Trends in drug use among electronic dance music party attendees in New York City, 2016-2019

Target analysis of psychoactive drugs in oral fluid by QuEChERS extraction and LC-MS/MS

This study aimed to validate a modified QuEChERS method, followed by liquid chromatography-tandem mass spectrometry, for the determination of 51 psychoactive substances and screening of 22 ones in oral fluid from electronic dance music party (EDM) attendees. Unstimulated oral fluid was collected in a polypropylene tube and stored in a glass vial at -20 ºC. The sample was extracted with acetonitrile:water and MgSO4/NaOAc, followed by cleanup with primary secondary amine and MgSO4. The effectiveness of the sample storage conditions was shown to be comparable to when the Quantisal™ buffer was used, with no substantial concentration loss (< 15%) for all the substances after up to 72 hours at -20º C. The method was satisfactorily validated, with limits of detection (LOD) and quantification (LOQ) ranging from 0.04 to 0.5 ng/mL and 0.1-1.5 ng/mL, respectively, and was applied to the analysis of 62 real samples. The main substances detected were 3,4-methylenedioxymethamphetamine (MDMA) (<0.5-829 ng/mL) and/or methylenedioxyamphetamine (MDA) (10.1 - 460.6 ng/mL), found in 27 samples, and cocaine (13.0-407.3 ng/mL) and its metabolites (benzoylecgonine 0.17-214.1 ng/mL; ecgonine methyl ester 1.8-150.1 ng/mL) in eight samples. Methamphetamine (11-439 ng/mL) was detected in eight samples, along with MDMA and MDA; eutylone was detected in two cases (4.7 and 24.1 ng/mL) reported as "ecstasy" ingestion. A comparison between self-reported drug use and results of oral fluid analysis indicated that the use of illicit substances is often underreported among EDM attendees, who are often unaware of the substances they consume.

Simultaneous cannabis and psychedelic use among festival and concert attendees in Colorado: characterizing enhancement and adverse reactions using mixed methods

BACKGROUND

Most studies examining the simultaneous use of cannabis with other drugs have focused on cannabis and alcohol, with fewer studies examining simultaneous use of cannabis with other drugs. The United States is currently experiencing an upward trend in psychedelic use and there is an increasing need to characterize cannabis and psychedelic drug interactions to best inform public health recommendations.

MATERIALS AND METHODS

A mixed methods field study design was used to survey participants (N = 128) on their lifetime co-use of cannabis with other drugs. Participants who reported lifetime co-use of cannabis and psychedelics (N = 63) were then asked open-ended questions about their most recent simultaneous co-use experience (i.e., how cannabis enhanced their psychedelic experience and whether they experienced any adverse reactions). We conducted a thematic analysis of responses describing how cannabis enhanced the psychedelic experience (N = 54). However, due to low response rate for participants reporting an adverse reaction (N = 7, 11.1%), responses to this question were not analyzed thematically and are instead presented individually.

RESULTS

Themes included tension reduction and balancing of drug effects (N = 27, 50%), enhancement to psychological processes (N = 11, 20.4%), intensified psychedelic drug effects (N = 12, 22.2%), enhanced psychedelic come-down experience (N = 8, 14.8%), and overall ambiguous enhancement (N = 7, 13%). Among participants reporting an adverse reaction, individual responses included increased anxiety and intensity of the experience, decreased sociability, increased negative affect, sleepiness, disassociation, and confusion.

CONCLUSION

Additional research is warranted to better characterize cannabis and psychedelic drug interactions to best inform public health recommendations.

Increases in the use of drug testing kits among nightclub and festival attendees in New York City who use ecstasy, 2017-2022

INTRODUCTION

Ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) is a drug commonly used by people who attend electronic dance music (EDM) events at nightclubs and dance festivals. Drug checking has gained popularity in recent years to test for adulterants, but epidemiology studies are needed to estimate potential shifts in prevalence of drug checking to further inform harm reduction efforts.

METHODS

Adults entering randomly selected EDM events in New York City were surveyed in 2017 and 2022. Those reporting past-year ecstasy use were asked if they tested their ecstasy in the past year using a drug testing kit and whether they found out or suspected their ecstasy contained other drugs. We compared estimates between 2017 and 2022.

RESULTS

In 2017, an estimated 23.1% had tested their ecstasy, and this estimate increased to 43.1% in 2022 (86.6% increase, p = 0.006). Among those who tested their ecstasy, in 2017, 31.2% always tested their drug, and this increased to 60.6% in 2022 (94.2% increase, p = 0.026). In 2017, 59.6% of those who tested their ecstasy reported finding out or suspecting their drug was adulterated, which decreased to 18.4% in 2022 (69.1% decrease, p < 0.001). Suspected methamphetamine adulteration in particular decreased, from 21.9% in 2017 to 3.6% in 2022 (83.6% decrease, p = 0.007).

DISCUSSION AND CONCLUSIONS

The use of drug testing kits has increased among EDM event attendees who use ecstasy and, at the same time, among those who had tested their ecstasy, suspected adulteration has decreased. Continued interest in understanding ecstasy contents among this population suggests the need for formal drug checking services.

Exploring the Link: Health Insurance Coverage and Historical Substance Use Patterns Among U.S. Adults-A NHANES-Based Analysis

This study analyzed the NHANES database (2016-2018), investigating substance use patterns among 6,108 U.S. adults (18-64 years), with a focus on health insurance, race/ethnicity, age, gender, and socioeconomic status. Among participants, 1,063 reported a history of substance use. A key finding was the correlation between health insurance coverage and substance use history; notably, 80% of those with a history of substance use were insured. Non-Hispanic Whites represented a significant proportion (76%) of substance users, exceeding their population representation. Age and gender differences were prominent, with older adults (50-64 years) comprising 41% of substance users, and males accounting for 61%. The study's reliance on self-reported substance use history from NHANES may introduce measurement bias. Such bias necessitates careful interpretation of the data, considering variations across demographic and socioeconomic variables. Logistic regression analysis revealed that lacking health insurance increased the odds of a history of substance use (OR = 1.43, p < .01). The interaction between insurance coverage and race/ethnicity was not significant. These findings underscore the multifaceted nature of substance use, highlighting the need for comprehensive public health strategies to address the diverse factors influencing substance use behaviors.

Cannabis use and dependence among festival attendees: results from the French OCTOPUS survey

BACKGROUND

Chronic use of cannabis is associated with an increased risk of psychosocial, mental and physical health impairments. Sociohealth institutions reach a very limited proportion of cannabis users in need of treatment. Using data collected from festival attendees, this study aimed to estimate the prevalence of dependent cannabis users and to characterize cannabis dependence.

METHODS

We used data from the cross-sectional OCTOPUS survey carried out at 13 music events in the French department of Loire-Atlantique between July 2017 and July 2018. 383 participants aged 18 or older underwent a face-to-face interview about their basic sociodemographics, tobacco use, alcohol use and past-year substance use. Using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, we estimated the prevalence of dependent cannabis users and characterized their dependence.

RESULTS

More than two-thirds of participants reported that they had used cannabis in the past 12 months. Among 194 regular cannabis users (at least monthly), 63.4% were dependent. At least 40% of regular users reported health and/or social consequences of cannabis use. Compared to nondependent cannabis users, dependent cannabis users were more likely to be stimulant users and hallucinogen users.

CONCLUSIONS

Dependent cannabis use is common among festival attendees, especially among stimulant or hallucinogen users. Festival settings may be important arenas for i) implementing efficient harm reduction measures to prevent dependence and ii) providing information on care structures and promoting the use of care to dependent users. In addition, healthcare professionals should be aware of trends in polysubstance use among dependent cannabis users.

Drug-related deaths at Australian music festivals

BACKGROUND

Illicit drug use is overrepresented in music festival attendees compared with the general population. Drug use often involves a wide range of substances with the potential to cause drug toxicity. Law enforcement-centred strategies intended to deter drug use and supply at these mass gatherings have been implemented throughout Australia. However, many have been criticised for their lack of effectiveness, with evidence suggesting that they can inadvertently increase the risk of drug harm. Drug deaths are often multifactorial, providing added challenges in the development of prevention strategies. This study aimed to determine the frequency of deaths involving alcohol and other drugs at music festivals in Australia and to identify potential risk factors that may inform future harm reduction strategies.

