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Freestone J, Ezard N, Bourne A, Brett J, Roberts DM, Hammoud M, Nedanoski A, Prestage G, Siefried KJ. Understandings, attitudes, practices and responses to GHB overdose among GHB consumers. Harm Reduct J 2023; 20:121. [PMID: 37660058 PMCID: PMC10475182 DOI: 10.1186/s12954-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.
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Affiliation(s)
- Jack Freestone
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
- ACON, 414 Elizabeth Street, Surry Hills, NSW, 2010, Australia.
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| | - Adam Bourne
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
- Australian Research Centre for Sex Health and Society, La Trobe University, Building NR6., Bundoora, VIC, 3086, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Mohamed Hammoud
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
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Palamar JJ. Prevalence and Correlates of GHB Use among Adults in the United States. J Psychoactive Drugs 2023; 55:268-273. [PMID: 35616605 PMCID: PMC9699895 DOI: 10.1080/02791072.2022.2081948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Gamma-hydroxybutyrate (GHB) was a somewhat prevalent club drug two decades ago, but research has been lacking regarding the current epidemiology of use. In this study, prevalence and correlates of past-year GHB use were estimated based on noninstitutionalized US adults participating in the 2015-2020 National Survey of Drug Use and Health (N= 241,675). An estimated 0.05% (95% CI: 0.04-0.07) of adults in the US have used GHB in the past year. Compared to those age 18-25, those age 35-49 were at increased odds for use (aOR = 2.28, 95% CI: 1.02-5.10), and compared to heterosexual men, gay men in particular were at high odds for use (aOR = 27.82, 95% CI: 11.09-69.80). Those identifying as bisexual men (aOR = 3.39, 95% CI: 1.17-9.82) and lesbian/bisexual women (aOR = 3.37, 95% CI: 1.44-7.90) were also at high odds for use. Despite all drugs examined being significant correlates of use in bivariable models (ps < .001), only past-year use of methamphetamine (aOR = 15.68, 95% CI: 7.40-33.25), ketamine (aOR = 8.52, 95% CI: 2.67-27.20), and ecstasy (aOR = 4.41, 95% CI: 1.80-10.75) was associated with increased odds of use in the multivariable model. Results suggest that GHB use is currently rare, but gay men and people who use other party drugs are at particularly high risk for use.
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Affiliation(s)
- Joseph J Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY USA
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3
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Ogeil RP, Faulkner A, Beard N, Killian JJ, Arunogiri S, Phan V, Wilson J, Smith K, Lubman DI, Scott D. Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103932. [PMID: 36527909 DOI: 10.1016/j.drugpo.2022.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia. METHODS A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB. RESULTS There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%). CONCLUSIONS We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.
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Affiliation(s)
- Rowan P Ogeil
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia.
| | | | | | - Jessica J Killian
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Vicky Phan
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | | | - Karen Smith
- Department of Paramedicine and Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia; Research and Evaluation, Ambulance Victoria, Blackburn North, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
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Freestone J, Prestage G, Bourne A, Ezard N, Race K, Nedanoski A, Murray J, Siefried KJ. Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103747. [DOI: 10.1016/j.drugpo.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Dijkstra BAG, Beurmanjer H, Goudriaan AE, Schellekens AFA, Joosten EAG. Unity in diversity: A systematic review on the GHB using population. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103230. [PMID: 33892279 DOI: 10.1016/j.drugpo.2021.103230] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over the past decades gamma-hydroxybutyrate (GHB) has emerged as a popular drug with high potential of (ab)use due to its euphoric and relaxing effects. An overview of different populations using GHB is urgently needed, since this would enable development of adequate prevention and treatment policies to diminish the risks associated with GHB use. We systematically reviewed literature on different GHB using populations, comparing demographic characteristics, GHB use patterns, psychosocial aspects and psychiatric comorbidity. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Rayyan software. Original studies published from January 1997 up to October 2019 on GHB use were included. Out of 80 full-text articles, 60 articles of 51 unique studies were included. Most studies included people using GHB 1) presenting at emergency departments (n = 22), 2) recruited from the general population (n = 11), or 3) presenting at addiction care (n = 8). RESULTS Three main sub-populations of people using GHB are described in the literature: people using GHB recreationally without adverse effects; people using GHB recreationally with adverse effects, and people with dependence on GHB. These groups show considerable overlap in gender, age range, and comorbid substance use, as well as amount of GHB use per occasion. Differences are related to frequency and function of GHB use, the number of comas experienced, as well as work status, and psychiatric comorbidity. CONCLUSION Policy interventions should aim at preventing the transition from recreational substance use to GHB use, as most users are experienced recreational substance users prior to starting GHB use. When people use GHB regularly, interventions should aim at reducing the level of GHB use and preventing GHB use-related harm. Longitudinal studies and population-based probability sampling are required for more insight in the dynamics of GHB use in different sub-populations, and the transition from one group to the other, ultimately leading to dependence on GHB.
