1
|
Cruz SL, Bencomo-Cruz M, Medina-Mora ME, Vázquez-Quiroz F, Fleiz-Bautista C. First drug-checking study at an electronic festival and fentanyl detection in the central region of Mexico. Harm Reduct J 2023; 20:174. [PMID: 38053148 PMCID: PMC10698886 DOI: 10.1186/s12954-023-00905-8] [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: 04/05/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Perception of drug adulteration has increased in Mexico, but there is little research on adulterants and toxicity. The aim of this study was to identify drug composition in an electronic music outdoor festival nearby Mexico City. METHODS The participants completed a questionnaire with demographic data, harm reduction strategies, drug-use patterns, history, and the drug they expected to find. We took a small sample of each substance and prepared it for drug checking. A two-section drug testing station was placed within the grounds of the festival. Interaction with participants occurred at the front part. Drug checking was conducted at the rear part. The service was free of charge, voluntary and confidential. Forty persons aged 22 to 48 years participated (mode = 28), of which 92.5% were male, most (82.5%) were single. Through the Substance Analysis Program of "ReverdeSer Collective," we conducted the testing with the attendants that provided 51 drug samples, following ethical and biosafety protocols. We used colorimetry, Fourier Transform Infrared Spectroscopy, and fentanyl immunoassay strips for sample analysis. RESULTS Substances of choice among attendants were psychostimulants (MDMA and other amphetamine-like drugs) and hallucinogens. Most samples contained what the users expected plus adulterants. Main adulterants were methylene-dioxy-ethyl-amphetamine, methylene-dioxy-propyl-amphetamine, hydroxyamphetamine, and the selective serotonin reuptake inhibitor venlafaxine. Fentanyl was present in 2 out of 4 cocaine samples and in 14 of the 22 confirmed MDMA samples. CONCLUSIONS Some of the adulterants found pose serious health risks, especially fentanyl, amphetamine-like substances, and venlafaxine. Therefore, it is urgent to monitor these adulterants at electronic music festivals and to implement prevention, treatment, and harm reduction public policies. Naloxone distribution and drug-assisted therapies should be part of government programs in Mexico.
Collapse
Affiliation(s)
- Silvia L Cruz
- Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Miguel Bencomo-Cruz
- Substance Analysis Program-Deliberar A. C. and ReverdeSer Collective A. C., Mexico City, Mexico
| | - María E Medina-Mora
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
- Faculty of Psychology Director, National Autonomous University of Mexico, Mexico City, Mexico
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico
| | - Fabiola Vázquez-Quiroz
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico
| | - Clara Fleiz-Bautista
- Opioids Working Group. Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
- National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Calzada México-Xochimilco 101 Col. San Lorenzo Huipulco, 14370, Mexico City, Mexico.
| |
Collapse
|
2
|
Virmani I, Oteo A, Dunn M, Vidler D, Roper C, Officer J, Hardy G, Dargan PI, Eddleston M, Cooper JG, Hill SL, Macfarlane R, Keating L, Haden M, Hudson S, Thomas SHL. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis. Clin Toxicol (Phila) 2023; 61:39-46. [PMID: 36322622 DOI: 10.1080/15563650.2022.2131566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). METHODS Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). RESULTS Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16-75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2-5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8-47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). CONCLUSIONS Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
Collapse
Affiliation(s)
- Ishita Virmani
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Alberto Oteo
- Addictions and Inclusion Directorate, Department of Health and Social Care, Office for Health Improvement & Disparities, London, UK
| | - Michael Dunn
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Daniel Vidler
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Clair Roper
- Medical Toxicology Centre, Newcastle University, Newcastle, UK
| | - Jane Officer
- Scottish Police Authority Forensic Services, Edinburgh, UK
| | - Gareth Hardy
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Paul I Dargan
- Clinical Toxicology, Guys & St Thomas' NHS Foundation Trust, London and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University of Edinburgh, Edinburgh, UK
| | | | - Simon L Hill
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| | | | - Liza Keating
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark Haden
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Simon Hudson
- LGC Sport and Specialised Analytical Services, Fordham, UK
| | - Simon H L Thomas
- Medical Toxicology Centre, Newcastle University, Newcastle, UK.,Newcastle Hospitals NHS Foundation Trust and National Poisons Information Service, Newcastle, UK
| |
Collapse
|
3
|
Chomynová P, Kočárová R, Kňažek F, Plevková M, Bláhová B, Valeš K, Mravčík V. Use of psychedelics in the Czech Republic: results of recent population surveys. Cent Eur J Public Health 2022; 30:144-153. [DOI: 10.21101/cejph.a7079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
|
4
|
Assessment of MDMA tablet and capsule dosages from seizures in Queensland, Australia. Forensic Chem 2022. [DOI: 10.1016/j.forc.2022.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
5
|
Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, Werb D, Scheim AI. Drug checking services for people who use drugs: a systematic review. Addiction 2022; 117:532-544. [PMID: 34729849 PMCID: PMC9299873 DOI: 10.1111/add.15734] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Drug checking services provide people who use drugs with chemical analysis results of their drug samples while simultaneously monitoring the unregulated drug market. We sought to identify and synthesize literature on the following domains: (a) the influence of drug checking services on the behaviour of people who use drugs; (b) monitoring of drug markets by drug checking services; and (c) outcomes related to models of drug checking services. METHODS Systematic review. A systematic literature search was conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, Web of Science and Dissertations and Theses Global. Eligible studies were peer-reviewed articles and conference abstracts or grey literature, published in any language since 1990 and including original data on the domains. We assessed risk of bias for quantitative peer-reviewed articles reporting on behaviour or models of drug checking services using National Institutes of Health tools. RESULTS We screened 2463 titles and abstracts and 156 full texts, with 90 studies meeting inclusion criteria. Most (n = 65, 72.2%) were from Europe and used cross-sectional designs (n = 79, 87.7%). Monitoring of drug markets by drug checking services (n = 63, 70%) was the most reported domain, followed by the influence of drug checking services on behaviour (n = 31, 34.4%), including intent to use, actual use and disposal of the drug, and outcomes related to models of drug checking services (n = 17, 18.9%). The most common outcome measures were detection of unexpected substances (n = 50, 55.6%), expected substances (n = 44, 48.9%), new psychoactive substances (n = 40, 44.4%) and drugs of concern (n = 32, 36.5%) by drug checking services. CONCLUSIONS Drug checking services appear to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking services are unexpected or drugs of concern. Monitoring of drug markets by drug checking services is well established in Europe, and increasingly in North America. Concerns about drug contents and negative health consequences facilitate the use of drug checking services; lack of concern; trust in drug sellers; lack of accessibility of drug checking services; and legal and privacy concerns are barriers to use.
Collapse
Affiliation(s)
- Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | - Justine Tanguay
- Munk School of Global Affairs and Public PolicyUniversity of TorontoTorontoONCanada
| | - Kristy Scarfone
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoONCanada
| | - Indhu Rammohan
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | | | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Division of Infectious Diseases and Global Public Health, School of MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Ayden I. Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge InstituteSt Michael's HospitalTorontoONCanada,Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPAUSA
| |
Collapse
|
6
|
Hirschfeld T, Smit-Rigter L, van der Gouwe D, Reiche S, Stöver H, Majić T. Safer Tripping: Serotonergic Psychedelics and Drug Checking. Submission and Detection Rates, Potential Harms, and Challenges for Drug Analysis. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
With the continuous emergence of new psychoactive substances, drug checking (DC) services are challenged by an increasingly complex drug market. Considering the resumed scientific and public interest in serotonergic psychedelics (SPs) like LSD, psilocybin, and 2C-B, we present the results of a literature search investigating the presence and proportion of SPs in DC samples.
Recent Findings
In 15 identified reports, submission and detection rates of SPs were comparably low, but increasing. Samples contained considerable amounts of adulterations or analogues, mostly novel SPs with unknown toxicological profiles and in some cases potentially life-threatening effects. The detection of SPs, however, requires advanced analysis techniques currently not available to most DC services.
Summary
Given the substantial proportion of novel SPs in DC samples and the associated risks, DC can be a valuable harm reduction and monitoring tool for SPs if analysis techniques with high sensitivity are employed.
Collapse
|
7
|
Jørgenrud B, Furuhaugen H, Gjerde H. Prevalence and Correlates of Illicit Drug Use among Norwegian Nightlife Patrons. Subst Use Misuse 2021; 56:1697-1706. [PMID: 34251973 DOI: 10.1080/10826084.2021.1949613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nightclubs and bars are recreational settings with extensive availability and consumption of alcohol and recreational drugs. OBJECTIVES This study aims to determine the proportion of nightclub patrons in Norway that tested positive for illicit drugs, moreover, we examined the correlation between positive test results and demographic and substance use characteristics. METHODS Patrons were recruited outside nightclubs on Friday and Saturday nights between 10:00 pm and 04:00 am. Substance use was determined by breath testing and oral fluid testing for alcohol and drugs, respectively, using accurate and specific analytical methods. Questionnaires recorded demographic and substance use characteristics. RESULTS Of the 1988 included nightclub patrons, 90% tested positive for alcohol, 14% for illicit drug use, and 3% for two or more illicit drugs. The proportion of patrons who tested positive for illicit drugs was highest in the early hours of the morning. Nine out of ten who tested positive for illicit drugs also consumed alcohol. Testing positive for one or more illicit drugs was most strongly correlated with being male and unemployed, using tobacco or other nicotine products, and early on-set illicit drug use; further the correlations were strongest among those who tested positive for two or more illicit drugs.Conclusions/Importance: Patrons who used illicit drugs before or during nightclub visits most often combined drug use with alcohol consumption. Substituting alcohol with cannabis or other drugs was not common in this cohort. The study results provide evidence to introduce harm-reduction prevention programs to address illicit drug and excessive alcohol consumption.
