1
|
Kühnl R, Aydin D, Horn S, Olderbak S, Verthein U, Kraus L. Taking the cat-and-mouse game to the next level: different perspectives on the introduction of the German New Psychoactive Substances Act. Harm Reduct J 2022; 19:122. [PMID: 36329471 PMCID: PMC9632031 DOI: 10.1186/s12954-022-00704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To counteract the spread of new psychoactive substances (NPS) and to prevent the emergence of novel substances, specifically designed as a response to the legal control of individual substances, a new law was introduced in Germany in 2016: the New Psychoactive Substances Act (NpSG). The NpSG combines a generic approach with the waiver of criminal liability for the acquisition and possession of NPS for personal use, which is a novelty in German narcotics law. The present study aimed at exploring the impact of the introduction of the NpSG from three different perspectives-NPS users, staff of addiction care facilities, and members of law enforcement authorities-to better understand the dynamics surrounding such a change in legislation and to contribute to the body of international experience in dealing with NPS. METHODS Semi-structured narrative interviews were conducted with a total of 193 representatives of the three different groups affected by the law. These interviews included questions on perceived changes associated with the introduction of the NpSG as well as questions on opinions regarding legal and criminal policy issues. The analysis was carried out using qualitative content analysis according to Mayring. RESULTS Most interviewees welcomed the non-criminalisation approach of the NpSG but also noticed that, in practice, not much has changed for users. Nevertheless, the changes in legislation have had an impact on the market. For example, novel substances have emerged circumventing the new legislation. According to users, this has led some to reduce NPS use and others to adopt more hazardous consumption patterns. Overall, most respondents did not expect the introduction of the NpSG to bring any significant changes. CONCLUSIONS Although the idea of non-criminalisation inherent to the NpSG is appreciated and the generic approach has been well implemented in the law, thus covering a wide range of substances, the introduction of the law-perhaps for that very reason-has also had unintended and negative consequences, taking the cat-and-mouse game to the next level. To end the game, or at least to defuse the game situation, a combination of different strategies will be necessary, with legislation always playing a key role.
Collapse
Affiliation(s)
- Regina Kühnl
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany
| | - Darya Aydin
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Sabine Horn
- Unit III.5 Criminal Law, Criminal Procedural Law and Criminal Politics, German Police University, Zum Roten Berge 18-24, 48165, Muenster, Germany
| | - Sally Olderbak
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Psychology Department, University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - Uwe Verthein
- Department of Psychiatry and Psychotherapy, Centre of Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany. .,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, 106 91, Stockholm, Sweden. .,Institute of Psychology, ELTE Eötvös Loránd University, Egyetem tér 1-3, 1053, Budapest, Hungary.
| |
Collapse
|
2
|
Hashim A, Mohammed NA, Othman A, Gab-Allah MA, Al-Kahodary AH, Gaber ER, Hassan AM, Aranda M, Hussien R, Mokhtar A, Islam MS, Lee KY, Asghar MS, Tahir MJ, Yousaf Z. Pattern of novel psychoactive substance use among patients presented to the poison control centre of Ain Shams University Hospitals, Egypt: A cross-sectional study. Heliyon 2022; 8:e10084. [PMID: 36039128 PMCID: PMC9418213 DOI: 10.1016/j.heliyon.2022.e10084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/10/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Novel psychoactive substances (NPSs) are relatively new substances in the illicit drug market, not previously listed in the United Nations Office on Drugs and Crime (UNDOC). Strox and Voodoo are considered some of the most popular blends of NPS in the Egyptian drug market. Objectives The current study was conducted to assess NPS's use pattern: Voodoo and Strox among acutely intoxicated patients presented to the poison control center of Ain Shams University Hospitals (PCC- ASUH). Methods A single center based cross-sectional study was carried out in the PCC-ASUH among acutely intoxicated patients presenting to the emergency department (ED) over four months (from January-April 2019. using a previously adopted and validated Fahmy and El-Sherbini socioeconomic scale (SES). Data were presented as mean, median and range as appropriate. Both smoking and crowding indexes were calculated and presented as previously reported. Results Fifty-one patients were presented to the ED of PCC-ASUH during the study period. A total of 96.1% (n = 49) were males. The mean age was 25 ± 7.5 years. The most common NPS used was Strox: 54.9% (n = 28), followed by Voodoo: 27.4% (n = 14). Neurological and gastrointestinal (GI) symptoms were the most frequent presentations. The most common motive behind NPS use was the desire to give a trial of new psychoactive substances. The mean SES score was 35.1 ± 13.17. Most patients have the preparatory as the highest education 36.0% (n = 18). Conclusions NPS use is common among young males in preparatory education from different social classes, starting it most commonly as a means to experiencing a new high. Neurological and GI manifestations are the most common presenting symptoms of NPS intoxication.
