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Popova L, Massey ZB, Giordano NA. Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications. Annu Rev Public Health 2024; 45:425-442. [PMID: 38166502 DOI: 10.1146/annurev-publhealth-060922-042254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA;
| | - Zachary B Massey
- School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Mars S, Ondocsin J, Holm N, Ciccarone D. The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States. Harm Reduct J 2024; 21:57. [PMID: 38443903 PMCID: PMC10913463 DOI: 10.1186/s12954-024-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality. METHOD We recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant. RESULTS A clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand. CONCLUSION Transformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs' market dominance at this location and possible interventions.
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Affiliation(s)
- Sarah Mars
- University of California, San Francisco, USA.
| | | | - Nicole Holm
- University of California, San Francisco, USA
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Brooks O, Hayashi K, Cui Z, Milloy MJ, Kerr T, Fairbairn N. Re-incarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104018. [PMID: 37060885 PMCID: PMC10683765 DOI: 10.1016/j.drugpo.2023.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND People who use drugs (PWUD) are disproportionately incarcerated, however little is known about specific substance use, social and structural factors associated with re-incarceration among PWUD. We aimed to identify the socio-structural and substance use factors associated with re-incarceration among structurally-marginalized PWUD. METHODS We used longitudinal data from two prospective cohorts of PWUD in Vancouver, Canada. We included adults reporting at least one incarceration event in the last six months and who completed at least one additional follow-up study visit. We performed multivariable extended Cox regression to explore factors associated with re-incarceration. RESULTS Among 468 eligible participants, the median age was 40 years (Q1-Q3 = 34-46 years), 346 (73.9%) were men, 177 (37.8%) identified as Indigenous, and 227 (48.5%) experienced at least one re-incarceration event. Incidence rate of re-incarceration was 157 incarceration events per 1000 person years. In multivariable analyses, homelessness (adjusted hazard ratio [AHR] = 2.17; 95% confidence interval [95% CI]: 1.79-2.61), community judicial supervision (AHR = 3.89; 95% CI: 3.21-4.71) and re-incarceration during the study period (once: AHR = 1.95, 95% CI: 1.55-2.44; two or more events: AHR = 1.53, 95% CI: 1.23-1.90) were positively associated with re-incarceration. Among substance use variables that included illicit drugs, only heavy alcohol use remained significantly associated with re-incarceration across analyses after adjustment (AHR = 1.32; 95% CI: 1.06-1.65). Engagement in addiction treatment (AHR = 0.63; 95% CI: 0.53-0.75), mental illness (AHR = 0.70; 95% CI: 0.59-0.84) and age (AHR = 0.96; 95% CI: 0.95-0.97) were negatively associated with re-incarceration. CONCLUSION Access to housing and substance use services, including treatment for alcohol use disorder, following incarceration may reduce re-incarceration among PWUD. The high rates of re-incarceration of PWUD in our sample underscores how structural factors-such as homelessness and criminalization of substance use-drive re-incarceration among PWUD.
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Affiliation(s)
- Olivia Brooks
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Smyth BP, Davey A, Keenan E. Deterrence effect of penalties upon adolescent cannabis use. Ir J Psychol Med 2023:1-6. [PMID: 36794356 DOI: 10.1017/ipm.2023.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Penalties are used in an effort to curtail drug use by citizens in most societies. There are growing calls for a reduction or elimination of such penalties. Deterrence theory suggests that use should increase if penalties reduce and vice versa. We sought to examine the relationship between changes to penalties for drug possession and adolescent cannabis use. METHOD Ten instances of penalty change occurred in Europe between 2000 and 2014, seven of which involved penalty reduction and three involved penalty increase. We conducted a secondary analysis of a series of cross-sectional surveys of 15-16-year-old school children, the ESPAD surveys, which are conducted every four years. We focused on past month cannabis use. We anticipated that an eight-year time span before and after each penalty change would yield two data points either side of the change. A simple trend line was fitted to the data points for each country. RESULTS In eight cases, the trend slope in past month cannabis use was in the direction predicted by deterrence theory, the two exceptions being the UK policy changes. Using the principals of binomial distributions, the likelihood of this happening by chance is 56/1024 = 0.05. The median change in the baseline prevalence rate was by 21%. CONCLUSIONS The science seems far from settled on this issue. There remains a distinct possibility that reducing penalties could contribute to small increases in adolescent cannabis use and consequently increase cannabis-related harms. This possibility should be considered in any political decision-making influencing drug policy changes.
