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EMCDDA DOCUMENTATION CENTRE INFORMATION BULLETIN

GENERAL INFORMATION BULLETIN

9 September 2016 ______

GREY LITERATURE

Will drug use rise? Exploring a key concern about decriminalising or regulating drugs Murkin, G Transform Drug Policy Foundation London: 8 September 2016

This report argues that this rationale for continuing with an enforcement-led approach to drugs is poorly supported by empirical research, and that alternative policies – in particular the decriminalisation of personal drug possession or the introduction of legally regulated drug markets – can produce better outcomes while also avoiding dramatic increases in use. It also makes the case that overall levels of drug use are not an accurate indicator of levels of drug-related harm, and should not be considered as such. Given the pace at which real-world alternatives to criminalisation and prohibition have taken hold in recent years, and the extent to which drug policy reform has become a mainstream issue, there is now no shortage of claims and counterclaims about how different policies affect levels of drug consumption. This report attempts to cut through this debate, addressing the widely held concern about increased use by reviewing the evidence acquired since the modern international drug control framework was established in the 1960s, and looking at what is known about other approaches to managing a range of substances. Ultimately, the intention is to provide a representative overview of what is known about the relationship between drug policy, drug use, and related harms. http://klmsvr.emcdda.org/vlib/Will_drug_use_rise- exploring_a_key_concern_about_decriminalising_or_regulating_drugs.pdf

Australia’s Annual Overdose Report 2016 Penington Institute Carlton: August 2016

The principal findings are: Deaths due to accidental overdose grew substantially from 2004 to 2014. They reached 1,137 in 2014, a rapid rise from 705 deaths in 2004 and a 61 per cent increase in a decade. Between 2013 and 2014 overdose deaths smashed through the 1,000 deaths mark, with a rise of 14.5 per cent in one year alone, from 993 to 1,137. Contrary to stereotypes about the age of people who die of accidental overdose, Australians aged 40-49 are the most likely to die of a drug overdose. Deaths in this age bracket have almost doubled from 174 deaths in 2004 to 342 in 2014 – a 96 per cent rise. In 2014, people aged 30-59 accounted for 78 per cent of all overdose deaths. Large increases in overdose deaths in rural and regional areas are driving the overall increase. Between 2008 and 2014, there was an increase from 3.1 deaths per 100,000 to 5.7 per 100,000– an 83 per cent increase. Meanwhile, the rate per capita in metropolitan areas has moved only slightly from 4.2 per 100,000 in 2008 to 4.4 per 100,000 in 2014. Despite common perceptions of accidental deaths due to drugs are caused by illicit drugs, in 2014 prescription medications were responsible for more drug- related deaths (71 per cent) than illicit drugs (29 per cent). (Note: this statistic is for total drug-related deaths, not just overdose deaths). Over the period 2008-2014 there was an 87 per cent increase in prescription opioid deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148 per cent increase. Accidental deaths due to drug overdose per capita for Aboriginal people has increased substantially between 2004 and 2014 with an increase of 141 per cent – from 3.9 per 100,000 in 2004 to 9.4 per 100,000 in 2014 in the five jurisdictions with Aboriginal data. In the same period, the increase among non-Aboriginal people was from 3.3 per 100,000 to 4.8 per 100,000 – an increase of 45 per cent. Western Australia is the worst state for overdose deaths per capita with 5.8 per 100,000 in 2014 followed by NSW with 5.1 per 100,000. Since 2004 Western Australia’s per capita overdose deaths have risen from the lowest to the highest in the country – an increase from 1.8 per 100,000 to 5.8 per 100,000 (a 222 per cent increase) – against a national increase over the same period of 37 per cent. http://klmsvr.emcdda.org/vlib/Australias_Annual_Overdose_Report_2016.pdf

Evaluation of the HSE Naloxone Demonstration Project Clarke, A; Eustace, A Health Service Executive Dublin: 2016 http://klmsvr.emcdda.org/vlib/Evaluation_of_the_HSE_Naloxone_Demonstrati on_Project.pdf

JOURNAL ARTICLES

Acute and chronic effects of cannabinoids on effort-related decision- making and reward learning: an evaluation of the cannabis ‘amotivational’ hypotheses Lawn, W; Freeman, T P; Pope, R A; Joye, A; Harvey, L; Hindocha, C; Mokrysz, C; Moss, A; Wall, M B; Bloomfield, M A P; Das, R K; Morgan, C J A; Nutt, D J; Curran, H V Psychopharmacology 2 September 2016 doi:10.1007/s00213-016-4383-x

