Development of a rational scale to assess the harm of drugs of potential misuse

Perceived harmfulness of various alcohol- and cannabis use modes: Secular trends, differences, and associations with actual substance use behaviors among Norwegian adolescents, 2007-2015

BACKGROUND

How youth perceive harmfulness of risk behaviors such as substance use relates to their engagement in those behaviors. Yet, little is known about how different substance use modes (i.e., variations in amounts and use frequencies) are perceived. We investigated how adolescent perceptions of harmfulness of various alcohol- and cannabis use modes changed over time, compared to one another, and related to actual substance use behaviors.

METHODS

We examined nationally-representative repeated cross-sectional samples of 16-year olds in Norway, assessed in 2007, 2011, and 2015 (N_Total = 9296) as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Adolescents reported their: 1) lifetime alcohol- and cannabis use, and 2) perceived harmfulness of various alcohol- and cannabis use modes.

RESULTS

Prevalence estimates for perceived harmfulness: 1) remained high and stable, or increased for alcohol use modes, and 2) declined for all cannabis use modes (i.e., using 1-2 times, occasionally, and regularly) since 2007-cohort. High quantity daily drinking was more commonly perceived as harmful than minimal or occasional cannabis use. Even though culturally-relevant use modes (i.e., weekend heavy drinking and experimental cannabis use) were not most commonly endorsed as harmful, only perceptions of those use modes as harmful were inversely associated with actual substance use.

CONCLUSIONS

How adolescents from Norway perceived harmfulness of alcohol- and cannabis use depended on the specific substance, its use modes, and secular cohort. Perceived harmfulness was associated with measures of actual substance use predominantly along the culturally- and adolescent-relevant modes of use.

Heavy marijuana use but not deprivation is associated with increased stressor reactivity

Although stressors appear to motivate marijuana use, and marijuana use, in turn, is believed to induce stress system neuroadaptations, relatively little empirical work has explicitly tested for stress neuroadaptations associated with heavy marijuana use. We examined stressor reactivity to threat of unpredictable electric shock via startle potentiation among heavy marijuana users and a control group that reported minimal history of marijuana use. Heavy marijuana users were randomly assigned to 3 days of marijuana deprivation or no deprivation. This design allowed us to test contrasts for heavy (vs. minimal) use and deprivation (vs. no deprivation) on stressor reactivity. Heavy marijuana users (both deprived and nondeprived) displayed increased startle potentiation during threat of unpredictable electric shock relative to minimal use controls. In contrast, marijuana deprivation had no effect on startle potentiation. Startle potentiation was also increased among users who reported greater stress-coping motives for their marijuana use and users with cannabis use disorder diagnoses. To our knowledge, this is the 1st study to demonstrate increased reactivity to unpredictable stressors among heavy marijuana users. However, comparable increased unpredictable stressor reactivity among patients with alcohol and other substance use disorders has been previously documented. This relationship to heavy marijuana use is consistent with predictions from rodent addiction models regarding stress neuroadaptations following heavy, chronic drug use but could also represent an etiologically relevant premorbid risk characteristic. Finally, the clinical import of unpredictable stressor reactivity is reinforced by its relationships with stress-coping motives and cannabis use disorder status. (PsycINFO Database Record

Longitudinal changes in cocaine intake and cognition are linked to cortical thickness adaptations in cocaine users

BACKGROUND

Cocaine use has been consistently associated with decreased gray matter volumes in the prefrontal cortex. However, it is unclear if such neuroanatomical abnormalities depict either pre-existing vulnerability markers or drug-induced consequences. Thus, this longitudinal MRI study investigated neuroplasticity and cognitive changes in relation to altered cocaine intake.

METHODS

Surface-based morphometry, cocaine hair concentration, and cognitive performance were measured in 29 cocaine users (CU) and 38 matched controls at baseline and follow-up. Based on changes in hair cocaine concentration, CU were classified either as Decreasers (n = 15) or Sustained Users (n = 14). Surface-based morphometry measures did not include regional tissue volumes.

RESULTS

At baseline, CU displayed reduced cortical thickness (CT) in lateral frontal regions, and smaller cortical surface area (CSA) in the anterior cingulate cortex, compared to controls. In Decreasers, CT of the lateral frontal cortex increased whereas CT within the same regions tended to further decrease in Sustained Users. In contrast, no changes were found for CSA and subcortical structures. Changes in CT were linked to cognitive performance changes and amount of cocaine consumed over the study period.

CONCLUSIONS

These results suggest that frontal abnormalities in CU are partially drug-induced and can recover with decreased substance use. Moreover, recovery of frontal CT is accompanied by improved cognitive performance confirming that cognitive decline associated with cocaine use is potentially reversible.

PERCEPTION OF RISK AND DRIVING UNDER THE EFFECTS OF ALCOHOL AND MARIJUANA ON UNIVERSITY STUDENTS IN A MULTICENTER STUDY: COLOMBIA

ABSTRACT Objective: analyze the relationship between the perception of risk and the behavior of driving under the influence of alcohol or marijuana or getting into a vehicle driven by someone under the effects of these substances in order to identify risk factors and protective factors. Method: multicenter study cross sectional survey with students from a University in Colombia (n = 493) completed a survey prepared during the International Program of Training in Research for Health Professionals and Related Areas to Study the Drug Phenomenon in Latin America and the Caribbean. Results: an inverse relationship was observed between each of the three levels of risk perception: detection (p<.001), punishment (p<.05) and harm (p<.001), and driving behaviors with alcohol. This same type of relationship is observed with marijuana in terms of perceived risk of being involved in an accident (p<.05). However, regarding to marijuana, there is not enough evidence of an association with the perceived risk of being arrested or punished. The results show that there is an inverse relationship between what the students' relatives and friends think and do and the perception of risk of being arrested (p<.001), punished (p<.001) or of being involved in an accident (p<.001) for driving under the influence of alcohol and marijuana at the same time. Conclusion: the results suggest that there are risk factors and protective factors that can be intervened to prevent injuries or fatal events associated with driving under the influence of alcohol or marijuana.

Planned and Unplanned Drug Use during a Night out at an Electronic Dance Music Party

BACKGROUND

Electronic dance music (EDM) parties at nightclubs and festivals are high-risk scenes for drug use. Although intention to use drugs (such as ecstasy) has been shown to be the most proximal determinant of use, little is known regarding the extent to which drug use is unplanned in this high-risk scene.

METHODS

We surveyed 954 adults entering EDM parties in New York City in 2017 and asked about planned drug use that night. A quarter (n = 236) completed the optional online follow-up survey which asked about drug use during their outing. We examined prevalence and correlates of planned and unplanned use.

RESULTS

A fifth (21.0%) of attendees reported planning to use a specific drug the night of the party and over a third (35.4%) reported using a drug later that night. A quarter (26.6%) used in an unplanned manner. Unplanned marijuana use was most common (10.7%), followed by unplanned use of ecstasy (7.3%), cocaine (4.7%), amphetamine (1.4%), LSD (1.3%), and MDA (1.1%). Unplanned initiation of ecstasy and PMA also occurred. Unplanned drug use was more likely to occur among those recruited outside of nightclubs compared to festivals. Non-heterosexual participants and those with a college degree or higher were also more likely to engage in unplanned marijuana use compared to heterosexual and less educated participants, respectively.