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Affiliation(s)
- Bobby P Smyth
- Department of Public Health & Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Aoife Davey
- National Drugs Rehabilitation Coordinator, National Social Inclusion Office, Health Service Executive, Palmerstown, Dublin 20, Ireland
| | - Eamon Keenan
- National Clinical Lead for Addiction Services, National Social Inclusion Office, Health Service Executive, Palmerstown, Dublin 20, Ireland
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Athanassiou M, Dumais A, Zouaoui I, Potvin S. The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes. Front Psychiatry 2023; 13:1060656. [PMID: 36713920 PMCID: PMC9874703 DOI: 10.3389/fpsyt.2022.1060656] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
Background Ineffective cannabis regulatory frameworks such as prohibition have sparked interest in alternative solutions to reduce individual and societal harms. While it has been suggested that the recreational legalization process has yielded early successes, the relatively recent implementation of the novel policies has provided a modest time frame for a truly thorough establishment and assessment of key population-level indicators. The following systematic review focuses on identifying the downstream public health sequelae of cannabis legalization policies, including parameters such as cannabis consumption rates, hospitalization rates, vehicular accidents and fatalities, criminal activity, and suicidal behaviors, as well as other substance use trends. Methods An exhaustive search of the MEDLINE and Google Scholar databases were performed to identify high-quality (1) longitudinal studies, which (2) compared key public health outcomes between regions which had and had not implemented recreational cannabis legalization (RML) policies, (3) using distinct databases and/or time frames. Thirty-two original research articles were retained for review. Results Adult past-month cannabis consumption (26+ years) seems to have significantly increased following RML, whereas young adult (18-26 years) and adolescent (12-17 years) populations do not show a significant rise in past-month cannabis use. RML shows preliminary trends in increasing service use (such as hospitalizations, emergency department visits, or poisonings) or vehicular traffic fatalities. Preliminary evidence suggests that RML is related to potential increases in serious/violent crimes, and heterogeneous effects on suicidal behaviors. While the research does not illustrate that RML is linked to changing consumptions patterns of cigarette, stimulant, or opioid use, alcohol use may be on the rise, and opioid prescribing patterns are shown to be significantly correlated with RML. Conclusion The current data supports the notion that RML is correlated with altered cannabis consumption in adults, potentially increased criminal activity, and a decline in opioid quantities and prescriptions provided to patients. Future work should address additional knowledge gaps for vulnerable populations, such as individuals with mental health problems or persons consuming cannabis frequently/at higher THC doses. The effects of varying legalization models should also be evaluated for their potentially differing impacts on population-level outcomes.
