Methamphetamine use and violence: Findings from a longitudinal birth cohort

Structural Influences on Methamphetamine Use Among Black Sexual Minority Men (HISTORY Study): Protocol for a Longitudinal Cohort Study

BACKGROUND

Sexual minority men are disproportionately affected by methamphetamine use, with recent studies suggesting an increase in use specifically among Black sexual minority men. Black sexual minority men face unique structural barriers to achieving optimal health. Given its harmful effects, and in light of existing health disparities, an increase in methamphetamine use among Black sexual minority men poses a significant public health concern.

OBJECTIVE

The Health Impacts and Struggles to Overcome the Racial Discrimination of Yesterday (HISTORY) study is investigating the potential impacts of exposure to the census tract-level structural racism and discrimination (SRD) on methamphetamine use among Black sexual minority men in Atlanta, Georgia, and will identify intervention targets to improve prevention and treatment of methamphetamine use in this population.

METHODS

This study uses a mixed methods and multilevel design over a 5-year period and incorporates participatory approaches. Individual-level quantitative data will be collected from a community-based cohort of Black sexual minority men (N=300) via periodic assessment surveys, ecological momentary assessments, and medical record abstractions. Census tract-level measures of SRD will be constructed using publicly available administrative data. Qualitative data collection will include longitudinal, repeated in-depth interviews with a subset (n=40) of study participants. Finally, using a participatory group model-building process, we will build on our qualitative and quantitative data to generate causal maps of SRD and methamphetamine use among Black sexual minority men, which in turn will be translated into actionable recommendations for structural intervention.

RESULTS

Enrollment in the HISTORY study commenced in March 2023 and is anticipated to be completed by November 2024.

CONCLUSIONS

The HISTORY study will serve as a crucial background upon which future structural interventions can be built, to mitigate the effects of methamphetamine use and SRD among Black sexual minority men.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63761.

Reasons for using methamphetamine: Systematic review

BACKGROUND AND OBJECTIVES

Use of methamphetamine has increased in the last decade. The reasons for using methamphetamine vary according to the characteristics of the users. The literature includes review studies on methamphetamine use; however, no systematic review on the reasons for using methamphetamine was found. This study aims to determine the reasons for methamphetamine use through a systematic review of the literature.

METHOD

The data from a systematic review of the literature review were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Science Direct, Ovid-Medline, and Google Scholar databases were scanned using the keywords "methamphetamine", "crystal", "meth", "addiction", "reason for use", and "motivation to use". The articles (n = 25,004) were reviewed based on the inclusion and exclusion criteria, and 21 articles were finally selected for this study.

RESULTS

The reasons for using methamphetamine included improving performance, staying awake, increasing sexual performance and impulses, reducing the effects of withdrawal from other substances, coping with problems, socializing, having fun, and coping with pain and discomfort.

DISCUSSION AND CONCLUSIONS

Methamphetamine users typically take this drug to provide performance enhancement and cope with problems in different areas. It is recommended to inform the users correctly about methamphetamine, to teach effective methods of coping with withdrawal, and to carry out supply prevention studies.

SCIENTIFIC SIGNIFICANCE

This is the first systematic literature review to reveal the reasons why people take methamphetamine. Revealing these causes is very important in terms of intervention (basic, primary, secondary, and tertiary protection) strategies.

20-year trends in Australian methamphetamine-related deaths, 2001-2020

BACKGROUND

Over the past two decades methamphetamine-related harms have increased in Australia. Previous analysis of methamphetamine-related deaths has covered limited timeframes, and largely focused on drug-toxicity deaths. This paper examines long-term trends in methamphetamine-related deaths over 20 years, including deaths due to a range of specific causes.

METHODS

Descriptive analyses were conducted on Australian methamphetamine-related deaths (2001-2023) by cause, extracted from the National Coronial Information System, an online database containing deaths reported to coroners in Australia and New Zealand. Joinpoint trend analyses were used to assess changes over time between 2001 and 2020 (with data from 2021 to 2023 likely incomplete and thus excluded).