Collapse
Affiliation(s)
- Ahmed Hashim
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran A. Mohammed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - AlFadl Othman
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohab A.K. Gab-Allah
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed H.M. Al-Kahodary
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eslam R. Gaber
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Hassan
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Aranda
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Hussien
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany Mokhtar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research, Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | | | | | | |
Collapse
|
3
|
Atzendorf J, Rauschert C, Seitz NN, Lochbühler K, Kraus L. The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:577-584. [PMID: 31587705 DOI: 10.3238/arztebl.2019.0577] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/03/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society. METHODS The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people. RESULTS In the 30 days prior to the survey, 71.6% of the respondents (correspond- ing to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%; 619 000). The prevalence of the use of anal- gesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence). CONCLUSION Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.
Collapse
Affiliation(s)
- Josefine Atzendorf
- IFT Institut für Therapieforschung (Institute for Therapy Research), München; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | | | | | | | | |
Collapse
|
4
|
Schwarzbach V, Lenk K, Laufs U. Methamphetamine-related cardiovascular diseases. ESC Heart Fail 2020; 7:407-414. [PMID: 31950731 PMCID: PMC7160483 DOI: 10.1002/ehf2.12572] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/02/2019] [Accepted: 11/11/2019] [Indexed: 12/23/2022] Open
Abstract
Aims Abuse of crystal methamphetamine (MA) poses a growing problem for health services worldwide. This review summarizes the current literature on the effects of MA on the cardiovascular system. Methods and results This article is a presentation of a case report and review of the current literature. In Europe, especially the eastern countries and the eastern states of Germany are affected. MA increases the concentration of catecholamines in the synaptic gap leading to euphoria, alertness, and hunger suppression as well as psychiatric and gastrointestinal complications. MA consumption is associated with hypertension, acute and chronic myocardial toxicity, stroke, coronary artery disease, and sudden cardiac death. Although many aspects of the underlying pathophysiology remain unknown, catecholamine‐mediated pathologies appear to play an important role. The duration of MA consumption is the most important determinant for the prognosis. Conclusions Awareness is needed as cardiac complications are important causes of morbidity and mortality in patients with MA consumption. Drug abstinence is the mainstay of therapy, cardiac and other complications should be treated according to the respective guidelines. Incompliance to therapy and frequent relapses are the main challenges for successful treatment. Further research is required to improve the understanding of this rapidly increasing cardiomyopathy.
Collapse
Affiliation(s)
- Valentin Schwarzbach
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karsten Lenk
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
5
|
Specka M, Kuhlmann T, Sawazki J, Bonnet U, Steinert R, Cybulska-Rycicki M, Eich H, Zeiske B, Niedersteberg A, Schaaf L, Scherbaum N. Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment. Front Psychiatry 2020; 11:569. [PMID: 32733288 PMCID: PMC7358402 DOI: 10.3389/fpsyt.2020.00569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/03/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND About 15 years ago, a diverse group of new recreational psychotropic substances began to emerge, which were marketed for example as "legal highs," "research chemicals," or "designer drugs." These substances were later subsumed under the label "Novel Psychoactive Substances" (NPS). Important NPS classes are cathinones, synthetic cannabimimetics, phenethylamines, and herbal drugs. The health care system for psychotropic substance use disorders (SUDs) traditionally focused on a few substances, such as alcohol, heroin, cocaine, amphetamines, or cannabis. Users of illicit substances often engage in polydrug use. However little is known about the prevalence of NPS use within the group of "classical" illicit substance users. OBJECTIVE We investigated lifetime and recent use of NPS and other drugs in patients who underwent in-patient detoxification treatment from illicit drugs in Germany. METHODS In a multicenter study with eight participating facilities, patients admitted to treatment underwent a standardized interview at admission, concerning their past and current substance use. The interview comprised classical substances of abuse, NPS, and rarely used substances such as LSD. In addition, participating sites had the opportunity to analyze their patients' routine drug screenings by means of gas chromatography/mass spectrometry (GC/MS), which permitted detection of NPS. RESULTS Interviews from 295 patients could be analyzed. Most patients were opiate dependent and multiple substance users. About 32% reported use of synthetic cannabimimetics during lifetime, but usually only a few times. An important reason for their use was that NPS were not detected by drug testing in prisons or drug treatment facilities. Cathinones, herbal drugs or other NPS had rarely been used during lifetime. NPS use during the last 30 days before admission was nearly zero. This was confirmed by urine analysis results. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. In addition, 18% reported of regular unprescribed pregabalin use during lifetime, and 20% had recently used pregabalin. CONCLUSION Patients admitted to drug detoxification treatment showed multiple substance use, but this did not include NPS use. The diversion of legal medications such as pregabalin in this group is a serious concern.