CONCLUSIONS

Unplanned drug use is common at EDM parties. Results can inform prevention and harm reduction in these scenes as unplanned use may exacerbate potential adverse outcomes related to drug use and often extreme party environments.

Difference in long-term relapse rates between youths with ketamine use and those with stimulants use

BACKGROUND

Understanding the relapse risk among different illicit drugs is vital for developing an adequate relapse prevention policy. Therefore, the current study aims to explore the potential difference in long-term relapse rates between youths who use ketamine and those who use stimulants (3,4-Methylenedioxymethamphetamine [MDMA] or methamphetamine).

METHODS

The study's participants included 92 youths with ketamine use (ketamine group, mean age: 16.0 years) and 43 youths with MDMA/methamphetamine use (stimulants group, mean age: 16.1 years) that had undergone a family-oriented treatment program in a medical center in Taiwan. All participants were followed up for a maximum of 7 years in order to observe their long-term outcomes with regard to substance use relapse.

RESULTS

During the follow-up period, compared to the 34.8% relapse rate in ketamine users, their counterparts who used MDMA or methamphetamine had a significantly higher relapse rate (60.5%, Adjusted HR = 1.86, 95%CI: 1.06-3.28, p = 0.032). Of the youths in the ketamine group that relapsed, 65.6% continued to use ketamine in their relapse event, while 34.4% switched to MDMA or methamphetamine. Among the relapsing youths in the stimulants group, 84.6% continued to use MDMA or methamphetamine in their relapse event, while 15.4% switched to ketamine (p = 0.042).

CONCLUSIONS

Compared to adolescents who use ketamine, those using MDMA or methamphetamine had higher relapse rates and were more likely to use the same type of drug upon relapsing. These results can serve as a crucial reference for developing relapse prevention policies of illicit drugs for the youth population.

Against the stream: drugs policy needs to be turned on its head

SummaryHumans have always used mind-altering drugs. However, in 1961 the United Nations approved the Single Convention, under which the production, sale or possession of a number of drugs, including heroin, cocaine, ecstasy and cannabis, became illegal. The prohibitionist regime was then introduced by most countries around the world and has substantially remained in place ever since. Some countries, particularly those in Latin America, have never criminalised the use of cannabis. A small number of countries have introduced more liberal policies. This article examines the evidence of the consequences of policy liberalisation and argues that there is now a clear case for every country to examine its drug policies and to introduce evidence-based policies with a public health focus.Declaration of interestNone.

Punishment of alcohol-reinforced responding in alcohol preferring P rats reveals a bimodal population: Implications for models of compulsive drug seeking

Individual variations in animal behaviour can be used to describe relationships between different constructs, as well as the underlying neurobiological mechanisms responsible for such variation. In humans, variation in the expression of certain traits contributes to the onset of psychopathologies, such as drug addiction. Addiction is characterised by persistent drug use despite negative consequences, but it occurs in only a sub-population of drug users. Compulsive drug use is modelled in laboratory animals by punishing a drug-reinforced operant response. It has been reported that there is individual variability in the response to punishment, and in this report we aim to further define the conditions under which this variation can be observed. We have previously used footshock punishment to suppress alcohol seeking in an animal model of context-induced relapse to alcohol seeking after punishment-imposed abstinence. Here we present a re-examination of the training and punishment data from a large cohort of rats (n=499) collected over several years. We found evidence for a bimodal distribution in the response to punishment in alcohol preferring P rats. We only observed this population split when rats received constant shock intensity for three sessions, but not when increasing shock intensity was used. This observation provides evidence for the existence of two distinct groups of rats, defined by their response to punishment, in an otherwise homogeneous population. The implications of this observation are discussed in reference to prior observations using punishment of other addictive drugs (cocaine and methamphetamine), the potential causes of this phenomenon, and with broader implications for the cause of alcohol and drug addiction in humans.

The active heroin metabolite 6-acetylmorphine has robust reinforcing effects as assessed by self-administration in the rat

Previous studies have suggested that at least some of the behavioral effects of heroin might be mediated by its active metabolite 6-acetylmorphine (6-AM). The aim of the present study was to investigate the reinforcing effects of 6-AM and its role in mediating those of heroin. We used an intravenous self-administration procedure in male Sprague-Dawley rats including four phases: acquisition, extinction, reinstatement of drug-seeking, and re-acquisition. Independent groups of rats readily learned to self-administer equimolar doses (0.135 μmol/kg) of either 6-AM (44.3 μg/kg) or heroin (50 μg/kg). Under a fixed ratio 1 (FR1) schedule of reinforcement, the rate of responding was the same for 6-AM and heroin, but it was significantly higher for 6-AM than for heroin under a FR2 schedule. A non-contingent infusion ('priming') of 0.068 μmol/kg of either 6-AM or heroin reinstated non-reinforced drug-seeking (relapse). The rats readily re-acquired self-administration behaviour when given access to one of two doses (0.068 and 0.135 μmol/kg) of 6-AM or heroin. Pretreatment with a specific monoclonal antibody (mAb) against 6-AM blocked the priming effect of 6-AM, and modified the rate of lever-pressing on re-acquisition of 6-AM self-administration in a manner compatible with a shift to the right of the dose-effect curve. The mAb did not affect heroin responding. The present results show that 6-AM possesses reinforcing effects similar to those of heroin. The lack of effect of 6-AM mAb on heroin priming and heroin self-administration calls for further studies to clarify the role of heroin and its metabolites in heroin reward. This article is part of the Special Issue entitled 'Opioid Neuropharmacology: Advances in treating pain and opioid addiction'.

Expectations about alcohol, cocaine, and benzodiazepine abstinence following inpatient heroin withdrawal management

BACKGROUND AND OBJECTIVES

Polysubstance use is associated with relapse and poor treatment outcomes among people dependent on heroin. Despite the high prevalence of polysubstance use among patients detoxifying from heroin, little is known about patients' expectations to abstain or use non-opiate substances. The current study examined factors associated with expectations about abstaining from alcohol, cocaine, and benzodiazepines (BZDs) following heroin withdrawal management.

METHODS

Between May and December of 2015, we surveyed 417 patients (71.9% male, 31.7 [±8.39] mean years old) initiating short-term inpatient heroin withdrawal management who reported alcohol, cocaine, or BZD use in the past 30 days. We used logistic regression to evaluate the adjusted associations of background characteristics with expectations about using each substance following discharge.

RESULTS

Approximately half of respondents reported past month alcohol (52%), cocaine (47.0%), or BZD (47.0%) use, and 25.9% reported using all three substances. Approximately half of those reporting drinking, 6.6% reporting cocaine use, and 27% of reporting BZD use expected to abstain from using that substance following heroin withdrawal. Prior opioid withdrawal was associated with a lower likelihood of expecting to stop using alcohol and BZDs, and more days of BZD use was associated with a greater likelihood of expecting to abstain from BZDs following discharge.