Rationale Anecdotally, both acute and chronic cannabis use have been associated with apathy, amotivation, and other reward processing deficits. To date, empirical support for these effects is limited, and no previous studies have assessed both acute effects of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), as well as associations with cannabis dependence. Objectives The objectives of this study were (1) to examine acute effects of cannabis with CBD (Cann + CBD) and without CBD (Cann-CBD) on effort-related decision- making and (2) to examine associations between cannabis dependence, effort-related decision-making and reward learning. Methods In study 1, 17 participants each received three acute vaporized treatments, namely Cann-CBD (8 mg THC), Cann + CBD (8 mg THC + 10 mg CBD) and matched placebo, followed by a 50 % dose top-up 1.5 h later, and completed the Effort Expenditure for Rewards Task (EEfRT). In study 2, 20 cannabis- dependent participants were compared with 20 non-dependent, drug-using control participants on the EEfRT and the Probabilistic Reward Task (PRT) in a non-intoxicated state. Results Cann-CBD reduced the likelihood of high-effort choices relative to placebo (p = 0.042) and increased sensitivity to expected value compared to both placebo (p = 0.014) and Cann + CBD (p = 0.006). The cannabis-dependent and control groups did not differ on the EEfRT. However, the cannabis- dependent group exhibited a weaker response bias than the control group on the PRT (p = 0.007). Conclusions Cannabis acutely induced a transient amotivational state and CBD influenced the effects of THC on expected value. In contrast, cannabis dependence was associated with preserved motivation alongside impaired reward learning, although confounding factors, including depression, cannot be disregarded. This is the first well powered, fully controlled study to objectively demonstrate the acute amotivational effects of THC. [FULL TEXT AVAILABLE]

Heroin addiction patterns of treatment-seeking patients, 1992-2013: comparison between pre- and post-drug policy reform in Portugal Pombo, S; Da Costa, N F Heroin Addiction and Related Clinical Problems 30 August 2016

Background The abuse of illicit drugs is a significant public health concern. In Portugal, a new drug policy was put into practice with the intent of preventing drug-related problems. Aim This study was designed to evaluate the patterns of heroin addiction and drug treatment involvement in the periods of pre- and post-drug policy reform. Methods A comparative study evaluated heroin treatment-seeking clients (N=627; 82.3% males and 17.7% females) at their first visit in one of the two periods 1992-1999 and 2002- 2013. Data on drug treatment admissions were also analysed for comparison (N=2,323 cases entering treatment). Results Comparison between the 1992-1999 and 2002-2013 periods showed that: treatment demand declined by 37%, whereas treatment engagement increased by 94%; drug users have aged, become better educated and reported more cocaine use. In general, men were more likely than women to receive treatment (82.3% to 17.7%), but the number of women accessing treatment increased (from 13.0% to 20.9%). Drug injection has decreased and heroin users are choosing to smoke heroin rather than injecting it. HIV infection decreased, too (28.0% to 19.6%). The prevalence of hepatitis C infection, alcohol use and abuse and a criminal history remain stable. Conclusions Drug scene has changed in Portugal. The drug-use profile of heroin-addicted patients changed after the new policy on drugs was implemented. Heroin indicators are generally stable or trending downwards. Our clinical findings are discussed in view of the recent drug policy reform. Assessing trends in drug use among heroin-using patients can reinforce prevention efforts. [FULL TEXT AVAILABLE]

Cannabis use and cannabis use disorders Hall, W The Lancet Psychiatry 31 August 2016 http://dx.doi.org/10.1016/S2215-0366(16)30270-X [FULL TEXT AVAILABLE]

Marijuana use and use disorders in adults in the USA, 2002–14: analysis of annual cross-sectional surveys Compton, W M; Han, B; Jones, C M; Blanco, C; Hughes, A The Lancet Psychiatry 31 August 2016 http://dx.doi.org/10.1016/S2215-0366(16)30208-5