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Affiliation(s)
- B A G Dijkstra
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands; Novadic-Kentron Addiction Treatment Center, Vught, the Netherlands.
| | - H Beurmanjer
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Novadic-Kentron Addiction Treatment Center, Vught, the Netherlands
| | - A E Goudriaan
- Jellinek and Arkin, Amsterdam, the Netherlands; Amsterdam University Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - A F A Schellekens
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands
| | - E A G Joosten
- Nijmegen Institute for Scientist-Practitioner in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands; Radboudumc, Department of Psychiatry, Nijmegen, the Netherlands
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6
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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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Hammoud MA, Bourne A, Maher L, Jin F, Haire B, Lea T, Degenhardt L, Grierson J, Prestage G. Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men - results from the Flux Study. Sex Health 2019; 15:123-134. [PMID: 29268075 DOI: 10.1071/sh17146] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM. AIM Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. METHODS The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected. RESULTS Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users. CONCLUSION Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Adam Bourne
- Australian Research Centre in Sex Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Bridget Haire
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- The National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Sydney, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus. East Rd, Cambridge CB1 1PT, UK
| | - Garrett Prestage
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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8
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Anilanmert B, Çavuş F, Narin I, Cengiz S, Sertler Ş, Özdemir AA, Açikkol M. Simultaneous analysis method for GHB, ketamine, norketamine, phenobarbital, thiopental, zolpidem, zopiclone and phenytoin in urine, using C18 poroshell column. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1022:230-241. [DOI: 10.1016/j.jchromb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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9
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Bosch OG, Seifritz E. The behavioural profile of gamma-hydroxybutyrate, gamma-butyrolactone and 1,4-butanediol in humans. Brain Res Bull 2016; 126:47-60. [PMID: 26855327 DOI: 10.1016/j.brainresbull.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 01/24/2023]
Abstract
Gamma-hydroxybutyrate (GHB) is a putative neurotransmitter, a drug of abuse, and a medical treatment for narcolepsy and other neuropsychiatric disorders. Its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are endogenously converted to GHB and thereby exert their psychobehavioural effects. In humans, GHB has a wide spectrum of properties ranging from stimulation and euphoria in lower doses, to sedation, deep sleep, and coma after ingestion of high doses. However, behavioural studies in healthy volunteers remain scarce and are usually limited to psychomotor performance testing. Most available data arise from either qualitative studies with illicit users or clinical trials examining therapeutic properties of GHB (then usually termed sodium oxybate). Here, we present an overview of the behavioural effects of GHB, GBL, and 1,4-BD in these three populations. GHB and its precursors strongly influence behaviours related to core human autonomic functions such as control of food intake, sexual behaviour, and sleep-wake regulation. These effects are instrumentalised by illicit users and clinically utilised in neuropsychiatric disorders such as narcolepsy, fibromyalgia, and binge-eating syndrome. Considering the industry withdrawal from psychopharmacology development, repurposing of drugs according to their behavioural and clinical profiles has gained increasing relevance. As such, GHB seems to be an attractive candidate as an experimental therapeutic in depression.
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Affiliation(s)
- Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital for Psychiatry, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital for Psychiatry, Lenggstrasse 31, 8032 Zurich, Switzerland
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10
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Palamar JJ, Griffin-Tomas M, Ompad DC. Illicit drug use among rave attendees in a nationally representative sample of US high school seniors. Drug Alcohol Depend 2015; 152:24-31. [PMID: 26005041 PMCID: PMC4458153 DOI: 10.1016/j.drugalcdep.2015.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/26/2015] [Accepted: 05/01/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The popularity of electronic dance music and rave parties such as dance festivals has increased in recent years. Targeted samples of party-goers suggest high rates of drug use among attendees, but few nationally representative studies have examined these associations. METHODS We examined sociodemographic correlates of rave attendance and relationships between rave attendance and recent (12-month) use of various drugs in a representative sample of US high school seniors (modal age: 18) from the Monitoring the Future study (2011-2013; Weighted N=7373). RESULTS One out of five students (19.8%) reported ever attending a rave, and 7.7% reported attending at least monthly. Females and highly religious students were less likely to attend raves, and Hispanics, students residing in cities, students with higher income and those who go out for fun multiple times per week were more likely to attend. Rave attendees were more likely than non-attendees to report use of an illicit drug other than marijuana (35.5% vs. 15.6%, p<0.0001). Attendees were more likely to report use of each of the 18 drugs assessed, and attendees were more likely to report more frequent use (≥6 times) of each drug (ps<0.0001). Controlling for sociodemographic covariates, frequent attendance (monthly or more often) was associated with higher odds of use of each drug (ps<0.0001). Frequent attendees were at highest risk for use of "club drugs." DISCUSSION Findings from this study can help inform prevention and harm reduction among rave attendees at greatest risk for drug use.
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Affiliation(s)
- Joseph J. Palamar
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA,Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | - Marybec Griffin-Tomas
- Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA,Global Institute of Public Health, New York University, New York, NY, USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA,Global Institute of Public Health, New York University, New York, NY, USA
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Grov C, Rendina HJ, Ventuneac A, Parsons JT. Partners met via sex parties present significantly greater odds for condomless anal sex among MSM: an event-level analysis of venues where male partners are met. J Acquir Immune Defic Syndr 2014; 67:564-8. [PMID: 25226209 PMCID: PMC4229438 DOI: 10.1097/qai.0000000000000343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One hundred forty-seven men who have sex with men completed time-line follow-back interviews about the venues where they met their male partners (n = 1180 sexual events with first-time partners, <30 days). We ran multivariate models to determine the association between venues and condomless anal sex (CAS). After adjusting for known correlates of CAS, partners met at sex parties presented significantly greater odds for CAS compared with meeting a partner at a gay bar/club (adjusted odds ratio = 0.44), online (adjusted odds ratio = 0.42), bathhouse (adjusted odds ratio = 0.35), or via "other" venues (adjusted odds ratio = 0.35), all P < 0.01. These findings highlight the need to develop innovative HIV/sexually transmitted infection prevention initiatives for men who attend sex parties.