CONCLUSION

Persons with opioid use disorder often do not expect to stop using other substances following withdrawal management, with very few planning cocaine cessation.

SCIENTIFIC SIGNIFICANCE

Inpatient heroin withdrawal programs need to address and educate patients about how polysubstance use complicates recovery from heroin use. (Am J Addict 2019;28:36-42).

Ethanol upregulates the P2X7 purinergic receptor in human macrophages

Alcohol consumption is considered to be the third leading cause of death in the United States. In addition to its direct toxicity, ethanol has two contrasting effects on the immune system: the nucleotide oligomerization domain-like receptor pyrin domain-containing-3 (NLRP3) inflammasome is inhibited by acute ethanol exposure but activated by chronic ethanol exposure. Purinergic receptors (especially the P2X7 receptor) are able to activate the NLRP3 inflammasome and are involved in many ethanol-related diseases (such as gout, pulmonary fibrosis, alcoholic steatohepatitis, and certain cancers). We hypothesized that ethanol regulates purinergic receptors and thus modulates the NLRP3 inflammasome's activity. In experiments with monocyte-derived macrophages, we found that interleukin (IL)-1β secretion was inhibited after 7 h of exposure (but not 48 h of exposure) to ethanol. The disappearance of ethanol's inhibitory effect on IL-1β secretion after 48 h was not mediated by the upregulated production of IL-1β, IL-1α, IL-6 or the inflammasome components NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain, and caspase 1. P2X7R expression was upregulated by ethanol, whereas expression of the P2X4 and P2X1 receptors was not. Taken as a whole, our results suggest that ethanol induces NLRP3 inflammasome activation by upregulating the P2X7 receptor. This observation might have revealed a new mechanism for inflammation in ethanol-related diseases.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey

BACKGROUND

Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions.

METHODS

The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances.

RESULTS

In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39-3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41-5.90, and AOR 5.87, 95%CI 3.08-11.18 respectively).

CONCLUSIONS

The prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

A computational strategy for finding novel targets and therapeutic compounds for opioid dependence

Opioids are widely used for treating different types of pains, but overuse and abuse of prescription opioids have led to opioid epidemic in the United States. Besides analgesic effects, chronic use of opioid can also cause tolerance, dependence, and even addiction. Effective treatment of opioid addiction remains a big challenge today. Studies on addictive effects of opioids focus on striatum, a main component in the brain responsible for drug dependence and addiction. Some transcription regulators have been associated with opioid addiction, but relationship between analgesic effects of opioids and dependence behaviors mediated by them at the molecular level has not been thoroughly investigated. In this paper, we developed a new computational strategy that identifies novel targets and potential therapeutic molecular compounds for opioid dependence and addiction. We employed several statistical and machine learning techniques and identified differentially expressed genes over time which were associated with dependence-related behaviors after exposure to either morphine or heroin, as well as potential transcription regulators that regulate these genes, using time course gene expression data from mouse striatum. Moreover, our findings revealed that some of these dependence-associated genes and transcription regulators are known to play key roles in opioid-mediated analgesia and tolerance, suggesting that an intricate relationship between opioid-induce pain-related pathways and dependence may develop at an early stage during opioid exposure. Finally, we determined small compounds that can potentially target the dependence-associated genes and transcription regulators. These compounds may facilitate development of effective therapy for opioid dependence and addiction. We also built a database (http://daportals.org) for all opioid-induced dependence-associated genes and transcription regulators that we discovered, as well as the small compounds that target those genes and transcription regulators.

Does perception of drug-related harm change with age? A cross-sectional online survey of young and older people

OBJECTIVES

To investigate how young and older people perceive the harms associated with legal and illegal drugs.

DESIGN

Cross-sectional study: adults aged 18-24 years versus 45+ completed an online survey ranking the perceived harms associated with 11 drugs on 16 drug-related harm criteria.

SETTING

Online survey.

PARTICIPANTS

184 participants aged 18-24 years (113 female: mean age 21: SD 1.3) and 91 participants aged 45+ (51 female: mean age 60: SD 8.5).

MAIN OUTCOME MEASURES

'Perception of drug-related harms': This was measured using a rating scale ranging from 1 (no risk of harm) to 4 (high risk of harm). Participants were also asked about sources which informed their perception on drug-related harms as well as their own personal self-reported drug experiences.

RESULTS

Of the illegal drugs, heroin, methamphetamine and cocaine were rated as the most harmful and cannabis was rated as the least harmful. Alcohol and tobacco were also rated as less harmful. The results showed that perceptions of drug-related harms were inconsistent with current knowledge from research on drugs. Furthermore, perceptions on drug harms were more conservative in the 45+ group for a number of illegal drugs and tobacco. However, the 45+ age group did not perceive alcohol as any more harmful than the younger group.

CONCLUSIONS

This survey demonstrates that the greatest misperception was in relation to alcohol-related harms which did not change with age. In order to minimise harms, this misperception needs to be addressed through education and policies that legislate drug use.

Response dynamics of midbrain dopamine neurons and serotonin neurons to heroin, nicotine, cocaine, and MDMA

Heroin, nicotine, cocaine, and MDMA are abused by billions of people. They are believed to target midbrain dopamine neurons and/or serotonin neurons, but their effects on the dynamic neuronal activity remain unclear in behaving states. By combining cell-type-specific fiber photometry of Ca²⁺ signals and intravenous drug infusion, here we show that these four drugs of abuse profoundly modulate the activity of mouse midbrain dopamine neurons and serotonin neurons with distinct potency and kinetics. Heroin strongly activates dopamine neurons, and only excites serotonin neurons at higher doses. Nicotine activates dopamine neurons in merely a few seconds, but produces minimal effects on serotonin neurons. Cocaine and MDMA cause long-lasting suppression of both dopamine neurons and serotonin neurons, although MDMA inhibits serotonin neurons more profoundly. Moreover, these inhibitory effects are mediated through the activity of dopamine and serotonin autoreceptors. These results suggest that the activity of dopamine neurons and that of serotonin neurons are more closely associated with the drug's reinforcing property and the drug's euphorigenic property, respectively. This study also shows that our methodology may facilitate further in-vivo interrogation of neural dynamics using animal models of drug addiction.

The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

This review assesses the abuse potential of medically-administered psilocybin, following the structure of the 8 factors of the US Controlled Substances Act (CSA). Research suggests the potential safety and efficacy of psilocybin in treating cancer-related psychiatric distress and substance use disorders, setting the occasion for this review. A more extensive assessment of abuse potential according to an 8-factor analysis would eventually be required to guide appropriate schedule placement. Psilocybin, like other 5-HT2A agonist classic psychedelics, has limited reinforcing effects, supporting marginal, transient non-human self-administration. Nonetheless, mushrooms with variable psilocybin content are used illicitly, with a few lifetime use occasions being normative among users. Potential harms include dangerous behavior in unprepared, unsupervised users, and exacerbation of mental illness in those with or predisposed to psychotic disorders. However, scope of use and associated harms are low compared to prototypical abused drugs, and the medical model addresses these concerns with dose control, patient screening, preparation and follow-up, and session supervision in a medical facility. CONCLUSIONS: (1) psilocybin has an abuse potential appropriate for CSA scheduling if approved as medicine; (2) psilocybin can provide therapeutic benefits that may support the development of an approvable New Drug Application (NDA) but further studies are required which this review describes; (3) adverse effects of medical psilocybin are manageable when administered according to risk management approaches; and (4) although further study is required, this review suggests that placement in Schedule IV may be appropriate if a psilocybin-containing medicine is approved. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.