METHODS

A descriptive case series study was conducted using the National Coronial Information System (NCIS) to investigate drug-related deaths at music festivals throughout Australia between 1 July 2000 (Queensland from 1 January 2001) and 31 December 2019, using a list of keywords comprising music festival names and terms.

RESULTS

There were 64 deaths, of which most involved males (73.4%) aged in their mid-20s (range 15-50 years). Drug toxicity was the most common primary cause of death (46.9%) followed by external injuries (37.5%). The drug most commonly detected or reported as being used was MDMA (65.6%), followed by alcohol (46.9%) and cannabis (17.2%), with most cases reporting the use of two or more drugs (including alcohol) and 36% reporting a history of drug misuse in the coroner's findings. Most deaths were unintentional, with less than a fifth of cases (17.2%) involving intentional self-harm. Clinical intervention was involved in 64.1% of cases and most festivals occurred in inner city locations (59.4%).

CONCLUSIONS

The findings suggest that drug-related deaths at music festivals in Australia typically involve young people using multiple illicit substances in combination with alcohol. Most are unintentional and could potentially be prevented through the implementation of a range of harm reduction strategies, including mobile medical care, drug checking services, and increased consumer education and awareness.

Use of Lysergic Acid Diethylamide by Major Depression Status

Importance

Renewed interest in the clinical potential of hallucinogens may lead people with depression to a generally more positive view of the use of lysergic acid diethylamide (LSD). Therefore, past-year LSD use among people with depression may be increasing in prevalence.

Objective

To assess time trends in the prevalence of past-year nonmedical LSD use by past-year major depression status and the variation in this association by sociodemographic characteristics.

Design, Setting, and Participants

This survey study used pooled publicly available data from 478 492 adults aged 18 years or older who were administered the National Survey on Drug Use and Health from 2008 through 2019. Statistical analysis was conducted from December 2022 to June 2023.

Main Outcome and Measures

Past-year major depression diagnoses per criteria from the DSM-IV were analyzed. Logistic regression models examined whether time trends in past-year nonmedical LSD use differed between adults with vs without past-year depression, adjusting for sociodemographic characteristics. Secondary analyses examined whether the trends in LSD use by depression status differed between sociodemographic subgroups.

Results

The analytic sample included 478 492 adults, of whom 51.8% were female, 56.1% were younger than 50 years, 11.7% were Black, 15.1% were Hispanic, 65.8% were White, and 7.5% were another race. Weighted interview response rates ranged from 64.9% to 75.6% during the study time frame. From 2008 to 2019, past-year use of LSD increased significantly more among adults with major depression (2008 prevalence, 0.5%; 2019 prevalence, 1.8%; prevalence difference [PD], 1.3% [95% CI, 1.0%-1.6%]) compared with adults without major depression (2008 prevalence, 0.2%; 2019 prevalence, 0.8%; PD, 0.6% [95% CI, 0.5%-0.7%]) (difference in difference, 0.8% [95% CI, 0.5%-1.1%]). This difference was particularly pronounced among young adults aged 34 years or younger (PD among those aged 18-25 years with depression, 3.3% [95% CI, 2.5%-4.2%]; PD among those aged 26-34 years with depression, 2.7% [95% CI, 1.6%-3.8%]) and individuals with incomes less than $75 000 per year (PD among those with income <$20 000, 1.9% [95% CI, 1.3%-2.6%]; PD among those with income $20 000-$49 999, 1.5% [95% CI, 1.0%-2.1%]; PD among those with income $50 000-$74 999, 1.3% [95% CI, 0.7%-2.0%]).

Conclusions and Relevance

This study suggests that, from 2008 to 2019, there was a disproportionate increase in the prevalence of past-year LSD use among US adults with past-year depression. Among those with depression, this increase was particularly strong among younger adults and those with lower household incomes. Among individuals with depression who also report LSD use, clinicians should discuss potential strategies for mitigating harm and maximizing benefits in medically unsupervised settings.

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

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

GHB: a life-threatening drug complications and outcome of GHB detoxification treatment-an observational clinical study

BACKGROUND

GHB (gammahydroxybutyrate) and its precursors are popular recreational drugs due to their sedative, anxiolytic and sexually stimulating effects. Their use has been steadily increasing in recent years. The detoxification process is complex and prone to high rates of complications while little is known about the pathophysiology. This study aims to elucidate the characteristics of GHB-addicted patients and to evaluate the risks and complications of GHB withdrawal treatment.

METHODS

This observational study describes prospectively the socioeconomic status, clinical history and course of inpatient detoxification treatment of a group of 39 patients suffering from GHB substance use disorder. Detoxification treatment took place in a highly specialized psychiatric inpatient unit for substance use disorders.

RESULTS

GHB patients were characterised by being young, well-educated and by living alone. More than 50% of the patients had no regular income. The patients were male and female in equal numbers. Detoxification treatment was complicated, with high rates of delirium (30.8%) and high need for intensive care (20.5%).

CONCLUSIONS

In our sample, GHB users were young, well-educated people and male and female in equal number. Detoxification proved to be dangerous for GHB-addicted patients. The presence of delirium and the need for transfer to an intensive care unit during detoxification treatment was extraordinarily high, even with appropriate clinical treatment. The reasons for this remain unknown. Therefore an intensive care unit should be available for GHB detoxification treatment. Further studies are needed to evaluate the options for prophylactic treatment of delirium during detoxification.

Tusi: a new ketamine concoction complicating the drug landscape

A drug concoction called tusi has emerged in Latin America and in Europe and is now beginning to acquire popularity in the United States. "Tusi" is a phonetic translation of "2C," a series of psychedelic phenethylamines. The concoction is also sometimes referred to as "pink cocaine" as it typically comes in the form of pink powder. However, despite its name, the concoction rarely contains 2C series drugs. Multiple drug checking studies have found that the majority of tusi samples contain ketamine, often combined with 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine, cocaine, opioids, and/or new psychoactive substances. The tusi phenomenon complicates the drug landscape because it has the potential to confuse both people who use it and researchers alike. People using may think the drug is 2C/2C-B, and they may also be unaware that the concoction tends to consist of ketamine and a wide variety of other drugs. Unintentional exposure to its contents can lead to increased risk of adverse effects. The tusi phenomenon also has the potential to complicate drug research as unknown exposure to drugs like ketamine and MDMA will lead to underreporting of use. A combination of self-report and toxicological testing may be needed to inform the most accurate estimates of use. Both researchers and people at risk for use need to be informed about this new concoction. Drug researchers need to be cognizant about the way they query use, and people at risk for using need to be educated about the possible contents of tusi and associated dangers.

Prevalence and Correlates of Past Year Ecstasy/MDMA Use in the United States

OBJECTIVES

3,4-Methylenedioxymethamphetamine (MDMA) (also known as "ecstasy" or "Molly") has regained attention in recent years for its efficacy in treating posttraumatic stress disorder, and the drug was granted breakthrough therapy designation for such use by the US Food and Drug Administration in 2017. However, little is known about the current epidemiology of recreational ecstasy/MDMA use.

METHODS

We estimated past-year prevalence and correlates of ecstasy/MDMA use based on a representative sample of noninstitutionalized US individuals 12 years or older from the 2015-2020 National Survey on Drug Use and Health (N = 315,661).

RESULTS

An estimated 0.9% (95% confidence interval [CI] = 0.9-1.0) of individuals used ecstasy/MDMA in the past year. Compared with those ages 35-49 years, all younger age groups were at increased odds for use, while those older than 50 years (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.08-0.23) were at low odds for use. Compared with heterosexual men, those identifying as bisexual women (aOR = 1.32, 95% CI = 1.02-1.72) were at increased odds for use, and compared with White individuals, those identifying as Asian (aOR = 1.92, 95% CI = 1.42-2.59), Black (aOR = 1.70, 95% CI = 1.41-2.06), or multiracial (aOR = 1.61, 95% CI = 1.19-2.16) were at increased odds for use. Past-year use of other drugs (e.g., cannabis, ketamine), prescription drug misuse (e.g., pain relievers, stimulants), nicotine dependence (aOR = 1.21, 95% CI = 1.00-1.45), and alcohol use disorder (aOR = 1.41, 95% CI = 1.25-1.58) were also associated with increased odds for use.

