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Masterson JM, Zhao H, Choi E, Kim HH, Anger JT. Characteristics and Long Term Follow up of Men Who Suffer Ischemic Priapism Secondary to Recreational Use of Intracavernosal Injectable Medications. Urology 2021; 156:163-168. [PMID: 34273403 DOI: 10.1016/j.urology.2021.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To better understand patient experience, risk factors, culture, and ED outcomes surrounding recreational ICI use that led to ischemic priapism. METHODS After IRB approval, men presenting for ischemic priapism secondary to recreational ICI use from January 2010 to December 2018 were contacted by mail and then via telephone. Standardized questions were asked of all study participants on the topics of erectile function (IIEF-5), sexual practices, and at-risk behavior at the time of priapism. Qualitative data analysis was performed using grounded theory methodology. RESULTS 14 men age 24-59 were successfully recruited. All men described themselves as men having sex with men (MSM) and one (7.1%) as having both male and female sexual partners. Average follow up IIEF-5 among participants was 13 (SD 4.0). Eleven men (78.6 %) described illicit drug use at the time of priapism. Qualitative data analysis yielded several preliminary themes: concomitant drug use, naivety, peer pressure, and delay in seeking treatment. Men frequently reported illicit drug use in group sex scenarios and ICI use under pressure to perform sexually or to counteract effects of illicit substances. CONCLUSIONS Recreational ICI in this cohort was part of a lifestyle of risky behavior. Methamphetamine use and group sex encounters strongly motivate recreational ICI use. Substance abuse centers may offer an entry point into this population for counseling and primary prevention.
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Affiliation(s)
- John M Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hanson Zhao
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eunice Choi
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard H Kim
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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Elshikh AH, Kango G, Baalbaki M, Lankowsky J, Bawa A. Amyl Nitrite-Induced Hemolytic Anemia: Acute Therapy and Prevention. Cureus 2021; 13:e16099. [PMID: 34345568 PMCID: PMC8325596 DOI: 10.7759/cureus.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Inhaled nitrites have been a substance of recreational use for centuries, primarily among men who have sex with men (MSM). However, there is a lack of awareness of the use of inhaled nitrites in this population and the possible complications and health disparities it carries. In this case report, we present a 62-year-old man with a past medical history of glucose-6 phosphate dehydrogenase (G6PD) deficiency presenting with severe hemolytic anemia and methemoglobinemia after recreational use of inhaled nitrites. The case was complicated with the presence of methemoglobinemia in a patient with G6PD deficiency. This report also aims to increase awareness of the use of nitrites in the MSM population. The use of nitrites is a predictor for high-risk sexual behavior and is associated with positive human immunodeficiency virus (HIV) status.
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Affiliation(s)
- Amira H Elshikh
- Internal Medicine, George Washington University, Washington, USA
| | - Ghazal Kango
- Internal Medicine, George Washington University, Washington, USA
| | - Marwa Baalbaki
- Internal Medicine, George Washington University, Washington, USA
| | - Jeffrey Lankowsky
- Pulmonology and Critical Care, George Washington University, Washington, USA
| | - Amandeep Bawa
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington DC, USA
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Cruz SL, Bowen SE. The last two decades on preclinical and clinical research on inhalant effects. Neurotoxicol Teratol 2021; 87:106999. [PMID: 34087382 DOI: 10.1016/j.ntt.2021.106999] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022]
Abstract
This paper reviews the scientific evidence generated in the last two decades on the effects and mechanisms of action of most commonly misused inhalants. In the first section, we define what inhalants are, how they are used, and their prevalence worldwide. The second section presents specific characteristics that define the main groups of inhalants: (a) organic solvents; (b) aerosols, gases, and volatile anesthetics; and (c) alkyl nitrites. We include a table with the molecular formula, structure, synonyms, uses, physicochemical properties and exposure limits of representative compounds within each group. The third and fourth sections review the direct acute and chronic effects of common inhalants on health and behavior with a summary of mechanisms of action, respectively. In the fifth section, we address inhalant intoxication signs and available treatment. The sixth section examines the health effects, intoxication, and treatment of nitrites. The seventh section reviews current intervention strategies. Finally, we propose a research agenda to promote the study of (a) solvents other than toluene; (b) inhalant mixtures; (c) effects in combination with other drugs of abuse; (d) age and (e) sex differences in inhalant effects; (f) the long-lasting behavioral effects of animals exposed in utero to inhalants; (g) abstinence signs and neurochemical changes after interrupting inhalant exposure; (h) brain networks involved in inhalant effects; and finally (i) strategies to promote recovery of inhalant users.
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Affiliation(s)
- Silvia L Cruz
- Department of Pharmacobiology, Center of Research and Advanced Studies (Cinvestav), Calzada de los Tenorios No. 235, Col. Granjas Coapa, México City 14330, México.
| | - Scott E Bowen
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7906.1, Detroit, MI 48202, USA.
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Rosenberger C, Gertzen M, Strasburger M, Schwarz J, Gernun S, Rabenstein A, Lermer E, Rüther T. We Have a Lot to Do: Lack of Sexual Protection and Information-Results of the German-Language Online Survey "Let's Talk About Chemsex". Front Psychiatry 2021; 12:690242. [PMID: 34135790 PMCID: PMC8200571 DOI: 10.3389/fpsyt.2021.690242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of chemsex and sexualized substance use is increasing in several European countries, particularly among men who have sex with men. In this subgroup, illegal substance use is associated with increased sexual risk behavior, which can result in severe physical and psychological impairments. The present study examined the incidence and prevalence of chemsex in German-speaking countries. Methods: To further describe the high-risk group of Chemsex users, participants (N = 429) were asked about their psychotropic substance use, sexual and health-related behavior, health status, and socio-demographic information by using an online questionnaire. Whether Chemsex has negative effects on well-being was measured with the WHO well-being index. Of additional interest was how informed Chemsex users are about the topic and what needs are placed on the practitioners. The online questionnaire consisted of 105 items, and data was collected from March to May 2019. Thousand forty seven datasets were saved with a dropout rate of 59%, 123 completed questionnaires fulfilled the criteria for chemsex users (n =123). Results: There were no significant differences in well-being between chemsex users and non-users. All participants protected themselves against sexually transmitted diseases irregularly or not at all. The majority of chemsex users reported intermittently using illegal substances (ketamine, methamphetamine, mephedrone, γ-butyrolactone/γ-hydroxy butyric acid). They viewed their sexual and substance use behavior as problematic, but few showed motivation for behavior change. Chemsex users clearly expressed a need for more information and advice centers. Conclusion: The results provide information on chemsex users that can be used for the future development of a therapy manual and thus contribute to improving health care for this group. The prevalence of chemsex is increasing and urgently needs more research to protect clients from health impairments and stigmatization.
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Affiliation(s)
- Cornelia Rosenberger
- Department of Addiction Medicine, kbo-Isar-Amper-Klinikum Munich East, Haar, Germany
| | - Marcus Gertzen
- Psychotherapy and Psychosomatics, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Moritz Strasburger
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Johanna Schwarz
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Solveig Gernun
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Eva Lermer
- FOM University of Applied Sciences for Economics and Management, Munich, Germany
- LMU Center for Leadership and People Management, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Reisinger A, Vogt S, Essl A, Rauch I, Bangerl F, Eller P, Hackl G. Lessons of the month 3: Intravenous poppers abuse: case report, management and possible complications. Clin Med (Lond) 2021; 20:221-223. [PMID: 32188665 DOI: 10.7861/clinmed.2019-0469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poppers are nitrite-containing liquids, which are inhaled for their aphrodisiac and hallucinogenic effects. Despite some cases of severe poisonings, poppers are often perceived as harmless by consumers. Inhalation and ingestion of poppers are well known, but, according to our literature review, intravenous abuse has not been reported before. CASE PRESENTATION A 34-year-old man injected poppers intravenously for recreational purposes. He then suffered from dyspnoea and general discomfort. Upon arrival of emergency medical services, the patient was dyspnoeic with blue-grey skin colour and oxygen saturation was 82% on ambient air. Non-invasive ventilation was necessary, and he was transferred to the intensive care unit. Toluidine blue was administered because of a methaemoglobinaemia of 40% and methaemoglobin levels dropped to 0.4%. He was discharged home after a 24-hour observation. We additionally analysed the contents of the poppers bottle: isopropyl nitrite, isopropanol and acetone were detected. Possible complications and the treatment regarding intravenous administration of poppers are discussed. CONCLUSION We present the first published case of intravenous poppers abuse. Our patient suffered from methaemoglobinaemia and was rapidly discharged after treatment with toluidine blue. No specific treatment regarding the contents of the poppers bottle, apart from isopropyl nitrite, was necessary.