Collapse
Affiliation(s)
- Benedicte Jørgenrud
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
8
|
Ghaffari-Rafi A, Eum KS, Villanueva J, Jahanmir J. Protracted hyperthermia and delayed rhabdomyolysis in ecstasy toxicity: A case report. Medicine (Baltimore) 2020; 99:e21842. [PMID: 33031256 PMCID: PMC7544301 DOI: 10.1097/md.0000000000021842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Despite toxicity and unpredictable adverse effects, ecstasy use has increased in the United States. Onset of hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation (DIC), among other symptoms, occurs within hours of ingestion. Moreover, patients who experience hyperpyrexia, altered mental status, DIC, and multiorgan failure, rarely survive. This case presents a chronic ecstasy user whose symptoms would have predicted mortality. The report demonstrates a patient who experiences protracted hyperthermia, with delayed rhabdomyolysis and DIC. In addition, his peak creatine kinase (CK) of 409,440 U/L was far greater than the expected 30,000 to 100,000 U/L, being the second largest CK recorded in a survivor. PATIENT CONCERNS This case report presents a 20-year-old man who presented to the emergency department after experiencing a severe reaction to ecstasy. He was a chronic user who took his baseline dosage while performing at a music event. He experienced hyperpyrexia immediately (106.5°F) while becoming stiff and unresponsive. Before emergency medical service arrival, his friends placed cold compresses on the patient and rested him in an ice filled bathtub. DIAGNOSES Per history from patient's friends and toxicology results, the patient was diagnosed with ecstasy overdose, which evolved to include protracted hyperthermia and delayed rhabdomyolysis. INTERVENTIONS Due to a Glasgow coma scale score of 5, he was intubated and sedated with a propofol maintenance. Hyperpyrexia resolved (temperature dropped to 99.1°F) after start of propofol maintenance. He was extubated after 24 hours, upon which he experienced hyperthermia (101.4°F at 48 hours), delayed rhabdomyolysis, and DIC (onset at 37 hours). He remained in hyperthermia for 120 hours until carvedilol permanently returned his temperature to baseline. His plasma CK reached a peak of 409,440 U/L at 35 hours. OUTCOMES After primary management with intravenous fluids, the patient returned to baseline health without any consequences and was discharged after 8 days. A follow-up of 3 months postdischarge revealed no complications or disability. LESSONS Clinically, the case highlights how physicians should be aware of the unusual time course adverse effects of ecstasy can have. Lastly, as intensity and duration of hyperpyrexia are predictors of mortality, our case indicates maintenance of sedation with propofol and use of oral carvedilol; both are efficacious for temperature reduction in ecstasy toxicity.
Collapse
Affiliation(s)
- Arash Ghaffari-Rafi
- University of Hawaiʻi at Mānoa, John A. Burns School of Medicine, Honolulu, HI
- University College London, Queen Square Institute of Neurology, London, UK
| | - Ki Suk Eum
- Tripler Army Medical Center, Department of Medicine, Honolulu, HI
| | - Jesus Villanueva
- Tripler Army Medical Center, Department of Medicine, Honolulu, HI
| | - Jay Jahanmir
- University of Hawaiʻi at Mānoa, John A. Burns School of Medicine, Honolulu, HI
- Tripler Army Medical Center, Department of Medicine, Honolulu, HI
| |
Collapse
|
9
|
Archer JRH, Mendes F, Hudson S, Layne K, Dargan PI, Wood DM. Evaluation of long-term detection trends of new psychoactive substances in pooled urine from city street portable urinals (London, UK). Br J Clin Pharmacol 2020; 86:517-527. [PMID: 32050035 DOI: 10.1111/bcp.14239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the long-term trends of new psychoactive substance (NPS) detection in pooled urine samples collected across a city centre. METHODS Pooled urine samples from portable stand-alone urinals were collected on a monthly basis over 5.5 years (July 2013-December 2018) across a city centre. These were analysed using a high-performance liquid chromatography system, interfaced to a high-resolution accurate mass spectrometer. Data were processed against a database containing over 2000 drugs/metabolites including over 800 NPS. RESULTS In total, 44 NPS were detected with variation over time including cathinones (15, 34.1%), synthetic cannabinoids (8, 18.2%) and 21 (47.7%) other NPS. Since the introduction of the UK Psychoactive Substances Act (May 2016) cathinone detection has decreased with minimal detection over the last 4 months of the study. Synthetic cannabinoids were not detected on a regular basis until July 2016 with a subsequent variable detection frequency. There was a consistent, low level detection frequency of all other NPS throughout the study, but which appears to have increased alongside the decrease in cathinone detection. CONCLUSION Pooled urine analysis of samples taken from portable urinals in a city centre can be used as an effective monitoring tool to determine long-term trends in the use of NPS. The results of this study demonstrate the impact of the Psychoactive Substances Act and reflect the findings of population surveys and clinical studies. Triangulation of these data with other data sources will enable greater insight into the NPS phenomenon.
Collapse
Affiliation(s)
- John R H Archer
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Fiona Mendes
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Simon Hudson
- Laboratory and Managed Services, LGC, Fordham, UK
| | - Kerry Layne
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Paul I Dargan
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
10
|
Maghsoudi N, McDonald K, Stefan C, Beriault DR, Mason K, Barnaby L, Altenberg J, MacDonald RD, Caldwell J, Nisenbaum R, Leece P, Watson TM, Tupper KW, Kufner L, Scheim AI, Werb D. Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale. Harm Reduct J 2020; 17:9. [PMID: 32204713 PMCID: PMC7092475 DOI: 10.1186/s12954-019-0336-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply. METHODS We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized. RESULTS Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs. CONCLUSIONS This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.
Collapse
Affiliation(s)
- N Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - K McDonald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
| | - C Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - D R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - K Mason
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - L Barnaby
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - J Altenberg
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - R D MacDonald
- Toronto Paramedic Services, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Caldwell
- Toronto Public Health, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions and Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - T M Watson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - K W Tupper
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Kufner
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - A I Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - D Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA.
| |
Collapse
|
11
|
Aguilar MA, García-Pardo MP, Parrott AC. Of mice and men on MDMA: A translational comparison of the neuropsychobiological effects of 3,4-methylenedioxymethamphetamine ('Ecstasy'). Brain Res 2020; 1727:146556. [PMID: 31734398 DOI: 10.1016/j.brainres.2019.146556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
Abstract
MDMA (3,4-methylendioxymethamphetamine), also known as Ecstasy, is a stimulant drug recreationally used by young adults usually in dance clubs and raves. Acute MDMA administration increases serotonin, dopamine and noradrenaline by reversing the action of the monoamine transporters. In this work, we review the studies carried out over the last 30 years on the neuropsychobiological effects of MDMA in humans and mice and summarise the current knowledge. The two species differ with respect to the neurochemical consequences of chronic MDMA, since it preferentially induces serotonergic dysfunction in humans and dopaminergic neurotoxicity in mice. However, MDMA alters brain structure and function and induces hormonal, psychomotor, neurocognitive, psychosocial and psychiatric outcomes in both species, as well as physically damaging and teratogen effects. Pharmacological and genetic studies in mice have increased our knowledge of the neurochemical substrate of the multiple effects of MDMA. Future work in this area may contribute to developing pharmacological treatments for MDMA-related disorders.
Collapse
Affiliation(s)
- Maria A Aguilar
- Department of Psychobiology, Faculty of Psychology, Valencia University, Valencia, Spain.
| | | | - Andrew C Parrott
- Department of Psychology, Swansea University, Swansea, United Kingdom; Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
| |
Collapse
|
12
|
Pantoni MM, Anagnostaras SG. Cognitive Effects of MDMA in Laboratory Animals: A Systematic Review Focusing on Dose. Pharmacol Rev 2019; 71:413-449. [PMID: 31249067 DOI: 10.1124/pr.118.017087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
±3,4-Methylenedioxymethamphetamine (MDMA) is a synthetic, psychoactive drug that is primarily used recreationally but also may have some therapeutic value. At low doses, MDMA produces feelings of relaxation, empathy, emotional closeness, and euphoria. Higher doses can produce unpleasant psychostimulant- and hallucinogen-like adverse effects and therefore are usually not taken intentionally. There is considerable evidence that MDMA produces neurotoxicity and cognitive deficits at high doses; however, these findings may not generalize to typical recreational or therapeutic use of low-dose MDMA. Here, we systematically review 25 years of research on the cognitive effects of MDMA in animals, with a critical focus on dose. We found no evidence that doses of less than 3 mg/kg MDMA-the dose range that users typically take-produce cognitive deficits in animals. Doses of 3 mg/kg or greater, which were administered most often and frequently ranged from 5 to 20 times greater than an average dose, also did not produce cognitive deficits in a slight majority of experiments. Overall, the preclinical evidence of MDMA-induced cognitive deficits is weak and, if anything, may be the result of unrealistically high dosing. While factors associated with recreational use such as polydrug use, adulterants, hyperthermia, and hyponatremia can increase the potential for neurotoxicity, the short-term, infrequent, therapeutic use of ultra low-dose MDMA is unlikely to pose significant cognitive risks. Future studies must examine any adverse cognitive effects of MDMA using clinically relevant doses to reliably assess its potential as a psychotherapeutic.