CONCLUSIONS

While use of ecstasy/MDMA continues to be relatively rare, findings from this study can help inform prevention and harm reduction strategies, especially among certain subpopulations that are at high risk for use.

Detection of fentanyl, synthetic opioids, and ketamine in hair specimens from purposive samples of American and Italian populations

With the current crisis related to the diffusion of fentanyl and other novel opioids in several countries and populations, new and effective approaches are needed to better elucidate the phenomenon. In this context, hair testing offers a unique perspective in the investigation of drug consumption, producing useful information in terms of exposure to psychoactive substances. In this research, we applied targeted ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) analytical methods to detect novel synthetic and prescription opioids and other common controlled psychoactive drugs in the keratin matrix. A total of 120 hair samples were analyzed from the United States (US) and Italy, segmented when longer than 6 cm, and then analyzed. In the 60 samples (83 segments in total) analyzed from a purposive sample of data collected in the US, fentanyl was detected in 14 cases (16.9%), with no detection of nitazens or brorphine. We also detected fentanyl metabolites, despropionyl-p-fluorofentanyl, and prescription opioids. In the 60 samples collected in Italy (91 segments in total), ketamine was the most prevalent compound detected (in 41 cases; 45.1%), with ketamine demonstrating a strong correlation with detection of amphetamines and MDMA, likely due to co-use of these substances in recreational contexts. Several common drugs were also detected but no exposure to fentanyl or its analogs were detected. Results of this retrospective exploration of drug use add to increasing evidence that hair testing can serve as a useful adjunct to epidemiology studies that seek to determine biologically confirmed use and exposure in high-risk populations.

Trends and correlates of discordant reporting of drug use among nightclub/festival attendees, 2019-2022

INTRODUCTION

People who attend nightclubs and festivals are known for high prevalence of party drug use, but more research is needed on underreporting in this population, in part because unintentional drug exposure through adulterated drug products is common. We examined the prevalence of drug use in this population, based both on self-reporting and on hair test results, with a focus on the detection of underreported use.

METHODS

Adults entering nightclubs and festivals in New York City were asked about past-year drug use in 2019-2022 (n = 1,953), with 328 providing an analyzable hair sample for testing. We compared trends in self-reported drug use, drug positivity, and "corrected" prevalence, adjusting for unreported use, and delineated correlates of testing positive for ketamine and cocaine after not reporting use (discordant reporting).

RESULTS

Of the 328 who provided a sample, cocaine and ketamine were the most frequently detected drugs (55.2% [n = 181] and 37.2% [n = 122], respectively), but these were also the two most underreported drugs, with 37.1% (n = 65) and 26.4% (n = 65), respectively, testing positive after not reporting use. Between 2019 and 2022, positivity decreased for cocaine, ketamine, 3,4-methylenedioxy-metamfetamine, and amfetamine, and underreported exposure to cocaine and ketamine also decreased (P < 0.05). Underreporting of the use of these drugs was common, but we also detected underreported exposure to ethylone, fentanyl, 3,4-methylenedioxyamfetamine, metamfetamine, and synthetic cannabinoids. Prevalence of discordant reporting of cocaine use was higher among those testing positive for ketamine exposure (adjusted prevalence ratio = 2.63; 95% CI: 1.48-4.69) and prevalence of discordant reporting of ketamine use was lower post-coronavirus disease caused by the SARS-CoV-2 virus (adjusted prevalence ratio = 0.39; 95% CI: 0.16-0.91) and among those reporting cocaine use (adjusted prevalence ratio = 0.53; 95% CI: 0.32-0.89).

DISCUSSION

Underreporting of drug use was common, suggesting the need for researchers to better deduce intentional underreporting versus unknown drug exposure via adulterants.

CONCLUSIONS

Researchers should consider both self-report and toxicology results from biological samples when examining trends in use.

Characteristics of poisonings involving ketamine in the United States, 2019-2021

BACKGROUND

The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression.

AIMS

We examined recent trends in adverse effects related to ketamine use.

METHODS

US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (n = 758). We examined quarterly trends in exposure and delineated correlates of patients experiencing a major adverse effect or death.

RESULTS

The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (p = 0.018). The majority of patients were male (57.1%), and the plurality of cases involved intentional misuse or "abuse" (39.5%), followed by suspected suicide attempt (19.7%) and unintentional exposure (18.9%). A fifth (19.6%) experienced a major adverse effect or death. A third (33.4%) co-used other drugs; the drugs most commonly co-used were benzodiazepines (14.6%), alcohol (10.3%), and opioids (8.7%). Co-use of gamma-hydroxybutyrate (GHB; adjusted prevalence ratio (aPR) = 3.43, 95% confidence interval (CI): 1.57-7.46) and opioids (aPR = 2.44, 95% CI: 1.46-4.08) was associated with increased risk for a major adverse effect or death, as was injection-only administration (aPR = 2.68, 95% CI: 1.21-5.92).

CONCLUSIONS

Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use-particularly with opioids or GHB-appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed.

Awareness that cocaine can contain fentanyl among nightclub and festival attendees in New York City, 2018-2022

People who attend nightclubs and dance festivals-particularly those that feature electronic dance music (EDM), are at high risk for use of cocaine and other party drugs. Given that cocaine is now sometimes adulterated with fentanyl, this study examines trends in people's knowledge about such risk of adulteration to inform prevention and harm reduction efforts. Adults were surveyed entering randomly selected EDM events (including dance festivals) in New York City in 2018, 2019, 2021, and 2022 (n = 2107). They were asked whether they agree that some dealers sell cocaine containing fentanyl, and trends in agreement were estimated. Prevalence of agreement that cocaine can be adulterated increased from 42.1% (95% CI: 36.8-47.6) in 2018 to 65.6% (95% CI: 54.1-75.4) in 2022-a 55.8% increase (p < .001). Between 2018 and 2022, particular increases occurred among those not reporting past-year cocaine use (by 61.6%, p < .001), among White individuals (by 68.1%, p < .001), those with some college (by 68.5%, p = .021), and those age ≥26 (by 83.8%, p = .001). Awareness that cocaine can contain fentanyl is increasing in this high-risk population. Continued education is needed for high-risk populations regarding both opioid overdose response and test strips that can test drugs for the presence of fentanyl.

Prevalence and Correlates of GHB Use among Adults in the United States

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.

The clinical toxicology of ketamine

INTRODUCTION

Ketamine is a pharmaceutical drug possessing both analgesic and anaesthetic properties. As an anaesthetic, it induces anaesthesia by producing analgesia with a state of altered consciousness while maintaining airway tone, respiratory drive, and hemodynamic stability. At lower doses, it has psychoactive properties and has gained popularity as a recreational drug.

OBJECTIVES

To review the epidemiology, mechanisms of toxicity, pharmacokinetics, clinical features, diagnosis and management of ketamine toxicity.

METHODS

Both OVID MEDLINE (January 1950-April 2023) and Web of Science (1900-April 2023) databases were searched using the term "ketamine" in combination with the keywords "pharmacokinetics", "kinetics", "poisoning", "poison", "toxicity", "ingestion", "adverse effects", "overdose", and "intoxication". Furthermore, bibliographies of identified articles were screened for additional relevant studies. These searches produced 5,268 non-duplicate citations; 185 articles (case reports, case series, pharmacokinetic studies, animal studies pertinent to pharmacology, and reviews) were considered relevant. Those excluded were other animal investigations, therapeutic human clinical investigations, commentaries, editorials, cases with no clinical relevance and post-mortem investigations.

EPIDEMIOLOGY

Following its introduction into medical practice in the early 1970s, ketamine has become a popular recreational drug. Its use has become associated with the dance culture, electronic and dubstep dance events.

MECHANISM OF ACTION

Ketamine acts primarily as a non-competitive antagonist on the glutamate N-methyl-D-aspartate receptor, causing the loss of responsiveness that is associated with clinical ketamine dissociative anaesthesia.