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Affiliation(s)
- Alexander Reisinger
- Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria
| | | | | | | | | | | | - Gerald Hackl
- Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria
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[Chemsex : A new challenge in addiction medicine and infectious diseases]. DER NERVENARZT 2021; 93:263-278. [PMID: 33852029 DOI: 10.1007/s00115-021-01116-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently there has been an increase in reports of the phenomenon called chemsex, a subform of sexualized substance use. Chemsex is a neologism consisting of the two terms "chemicals" and "sex". It describes the use of methamphetamine, γ‑hydroxybutyrate/γ-butyrolactone (GHB/GBL), mephedrone and sometimes other substances in a sexual context, especially by men who have sex with men (MSM). Chemsex has been described as a significant risk factor for mental and physical diseases. OBJECTIVE Due to the increasing importance of the phenomenon and the significantly increased number of publications on the subject, this article provides an overview of the current and relevant literature. The aim is to raise awareness on this topic among practitioners and researchers and thus to facilitate access to the help system for those affected. METHOD A literature search was conducted in PubMed/Medline, Cochrane and Embase for the terms "chemsex", "sexualized drug use" and "slamming. A total of 22 articles were identified as being relevant. RESULTS In the published literature on chemsex the current focus lies on somatic comorbidities. There is a significantly increased risk of sexually transmitted diseases. Mental illnesses such as depression, substance-induced psychosis and addiction also appear to be a significant consequence of chemsex. An individualized and specialized treatment approach is not yet established. DISCUSSION The complexity of chemsex with its psychiatric and somatic aspects does not yet appear to be sufficiently reflected by the current data situation; however, due to the mutual influence of these different comorbidities, this patient clientele appears to be particularly at risk in the absence of a specialized treatment option, which is why further research on this topic is needed.
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Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men. J Clin Med 2021; 10:jcm10081662. [PMID: 33924530 PMCID: PMC8068924 DOI: 10.3390/jcm10081662] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.
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Chemsex/slamsex-related intoxications: A case report involving gamma-hydroxybutyrate (GHB) and 3-methylmethcathinone (3-MMC) and a review of the literature. Forensic Sci Int 2021; 321:110743. [DOI: 10.1016/j.forsciint.2021.110743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
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The Crisis We Are Not Talking About: One-in-Three Annual HIV Seroconversions Among Sexual and Gender Minorities Were Persistent Methamphetamine Users. J Acquir Immune Defic Syndr 2021; 85:272-279. [PMID: 32740370 DOI: 10.1097/qai.0000000000002461] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Methamphetamine use is once again on the rise among sexual and gender minorities who have sex with men (SGMSM). METHODS Baseline and 12-month data are taken from an ongoing cohort study of n = 4786 SGMSM aged 16-49 at risk for HIV from across the United States. Participants completed annual online surveys and at-home HIV testing (oral fluid samples returned through mail). RESULTS Overall, 2.47 per 100 persons seroconverted over 12 months. In addition, 13.8% of participants reported any methamphetamine use over the 12-month study period. Nearly three-fourths (74.7%; 422 of 565) of those who reported using methamphetamine at baseline were persistent users at 12 months. In adjusted analyses, compared with those who did not use methamphetamine, incident methamphetamine users (ie, those who indicated use between baseline and follow-up) and persistent methamphetamine users had significantly higher odds of HIV seroconverting (adjusted odds ratio = 3.95, 95% confidence interval: 1.64 to 9.47; and 7.11, 4.53 to 11.17, respectively). Persistent methamphetamine users accounted for one-third of all observed HIV seroconversions (41 of 115). DISCUSSION Among SGMSM at elevated risk for HIV, persistent methamphetamine use was prevalent and associated with substantially amplified risk for HIV seroconversion. Expanded efforts are needed to test implementation strategies for scalable, evidence-based interventions to reduce HIV risk in SGMSM who use methamphetamine.
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60
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The e-psychonaut drugs' psychopharmacology. Curr Opin Pharmacol 2021; 57:165-174. [PMID: 33774473 DOI: 10.1016/j.coph.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/31/2023]
Abstract
The focus here was on the pharmacological and clinical pharmacological issues pertaining to the vast range of drugs (e.g. synthetic cannabimimetics, synthetic opioids, novel stimulants, novel psychedelics, PCP/ketamine-like compounds, prescribed medicinal compounds and popular psychotropic herbs/plants) discussed by Internet-based enthusiasts of new/novel psychoactive substances (NPS), 'e-psychonauts'. Currently ongoing related in silico studies, followed by further in vitro and in vivo/preclinical studies, will hopefully provide important findings in terms of which molecules within each given NPS class may present with higher levels of receptor affinities, and hence clinical potency. Understanding the pharmacological characteristics/potency of those novel recreational molecules will hopefully help in predicting related NPS diffusion, morbidity and possible lethality data.
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Elliott JC, Greene AL, Thompson RG, Eaton NR, Hasin DS. Substance use in a sexual context: The association of sex-related substance use motives with substance choice and use behaviors. JOURNAL OF SUBSTANCE USE 2021; 26:212-217. [PMID: 33732094 DOI: 10.1080/14659891.2020.1807633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance use before sex is associated with riskier behaviors. Sex-related substance use motives may explain pre-sex substance use. We explored what sex-related motives are associated with alcohol versus drug use, and which motives underlie heavier use. METHODS A sample of 936 participants (50% male, 80% White) completed an Internet survey about sexuality. Those who drank before sex (n=657) reported on six sex-related drinking motives; those who used drugs before sex (n=271) reported on six (parallel) sex-related drug use motives. The frequency of endorsement of each motive between drinkers and drug users was compared with z-distributions. Logistic regressions assessed whether motives were associated with substance use frequency and intoxication before sex. RESULTS Substance use to relax and to get a sex partner to use were more commonly endorsed for alcohol than drugs; substance use to improve performance and enhance experience were more commonly endorsed for drugs. Most motives were associated with alcohol frequency and intoxication before sex. None were associated with drug frequency; some were associated with drug intoxication. CONCLUSIONS Alcohol was generally used to facilitate sex, and drugs to enhance sex. Sex-related drinking motives were associated with drinking before sex; sex-related drug use motives were less predictive.
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Affiliation(s)
- Jennifer C Elliott
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Ashley L Greene
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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Hirjak D, Meyer-Lindenberg A, Brandt GA, Dreßing H. [Differential diagnostic distinction between substance-induced and primary psychoses: : Recommendations for general psychiatric and forensic practice]. DER NERVENARZT 2021; 93:11-23. [PMID: 33656571 PMCID: PMC8763934 DOI: 10.1007/s00115-021-01083-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Substanzinduzierte psychotische Störungen (SIPS) sind häufig und für ca. 25 % der ersten Einweisungen in eine psychiatrische Klinik verantwortlich. Aus klinischer Sicht ist aufgrund ähnlicher psychopathologischer Phänomene die diagnostische Unterscheidung zwischen SIPS und primären (genuinen oder kryptogenen) psychotischen Störungen oft eine Herausforderung. Dieser Umstand wird dadurch erschwert, dass SIPS im Zusammenhang mit Cannabis, Halluzinogenen und Amphetaminen ein erhebliches Risiko des Übergangs in eine primäre psychotische Störung (z. B. Schizophrenie) haben. Im ersten Abschnitt dieser Arbeit werden zunächst zwei exemplarische Fallvignetten aus der allgemeinpsychiatrischen und forensischen Praxis vorgestellt. Danach wird im Sinne einer selektiven Literaturübersicht die Relevanz der differenzialdiagnostischen Unterscheidung beider Störungsbilder aus der Sicht der allgemeinen und forensischen Psychiatrie in Bezug auf Therapie, Prognose und richterliche Entscheidung bezüglich der Unterbringung im Maßregelvollzug (§ 63 vs. § 64 StGB) beleuchtet. Der letzte Abschnitt hat das Ziel, ein strukturiertes Vorgehen zur differenzialdiagnostischen Unterscheidung zwischen SIPS und primären psychotischen Störungen zu erarbeiten. Die in dieser Arbeit dargestellten und diskutierten Konzepte und Befunde sollen klinisch tätigen Psychiatern und Psychologen die Diagnosestellung im allgemeinen und forensischen Kontext erleichtern.