Collapse
Affiliation(s)
- Madeline M Pantoni
- Molecular Cognition Laboratory, Department of Psychology (M.M.P., S.G.A.) and Program in Neurosciences (S.G.A.), University of California San Diego, La Jolla, California
| | - Stephan G Anagnostaras
- Molecular Cognition Laboratory, Department of Psychology (M.M.P., S.G.A.) and Program in Neurosciences (S.G.A.), University of California San Diego, La Jolla, California
| |
Collapse
|
13
|
Peck Y, Clough AR, Culshaw PN, Liddell MJ. Multi-drug cocktails: Impurities in commonly used illicit drugs seized by police in Queensland, Australia. Drug Alcohol Depend 2019; 201:49-57. [PMID: 31181437 DOI: 10.1016/j.drugalcdep.2019.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impurities in commonly used illicit drugs raise concerns for unwitting consumers when pharmacologically active adulterants, especially new psychoactive substances (NPS), are used. This study examines impurities detected in illicit drugs seized in one Australian jurisdiction. METHODS Queensland Health Forensic and Scientific Services provided analytical data. Data described the chemical composition of 9346 samples of 11 illicit drugs seized by police during 2015-2016. Impurities present in primary drugs were summarized and tabulated. A systematic search for published evidence reporting similar analyses was conducted. RESULTS Methamphetamine was the primary drug in 6608 samples, followed by MDMA (1232 samples) and cocaine (516 samples). Purity of primary drugs ranged from ∼30% for cocaine, 2-CB and GHB to >90% for THC, methamphetamine, heroin and MDMA. Methamphetamine and MDMA contained the largest variety of impurities: 22 and 18 variants, respectively. Drug adulteration patterns were broadly similar to those found elsewhere, including NPS, but in some primary drugs impurities were found which had not been reported elsewhere. Psychostimulants were adulterated with each other. Levamisole was a common impurity in cocaine. Psychedelics were adulterated with methamphetamine and NPS. Opioids were quite pure, but some samples contained methamphetamine and synthetic opioids. CONCLUSIONS Impurities detected were mostly pharmacologically active adulterants probably added to enhance desired effects or for active bulking. Given the designer nature of these drug cocktails, the effects of the adulterated drugs on users from possible complex multi-drug interactions is unpredictable. Awareness-raising among users, research into complex multi-drug effects and ongoing monitoring is required.
Collapse
Affiliation(s)
- Yoshimi Peck
- College of Science and Engineering, James Cook University, 14-88 McGregor Road, Smithfield, Queensland, Australia.
| | - Alan R Clough
- College of Public Health, Medical and Vet Sciences, James Cook University, 14-88 McGregor Road, Smithfield, Queensland, Australia
| | - Peter N Culshaw
- Forensic Chemistry, Forensic and Scientific Services, Queensland Health, 39 Kessels Road, Coopers Plains, 4108, Queensland, Australia
| | - Michael J Liddell
- College of Science and Engineering, James Cook University, 14-88 McGregor Road, Smithfield, Queensland, Australia
| |
Collapse
|
14
|
Couchman L, Frinculescu A, Sobreira C, Shine T, Ramsey J, Hecht M, Kipper K, Holt D, Johnston A. Variability in content and dissolution profiles of MDMA tablets collected in the UK between 2001 and 2018 - A potential risk to users? Drug Test Anal 2019; 11:1172-1182. [PMID: 31009168 DOI: 10.1002/dta.2605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/07/2022]
Abstract
3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) tablets are widely used recreationally, and not only vary in appearance, but also in MDMA content. Recently, the prevalence of high-content tablets is of concern to public health authorities. To compare UK data with other countries, we evaluated MDMA content of 412 tablets collected from the UK, 2001-2018, and investigated within-batch content variability for a sub-set of these samples. In addition, we investigated dissolution profiles of tablets using pharmaceutical industry-standard dissolution experiments on 247 tablets. All analyses were carried out using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Our data supported other studies, in that recent samples (2016-2018) tend to have higher MDMA content compared to earlier years. In 2018, the median MDMA content exceeded 100 mg free-base for the first time. Dramatic within-batch content variability (up to 136 mg difference) was also demonstrated. Statistical evaluation of dissolution profiles at 15-minutes allowed tablets to be categorized as fast-, intermediate-, or slow-releasing, but no tablet characteristics correlated with dissolution classification. Hence, there would be no way of users knowing a priori whether a tablet is more likely to be fast or slow-releasing. Further, within-batch variation in dissolution rate was observed. Rapid assessment of MDMA content alone provides important data for harm reduction, but does not account for variability in (a) the remainder of tablets in a batch, or (b) MDMA dissolution profiles. Clinical manifestations of MDMA toxicity, especially for high-content, slow-releasing tablets, may be delayed or prolonged, and there is a significant risk of users re-dosing if absorption is delayed.
Collapse
Affiliation(s)
- Lewis Couchman
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, UK.,Pharmaceutical Sciences Clinical Academic Group, King's College London, London, UK
| | - Anca Frinculescu
- TICTAC Communications, St. George's University of London, Cranmer Terrace, London, UK
| | - Catarina Sobreira
- TICTAC Communications, St. George's University of London, Cranmer Terrace, London, UK.,Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Trevor Shine
- TICTAC Communications, St. George's University of London, Cranmer Terrace, London, UK
| | - John Ramsey
- TICTAC Communications, St. George's University of London, Cranmer Terrace, London, UK
| | - Max Hecht
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, UK.,Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - Karin Kipper
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, UK.,Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - David Holt
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, UK
| | - Atholl Johnston
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, UK.,Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| |
Collapse
|
15
|
Gjerde H, Gjersing L, Baz-Lomba JA, Bijlsma L, Salgueiro-González N, Furuhaugen H, Bretteville-Jensen AL, Hernández F, Castiglioni S, Johanna Amundsen E, Zuccato E. Drug Use by Music Festival Attendees: A Novel Triangulation Approach Using Self-Reported Data and Test Results of Oral Fluid and Pooled Urine Samples. Subst Use Misuse 2019; 54:2317-2327. [PMID: 31398072 DOI: 10.1080/10826084.2019.1646285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Self-reported data are commonly used when investigating illicit substance use. However, self-reports have well-known limitations such as limited recall and socially desirable responding. Mislabeling or adulteration of drugs on the illicit market may also cause incorrect reporting. Objectives: We aimed to examine what could be gained in terms of illicit drug use findings among music festival attendees when including biological sample test results in the assessment. Methods: We included 651 attendees at three music festivals in Norway from June to August 2016. Self-reported drug use was recorded using questionnaires, and samples of oral fluid were analyzed to detect use of illicit drugs. In addition, we analyzed samples of pooled urine from portable toilets at each festival. Results: All methods identified cannabis, MDMA, and cocaine as the most commonly used drugs. Overall, 6.6% of respondents reported use of illicit substances during the previous 48 hours. Oral fluid testing identified a larger number of drug users as 12.6% tested positive for illicit drugs. In oral fluid testing, we identified ketamine and three new psychoactive substances (NPS) that had not been reported on the questionnaire. In pooled urine testing, we identified amphetamine and three additional NPS that were neither reported used nor found in oral fluid samples. Conclusions/Importance: Drug testing of biological samples proved to be an important supplement to self-reports as a larger number of illicit substances could be detected.
Collapse
Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Linn Gjersing
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Lubertus Bijlsma
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | | | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Félix Hernández
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Sara Castiglioni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ellen Johanna Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Ettore Zuccato
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
16
|
Palamar JJ, Barratt MJ. Prevalence of reagent test-kit use and perceptions of purity among ecstasy users in an electronic dance music scene in New York City. Drug Alcohol Rev 2019; 38:42-49. [PMID: 30575155 PMCID: PMC6338488 DOI: 10.1111/dar.12882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND AIMS Ecstasy users in the electronic dance music scene are at high risk for using ecstasy adulterated with new psychoactive substances and/or methamphetamine. We examined self-reported testing of ecstasy among users in this scene. DESIGN AND METHODS We surveyed individuals (aged 18-40 years) entering electronic dance music parties in New York City in 2017. Past-year ecstasy users (n = 351) were asked if they had tested their ecstasy in the past year. We estimated prevalence and correlates of having tested one's ecstasy. RESULTS 23.1% reported having tested their ecstasy in the past year. Those with some college (adjusted prevalence ratio [aPR] = 0.49, P = 0.014) or a college degree (aPR = 0.41, P = 0.025) were less likely to test their ecstasy than those with a high school diploma or less. Using ecstasy pills (aPR = 1.89, P = 0.036) or crystals (aPR = 1.90, P = 0.006) ≥3 times in the past year was associated with increased likelihood of testing one's ecstasy, and purchasing from an unknown or untrustworthy dealer was associated with decreased likelihood (aPR = 0.63, P = 0.034) of testing one's ecstasy. Half (51.1%) of ecstasy users reported finding out or suspecting their ecstasy had contained a drug other than MDMA. Of these, 49.2% reported finding out their ecstasy contained methamphetamine or speed/amphetamine. Most ecstasy users reported that they would be less likely to use again upon learning their ecstasy contained 'bath salts' (54.8%) or methamphetamine (54.3%). DISCUSSION AND CONCLUSIONS Drug testing appears to help ecstasy users detect adulterants and results can help inform harm reduction efforts. Less frequent users in particular may require education about adulteration and drug-testing.