Dark Classics in Chemical Neuroscience: 3,4-Methylenedioxymethamphetamine

Better known as "ecstasy", 3,4-methylenedioxymethamphetamine (MDMA) is a small molecule that has played a prominent role in defining the ethos of today's teenagers and young adults, much like lysergic acid diethylamide (LSD) did in the 1960s. Though MDMA possesses structural similarities to compounds like amphetamine and mescaline, it produces subjective effects that are unlike any of the classical psychostimulants or hallucinogens and is one of the few compounds capable of reliably producing prosocial behavioral states. As a result, MDMA has captured the attention of recreational users, the media, artists, psychiatrists, and neuropharmacologists alike. Here, we detail the synthesis of MDMA as well as its pharmacology, metabolism, adverse effects, and potential use in medicine. Finally, we discuss its history and why it is perhaps the most important compound for the future of psychedelic science-having the potential to either facilitate new psychedelic research initiatives, or to usher in a second Dark Age for the field.

Marijuana use by middle-aged and older adults in the United States, 2015-2016

BACKGROUND

Marijuana use is increasing among middle-aged and older adults in the US, but little is understood of its pattern of use by this population.

METHODS

We performed a cross-sectional analysis of responses from 17,608 adults aged ≥50 years from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. Prevalence of past-year marijuana use was estimated and compared between middle-aged adults (age 50-64) and older adults (≥65). Characteristics of past-year marijuana users including demographics, substance use, chronic disease, and emergency room use, were compared to non-marijuana users and stratified by age group. Marijuana use characteristics were also compared between middle-aged and older adults. We used multivariable logistic regression to determine correlates of past-year marijuana use.

RESULTS

Prevalence of past-year marijuana use was 9.0% among adults aged 50-64 and 2.9% among adults aged ≥65. Prevalence of past-year alcohol use disorder (AUD), nicotine dependence, cocaine use, and misuse of prescription medications (i.e., opioids, sedatives, tranquilizers) were higher among marijuana users compared to non-users. In adjusted models, initiation of marijuana use <19 years of age [adjusted odds ratio (AOR) = 13.43, 95% confidence interval (CI) 9.60, 18.78)], AUD (AOR = 2.11, 95% CI 1.51, 2.94), prescription opioid misuse (AOR 2.49, 95% CI 1.61, 3.85), nicotine dependence (AOR = 1.90, 95% CI 1.59, 2.26), and cocaine use (AOR 7.43, 95% CI 4.23, 13.03), were all associated with increased odds of past-year marijuana use.

CONCLUSION

Marijuana use is becoming more prevalent in this population and users are also at high risk for other drug use.

Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions

Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.

Toward an Improved Multi-Criteria Drug Harm Assessment Process and Evidence-Based Drug Policies

Drug scheduling within the international system of drug control and national legislation has been recently criticized as having insufficient footing in scientific evidence. The legal harms related to non-medical uses of certain drugs (e.g., cannabis) have arguably exceeded their physiological and social harmfulness compared to legally available substances (e.g., tobacco), which prompted some states to explore alternative regulation policies, similar to the drug regime in the Netherlands. Other legally prescribed drugs (e.g., stimulants) created a surge of interest for "better than well" uses, while yet others (e.g., opioids) caused an epidemic of dramatic proportions in North America. The evidence-based multi-criteria drug harm scale (MCDHS) has been proposed as a way of grounding policy in the actual degree of harmfulness of drugs. Indeed, the scale has had great ramifications in several areas of policy, and it has been used extensively in distinct lines of interdisciplinary research. However, some aspects of MCDHS remain disputed. For example, the way the data has been generated has been criticized as suffering from "expert bias." This article reviews strengths and weaknesses of evidence provided with the use of MCDHS. Furthermore, the author argues that the shortcomings of MCDHS can be resolved by offering methodological improvements. These include (1) dissociating the harms of use from harms of abuse, (2) adding the perspectives of people who use drugs, pharmacists, and general medical practitioners along with the expert assessments, and (3) focusing on subsets of drugs to allow for comparison without mixing different social contexts of drug use. The paper concludes with outlines of substance subset-specific extensions of the MCDHS and related policy proposals in the four areas identified as generating the most controversy: non-medical use of opioids, "study aid" uses of stimulants, shifting trends in nicotine containing products, and regulation of medical and recreational uses of cannabis.

Drinking wine to "get high": The influence of awareness of the negative effects among young adults

Introduction

In a group of university students, the current study investigated the relationship between drinking wine to get high and the awareness about its characteristics, composition, positive and negative effects on health.

Methods

Through a web-based survey, 1685 students at the University of Siena completed a self-report questionnaire to assess consumption behaviours, knowledge about wine and the awareness about its effects.

Results

Seventy-three percent reported drinking wine. Males were more frequently wine consumers (p = 0.037). Among the students who reported drinking, 69.3% engaged this habit during the weekend. Almost 12% reported drinking wine to get high. Drinking wine to get high correlated with the consideration of its consumption: using this beverage to get high was strongly associated with considering wine like other spirits (p = 0.033).

Conclusions

Older age, female gender, and considering wine as a part of the diet were found to be protective factors against wine drinking-to get high. In contrast with some literature, awareness of the negative effects correlated with higher propensity to use wine to get high. Potential interpretations and limitations are addressed.

•

Wine is frequently used by young people to get high, similarly to other spirits.

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Gender and age affect wine drinking behaviours.

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Gender and age do not mediate the awareness on wine drinking-to get high.

•

Being female and older are protective factors against abuse of wine.

•

The knowledge about negative effects influence the likelihood of using wine to get high.

PCE Use in the Workplace: The Open Secret of Performance Enhancement

Increasing evidence suggests employees are turning to the nonprescribed use of stimulants to supplement their performance. We sit in a unique position regarding stimulants in the workforce. They are easily available, there is little stigma attached to use, and there is little information regarding the long-term safety effects of use. With that in mind, almost no formal research has been executed in the realm of organizational behavior. The purpose of this JMI ( Journal of Management Inquiry) Generative Curiosity article is to introduce readers to this literature and identify what we believe are the most important avenues of inquiry for management scholars.