PHARMACOKINETICS

Absorption of ketamine is rapid though the rate of uptake and bioavailability is determined by the route of exposure. Ketamine is metabolized extensively in the liver. Initially, both isomers are metabolized to their major active metabolite, norketamine, by CYP2B6, CYP3A4 and CYP2C9 isoforms. The hydroxylation of the cyclohexan-1-one ring of norketamine to the three positional isomers of hydroxynorketamine occurs by CYP2B6 and CYP2A6. The dehydronorketamine metabolite occurs either by direct dehydrogenation from norketamine via CYP2B6 metabolism or non-enzymatic dehydration of hydroxynorketamine. Norketamine, the dehydronorketamine isomers, and hydroxynorketamine have pharmacological activity. The elimination of ketamine is primarily by the kidneys, though unchanged ketamine accounts for only a small percentage in the urine. The half-life of ketamine in humans is between 1.5 and 5 h.

CLINICAL FEATURES

Acute adverse effects following recreational use are diverse and can include impaired consciousness, dizziness, irrational behaviour, hallucinations, abdominal pain and vomiting. Chronic use can result in impaired verbal information processing, cystitis and cholangiopathy.

DIAGNOSIS

The diagnosis of acute ketamine intoxication is typically made on the basis of the patient's history, clinical features, such as vomiting, sialorrhea, or laryngospasm, along with neuropsychiatric features. Chronic effects of ketamine toxicity can result in cholangiopathy and cystitis, which can be confirmed by endoscopic retrograde cholangiopancreatography and cystoscopy, respectively.

MANAGEMENT

Treatment of acute clinical toxicity is predominantly supportive with empiric management of specific adverse effects. Benzodiazepines are recommended as initial treatment to reduce agitation, excess neuromuscular activity and blood pressure. Management of cystitis is multidisciplinary and multi-tiered, following a stepwise approach of pharmacotherapy and surgery. Management of cholangiopathy may require pain management and, where necessary, biliary stenting to alleviate obstructions. Chronic effects of ketamine toxicity are typically reversible, with management focusing on abstinence.

CONCLUSIONS

Ketamine is a dissociative drug employed predominantly in emergency medicine; it has also become popular as a recreational drug. Its recreational use can result in acute neuropsychiatric effects, whereas chronic use can result in cystitis and cholangiopathy.

Prevalence of self-reported adverse effects associated with drug use among nightclub and festival attendees, 2019-2022

BACKGROUND

Research investigating adverse effects from drug use has focused extensively on poisonings and mortality. This study focuses on drug-related adverse effects not necessarily resulting in hospitalization or death among a population known for high prevalence of party drug use-electronic dance music (EDM) nightclub and festival attendees.

METHODS

Adults entering EDM venues were surveyed in 2019-2022 (n = 1952). Those reporting past-month use of a drug were asked whether they had experienced a harmful or very unpleasant effect after use. We examined 20 drugs and drug classes with a particular focus on alcohol, cannabis, cocaine, and ecstasy. Prevalence and correlates of adverse effects were estimated.

RESULTS

Almost half (47.6%) of adverse effects involved alcohol and 19.0% involved cannabis. 27.6% of those using alcohol reported an adverse effect, while 19.5%, 15.0%, and 14.9% of participants reported an effect from use of cocaine, ecstasy, and cannabis, respectively. Use of less prevalent drugs, such as NBOMe, methamphetamine, fentanyls, and synthetic cathinones, tended to be associated with higher prevalence of adverse effects. The most consistent risk factor was younger age, while past-month use of a greater number of drugs was often a protective factor against adverse effects. For most drugs, taking too much was the most common perceived reason for the adverse effect, and visiting a hospital after use was most prevalent among those experiencing an adverse effect from cocaine (11.0%).

CONCLUSIONS

Adverse drug effects are common in this population and results can inform prevention and harm reduction in this population and the general population.

Trends in drug use among nightclub and festival attendees in New York City, 2017-2022

BACKGROUND

Drug use is prevalent among people who attend electronic dance music (EDM) parties at nightclubs or festivals. This population can serve as a sentinel population to monitor trends in use of party drugs and new psychoactive substances (NPS) that may diffuse through larger segments of the population.

METHODS

We surveyed adults entering randomly selected EDM parties at nightclubs and dance festivals in New York City about their drug use in 2017 (n=954), 2018 (n=1,029), 2019 (n=606), 2021 (n=229), and 2022 (n=419). We estimated trends in past-year and past-month use of 22 drugs or drug classes based on self-report from 2017-2022 and examined whether there were shifts pre- vs. post-COVID (2017-2019 vs. 2021-2022).

RESULTS

Between 2017 and 2022, there were increases in past-year and past-month use of shrooms (psilocybin), ketamine, poppers (amyl/butyl nitrites), synthetic cathinones ("bath salts"), and novel psychedelics (lysergamides and DOx series), increases in past-year cannabis use, and increases in past-month use of 2C series drugs. Between 2017 and 2022, there were decreases in past-year heroin use and decreases in past-month cocaine use, novel stimulant use, and nonmedical benzodiazepine use. The odds of use of shrooms, poppers, and 2C series drugs significantly increased after COVID, and the odds of use of cocaine, ecstasy, heroin, methamphetamine, novel stimulants, and prescription opioids (nonmedical use) decreased post-COVID.

CONCLUSIONS

We estimate shifts in prevalence of various drugs among this sentinel population, which can inform ongoing surveillance efforts and public health response in this and the general populations.

College students' experiences with substance use at electronic music events: A qualitative study

Objective: To understand college students' experiences with substance use at electronic music events (EME), including harm-reduction strategies and receptivity to educational intervention.Participants: A purposeful sample of undergraduate students at a private Southeastern university was recruited from April 2019 to May 2019 using online advertising and in-person tabling.Methods: A qualitative, descriptive research design utilizing semistructured focus groups.Results: Five focus groups were conducted (n = 18). A thematic analysis revealed three main themes: substance use is commonplace; substance use and protective behaviors; and universities' role in substance education. Additional categories and subcategories were identified within each theme.Conclusion: Substance use at EME is a common experience for college students. Several challenges and opportunities exist for universities working to promote harm reduction practices. Prevention efforts should be event-specific, incorporate student input to engage learning more effectively, and work to reduce barriers that deter students from taking safety precautions when using substances.

First results of the French OCTOPUS survey among festival attendees: a latent class analysis

BACKGROUND

Illicit substance use has constantly evolved over the years, particularly in the party scene. Monitoring these changes is essential to adapt harm reduction strategies. The OCTOPUS survey was implemented to enhance knowledge on drug use at music festivals. The objective of the work presented here was to describe drug use and to characterize profiles of substance use in music festival attendees.

METHODS

OCTOPUS was a cross-sectional survey carried out during 13 various music festivals (dub, eclectic and electronic music) in the Loire-Atlantique department (France) from July 2017 to July 2018. Participants were festival attendees. Data were collected by trained research staff using a face-to-face structured interview. We analysed the use of illicit drugs in the last 12 months to describe the prevalence of use and to characterize the profile of substance use using a latent class analysis.

RESULTS

In total, 383 festival attendees were included. Of 314 (82%) participants who reported drug use, the most reported drugs were cannabis, ecstasy/MDMA and cocaine. We identified two profiles of drug use: (i) a "no/low polysubstance use" profile mainly characterized by the use of "classic" stimulants (ecstasy/MDMA, cocaine) and (ii) "moderate/extensive polysubstance use", with high probabilities of "classic" stimulants use and especially other drugs reported: speed, ketamine, new psychoactive substances (NPSs).

CONCLUSION

We observed frequent polysubstance use in festival attendees. Harm reduction should be targeted at the increased risk of toxicity linked to polysubstance use, and the reduction in harm caused by particular drugs (ketamine, NPS, speed) could be further strengthened.