Collapse
Affiliation(s)
| | - Monica J. Barratt
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| |
Collapse
|
17
|
Amoroso T. The spurious relationship between ecstasy use and neurocognitive deficits: A Bradford Hill review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 64:47-53. [PMID: 30579220 DOI: 10.1016/j.drugpo.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/13/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
Abstract
Numerous studies have suggested that MDMA can cause neurocognitive deficits. However, the available data can only suggest an association - rather than a causal relationship - between MDMA use and neurocognitive deficits. The reliability and robustness of this association was evaluated using Bradford Hill's criteria for determining causation in epidemiology research. Several limitations in the literature were found. Studies have recruited people who abuse ecstasy - an illicit drug that does not always contain MDMA. There is inherent risk in consuming impure or falsely identified substances; and using this as a source as for scientific opinion may introduce biases in our understanding the actuals risks associated with MDMA. Importantly, given that ecstasy research is predominately retrospective, baseline functioning cannot be established; which may be influenced by a variety of preexisting factors. Many studies introduce statistical errors by inconsistently dichotomizing and comparing light and heavy ecstasy users, making dose-response relationships inconclusive. When interpreting the ecstasy literature effect sizes are a more meaningful indicator of neurocognitive functioning rather than relying on p-values alone. Most meta-analyses have failed to find clinically relevant differences between ecstasy users and controls. There is also consistent evidence of publication bias in this field of research, which indicates that the literature is both biased and incomplete. Finally, suggestions for improving the ecstasy literature are provided.
Collapse
Affiliation(s)
- Timothy Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
18
|
Highgate Q, Schenk S. Comparison of the effects of abstinence on MDMA and cocaine self-administration in rats. Psychopharmacology (Berl) 2018; 235:3233-3241. [PMID: 30209532 DOI: 10.1007/s00213-018-5026-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE 3,4-Methylenedioxymethamphetamine (MDMA) preferentially increases synaptic serotonin (5HT). This response was attenuated following repeated exposure but there was recovery as a result of abstinence. Effects of abstinence on self-administration of many drugs have been documented but the impact on MDMA self-administration is unknown. OBJECTIVE This study compared the effects of abstinence on MDMA and cocaine self-administration. METHODS Six-hour daily MDMA or cocaine sessions were conducted until a total of 350 mg/kg had been self-administered. Following this, rats were randomly assigned to either a 0- or 14-day abstinence group. Self-administration testing then continued for an additional 7 days. RESULTS The latency to self-administer 350 mg/kg was shorter for rats that self-administered cocaine. The temporal distribution of responding within each test session also differed; MDMA self-administration was high during the first hour of each session, and decreased during subsequent hours, whereas cocaine self-administration was evenly distributed throughout each hour of the session. Abstinence decreased MDMA but not cocaine self-administration. CONCLUSIONS The selective reduction of MDMA self-administration following abstinence is consistent with the idea that MDMA-stimulated 5-HT release is inhibitory to MDMA self-administration.
Collapse
Affiliation(s)
- Quenten Highgate
- School of Psychology, Victoria University of Wellington, Wellington, 6011, New Zealand
| | - Susan Schenk
- School of Psychology, Victoria University of Wellington, Wellington, 6011, New Zealand.
| |
Collapse
|
19
|
Palamar JJ, Salomone A, Cleland CM, Sherman S. Willingness to provide a hair sample for drug testing among electronic dance music party attendees. Subst Abus 2018; 40:116-123. [PMID: 29694301 DOI: 10.1080/08897077.2018.1469106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Nondisclosure of drug use on surveys is common, and many drug users unknowingly ingest adulterant or replacement drugs, which leads to underreporting of use of these drugs. Biological testing can complement survey research, and hair testing is an appealing method, as many drugs are detectable for months post-use. We examined willingness to donate a hair sample to be tested among those surveyed in a population at high risk for consuming adulterated drugs-electronic dance music (EDM) party attendees. Methods: We surveyed 933 adults entering EDM parties in New York City in 2017. Hair donation response rates and reasons for refusal were examined from this cross-sectional study. Results: A third (n = 312; 33.4%) provided a hair sample. Lack of interest (21.0%), lack of time (19.8%), not wanting a lock of hair cut (17.7%), and disinterest in having hair cut in public (13.8%) were the main reported reasons for refusal; 4.7% refused because they could not receive results. Past-year drug users were more likely to fear identification than nonusers (P < .001). Asian participants were at lower odds of providing a hair sample (adjusted odds ratio [aOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87), and those reporting past-year use of LSD (aOR = 1.62, 95% CI = 1.11-2.35), opioids (nonmedical; aOR = 1.93, 95% CI = 1.25-2.99), and/or methamphetamine (aOR = 3.43, 95% CI = 1.36-8.62) were at higher odds of providing a sample than nonusers of these drugs. Conclusions: Only a third of participants provided a hair sample, and we found individual-level differences regarding willingness to provide a sample. Factors contributing to refusal should be considered to increase response rates and generalizability of results.
Collapse
Affiliation(s)
- Joseph J Palamar
- a Department of Population Health , New York University Langone Medical Center , New York, New York , USA.,b Center for Drug Use and HIV Research , NYU Rory Meyers College of Nursing , New York, New York , USA
| | - Alberto Salomone
- c Centro Regionale Antidoping e di Tossicologia "A. Bertinaria" , Orbassano, Turin , Italy
| | - Charles M Cleland
- b Center for Drug Use and HIV Research , NYU Rory Meyers College of Nursing , New York, New York , USA
| | - Scott Sherman
- a Department of Population Health , New York University Langone Medical Center , New York, New York , USA.,b Center for Drug Use and HIV Research , NYU Rory Meyers College of Nursing , New York, New York , USA
| |
Collapse
|
20
|
Schenberg EE. Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Front Pharmacol 2018; 9:733. [PMID: 30026698 PMCID: PMC6041963 DOI: 10.3389/fphar.2018.00733] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/18/2018] [Indexed: 12/20/2022] Open
Abstract
Mental disorders are rising while development of novel psychiatric medications is declining. This stall in innovation has also been linked with intense debates on the current diagnostics and explanations for mental disorders, together constituting a paradigmatic crisis. A radical innovation is psychedelic-assisted psychotherapy (PAP): professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs. Clinical results so far have shown safety and efficacy, even for “treatment resistant” conditions, and thus deserve increasing attention from medical, psychological and psychiatric professionals. But more than novel treatments, the PAP model also has important consequences for the diagnostics and explanation axis of the psychiatric crisis, challenging the discrete nosological entities and advancing novel explanations for mental disorders and their treatment, in a model considerate of social and cultural factors, including adversities, trauma, and the therapeutic potential of some non-ordinary states of consciousness.
Collapse
|
21
|
Pereira LS, Lisboa FL, Coelho Neto J, Valladão FN, Sena MM. Screening method for rapid classification of psychoactive substances in illicit tablets using mid infrared spectroscopy and PLS-DA. Forensic Sci Int 2018; 288:227-235. [DOI: 10.1016/j.forsciint.2018.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/06/2018] [Accepted: 05/01/2018] [Indexed: 12/28/2022]
|
22
|
Fox J, Smith A, Yale A, Chow C, Alaswad E, Cushing T, Monte AA. Drugs of Abuse and Novel Psychoactive Substances at Outdoor Music Festivals in Colorado. Subst Use Misuse 2018; 53:1203-1211. [PMID: 29148866 PMCID: PMC5935531 DOI: 10.1080/10826084.2017.1400067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Drugs of abuse (DOA) are widely used in the United States and are ubiquitous at outdoor music festivals. Attendees at music festivals are at high-risk for novel psychoactive substance (NPS) use, which is becoming more prevalent worldwide. No U.S. studies have employed an qualitative approach to investigate the etiologies of both traditional DOA and NPS use amongst music festival attendees. OBJECTIVES The objective of this study was to improve understanding of the knowledge, attitudes, beliefs, and practices of festival attendees using NPS and DOA. METHODS We conducted semi-structured interviews of 171 attendees during the Sonic Bloom and Arise music festivals in Colorado in 2015 and 2016. Discrete variables were summarized with descriptive statistics. The anonymous, multi-domain interview documented the knowledge, attitudes beliefs, and practices underlying DOA use, which were analyzed with qualitative methods. RESULTS We enrolled 171 participants that endorsed DOA use at the festivals. Most were experienced DOA users, who perceived minimal risks associated with DOA and NPS use. Nearly all unanimously reported normalization of DOA at music festivals. Participants popularly cited empathogenic, entactogenic, and entheogenic effects of DOA as their primary motivations for use. NPS use was endorsed by 39.8% (n = 68) of respondents, all of whom identified as being experienced DOA users. CONCLUSIONS This population of novel psychoactive substance users is primarily composed of experienced drug users that endorsed use because of low cost, minimal perceived risk, accessibility, and normalization of drug use at music festivals.