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Affiliation(s)
- Maria Athanassiou
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Philippe-Pinel National Institute of Legal Psychiatry, Montreal, QC, Canada
| | - Inès Zouaoui
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Zhang Y, Lu S. Effects of traditional Chinese exercises on mental health in individuals with drug rehabilitee: A systematic review and meta-analysis. Front Public Health 2022; 10:944636. [PMID: 35991075 PMCID: PMC9386426 DOI: 10.3389/fpubh.2022.944636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe intent of this systematic review and meta-analysis was to examine the effects of Traditional Chinese Exercise (TCE) on mental health and drug cravings in drug rehabilitees.MethodsSix electronic databases (PubMed, Web of Science, MEDLINE, CINAHL, PsycArticles, and CNKI) were searched to identify the potential literature from inception to March 2022. The controlled studies with a pro-posttest design that investigated the effects of TCE on mental health (depression, anxiety, drug craving, and sleep quality) were included. The effect sizes were calculated using the random-effect models with a 95% confidence interval. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate study quality.ResultsA total of 10 studies (740 participants, mean age 35 years old) were included in this study. The pooled results showed that TCE produced significant improvements in depression (SMD = 0.65, 95% CI 0.29 to 1.02, p < 0.01), anxiety (SMD = 0.98, 95% CI 0.44 to 1.53, p < 0.01), and drug craving (SMD = 0.87, 95% CI 0.54 to 1.21, p < 0.01) compared to the control group. The subgroup analysis results showed that TCE resulted in significant improvements in depression compared to active intervention (SMD = 0.33, 95% CI 0.07 to 0.60) or passive intervention (SMD = 1.07, 95% CI 0.40 to 1.74). A significant improvement in depression was observed in both male and female drug rehabilitee (p < 0.05). Moreover, Tai Chi (SMD = 0.69, 95% CI 0.19 to 1.18) or Qigong (SMD = 0.49, 95% CI 0.24 to 0.74) exercise, 3–4 times per week (SMD = 1.06, 95% CI 0.39 to 1.74) or ≥5 times (SMD = 0.39, 95% CI 0.12 to 0.66), >45 min (SMD = 0.62, 95% CI 0.09 to 1.15) or ≤ 45 min (SMD = 0.68, 95% CI 0.10 to 1.27), and for a duration of 12 weeks (SMD = 0.84, 95% CI 0.15 to 1.54) produced significant improvement in depression.ConclusionThis current study suggests that TCE (Tai Chi, Qigong) may have benefits in alleviating depression, anxiety, and drug cravings in drug rehabilitees. Further studies are required to verify our results through the implementation of well-designed experimental protocols.
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Affiliation(s)
- Yulong Zhang
- Hunan Judicial Police Vocational College, Changsha, China
| | - Shenghua Lu
- College of Sports Science, Jishou University, Jishou, China
- Hunan Academy of Education Sciences, Changsha, China
- *Correspondence: Shenghua Lu
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Mirzaei S, Yazdi-Feyzabadi V, Mehrolhassani MH, Nakhaee N, Oroomiei N. Setting the policy agenda for the treatment of substance use disorders in Iran. Harm Reduct J 2022; 19:27. [PMID: 35292060 PMCID: PMC8922872 DOI: 10.1186/s12954-022-00612-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Drug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979. Methods The current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data. Results The results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers. Conclusions For a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.
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Affiliation(s)
- Saeid Mirzaei
- Non Communicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran, Sardaran Shahid Square- Shahid Rajaei Boulevard, 7616913555
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nadia Oroomiei
- Non Communicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran, Sardaran Shahid Square- Shahid Rajaei Boulevard, 7616913555.
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Shafi A, Berry AJ, Sumnall H, Wood DM, Tracy DK. Synthetic opioids: a review and clinical update. Ther Adv Psychopharmacol 2022; 12:20451253221139616. [PMID: 36532866 PMCID: PMC9747888 DOI: 10.1177/20451253221139616] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
The term 'opioids' refers to both the natural compounds ('opiates') which are extracted from the opium poppy plant (Papaver somniferum) and their semi-synthetic and synthetic derivatives. They all possess relatively similar biochemical profiles and interact with the opioid receptors within the human body to produce a wide range of physiological effects. They have historically been used for medicinal purposes, their analgesic and sedative effects, and in the management of chronic and severe pain. They have also been used for non-medicinal and recreational purposes to produce feelings of relaxation, euphoria and well-being. Over the last decade, the emergence of an illegal market in new synthetic opioids has become a major global public health issue, associated with a substantial increase in unintentional overdoses and drug-related deaths. Synthetic opioids include fentanyl, its analogues and emerging non-fentanyl opioids. Their popularity relates to changes in criminal markets, pricing, potency, availability compared to classic opioids, ease of transport and use, rapid effect and lack of detection by conventional testing technologies. This article expands on our previous review on new psychoactive substances. We now provide a more in-depth review on synthetic opioids and explore the current challenges faced by people who use drugs, healthcare professionals, and global public health systems.