RESULTS

Unintentional drug toxicity was the cause of 49.8 % of methamphetamine-related deaths, intentional self-harm (including toxicity) 23.3 %, unintentional injury 15.1 %, natural causes 9.6 %, and assaults 2.3 %. Between 2001 and 2020, joinpoint analysis showed three trend change points among all-cause methamphetamine-related mortality rates, resulting in four distinct periods: two periods where they increased (2001-2006 - annual percentage change (APC) = 15.4 %; 2009-2016 - APC 25.5 %), and two where they decreased (2006-2009 - APC = -11.8 %; 2017-2020 - APC = -2.9 %). Similar patterns were evident among rates of intentional self-harm and unintentional injury. Deaths caused by unintentional drug toxicity saw two trend change points (2011, 2016), and rates increased across all three periods. Natural cause deaths had three trend change points (2007, 2010, 2015), and rates continued to rise after 2015, largely driven by increases in circulatory diseases.

CONCLUSION

Cause-specific models highlighted diverse trends. Recent trends show unintentional drug toxicity deaths have slightly increased, intentional self-harm stabilised, and unintentional injury and assault deaths have declined. Deaths from natural causes involving methamphetamine continued to increase, highlighting a public health concern and a potential need for early circulatory disease screening among people who use methamphetamine.

Characteristics of blunt and penetrating trauma among victims of physical violence: A retrospective study

BACKGROUND

A significant number of referrals to the emergency departments is due to violence and conflict leading to serious injuries and death. The increasing number of such cases highlights the urgent need for investigating victimization of physical violence.

AIM

The purpose of this study was to determine the frequency of demographic and clinical characteristics in victims of violence and classify them based on penetrating or blunt trauma.

METHODS

The data of the patients who had been the victims of violence in 2020 were extracted from the Trauma Registry System(TRS) of the Guilan Road Trauma Research Center(GTRC). All analyses were performed using SPSS software version 24. The significance level was considered less than 0.05.

RESULTS

There was a significant difference in the type of violence-related trauma in different age groups (P < 0.001), based on sex (P = 0.002), and marital status (P = 0.012). A significant difference also existed between the trauma type and clinical variables including smoking (P = 0.032), history of alcohol drinking (P = 0.005), and other substance use (P = 0.002), the anatomical location of injury (P < 0.001) and therapeutic interventions (p < 0.001(.

CONCLUSION

Most of the clients of the violence suffered from blunt trauma, the severity of which was mild, and they were treated supportively without the need for surgery. Blunt trauma was seen more in women, divorcees, over 40 years and non-smokers. Penetrating trauma was observed more in lower limb injuries and alcohol and amphetamine users. Prevention programs and educational interventions should be programmed for the society long before men alcohol and amphetamine abusers reach their fourth decade of life. Accurately recording the type of physical violence, and the weapon used, and determining the injury severity score in TRS can lead to more reliable results in researching the field of violence issues.

SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use

INTRODUCTION

Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use.

METHODS

Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion.

RESULTS

Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement.

CONCLUSIONS

Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.

The impact of methamphetamine on psychosocial variables in patients from Iraq

Background

The current work reviews the psychosocial factors associated with different urinary methamphetamine concentration levels.

Methods

From April to November 2023, 243 participants from Baghdad's Al-Ataa Hospital were the subjects of a cross-sectional descriptive analysis study. We included 73 patients in this study.

Result

The urinary methamphetamine concentration levels were from 3 to 92,274 ng/ml, with a mean ± SD of 10,873.6 ± 18,641. Patients diagnosed with major depression disorder exhibited higher scores on GHQ-30, UCLA, MOAS, and BDI-II with a significant P-value of 0.0001, 0.001, 0.0001, and 0.0001, consequently with an effect size of 0.015, 0.001, 1.05, and 3.24, respectively.