Collapse
Affiliation(s)
- Jacob Fox
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexis Smith
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexander Yale
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher Chow
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado, USA
| | - Elsa Alaswad
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado, USA
| | - Tracy Cushing
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado, USA
- Groove Medical Services, Inc., Aurora, Colorado, USA
| | - Andrew A. Monte
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado, USA
- Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA
| |
Collapse
|
23
|
Genuine sildenafil tablets sold in Brazil disguised as MDMA. Forensic Sci Int 2017; 283:e8-e12. [PMID: 29295746 DOI: 10.1016/j.forsciint.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/13/2017] [Accepted: 12/03/2017] [Indexed: 11/20/2022]
Abstract
MDMA and sildenafil are two examples among many substances consumed in "raves", as well as in other types of "recreative" social events nowadays. During the first six months of 2017, five cases of supposedly MDMA tablets seized by local law enforcement forces in the state of Minas Gerais, Brazil, and brought to our forensic laboratory for examination, attracted our attention among dozens of others, as the tablets apprehended in these cases were, in fact, colorfully painted versions of genuine, pentagon-shaped, sildenafil tablets, freely available for sale in local pharmacies and drugstores. Physical profiling, together with ATR-FTIR spectral matching, multi-component/deconvolution analysis and correlation were employed to prove that these tablets were genuine sildenafil tablets from a specific manufacturer, painted in a colorful way so that they could be marketed as MDMA tablets to unsuspecting buyers.
Collapse
|
24
|
Palamar JJ. What's in a Name? Correlates of Ecstasy Users Knowing or Agreeing that Molly is Ecstasy/MDMA. J Psychoactive Drugs 2017; 50:88-93. [PMID: 28937933 DOI: 10.1080/02791072.2017.1369200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ecstasy (MDMA) has regained popularity in powder and crystalline form, known as Molly. However, it is unknown whether all Molly users are aware that Molly is ecstasy. A total of 1045 nightclub/festival-attending adults in New York City were surveyed about ecstasy/MDMA/Molly use in 2016. Users were asked if they agreed that "Molly is (or is supposed to be) ecstasy/MDMA." Of the 43.5% reporting lifetime use, 84.6% agreed that Molly is ecstasy, 9.5% disagreed, and 5.9% reported not knowing that Molly is ecstasy. Prevalence of use of other drugs (e.g., ketamine, opioids, methamphetamine, NBOMe, 2C series) was lowest among those not knowing that Molly is ecstasy, and highest among those not agreeing that Molly is ecstasy. Those not knowing that Molly is ecstasy were less likely to have used powder or crystal MDMA and less likely to have used in the past 12 months or to report intention to use again. Those disagreeing or not knowing that Molly is ecstasy were at over six times the odds of obtaining ecstasy from an unknown dealer, and those disagreeing were at four times higher odds of having suspected or found out that their ecstasy was adulterated. Results suggest that knowing or agreeing that Molly is ecstasy/MDMA can help indicate ecstasy-related risk.
Collapse
Affiliation(s)
- Joseph J Palamar
- a Associate Professor, Department of Population Health , New York University Langone Medical Center , New York , NY , USA.,b Research Affiliate, Center for Drug Use and HIV Research , NYU Rory Meyers College of Nursing , New York , NY , USA
| |
Collapse
|
25
|
Cadoni C, Pisanu A, Simola N, Frau L, Porceddu PF, Corongiu S, Dessì C, Sil A, Plumitallo A, Wardas J, Di Chiara G. Widespread reduction of dopamine cell bodies and terminals in adult rats exposed to a low dose regimen of MDMA during adolescence. Neuropharmacology 2017; 123:385-394. [DOI: 10.1016/j.neuropharm.2017.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/16/2022]
|
26
|
Saleemi S, Pennybaker SJ, Wooldridge M, Johnson MW. Who is 'Molly'? MDMA adulterants by product name and the impact of harm-reduction services at raves. J Psychopharmacol 2017; 31:1056-1060. [PMID: 28693371 DOI: 10.1177/0269881117715596] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Methylenedioxymethamphetamine (MDMA), often sold as 'Ecstasy' or 'Molly', is commonly used at music festivals and reported to be responsible for an increase in deaths over the last decade. Ecstasy is often adulterated and contains compounds that increase morbidity and mortality. While users and clinicians commonly assume that products sold as Molly are less-adulterated MDMA products, this has not been tested. Additionally, while pill-testing services are sometimes available at raves, the assumption that these services decrease risky drug use has not been studied. This study analyzed data collected by the pill-testing organization, DanceSafe, from events across the United States from 2010 to 2015. Colorimetric reagent assays identified MDMA in only 60% of the 529 samples collected. No significant difference in the percentage of samples testing positive for MDMA was determined between Ecstasy and Molly. Individuals were significantly less likely to report intent to use a product if testing did not identify MDMA (relative risk (RR) = 0.56, p = 0.01). Results suggest that Molly is not a less-adulterated substance, and that pill-testing services are a legitimate harm-reduction service that decreases intent to consume potentially dangerous substances and may warrant consideration by legislators for legal protection. Future research should further examine the direct effects of pill-testing services and include more extensive pill-testing methods.
Collapse
Affiliation(s)
- Sarah Saleemi
- 1 Johns Hopkins University School of Medicine, Baltimore, USA
| | | | | | - Matthew W Johnson
- 3 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
27
|
Crutzen R, Peters GJY, Noijen J. Using Confidence Interval-Based Estimation of Relevance to Select Social-Cognitive Determinants for Behavior Change Interventions. Front Public Health 2017; 5:165. [PMID: 28785553 PMCID: PMC5508122 DOI: 10.3389/fpubh.2017.00165] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/22/2017] [Indexed: 01/04/2023] Open
Abstract
When developing an intervention aimed at behavior change, one of the crucial steps in the development process is to select the most relevant social-cognitive determinants. These determinants can be seen as the buttons one needs to push to establish behavior change. Insight into these determinants is needed to select behavior change methods (i.e., general behavior change techniques that are applied in an intervention) in the development process. Therefore, a study on determinants is often conducted as formative research in the intervention development process. Ideally, all relevant determinants identified in such a study are addressed by an intervention. However, when developing a behavior change intervention, there are limits in terms of, for example, resources available for intervention development and the amount of content that participants of an intervention can be exposed to. Hence, it is important to select those determinants that are most relevant to the target behavior as these determinants should be addressed in an intervention. The aim of the current paper is to introduce a novel approach to select the most relevant social-cognitive determinants and use them in intervention development. This approach is based on visualization of confidence intervals for the means and correlation coefficients for all determinants simultaneously. This visualization facilitates comparison, which is necessary when making selections. By means of a case study on the determinants of using a high dose of 3,4-methylenedioxymethamphetamine (commonly known as ecstasy), we illustrate this approach. We provide a freely available tool to facilitate the analyses needed in this approach.
Collapse
Affiliation(s)
- Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands
| | - Gjalt-Jorn Ygram Peters
- Faculty of Psychology and Education Science, Open University of the Netherlands, Heerlen, Netherlands
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | | |
Collapse
|
28
|
Sutherland R, Bruno R, Peacock A, Lenton S, Matthews A, Salom C, Dietze P, Butler K, Burns L, Barratt MJ. Motivations for new psychoactive substance use among regular psychostimulant users in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 43:23-32. [DOI: 10.1016/j.drugpo.2016.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/22/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
|
29
|
Miner NB, O'Callaghan JP, Phillips TJ, Janowsky A. The combined effects of 3,4-methylenedioxymethamphetamine (MDMA) and selected substituted methcathinones on measures of neurotoxicity. Neurotoxicol Teratol 2017; 61:74-81. [PMID: 28212938 PMCID: PMC5453829 DOI: 10.1016/j.ntt.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/19/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022]
Abstract
The rise in popularity of substituted methcathinones (aka "bath salts") has increased the focus on their neurotoxic effects. Two commonly abused methcathinones, 3,4-methylenedioxymethcathinone (methylone, MDMC) and 3,4-methylenedioxypyrovalerone (MDPV), are often concomitantly ingested with the illicit drug 3,4-methylenedioxymethamphetamine (MDMA). To examine potential neurotoxic effects of these drug combinations, C57BL/6J mice were administered 4 i.p. injection of the drugs, at 2h intervals, either singularly: MDMA 15 or 30mg/kg, methylone 20mg/kg, MDPV 1mg/kg; or in combination: methylone/MDMA 20/15mg/kg, MDPV/MDMA 1/15mg/kg. Drug effects on thermoregulation were characterized and striatal tissue analyzed after 2 or 7days for dopamine (DA) and tyrosine hydroxylase (TH) levels, as well as glial fibrillary acidic protein (GFAP) expression. Two days following drug administration, DA and TH were decreased only in the MDMA 30mg/kg group, whereas GFAP expression was dose-dependently increased by MDMA alone. While the combination of the methcathinones with the lower MDMA dose did not affect DA or TH levels, both blocked the MDMA-induced increase in GFAP expression. Seven days following drug administration, there were no significant differences in DA, TH, or GFAP for any treatment group, indicating that changes in DA, TH, and GFAP were transient. Five of the six drug groups exhibited acute hypothermia followed by gradually increasing temperatures. Animals treated with MDPV did not exhibit these biphasic temperature changes, and resembled the saline group. These results indicate that specific effects of both methylone and MDPV on DA depletion or astrocyte activation in the striatum are not additive with effects of MDMA, but block astrogliosis caused by MDMA alone. Additionally, MDPV modulates thermoregulation through a different mechanism than methylone or MDMA.