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Affiliation(s)
- Abu Shafi
- South West London and Saint George's Mental Health NHS Trust, London, UK
| | - Alex J Berry
- Division of Psychiatry, University College London, London, UK
| | | | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Derek K Tracy
- West London NHS Trust, Trust Headquarters, 1 Armstrong Way, Southall UB2 4SD, UK
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MacQuarrie AL, Brunelle C. Emerging Attitudes Regarding Decriminalization: Predictors of Pro-Drug Decriminalization Attitudes in Canada. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211050030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canada and the United States have recently evaluated the decriminalization of drugs as multiple provinces and states put motions forward to consider drug decriminalization legislation. The influence of factors such as demographics, substance use, perceived substance use risk, and personality have not been widely studied in predicting attitudes toward drug decriminalization. A total of 504 participants were drawn from university ( n = 269, 53.37%) and community samples ( n = 235, 46.63%) through online social media groups and posts (i.e., Facebook, Twitter, Reddit, etc). Analyses indicated that male gender, single or non-married relationship status, living outside of Atlantic Canada, higher problematic alcohol use scores, lower Extraversion, higher Open-mindedness, and lower perceived risk of using substances emerged as significant predictors of support for drug decriminalization. These findings have important implications as public attitudes toward a substance influence drug policy.
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Affiliation(s)
- Amy L. MacQuarrie
- Department of Psychology, University of New Brunswick Saint John Campus, Saint John, NB, Canada
| | - Caroline Brunelle
- Department of Psychology, University of New Brunswick Saint John Campus, Saint John, NB, Canada
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Rosenberger C, Gertzen M, Strasburger M, Schwarz J, Gernun S, Rabenstein A, Lermer E, Rüther T. We Have a Lot to Do: Lack of Sexual Protection and Information-Results of the German-Language Online Survey "Let's Talk About Chemsex". Front Psychiatry 2021; 12:690242. [PMID: 34135790 PMCID: PMC8200571 DOI: 10.3389/fpsyt.2021.690242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of chemsex and sexualized substance use is increasing in several European countries, particularly among men who have sex with men. In this subgroup, illegal substance use is associated with increased sexual risk behavior, which can result in severe physical and psychological impairments. The present study examined the incidence and prevalence of chemsex in German-speaking countries. Methods: To further describe the high-risk group of Chemsex users, participants (N = 429) were asked about their psychotropic substance use, sexual and health-related behavior, health status, and socio-demographic information by using an online questionnaire. Whether Chemsex has negative effects on well-being was measured with the WHO well-being index. Of additional interest was how informed Chemsex users are about the topic and what needs are placed on the practitioners. The online questionnaire consisted of 105 items, and data was collected from March to May 2019. Thousand forty seven datasets were saved with a dropout rate of 59%, 123 completed questionnaires fulfilled the criteria for chemsex users (n =123). Results: There were no significant differences in well-being between chemsex users and non-users. All participants protected themselves against sexually transmitted diseases irregularly or not at all. The majority of chemsex users reported intermittently using illegal substances (ketamine, methamphetamine, mephedrone, γ-butyrolactone/γ-hydroxy butyric acid). They viewed their sexual and substance use behavior as problematic, but few showed motivation for behavior change. Chemsex users clearly expressed a need for more information and advice centers. Conclusion: The results provide information on chemsex users that can be used for the future development of a therapy manual and thus contribute to improving health care for this group. The prevalence of chemsex is increasing and urgently needs more research to protect clients from health impairments and stigmatization.