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Affiliation(s)
- Christian Grov
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY). 2900 Bedford Avenue, Brooklyn, NY. 11210
- Doctoral Program in Public Health, The Graduate Center of CUNY
- Center for HIV/AIDS Educational Studies and Training (CHEST)
| | - H. Jonathon Rendina
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY
| | - Ana Ventuneac
- Center for HIV/AIDS Educational Studies and Training (CHEST)
| | - Jeffrey T. Parsons
- Doctoral Program in Public Health, The Graduate Center of CUNY
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY
- Doctoral Program in Health Psychology, The Graduate Center of CUNY
- Department of Psychology, Hunter College of CUNY
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12
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Grov C, Rendina HJ, Parsons JT. Comparing three cohorts of MSM sampled via sex parties, bars/clubs, and Craigslist.org: implications for researchers and providers. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:362-82. [PMID: 25068182 PMCID: PMC4116634 DOI: 10.1521/aeap.2014.26.4.362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
With limited exceptions, few studies have systematically reported on psychosocial and demographic characteristic differences in samples of men who have sex with men (MSM) based on where they were recruited. This study compared three sexually active cohorts of MSM recruited via Craigslist.org (recruited via modified time-space sampling), gay bars and clubs (recruited via time-space sampling), and private sex parties (identified via passive recruitment and listserves), finding mixed results with regard to differences in demographic characteristics, STI history, and psychosocial measures. Men recruited from sex parties were significantly older, reported more symptoms of sexual compulsivity, more likely to be HIV-positive, more likely to report a history of STIs, and more likely to self-identify as a barebacker, than men recruited from the other two venues. In contrast, men from Craigslist.org reported the lowest levels of attachment to the gay and bisexual community and were the least likely to self-identify as gay. Men from bars and clubs were significantly younger, and were more likely to report use of hallucinogens and crack or cocaine. Our findings highlight that the venues in which MSM are recruited have meaningful consequences in terms of the types of individuals who are reached.
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Affiliation(s)
- Christian Grov
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY). 2900 Bedford Avenue, Brooklyn, NY. 11210
- Doctoral Program in Public Health, The Graduate Center of CUNY
- Center for HIV/AIDS Educational Studies and Training (CHEST)
| | - H. Jonathon Rendina
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY
| | - Jeffrey T. Parsons
- Doctoral Program in Public Health, The Graduate Center of CUNY
- Center for HIV/AIDS Educational Studies and Training (CHEST)
- Doctoral Program in Basic and Applied Social Psychology, The Graduate Center of CUNY
- Doctoral Program in Health Psychology, The Graduate Center of CUNY
- Department of Psychology, Hunter College of CUNY
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13
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Brennan R, Van Hout MC. Gamma-Hydroxybutyrate (GHB): A Scoping Review of Pharmacology, Toxicology, Motives for Use, and User Groups. J Psychoactive Drugs 2014; 46:243-51. [DOI: 10.1080/02791072.2014.921746] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Rebekah Brennan
- Post-graduate student (RB), Coordinator Substance Abuse Research Centre (MCVH), Waterford, Ireland
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Lea T, Prestage G, Mao L, Zablotska I, de Wit J, Holt M. Trends in drug use among gay and bisexual men in Sydney, Melbourne and Queensland, Australia. Drug Alcohol Rev 2012; 32:39-46. [DOI: 10.1111/j.1465-3362.2012.00494.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/10/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Toby Lea
- National Centre in HIV Social Research; The University of New South Wales; Sydney; Australia
| | - Garrett Prestage
- The Kirby Institute; The University of New South Wales; Sydney; Australia
| | - Limin Mao
- National Centre in HIV Social Research; The University of New South Wales; Sydney; Australia
| | - Iryna Zablotska
- The Kirby Institute; The University of New South Wales; Sydney; Australia
| | - John de Wit
- National Centre in HIV Social Research; The University of New South Wales; Sydney; Australia
| | - Martin Holt
- National Centre in HIV Social Research; The University of New South Wales; Sydney; Australia
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Palamar JJ, Kiang MV, Storholm ED, Halkitis PN. A Qualitative Descriptive Study of Perceived Sexual Effects of Club Drug Use in Gay and Bisexual Men. PSYCHOLOGY & SEXUALITY 2012; 5:143-160. [PMID: 24883174 DOI: 10.1080/19419899.2012.679363] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Club drug use is often associated with unsafe sexual practices and use remains prevalent among gay and bisexual men. Although epidemiological studies commonly report the risk of engaging in unsafe sex due to the effects of particular club drugs, there remain gaps in the literature regarding the specific sexual effects of such substances and the context for their use in this population. We examined secondary data derived from interviews with 198 club drug using gay and bisexual males in New York City and qualitatively describe subjective sexual effects of five drugs: ecstasy, GHB, ketamine, powder cocaine and methamphetamine. Differences and commonalities across the five drugs were examined. Results suggest that each drug tends to provide: 1) unique sexual effects, 2) its own form of disinhibition, and 3) atypical sexual choices, often described as "lower sexual standards." Differences across drugs emerged with regard to social, sensual and sexual enhancement, sexual interest, and impotence. Although some common perceived sexual effects exist across drugs, the wide variation in these effects suggests different levels of risk and may further suggest varying motivations for using each substance. This study seeks to educate public health officials regarding the sexual effects of club drug use in this population.