Collapse
Affiliation(s)
- Nicholas B Miner
- Research Service, VA Portland Health Care System, Portland, OR, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - James P O'Callaghan
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Tamara J Phillips
- Research Service, VA Portland Health Care System, Portland, OR, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA; The Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Aaron Janowsky
- Research Service, VA Portland Health Care System, Portland, OR, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA; The Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
30
|
van der Gouwe D, Brunt TM, van Laar M, van der Pol P. Purity, adulteration and price of drugs bought on-line versus off-line in the Netherlands. Addiction 2017; 112:640-648. [PMID: 27936283 DOI: 10.1111/add.13720] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/25/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS On-line drug markets flourish and consumers have high expectations of on-line quality and drug value. The aim of this study was to (i) describe on-line drug purchases and (ii) compare on-line with off-line purchased drugs regarding purity, adulteration and price. DESIGN Comparison of laboratory analyses of 32 663 drug consumer samples (stimulants and hallucinogens) purchased between January 2013 and January 2016, 928 of which were bought on-line. SETTING The Netherlands. MEASUREMENTS Primary outcome measures were (i) the percentage of samples purchased on-line and (ii) the chemical purity of powders (or dosage per tablet); adulteration; and the price per gram, blotter or tablet of drugs bought on-line compared with drugs bought off-line. FINDINGS The proportion of drug samples purchased on-line increased from 1.4% in 2013 to 4.1% in 2015. The frequency varied widely, from a maximum of 6% for controlled, traditional substances [ecstasy tablets, 3,4-methylenedioxy-methamphetamine (MDMA) powder, amphetamine powder, cocaine powder, 4-bromo-2,5-dimethoxyphenethylamine (2C-B) and lysergic acid diethylamide (LSD)] to more than a third for new psychoactive substances (NPS) [4-fluoroamphetamine (4-FA), 5/6-(2-aminopropyl)benzofuran (5/6-APB) and methoxetamine (MXE)]. There were no large differences in drug purity, yet small but statistically significant differences were found for 4-FA (on-line 59% versus off-line 52% purity for 4-FA on average, P = 0.001), MDMA powders (45 versus 61% purity for MDMA, P = 0.02), 2C-B tablets (21 versus 10 mg 2C-B/tablet dosage, P = 0.49) and ecstasy tablets (131 versus 121 mg MDMA/tablet dosage, P = 0.05). The proportion of adulterated samples purchased on-line and off-line did not differ, except for 4-FA powder, being less adulterated on-line (χ2 = 8.3; P < 0.02). Drug prices were mainly higher on-line, ranging for various drugs from 10 to 23% higher than that of drugs purchased off-line (six of 10 substances: P < 0.05). CONCLUSIONS Dutch drug users increasingly purchase drugs on-line: new psychoactive substances in particular. Purity and adulteration do not vary considerably between drugs purchased on-line and off-line for most substances, while on-line prices are mostly higher than off-line prices.
Collapse
Affiliation(s)
- Daan van der Gouwe
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Tibor M Brunt
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Margriet van Laar
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| |
Collapse
|
31
|
Palamar JJ. There's something about Molly: The underresearched yet popular powder form of ecstasy in the United States. Subst Abus 2016; 38:15-17. [PMID: 27925866 DOI: 10.1080/08897077.2016.1267070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Molly has been the street name for powder or crystalline ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) in the United States since the early 2000s; however, few studies have examined Molly use or included Molly in the definition of ecstasy/MDMA. Prevalence of self-reported ecstasy use is being underreported on surveys due to the lack of inclusion of "Molly," although Molly is often so adulterated with novel psychoactive substances such as synthetic cathinones ("bath salts") that the name "Molly" may no longer adequately represent ecstasy/MDMA. The author recommends that Molly use and Molly purity be further studied to more adequately inform prevention and harm reduction.
Collapse
Affiliation(s)
- Joseph J Palamar
- a Department of Population Health , New York University Langone Medical Center , New York , New York , USA.,b Center for Drug Use and HIV Research, New York University College of Nursing , New York , New York , USA
| |
Collapse
|
32
|
Shortall SE, Green AR, Fone KC, King MV. Caffeine alters the behavioural and body temperature responses to mephedrone without causing long-term neurotoxicity in rats. J Psychopharmacol 2016; 30:698-706. [PMID: 27257032 DOI: 10.1177/0269881116650408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Administration of caffeine with 3,4-methylenedioxymethamphetamine (MDMA) alters the pharmacological properties of MDMA in rats. The current study examined whether caffeine alters the behavioural and neurochemical effects of mephedrone, which has similar psychoactive effects to MDMA. Rats received either saline, mephedrone (10 mg/kg), caffeine (10 mg/kg) or combined caffeine and mephedrone intraperitoneally twice weekly on consecutive days for three weeks. Locomotor activity (days 1 and 16), novel object discrimination (NOD, day 2), elevated plus maze (EPM) exploration (day 8), rectal temperature changes (day 9) and pre-pulse inhibition (PPI) of acoustic startle response (day 15) were assessed. Seven days after the final injection, brain regions were collected for the measurement of 5-hydroxytryptamine (5-HT), dopamine and their metabolites. Combined caffeine and mephedrone further enhanced the locomotor response observed following either drug administered alone, and converted mephedrone-induced hypothermia to hyperthermia. Co-administration also abolished mephedrone-induced anxiogenic response on the EPM, but had no effect on NOD or PPI. Importantly, no long-term neurotoxicity was detected following repeated mephedrone alone or when co-administered with caffeine. In conclusion, the study suggests a potentially dangerous effect of concomitant caffeine and mephedrone, and highlights the importance of taking polydrug use into consideration when investigating the acute adverse effect profile of popular recreational drugs.
Collapse
Affiliation(s)
- Sinead E Shortall
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, UK
| | - A Richard Green
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, UK
| | - Kevin Cf Fone
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, UK
| | - Madeleine V King
- School of Life Sciences, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, UK
| |
Collapse
|
33
|
Palamar JJ, Acosta P, Sherman S, Ompad DC, Cleland CM. Self-reported use of novel psychoactive substances among attendees of electronic dance music venues. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:624-632. [PMID: 27315522 DOI: 10.1080/00952990.2016.1181179] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Novel psychoactive substances (NPSs) continue to emerge in the United States and worldwide. Few epidemiological studies have examined the prevalence and correlates of use. OBJECTIVE We examined the extent of NPS use in a high-risk population-attendees of electronic dance music (EDM) parties at nightclubs and festivals. METHODS We surveyed 682 adults (age 18-25) entering EDM events at nightclubs and festivals in New York City (NYC) in 2015. A variation of time-space sampling was used. We examined the prevalence of self-reported use of 196 NPS and correlates of any NPS use. RESULTS Over a third (35.1%) of participants reported lifetime use of any NPS. Self-reported use of synthetic cannabinoids was most prevalent (16.3%), followed by psychedelic phenethylamines (14.7%; 2C series: 10.3%, 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine [NBOMe] series: 9.0%, Dox series: 3.5%), synthetic cathinones ("bath salts", 6.9%), other psychedelics (6.6%), tryptamines (5.1%), and dissociatives (4.3%). 2C-I was the most prevalent 2C series drug (5.1%); methylone was the most prevalent synthetic cathinone (3.3%), 2-MeO-ketamine was the most prevalent dissociative (3.7%), and 1P-lysergic acid diethylamide (LSD) (2.9%) was the most prevalent non-phenethylamine psychedelic. Risk factors for NPS use included Ecstasy/MDMA/Molly, LSD, and ketamine use; identifying as bisexual (compared to heterosexual), reporting higher frequency of nightclub/festival attendance, and being surveyed outside of a festival (compared to those surveyed outside of nightclubs). DISCUSSION NPS use is prevalent in the nightclub and festival scenes in NYC. Since individuals in these scenes-especially frequent attendees-are at high risk for use, prevention and harm reduction services need to be geared toward this population.
Collapse
Affiliation(s)
- Joseph J Palamar
- a Department of Population Health , New York University Langone Medical Center , New York , NY , USA.,b Center for Drug Use and HIV Research , New York University College of Nursing , New York , NY , USA.,c Center for Health, Identity, Behavior & Prevention Studies, New York University , New York University , New York , NY , USA
| | - Patricia Acosta
- a Department of Population Health , New York University Langone Medical Center , New York , NY , USA
| | - Scott Sherman
- a Department of Population Health , New York University Langone Medical Center , New York , NY , USA.,b Center for Drug Use and HIV Research , New York University College of Nursing , New York , NY , USA.,d College of Global Public Health , New York University , New York , NY , USA
| | - Danielle C Ompad
- b Center for Drug Use and HIV Research , New York University College of Nursing , New York , NY , USA.,c Center for Health, Identity, Behavior & Prevention Studies, New York University , New York University , New York , NY , USA.,d College of Global Public Health , New York University , New York , NY , USA
| | - Charles M Cleland
- b Center for Drug Use and HIV Research , New York University College of Nursing , New York , NY , USA.,e College of Nursing , New York University , New York , NY , USA
| |
Collapse
|
34
|
Crystals and tablets in the Spanish ecstasy market 2000–2014: Are they the same or different in terms of purity and adulteration? Forensic Sci Int 2016; 263:164-168. [DOI: 10.1016/j.forsciint.2016.04.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
|
35
|
Palamar JJ, Salomone A, Vincenti M, Cleland CM. Detection of "bath salts" and other novel psychoactive substances in hair samples of ecstasy/MDMA/"Molly" users. Drug Alcohol Depend 2016; 161:200-5. [PMID: 26883685 PMCID: PMC4792679 DOI: 10.1016/j.drugalcdep.2016.02.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ecstasy (MDMA) in the US is commonly adulterated with other drugs, but research has not focused on purity of ecstasy since the phenomenon of "Molly" (ecstasy marketed as pure MDMA) arose in the US. METHODS We piloted a rapid electronic survey in 2015 to assess use of novel psychoactive substances (NPS) and other drugs among 679 nightclub/festival-attending young adults (age 18-25) in New York City. A quarter (26.1%) of the sample provided a hair sample to be analyzed for the presence of select synthetic cathinones ("bath salts") and some other NPS. Samples were analyzed using fully validated UHPLC-MS/MS methods. To examine consistency of self-report, analyses focused on the 48 participants with an analyzable hair sample who reported lifetime ecstasy/MDMA/Molly use. RESULTS Half (50.0%) of the hair samples contained MDMA, 47.9% contained butylone, and 10.4% contained methylone. Of those who reported no lifetime use of "bath salts", stimulant NPS, or unknown pills or powders, about four out of ten (41.2%) tested positive for butylone, methylone, alpha-PVP, 5/6-APB, or 4-FA. Racial minorities were more likely to test positive for butylone or test positive for NPS after reporting no lifetime use. Frequent nightclub/festival attendance was the strongest predictor of testing positive for MDMA, butylone, or methylone. DISCUSSION Results suggest that many ecstasy-using nightclub/festival attendees may be unintentionally using "bath salts" or other NPS. Prevention and harm reduction education is needed for this population and "drug checking" (e.g., pill testing) may be beneficial for those rejecting abstinence.