Role of the mesolimbic dopamine pathway in the antidepressant effects of ketamine

Depression is a complex and highly heterogeneous disorder which diagnosis is based on an exceedingly variable set of clinical symptoms. Current treatments focus almost exclusively on the manipulation of monoamine neurotransmitter systems, but despite considerable efforts, these remain inadequate for a significant proportion of those afflicted by the disorder. The emergence of racemic (R, S)-ketamine as a fast-acting antidepressant has provided an exciting new path for the study of major depressive disorder (MDD) and the search for better therapeutics for its treatment. Previous work suggested that ketamine's mechanism of action is primarily mediated via blockaded of N-methyl-d-aspartate (NMDA) receptors, however, this is an area of active research and clinical and preclinical evidence now indicate that ketamine acts on multiple systems. The last couple of decades have cemented the mesolimbic dopamine reward pathway's involvement in the pathogenesis of MDD and related mood disorders. Exposure to negative stress dysregulates dopamine neuronal activity disrupting reward and motivational processes resulting in anhedonia (lack of pleasure), a hallmark symptom of depression. Although the mechanism(s) underlying ketamine's antidepressant activity continue to be elucidated, current evidence indicate that its therapeutic effects are mediated, at least in part, via long-lasting synaptic changes and subsequent molecular adaptations in brain regions within the mesolimbic dopamine system. Notwithstanding, ketamine is a drug of abuse, and this liability may pose limitations for long term use as an antidepressant. This review outlines the current knowledge of ketamine's actions within the mesolimbic dopamine system and its abuse potential. This article is part of the Special Issue on 'Ketamine and its Metabolites'.

Exploring Potential Bellwethers for Drug-Related Mortality in the General Population: A Case for Sentinel Surveillance of Trends in Drug Use among Nightclub/Festival Attendees

Background: Drug-related deaths in the US continue to increase. Sentinel surveillance of high-risk populations can provide early warning for shifts in trends. Nightclub/festival attendees have high levels of drug use, so we explored whether use among this population can serve as a potential bellwether or indicator for use-related mortality in the general population.Methods: Trends in past-year cocaine and methamphetamine use were estimated from nightclub/festival attendees in New York City (NYC) and among NY residents, and trends were estimated for related death rates in NYC (2014/15-2019/20). Using national data from England and Wales (2010-2019), trends in past-year cocaine and ecstasy use (among the full population and among nightclub attendees) and related deaths were also estimated.Results: In NY/NYC, cocaine use remained stable in the general population, but use among nightclub/festival attendees and cocaine-related deaths doubled. Methamphetamine use among nightclub/festival attendees and death rates also more than doubled while use among the general population remained stable. In UK countries, increases in cocaine and ecstasy use were larger for infrequent/frequent nightclub attendees than in the general population, with 3.6- and 8-fold increases in related deaths, respectively. In UK countries, the association between nightclub attendance and death rates increased in a dose-response-like manner with larger associations detected when death rates were lagged by one year.Conclusions: Patterns of use among nightclub/festival attendees, more so than patterns in the general population, were similar to patterns of drug-related deaths. Use among this subpopulation could possibly serve as a bellwether for use-related outcomes. Continued surveillance is recommended.

Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP

BACKGROUND AND AIMS

Hallucinogen use is potentially harmful. Information on whether such use has increased in recent decades is lacking. This study assessed overall and age-specific time trends in the prevalence of 12-month hallucinogen use in the US general population.

DESIGN

Cross-sectional.

SETTING

Data from the US National Survey on Drug Use and Health, 2002-19.

PARTICIPANTS

Respondents aged ≥ 12 years (n = 1 006 051).

MEASUREMENTS

Predictors were continuous years. Outcome variables included any hallucinogen use and use of lysergic acid diethylamide (LSD), ecstasy and phencyclidine (PCP) in the past year. Socio-demographic variables (gender, age, race/ethnicity, educational level and family income) were covariates.

FINDINGS

Overall, hallucinogen use increased between 2015 and 2019 [prevalence difference (PD) = +0.44, P < 0.05]. Since 2002, hallucinogen use has increased in adults aged ≥ 26 years (PD, 2002-14 = +0.24, P < 0.05; PD, 2015-19 = +0.45, P < 0.001) and decreased in adolescents aged 12-17 years (PD, 2002-14 = -1.60, P < 0.0001; PD, 2015-19 = -0.73, P < 0.001). Ecstasy use has decreased in adolescents (PD, 2002-14 = -0.56, P < 0.001), adults aged 18-25 years (PD, 2015-19 = -0.96, P < 0.01) and ≥ 26 years (PD, 2015-19 = -0.13, P < 0.05). LSD use between 2002 and 2019 increased overall (PD = +0.71, P < 0.0001) and in all age groups (12-17: PD = +0.67, P < 0.001; 18-25: PD = +3.12, P < 0.0001; ≥ 26: PD = +0.36, P < 0.0001). Conversely, PCP use between 2002 and 2019 decreased overall (PD = -0.06, P < 0.001), in adolescents (PD = -0.24, P < 0.001) and young adults (PD = -0.32, P < 0.0001).

CONCLUSIONS

Since 2002, hallucinogen use in the United States has decreased among adolescents but increased in adults and is now estimated to affect more than 3 million adults aged 26+ years and more than 5.5 million adults aged 18+ years.

Risky Party and Nightclub Attendance during the COVID-19 Nightlife Shutdown in New York City

From March 2020 through May 2021, nightlife venues were shut down and large gatherings were deemed illegal in New York City (NYC) due to COVID-19. This study sought to determine the extent of risky party attendance during the COVID-19 shutdown among people who attend electronic dance music parties in NYC. During the first four months that venues were permitted to reopen (June through September 2021), time-space sampling was used to survey adults (n = 278) about their party attendance during the first year of the shutdown (March 2020-March 2021). We examined prevalence and correlates of attendance and mask-wearing at such parties. A total of 43.9% attended private parties with more than 10 people, 27.3% attended nightclubs, and 20.5% attended other parties such as raves. Among those who attended any, 32.3% never wore a mask and 19.3% reported attending parties in which no one wore a mask. Past-year ecstasy use was associated with increased risk for attending private (aPR = 1.51, 95% CI: 1.00-2.28) or other parties (aPR = 2.75, 95% CI: 1.48-5.13), and use of 2C series drugs was associated with increased risk for attending nightclubs (aPR = 2.67, 95% CI: 1.24-5.77) or other parties (aPR = 2.50, 95% CI: 1.06-5.87). Attending &gt;10 parties was associated with increased risk for never wearing a mask (aPR = 2.74, 95% CI: 1.11-6.75) and for no other attendees wearing masks (aPR = 4.22, 95% CI: 1.26-14.07). Illegal dance parties continued in NYC during the COVID-19 shutdown. Prevention and harm reduction efforts to mitigate risk of COVID-19 transmission during such shutdowns are sorely needed.

Neurobiological, behavioral, and cognitive effects of ketamine in adolescents: A review of human and pre-clinical research

S-ketamine is approved for treatment-resistant patients with depression and adult patients with suicide behavior. While ketamine is therapeutically beneficial in adults, there is a dearth of research on the effects of ketamine on adolescent brain function and behavior. In this review we summarize the current literature on the neurobiological and behavioral effects of adolescent ketamine exposure in preclinical animal models and humans. A search of PubMed was conducted using pre-defined criteria, resulting in the evaluation of 406 articles. A total of 39 animal studies and 7 human studies met the selection criteria. The included studies examined the effects of ketamine exposure during adolescence and excluded studies on ketamine use for pain or anesthesia and ketamine as a model of schizophrenia. Pre-clinical animal models of adolescent ketamine exposure show ketamine-induced neurotoxicity and apoptosis, and changes in locomotor activity, social behaviors, anxiety- and depression-like behaviors, and memory. There is variability in the results, and differences in ketamine dose and length of exposure appears to influence the results. Ketamine reduces symptoms of depression and anxiety and improves mood in human adolescents. Much of the literature on adolescent ketamine exposure examines the effects in males, with more limited research in females. Relatively little research has focused on adolescent ketamine exposure. Despite its effectiveness for mitigating symptoms of depression, adolescent ketamine exposure can disrupt memory and other behaviors and have deleterious effects on brain function. Further research is warranted to better define doses and dosing paradigms that are beneficial without unintended side effects in adolescence.

Higher glutamatergic activity in the medial prefrontal cortex in chronic ketamine users

BACKGROUND

The medial prefrontal cortex (mPFC) plays an important role in depression and addiction. Previous studies have shown alterations in glutamatergic activity in the mPFC following the administration of ketamine in patients with depression and healthy controls. However, it remains unclear whether chronic, nonmedical use of ketamine affects metabolites in the mPFC.