Background The study of marijuana use disorders is urgently needed because of increasing marijuana legalisation in multiple jurisdictions, the effect of marijuana use on future risk of psychiatric disorders, and deleterious effects of marijuana exposure. Thus, understanding trends of marijuana use and use disorders and examining factors that might drive these trends (eg, perceptions of harms from marijuana use) is essential. Methods We analysed data from US civilians aged 18 years or older who participated in annual, cross-sectional US National Surveys on Drug Use and Health from 2002 to 2014. The sample in each US state was designed to be approximately equally distributed between participants aged 12–17 years, 18– 25 years, and 26 years or older. For each survey year, we estimated prevalence of marijuana use and use disorders, initiation of marijuana use, daily or near daily use, perception of great or no risk of harm from smoking marijuana, perception of state legalisation of medical marijuana use, and mean number of days of marijuana use in the previous year. Descriptive analyses, multivariable logistic regressions, and zero-truncated negative binomial regressions were applied. Findings 596 500 adults participated in the 2002–14 surveys. Marijuana use increased from 10·4% (95% CI 9·97–10·82) to 13·3% (12·84–13·70) in adults in the USA from 2002 to 2014 (β=0·0252, p<0·0001), and the prevalence of perceiving great risk of harm from smoking marijuana once or twice a week decreased from 50·4% (49·60–51·25) to 33·3% (32·64–33·96; β=–0·0625, p<0·0001). Changes in marijuana use and risk perception generally began in 2006–07. After adjusting for all covariates, changes in risk perceptions were associated with changes in prevalence of marijuana use, as seen in the lower prevalence of marijuana use each year during 2006–14 than in 2002 when perceiving risk of harm from smoking marijuana was included in models. However, marijuana use disorders in adults remained stable at about 1·5% between 2002 and 2014 (β=–0·0042, p=0·22). Interpretation Prevalence and frequency of marijuana use increased in adults in the USA starting in approximately 2007 and showing significantly higher results in multivariable models during 2011–14 (compared with 2002). The associations between increases in marijuana use and decreases in perceiving great risk of harm from smoking marijuana suggest the need for education regarding the risk of smoking marijuana and prevention messages. [FULL TEXT AVAILABLE]

Illicit drugs and their metabolites in 36 rivers that drain into the Bohai Sea and north Yellow Sea, north China Wang DG, Zheng QD, Wang XP, Du J, Tian CG, Wang Z, Ge LK Environmental Science & Pollution Research International 23 (16) P.16495-503, 2016

Illicit drugs and their metabolites have recently been recognized as an emerging group of contaminants due to their potential ecotoxicological impact in aquatic ecosystems. To date, information on the occurrence of these compounds in the aquatic environment of China remains limited. In this study, we collected surface water samples from 36 rivers in north China that discharge into the Bohai Sea and north Yellow Sea and measured the concentrations of amphetamine-like compounds, ketamines, cocainics, and opioids. The occurrence and spatial patterns of these substances show significant differences between the rivers and regions. Two designer drugs, methamphetamine (METH) and ketamine (KET), were the most abundant compounds detected in the entire set of samples (detection frequency of 92 and 69 %). The concentrations of METH and KET ranged from <0.1 to 42.0 ng L(-1) (mean = 4.53 ng L(-1)) and <0.05 to 4.50 ng L(-1) (mean = 0.49 ng L(-1)), respectively. The high detection frequencies of METH and KET are consistent with the fact that they are the main illicit drugs consumed in China. The high concentrations of these illicit drugs and their metabolites were found in areas that have a high population density. The riverine input of total illicit drugs into the Bohai Sea and north Yellow Sea was estimated to be in the range of 684 to 1160 kg per year.

A significant association between BDNF promoter methylation and the risk of drug addiction Xu X, Ji H, Liu G, Wang Q, Liu H, Shen W, Li L, Xie X, Zhou W, Duan S Gene 584 (1) p.54-59, 2016

As a member of the neurotrophic factor family, brain derived neurotrophic factor (BDNF) plays an important role in the survival and differentiation of neurons. The aim of our work was to evaluate the role of BDNF promoter methylation in drug addiction. A total of 60 drug abusers (30 heroin and 30 methylamphetamine addicts) and 52 healthy age- and gender-matched controls were recruited for the current case control study. Bisulfite pyrosequencing technology was used to determine the methylation levels of five CpGs (CpG1-5) on the BDNF promoter. Among the five CpGs, CpG5 methylation was significantly lower in drug abusers than controls. Moreover, significant associations were found between CpG5 methylation and addictive phenotypes including tension-anxiety, anger-hostility, fatigue-inertia, and depression-dejection. In addition, luciferase assay showed that the DNA fragment of BDNF promoter played a key role in the regulation of gene expression. Our results suggest that BDNF promoter methylation is associated with drug addiction, although further studies are needed to understand the mechanisms by which BDNF promoter methylation contributes to the pathophysiology of drug addiction.