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Affiliation(s)
- Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Geva A Brandt
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Harald Dreßing
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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Christie NC. The role of social isolation in opioid addiction. Soc Cogn Affect Neurosci 2021; 16:645-656. [PMID: 33681992 PMCID: PMC8259283 DOI: 10.1093/scan/nsab029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022] Open
Abstract
Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain’s opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.
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Affiliation(s)
- Nina C Christie
- Department of Psychology, University of Southern California, Los Angeles, CA, USA., USC Brain and Creativity Institute, University of Southern California, Los Angeles, CA, USA
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The Chemsex ‘Consent Ladder’ in Male Sex Work: Perspectives of Health Providers on Derailment and Empowerment. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10020069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexualized substance use or ‘chemsex’ is a key element in the syndemic of violence and infection in gay, bisexual, and other men who have sex with men. Chemsex is more prolific amongst men who have sex with men but is also associated with high risk behaviours that can negatively impact on health and wellbeing in heterosexual, bisexual men and women, and in homosexual women too. This qualitative study investigated perceptions and experiences of chemsex, motivations, cisgender male sex work, consent, economic exploitation, and ways to address and reduce harms. We conducted semi-structured interviews with health care providers and their clients—including sex workers and their customers (n = 14) between the ages of 28 and 46 years following a purposive sampling strategy. Interview topics included perceptions and experiences of chemsex use, reasons for drug use and chemsex, and proposals to address harms associated with chemsex in the UK. Interviews were audio-recorded, transcribed, coded, and analysed using Grounded Theory. The findings revealed a stepwise process of chemsex use in a ‘ladder of consent’, whereby the process starts with willing participation that is both highly pleasurable and controllable. Sexual polydrug activity often descended in rungs so that lines of consent became blurred, and even broken, resulting in physical detriment and financial exploitation. Strategies for elevation back up the consent ladder also emerged. The findings clarify the conditions of willing participation, the stepwise relationship to exploitation, and the support strategies that help re-empower individuals whose lives get taken over by chemsex, including peer-to-peer support, poly-centres, and smartphone apps to climb back up the consent ladder to improve the health, safety, and social rights of sex workers.
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66
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Lafortune D, Blais M, Miller G, Dion L, Lalonde F, Dargis L. Psychological and Interpersonal Factors Associated with Sexualized Drug Use Among Men Who Have Sex with Men: A Mixed-Methods Systematic Review. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:427-460. [PMID: 33108566 DOI: 10.1007/s10508-020-01741-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
Chemsex-the use of specific drugs during planned sexual activity to sustain or enhance sexual functioning (Bourne et al., 2015)-is widely reported as a major public health issue among gay, bisexual, and other men who have sex with men (GBM) in Western countries. Considering current evidence surrounding Chemsex, we conducted a mixed-methods systematic review regarding psychological and interpersonal factors associated with Chemsex behaviors among GBM. Publications covering Chemsex and psychological or social variables were eligible. Theoretical papers and studies solely presenting physical health outcomes were excluded. 35 English papers published between January 2008 and June 2019 were identified through PubMed, Scopus, and PsycINFO. We performed a parallel-results convergent synthesis (Hong, Pluye, Bujold, & Wassef, 2017) on results extracted from qualitative and quantitative studies comprising the final corpus. Qualitative data suggest that six mechanisms promote Chemsex-related behaviors: dealing with painful emotions or stressful events; normalization and risk minimization of sexualized drug use; giving into interpersonal pressure or fulfilling desire for community belonging; increasing intimacy or connectedness; enhancing sexual performance and functioning; lessening interpersonal and sexual inhibitions. In quantitative reports, six variable categories emerged: sexual control and self-efficacy; sexual functioning; mental health; attitudes toward substance use; life stressors and internalized stressors; and identification with sexual identities or scenes. This review summarizes key psychological and interpersonal correlates of Chemsex among GBM. Further research is needed to replicate current findings and explore new hypotheses across multiple GBM sociodemographic groups and cultural contexts, following best practices in sampling for hard-to-reach populations.
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Affiliation(s)
- David Lafortune
- Département de sexologie, Université du Québec à Montréal, 455, René-Lévesque Est, Montréal, QC, H2L 4Y2, Canada.
| | - Martin Blais
- Département de sexologie, Université du Québec à Montréal, 455, René-Lévesque Est, Montréal, QC, H2L 4Y2, Canada
| | - Geneviève Miller
- Département de sexologie, Université du Québec à Montréal, 455, René-Lévesque Est, Montréal, QC, H2L 4Y2, Canada
| | - Laurence Dion
- Département de sexologie, Université du Québec à Montréal, 455, René-Lévesque Est, Montréal, QC, H2L 4Y2, Canada
| | - Frédérick Lalonde
- Département de sexologie, Université du Québec à Montréal, 455, René-Lévesque Est, Montréal, QC, H2L 4Y2, Canada
| | - Luc Dargis
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
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Khan SI, Khan MNM, Irfan SD, Rumayan Hasan AM, Ross AG, Horng LMS, Lachowsky N, Knudson G, Azim T. The Effects of Methamphetamine Use on the Sexual Lives of Gender and Sexually Diverse People in Dhaka, Bangladesh: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:479-493. [PMID: 32239362 PMCID: PMC7529687 DOI: 10.1007/s10508-020-01674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh.
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - Allen G Ross
- Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nathan Lachowsky
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gail Knudson
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Tasnim Azim
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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68
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Goncalves R, Castaing N, Titier K, Dumestre-Toulet V. Hair Analysis of Methoxphenidine in a Forensic Chemsex Case. J Anal Toxicol 2021; 46:328-336. [PMID: 33523230 DOI: 10.1093/jat/bkab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
Methoxphenidine (MXP, 2-MeO-diphenidine) is a dissociative anaesthetic drug of the diarylethylamine type, recently introduced for recreational purposes through the online-based sale of new psychoactive substances (NPS). The concentration of MXP in hair has never been reported, either in cases of chemsex use or in fatal cases. A 55-year-old man was found dead at home the morning after a chemsex party. Toxicological analyses indicated high concentrations of MXP in femoral blood (606 µg/L), cardiac blood (254 µg/L), and hair (13 ng/mg). We also identified 3-MMC in femoral blood (traces) and urine (238 µg/L). The concentrations of all other drugs were consistent with living subjects. This case highlights the risk of methoxphenidine poisoning in the context of chemsex and emphasises the importance of including NPS in post-mortem toxicology examinations.
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Affiliation(s)
- R Goncalves
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, F-33076 Bordeaux, France.,Univ. Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France
| | - N Castaing
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, F-33076 Bordeaux, France
| | - K Titier
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, F-33076 Bordeaux, France
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69
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MacGregor L, Kohli M, Looker KJ, Hickson F, Weatherburn P, Schmidt AJ, Turner KM. Chemsex and diagnoses of syphilis, gonorrhoea and chlamydia among men who have sex with men in the UK: a multivariable prediction model using causal inference methodology. Sex Transm Infect 2021; 97:282-289. [PMID: 33452129 DOI: 10.1136/sextrans-2020-054629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In the last decade diagnoses of most STIs have risen among men who have sex with men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure the associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, pre-exposure prophylaxis (PrEP) users and other MSM. METHODS We used the UK 2017-2018 European MSM Internet Survey data (n=9375). We constructed causal inference models using multivariable logistic regression, calculating adjusted OR (aOR) and 95% CI of the associations between participation in recent (≤12 months) exclusively dyadic or multipartner chemsex versus no chemsex and recent self-reported diagnoses of syphilis, gonorrhoea and chlamydia. RESULTS Among MSM with an HIV diagnosis, 25% of users indicated recent multipartner chemsex, vs 28% of PrEP users and 5% of other MSM. Adjusting for age, ethnicity, UK birth, cis-trans status, sexual identity, education, settlement size and relationship status, participation in recent multipartner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were 2.6 (95% CI 1.7 to 4.1), 3.9 (95% CI 2.6 to 5.8) and 2.9 (95% CI 1.9 to 4.3), respectively, in HIV-diagnosed MSM; 1.9 (95% CI 1.1 to 3.3), 2.9 (95% CI 2.0 to 4.2) and 1.9 (95% CI 1.3 to 2.8), respectively, in PrEP users; and 4.0 (95% CI 2.3 to 6.9), 2.7 (95% CI 1.9 to 3.8) and 2.3 (95% CI 1.6 to 3.4), respectively, in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea (aOR 2.4, 95% CI 1.2 to 4.7) among PrEP users and syphilis (aOR 2.8, 95% CI 1.4 to 5.6) among other MSM. DISCUSSION Multipartner chemsex may drive the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM and particularly chemsex participants has generated an emergent group suitable for such interventions.