Human fascioliasis infection sources, their diversity, incidence factors, analytical methods and prevention measures

Human fascioliasis infection sources are analysed for the first time in front of the new worldwide scenario of this disease. These infection sources include foods, water and combinations of both. Ingestion of freshwater wild plants is the main source, with watercress and secondarily other vegetables involved. The problem of vegetables sold in uncontrolled urban markets is discussed. Distinction between infection sources by freshwater cultivated plants, terrestrial wild plants, and terrestrial cultivated plants is made. The risks by traditional local dishes made from sylvatic plants and raw liver ingestion are considered. Drinking of contaminated water, beverages and juices, ingestion of dishes and soups and washing of vegetables, fruits, tubercles and kitchen utensils with contaminated water are increasingly involved. Three methods to assess infection sources are noted: detection of metacercariae attached to plants or floating in freshwater, anamnesis in individual patients, and questionnaire surveys in endemic areas. The infectivity of metacercariae is reviewed both under field conditions and experimentally under the effects of physicochemical agents. Individual and general preventive measures appear to be more complicated than those considered in the past. The high diversity of infection sources and their heterogeneity in different countries underlie the large epidemiological heterogeneity of human fascioliasis throughout.

Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey

OBJECTIVES

To examine the knowledge and attitudes of Australian general practitioners (GP) towards medicinal cannabis, including patient demand, GP perceptions of therapeutic effects and potential harms, perceived knowledge and willingness to prescribe.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional survey completed by 640 GPs (response rate=37%) attending multiple-topic educational seminars in five major Australian cities between August and November 2017.

MAIN OUTCOME MEASURES

Number of patients enquiring about medicinal cannabis, perceived knowledge of GPs, conditions where GPs perceived it to be beneficial, willingness to prescribe, preferred models of access, perceived adverse effects and safety relative to other prescription drugs.

RESULTS

The majority of GPs (61.5%) reported one or more patient enquiries about medicinal cannabis in the last three months. Most felt that their own knowledge was inadequate and only 28.8% felt comfortable discussing medicinal cannabis with patients. Over half (56.5%) supported availability on prescription, with the preferred access model involving trained GPs prescribing independently of specialists. Support for use of medicinal cannabis was condition-specific, with strong support for use in cancer pain, palliative care and epilepsy, and much lower support for use in depression and anxiety.

CONCLUSIONS

The majority of GPs are supportive or neutral with regards to medicinal cannabis use. Our results highlight the need for improved training of GPs around medicinal cannabis, and the discrepancy between GP-preferred models of access and the current specialist-led models.

Assessing the longitudinal stability of latent classes of substance use among gay, bisexual, and other men who have sex with men

BACKGROUND

Association between substance use and HIV-risk among gay and bisexual men (GBM) is well documented. However, their substance use patterns are diverse, and it is unknown whether self-reported use patterns are stable over time.

METHODS

Sexually-active GBM, aged >16 years, were recruited in Metro Vancouver using respondent-driven sampling and followed across 5 study visits at six-month intervals (n = 449). To identify distinct patterns of substance use and their longitudinal stability, Latent Transition Analysis (LTA) was conducted for drugs reported by at least 30 participants. Intraclass correlation coefficients (ICC) quantified the stability of class assignments.

RESULTS

Six classes characterizing 'limited drug use' (i.e., low use of all drugs, except alcohol), 'conventional drug use' (i.e., use of alcohol, marijuana, and tobacco), 'club drug use' (i.e., use of alcohol, cocaine, and psychedelics), 'sex drug use' (i.e., use of alcohol, crystal meth, GHB, poppers, and erectile dysfunction drugs), 'street drug use' (i.e., use of alcohol and street opioids) and 'assorted drug use' (i.e., use of most drugs) were identified. Across five visits (2.5 years), 26.3% (n = 118/449) of GBM transitioned between classes. The prevalence of limited use trended upwards (Baseline:24.5%, Visit 5:28.3%, p < 0.0001) and assorted use trended downwards (13.4%-9.6%, p = 0.001). All classes had strong longitudinal stability (ICC > 0.97).

CONCLUSION

The stability of latent substance use patterns highlight the utility of these measures in identifying patterns of substance use among people who use drugs - potentially allowing for better assessment of these groups and interventions related to their health.

Psychedelics Promote Structural and Functional Neural Plasticity

Atrophy of neurons in the prefrontal cortex (PFC) plays a key role in the pathophysiology of depression and related disorders. The ability to promote both structural and functional plasticity in the PFC has been hypothesized to underlie the fast-acting antidepressant properties of the dissociative anesthetic ketamine. Here, we report that, like ketamine, serotonergic psychedelics are capable of robustly increasing neuritogenesis and/or spinogenesis both in vitro and in vivo. These changes in neuronal structure are accompanied by increased synapse number and function, as measured by fluorescence microscopy and electrophysiology. The structural changes induced by psychedelics appear to result from stimulation of the TrkB, mTOR, and 5-HT2A signaling pathways and could possibly explain the clinical effectiveness of these compounds. Our results underscore the therapeutic potential of psychedelics and, importantly, identify several lead scaffolds for medicinal chemistry efforts focused on developing plasticity-promoting compounds as safe, effective, and fast-acting treatments for depression and related disorders.

A reciprocal effects analysis of cannabis use and perceptions of risk

BACKGROUND AND AIMS

Adolescents and young adults increasingly view cannabis as a relatively safe drug. Perception of risk associated with cannabis use is correlated negatively with the prevalence of use, but the causal nature of this association is debated. The aim of this study is to quantitate the reciprocal associations between cannabis use and risk perception in a longitudinal panel of emerging adults.

DESIGN

Observational study of longitudinal data from the Monitoring the Future longitudinal study using autoregressive cross-lagged panel analyses to investigate reciprocal associations between cannabis risk perception and frequency of past-year cannabis use.

SETTING

Surveys administered to 12th-grade students from the United States general population.

PARTICIPANTS

A total of 9929 12th-grade students (mean age 18.0 years) who were surveyed initially during 2000-05 and follow-up data until approximately 23-24 years old (three waves; n = 9929).

MEASUREMENTS

Perception of risk association with cannabis use and frequency of past-year cannabis use.

RESULTS

At baseline, 33% of the 12th-graders used cannabis in the past year versus 28% by the third follow-up; 83% believed that smoking cannabis regularly carried moderate or great risk versus 78% by the third follow-up. All cross-lagged paths in both directions were statistically significant (all P < 0.001), consistent with reciprocal influences between cannabis use and risk perception. The negative association between past-year cannabis use and subsequent risk perception (standardized coefficient range -0.21 to -0.27) was stronger than that between risk perception and subsequent use (standardized coefficient range -0.08 to -0.11; confidence intervals did not overlap with those for the coefficients reported above). Similar results were obtained when the analysis was limited to those who had never used cannabis prior to baseline.

CONCLUSIONS

Longitudinal associations between cannabis use and perception of risks from cannabis use are reciprocal in nature, with a stronger association between cannabis use and lower subsequent risk perception.

Nicotine dependence predicts cannabis use disorder symptoms among adolescents and young adults

PURPOSE

We evaluate if cigarette smoking and/or nicotine dependence predicts cannabis use disorder symptoms among adolescent and young adult cannabis users and whether the relationships differ based on frequency of cannabis use.