Conclusions

The multi-screening test can produce a false positive. It frequently interferes with other drugs, especially antidepressants. This will result in patients being stigmatized and accused. On the other hand, those who accidentally come into contact with crystal smoke will experience the same withdrawal symptoms as the addicted patients. Their urinary methamphetamine level (titer) could have negative results. Urinary methamphetamine levels should be zero in healthy patients. In this situation, screening tests, expert opinion, and urine methamphetamine testing are strongly recommended.

Treatment Disparities in Georgia: Methamphetamine Use Disorder

BACKGROUND

Methamphetamine use disorder (MUD) is becoming more of a public health issue in Georgia State, with health and social effects affecting both people and communities. This study aimed to investigate attributes that may affect the accessibility of treatment among the methamphetamine-use population in the state of Georgia.

METHODS

We utilized the Treatment Episode Data Set - Discharges (TEDS-D) for 2016-2020 in Georgia, comprising participants with MUD (175,270). We utilized descriptive statistics and inferential techniques to ascertain the relationship between variables. Multiple logistic regression was used to control for confounding variables at a 95% confidence interval.

RESULTS

This study's findings showed individuals aged 25-49 years had 1.8 times higher odds of getting treatment for methamphetamine use compared to those aged 12-24 years (adjusted odds ratio (AOR) = 1.8; 95% CI: 1.50-2.16). Alaska Native individuals (Aleut, Eskimo, and Indian) had 7.07 times higher odds of receiving treatment than Asian or Pacific Islander individuals (AOR = 7.07; 95% CI: 2.02-24.67). Compared to Asian or Pacific Islander individuals, Black or African American individuals had 12.11 times higher odds of receiving treatment (AOR = 12.11; 95% CI: 9.37-15.66), while White individuals had 6.82 times higher odds of getting treatment (AOR = 1.09; 95% CI: 0.86-1.37).

CONCLUSION

MUD treatment disparity challenges are revealed in our study, emphasizing the critical need for focused intervention programs.

A Systematic Review of Interpersonal Violence Perpetration and Victimization Risk Examined Within Single Study Cohorts, Including in Relation to Mental Illness

Rates of both violent victimization and violence perpetration are known to be elevated among individuals with mental illness compared with those in the general population, though the relative risk of each outcome is less well established. In this systematic review, PubMed, Embase, Web of Science, PsycINFO, and Criminal Justice Abstracts were searched for articles published any time before October 2021 that reported the prevalence or incidence of both violent victimization and perpetration. We performed two searches to identify studies using samples or cohorts of (1) persons with mental illnesses and (2) persons in the general population. A total of 25 studies (9 examining persons with mental illnesses, 13 examining persons in the general population, and 3 examining both sample/cohort types) were identified and data was extracted to describe the type and size of cohort or sample, definitions and terminology (i.e., mental illness, violence victimization, violence perpetration), data source(s), observation period, prevalence/incidence of victimization, and prevalence/incidence of perpetration. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to conduct a quality assessment of all included studies. Due to marked study heterogeneity, results were presented using a narrative synthesis approach. Across studies, findings were mixed, and the methodological approaches varied greatly. Broadly, the review provides evidence for (1) higher rates of victimization than perpetration for both individuals with mental illness and those in the general population and (2) higher rates of both victimization and perpetration for those with mental illness compared to those in the general population.

Effects of Positive versus Negative Framing on Stigma toward Individuals Recovering from Methamphetamine Use Disorder during Randomized Brief Video Exposure

Eighty-two Australians (mean age = 30.07; 61% female) were blindly randomized to view either a video edited to depict a positive or negative presentation of individuals in recovery from methamphetamine use disorder. Participants completed the Social Distance Scale for Substance Users, Dangerousness Scale for Substance Users and Affect Scale for Substance Users before and after video exposure. Following video exposure, those exposed to the positive video portrayal reported lower desire for social distance (p < .001), lower perceptions of dangerousness (p = .011), and more favorable affective reactions (p < .001). Participants' previous level of contact with the target group did not predict baseline stigma or moderate the experimental effect. Participants' qualitative responses to the experiment were assessed via content analysis and indicated mainly positive or ambivalent attitudes, unchanged by the video; however, 18% of those receiving the positive video reported attitudes becoming more sympathetic/favorable. Findings suggest that media depictions which include people with methamphetamine use disorder displaying friendliness and recovery narratives may improve community perceptions of people recovering from methamphetamine use disorder, and conversely, unsmiling portrayals focusing on harm done to others increases desire for social distance and perceived dangerousness.