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Affiliation(s)
- Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Manik Kohli
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ford Hickson
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Axel J Schmidt
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katy Me Turner
- Population Health Sciences, University of Bristol, Bristol, UK.,Bristol Veterinary School, University of Bristol, Bristol, UK
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70
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Lu D, Sun H, Yu J, Kuang YQ, Wang KH. Chemical sex drugs regulate HIV infection and replication in immune cells: a vicious circle. AIDS 2021; 35:147-150. [PMID: 33048887 DOI: 10.1097/qad.0000000000002708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Danfeng Lu
- NHC Key Laboratory of Drug Addiction Medicine
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Hua Sun
- NHC Key Laboratory of Drug Addiction Medicine
| | - Juehua Yu
- NHC Key Laboratory of Drug Addiction Medicine
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
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71
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Chan ASW, Tang PMK. Application of Novel Psychoactive Substances: Chemsex and HIV/AIDS Policies Among Men Who Have Sex With Men in Hong Kong. Front Psychiatry 2021; 12:680252. [PMID: 34335329 PMCID: PMC8316596 DOI: 10.3389/fpsyt.2021.680252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, The Hong'Kong Polytechnic University, Hong Kong, China
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
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72
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Wicki M, Marmet S, Studer J, Epaulard O, Gmel G. Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men. Addict Behav 2021; 112:106609. [PMID: 32861992 DOI: 10.1016/j.addbeh.2020.106609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation. SAMPLE AND METHOD A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions. RESULTS Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk. DISCUSSION AND CONCLUSION Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions.
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73
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Bernstein A. Gamma-Hydroxybutyrate (GHB) Withdrawal in a Patient with Polysubstance Use. J Psychoactive Drugs 2020; 53:299-301. [PMID: 33357048 DOI: 10.1080/02791072.2020.1865591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gamma-hydroxybutyrate (GHB) and its various pro-drugs are GABA-B central nervous system depressants more commonly known as "G" and "liquid ecstasy" among those who consume. Due to the depressant quality of the substance and its convenience in online marketplaces, it has become a more commonly abused drug, characteristically among people involved in the "club scene" and among men who have sex with men. As the dose of GHB necessary to obtain feelings of euphoria is relatively low combined with the substance's rapid metabolism, GHB is nearly undetectable through traditional emergency department urinary drug testing. Consequentially, although the treatment of GHB intoxication and withdrawal is mainly supportive, it is difficult for providers to determine whether GHB is the cause of a patient's symptoms. Moreover, when GHB is combined with other substances, treatment becomes more complicated. The author presents a case of GHB intoxication and withdrawal in a patient with an extensive polysubstance use history demonstrating not only the difficulty of diagnosis but also a timeline outlining the interventions taken from arrival to discharge with a successful outcome faster than the conventional timeline of GHB withdrawal and recovery.
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Affiliation(s)
- Adam Bernstein
- Department of Psychiatry, Creedmoor Psychiatric Center, Queens Village, NY, USA
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74
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Donnadieu-Rigole H, Peyrière H, Benyamina A, Karila L. Complications Related to Sexualized Drug Use: What Can We Learn From Literature? Front Neurosci 2020; 14:548704. [PMID: 33328844 PMCID: PMC7732585 DOI: 10.3389/fnins.2020.548704] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
Chemsex is described as the use of specific psychoactive substances (PS) during sexual activity to sustain, enhance, disinhibit or facilitate the sexual experience. It preferentially concerns men who have sex with men (MSM). They use new synthetic substances like cathinones, methamphetamines, gamma-butyrolactone/gamma-hydroxybutyrate (GBL/GHB), ketamine, and cocaine. The prevalence of chemsex varies from 3 to 31% during lifetime. The Internet has participated significantly in the evolution of sexual behaviors, both in terms of sexual dating and the availability of new synthetic substances. The advent of geolocation applications contributed to the development of chemsex. The literature describes many complications linked to these sexual practices; the main clinical effects related to cathinones consumption were psychiatric symptoms; agitation, hallucinations, anxiety, suicidal ideation, paranoia, and confusion. Regular GBL/GHB consumption alter cognitive functions, particularly memory and emotion management. Use of these drugs in party and play is dramatically associated with high-risk sexual behaviors. The prevalence of hepatitis B, hepatitis C syphilis, and HIV is higher in men who use methamphetamine and Viagra and/or who declared they practiced slamming, chemsex, and fisting. Other sexually transmitted infections (STIs) such as gonorrhea have increased with methamphetamine and GHB/GBL use. Actually, the care of individuals who practice Chemsex in a problematic way is currently not codified, but the use of integrative and specific interventions is necessary.
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Affiliation(s)
- Hélène Donnadieu-Rigole
- Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France.,INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France
| | - Hélène Peyrière
- INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier, France.,Addictovigilance Center, Department of Medical Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Amine Benyamina
- Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Universitaire Paul-Brousse (APHP), Villejuif, France.,Paris-Saclay University, Saint-Aubin, France
| | - Laurent Karila
- Centre d'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Universitaire Paul-Brousse (APHP), Villejuif, France.,Paris-Saclay University, Saint-Aubin, France.,Unité de Recherche PSYCOMADD, Villejuif, France
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75
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Review of sexualized drug use associated with sexually transmitted and blood-borne infections in gay, bisexual and other men who have sex with men. Drug Alcohol Depend 2020; 216:108237. [PMID: 33091811 DOI: 10.1016/j.drugalcdep.2020.108237] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of the present study was to quantify associations between sexualized drug use (SDU) and sexually-transmitted and blood-borne infection (STBBI) diagnoses in gay, bisexual and other men who have sex with men (GBMSM) with defined temporal proximity between SDU exposure and STBBI diagnoses. METHODS In May 2018 and June 2019, we searched the literature for primary studies that quantified the association between STBBI and SDU among GBMSM. A random-effects model was used to meta-analyze the data and estimate the association between SDU and STBBIs. RESULTS Nineteen studies met the inclusion criteria and fourteen studies were included in the meta-analyses. SDU was associated with higher odds of bacterial STI diagnoses, higher odds of HCV diagnoses, and higher odds of HIV diagnoses. Associations between SDU and diagnoses of bacterial STIs or HCV remained after adjustment for behavioral and sociodemographic factors. CONCLUSIONS Robust and consistent associations between SDU and STBBI identified in this review add to the evidence suggesting SDU is a potential contributor to bacterial STIs and HCV or a proxy indicator for other risk factors.
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Matey JM, López-Fernández A, García-Ruiz C, Montalvo G, Moreno MD, Martínez MA. Potential Of High-Resolution Mass Spectrometry For The Detection Of Drugs And Metabolites In Hair: Methoxetamine In A Real Forensic Case. J Anal Toxicol 2020; 46:e1-e10. [PMID: 33104803 DOI: 10.1093/jat/bkaa168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
The analysis of drugs of abuse in hair and other biological matrices of forensic interest requires great selectivity and sensitivity. This is done traditionally through target analysis, with one or more analytical methods, or with different and specific preanalytical phases, and complex procedures performed by the toxicological laboratories, and there is no exception with ketamine-like compounds, such as methoxetamine, a new psychoactive substance (NPS) whose use has increased in the last decades, and continues to grow quickly year by year. More validated methods of analysis are needed to detect these substances in low concentrations selectively. Reanalyzing the samples of a former case of a polydrug consumer accused of a crime against public health in Spain, five metabolites of methoxetamine (normethoxetamine, O-desmethylmethoxetamine, dehydromethoxetamine, dihydronormethoxetamine and hydroxynormethoxetamine) were tentatively detected using a high-resolution technique that is liquid chromatography coupled to high-resolution mass spectrometry (LC-HR-MS/MS). The most selective analytical LC-HR-MS/MS method together a universal and simpler pretreatment stages has demonstrated to allow faster analysis and more sensitivity than the one performed traditionally at the INTCF laboratories, which was gas chromatography coupled to mass spectrometry (GC-MS).