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Affiliation(s)
- Cornelia Rosenberger
- Department of Addiction Medicine, kbo-Isar-Amper-Klinikum Munich East, Haar, Germany
| | - Marcus Gertzen
- Psychotherapy and Psychosomatics, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Moritz Strasburger
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Johanna Schwarz
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Solveig Gernun
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Eva Lermer
- FOM University of Applied Sciences for Economics and Management, Munich, Germany
- LMU Center for Leadership and People Management, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Hammond AS, Dunn KE, Strain EC. Drug Legalization and Decriminalization Beliefs Among Substance-using and Nonusing Individuals. J Addict Med 2021; 14:56-62. [PMID: 31385846 PMCID: PMC7219468 DOI: 10.1097/adm.0000000000000542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There has been advocacy for legalization of abusable substances, but systematic data on societal beliefs regarding such legalization are limited. People who use substances may have unique beliefs about legalization, and this study assessed whether they would be in favor of drug legalization/decriminalization. It was hypothesized that those who use particular drugs (especially marijuana) would support its legalization/decriminalization, but that this would not be the case across all classes (especially opioids and stimulants). METHODS A nationwide sample of 506 adults were surveyed online to assess demographic characteristics, substance misuse, and beliefs regarding drug legalization/decriminalization. Legalization/decriminalization beliefs for specific drugs were assessed on an 11-point scale (0, strongly disagree; 10, strongly agree). RESULTS For persons with opioid misuse (15.4%), when asked about their agreement with: "heroin should be legalized," the mean score was 4.6 (SEE = 0.4; neutral). For persons with stimulant misuse (12.1%), when asked about their agreement with: "cocaine should be legalized," the score was 4.2 (0.5). However, for persons with marijuana misuse (34.0%), when asked about their agreement with: "medical marijuana should be legalized" the score was 8.2 (0.3; indicating agreement), and for "recreational marijuana" the score was also 8.2 (0.3). CONCLUSIONS These results suggest that persons who used marijuana strongly support the legalization of both recreational and medical marijuana, whereas persons who primarily have opioid or stimulant misuse have less strongly held beliefs about legalization of substances within those respective categories. By including those who misuse drugs, these data assist in framing discussions of drug legalization and have the potential to inform drug policy considerations.
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Affiliation(s)
- Alexis S Hammond
- Behavioral Pharmacology Research Unit (BPRU), Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, MD
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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Taghinasab M, Jabaji S. Cannabis Microbiome and the Role of Endophytes in Modulating the Production of Secondary Metabolites: An Overview. Microorganisms 2020; 8:E355. [PMID: 32131457 PMCID: PMC7143057 DOI: 10.3390/microorganisms8030355] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
Plants, including cannabis (Cannabis sativa subsp. sativa), host distinct beneficial microbial communities on and inside their tissues and organs, including seeds. They contribute to plant growth, facilitating mineral nutrient uptake, inducing defence resistance against pathogens, and modulating the production of plant secondary metabolites. Understanding the microbial partnerships with cannabis has the potential to affect the agricultural practices by improving plant fitness and the yield of cannabinoids. Little is known about this beneficial cannabis-microbe partnership, and the complex relationship between the endogenous microbes associated with various tissues of the plant, and the role that cannabis may play in supporting or enhancing them. This review will consider cannabis microbiota studies and the effects of endophytes on the elicitation of secondary metabolite production in cannabis plants. The review aims to shed light on the importance of the cannabis microbiome and how cannabinoid compound concentrations can be stimulated through symbiotic and/or mutualistic relationships with endophytes.
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Affiliation(s)
| | - Suha Jabaji
- Plant Science Department, Faculty of Agricultural and Environmental Sciences, MacDonald Campus of McGill University, QC H9X 3V9, Canada;
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Greer A, Ritter A. The legal regulation of drugs and role of government: Perspectives from people who use drugs. Drug Alcohol Depend 2020; 206:107737. [PMID: 31760251 DOI: 10.1016/j.drugalcdep.2019.107737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The legalization and regulation of currently illicit drugs has come to the forefront of drug policy debates in recent years, particularly in the context of cannabis legalization and the opioid crisis in North America. However, sufficient granularity on the various aspects of a legally regulated drug supply is missing from these debates. Further, the voices and opinions of people who use drugs have generally been absent from drug law reform deliberations. This study aimed to examine the views of people who use drugs and who are deeply impacted by drug policies to understand the perceived impacts and role of government under a legalized-regulated market. METHODS Four focus groups were held with people who use drugs in Sydney, Australia. RESULTS Most participants supported various models of legalization, although the perspectives on these models were diverse. Overriding these views was skepticism over the government's role in regulating a legal market, as well as concern for the personal agency of people who use drugs under a medically regulated drug supply model. Some participants discussed potential harms (e.g. increases in use and initiation), but emphasized the benefits (e.g. increases in quality and safety) from legal reform. DISCUSSION While there was support for legal models of drug supply regulation, findings have major implications in terms of how governments and medical systems may perpetuate the oppression of people who use drugs through regulation, and urge future drug policy deliberations to include broader perspectives from the affected community.