METHODS

Data were drawn from seven annual surveys of the NSDUH to include adolescents and young adults (age 12-21) who reported using cannabis at least once in the past 30 days (n = 21,928). Cannabis use frequency trends in the association between cigarette smoking, nicotine dependence and cannabis use disorder symptoms were assessed using Varying Coefficient Models (VCM's).

RESULTS

Over half of current cannabis users also smoked cigarettes in the past 30 days (54.7% SE 0.48). Cigarette smoking in the past 30 days was associated with earlier onset of cannabis use, more frequent cannabis use and a larger number of cannabis use disorder symptoms compared to those who did not smoke cigarettes. After statistical control for socio-demographic characteristics and other substance use behaviors, nicotine dependence but not cigarette smoking quantity or frequency was positively and significantly associated with each of the cannabis use disorder symptoms as well as the total number of cannabis symptoms endorsed. Higher nicotine dependence scores were consistently associated with the cannabis use disorder symptoms across all levels of cannabis use from 1 day used (past month) to daily cannabis use, though the relationship was strongest among infrequent cannabis users.

CONCLUSION

Prevention and treatment efforts should consider cigarette smoking comorbidity when addressing the increasing proportion of the US population that uses cannabis.

Is the recreational use of 3,4-methylenedioxy-methamphetamine safe?

3,4-methylenedioxy-methamphetamine is taken recreationally by thousands of people, especially the young, across the globe. It is highly associated with electronic music and its use in the UK remains high at around 4.5% of 16-24 year olds. This review discusses both the short- and long-term effects of 3,4-methylenedioxy-methamphetamine including methods by which some of these adverse effects can be prevented or even reversed to increase the safety of the commonly used drug.

The Gamma-Aminobutyric Acid B Receptor in Depression and Reward

The metabotropic gamma-aminobutyric acid B (GABA_B) receptor was the first described obligate G protein-coupled receptor heterodimer and continues to set the stage for discoveries in G protein-coupled receptor signaling complexity. In this review, dedicated to the life and work of Athina Markou, we explore the role of GABA_B receptors in depression, reward, and the convergence of these domains in anhedonia, a shared symptom of major depressive disorder and withdrawal from drugs of abuse. GABA_B receptor expression and function are enhanced by antidepressants and reduced in animal models of depression. Generally, GABA_B receptor antagonists are antidepressant-like and agonists are pro-depressive. Exceptions to this rule likely reflect the differential influence of GABA_B1 isoforms in depression-related behavior and neurobiology, including the anhedonic effects of social stress. A wealth of data implicate GABA_B receptors in the rewarding effects of drugs of abuse. We focus on nicotine as an example. GABA_B receptor activation attenuates, and deactivation enhances, nicotine reward and associated neurobiological changes. In nicotine withdrawal, however, GABA_B receptor agonists, antagonists, and positive allosteric modulators enhance anhedonia, perhaps owing to differential effects of GABA_B1 isoforms on the dopaminergic system. Nicotine cue-induced reinstatement is more reliably attenuated by GABA_B receptor activation. Separation of desirable and undesirable side effects of agonists is achievable with positive allosteric modulators, which are poised to enter clinical studies for drug abuse. GABA_B1 isoforms are key to understanding the neurobiology of anhedonia, whereas allosteric modulators may offer a mechanism for targeting specific brain regions and processes associated with reward and depression.

S(+)-ketamine : Current trends in emergency and intensive care medicine

S(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

Mass spectrometric strategies for the investigation of biomarkers of illicit drug use in wastewater

The analysis of illicit drugs in urban wastewater is the basis of wastewater-based epidemiology (WBE), and has received much scientific attention because the concentrations measured can be used as a new non-intrusive tool to provide evidence-based and real-time estimates of community-wide drug consumption. Moreover, WBE allows monitoring patterns and spatial and temporal trends of drug use. Although information and expertise from other disciplines is required to refine and effectively apply WBE, analytical chemistry is the fundamental driver in this field. The use of advanced analytical techniques, commonly based on combined chromatography-mass spectrometry, is mandatory because the very low analyte concentration and the complexity of samples (raw wastewater) make quantification and identification/confirmation of illicit drug biomarkers (IDBs) troublesome. We review the most-recent literature available (mostly from the last 5 years) on the determination of IDBs in wastewater with particular emphasis on the different analytical strategies applied. The predominance of liquid chromatography coupled to tandem mass spectrometry to quantify target IDBs and the essence to produce reliable and comparable results is illustrated. Accordingly, the importance to perform inter-laboratory exercises and the need to analyze appropriate quality controls in each sample sequence is highlighted. Other crucial steps in WBE, such as sample collection and sample pre-treatment, are briefly and carefully discussed. The article further focuses on the potential of high-resolution mass spectrometry. Different approaches for target and non-target analysis are discussed, and the interest to perform experiments under laboratory-controlled conditions, as a complementary tool to investigate related compounds (e.g., minor metabolites and/or transformation products in wastewater) is treated. The article ends up with the trends and future perspectives in this field from the authors' point of view. © 2016 Wiley Periodicals, Inc. Mass Spec Rev 37:258-280, 2018.

A rapid solution-based method for determining the affinity of heroin hapten-induced antibodies to heroin, its metabolites, and other opioids

We describe for the first time a method that utilizes microscale thermophoresis (MST) technology to determine polyclonal antibody affinities to small molecules. Using a novel type of heterologous MST, we have accurately measured a solution-based binding affinity of serum antibodies to heroin which was previously impossible with other currently available methods. Moreover, this mismatch approach (i.e., using a cross-reactive hapten tracer) has never been reported in the literature. When compared with equilibrium dialysis combined with ultra-performance liquid chromatography/tandem mass spectrometry (ED-UPLC/MS/MS), this novel MST method yields similar binding affinity values for polyclonal antibodies to the major heroin metabolites 6-AM and morphine. Additionally, we herein report the method of synthesis of this novel cross-reactive hapten, MorHap-acetamide—a useful analog for the study of heroin hapten–antibody interactions. Using heterologous MST, we were able to determine the affinities, down to nanomolar accuracies, of polyclonal antibodies to various abused opioids. While optimizing this method, we further discovered that heroin is protected from serum esterase degradation by the presence of these antibodies in a concentration-dependent manner. Lastly, using affinity data for a number of structurally different opioids, we were able to dissect the moieties that are crucial to antibody binding. The novel MST method that is presented herein can be extended to the analysis of any ligand that is prone to degradation and can be applied not only to the development of vaccines to substances of abuse but also to the analysis of small molecule/protein interactions in the presence of serum.

Graphical abstract

Prevalence and predictors of khat chewing among Ethiopian university students: A systematic review and meta-analysis

Background

Khat chewing has become a common practice among university students in developing countries like Ethiopia. It has a potential effect on physical, mental, social and cognitive aspects of student functioning. In Ethiopia, study findings regarding the prevalence of khat chewing were highly dispersed and inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled prevalence of khat chewing and its predictors among Ethiopian university students.