Collapse
Affiliation(s)
- Michael Specka
- LVR Hospital Essen Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Thomas Kuhlmann
- Psychosomatische Klinik Bergisch Gladbach, Bergisch Gladbach, Germany
| | | | - Udo Bonnet
- Castrop-Rauxel Evangelical Hospital, Castrop-Rauxel, Germany
| | - Renate Steinert
- LWL-Klinik Münster, Münster, North Rhine-Westphalia, Germany
| | | | - Helmut Eich
- Clinic Maria Hilf GmbH, Moenchengladbach, Germany
| | | | | | | | - Norbert Scherbaum
- LVR Hospital Essen Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
6
|
Petzold J, Weber B, Bassett TR, Bauer M, Bernhardt N, Groß C, Hasler H, Schützwohl M, Pilhatsch M. Effectiveness of the First German-Language Group Psychotherapy Manual to Accompany Short-Term Treatment in Methamphetamine Dependence. Front Psychiatry 2020; 11:130. [PMID: 32180742 PMCID: PMC7059436 DOI: 10.3389/fpsyt.2020.00130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Methamphetamine abuse is expanding in Europe, leading to a shortfall in medical care for related disorders in many regions. Research focusing on the effectiveness and feasibility of methamphetamine-specific treatment programs is scarce, especially in short-term settings. Methods: To this end, we treated 31 patients with methamphetamine dependence using a new group psychotherapy manual added to standard psychiatric care. Trained research assistants recorded demographic, illness and treatment variables using a standardized interview at baseline and a follow-up visit 3 months later. Outcome and process variables for this intervention encompassing 15 modules for qualified detoxification and motivation of patients with methamphetamine dependence are reported. Results: Retention and abstinence rates as well as acceptance and feasibility in daily routine were assessed positively. Patients with an unsuccessful outcome were characterized by longer regular methamphetamine use (t = -2.513, df = 29, p = 0.018) and a shorter abstinence period at baseline (U = 74.500, z = -1.808, p = 0.072). Among the demographic and clinical variables, the only predictor significantly increasing the odds of a successful outcome was a shorter period of regular methamphetamine use (OR = 1.318, CI 95% for OR = 1.021-1.700, b = 0.276, SE = 0.130, p = 0.034). Conclusions: This freely available therapy manual can help counter the shortfall in available psychotherapeutic interventions for patients with methamphetamine dependence in German-speaking countries. The routinely assessed parameters duration of regular methamphetamine use and abstinence before treatment were associated with outcome and may be used to personalize therapeutic strategies.
Collapse
Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Weber
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Tyler Ray Bassett
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cornelius Groß
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Helena Hasler
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
7
|
Dyba J, Moesgen D, Klein M, Leyendecker B. Methamphetamine Use in German Families: Parental Substance Use, Parent-Child Interaction and Risks for Children Involved. Subst Use Misuse 2019; 54:583-591. [PMID: 30636479 DOI: 10.1080/10826084.2018.1528459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND With an immense increase in methamphetamine use in Germany in the past decade, large sections of the drug-using community have been identified as parents of young children. OBJECTIVE With the fast-emerging issue of psychosocial and familial consequences of methamphetamine use, this study focused on gaining an insight into substance use, parenthood, and parenting by German methamphetamine users, with special emphasis on the psychological outcomes for the children involved. METHODS We conducted 24 qualitative interviews with parents (16 mothers and eight fathers), who were in outpatient treatment for their Crystal Meth use and were currently abstinent from using drugs. Personal information on parenting, drug use, and effects on the children was supplemented by standardized parents' reports on the children's behavioral patterns. RESULTS Parenting was described as challenging and often emotionally neglectful, impulsive, and inconsistent. The interview results further indicated an inter-relatedness of substance use and the parental role. Overall, children of methamphetamine users appeared to be at an increased risk of pre-and postnatal substance exposure and great psychosocial distress, especially evident in externalizing behavior such as hyperactivity and behavioral problems. CONCLUSION Results demonstrate the complex problems of methamphetamine-involved parents and suggest the need for a close cooperation between addiction treatment and child welfare services in providing appropriate psychological and educational support for parents and children.
Collapse
Affiliation(s)
- Janina Dyba
- a German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences , Koeln , Germany
| | - Diana Moesgen
- a German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences , Koeln , Germany
| | - Michael Klein
- a German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences , Koeln , Germany
| | | |
Collapse
|