Collapse
Affiliation(s)
- Joseph J Palamar
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA; Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA.
| | - Alberto Salomone
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Orbassano, Turin, Italy
| | - Marco Vincenti
- Centro Regionale Antidoping e di Tossicologia "A. Bertinaria", Orbassano, Turin, Italy; Dipartimento di Chimica, Università di Torino, Turin, Italy
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA; New York University College of Nursing, New York, NY, USA
| |
Collapse
|
36
|
Neuroimaging in moderate MDMA use: A systematic review. Neurosci Biobehav Rev 2016; 62:21-34. [DOI: 10.1016/j.neubiorev.2015.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/11/2015] [Accepted: 12/19/2015] [Indexed: 12/29/2022]
|
37
|
Brunt TM, Nagy C, Bücheli A, Martins D, Ugarte M, Beduwe C, Ventura Vilamala M. Drug testing in Europe: monitoring results of the Trans European Drug Information (TEDI) project. Drug Test Anal 2016; 9:188-198. [PMID: 26888408 DOI: 10.1002/dta.1954] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 12/22/2022]
Abstract
Drug testing is a harm reduction strategy that has been adopted by certain countries in Europe. Drug users are able to hand in their drugs voluntarily for chemical analysis of composition and dose. Drug users will be alerted about dangerous test results by the drug testing systems directly and through warning campaigns. An international collaborative effort was launched to combine data of drug testing systems, called the Trans European Drug Information (TEDI) project. Drug testing systems of Spain, Switzerland, Belgium, Austria, Portugal, and the Netherlands participated in this project. This study presents results of some of the main illicit drugs encountered: cocaine, ecstasy and amphetamine and also comments on new psychoactive substances (NPS) detected between 2008 and 2013. A total of 45 859 different drug samples were analyzed by TEDI. The drug markets of the distinct European areas showed similarities, but also some interesting differences. For instance, purity of cocaine and amphetamine powders was generally low in Austria, whilst high in Spain and the Netherlands. And the market for ecstasy showed a contrast: whereas in the Netherlands and Switzerland there was predominantly a market for ecstasy tablets, in Portugal and Spain MDMA (3,4-methylenedioxymethamphetamine) crystals were much more prevalent. Also, some NPS appearing in ecstasy seemed more specific for one country than another. In general, prevalence of NPS clearly increased between 2008 and 2013. Drug testing can be used to generate a global picture of drug markets and provides information about the pharmacological contents of drugs for the population at risk. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Tibor M Brunt
- Drug Information and Monitoring System (DIMS), Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, the Netherlands
| | | | | | - Daniel Martins
- Agência Piaget para o Desenvolvimento (APDES), V. N. Gaia, Portugal
| | | | - Cécile Beduwe
- Modus Vivendi ASBL, Harm Reduction among drug users, Brussels, Belgium
| | | |
Collapse
|
38
|
Vegting Y, Reneman L, Booij J. The effects of ecstasy on neurotransmitter systems: a review on the findings of molecular imaging studies. Psychopharmacology (Berl) 2016; 233:3473-501. [PMID: 27568200 PMCID: PMC5021729 DOI: 10.1007/s00213-016-4396-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/20/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE Ecstasy is a commonly used psychoactive drug with 3,4-methylenedioxymethamphetamine (MDMA) as the main content. Importantly, it has been suggested that use of MDMA may be neurotoxic particularly for serotonergic (5-hydroxytryptamine (5-HT)) neurons. In the past decades, several molecular imaging studies examined directly in vivo the effects of ecstasy/MDMA on neurotransmitter systems. OBJECTIVES The objective of the present study is to review the effects of ecstasy/MDMA on neurotransmitter systems as assessed by molecular imaging studies in small animals, non-human primates and humans. METHODS A search in PubMed was performed. Eighty-eight articles were found on which inclusion and exclusion criteria were applied. RESULTS Thirty-three studies met the inclusion criteria; all were focused on the 5-HT or dopamine (DA) system. Importantly, 9 out of 11 of the animal studies that examined the effects of MDMA on 5-HT transporter (SERT) availability showed a significant loss of binding potential. In human studies, this was the case for 14 out of 16 studies, particularly in heavy users. In abstinent users, significant recovery of SERT binding was found over time. Most imaging studies in humans that focused on the DA system did not find any significant effect of ecstasy/MDMA use. CONCLUSIONS Preclinical and clinical molecular imaging studies on the effects of ecstasy/MDMA use/administration on neurotransmitter systems show quite consistent alterations of the 5-HT system. Particularly, in human studies, loss of SERT binding was observed in heavy ecstasy users, which might reflect 5-HT neurotoxicity, although alternative explanations (e.g. down-regulation of the SERT) cannot be excluded.
Collapse
Affiliation(s)
- Yosta Vegting
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, 1105, AZ, Amsterdam, The Netherlands.
| | - Liesbeth Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands ,Brain Imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands ,Brain Imaging Center, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
39
|
Archer JRH, Hudson S, Jackson O, Yamamoto T, Lovett C, Lee HM, Rao S, Hunter L, Dargan PI, Wood DM. Analysis of anonymized pooled urine in nine UK cities: variation in classical recreational drug, novel psychoactive substance and anabolic steroid use. QJM 2015; 108:929-33. [PMID: 25770158 DOI: 10.1093/qjmed/hcv058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Analysis of anonymous pooled urine samples from street urinals has been used to demonstrate time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). AIM This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across UK. METHODS Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, NPS anabolic steroids using high-performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry and gas chromatography coupled to electron impact ionization mass spectrometry operating in selected ion monitoring and full-scan modes. RESULTS Ten classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and 3,4-methylenedioxy-methamphetamine (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (3-trifluoromethylphenylpiperazine and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. CONCLUSIONS There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions.
Collapse
Affiliation(s)
- J R H Archer
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - S Hudson
- Laboratory and Managed Services, LGC, Fordham, UK
| | - O Jackson
- Hull York Medical School, Hull, UK and
| | - T Yamamoto
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - C Lovett
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - H M Lee
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - S Rao
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - L Hunter
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, King's College London, London, UK
| | - D M Wood
- From the Clinical Toxicology Service Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, King's College London, London, UK
| |
Collapse
|
40
|
Kumano S, Sugiyama M, Yamada M, Nishimura K, Hasegawa H, Morokuma H, Inoue H, Hashimoto Y. Probe Heating Method for the Analysis of Solid Samples Using a Portable Mass Spectrometer. ACTA ACUST UNITED AC 2015; 4:A0038. [PMID: 26819909 DOI: 10.5702/massspectrometry.a0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/17/2015] [Indexed: 01/15/2023]
Abstract
We previously reported on the development of a portable mass spectrometer for the onsite screening of illicit drugs, but our previous sampling system could only be used for liquid samples. In this study, we report on an attempt to develop a probe heating method that also permits solid samples to be analyzed using a portable mass spectrometer. An aluminum rod is used as the sampling probe. The powdered sample is affixed to the sampling probe or a droplet of sample solution is placed on the tip of the probe and dried. The probe is then placed on a heater to vaporize the sample. The vapor is then introduced into the portable mass spectrometer and analyzed. With the heater temperature set to 130°C, the developed system detected 1 ng of methamphetamine, 1 ng of amphetamine, 3 ng of 3,4-methylenedioxymethamphetamine, 1 ng of 3,4-methylenedioxyamphetamine, and 0.3 ng of cocaine. Even from mixtures consisting of clove powder and methamphetamine powder, methamphetamine ions were detected by tandem mass spectrometry. The developed probe heating method provides a simple method for the analysis of solid samples. A portable mass spectrometer incorporating this method would thus be useful for the onsite screening of illicit drugs.