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Affiliation(s)
- J M Matey
- National Institute of Toxicology and Forensic Sciences, Department of Chemical and Drugs. José Echegaray, 4. 28232 Las Rozas de Madrid, Madrid, Spain.,University of Alcalá, Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering.,University Institute of Research in Police Sciences (IUICP)
| | - Adrián López-Fernández
- University of Alcalá, Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering
| | - Carmen García-Ruiz
- University of Alcalá, Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering.,University Institute of Research in Police Sciences (IUICP)
| | - Gemma Montalvo
- University of Alcalá, Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering.,University Institute of Research in Police Sciences (IUICP)
| | - M D Moreno
- National Institute of Toxicology and Forensic Sciences, Department of Chemical and Drugs. José Echegaray, 4. 28232 Las Rozas de Madrid, Madrid, Spain
| | - M A Martínez
- National Institute of Toxicology and Forensic Sciences, Department of Chemical and Drugs. José Echegaray, 4. 28232 Las Rozas de Madrid, Madrid, Spain.,University Institute of Research in Police Sciences (IUICP)
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Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects. Pharmaceuticals (Basel) 2020; 13:ph13100309. [PMID: 33066617 PMCID: PMC7602496 DOI: 10.3390/ph13100309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Sexual enhancers increase sexual potency, sexual pleasure, or libido. Substances increasing libido alter the concentrations of specific neurotransmitters or sex hormones in the central nervous system. Interestingly, the same pathways are involved in the mechanisms underlying many psychiatric and neurological disorders, and adverse reactions associated with the use of aphrodisiacs are strongly expected. However, sexual enhancers of plant origin have gained popularity over recent years, as natural substances are often regarded as a safer alternative to modern medications and are easily acquired without prescription. We reviewed the psychiatric and neurological adverse effects associated with the consumption of herbal aphrodisiacs Areca catechu L., Argemone Mexicana L., Citrus aurantium L., Eurycoma longifolia Jack., Lepidium meyenii Walp., Mitragyna speciosa Korth., Panax ginseng C. A. Mey, Panax quinquefolius L., Pausinystalia johimbe (K. Schum.) Pierre ex Beille, Piper methysticum G. Forst., Ptychopetalum olacoides Benth., Sceletium tortuosum (L.) N. E. Brown, Turnera diffusa Willd. ex. Schult., Voacanga africana Stapf ex Scott-Elliot, and Withania somnifera (L.) Dunal. A literature search was conducted on the PubMed, Scopus, and Web of Science databases with the aim of identifying all the relevant articles published on the issue up to June 2020. Most of the selected sexual enhancers appeared to be safe at therapeutic doses, although mild to severe adverse effects may occur in cases of overdosing or self-medication with unstandardized products. Drug interactions are more concerning, considering that herbal aphrodisiacs are likely used together with other plant extracts and/or pharmaceuticals. However, few data are available on the side effects of several plants included in this review, and more clinical studies with controlled administrations should be conducted to address this issue.
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McVeigh J, Salinas M, Ralphs R. A sentinel population: The public health benefits of monitoring enhanced body builders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 95:102890. [PMID: 32912824 DOI: 10.1016/j.drugpo.2020.102890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 07/24/2020] [Indexed: 01/24/2023]
Abstract
There is heightened recognition of the public health implications of anabolic androgenic steroids (AAS) for the use of image and performance enhancement; with increasing evidence of their long-term negative health impacts, the hazards associated with their administration (often via injection), and the variability and unpredictability of their contents. In order to optimise the effects of these drugs, together with strict dietary and training regimes, AAS users typically supplement their use with an expansive and continually evolving range of ancillary drugs. The discovery and subsequent adoption of these drugs by the broader AAS user population is largely dependent upon a minority of social influencers within the bodybuilding community. Pioneering enhanced bodybuilders who self-experiment with a diverse range of image and performance enhancing drugs (IPEDs) and ancillary drugs have been the forerunners in the development of an underground user-led literature, online discussion forums, and were early adopters of internet-facilitated drug markets. Yet the impact of their self-experimentations extends well beyond the enhanced bodybuilding community, particularly in their use of ancillary drugs. Most significantly has been their role in the diffusion of various enhancement and psychoactive drugs to the wider population. Using the theoretical framework of the 'diffusion of innovation' we consider the role that pioneering enhanced bodybuilders have played in the diffusion of various enhancement and psychoactive drugs to the wider population through a focus on three substances: dinitrophenol (DNP), melanotan II and gamma-hydroxybtyrate (GHB). With an increasing range of drugs used by bodybuilders, coupled with an expansion in the use of online forums and online platforms to purchase pharmacological and new psychoactive drugs, we anticipate this trend of diffusion amongst the wider population will continue to flourish. Therefore, we highlight the need for policy makers to monitor emergent trends, not only in the general AAS population but particularly amongst enhanced bodybuilders.
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Affiliation(s)
- Jim McVeigh
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom.
| | - Mike Salinas
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom
| | - Rob Ralphs
- Substance Use and Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Geoffrey Manton Building, Rosamond Street West, Manchester M15 6LL, United Kingdom
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79
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Van Beckhoven D, Florence E, De Wit S, Wyndham-Thomas C, Sasse A, Van Oyen H, Macq J. Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort. HIV Med 2020; 21:557-566. [PMID: 32627351 PMCID: PMC7540395 DOI: 10.1111/hiv.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in Belgium. Methods We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care using a cumulative incidence function with death as a competing risk, and viral load (VL) status upon return to HIV care using logistic regression. Results We included 16 066 patients accounting for 78 625 person‐years of follow‐up. The incidence rate of HCI was 5.3/100 person‐years [95% confidence interval (CI) 5.1–5.4/100 person‐years]. The incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7–79.2%). Of those who returned to care, 43.7% had a VL ≤ 200 HIV‐1 RNA copies/mL, suggesting care abroad or suboptimal care (without an HIV‐related care record) in Belgium during the HCI, and 56.3% returned without controlled VL and were therefore considered as having experienced a real gap in HIV care; they represented 2.3/100 person‐years of follow‐up. Factors individually associated with HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non‐Belgian nationality, male gender, not being a man who has sex with men, a shorter time since HIV diagnosis, no high blood pressure and CD4 count < 350 cells/µL. Conclusions This study highlights the need to investigate return to care and viral status at return, to better understand HCI. Identified predictors can help health care workers to target patients at higher risk of HCI for awareness and support.
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Affiliation(s)
| | - E Florence
- Institute of Tropical Medicine, Antwerp, Belgium
| | - S De Wit
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - A Sasse
- Sciensano, Brussels, Belgium
| | - H Van Oyen
- Sciensano, Brussels, Belgium.,University of Ghent, Ghent, Belgium
| | - J Macq
- Université Catholique de Louvain, Brussels, Belgium
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80
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Skryabin VY, Khoryaev D, Torrado M. Changes in sexual behavior patterns due to stimulants use: three case reports. J Addict Dis 2020; 38:375-379. [PMID: 32500822 DOI: 10.1080/10550887.2020.1771236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The paper describes three case reports of changes in sexual behavior patterns in male patients who use stimulants (amphetamine and mephedrone). Two of them demonstrate that the consumption of stimulants may lead to hypersexuality and excessive masturbation. Case report three shows that mephedrone use results in such typical stimulant-related subjective effects as the intensification of sensory experiences and sexual arousal. It leads to the loss of interest in sex without mephedrone. In light of the popularity of sex under the influence of drugs, clinicians should be aware of this phenomenon, since it is associated with high-risk sexual behavior. The description of clinical cases on the link between sex and drugs expands our knowledge in this area, leading to more effective treatment interventions.