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Affiliation(s)
- Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
| | - Alison Ritter
- Drug Policy Modeling Program, Social Policy Research Centre, University of New South Wales, Kensington NSW 2052, Australia
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15
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Cross JH, Cock H. A perspective on cannabinoids for treating epilepsy: Do they really change the landscape? Neuropharmacology 2019; 170:107861. [PMID: 31770546 DOI: 10.1016/j.neuropharm.2019.107861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/22/2022]
Abstract
With the licensing of cannabidiol for drug resistant seizures in Dravet and Lennox Gastaut syndromes in the United states in 2018, interest in the potential for cannabis-based-medicinal products to meet currently unmet needs for people with epilepsy continues to grow. This review summarizes current knowledge and discusses the implications for future research and practice. Both cannabidiol and tetrahydrocannabinol, the main components, have been extensively studied in animal models, with multimodal mechanisms of action proposed. Only pure cannabidiol formulations have been rigorously evaluated in controlled trials thus far, with modest but significant improvements in motor seizures. Adverse effects include diarrhoea, somnolence and reduced appetite, with mostly acceptable tolerability, but a not insignificant (up to 1 in 23) risk of serious adverse events. Recognized drug interactions include with valproate (increased risk of hepatotoxicity) and clobazam (contributing to somnolence, increased secretions, probably chest infections, and potentially efficacy). Whilst there is public (and producer) interest in products also containing tetrahydrocannabinol, clinicians have justifiable concerns about exposing a group already vulnerable to mental health and neurobehavioural comorbidities to the associated additional risks in these domains. Artisanal preparations, with often inconsistent/unknown constituents are frequently used but not recommended. A gulf exists between the actual evidence, including a lack of comparative studies and public beliefs, fuelled by media and anecdote. Continued education of the public, policymakers, researchers and healthcare providers about what is and isn't yet known, together with on-going good quality research is essential to mitigate against future potential risks, particularly in relation to vulnerable populations. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Affiliation(s)
- J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, Guilford St, London, WC1N 1EH, UK; Great Ormond Street for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Young Epilepsy, Lingfield, Surrey, UK
| | - Hannah Cock
- Institute of Molecular and Clinical Sciences, St George's University of London, SW17 0RE, UK; Atkinson Morley Regional Epilepsy Network, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
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16
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Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Queensland, Australia; National Addiction Centre, King's College London, London, UK
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17
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Bewley-Taylor DR. Canada, cannabis legalization and uncertainty around the United Nations drug control conventions. Addiction 2018; 113:1226-1228. [PMID: 29883033 DOI: 10.1111/add.14141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- David R Bewley-Taylor
- Global Drug Policy Observatory, Department of Political and Cultural Studies, Swansea University, Swansea, UK
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18
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Wodak A. From failed global drug prohibition to regulating the drug market. Addiction 2018; 113:1225-1226. [PMID: 29883025 DOI: 10.1111/add.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Wodak
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW, Australia
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20
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Carpentier C, Niaz K, Tettey J. The international drug conventions continue to provide a flexible framework to address the drug problem. Addiction 2018; 113:1228-1229. [PMID: 29883034 DOI: 10.1111/add.14112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Chloé Carpentier
- Chief of the Drug Research Section, United Nations Office on Drugs and Crime, Austria
| | - Kamran Niaz
- Epidemiologist in the Drug Research Section, United Nations Office on Drugs and Crime, Austria
| | - Justice Tettey
- Chief of the Laboratory and Scientific Section, United Nations Office on Drugs and Crime, Austria
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Mostyn B, Gibbon H. Transnational social movement theory and the waning war on drugs: Case studies from UNGASS 2016. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 51:148-155. [DOI: 10.1016/j.drugpo.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 11/16/2022]
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