Collapse
|
41
|
Hondebrink L, Nugteren-van Lonkhuyzen JJ, Van Der Gouwe D, Brunt TM. Monitoring new psychoactive substances (NPS) in The Netherlands: data from the drug market and the Poisons Information Centre. Drug Alcohol Depend 2015; 147:109-15. [PMID: 25541244 DOI: 10.1016/j.drugalcdep.2014.11.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/30/2014] [Accepted: 11/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND In recent years, the number of new psychoactive substances (NPS) appearing on the illicit drug market strongly increased. However, little is known about their toxic effects and risks. Therefore, we determined the most frequently occurring NPS in The Netherlands and combined this with data regarding drug-related intoxications. METHODS Data from the Drugs Information and Monitoring System (DIMS) and the Dutch Poisons Information Centre (DPIC) were combined and jointly analyzed. RESULTS The number of drug samples submitted to DIMS for analysis containing NPS increased from 22 in 2007 to 431 samples in 2013. The most frequently submitted NPS in 2013 included 4-bromo-2,5-dimethoxyphenethylamine (2C-B), 4-fluoroamphetamine (4-FA), methoxetamine (MXE) and 6-(2-aminopropyl)benzofuran (6-APB). From 2012 onwards, the number of NPS bought as drug of choice exceeded those appearing as adulterants in established drugs. The DPIC was consulted about 35 NPS exposures in 2013, most frequently involving 4-FA, mephedrone, MXE, 2C-B and 6-APB. Following NPS exposure, neurological and psychological symptoms were most frequently reported, like agitation and hallucinations. In addition, cardiovascular symptoms like hypertension and tachycardia often occurred. CONCLUSIONS NPS are currently being purchased as drug of choice in The Netherlands and their availability and use is increasing. Although pharmacological and toxicological data are scarce, NPS can induce pronounced clinical effects. Therefore, the monitoring of trends in NPS prevalence needs to be continued, combined with reported clinical effects, and preferably supported by analytical confirmation of exposures in such patients.
Collapse
Affiliation(s)
- Laura Hondebrink
- National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Daan Van Der Gouwe
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Department of Drug Monitoring, Utrecht, The Netherlands
| | - Tibor M Brunt
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Department of Drug Monitoring, Utrecht, The Netherlands; Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Steinhardt SJ, Moore TR, Casella SS. Have you seen Molly? A review of Molly in primary literature. Ment Health Clin 2014. [DOI: 10.9740/mhc.n207181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There has been a recent increase in public awareness of the drug 3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy. A purified version of this drug, known as “Molly”, is perceived by users to be safer than other illicit drugs, as it is expected to be free of toxic adulterants. This article reviews the clinical effects and toxicity associated with MDMA, as well as data on the purity of Molly and Ecstasy.
Collapse
Affiliation(s)
- Sarah J. Steinhardt
- 1 Assistant Professor Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, FL
| | - Thea R. Moore
- 2 Associate Professor Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, FL
| | - Sean S. Casella
- 3 Clinical Pharmacologist, Clinical Pharmacology Services, Inc., Tampa, FL
| |
Collapse
|
43
|
Togni LR, Lanaro R, Resende RR, Costa JL. The Variability of Ecstasy Tablets Composition in Brazil. J Forensic Sci 2014; 60:147-51. [DOI: 10.1111/1556-4029.12584] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 11/26/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Loraine R. Togni
- Forensic Toxicology and Chemistry Laboratory; Criminalistic Institute of São Paulo; São Paulo SP 05507-060 Brazil
| | - Rafael Lanaro
- Poison Control Center; State University of Campinas; Campinas SP 13083-887 Brazil
| | - Rodrigo R. Resende
- Department of Biochemistry and Immunology; Institute of Biological Sciences; Federal University of Minas Gerais; Belo Horizonte MG 29075-910 Brazil
| | - Jose L. Costa
- Forensic Toxicology and Chemistry Laboratory; Criminalistic Institute of São Paulo; São Paulo SP 05507-060 Brazil
- Poison Control Center; State University of Campinas; Campinas SP 13083-887 Brazil
| |
Collapse
|
44
|
Schneir A, Ly BT, Casagrande K, Darracq M, Offerman SR, Thornton S, Smollin C, Vohra R, Rangun C, Tomaszewski C, Gerona RR. Comprehensive analysis of “bath salts” purchased from California stores and the internet. Clin Toxicol (Phila) 2014; 52:651-8. [DOI: 10.3109/15563650.2014.933231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Green AR, Nutt DJ. Pharmacology should be at the centre of all preclinical and clinical studies on new psychoactive substances (recreational drugs). J Psychopharmacol 2014; 28:711-8. [PMID: 24674814 DOI: 10.1177/0269881114528593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the publication of a substantial body of preclinical and clinical information on recent recreational drugs such as 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and cathinone compounds such as mephedrone there remains a disturbing lack of consensus as to how dangerous these compounds are to the health of the individual and to society in general. This perspective proposes that use of good pharmacological practice should be mandatory in all preclinical and clinical studies. Its use will assist both translation and reverse translation of information produced in animals and clinical subjects. We propose several basic rules to be followed in all future studies. Preclinical studies should employ pharmacokinetic-pharmacodynamic integration thereby exposing animals to known or calculable drug concentrations. This will provide results relevant to pharmacology rather than toxicology and, crucially, data relevant to human drug use. Full experimental detail should be routinely provided, to allow comparison with other similar work. In clinical studies evidence should be provided that the drug under investigation has been ingested by the subjects being examined, and details given of all other drugs being ingested. Drug-drug interactions are an unavoidable confound but studies of a size that allows reliable statistical evaluation and preferably allows sub-group analysis, particularly by using meta-analysis, should help with this problem. This may require greater collaboration between investigative groups, as routinely occurs during pharmaceutical clinical trials. Other proposals include greater integration of preclinical and clinical scientists in both preclinical and clinical studies and changes in the law regarding Good Manufacturing Process (GMP) sourcing of drug for human studies.
Collapse
Affiliation(s)
- A Richard Green
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - David J Nutt
- Division of Neurosciences and Mental Health, Imperial College London, London, UK
| |
Collapse
|
46
|
Abstract
In 2007, a young woman, Annabel Catt, died after consuming a capsule sold as "ecstasy" that contained para-methoxyamphetamine. In this paper, we describe how this death was depicted in online drug-user communities and illustrate how the meanings of drug use are negotiated in online settings. News articles, public online discussions, and online fieldwork formed the data. This paper demonstrates how dominant drug discourses may be resisted by drug users, drawing on theories of health resistance and Kane Race's concept of counterpublic health. Online environments may offer ways of engaging people who use drugs that acknowledge both pleasure and safety. The study's limitations are noted.
Collapse
Affiliation(s)
- Monica J Barratt
- 1National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | | |
Collapse
|
47
|
Khairnar A, Frau L, Plumitallo A, Morelli M, Simola N. Antagonism of Adenosine A1 or A2A Receptors Amplifies the Effects of MDMA on Glial Activation in the Mouse Brain: Relevance to Caffeine–MDMA Interactions. JOURNAL OF CAFFEINE RESEARCH 2014. [DOI: 10.1089/jcr.2014.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amit Khairnar
- CEITEC—Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Lucia Frau
- Section of Neuropsychopharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio Plumitallo
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Micaela Morelli
- Section of Neuropsychopharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- National Institute of Neuroscience (INN), University of Cagliari, Cagliari, Italy
- National Research Council (CNR), Neuroscience Institute, University of Cagliari, Cagliari, Italy
| | - Nicola Simola
- Section of Neuropsychopharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| |
Collapse
|
48
|
Current preclinical studies on neuroinflammation and changes in blood-brain barrier integrity by MDMA and methamphetamine. Neuropharmacology 2014; 87:125-34. [PMID: 24594477 DOI: 10.1016/j.neuropharm.2014.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/05/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
The blood-brain barrier (BBB) is essential in the maintenance of brain homeostasis both by preserving normal brain functioning and also by protecting the brain from exposure to a range of potentially harmful substances. This review presents some of the evidence of BBB disruption following exposure to the substituted amphetamines 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and methamphetamine (METH), two drugs of abuse which are widely consumed recreationally by younger sectors of the population. Both MDMA and METH have been shown to produce disruption of the BBB as reflected by IgG extravasation and Evans Blue leakage. In particular, METH decreases the expression of basal lamina proteins associated with an increase in matrix metalloproteinase activity. These changes in BBB integrity appear to be related to MDMA-induced activation of the mitogen-activated protein kinase (MAPK) JNK1/2. The consequences of the disruption in the BBB by these two drugs remain to be established, but there is evidence in the literature that, at least in the case of METH, increased matrix metalloproteinase (MMP) activity may be related to increased behavioural sensitization and reward perhaps because of the modification of the passage of the drug into the CNS. In addition, the high incidence of AIDS-related neurologic disease in METH users may also be related to increased entry into the brain of virally derived neurotoxic products. This article is part of the Special Issue entitled 'CNS Stimulants'.
Collapse
|
49
|
Downey C, Daly F, O’Boyle K. An in vitro approach to assessing a potential drug interaction between MDMA (ecstasy) and caffeine. Toxicol In Vitro 2014; 28:231-9. [DOI: 10.1016/j.tiv.2013.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/24/2013] [Accepted: 10/30/2013] [Indexed: 11/27/2022]
|
50
|
Archer JRH, Dargan PI, Lee HMD, Hudson S, Wood DM. Trend analysis of anonymised pooled urine from portable street urinals in central London identifies variation in the use of novel psychoactive substances. Clin Toxicol (Phila) 2014; 52:160-5. [DOI: 10.3109/15563650.2014.885982] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|