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Affiliation(s)
- Joseph J Palamar
- Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, 726 Broadway, Suite 525, New York, NY 10003, USA
| | - Mathew V Kiang
- Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, 726 Broadway, Suite 525, New York, NY 10003, USA
| | - Erik D Storholm
- Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, 726 Broadway, Suite 525, New York, NY 10003, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, 726 Broadway, Suite 525, New York, NY 10003, USA
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The discriminative stimulus effects of midazolam are resistant to modulation by morphine, amphetamine, dizocilpine, and γ-butyrolactone in rhesus monkeys. Psychopharmacology (Berl) 2011; 217:495-504. [PMID: 21503606 PMCID: PMC3195358 DOI: 10.1007/s00213-011-2302-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
RATIONALE Although abuse of benzodiazepines alone is uncommon, it is high in polydrug abusers, including those who primarily use opioids or stimulants. OBJECTIVES This study investigated whether drugs that are abused (e.g., amphetamine) or drugs that have mechanisms of action similar to abused drugs (e.g., morphine) alter the discriminative stimulus effects of the benzodiazepine midazolam. METHODS Three rhesus monkeys discriminated 0.56 mg/kg of midazolam while responding under a fixed-ratio 10 schedule of food presentation. Dose-effect curves were determined for midazolam alone and in the presence of morphine (opioid receptor agonist), amphetamine (dopamine receptor indirect agonist), dizocilpine (N-methyl-D: -aspartic acid receptor antagonist), or γ-butyrolactone (prodrug of γ-hydroxybutyrate, which acts primarily at GABA(B) receptors). RESULTS Doses of midazolam larger than 0.32 mg/kg produced ≥80% midazolam-lever responding. When administered alone, morphine, amphetamine, dizocilpine, and γ-butyrolactone did not produce midazolam-lever responding, although large doses of each drug eliminated responding; when administered in combination with midazolam, they did not alter the discriminative stimulus effects of midazolam up to doses that markedly decreased response rates. CONCLUSIONS The current study demonstrates a lack of modulation of the discriminative stimulus effects of midazolam by morphine, amphetamine, dizocilpine, and γ-butyrolactone. Other effects of benzodiazepines, such as their reinforcing effects, might be altered by these other drugs, or benzodiazepines might modulate the discriminative stimulus or reinforcing effects of the other drugs, which might contribute to the relatively high incidence of benzodiazepine abuse among polydrug abusers.
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Fisher DG, Reynolds GL, Ware MR, Napper LE. Methamphetamine and Viagra use: relationship to sexual risk behaviors. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:273-279. [PMID: 19330436 PMCID: PMC3047702 DOI: 10.1007/s10508-009-9495-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 02/09/2009] [Accepted: 02/16/2009] [Indexed: 05/27/2023]
Abstract
Recent studies show that Viagra and methamphetamine use are associated with unprotected anal intercourse among men who have sex with men (MSM). In Long Beach, California, we have reported on an association between Viagra use and the use of amphetamines during sex. The current research investigated the use of both Viagra and amphetamine in men in Long Beach, California. Data on 1,839 men recruited into HIV prevention and testing programs were collected using the Risk Behavior Assessment. A generalized logit model was constructed comparing ever having used both amphetamine and Viagra together and separately, as compared to never having used either (referent). Men who used both methamphetamine and Viagra showed a significantly higher prevalence of hepatitis B, syphilis, and HIV compared to those who used only one or neither drug. Of the 1,794 complete cases, 11.1% (199/1794) had used both amphetamine and Viagra. Of 20 potential risk and protective factors for use of amphetamine and Viagra, 12 were significant predictors: ever used gamma-hydroxybutyrate (GHB), ever used cocaine, ever used ecstasy, being infected with HIV, race=White compared to other, ever having hepatitis B, ever using crack, ever given money to have sex, living in a hotel, ever been in drug treatment, and ever using heroin. The protective factor was being heterosexual. Viagra use was associated with insertive, and methamphetamine was associated with receptive, anal intercourse. GHB use appears to play a more important role than previously thought.
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Affiliation(s)
- Dennis G Fisher
- Center for Behavioral Research and Services, California State University, 1090 Atlantic Avenue, Long Beach, CA 90813, USA.
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18
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Abstract
Private sex parties are an emerging risk environment for HIV among men who have sex with men (MSM). In 2009, 103 participants who reported attending at least one sex party in Massachusetts in the prior 12 months completed an in-depth, interviewer-administered quantitative assessment. Multivariable logistic regression analyses were conducted to examine associations with having engaged in one or more serodiscordant unprotected anal sex (SDUAS) acts at the most recent sex party attended. Nearly one-third (32%) of the sample reported engaging in SDUAS at the most recent sex party attended. Adjusting for age, race/ethnicity, and educational attainment, variables associated with an increased odds of engaging in SDUAS at the most recent sex party were: total number of unprotected anal receptive sex acts at sex parties in the past 12 months, self-perception of being at-risk for transmitting or acquiring HIV, and sexual sensation seeking. Examined in the same model, if condoms were provided/available at the most recent sex party attended, participants were at a decreased odds of engaging in SDUAS at that sex party. The majority (80%) expressed an interest in HIV prevention activities for MSM who attend sex parties. HIV prevention interventions are needed to reach MSM who attend sex parties and should take into account individual and contextual factors that may contribute to sexual risk. Environmental factors in the sex party setting, in particular the presence and availability of condoms, may potentially mitigate individual-level factors such as unprotected anal sex.
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Halkitis PN, Pollock JA, Pappas MK, Dayton A, Moeller RW, Siconolfi D, Solomon T. Substance use in the MSM population of New York City during the era of HIV/AIDS. Subst Use Misuse 2011; 46:264-73. [PMID: 21303246 DOI: 10.3109/10826084.2011.523265] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.
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Affiliation(s)
- Perry N Halkitis
- Center for Health, Identity, Behavior, & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, USA.