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Affiliation(s)
| | - Denis Khoryaev
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - Marco Torrado
- Faculty of Medicine, ISAMB (Instituto de Saúde Ambiental), University of Lisbon, Lisboa, Portugal
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81
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Busardò FP, Gottardi M, Pacifici R, Varì MR, Tini A, Volpe AR, Giorgetti R, Pichini S. Nails Analysis for Drugs Used in the Context of Chemsex: A Pilot Study. J Anal Toxicol 2020; 44:69-74. [PMID: 30855673 DOI: 10.1093/jat/bkz009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/23/2018] [Indexed: 11/12/2022] Open
Abstract
Nail analysis can be performed as a substitute or complement to hair analysis for the retrospective determination of psychotropic drugs consumption in forensic contexts. The application of nail analysis in a "chemsex" context is reported herein. An ultra-performance liquid chromatography-tandem mass spectrometry method was developed to quantify the most common drugs of abuse, synthetic cannabinoids, synthetic cathinones and GHB in fingernails and toenails of individuals presumptively using these drugs in music and sex settings. Results were compared to the concentrations measured in hair. Nail and hair keratin matrices were digested with VMA-TM3® buffer reagent and underwent a solid phase extraction before chromatographic separation with reversed phase columns and a linear gradient elution with 5 mM ammonium formate and acetonitrile, for detecting classic drugs of abuse, or 0.1% formic acid and methanol, for detecting synthetic cathinones, synthetic cannabinoids, and GHB. Analytes were detected with a triple quadrupole mass spectrometer operated in multiple reaction monitoring mode after positive electrospray ionization. Nails of individuals practicing "chemsex" contained at least three different psychoactive drugs, and up to eight drugs simultaneously. Identified drugs included cocaine, benzoylecgonine, cocaethylene, delta-9-tetrahydrocannabinol, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine, ketamine, norketamine, mephedrone, methylone, 4-methyletcathinone, methcathinone, γ-hydroxybutyric acid (GHB) and γ-butyrolactone. Most used drugs were MDMA and GHB followed by cocaine and ketamine. Drugs concentrations ranged from 0.1 to 690 ng/mg in fingernails. In the two individuals who also provided toenails, concentrations were always higher in fingernails than in toenails, while in two other individuals who donated also hair, concentrations in this latter matrix were either higher or lower than those measured in fingernails. This study demonstrated that nails may well represent an appropriate non-conventional biological matrix to provide additional information in forensic toxicology.
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Affiliation(s)
- Francesco Paolo Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, Via Conca 41, 60126 Torrette di Ancona, Ancona, Italy
| | - Massimo Gottardi
- Comedical S.r.L. Trento, Va della Cooperazione 29, 38123 Trento, Italy
| | - Roberta Pacifici
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
| | - Anastasio Tini
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Viale Regina Elena 366, 00161, Rome, Italy
| | - Anna Rita Volpe
- Laboratory of Pharmacology and Toxicologyy, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 67100, Coppito (AQ), Italy
| | - Raffaele Giorgetti
- Section of Legal Medicine, Università Politecnica delle Marche, Via Conca 41, 60126 Torrette di Ancona, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, V.Le Regina Elena 299, 00161, Rome, Italy
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Evers Y, Hoebe C, Dukers-Muijrers N, Kampman C, Kuizenga-Wessel S, Shilue D, Bakker N, Schamp S, Van Buel H, Van Der Meijden W, Van Liere G. Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex - a cross-sectional study in the Netherlands. Prev Med Rep 2020; 18:101074. [PMID: 32226730 PMCID: PMC7093829 DOI: 10.1016/j.pmedr.2020.101074] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Almost one in four chemsex-MSM might want to be counselled by a professional. Sexual health experts were the preferred professionals to discuss chemsex. Increasing self-control was the most reported issue to discuss with professionals. Frequent chemsex was one of the indicative characteristics for needing counselling.
Drug use during sex (‘chemsex’) has been associated with sexually transmitted infections (STIs) and mental health harms. Little quantitative evidence exists on the health care needs of MSM practicing chemsex from a patient perspective. This study assessed self-perceived benefits and harms and the needs for professional counselling among MSM practicing chemsex. In 2018, 785 MSM were recruited at nine Dutch STI clinics and 511 (65%) completed the online questionnaire. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed and/or XTC/MDMA during sex <6 months. Chemsex was reported by 41% (209/511), of whom 23% (48/209) reported a need for professional counselling. The most reported topic to discuss was increasing self-control (52%, 25/48). Most MSM preferred to be counselled by sexual health experts (56%, 27/48). The need for professional counselling was higher among MSM who engaged in chemsex ≥2 times per month (30% vs. 17%, p = 0.03), did not have sex without drugs (sober sex) in the past three months (41% vs. 20%, p = 0.04), experienced disadvantages of chemsex (28% vs. 15%, p = 0.03), had a negative change in their lives due to chemsex (53% vs. 21%, p = 0.002), and/or had an intention to change chemsex behaviours (45% vs. 18%, p < 0.001). Our study shows that almost one in four MSM practicing chemsex expressed a need for professional counselling on chemsex-related issues. STI healthcare providers should assess the need for professional counselling in MSM practicing chemsex, especially in MSM with above mentioned characteristics, such as frequent users.
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Affiliation(s)
- Y.J. Evers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, The Netherlands
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, The Netherlands
- Corresponding author at: Public Health Service South Limburg, Het Overloon 2, 6411 TE Heerlen, The Netherlands.
| | - C.J.P.A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, The Netherlands
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, The Netherlands
| | - N.H.T.M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, The Netherlands
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, The Netherlands
| | - C.J.G. Kampman
- Department of Sexual Health, Public Health Service Twente, The Netherlands
| | - S. Kuizenga-Wessel
- Department of Sexual Health, Public Health Service Haaglanden, The Netherlands
| | - D. Shilue
- Department of Sexual Health, Public Health Service Middle Brabant, The Netherlands
| | - N.C.M. Bakker
- Department of Sexual Health, Public Health Service Middle Gelderland, The Netherlands
| | - S.M.A.A. Schamp
- Department of Sexual Health, Public Health Service Brabant South-East, The Netherlands
| | - H. Van Buel
- Department of Sexual Health, Public Health Service Ijsselland, The Netherlands
| | | | - G.A.F.S. Van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, The Netherlands
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, The Netherlands
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Marinelli E, Beck R, Malvasi A, Faro AFL, Zaami S. Gamma-hydroxybutyrate abuse: pharmacology and poisoning and withdrawal management. Arh Hig Rada Toksikol 2020; 71:19-26. [PMID: 32597141 PMCID: PMC7837237 DOI: 10.2478/aiht-2020-71-3314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/01/2019] [Accepted: 03/01/2020] [Indexed: 12/19/2022] Open
Abstract
Gamma-hydroxybutyrate (GHB) is a central nervous system depressant primarily used as a recreational drug of abuse, but also for the treatment of narcolepsy with cataplexy in adult patients and as an adjuvant for control of alcohol withdrawal syndrome. The main aim of this review is to summarise updated knowledge about GHB pharmacokinetics and pharmacodynamics, acute poisoning, and clinical features of GHB withdrawal syndrome, its diagnosis and medical treatment. The most common clinical signs and symptoms of acute poisoning include sleepiness to deep coma, bradycardia, hypotension, and respiratory failure. Therapy is essentially supportive and based on continuous monitoring of vital signs. GHB withdrawal syndrome shares patterns with other withdrawal syndromes such as alcohol withdrawal and is sometimes difficult to distinguish, especially if toxicological tests are GHB-negative or cannot be performed. There are no official detoxification protocols for GHB withdrawal syndrome, but its therapy is based on benzodiazepine. When benzodiazepine alone is not effective, it can be combined with barbiturates or antipsychotics. Information about abuse and distribution of GHB and its precursors/analogues among the general population is still limited. Their prompt identification is therefore crucial in conventional and non-conventional biological matrices, the latter in particular, to clarify all the issues around this complex molecule.
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Affiliation(s)
- Enrico Marinelli
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Renata Beck
- Department of Anaesthesia, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Alfredo Fabrizio Lo Faro
- Section of Legal Medicine, Department of Excellence SBSP, University “Politecnica delle Marche” of Ancona, Ancona, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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84
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Mollaioli D, Ciocca G, Limoncin E, Di Sante S, Gravina GL, Carosa E, Lenzi A, Jannini EAF. Lifestyles and sexuality in men and women: the gender perspective in sexual medicine. Reprod Biol Endocrinol 2020; 18:10. [PMID: 32066450 PMCID: PMC7025405 DOI: 10.1186/s12958-019-0557-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/17/2018] [Indexed: 01/13/2023] Open
Abstract
Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.