METHODS

Using proton magnetic resonance spectroscopy, we measured metabolites (glutamate and glutamine [Glx]; phosphocreatine and creatine [PCr+Cr]; myo-inositol; N-acetyl-aspartate; and glycerophosphocholine and phosphocholine [GPC+PC]) in the mPFC of chronic ketamine users (n = 20) and healthy controls (n = 43). Among ketamine users, 60% consumed ketamine once per day or more, 10% consumed it every 2 days and 30% consumed it every 3 or more days. Using analysis of covariance, we evaluated between-group differences in the ratios of Glx:PCr+Cr, myo-inositol:PCr+Cr, N-acetyl-aspartate:PCr+Cr and GPC+PC:PCr+Cr.

RESULTS

Chronic ketamine users showed significantly higher Glx:PCr+Cr ratios than healthy controls (median 1.05 v. 0.95, p = 0.008). We found no significant differences in myoinositol:PCr+Cr, N-acetyl-aspartate:PCr+Cr or GPC+PC:PCr+Cr ratios between the 2 groups. We found a positive relationship between N-acetyl-aspartate:PCr+Cr and Glx:PCr+Cr ratios in the healthy control group (R = 0.345, p = 0.023), but the ketamine use group failed to show such an association (ρ = 0.197, p = 0.40).

LIMITATIONS

The cross-sectional design of this study did not permit causal inferences related to higher Glx:PCr+Cr ratios and chronic ketamine use.

CONCLUSION

This study provides the first evidence that chronic ketamine users have higher glutamatergic activity in the mPFC than healthy controls; this finding may provide new insights relevant to the treatment of depression with ketamine.

Music as an Element of Tourism Innovation: Types of Nightlife Premises in Ibiza (Spain)

The island of Ibiza is a western Mediterranean destination known internationally for its nightlife. The aim of this paper is to make a proposal to classify the different types of premises in the Ibiza nightlife offer. This involves making a first definition that allows to delimit which businesses are parts of the sector. The methodology used is based on the case study and specifically, on the review of the promotional actions and activities carried out, completed with the visit to the premises. The classification has been made based on the offer marketed and not only on the legal forms used, as innovation goes ahead of the existing legal classifications. Although it is a particular application, due to the international importance of Ibiza, it is a good starting point to classify the nightlife offer of many other tourist destinations. The resulting typology divides the sector into two large groups: nightclubs and other premises. While nightclubs have musical parties as their main activity declared, the other premises have accommodation or catering as their main activity, with music being an element of differentiation. Nightclubs are divided into several subgroups, depending on their size and relevance. The other premises are subdivided into Beach Clubs, Hotel Clubs, Party Boats, Lounge Clubs, Disco Pubs, among others.

Party keepers: a significant community-based intervention for harm reduction

Background

Gay men use recreational drugs more often than heterosexuals—especially at social events. While partying at a venue, partygoers are at risk of drug overdosing, without access to an emergency help. This study evaluates a unique and novel intervention aimed at training men who have sex with men (MSM) and transgender individuals who frequent parties, to provide immediate assistance on-site to partygoers who have overdosed.

Methods

The Party Keepers (PK) course is a unique 4-h training course that provides the participants with tools to identify, prevent, and treat common medical syndromes that are associated with excessive substance use. Participants were asked to complete a questionnaire on their sociodemographic attributes; their sexual risk behaviour; pre-exposure prophylaxis (PrEP) use and drug-use behaviour before and after the course; and the emergency situations they encountered in party venues after the course.

Results

Of the 85 participants who completed the training and left valid contact information, 52 (62%) completed the questionnaires. Their average age was 37.0 years, most lived in Tel-Aviv, and were single. Participants reported that, after the course, they reduced their own use of recreational drugs (cocaine, amyl nitrates, alcohol), reduced their sexual risk behaviours, and significantly increased their use of PrEP. Of all the PKs, 63% (N = 32) indicated that they now provided first-aid and other assistance to partygoers at public venues, which enhanced their sense of community responsibility. In the multivariate analysis, a high level of confidence as a PK, and the knowledge gained in the course, predicted the incidence of subsequent assistance to partygoers in emergency situations.

Conclusions

The PK initiative—a harm-reduction intervention led by peers, aimed at fighting drug overdosing at gay venues—was useful in reducing drug use and sexual risk behaviours among the course participants. Most course participants also responded to drug-related emergency situations at gay parties, as a result. This evaluation of community health intervention within a sexual minority community can help health policy makers design more community based interventions and allocate resources to include community participants in harm-reduction policies.

Past-Year Ketamine Use: Evidence from a United States Population, 2015-2019

Ketamine is an analgesic that has gained notoriety in nightclub scenes. Yet, a paucity of research exists on the prevalence and associated factors in the United States (US). The present study estimated the prevalence of past-year ketamine use among a national sample of US adults and investigated sociodemographic characteristics and past-year use of other substances associated with past-year ketamine use. Data from the 2015-2019 National Survey on Drug Use and Health was conducted among 210,392 adults over the ages of 18 years old. An estimated 0.13% of adults used ketamine in the past year, with males more likely to use. Significant risk factors included past-year drug use and sexual minority status, with sexual minority males reporting more than use of one substance at highest risk for ketamine use. Findings from the present study may inform harm reduction efforts and policy initiatives.

Cognitive Impairment Following Clinical or Recreational Use of Gammahydroxybutyric Acid (GHB): A Systematic Review

BACKGROUND

GHB (gamma-hydroxybutyric acid; sodium oxybate) is a general anaesthetic that is clinically used for the treatment of narcolepsy, cataplexy, alcohol withdrawal and alcohol relapse prevention. In addition, GHB is recreationally used. Most clinical and recreational users regard GHB as an innocent drug devoid of adverse effects, despite its high dependence potential and possible neurotoxic effects. At high doses, GHB may lead to a comatose state. This paper systematically reviews possible cognitive impairments due to clinical and recreational GHB use.

METHODS

PubMed and PsychINFO were searched for literature data about the acute and residual cognitive deficits following GHB use. This review is conducted using the PRISMA protocol.

RESULTS

A total of 43 reports covering human and animal data on GHB-induced cognitive impairments were eligible and reviewed. This systematic review found no indication for cognitive impairments after clinical GHB use. However, it supports the view that moderate GHB use may result in acute short-term cognitive impairments, whereas regular high-dose GHB use and/or multiple GHB-induced comas are probably neurotoxic resulting in long-term residual cognitive impairments.

CONCLUSION

These results emphasize the need for awareness among clinicians and recreational users to minimize negative health consequences of recreational GHB use, particularly when high doses are used and GHB-induced comas occur.

Ketamine use in relation to depressive symptoms among high school seniors

BACKGROUND AND OBJECTIVES

Ketamine is efficacious in treating treatment-resistant depression in medical settings and the drug was approved for such use by the US Federal Drug Administration in 2019. However, little is known about how use outside of medical settings relates to depression. We determined whether recreational ketamine use, relative to the use of other drugs, is related to the current experience of depression among adolescents.

METHODS

We examined data from the 2016 to 2019 Monitoring the Future nationally representative survey of high school seniors in the United States (N = 15,673). We determined how past-year drug use and frequency of past-year drug use were associated with students reporting a high level of current depressive symptoms relative to other students.

RESULTS

Ketamine use was associated with highest risk for a high level of depression (aPR = 1.55, 95% confidence interval [CI]: 1.24-1.94), followed by use of cannabis (aPR = 1.29, 95% CI: 1.19-1.39), and nonmedical use of tranquilizers (aPR = 1.22, 95% CI: 1.04-1.44) and amphetamine (aPR = 1.17, 95% CI: 1.01-1.34). Alcohol use was associated with decreased risk (aPR = 0.92, 95% CI: 0.85-0.99). With respect to frequency of past-year use, more frequent use of ketamine and cannabis was associated with increased risk for a high level of depression in a dose-response-like manner, with past-year use of ketamine and cannabis ≥10 times associated with increased risk for depression by 70% and 40%, respectively.

DISCUSSION AND CONCLUSIONS

Past-year recreational ketamine use is a risk factor for reporting current depression than most other drugs.