Method

A systematic review and meta-analysis was conducted to assess the prevalence and predictors of khat chewing among university students in Ethiopia. We searched literature from the databases of PubMed, Google Scholar, Science Direct, and the Cochrane Library. A total of 24 Ethiopian studies reporting the prevalence of khat chewing among university students were included. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistics and I² test were used. Since the included studies exhibit high heterogeneity, a random effect meta-analysis model was computed to estimate the pooled prevalence of khat chewing. Moreover, the association between predictor variables, and khat chewing practice were examined.

Results

The meta-analysis of 24 studies revealed that the pooled prevalence of khat chewing among university students in Ethiopia was 23.22% (95% CI: 19.5, 27.0). In the subgroup analysis, the highest prevalence was observed in Oromia region (31.6%; 95CI: 21.2, 41.9) whereas the lowest prevalence was observed in Amhara region (18.1%; 95%CI: 12.4, 23.8). Being male OR: 2.76 (95% CI 1.64, 4.63), family khat chewing practice OR: 2.91 (95% CI 1.06, 7.98), friend khat chewing habit OR: 4.74 (95% CI 3.48, 13.06), alcohol drinking OR: 7.06 (95% CI 5.65, 8.82) and cigarette smoking habit OR: 15.11 (95% CI 8.96, 25.51) were found to be predictors of khat chewing.

Conclusion

The study found that the prevalence of khat chewing among university students was quite common, with slightly more than 1 in 5 students engaging in the use of this substance. Being male, family khat chewing practice, friend’s khat chewing habit, alcohol drinking, and cigarette smoking were found to be predictors of khat chewing practice among university students.

Marijuana Use and Perceptions of Risk and Harm: A Survey among Canadians in 2016

OBJECTIVES

To describe marijuana use by Canadians and their perceptions of risk and harm.

DESIGN

A cross-sectional, structured, online and telephone survey.

PARTICIPANTS

A nationally representative sample of Canadians.

METHODS

This survey used random probability sampling and targeted respondents based on age, sex, region and their expected response rate.

RESULTS

Of the 20% of respondents reporting marijuana use in the past 12 months, they were more likely to be younger and male. The most common form of use was smoking, 79%. When asked about harmfulness, 42% and 41% responded that they considered marijuana more harmful than helpful to mental health and to physical health, respectively. When asked about driving under the influence, 71% responded that it was the same as alcohol.

CONCLUSION

This research is important for health providers and policy makers seeking to maximize public health through clinical and legislative reform of non-medical use of marijuana.

Metabolomics analysis of serum in a rat heroin self-administration model undergoing reinforcement based on 1H-nuclear magnetic resonance spectra

Background

Understanding the process of relapse to abused drugs and ultimately developing treatments that can reduce the incidence of relapse remains the primary goal for the study of substance dependence. Therefore, exploring the metabolite characteristics during the relapse stage is valuable.

Methods

A heroin self-administered rat model was employed, and analysis of the ¹H-nuclear magnetic resonance-based metabolomics was performed to investigate the characteristic metabolite profile upon reintroduction to the drug after abstinence.

Results

Sixteen metabolites in the serum of rats, including phospholipids, intermediates in TCA (Tricarboxylic Acid Cycle) cycle, keto bodies, and precursors for neurotransmitters, underwent a significant change in the reinstatement stage compared with those in the control group. In particular, energy production was greatly disturbed as evidenced by different aspects such as an increase in glucose and decrease in intermediates of glycolysis and the TCA cycle. The finding that the level of 3-hydroxybutyrate and acetoacetate increased significantly suggested that energy production was activated from fatty acids. The concentration of phenylalanine, glutamine, and choline, the precursors of major neurotransmitters, increased during the reinstatement stage which indicated that an alteration in neurotransmitters in the brain might occur along with the disturbance in substrate supply in the circulatory system.

Conclusions

Heroin reinforcement resulted in impaired energy production via different pathways, including glycolysis, the TCA cycle, keto body metabolism, etc. A disturbance in the substrate supply in the circulatory system may partly explain heroin toxicity in the central nervous system. These findings provide new insight into the mechanism underlying the relapse to heroin use.

Electronic supplementary material

The online version of this article (10.1186/s12868-018-0404-5) contains supplementary material, which is available to authorized users.

Intravenous self-administration of benzydamine, a non-steroidal anti-inflammatory drug with a central cannabinoidergic mechanism of action

Benzydamine (BZY) is a non-steroidal anti-inflammatory drug used for the topical treatment of inflammations of the oral and vaginal mucosae. Virtually nothing is known about the central pharmacological actions of BZY. Yet there are reports of voluntary systemic overdosage of BZY in drug addicts, resulting in a euphoric, hallucinatory state. In the present study, we investigated the reinforcing properties of BZY in a rat self-administration paradigm. We found that BZY has a powerful reinforcing effect and that this effect is greatly facilitated in animals that already had substance experience, having previously self-administered heroin and cocaine, indicating cross sensitization between BZY and other common drugs of abuse. We then assessed the effect of BZY on prelimbic cortex-to-nucleus accumbens glutamatergic transmission, using field recordings in rat parasagittal brain slices. BZY dose-dependently reduced both field excitatory post synaptic potential amplitude and paired pulse ratio, suggesting a presynaptic mechanism of action. Similarly to the in vivo paradigm, also the electrophysiological effects of BZY were potentiated in slices from animals that had undergone cocaine and heroin self-administration. Furthermore, BZY-induced Long Term Depression (LTD)-like responses in the prelimbic cortex-to-nucleus accumbens circuitry were significantly reduced in the presence of the CB1 receptor antagonist AM251. These findings provide firm evidence of the abuse liability of BZY and suggest a possible cannabinoidergic mechanism of action. Further research is needed in order to give insights into the molecular mechanism underlying BZY psychoactive and reinforcing effects, to better understand its abuse potential.

Scientific Evidence for the Addictiveness of Tobacco and Smoking Cessation in Tobacco Litigation

Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others’. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research. Nicotine that enters the body via smoking is rapidly transmitted to the central nervous system and causes various effects, including an arousal response. The changes in the nicotine receptors in the brain due to continuous smoking lead to addiction symptoms such as tolerance, craving, and withdrawal. Compared with other addictive substances, including alcohol and opioids, tobacco is more likely to cause dependence in smokers, and smokers are less likely to recover from their dependence. Moreover, the thinning of the cerebral cortex and the decrease in cognitive functions that occur with aging accelerate with smoking. Such changes occur in the structure and functions of the brain in proportion to the amount and period of smoking. In particular, abnormalities in the neural circuits that control cognition and decision-making cause loss of the ability to exert self-control and autonomy. This initiates nicotine dependence and the continuation of addictive behaviors. Therefore, smoking is considered to be a behavior that is repeated due to dependence on an addictive substance, nicotine, instead of one’s choice by free will.