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Affiliation(s)
- Daniele Mollaioli
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giacomo Ciocca
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Erika Limoncin
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Stefania Di Sante
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
| | - Giovanni Luca Gravina
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Eleonora Carosa
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Andrea Lenzi
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
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85
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Drysdale K, Bryant J, Hopwood M, Dowsett GW, Holt M, Lea T, Aggleton P, Treloar C. Destabilising the 'problem' of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102697. [PMID: 32065931 DOI: 10.1016/j.drugpo.2020.102697] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia.
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
| | - Gary W Dowsett
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia; Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia
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86
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Schifano F, Napoletano F, Arillotta D, Zangani C, Gilgar L, Guirguis A, Corkery JM, Vento A. The clinical challenges of synthetic cathinones. Br J Clin Pharmacol 2020; 86:410-419. [PMID: 31674690 DOI: 10.1111/bcp.14132] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS Within the new psychoactive substances (NPS) scenario, several hundred different molecules, mostly including synthetic cannabinoids and cathinones, have been identified so far. The aims of the paper were to: (i) identify the number of synthetic cathinones mentioned in a range of psychonaut, NPS-related, online sources; and (ii) describe the associated acute/long term clinical scenario and the related treatment/management plan. METHODS After about 18 months of operation and exclusion of false positives/duplicates, some 4204 unique NPS molecules were included in the NPSfinder® crawling/navigating software database. Most popular NPS included: 1265 psychedelic phenethylamines (30.1%; confidence interval [CI] 95%: 28.7-31.5%); 1253 synthetic cannabinoids (29.8%; CI 95%: 28.4-31.2%); 429 synthetic opioids (10.2%; CI 95%: 9.3-10.2%); and 171 synthetic cathinones (4.1%; CI 95% 3.5-4.7%). Conversely, the United Nations Office on Drugs and Crime and the European Monitoring Centre for Drugs and Drug Addiction databases respectively included 169 and 140 cathinones. Overall, the 3 databases reported some 222 synthetic cathinones, and 41 were uniquely identified by the NPSfinder®. RESULTS In terms of clinical scenarios, synthetic cathinone ingestion is initially associated with stimulant effects; however, psychopathological disturbances, violence, suicidal behaviour, hyperthermia, coma and death have also been described. CONCLUSION The proportion of cathinones commented on by psychonaut fora appeared to be relatively small, and similar to those reported by both the United Nations Office on Drugs and Crime and European Monitoring Centre for Drugs and Drug Addiction. This may be associated with a recent significant decline in both cathinone-related consumption and acute medical presentation. Due to their complex behavioural and medical toxicity issues, healthcare professionals should be, however, be educated to recognise the signs and symptoms of NPS, including synthetic cathinone, ingestion.
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Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Flavia Napoletano
- East London Foundation Trust (ELFT), Homerton University Hospital, London, UK
| | - Davide Arillotta
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Caroline Zangani
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Liam Gilgar
- Gabalfa Clinic, Cardiff and Vale NHS Health Board, Cardiff, UK
| | - Amira Guirguis
- Swansea University Medical School; Institute of Life Sciences; Swansea, UK
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Alessandro Vento
- Addictions' Observatory (ODDPSS), Rome, Italy.,Guglielmo Marconi University, Rome, Italy.,Department of Mental Health, ASL Roma 2, Rome, Italy
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87
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Vaccher SJ, Hammoud MA, Bourne A, Lea T, Haire BG, Holt M, Saxton P, Mackie B, Badge J, Jin F, Maher L, Prestage G. Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102659. [PMID: 31927224 DOI: 10.1016/j.drugpo.2019.102659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. METHODS Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. RESULTS Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them. CONCLUSIONS Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
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Affiliation(s)
- Stefanie J Vaccher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Toby Lea
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Konrad-Adenauer-Ufer 79-81, 50668 Cologne, Germany; Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Bridget G Haire
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Brent Mackie
- ACON, 414 Elizabeth St, Surry Hills, NSW 2010, Australia.
| | - Joshua Badge
- School of Humanities and Social Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
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88
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Pichini S, Di Trana A, Torrens M, Scherbaum N, Zaami S. Editorial: New Trends of Substance Abuse: Looking for New Psychotropic Effects of Chem Sex Drugs, Cognitive Enhancers, and New Psychoactive Substances. Front Psychiatry 2020; 11:612192. [PMID: 33329162 PMCID: PMC7719771 DOI: 10.3389/fpsyt.2020.612192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Annagiulia Di Trana
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marta Torrens
- Departament de Neuropsiquiatria, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Simona Zaami
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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89
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Interpreting GHB concentrations in hair: can a cut-off be established? Forensic Sci Int 2020; 306:110009. [DOI: 10.1016/j.forsciint.2019.110009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
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90
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Brown TR. The Role of Dehumanization in Our Response to People With Substance Use Disorders. Front Psychiatry 2020; 11:372. [PMID: 32499724 PMCID: PMC7242743 DOI: 10.3389/fpsyt.2020.00372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Teneille R Brown
- Center for Law and the Biomedical Sciences, University of Utah, Salt Lake City, UT, United States.,S.J. Quinney College of Law, Center for Law and the Biosciences, Program in Medical Ethics and Humanities, The University of Utah, Salt Lake City, UT, United States
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91
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Griffin M, Callander D, Duncan DT, Palamar JJ. Differential Risk for Drug Use by Sexual Minority Status among Electronic Dance Music Party Attendees in New York City. Subst Use Misuse 2020; 55:230-240. [PMID: 31530057 PMCID: PMC6980202 DOI: 10.1080/10826084.2019.1662811] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Drug use among electronic dance music (EDM) party attendees is common; however, studies are needed to examine associations between drug use and sexual orientation as this can inform prevention and harm reduction efforts in the lesbian, gay, and bisexual (LGB) community. Methods: Data were examined from a repeated cross-sectional study of 3066 young adult EDM party attendees surveyed entering nightclubs and dance festivals in New York City between 2016 and 2018. Of these participants, 277 identified as gay/lesbian, 293 identified as bisexual, and 83 identified as other sexuality. We examined how sexual orientation relates to past-year use of various 'traditional' drugs (e.g., ecstasy/MDMA/Molly) and new psychoactive substances (NPS; e.g., "bath salts") in a bivariable and multivariable manner, stratified by sex. Results: Compared to heterosexual males, gay males were at higher odds for use of ecstasy, GHB, and methamphetamine; bisexual males were at higher odds for use of LSD and unknown powders, and males identifying as "other" sexuality were at higher odds for use of mushrooms and 2C drugs. Compared to heterosexual females, lesbians were at higher odds for use of mushrooms and GHB; bisexual females were at higher odds for use of cocaine, LSD, mushrooms, and tryptamines, and females identifying as "other" sexuality were at higher odds for use of cocaine and tryptamines. Conclusions: We determined differential risk of use of different drugs among those who attend EDM parties according to sexual orientation. Findings can be used to tailor prevention messaging to specific groups within the LGB community.
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Affiliation(s)
- Marybec Griffin
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Denton Callander
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Joseph J Palamar
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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92
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93
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Delineation of chemsex patterns of men who have sex with men in association with their sexual networks and linkage to HIV prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 75:102591. [PMID: 31756695 DOI: 10.1016/j.drugpo.2019.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/04/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have shown that men who have sex with men (MSM) and who engage in drug use in sexualized contexts (chemsex) were more likely to be HIV positive. Their social networks and adoption of HIV prevention measures have, however, not been fully investigated. We aim to compare the sexual behavior, HIV prevention efforts and social networks of MSM by the intensity and patterns of their drug use. METHODS Data from respondents of a community-based, cross-sectional survey (PRiSM) conducted among MSM in Hong Kong in 2017 were collected retrospectively. Characteristics of MSM engaged and not engaged in chemsex were compared in logistic regressions, delineated by latent class analysis (LCA) and compared in multinominal logistic regression. FINDINGS Of 4133 respondents, 3044 were sexually active with an HIV prevalence of 6.5%. The prevalence of chemsex engagement in the preceding 6 months was 12%, after excluding use of poppers or erectile dysfunction agents (EDA) alone. Four types of drug user were identified by LCA: Minimal (mainly poppers), low-threshold (mainly poppers and EDA), medium-threshold (mainly methamphetamine, GHB, poppers and EDA) and intense (extensive use of different types of drug). Medium-threshold and intense drug users were more likely to be HIV positive, be diagnosed with sexually transmitted infections, make gay friends through mobile apps and sex parties, and intend to take pre-exposure prophylaxis (PrEP). Medium-threshold drug users had a more influential role in their social network, as shown by their higher centrality in mobile apps network. CONCLUSION Chemsex engagement in MSM is significantly associated with HIV infection in Hong Kong. The HIV transmission risk could however be offset by the inclination of MSM belonging to medium-threshold and intense drug users to take PrEP, should the intervention become accessible to the community. Further mobile apps could be a good channel to access MSM who are medium-threshold drug users.