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Mimiaga MJ, Reisner SL, Bland S, Cranston K, Isenberg D, Driscoll MA, VanDerwarker R, Mayer KH. “It's a quick way to get what you want”: a formative exploration of HIV risk among urban Massachusetts men who have sex with men who attend sex parties. AIDS Patient Care STDS 2010; 24:659-74. [PMID: 20846008 DOI: 10.1089/apc.2010.0071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Community-based studies with men who have sex with men (MSM) suggest that between 8% and 25% of MSM have met recent male sexual partners at private sex parties. Little is known about HIV sexual risk behaviors of MSM who attend sex parties and whether risk reduction interventions can be delivered in this setting. In 2008, 40 MSM who reported attending and/or hosting sex parties in Massachusetts in the past 12 months completed a qualitative interview and quantitative assessment. Participants reported attending a mean number of 10 sex parties in Massachusetts in the past 12 months. A significant percentage (43%) reported also hosting sex parties. Participants had made sexual partner connections across multiple venues, including public cruising areas, bars/clubs, and the Internet. At the most recent sex party attended, the majority had used alcohol (58%) and/or drugs (50%), and one quarter (25%) put themselves at risk of acquiring or transmitting HIV or other sexually transmitted infections (STIs) by having unprotected anal sex with a mean number of three serodiscordant male sex partners. Although many participants perceived that communicating about sexual health in the sex party context would “ruin the mood,” the majority (80%) considered some form of HIV prevention at sex parties to be appropriate and necessary, as well as acceptable. Nonintrusive prevention and education activities were especially endorsed (i.e., condoms, lubricants, and coupons for free HIV/STI testing). The majority of participants (75%) expressed some interest in “safer sex” parties. MSM attending sex parties appear to be a subpopulation at high risk for HIV and STI acquisition and transmission. Risk reduction interventions responsive to the needs of MSM who attend sex parties are warranted.
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Affiliation(s)
- Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
- Harvard School of Public Health, Boston, Massachusetts
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Harvard School of Public Health, Boston, Massachusetts
| | - Sean Bland
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Kevin Cranston
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Deborah Isenberg
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Warren Alpert School of Medicine, Brown University/Miriam Hospital, Providence, Rhode Island
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Anderson I, Kim-Katz S, Dyer J, Blanc P. The Impact of Gamma Hydroxybutyrate (GHB) Legal Restrictions on Patterns of Use: Results from an International Survey. DRUGS (ABINGDON, ENGLAND) 2010; 17:455-469. [PMID: 20953310 PMCID: PMC2953864 DOI: 10.3109/09687630902729594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS: To conduct an Internet-based survey of GHB use, identifying differences by respondent residence. METHODS: We recruited GHB-knowledgeable persons via "social networking Internet sites." Individuals (n=314) or groups (n=66) were approached based on GHB-use testimonials. DATA COLLECTED: location, use, reason for cessation (if applicable). FINDINGS: We recruited 155 GHB users. U.S. respondents (53 of 70; 76%) compared to non-U.S. respondents (38 of 85; 45%) were older and more highly educated (p<0.05) but manifest a 3-fold greater adjusted odds of GHB cessation (Odds Ratio [OR] 3.1; 95% CI 1.4-6.9; p < 0.05). Of the 80 respondents stating reason for cessation, 36 (45%) cited legal risk, price, or access; 44 (55%) cited health or related concerns. U.S. compared to non-U.S. respondents more frequently invoked legal and related concerns (OR 2.5; 95% CI 0.99-6.3; p=0.05). In a nested analysis, narrowly stated legal (n=4/5 U.S.) versus health (n=6/18 U.S.) reasons differed by location (p=0.048, one-tailed). CONCLUSIONS: In the U.S., where GHB has stricter legal penalties, GHB cessation is more likely, with legal and related reasons more commonly invoked for cessation. These findings support a link between declining U.S. GHB abuse and more stringent restrictions; although other un-assessed factors may also explain this association. The Impact of Gamma Hydroxybutyrate (GHB) Legal Restrictions on Patterns of Use: Results from an International Survey.
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Németh Z, Kun B, Demetrovics Z. The involvement of gamma-hydroxybutyrate in reported sexual assaults: a systematic review. J Psychopharmacol 2010; 24:1281-7. [PMID: 20488831 DOI: 10.1177/0269881110363315] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past few years gamma-hydroxybutyrate (GHB) has generated widespread media interest as a possible 'date rape drug'. Our goal was to examine the extent to which GHB is associated with drug-facilitated sexual assaults. Literature was searched systematically and 11 studies, published between 1961 and June 30, 2009, were identified dealing specifically with the role of GHB in sexual assaults. GHB was detected in 0.2-4.4% of reported sexual assaults. The results demonstrate that a wide range of drugs may be present in cases of sexual assault, and many of them are much more frequent than GHB. Our results do not support the widespread labelling of GHB as a date rape drug as the prevalence of GHB is much lower than of other substances used in sexual assaults. On the other hand, however, the possible risk of GHB in this regard should not be neglected. Nevertheless, over-sensitive and sensation seeking media reports focusing on the association of sex crime and GHB might be counterproductive and misleading as they turn the attention away from other substances that are often used in sexual assaults.