Reflection of socio-economic changes in wastewater: licit and illicit drug use patterns Thomaidis NS, Gago Ferrero P, Ort C, Maragou NC, Alygizakis NA, Borova VL, Dasenaki ME Environmental Science and Technology 24 August 2016 [Epub ahead of print]

The economic crisis plaguing Greece was expected to impact consumption of pharmaceuticals and illicit drugs - a priori to an unknown extent. We quantified the change of use for various classes of licit and illicit drugs by monitoring Athens' wastewater from 2010 to 2014. A high increase in the use of psychoactive drugs was detected between 2010 and 2014, especially for antipsychotics (35-fold), benzodiazepines (19-fold), and antidepressants (11- fold). This directly reflects the perceived increase of incidences associated with mental illnesses in the population, as a consequence of severe socio- economic changes. Other therapeutic classes, like antiepileptics, hypertensives and gastric and ulcer drugs also showed an increase in use (from 2-fold increase for antiepileptics to 13-fold for hypertensives). In contrast, the overall use of antibiotics and NSAIDs decreased. For mefenamic acid, an almost 28-fold decrease was observed. This finding is likely related to the reduction in drug expenditure applied in public health. A 2-fold increase of methamphetamine use was detected, associated with a cheap street drug called "sisa" (related to marginal conducts), which is a health concern. MDMA (5-fold) and methadone (7-fold) use showed also an increase, while cocaine and cannabis estimates did not show a clear trend.

Crack cocaine use in adolescents: clinical characteristics and predictors of early initiation Thiago G. Pianca; Luis Augusto Rohde; Ronaldo L. Rosa; Ana Paula A. Begnis; Pedro B. Ferronatto; Mariana C. Jensen; Flavio Pechansky; Keila Maria Mendes Ceresér; Victoria P. Fairchild; Claudia M. Szobot Journal of Clinical Psychiatry 30 August 2016 DOI: 10.4088/JCP.15m09894

Objective: To describe the clinical characteristics of adolescents with crack cocaine dependence and possible predictors of transition from drug experimentation to crack cocaine dependence. Methods: This cross-sectional study enrolled a consecutive sample of 90 adolescents admitted to a psychiatric inpatient unit in the city of Porto Alegre in southern Brazil for crack cocaine detoxification between May 2011 and November 2012. Comorbid psychological conditions were assessed using the Kiddie- SADS-Present and Lifetime Version, and severity of drug use was assessed using the Teen Addiction Severity Index (T-ASI). Comorbidities were compared with those in a community sample of non–drug using controls (n = 81). Results: Patients’ mean age was 15.6 years (85.6% boys, 14.4% girls). Seventy-nine (93.2%) met criteria for cocaine dependence (DSM-IV-TR), while 78 (91.8%) had symptoms consistent with cocaine abuse. All patients had experimented with at least 1 other addictive substance before crack cocaine: 61.4%, tobacco (mean age at first use = 11.61 years); 44.3%, alcohol (age at first use = 12.43 years); and 54.5%, cannabis (age at first use = 12.15 years). Patients had used crack cocaine 23.2 days in the last month, and the mean age at first use of crack cocaine was 13.38 years. The most common psychiatric comorbidity was conduct disorder (81.8%), followed by oppositional defiant disorder (52.3%) and attention-deficit/hyperactivity disorder (44.3%), all of which were more prevalent in the patient population than in controls (P < . 001). The T-ASI questionnaire showed severe consequences of drug use in most areas of life assessed. The mean time between onset of drug experimentation and crack cocaine dependence was 2.53 (SD = 1.96) years. When Cox regression models were applied, we found that predictors of earlier progression to using crack cocaine were age at first use of any drug (hazard ratio [HR] = 0.79 [95% CI, 0.71–0.88]; P < .001) and age at admission (HR = 0.7 [95% CI, 0.57–0.87]; P = .001). Conclusions: Patients were found to have a multitude of comorbid conditions, which supports the idea of treatment by a multidisciplinary health care team. For each year of delay in the age at first drug use, the chance of crack cocaine initiation is reduced by 18%. Prevention programs aimed at delaying experimentation with addictive substances, especially “gateway” drugs, could delay the progression to crack cocaine dependence.