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94
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Hugo JM, Rebe KB, Tsouroulis E, Manion A, de Swart G, Struthers H, McIntyre JA. Anova Health Institute's harm reduction initiatives for people who use drugs. Sex Health 2019; 15:176-178. [PMID: 29559070 DOI: 10.1071/sh17158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022]
Abstract
Chemsex is the colloquial term used for a specific pattern of drug use that is increasingly common among men who have sex with men (MSM) globally. The recreational substances employed are used specifically in a sexualized context. The reasons for chemsex among MSM are complex. The Anova Health Institute (Anova) provided harm-reduction services in Cape Town, South Africa in 2013 and 2014. This project, known as Tikking the Boxes had two objectives: first to provide direct harm-reduction services to drug-using MSM in Cape Town, South Africa, and second, to reduce HIV and hepatitis B and C transmission among this population. This was done by identifying drug-using behaviour among MSM and linking them to harm-reduction services. Employing people who were currently using drugs was a novel aspect of this program, and successfully facilitated access to MSM drug-using networks. At the launch of the project, the concept of harm reduction was easily misunderstood by MSM. Another challenge was that the harm-reduction service, encompassing needle exchange, excluded opioid substitution therapy. People who use drugs were employed as outreach workers, requiring the project to be very flexible and adaptable to sometimes complex lives and difficult-to-reach peers. JAB SMART is Anova's new harm-reduction initiative and started in May 2017, with support from the City of Johannesburg Health Department, and is the first project of its kind in the city to provide harm-reduction services to people who inject drugs (PWID) and their sexual partners.
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Affiliation(s)
- Johannes M Hugo
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - Kevin B Rebe
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - Evan Tsouroulis
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - Anthony Manion
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - Glenn de Swart
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - Helen Struthers
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
| | - James A McIntyre
- Anova Health Institute, 12 Sherborne Rd, Parktown, Johannesburg 2193, South Africa
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95
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Van Hout MC, Crowley D, O'Dea S, Clarke S. Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene. CULTURE, HEALTH & SEXUALITY 2019; 21:1074-1086. [PMID: 30600787 DOI: 10.1080/13691058.2018.1529336] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Club drug use among gay, bisexual and other men who have sex with men is increasingly normalised within sexual contexts and is associated with increased sexual risk behaviours. The term Chemsex is used to describe sexualised drug use lasting several hours or days with multiple sexual partners. A small pilot study, underpinned by interpretative phenomenological analysis (IPA), was conducted in Dublin, Ireland. Interviews were conducted with 10 men who were experiencing physical and emotional health problems as a consequence of their participation in sexualised drug use and wished to exit the Chemsex scene. Interviews explored experiences of sexualised drug use, motives to partake, the organisation of Chemsex parties and group connectivity, drugs used, harm reduction, pleasure and consequences of participation over time. Four basic themes emerged from the analysis: social and cyber arrangements within the Dublin Chemsex scene; poly drug use and experiences of drug dependence; drug and sexual harm reduction within the Chemsex circle of novices and experts; and sexualised drug use, escapism and compulsive participation. Two higher-order themes were also apparent: first, the reinforcing aspects of drug and sexual pleasure; and second, the interplay between excess drug consumption and sex, and drug dependence.
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Affiliation(s)
| | - Des Crowley
- b Substance Misuse Programme, Irish College of General Practitioners , Dublin , Ireland
| | - Siobhan O'Dea
- c Gay Men's Health Service, Baggot Street Hospital , Dublin , Ireland
| | - Susan Clarke
- c Gay Men's Health Service, Baggot Street Hospital , Dublin , Ireland
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96
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Bunzel L, Koelzer SC, Zedler B, Verhoff MA, Parzeller M. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019; 16:1547-1556. [PMID: 31447384 DOI: 10.1016/j.jsxm.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/24/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons. AIM The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques. METHODS This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany. MAIN OUTCOME MEASURE Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context. RESULTS Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages. CLINICAL IMPLICATIONS The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur. STRENGTHS & LIMITATIONS This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption. CONCLUSION In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks. Bunzel L, Koelzer SC, Zedler B, et al. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019;16:1547-1556.
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Affiliation(s)
- Lena Bunzel
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany.
| | - Sarah C Koelzer
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
| | - Barbara Zedler
- Institute of Legal Medicine, Justus Liebig University of Gießen, Gießen, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
| | - Markus Parzeller
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
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Pellegrini M, Bolino G, Varì MR, Giorgetti R, Pichini S, Busardò FP. A fatal chemsex case involving γ‐butyrolactone and 4‐methylethcathinone. Drug Test Anal 2019; 11:1465-1470. [DOI: 10.1002/dta.2677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Manuela Pellegrini
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Giorgio Bolino
- Unit of Forensic Pathology, SAIMLAL DepartmentSapienza University of Rome Rome Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Raffaele Giorgetti
- Section of Legal Medicine, Department of Excellence SBSPUniversity Politecnica delle Marche of Ancona Ancona Italy
| | - Simona Pichini
- National Centre on Addiction and DopingIstituto Superiore di Sanità Rome Italy
| | - Francesco Paolo Busardò
- Section of Legal Medicine, Department of Excellence SBSPUniversity Politecnica delle Marche of Ancona Ancona Italy
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Troya J, Martínez de Gándara A, Ryan P, Cuevas G, Pardo V. Mephedrone and chemsex: when it stops being a party and becomes a fatal problem. Int J STD AIDS 2019; 30:1028-1030. [DOI: 10.1177/0956462419857004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chemsex is the use of psychoactive substances, mainly gamma-hydroxybutyrate, 4-methylmethcathinone (mephedrone), and methamphetamines to facilitate and enhance the experience of sexual intercourse. The toxicity of these drugs may be problematic and lead to a fatal outcome in some patients. We present the case of a 26-year-old man living with human immunodeficiency virus whose frequent use of mephedrone caused his death.
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Affiliation(s)
- Jesús Troya
- Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Pablo Ryan
- Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Virginia Pardo
- Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
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Flores-Aranda J, Goyette M, Aubut V, Blanchette M, Pronovost F. Let’s talk about chemsex and pleasure: the missing link in chemsex services. DRUGS AND ALCOHOL TODAY 2019. [DOI: 10.1108/dat-10-2018-0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to document the experience of current and former methamphetamine users on their crystal meth use patterns and on their use of services related to their chemsex practice.
Design/methodology/approach
For qualitative component, two focus groups were formed with nine current users of methamphetamine and eight former users. Thematic analysis was performed to know their experiences.
Findings
All participants were already engaging in chemsex with various substances before they first started using methamphetamine. Methamphetamine use led some to slam (methamphetamine or mephedrone injection). Some participants report that their sexual experiences were intensified early in their chemsex practice. They reported feeling more confident with their partners, feeling like they are sexually attractive and overcoming their barriers to sexuality. The intensification of methamphetamine use and, in particular, injection change the positive perception of sexual life. Thus, for some participants, substance use takes more space and their sexual experiences become less satisfactory.
Practical implications
Participants report the services that address the phenomenon of chemsex are still scarce in Quebec province. In addition, the few services available aim to relearn a sober sexuality. However, the mourning of the positive aspects of chemsex on sexual experiences seems still very little discussed. Greater consideration of positive chemsex experiences is needed in services that address this issue.
Originality/value
This project documented the perception of pleasure related to sexual practices among regular methamphetamine users. Their perception of pleasure will help develop services adapted to their reality.
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Gamma-hydroxybutyric acid, gamma-butyrolactone, and 1,4-butanediol addiction: a serious health threat. Arh Hig Rada Toksikol 2019; 70:149-150. [PMID: 31246568 DOI: 10.2478/aiht-2019-70-3295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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