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Affiliation(s)
- Zsófia Németh
- Eötvös Loránd University, Institutional Group on Addiction Research, Budapest, Hungary, National Institute for Health Development, Budapest, Hungary
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Oliveto A, Gentry WB, Pruzinsky R, Gonsai K, Kosten TR, Martell B, Poling J. Behavioral effects of gamma-hydroxybutyrate in humans. Behav Pharmacol 2010; 21:332-42. [PMID: 20526195 PMCID: PMC2911496 DOI: 10.1097/fbp.0b013e32833b3397] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the therapeutic use and abuse potential of gamma-hydroxybutyrate (GHB or Xyrem), relatively few studies have examined the behavioral effects of GHB in humans under controlled laboratory conditions. Thus, this eight-session study examined in 10 non-substance-abusing volunteers the behavioral effects of GHB at each of the following doses: 0, 0.32, 0.56, 0.75, 1.0, 1.8, 2.4, 3.2 g/70 kg, orally. Order of dose testing was random, except that the first two participants received active doses in ascending order and 2.4 g/70 kg was always tested before 3.2 g/70 kg. Before drug administration and at several postdrug time points, self-report, observer report, physiological, and psychomotor performance measures were obtained. Analyses based on area under the curve showed that GHB produced dose-related increases in subjective ratings of sedative-like, stimulant-like, positive mood, and dissociative effects, but no changes in psychomotor performance measures or blood pressure. Analyses based on peak effects generally showed dose-related increases in ratings indicating sedative-like, dissociative, and drug liking, although some measures showed U-shaped dose-related changes. These initial findings suggest that GHB at doses of 0.32-3.2 g/70 kg produces dissociative, sedating and some stimulant-like effects in humans without a history of sedative abuse.
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Affiliation(s)
- Alison Oliveto
- Department of Psychiatry and Behavioral Sciences,University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA.
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Pichini S, Farré M, Abanades S, Pacifici R, Zuccaro P, Langohr K, de la Torre R. Immunomodulating properties of gamma-hydroxybutyrate (GHB), flunitrazepam and ethanol in 'club drugs' users. Addict Biol 2010; 15:336-45. [PMID: 20456291 DOI: 10.1111/j.1369-1600.2010.00210.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite the increasing concern about gamma-hydroxybutyrate (GHB) toxicity in users, no studies have addressed GHB and other club drugs effects on the immune system under controlled administration. Lymphocyte subsets and functional responsiveness of lymphocytes to mitogenic stimulation were measured in 10 healthy male recreational users of GHB who participated in five experimental sessions within the framework of a clinical trial. The study was randomized, double blind, double dummy and cross-over. Drug conditions were: a single oral dose of GHB (40 mg/kg or 60 mg/kg), ethanol (0.7 g/kg), flunitrazepam (1.25 mg) and placebo. Acute GHB produced a time-dependent immune impairment in the first 4 hours after drug administration associated with an increase in cortisol secretion. Although total leukocyte count remained unchanged, there was a significant decrease in the CD4 T/CD8 T-cell ratio, as well as in the percentage of mature T lymphocytes, probably because of a decrease in both the percentage and absolute number of T helper cells. A significant decrease was also observed in natural killer cells and in functional responsiveness of lymphocytes to mitogenic stimulation. Flunitrazepam administration did not produce any change in the immune system, while ethanol intake produced a decrease in B lymphocytes and in lymphocyte proliferative response to mitogens. These results provide the first evidence that GHB intake under a controlled environmental setting impairs the immunological status and confirms the alterations in the immune function caused by ethanol.
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Affiliation(s)
- Simona Pichini
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Italy
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Hatfield LA, Horvath KJ, Jacoby SM, Simon Rosser BR. Comparison of substance use and risky sexual behavior among a diverse sample of urban, HIV-positive men who have sex with men. J Addict Dis 2010; 28:208-18. [PMID: 20155589 DOI: 10.1080/10550880903014726] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine substance use among a racially and ethnically diverse group of HIV-positive men who have sex with men (MSM) living in six U.S. cities, model associations between drug use and serodiscordant unprotected anal intercourse (SDUAI), and characterize users of the substances strongly associated with risky sexual behavior. Baseline questionnaire data from 675 participants of the Positive Connections intervention trial were analyzed. Overall, substance use was common; however, the highest percentage of stimulant (30%), methamphetamine (27%), and popper (i.e., amyl nitrite) (46%) use was reported among white MSM and crack/cocaine (38%) use was highest among African American MSM. Popper use versus non-use (odds ratio = 2.46; 95% confidence interval = 1.55-3.94) and condom self-efficacy (1 standard deviation (sd) increase on scale; odds ratio = .58; 95% confidence interval = .46-.73) were significantly associated with SDUAI after adjusting for key demographic and psychosocial factors. These results highlight the importance of addressing drug use in the context of sex for possible HIV transmission risk.
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Affiliation(s)
- Laura A Hatfield
- School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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Dew BJ. Toward a Better Understanding of Non-Addicted, Methamphetamine-Using, Men who Have Sex with Men (MSM) in Atlanta. Open AIDS J 2010; 4:141-7. [PMID: 20657718 PMCID: PMC2908926 DOI: 10.2174/1874613601004030141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/15/2009] [Accepted: 11/25/2009] [Indexed: 11/22/2022] Open
Abstract
Methamphetamine use has increasingly become linked with sexual risk behaviors among men have sex with men (MSM). Yet, the majority of research has been done with methamphetamine dependent MSM or with samples in which addiction to the substance was not evaluated. Furthermore, research with methamphetamine-using MSM in the Southern U.S. is lacking. In this study, focus groups and in-depth interviews were conducted in order to understand the motives, context, and other facilitators and barriers of methamphetamine use among non-addicted MSM residing in Atlanta. Participants included 30 non-addicted, methamphetamine-using MSM and 16 local mental and public health officials. Findings from the first of this two-phase formative research project will result in the initial development of a community-tested, culturally-specific social marketing campaign and an individual-based intervention based in HIV-testing facilities.