Buying drugs on a Darknet market: a better deal? Studying the online illicit drug market through the analysis of digital, physical and chemical data Damien, R; Ludovic, S; Julian, B; Quentin, R; Pierre, E Forensic Science International 31 August 2016 http://dx.doi.org/10.1016/j.forsciint.2016.08.032

Darknet markets, also known as cryptomarkets, are websites located on the Darknet and designed to allow the trafficking of illicit products, mainly drugs. This study aims at presenting the added value of combining digital, chemical and physical information to reconstruct sellers’ activities. In particular, this research focuses on Evolution, one of the most popular cryptomarkets active from January 2014 to March 2015. Evolution source code files were analysed using Python scripts based on regular expressions to extract information about listings (i.e. sales proposals) and sellers. The results revealed more than 48′000 listings and around 2′700 vendors claiming to send illicit drug products from 70 countries. The most frequent categories of illicit drugs offered by vendors were cannabis-related products (around 25%) followed by ecstasy (MDA, MDMA) and stimulants (cocaine, speed). The cryptomarket was then especially studied from a Swiss point of view. Illicit drugs were purchased from three sellers located in Switzerland. The purchases were carried out to confront digital information (e.g. the type of drug, the purity, the shipping country and the concealment methods mentioned on listings) with the physical analysis of the shipment packaging and the chemical analysis of the received product (purity, cutting agents, chemical profile based on minor and major alkaloids, chemical class). The results show that digital information, such as concealment methods and shipping country, seems accurate. But the illicit drugs purity is found to be different from the information indicated on their respective listings. Moreover, chemical profiling highlighted links between cocaine sold online and specimens seized in Western Switzerland. This study highlights that (1) the forensic analysis of the received products allows the evaluation of the accuracy of digital data collected on the website, and (2) the information from digital and physical/chemical traces are complementary to evaluate the practices of the online selling of illicit drugs on cryptomarkets. [FULL TEXT AVAILABLE] Marijuana use and use disorders in adults in the USA, 2002–14: analysis of annual cross-sectional surveys Compton, W M; Han, B; Jones, C M; Blanco, C; Hughes, A The Lancet Psychiatry, August 2016 DOI: 10.1016/S2215-0366(16)30208-5

Background The study of marijuana use disorders is urgently needed because of increasing marijuana legalisation in multiple jurisdictions, the effect of marijuana use on future risk of psychiatric disorders, and deleterious effects of marijuana exposure. Thus, understanding trends of marijuana use and use disorders and examining factors that might drive these trends (eg, perceptions of harms from marijuana use) is essential. Methods We analysed data from US civilians aged 18 years or older who participated in annual, cross-sectional US National Surveys on Drug Use and Health from 2002 to 2014. The sample in each US state was designed to be approximately equally distributed between participants aged 12–17 years, 18– 25 years, and 26 years or older. For each survey year, we estimated prevalence of marijuana use and use disorders, initiation of marijuana use, daily or near daily use, perception of great or no risk of harm from smoking marijuana, perception of state legalisation of medical marijuana use, and mean number of days of marijuana use in the previous year. Descriptive analyses, multivariable logistic regressions, and zero-truncated negative binomial regressions were applied. Findings 596 500 adults participated in the 2002–14 surveys. Marijuana use increased from 10·4% (95% CI 9·97–10·82) to 13·3% (12·84–13·70) in adults in the USA from 2002 to 2014 (β=0·0252, p<0·0001), and the prevalence of perceiving great risk of harm from smoking marijuana once or twice a week decreased from 50·4% (49·60–51·25) to 33·3% (32·64–33·96; β=–0·0625, p<0·0001). Changes in marijuana use and risk perception generally began in 2006–07. After adjusting for all covariates, changes in risk perceptions were associated with changes in prevalence of marijuana use, as seen in the lower prevalence of marijuana use each year during 2006–14 than in 2002 when perceiving risk of harm from smoking marijuana was included in models. However, marijuana use disorders in adults remained stable at about 1·5% between 2002 and 2014 (β=–0·0042, p=0·22). Interpretation Prevalence and frequency of marijuana use increased in adults in the USA starting in approximately 2007 and showing significantly higher results in multivariable models during 2011–14 (compared with 2002). The associations between increases in marijuana use and decreases in perceiving great risk of harm from smoking marijuana suggest the need for education regarding the risk of smoking marijuana and prevention messages.