Firearm injury among people experiencing homelessness: Cross-sectional evidence from a national survey of United States emergency departments

Objectives

Persons experiencing homelessness (PEH) are at high risk for violent victimization. This study leverages unique data from a national study in the United States of America to provide estimates of non-fatal firearm injury among PEH and to describe the contexts related to injury, such as substance use, intent of the injury, and precipitating interpersonal factors.

Study design

Cross-sectional.

Methods

Data from the 1993-2020 National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS) were used to describe the context and characteristics of non-fatal firearm injury among PEH aged 16 years or older. Homeless status and substance use data were extracted from a de-identified narrative field. Estimates were weighted to account for the NEISS-FISS complex sampling design.

Results

Probable homelessness was identified in 0.10% of cases (n = 3,225). Substance use was documented in 22.73% of cases. Assault comprised 82.64% of injuries. Patients were mostly male (81.38%). Missing data were common on contextual variables: verbal argument (64.62%), physical fight (54.48%) or other criminal activity (62.33%).

Conclusions

Assault is a leading cause of non-fatal firearm injury for PEH and is greater than rates of assault in non-fatal firearm injuries in the general population. Substance use was documented in nearly one quarter of patients, although this is less than expected given prior evidence. Reliance on narrative fields for key variables likely underestimates rates of PEH and substance use.

Elevated C-reactive protein/albumin ratio in patients with methamphetamine use disorder

BACKGROUND

Methamphetamine use disorder causes significant crises, which have individual, familial, and social consequences. Identifying inflammatory biomarkers for methamphetamine use disorder may be useful for following the inflammatory status of patients in clinical assessment. In this study, we aimed to investigate whether neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), C-reactive protein/albumin ratio (CAR) and neutrophil/albumin ratio (NAR) levels can be used as inflammatory biomarkers in methamphetamine use disorder.

METHODS

The sample comprised 139 treatment-seeking participants who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for methamphetamine use disorder and 139 sociodemographically matched controls. Only hospitalised patients were included. An independent sample t-test, Pearson's correlation test, and binominal logistic regression analysis were performed.

RESULTS

CAR (p = 0.016) and NAR (p = 0.048) levels were significantly higher in individuals with methamphetamine use disorder when compared with healthy controls. The CAR level was found to be a significant predictor of group membership in regression analysis for methamphetamine use disorder.

CONCLUSION

CAR may be a potential inflammatory biomarker for patients with methamphetamine use disorder. CAR as a relatively easier-to-measure biomarker could be beneficial to follow the inflammatory status and treatment response of patients.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Chatbot-assisted therapy for patients with methamphetamine use disorder: a preliminary randomized controlled trial

Background

Methamphetamine (MA) use disorder is associated with a large public health burden. Despite the therapeutic effects of psychosocial interventions based on current evidence, finding an approach to retain patients in treatment remains a real-world challenge. The rapid development of mobile health (mHealth) systems suggests the potential to provide real-time personalized care at any time and from any location, minimize barriers to treatment, maximize use, and promote the dissemination of accessible therapeutic tools in at-risk populations. Our study aimed to investigate the feasibility and effectiveness of chatbots for the treatment of MA use disorder.

Method

The inclusion criteria were (a) a diagnosis of MA use disorder as defined by the DSM-5, (b) age between 18 and 65 years, (c) no acute exacerbation of severe mental illness during the initial assessment, such as schizophrenia or bipolar I disorder, (d) willingness to participate in standard outpatient treatment for ≥ 6 months, and (e) an Android phone. Participants were randomly allocated to either a chatbot-assisted therapy via smartphone (CAT) group or a control group following simple randomization procedures (computerized random numbers) without blinding. All participants were followed up for 6 months. Treatment retention and monthly urine test results were analyzed as outcome measures. Participants' satisfaction with CAT was also assessed.

