal use (57%). Thirty-one of 59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%).

CONCLUSIONS

Among respondents on these Reddit forums, xylazine seems to be an unwanted adulterant. People who use drugs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This seemed to be more common in the Northeast.

Comparison of three DNA extraction methods tested on illicit drug-related powders

The detection of human DNA on and within illicit drug preparations is novel and a focus of current research. Previous studies have indicated that certain drug-related powders present in illicit drug preparations can interfere with downstream DNA analysis when directly added to the PCR. Therefore, it is important to determine if these drug-related powders are effectively removed during the DNA extraction or whether traces of powder remain to interfere with DNA processing. Three extraction methods were selected to assess their efficiency at removing drug-related powders for downstream processes using DNA from both saliva and touch depositions. This is the first study to compare efficiencies of DNA extraction methods from drug-related powders. The extraction methods compared were the DNA IQ™ System, the QIAamp® DNA Investigator Kit and the combination of a simple lysis step followed by use of the Microcon® DNA Fast Flow device. Saliva was added to dimethylsulfone (DMS), nitrostyrene and PROSOLV® tablet mixture to determine the effect of powder type (based on solubility). Saliva was also added to 0, 50, 200 and 400 mg of DMS to determine the effect of an increase in DMS quantity. Trace DNA was deposited onto DMS using a worn glove approach. These samples were re-tested six months post-DNA deposition and profiled for further comparisons. Ten replicates were conducted for each condition with five replicates of saliva positive controls per method (n = 255 samples). A subset of samples was chemically analysed to determine if DMS was present in the final DNA eluant. The readily soluble DMS did not interfere with any of the extraction methods at lower amounts, however increasing the DMS to 400 mg reduced the relative DNA yields using the Microcon® and Investigator methods. The tablet mixture reduced the relative DNA yield of all three methods, however the nitrostyrene (which was relatively insoluble) only reduced the relative DNA yield of the DNA IQ™. The Investigator method performed the best with the trace samples, followed by the Microcon® method and then the DNA IQ™. DMS was detected in all extracts chemically analysed from the DNA IQ™ and Microcon®, whereas only one sample tested from the Investigator kit contained DMS in the extract and was in a relatively low amount compared to the other samples. Not one kit outperformed the others in all comparisons, however the Investigator kit was the most efficient overall at optimising the DNA yield whilst also removing the powders more effectively.

"Safer Drug Supply" Measures in Canada to Reduce the Drug Overdose Fatality Toll: Clarifying Concepts, Practices and Evidence Within a Public Health Intervention Framework

North America has been home to an unprecedented crisis of drug overdose deaths, driven largely by drug users' exposure to highly potent and toxic, illicit opioid drugs (e.g., fentanyl). Although a large and diverse menu of interventions (e.g., targeted prevention or treatment measures) has been implemented or expanded in Canada, these have not effectively managed to revert and reduce this excessive death toll. Given the fact that these interventions do not directly aim to address toxic drug exposure as the primary vector and cause of acute overdose deaths, public health-oriented "safer drug supply" measures have been initiated in local settings across Canada. These safer supply initiatives provide users with prescribed, pharmaceutical-grade drug supply with the aim of reducing overdose and death risks. These measures have been criticized but also misconstrued from several angles, e.g., as representing inadequate medical or even unethical and harmful practice. Related concerns regarding "diversion" have been raised. In this Perspective, we briefly address some of these issues and clarify selected issues of elementary concepts, practices, and evidence related to safer supply measures within a public health-oriented intervention framework. These measures are also discussed in reference to other, comparable types of public health-oriented emergency health or survival care standards, while considering the extreme contexts of an ongoing, acute drug death crisis in Canada.