National estimates of marijuana use and related indicators — National Survey on Drug Use and Health, United States, 2002–2014 Azofeifa, A; Mattson, M E; Schauer, G; McAfee, T; Grant, A; Lyerla, R Morbidity and Mortality Weekly Report (MMWR) – Surveillance Summaries 65, 11, p.1–25, 2016

Problem/Condition In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States. Period Covered 2002–2014. Description of System The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession. Results In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002–2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12–17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy to obtain increased. The percentage of persons aged ≥12 reporting the mode of acquisition of marijuana was buying it and growing it increased versus getting it for free and sharing it. The percentage of persons aged ≥12 years reporting that the perceived maximum legal penalty for the possession of an ounce or less of marijuana in their state is a fine and no penalty increased versus probation, community service, possible prison sentence, and mandatory prison sentence. Interpretation Since 2002, marijuana use in the United States has increased among persons aged ≥18 years, but not among those aged 12–17 years. A decrease in the perception of great risk from smoking marijuana combined with increases in the perception of availability (i.e., fairly easy or very easy to obtain marijuana) and fewer punitive legal penalties (e.g., no penalty) for the possession of marijuana for personal use might play a role in increased use among adults. Public Health Action National- and state-level data can help federal, state, and local public health officials develop targeted prevention activities to reduce youth initiation of marijuana use, prevent marijuana dependence and abuse, and prevent adverse health effects. As state-level laws on medical and recreational marijuana use change, modifications might be needed to national- and state- level surveys and more timely and comprehensive surveillance systems might be necessary to provide these data. Marijuana use in younger age groups is a particular public health concern, and changing the perception of harm risk from smoking marijuana is needed. http://www.cdc.gov/mmwr/volumes/65/ss/ss6511a1.htm?s_cid=ss6511a1_w

Which psychoactive substances are used by patients seen in the health care system in French overseas territories? Results of the OPPIDUM survey Daveluy A, Frauger E, Peyrière H, Moracchini C, Haramburu F, Micallef J Fundamental Clinical Pharmacology 1 September 2016 doi: 10.1111/fcp.12233 [Epub ahead of print]

Addiction to illicit substances or medicines is influenced by cultural, religious, ethnic factors, as well as local availability. The purpose of this study was to evaluate the profile of drug users and characteristics of the psychoactive substances used in French overseas territories, using data from the OPPIDUM survey. OPPIDUM is an annual, nationwide, multicentric, cross-sectional study, based on specialized care centres that included subjects presenting a drug addiction or under opiate maintenance treatment. The current study includes data from the 2012 and 2013 surveys and focuses on patients included by drug addiction centres located in French overseas departments and territories: French Pacific Ocean (French Polynesia, New Caledonia), French Americas (Guadeloupe, Saint-Martin, French Guyana) and Reunion Island. Data from metropolitan France (2013 survey) were included as reference. Two hundred and forty-five patients were included. The sex ratio was 3.7 for the Pacific Ocean, 3.5 for the French Americas, and 3.3 for Reunion Island. Cannabis was consumed in all the territories, from 50.8% in Reunion Island to 81.7% in Pacific Ocean. Cocaine was most frequently consumed in the French Americas (61%), mainly in the "freebase" form (91%), whereas 6.5% of cocaine users in metropolitan France did so. Problematic use of medicines was most frequent in Reunion Island. Heroin seems rarely used in all overseas territories. This study highlights the complexity of substances use in French overseas territories, which often differ from that in mainland France. The relative difference between different areas provides valuable information for future investigations and possible interventions.