The 21st century psychedelic renaissance: heroic steps forward on the back of an elephant

Given the plethora of new studies and published papers in the scientific press and the increasingly emerging presence of articles about positive psychedelic experiences appearing in the popular media, there is little doubt that we are in the midst of a Psychedelic Renaissance. The classical psychedelic drugs LSD and psilocybin and the entactogen MDMA are showing promise as tools to assist psychotherapy for a wide range of mental disorders, with multiple pilot studies demonstrating their safety and efficacy. In this article, the author describes how MDMA in particular has inherent characteristics that make it well suited for assisting trauma-focused psychotherapy in a population of patients who have experienced child abuse. But despite these advances, there remain many obstacles ahead of the widespread mainstream acceptance of psychedelic medicines. The author argues that the Misuse of Drugs Act 1971 is one such obstacle. Other impediments include a prevailing attitude of pseudoscience and rigidity from within the non-scientific psychedelic community itself. Resolution of these conflicts must be sought if medicine and society are to see psychedelics gaining a place in mainstream culture and science.

Criterion validity of self-reports of alcohol, cannabis, and methamphetamine use among young men in Cape Town, South Africa

Valid measurement of substance use is necessary to evaluate preventive and treatment interventions. Self-report is fast and inexpensive, but its accuracy can be hampered by social desirability bias and imperfect recall. We examined the agreement between self-report of recent use and rapid diagnostic tests for three substances (alcohol, cannabis, and methamphetamine) among 904 young men living in Cape Town, South Africa. Rapid diagnostic tests detected the respective substances in 32%, 52%, and 22% of men. Among those who tested positive, 61% (95% CI [56%, 66%]), 70% ([67%, 74%]), and 48% ([42%, 54%]) admitted use. Men were moderately more willing to admit use of cannabis than alcohol (log OR 0.42) or admit use of alcohol than methamphetamine (log OR 0.53). Our findings show that self-report has reasonable criterion validity in this population, but criterion validity can vary substantially depending on the substance.

Changes in opiate and stimulant use through 10 years: The role of contextual factors, mental health disorders and psychosocial factors in a prospective SUD treatment cohort study

AIM

To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes.

METHODS

A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway.

RESULTS

The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up.

CONCLUSIONS

There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.

Long-Lasting In Vivo Effects of the Cannabinoid CB1 Antagonist AM6538

AM6538 is a cannabinoid antagonist that binds CB1 receptors expressed in HEK-293 cells in a wash-resistant manner. The effects of AM6538 in live animals has not previously been established. We characterized the antagonist effects of AM6538 in male mice, using a warm-water tail-withdrawal assay, and in male squirrel monkeys trained to discriminate the CB1 agonist AM4054 from vehicle. The cannabinoid agonists WIN 55,212, Δ⁹-tetrahydrocannabinol (THC), and AM4054 all produced 100% maximum possible antinociceptive effects in mice following vehicle pretreatment. One-hour pretreatment with increasing doses of AM6538 (0.1-10 mg/kg) produced first rightward, then downward shifts of the agonist dose-effect functions. Rimonabant, 1-10 mg/kg, produced parallel rightward shifts of the AM4054 dose-effect functions, and baseline effects of AM4054 were nearly recovered within 24 hours following 10 mg/kg of rimonabant. In contrast, in mice treated with 10 mg/kg of AM6538, antagonism of THC or AM4054 lasted up to 7 days. AM6538 also antagonized the discriminative stimulus effects of AM4054 in squirrel monkeys in a dose-related manner, and the effects of 3.2 mg/kg of AM6538 endured for more than 7 days. The effective reduction in CB1 receptor reserve was used to calculate the relative efficacy (tau values) of WIN 55,212, THC, and AM4054 in mice and of AM4054 monkeys, with results indicating that THC has a lower efficacy than WIN 55,212 or AM4054 in mice. These results demonstrate that AM6538 is a long-acting CB antagonist in vivo, and further suggest that differences in CB efficacy can be revealed in behavioral assays following AM6538 treatment.

A comparison of self-reported sexual effects of alcohol, marijuana, and ecstasy in a sample of young adult nightlife attendees

Alcohol, marijuana, and ecstasy (3,4-methylenedioxymethamphetamine [MDMA], 'Molly') are among the most prevalent substances used by young adults; however, few studies have focused on the specific sexual effects associated with use. Examining subjective sexual effects (e.g. increased libido) associated with use can inform prevention efforts. Data were analysed from 679 nightclub and dance festival attendees in New York City (ages 18-25) to examine and compare self-reported sexual effects associated with use of alcohol, marijuana, and ecstasy. Results suggest that compared to marijuana, alcohol and ecstasy were more strongly associated with heightened perceived sexual effects (i.e. perceived sexual attractiveness of self and others, sexual desire, length of intercourse, and sexual outgoingness). Increased body and sex organ sensitivity and increased sexual intensity were most commonly associated with ecstasy use. Sexual dysfunction was most common while using alcohol or ecstasy, especially among males, and females were more likely to report sexual dysfunction after using marijuana. Post-sex regret was most common with alcohol use. Alcohol, marijuana, and ecstasy each have different sexual effects; therefore, each is associated with different risks and benefits for users. Findings can inform prevention and harm reduction as young adults are prone to use these substances.

Aspects of Methamphetamine Abuse in Adolescents and Young Adults in a Thuringian County

BACKGROUND/OBJECTIVE

Drug abuse is an increasing problem among young adults in European countries. We wanted to assess the prevalence of methamphetamine and cannabis use in young people and to ask for their socioeconomic, parental and emotional background.

METHODS

All pupils (n = 1,087) in the final class of 3 school types (-general school [in Germany: Hauptschule/Regelschule mit Hauptschulabschluss] class 9, regular school [in Germany: Regelschule] class 10, high school [in Germany: Gymnasium] class 10) and the first 2 classes of the vocational school (in Germany: Berufsschule) in the entire rural district of Altenburger Land, a Thuringian county in Germany with a total of 92,344 inhabitants were asked to fill out a 2-page questionnaire. In all, 920 questionnaires could be finally evaluated (mean age: 16.6 ± 0.07 years; mode value: 16; maximum range: 13-29).

RESULTS

In the entire group, 5.81% (33 females, 20 males) reported the use of methamphetamine, while 42.8% stated that they have used it only once, the remaining 57.2% specified that they have used it on a more regular basis, mostly once a month, but 14.2% had used it almost daily. With regard to the socioeconomic background, 55% of the parents of the methamphetamine users were employees and 10% of the parents were in a leading position. This was not different from the non-user group (p = 0.193). Unemployment of the parents was found in 6.5% of the methamphetamine users and in 4.7% of the non-users. Overall, 67.92% had a basic knowledge of the side effects of this drug. In 55.32% of the methamphetamine users, the parents lived alone, were divorced or widowed, while this was only 33.1% in the non-user group. Of all the methamphetamine users, 69% had friends who also consumed the drug, which may give a hint on the impact of a peer group. In the entire group, 29.84% were smokers (female group: 28.47%; male group 31.25%) and 25.5% consumed cannabis. Ecstasy was used by a total of 4.05% and cocaine by 1.53%. No participant mentioned that they have used opiates.

CONCLUSION

Among pupils aged about 16 years nearly 6% reported to have consumed methamphetamine. This group has a middle socioeconomic background. Two factors were strongly associated with methamphetamine usage: a family with only a single parent and friends who were used to taking methamphetamine. The self-perception of users was generally considered to be a disadvantage as compared to the other factors.