Results

In total, 50 and 49 participants were allocated to the CAT and control groups, respectively. There were no significant differences in retention time between the two treatment groups (df = 1, p = 0.099). The CAT group had fewer MA-positive urine samples than the control group (19.5% vs. 29.6%, F = 9.116, p = 0.003). The proportion of MA-positive urine samples was positively correlated with the frequency of MA use (r = 0.323, p = 0.001), severity of MA use disorder (r = 0.364, p < 0.001), and polysubstance use (r = 0.212, p = 0.035), and negatively correlated with readiness to change (r = -0.330, p = 0.001). Totally 55 participants completed the study at the 6-month follow-up and 60% reported relative satisfaction.

Conclusion

Participants in this study had favorable acceptance and generally positive outcomes, which indicates that chatbot is feasible for treating people who use MA.

Methamphetamine dependence in Australia-why is 'ice' (crystal meth) so addictive?

Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia.

Evaluation of the BEAT Meth Intervention for Emergency Department Patients with Methamphetamine Psychosis

OBJECTIVES

Methamphetamine is the second leading cause of overdose death in America and a leading cause of emergency department (ED) visits. Methamphetamine-induced psychosis is a dangerous and difficult-to-treat consequence of methamphetamine use. We describe the pilot implementation and outcomes of a multimodal treatment intervention for ED patients with methamphetamine psychosis, Beginning Early and Assertive Treatment for Methamphetamine Psychosis (BEAT Meth).

METHODS

BEAT Meth was implemented in an urban safety net health system. The protocol includes early identification and treatment of methamphetamine psychosis, a protocolized hospitalization, and support for transitioning patients to specialty addiction treatment. Patients receiving BEAT Meth were compared with ED patients with methamphetamine psychosis who were discharged. Implementation fidelity was measured to assess feasibility.

RESULTS

BEAT Meth patients were nearly 3 times more likely to attend an outpatient specialty addiction appointment in the 30 days after discharge than comparison patients (32% vs 11%, P < 0.01). Subsequent ED utilization was common among all patients, and there was no significant difference in 30-day ED return rates between BEAT Meth and comparison patients (28% vs 37%, P = 0.10). Exploratory analyses suggested that increased attendance at outpatient treatment reduced ED utilization.

CONCLUSIONS

BEAT Meth is an intervention framework to support identification, management, and treatment engagement of ED patients with methamphetamine psychosis. Treatment strategies like BEAT Meth are necessary to manage the unique challenges of methamphetamine addiction. These findings will guide clinical care, program development, and research.

Violence and victimisation in the lives of persons experiencing homelessness who use methamphetamine: A scoping review

Methamphetamine (MA) use among individuals who experience homelessness has tripled in recent years. This is a problematic trend given the harmful impacts of this substance on health and social well-being. While there is a large body of literature on the relationship between substance use and trauma, little is known about the scope of existing empirical literature exploring this topic related to MA use. Anecdotally, MA is frequently associated with violence and victimisation, which may be related to stigma associated with using MA. However, little is known about the scope of empirical literature exploring violence and victimisation in the lives of individuals who experience homelessness and use MA. We conducted a scoping review to fill this gap in existing literature using Arksey and O'Malley's methodological framework. Our search was conducted between January 2021 and March 2021 and was deployed in seven databases: Medline, Embase, CINAHL, PsycINFO, Sociological Abstracts, Nursing and Allied Health and AMED. Two independent raters screened 700 titles and abstracts after the removal of duplicates. A total of 54 articles were subjected to a full-text review and 20 articles met the inclusion criteria. We generated two themes: methamphetamine and victimisation and challenging behaviours. Six (30%) of the included articles explored MA use in relation to violence, while 18 (90%) explored experiences of victimisation among persons experiencing homelessness. Our findings highlight that individual who experience homelessness and use MA are particularly vulnerable to experiences of trauma. Though existing literature does acknowledge the challenging behaviour associated with MA use, only three existing studies demonstrated a relationship between MA use and physical violence. Research exploring the impacts of MA use on victimisation among persons who experience homelessness, and the development of interventions for managing challenging behaviours associated with MA use are needed.