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Affiliation(s)
- Brian J Dew
- Georgia State University, Department of Counseling & Psychological Services, Atlanta, GA 30302-3980, USA
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Factors associated with sex in the context of methamphetamine use in different sexual venues among HIV-positive men who have sex with men. BMC Public Health 2010; 10:178. [PMID: 20359362 PMCID: PMC2858118 DOI: 10.1186/1471-2458-10-178] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/01/2010] [Indexed: 11/25/2022] Open
Abstract
Background Harm reduction has focused primarily on reduction of high-risk substance using behaviors rather than reductions in high-risk sexual behaviors. Furthermore, most studies focus on individual behavior change, with less attention paid to the social and environmental context. This paper promotes understanding of the interplay between the individual and the social context by examining the psychosocial and behavioral characteristics of 321 methamphetamine-using HIV-positive men who have sex with men (MSM) in San Diego, CA based on the locations or venues of their sexual activities when "high" on methamphetamine. Methods Participants in a safer-sex intervention study underwent a baseline assessment that queried demographic and psychosocial characteristics as well as drug use and sexual risk behaviors. For purposes of analysis, respondents were classified according to their preference of sexual venue: private (e.g., home), commercial (e.g., bathhouse), or public (e.g., public park or restroom). Results The commercial venue group was younger, better educated, more likely to identify as gay, and significantly more likely to have used "club drugs" as compared to the other two groups. Men in the commercial- and public-venue groups reported more high-risk sex compared to the private-venue group. The public-venue group reported heavier drug and alcohol use, had significantly higher Beck depression scores, reported more experiences of stigma, and scored higher on a measure of sexual compulsivity than did the other two groups. Conclusion In an effort to reduce HIV/STI risk-behaviors, future studies should investigate the feasibility of modifying personal, psychosocial and structural factors associated with the use of risky sexual venues where HIV-positive methamphetamine users engage in sexual activity when "high" on methamphetamine. Trial registration ClinicalTrials.gov NCT00432926
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry (MC 0680), University of California - San Diego, 9500 Gilman Drive, La Jolla, California 92093-0680, USA
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Kantrowitz JT, Citrome L, Javitt DC. A review of tolerability and abuse liability of gamma-hydroxybutyric acid for insomnia in patients with schizophrenia. Clin Ther 2009; 31 Pt 1:1360-73. [PMID: 19698899 DOI: 10.1016/j.clinthera.2009.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approved therapeutic uses for gamma-hydroxybutyric acid (GHB) (or sodium oxybate), a gamma-aminobutyric acid type B and GHB receptor agonist, include narcolepsy in the United States and Europe and alcohol abuse treatment in Italy. Possible efficacy of GHB in schizophrenia has also been proposed. A tolerability concern regarding use of GHB is its abuse potential. Given the high comorbidity of substance disorders and schizophrenia, a systematic assessment of the published literature is crucial. OBJECTIVE The aim of this review was to assess the tolerability and abuse liability of GHB in the context of future clinical studies as a potential treatment for insomnia in patients with schizophrenia. METHODS A literature search in English (inception through April 2009, inclusive) was conducted of MEDLINE, EMBASE, and PsycINFO using the search term GHB. All articles whose abstracts mentioned human use of GHB were read in their entirety. The reference sections of identified articles were reviewed for publications that might have been missed by the initial search. RESULTS GHB is abused by a small percentage of people (<1%) as a "club drug" and is commonly associated with enhanced sexual experiences (65%), euphoria (41%), somnolence (71%), and confusion (24%), according to a recent study. A review of all available emergency room case series suggests that while GHB can be associated with serious coma necessitating intubation, the number of reported fatal cases associated with GHB appears limited. Clarity on the lethality of GHB is complicated by instability of GHB in postmortem samples and frequent concomitant ingestions. Furthermore, formal abuse liability studies do not support high abuse propensity for GHB, mainly because oversedation and dizziness may lead most individuals to find GHB unpleasant at high doses. As supported by 2 large studies, there is limited evidence to suggest widespread use as an agent in sexual assault. Years of clinical use in narcolepsy do not support the development of tolerance or withdrawal in those subjects without substance dependence. CONCLUSIONS Tolerability and abuse liability issues, while a concern with GHB given its abuse potential, do not preclude further study of the potential use for insomnia in nondually diagnosed schizophrenia. Full cognizance must be taken of risk/benefit tradeoffs, and to the development of improved formulations with decreased abuse liability.
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Affiliation(s)
- Joshua T Kantrowitz
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA.
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Acide gamma-hydroxy-butyrique (GHB) : plus qu’un agent de soumission chimique, une véritable source d’addiction. Presse Med 2009; 38:1526-38. [DOI: 10.1016/j.lpm.2009.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/14/2009] [Accepted: 05/18/2009] [Indexed: 11/18/2022] Open
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30
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Retrospective drug detection in cases of drug-facilitated sexual assault: challenges and perspectives for the forensic toxicologist. Bioanalysis 2009; 1:1001-13. [DOI: 10.4155/bio.09.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reported incidences of drug-facilitated sexual assault (DFSA) are on the increase worldwide. These cases represent a particular challenge for the forensic toxicologist due to the difficulty in obtaining adequate evidence of drug administration. Primarily, this is due to the nature and diversity of the drugs involved, their pharmacology and sampling timescales. Evaluating whether a drug has been administered to a victim for the purpose of sexual assault can often be difficult, if not impossible. This review draws attention to this burgeoning crime and focuses on the unique challenges DFSA cases present in terms of evidential analysis. Current analytical methodologies for investigating DFSA are highlighted and discussed along with developments in improving analytical procedures. In particular, enlarging detection windows by adopting emerging LC–MS techniques is also discussed. This review also highlights the use of cutting-edge technologies such as ultra-HPLC and the use of alternative matrices for addressing the problem of improved retrospective drug detection.