SCIENTIFIC SIGNIFICANCE

This was the first study to compare the risk of use of various drugs in relation to depression.

Trends in Ketamine Use, Exposures, and Seizures in the United States up to 2019

Objectives. To determine whether there have been shifts in nonmedical ketamine use, poisonings ("exposures"), and seizures. Methods. We used generalized additive models to detect trends in past-year use (2006-2019), exposures (1991-2019), and seizures (2000-2019) involving ketamine in the United States. Results. There was a quarterly increase in self-reported past-year nonmedical ketamine use in 2006 to 2014 (Β = 0.21; P = .030) and an increase in 2015 to 2019 (Β = 0.29; P = .036), reaching a peak of 0.9% in late 2019. The rate of exposures increased from 1991 through 2019 (Β = 0.87; P = .006), and there was an increase to 1.1 exposures per 1 000 000 population in 2014, with rates remaining stable through 2019. The rate of ketamine seizures increased from 2000 through 2019 (Β = 2.27; P < .001), with seizures reaching a peak in 2019 at 3.2 per 1000 seizures. Conclusions. Indicators suggest that ketamine use and availability has increased, including before increased medical indications, but nonmedical use is still currently uncommon despite increased acceptance and media coverage. (Am J Public Health. 2021;111(11):2046-2049. https://doi.org/10.2105/AJPH.2021.306486).

Test-retest reliability and cross-cultural applicability of DSM-5 adopted diagnostic criteria for ketamine use disorders

BACKGROUND

Despite increasing prevalence of nonmedical ketamine use globally, data on ketamine use disorders, which are classified in the DSM-5 under criteria for phencyclidine, are limited. This study assessed the reliability and applicability of DSM-based diagnostic criteria for ketamine use disorder.

METHODS

Participants who used ecstasy were recruited through the Tri-City Study of Club Drug Use, Abuse, and Dependence in St. Louis, Miami, and Sydney. Those who reported using ketamine (lifetime use >5 times) were included in these analyses (n = 205). Participants were interviewed using the computerized Substance Abuse Module for Club Drugs (CD-SAM) at baseline and 7 days later for the reliability of diagnoses and individual diagnostic criteria.

RESULTS

Overall, 29.3% met DSM-5 adopted criteria for ketamine use disorder at Time 1. Moderate to excellent test-retest reliability was observed consistently across study sites for any ketamine use disorder (κ = 0.57, Y = 0.61) and severe ketamine use disorder (κ = 0.62, Y = 0.79). Continued use of ketamine despite knowledge of physical or psychological problems was the most frequently endorsed individual criterion (59.0%), followed by reported withdrawal (30.2%) and physically hazardous use (29.8%). All individual criteria had acceptable reliability estimates (κ ≥ 0.41).

CONCLUSIONS

Diagnoses of ketamine use disorder can be reliably evaluated using this fully structured diagnostic instrument's questions and algorithm. Ketamine-related withdrawal among people who use ketamine should be re-evaluated. Considering that after-effects of this dissociative anesthetic can last for many hours, it is important to explore a different timeframe for possible withdrawal effects.

Prevalence of new psychoactive substances (NPS) in Brazil based on oral fluid analysis of samples collected at electronic music festivals and parties

BACKGROUND

New psychoactive substances (NPS) use is a worldwide public health issue. Knowing the prevalence of NPS guides public health and legal policies to address the problem. The objective of this study was to identify NPS in Brazil through the analysis of oral fluid (OF) samples collected at parties and electronic music festivals.

METHODS

Anonymous questionnaires and oral fluid samples were collected from volunteers (≥18 years) who reported the consumption of at least one illicit psychoactive substance in the last 24 h. Oral fluid sample collections occurred at eleven parties and two electronic music festivals over 16 months (2018-2020). Questionnaire answers were matched to oral fluid toxicological results.

RESULTS

Of 462 oral fluid samples, 39.2 % were positive for at least one NPS by liquid chromatography‒tandem mass spectrometry (LC-MS/MS). The most prevalent NPS was ketamine (29.4 %), followed by methylone (6.1 %) and N-ethylpentylone (4.1 %); however, MDMA was the most commonly identified (88.5 %) illicit psychoactive substance. More than one drug was identified in 79.9 % of samples, with two (34.2 %) and three (23.4 %) substances most commonly observed. Only 5 % of volunteers reported recent NPS consumption.

CONCLUSION

MDMA is still the most common party and electronic music festival drug, although NPS were identified in more than one-third of oral fluid samples.

Opt-Out Design for an Observational Toxicology Study Involving Intoxicated Patients at a Dance Music Event

At electronic dance music events in Belgium in 2013 to 2015, seemingly intoxicated patients were included without their informed consent in an observational toxicology study when the attending physicians determined that they needed treatment with an intravenous line. All included patients received an information letter inviting them to contact the principal investigator (PI) to obtain more information about the study and/or to inform the PI that they wanted to be excluded from it. Overall, 238 patients were included in the study. Nine participants (4%) responded to the information letter, either on their own or through their parent; none of them asked to be excluded from the study. All respondents expressed their gratitude for the information they received. The opt-out study design seemed to be acceptable to the patient-participants, and it provided a fuller picture of the drug-related medical incidents at such music events than what could likely be achieved through a study that includes only people who explicitly choose to participate. These findings may help institutional review boards when evaluating study designs involving recreational drug use, especially at electronic dance music events. Nevertheless, we warn against extrapolation to other settings where informed consent is difficult to obtain.

Does the Presence of On-Site Medical Services at Outdoor Music Festivals Affect Attendees' Planned Alcohol and Recreational Drug Use?

BACKGROUND

Dedicated on-site medical services have long been recommended to improve health outcomes at mass-gathering events (MGEs). In many countries, they are being reviewed as a mandatory requirement. While it is known that perceptions of risk shape substance use plans amongst outdoor music festival (OMF) attendees, it is unclear if attendees perceive the presence of on-site medical services as a part of the safety net. The aim of this paper is to better understand whether attendees' perceptions of on-site medical services influence high-risk behaviors like alcohol and recreational drug use at OMFs.

METHOD

A questionnaire was distributed to a random sample of attendees entering and attending two separate 20,000-person OMFs; one in Canada (Festival A) and one in New Zealand (Festival B). Responses focused on demographics, planned alcohol and recreational drug use, perceptions of medical services, and whether the absence of medical services would impact attendees' planned substance use.

RESULTS

A total of 851 (587 and 264 attendees for Festival A and Festival B, respectively) attendees consented and participated. Gender distribution was equal and average ages were 23 to 25. At Festival A, 48% and 89% planned to use alcohol and recreational drugs, respectively, whereas at Festival B, it was 92% and 44%. A great majority were aware and supportive of the presence of medical services at both festivals, and a moderate number considered them a factor in attendance and something they would not attend without. There was significant (>10%) agreement (range 11%-46%; or 2,200-9,200 attendees for a 20,000-person festival) at both festivals that the absence of medical services would affect attendees' planned use of alcohol and recreational drugs.

CONCLUSIONS

This study found that attendees surveyed at two geographically and musically distinct OMFs had high but differing rates of planned alcohol and recreational drug use, and that the presence of on-site medical services may impact attendees' perceptions of substance use risk. Future research will aim to address the limitations of this study to clarify these findings and their implications.

Media coverage about medical benefits of MDMA and ketamine affects perceived likelihood of engaging in recreational use

Background

Research on the efficacy of ketamine in treating depression and 3,4-methylenedioxymethamphetamine (MDMA) in treating post-traumatic stress disorder have been widely covered by the media. Given recent widespread coverage of the efficacy of these drugs, it is important to determine whether such coverage influences prevalence of recreational use. While longitudinal studies would be most ideal for assessing this, to acquire preliminary data, we tested survey items assessing this potential phenomenon in a population known for high prevalence of use of these drugs.

Method

Adults entering randomly selected nightclubs in New York City (n = 209) were surveyed about drug use. Questions were included to assess their perceived likelihood of recent media coverage about medical benefits associated with use of ketamine and MDMA affecting their own use.