Biennial Changes in the Characteristics of Patients with Methamphetamine Use Disorder in Japan from 2000 to 2020

Methamphetamine is an illegal drug with the greatest burdens in Japan. Social and medical measures to combat methamphetamine dependence have been implemented, but no reports on changes in the characteristics of methamphetamine use disorder patients have been conducted. We aimed to describe these changes, and provide information on the results of social and medical measures. We concatenated cross-sectional surveys from 2000 to 2020 and analyzed biennial changes. Twenty-year data from 2000 to 2018 were age-weighted according to the age structure in 2020. We performed Cochran-Armitage trend tests for crude and age-weighted changes in patient variables. There was an increase in the number of patients with methamphetamine use disorder undergoing treatment and those with a history of drug-related arrests. Patients who achieved 1-year abstinence increased, and those diagnosed with psychotic disorders decreased. Patients with a history of non-drug-related arrests and without revealing their source of methamphetamine decreased. The ages of the patient population increased, and patients with a history of benzodiazepine misuse increased. Social measures linking methamphetamine users to psychiatric care may increase the number of patients who undergo treatment.

Vulnerabilidades associadas à violência contra a mulher antes do ingresso no sistema prisional

RESUMO Objetivo: analisar as vulnerabilidades individuais e sociais de mulheres privadas de liberdade para violência sofrida antes da entrada no sistema prisional. Método: estudo transversal analítico, realizado com 272 internas de uma unidade prisional feminina, na Região Metropolitana de Fortaleza, Ceará. Foram aplicados dois instrumentos: formulário para análise de informações sociodemográficas e da violência sofrida previamente à entrada no presídio e o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), que analisou o histórico do uso de substâncias psicoativas. Resultados: 44,5% das mulheres sofreram violência. A maior parte da amostra total apresentava idade entre 18 e 29 anos, com filhos, baixa escolaridade e renda, início precoce da vida sexual e histórico de uso de drogas ilícitas. A idade entre 18 e 29 anos mostrou ser fator protetor da violência (OR = 0,632). Uso de cocaína e crack (p = 0,002), anfetaminas e êxtase (p = 0,018) aumenta a chance de violência de 2,2 a 3,3 vezes. Conclusão: aspectos das dimensões individuais e sociais da vulnerabilidade estão associadas à ocorrência de violência em mulheres internas do sistema prisional feminino. Estratégias efetivas necessitam ser traçadas com base nas vulnerabilidades, para prevenir violência contra a mulher.

Vulnerabilities associated with violence against women before entering the prison system

OBJECTIVE

to analyze the individual and social vulnerabilities of women deprived of their liberty for violence suffered before entering the prison system.

METHOD

an analytical crosssectional study, carried out with 272 inmates of a female prison unit, in the Metropolitan Region of Fortaleza, Ceará. We applied two instruments: a form to analyze sociodemographic information and the violence suffered prior to entering the prison and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which analyzed the history of psychoactive substance use.

RESULTS

44.5% of women suffered violence. Most of the total sample was between 18 and 29 years old, with children, low education and income, early onset of sexual life and history of illicit drug use. Age between 18 and 29 years proved to be a protective factor against violence (OR = 0.632). Cocaine and crack use (p =0.002), amphetamines and ecstasy (p =0.018) increase the chance of violence by 2.2 to 3.3 times.

CONCLUSION

aspects of the individual and social dimensions of vulnerability are associated with the occurrence of violence in women in the female prison system. Effective strategies need to be designed based on vulnerabilities to prevent violence against women.