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31
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Rhodes SD, McCoy TP, Wilkin AM, Wolfson M. Behavioral risk disparities in a random sample of self-identifying gay and non-gay male university students. JOURNAL OF HOMOSEXUALITY 2009; 56:1083-100. [PMID: 19882428 PMCID: PMC3715091 DOI: 10.1080/00918360903275500] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This Internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (+/-2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.
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Affiliation(s)
- Scott D Rhodes
- Section on Society and Health, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27158-1063, USA.
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Carter LP, Koek W, France CP. Behavioral analyses of GHB: receptor mechanisms. Pharmacol Ther 2008; 121:100-14. [PMID: 19010351 DOI: 10.1016/j.pharmthera.2008.10.003] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 10/14/2008] [Indexed: 11/25/2022]
Abstract
GHB is used therapeutically and recreationally, although the precise mechanism of action responsible for its different behavioral effects is not entirely clear. The purpose of this review is to summarize how behavioral procedures, especially drug discrimination procedures, have been used to study the mechanism of action of GHB. More specifically, we will review several different drug discrimination procedures and discuss how they have been used to qualitatively and quantitatively study different components of the complex mechanism of action of GHB. A growing number of studies have provided evidence that the behavioral effects of GHB are mediated predominantly by GABAB receptors. However, there is also evidence that the mechanisms mediating the effects of GHB and the prototypical GABAB receptor agonist baclofen are not identical, and that other mechanisms such as GHB receptors and subtypes of GABAA and GABAB receptors might contribute to the effects of GHB. These findings are consistent with the different behavioral profile, abuse liability, and therapeutic indications of GHB and baclofen. A better understanding of the similarities and differences between GHB and baclofen, as well as the pharmacological mechanisms of action underlying the recreational and therapeutic effects of GHB, could lead to more effective medications with fewer adverse effects.
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Abstract
This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a year-long longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs-cocaine, GHB, ketamine, ecstasy, and methamphetamine-using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.
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Oser C, Havens J, Staton-Tindall M, Wong C, Leukefeld C, Prendergast M. HIV Sexual Risk Behaviors among Ketamine and Non-Ketamine Using Criminal Offenders Prior to Prison Entry. ADDICTION RESEARCH & THEORY 2008; 16:289-302. [PMID: 19287506 PMCID: PMC2654764 DOI: 10.1080/16066350801983723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study is the first to examine ketamine use and its association with HIV sexual risk behaviors among a criminal offending population in the United States. Data were collected from 716 inmates as part of the Transitional Case Management (TCM) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses were used to identify differences between ketamine users (n=44) and non-ketamine users (n=672). Three Poisson regression models were used to identify the significant correlates of high risk sexual behaviors in the 30 days prior to incarceration-- (1) number of times had unprotected sex while high, (2) number of times had unprotected vaginal sex, and (3) number of times had unprotected anal sex. Results indicate that ketamine was a significant correlate in all of the Poisson regression models. Findings add to the literature and indicate that ketamine use may be a marker for engaging in HIV risk behaviors among criminal offenders.
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Affiliation(s)
- Carrie Oser
- 1531 Patterson Office Tower, Department of Sociology, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40506;
| | - Jennifer Havens
- 915B South Limestone, Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536;
| | - Michele Staton-Tindall
- 3470 Blazer Parkway, College of Social Work, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40509;
| | - Conrad Wong
- 515 Oldham Court, Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40502;
| | - Carl Leukefeld
- 111 College of Medicine Office Building, Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40506;
| | - Michael Prendergast
- 1640 S. Sepulveda Blvd., Suite 200, Integrated Substance Abuse Programs, University of California Los Angeles, Los Angeles, CA 90025;
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Kim SY, Anderson IB, Dyer JE, Barker JC, Blanc PD. High-risk behaviors and hospitalizations among gamma hydroxybutyrate (GHB) users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2007; 33:429-38. [PMID: 17613970 PMCID: PMC2257866 DOI: 10.1080/00952990701312316] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Little is known about behaviors linked to gamma hydroxybutyrate (GHB) morbidity. METHODS We surveyed 131 GHB users, using logistic regression to test the associations between the high risk behaviors and hospital treatment for GHB (26 [20%] of subjects). RESULTS Increased risk of GHB hospital treatment was associated with: co-ingestion of ethanol (OR 5.2; 95% CI 1.7-16), driving under the influence of GHB (OR 3.2; 95%, CI 1.3-7.8),use of GHB to treat withdrawal symptoms (OR 2.9; 95% CI 1.1-7.9), and co-ingestion of ketamine (OR 2.7; 95% CI 1.1-6.7). CONCLUSION Targeted prevention activities could focus on selected high-risk behaviors.
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Affiliation(s)
- Susan Y Kim
- California Poison Control System, Department of Clinical Pharmacy, University of California, San Francisco, CA 94143-1369, USA.
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36
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Halkitis PN, Palamar JJ, Mukherjee PP. Poly-club-drug use among gay and bisexual men: a longitudinal analysis. Drug Alcohol Depend 2007; 89:153-60. [PMID: 17267140 PMCID: PMC1945225 DOI: 10.1016/j.drugalcdep.2006.12.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 11/28/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City. METHODS Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period. RESULTS Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB. CONCLUSIONS The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered.
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Affiliation(s)
- Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies (CHIBPS), Steinhardt School of Culture, Education & Human Development, New York University, 726 Broadway, Suite 525, New York, NY 10003, USA.
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