Results

Two-thirds (66.8%) of participants had ever used ecstasy/MDMA and 22.6% had ever used ketamine. The plurality of participants reported that media coverage about ketamine (46.1%) and MDMA (39.9%) did not affect their likelihood of using. 10.1% and 21.0% of participants reported increased likelihood of using ketamine and MDMA, respectively. 52.3% of those reporting past-month ketamine use and 6.1% of those reporting no lifetime use reported being more likely to use in response to media coverage about ketamine. 28.6% of those reporting past-month ecstasy use and 5.5% of those reporting no lifetime use reported being more likely to use in response to media coverage about MDMA.

Discussion

Media coverage about the medical benefits of ketamine and MDMA might influence specific subsets of people to use.

Drug checking at dance festivals: A review with recommendations to increase generalizability of findings

Dance festival attendees are at high risk for consuming adulterated drugs. In recent years, drug checking studies have been conducted at various dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest-festival attendees at risk for using adulterated drugs. Six published studies involving drug checking at festivals were reviewed. All relied on self-selected samples and male attendees were overrepresented based on previous research. Test methods, drugs tested, definitions of adulteration, and prevalence of adulteration varied across studies. Prevalence of detection of adulterants ranged from 11% to 55%. While the drug checking services described appear to have been beneficial for participants, results have limited generalizability to the target population. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques such as systematic random sampling, stratified random sampling, or time-space sampling within festivals. We also recommend that individuals approached are surveyed for demographic characteristics, planned drug use at the festival, and willingness to test their drugs. These methods would help determine how representative the sample is compared to the target population and allow for more generalizable estimates. In conclusion, as these valuable harm reduction services expand, it may be possible to reach a wider portion of the population at risk and to obtain more generalizable estimates of engagement, adulteration, and reactions to learning one possesses adulterated drugs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Illicit Drug Use and Associated Problems in the Nightlife Scene: A Potential Setting for Prevention

Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18-34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.

Shifts in Drug Use Behavior Among Electronic Dance Music Partygoers in New York During COVID-19 Social Distancing

Background: Little is known about how COVID-19-related social distancing has affected illegal drug use. We surveyed electronic dance music (EDM) partygoers-a population known for high levels of drug use-to determine whether their drug use patterns had changed during state-mandated social distancing in New York. Methods: Individuals were recruited online and screened for eligibility throughout April and May 2020. We surveyed 128 eligible adults and queried, retrospectively, whether their drug use behavior had changed during COVID-19-related social distancing. Results: Most participants reporting past-three-month use reported decreased frequency of use during COVID-19-related social distancing. Specifically, 78.6% reduced frequency of use of cocaine, 71.1% reduced frequency of use of ecstasy/MDMA/Molly, and 68.0% reduced frequency of use of LSD. Although some participants reported increased frequency of use of cocaine (7.1%), ecstasy (7.9%), or LSD (12.0%), 35.0% reported increased frequency of cannabis use. Most (66.7%) of those reporting cocaine use reduced the amount used. The majority of those reporting use of cannabis, ecstasy, cocaine, and/or LSD reported that drug cost (80.0-84.0%) and drug quality (84.2-92.0%) did not change during social distancing. Having a college degree was associated with higher odds for decreasing frequency of cannabis use. Older participants (ages ≥23) were at lower odds for decreasing frequency of cocaine use, as were those earning >$500 per week, and participants who attended EDM events biweekly or more often were at higher odds for decreasing frequency of LSD use. Conclusions: Participants in this sample tended to reduce party drug use during COVID-19-related social distancing.

Harm Reduction Strategies and Drug-Related Negative Consequences in the Dance Music Scene: The Moderating Role of Polysubstance Use

Although simultaneous polysubstance use (SPU) is associated with greater harms than concurrent polysubstance use (CPU), no previous research has examined the effectiveness of harm reduction strategies in reducing drug-related harms in people who use drugs simultaneously and whether these strategies have a differential impact on drug-related negative consequences according to SPU patterns. Objectives: to examine the relationship between SPU patterns, harm reduction strategies and drug-related consequences experienced among people who attend dance music settings, and to examine the moderating role of SPU patterns in the relationship between harm reduction strategies and drug-related negative consequences Methods: a web-based survey was used to gather data from 649 substance-using attendees at dance music settings (mean age = 26.2, 68% male). The survey collected data on: settings of last party attended, drug use, harm reduction strategies used and drug-related negative consequences experienced during last party attended. Results: Latent class analysis identified two SPU profiles: Moderate SPU and Severe SPU. Participants in the severe SPU class experienced more drug-related negative consequences at their last party in comparison with those in the moderate SPU class. Regardless of SPU pattern, avoiding binge drinking was related to fewer drug-related negative consequences, whilst avoiding mixing stimulants was related to fewer drug-related negative consequences only among those participants in the severe simultaneous polysubstance use class. Conclusions: These findings could help to inform the design of messages and tailored interventions aimed at minimizing drug-related negative consequences among people who use multiple substances in the dance music scene.

Nightlife scene involvement and patterns of prescription drug misuse

INTRODUCTION AND AIMS

Participation in nightlife influences a range of health behaviours. Participants in various nightlife scenes have increasingly adopted prescription drug misuse into their substance use repertoires.

DESIGN AND METHODS

With 404 young adults recruited via time-space sampling in New York, we examine the relationship of nightlife participation-measured by number of scenes and the number of nights out in nightlife scenes-to prescription drug misuse during the past 3 months. Outcomes included frequency of misuse, escalation to non-oral consumption, polydrug use, social problems and symptoms of dependence.

RESULTS

Negative binomial regressions indicate nightlife participation is associated with increased frequency of misuse measured by number of scenes (incidence rate ratio = 1.114, P < 0.05) and number of nights out (incidence rate ratio = 1.009, P < 0.001). Logistic regression models show nightlife participation is associated with increased odds of non-oral use (adjusted odds ratio; AOR = 1.334, P < 0.01) and polydrug use (AOR = 1.776, P < 0.001) measured by number of scenes, and non-oral use (AOR = 1.021, P < 0.001) and polydrug use (AOR = 1.023, P < 0.001) as measured by number of nights out. Nightlife participation is not associated with prescription drug problems or symptoms of dependence. Frequency of participation is associated with peer norms favourable to prescription drugs (B = 0.003, P < 0.01).

DISCUSSION AND CONCLUSIONS

Nightlife participation has implications for prescription drug misuse. While shaping how often and in what manner young people consume prescription drugs, nightlife participation is not associated with harms experienced. Given the significance of the prescription drug trend in many world regions, these results suggest that increasing participation in nightlife shapes patterns of drug use, but in ways that do not lead to reported problems.

Trends in characteristics of individuals who use methamphetamine in the United States, 2015-2018

BACKGROUND

Prevalence of self-reported methamphetamine use has remained relatively stable over the past decade; however, deaths and seizures involving methamphetamine have been increasing. Research is needed to determine if select subgroups in the US are at increased risk for use.

METHODS

We examined data from individuals ages ≥12 from the 2015-2018 National Survey on Drug Use and Health (n = 226,632), an annual nationally representative cross-sectional survey of non-institutionalized individuals in the US. Log-linear trends in past-year methamphetamine use were examined, stratified by demographic and drug use characteristics.

RESULTS

Methamphetamine use increased in the US from 2015 to 2018, including among those reporting past-year use of ecstasy/MDMA (6.1 % to 10.8 % [p = .018], a 78.2 % increase), cocaine (8.4 % to 11.8 % [p = .013], a 40.1 % increase), and among those reporting past-year prescription opioid misuse (5.4 % to 8.0 % [p = .019], a 49.2 % increase). Increases were particularly pronounced among those reporting past-year use of heroin (22.5 % to 37.4 % [p = .032], a 66.2 % increase) and LSD (5.1 %-= to 10.3 % [p = .002], a 100.4 % increase). Small increases were also detected among heterosexuals (0.6 % to 0.7 % [p = .044], a 16.2 % increase), those with a high school diploma or less (1.0 % to 1.2 % [p = .020], a 22.0 % increase), and among those receiving government assistance (1.4 % to 1.8 % [p = .046], a 26.2 % increase).

CONCLUSIONS

Methamphetamine use is increasing among people who use other drugs with sharp increases among people who use heroin or LSD in particular, and this could have serious public health consequences. Results may signal that methamphetamine use may continue to increase in the general population.