Association between childhood trauma, intimate partner violence, and perceived parental competence among women abusing amphetamine-type stimulant

INTRODUCTION

This cross-sectional study examines the correlation between childhood trauma, intimate partner violence (IPV), and parenting self-efficacy among women who reported using amphetamine-type stimulants (ATS) in an institutional drug rehabilitation center.

METHODS

A total of 106 participants were recruited by purposive sampling, of which 88 were mothers. Questionnaires were used to collect sociodemographic data and study variables.

RESULTS

Most of these women had experienced emotional abuse, sexual abuse, and physical neglect in their childhood. IPV assessments revealed that 70.5% (n = 74) and 30.5% (n = 32) had experienced physical and sexual violence, respectively. In terms of parenting competency, they scored 79.5% for self-efficacy and 54.4% for parenting satisfaction. Childhood emotional abuse significantly increases the odds of individuals experiencing sexual violence by 20.9%.

DISCUSSION

We found that childhood trauma and IPV did not have a significant relationship with parenting efficacy. Conversely, childhood emotional abuse and physical abuse were negatively correlated to parenting satisfaction. It is imperative that any form of childhood abuse be recognized and stopped early to reduce the harm it brings to women later in life.

The fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspective

The current opioid epidemic in the United States has been characterized as having three waves: prescription opioid use, followed by heroin use, and then use of synthetic opioids (e.g., fentanyl), with early waves affecting a population that was younger, less predominantly male, and more likely to be Caucasian and rural than in past opioid epidemics. A variety of recent data suggest that we have entered a fourth wave which can be characterized as a stimulant/opioid epidemic, with mental illness co-morbidities being more evident than in the past. Stimulant use has introduced new complexities in terms of behavioral consequences (e.g., neurological deficits, suicidal ideation, psychosis, hostility, violence), available treatments, and engagement into services. These compound existing issues in addressing the opioid epidemic in rural areas, including the low density of populations and the scarcity of behavioral health resources (e.g., fewer credentialed behavioral health professionals, particularly those able to prescribe Buprenorphine). Considerations for addressing this new wave are discussed, along with the drawbacks of a wave perspective and persistent concerns in confronting drug abuse such as stigma.

Patterns of smoking and injecting methamphetamine and their association with health and social outcomes

Introduction

We examine how smoking and injecting methamphetamine change over time and correlate with specific health and social outcomes.

Methods

Panel data from a longitudinal cohort dependent on methamphetamine (N = 444; 891 months). Random effects regression models examined the relationship between smoking and/or injecting methamphetamine and past month outcomes (substance use, ≥daily injection, needle/syringe sharing, psychological distress, poor mental and physical health, sexual behaviour, psychotic symptoms, violent behaviour and crime). Effects were adjusted for between‐group differences at baseline.

Results

At baseline, 56% of participants only injected methamphetamine in the past month, 18% only smoked and 26% both injected and smoked (concurrent injecting and smoking). Compared to injecting only, concurrent injecting and smoking was associated with more days of methamphetamine use (b = 1.3, P < 0.001; adjusted [A] b = 1.2, P < 0.001), more frequent injection [odds ratio (OR) 1.8, P = 0.013; adjusted OR (AOR) 1.6, P = 0.042], violent behaviour (OR 2.1, P = 0.001; AOR 1.8, P = 0.013] and crime (OR 3.1, P < 0.001; AOR 2.5, P < 0.001). Non‐injecting related outcomes did not differ significantly for only smoking versus only injecting. There was no significant transition from injecting methamphetamine at baseline to non‐injecting methamphetamine use at follow up, or from exclusively smoking methamphetamine at baseline to any methamphetamine injection at follow up.

Discussion and Conclusion

Efforts are needed to address heavier methamphetamine use, more frequent drug injection and elevated violent behaviour and crime among people who concurrently smoke and inject methamphetamine.

Being Simultaneously Curious and Stressed, Precipitants to Methamphetamine Initiation Among Chinese Men Who Have Sex With Men: Findings From a Qualitative Study

ABSTRACT

The cultural context and precipitants for initiating methamphetamine (MA) using among Chinese men who have sex with men (MSM) are unclear. This qualitative descriptive study, which explores the specific precipitants of MA initiation within a cultural context among MSM in China, was conducted with data from semistructured, face-to-face interviews with 24 MA-using MSM (8 HIV positive). Two themes were identified, internal precipitants included the following: (a) curiosity, (b) desire for maximum sexual pleasure, (c) experience with other drugs, and (d) strong sense of self-control capacity. External precipitants included (a) Xiao (filial piety), (b) peer pressure, (c) negative life events, (d) parental emotional neglect, and (e) experiences of homophobia. Internal precipitants to MA initiation for Chinese MSM are consistent with past research. External precipitants were more culture specific. This exacerbates the vulnerability of MSM to MA initiation and keeps it hidden among this population. Future drug use prevention interventions for MSM should address external precipitants and integrate culture-specific strategies.

Treatment Response Distinguishes Persistent Type of Methamphetamine Psychosis From Schizophrenia Spectrum Disorder Among Inmates at Japanese Medical Prison

Introduction: Persistent methamphetamine-associated psychosis (pMAP) is a disorder similar to schizophrenia, so much so that the differences in clinical symptoms and treatment response between the two remain unknown. In this study, we compared the features of pMAP with those of schizophrenia spectrum disorders (SSD). Materials and Methods: This was a retrospective quasi-experimental case-control study of inmates in a medical prison. The behavioral problems, clinical symptoms, and chlorpromazine (CP)-equivalent doses of 24 patients with pMAP and 27 with SSD were compared. Results: Patients in the pMAP group were hospitalized for fewer days than those in the SSD group (281.5 vs. 509.5; p = 0.012), but there were no other significant group differences in behavioral problems or clinical symptoms. The pMAP group received fewer antipsychotics in CP-equivalent doses than the SSD group at 4, 8, and 12 weeks after admission and at the time of discharge (p = 0.018, 0.001, 0.007, and 0.023, respectively). The number of CP-equivalent doses in the SSD group tended to increase after admission, but not in the pMAP group. Discussion: These findings suggest that differentiation between pMAP and SSD based on behavior and symptoms alone may be difficult, and that patients with pMAP may respond better to treatment with a lower dose of antipsychotic medication than those with SSD. Further confirmatory studies are warranted.

The contribution of methamphetamine use to crime: Evidence from Australian longitudinal data

BACKGROUND

To quantify the extent to which methamphetamine use is associated with increases in crime net of any premorbid risk of criminality among people who use the drug.

METHODS

Four one-month data panels from 469 participants dependent on methamphetamine were drawn from the MATES cohort (N = 501). Odds ratios for within-person effects were extracted from a random intercept logistic regression model for crime during periods of methamphetamine use compared to no use. Effects were adjusted for time-varying measures of age, other substance use, and socio-economic disadvantage (income, unemployment and unstable accommodation). Involvement in crime (property crime, drug dealing, fraud, violent crime) and days of methamphetamine in the past month were assessed using the Opiate Treatment Index.

RESULTS

Crime was more likely during months when participants used methamphetamine compared to when they did not (OR 13.2 95% CI 8.5-20.6; AOR 4.7 95% CI 2.8-8.0), this reflecting more property crime (OR 10.6 95% CI 6.3-18.0; AOR 5.5 95% CI 2.8-10.8), violent crime (OR 8.2 95% CI 4.2-15.9; AOR 3.4 95% CI 1.5-8.0), fraud (OR 3.4, 95% CI 2.0-5.8; AOR 1.7 95% CI 0.8-3.3) and dealing drugs (OR 18.2 95% CI 10.2-32.5; AOR 5.9 95% CI 3.0-11.9), although the adjusted relationship for fraud was not significant. Effects were dose related.

CONCLUSIONS

The use of methamphetamine was associated with significant increases in crime beyond premorbid risk for criminality. Crime is a likely social consequence of methamphetamine use and efforts are needed to reduce this impact.