Heritability of high sugar consumption through drinks and the genetic correlation with substance use Treur JL, Boomsma DI, Ligthart L, Willemsen G, Vink JM American Journal of Clinical Nutrition 31 August 2016 pii: ajcn127324 [Epub ahead of print] Background High sugar consumption contributes to the rising prevalence of obesity. Sugar can have rewarding effects that are similar to, but less strong than, the effects of addictive substances. People who consume large amounts of sugar also tend to use more addictive substances, but it is unclear whether this is due to shared genetic or environmental risk factors. Objective We examined whether there are genetic influences on the consumption of sugar- containing drinks and whether genetic factors can explain the association with substance use. Design The frequency of consumption of sugar-containing drinks (e.g., cola, soft drinks, and energy drinks) and addictive substances (nicotine, caffeine, alcohol, cannabis, and illicit drugs) was obtained for 8586 twins who were registered at the Netherlands Twin Register (women: 68.7%; mean ± SD age: 33.5 ± 15.3 y). Participants were categorized as high or low sugar consumers (>1 compared with ≤1 SD above daily consumption in grams) and as high or low substance users (≥2 compared with <2 substances). Through bivariate genetic modeling, genetic and environmental influences on sugar consumption, substance use, and their association were estimated. Results Genetic factors explained 48% of the variation in high sugar consumption, whereas unique environmental factors explained 52%. For high substance use, these values were 62% and 38%, respectively. There was a moderate phenotypic association between high sugar consumption and high substance use (r = 0.2), which was explained by genetic factors (59%) and unique environmental factors (41%). Conclusions The positive association between high sugar consumption and high substance use was partly due to unique environmental factors (e.g., social situations). Genetic factors were also of influence, suggesting that neuronal circuits underlying the development of addiction and obesity are related. Further research is needed to identify genes that influence sugar consumption and those that overlap with substance use.

Prevalence, correlates and patterns of heroin use among young adults in the United States Ihongbe TO, Masho SW Addictive Behaviors 63, p.74-81, 2016

Introduction: The prevalence of heroin use, abuse, and dependence has increased considerably over the past decade. This increase has largely been driven by young adults (18-25years). This study aims to improve the understanding of heroin use among young adults by determining the prevalence, correlates, patterns and attitude of heroin use among young adults in the US. Methods: The 2011-2013 National Survey on Drug Use and Health was analyzed. Study population included 55,940 young adults with valid interviews. Self-reported lifetime, past-year and past-month use of heroin were examined. Descriptive statistics and adjusted odds ratios were estimated in accordance with the complex survey design. Results: Of the respondents, 18.4 per 1000 (95% CI=16.8-20.0) used heroin at some time in their lives, and 7.3 per 1000 (95% CI=6.3-8.3) and 3.3 per 1000 (95% CI=2.6-4.0) used heroin in the past year and past month, respectively. The single most common route of heroin use was by sniffing. Majority of young adults reported using heroin in combination with other substances. Users of non-prescribed opioid pain relievers, cigarette smokers, illicit drug users and those arrested and booked for breaking the law, had higher odds of using heroin during their lifetime, in the past-year and past-month. Conclusion: Fewer than 2% reported ever using heroin, and 82% of those reported no use in the past month. Majority were polysubstance users and sniffed heroin in combination with other routes of use. Comprehensive programs that target young adult heroin users and address important risk factors for heroin use are needed.

Narcotecture O’Neill, K L Environment and Planning D: Society and Space 21 March 2016 doi: 10.1177/0263775816637873

The term narcotecture often refers to grand mansions built with drug money. A blend of the words “narcotics” and “architecture,” the portmanteau evokes florid gated communities in Afghanistan, Africa, and the Americas. Yet, this interest in ostentation strips narcotecture of full analytical purchase. To expand the term's significance, this article samples how the global drug trade interacts every day with the War on Drugs at the level of built environments. This interaction makes flashy mansions, to be sure, but also airplane hangars and shipping containers, security booths and watch towers, drop sites and crack houses—not to mention prisons, hospitals, and barracks. This broader notion of narcotecture is organized by the tactical manipulation of space pursued in ways that self-consciously attempt to avoid detection. This article's central claim is that narcotecture is not simply a form of conspicuous consumption but more importantly a mode of inconspicuous construction.

Using respondent-driven sampling (RDS) to recruit illegal poly-substance users in Cape Town, South Africa: implications and future directions Harker Burnhams N, Laubscher R, Howell S, Shaw M, Erasmus J, Townsend L Substance Abuse Treatment, Prevention, and Policy 2016, 11, 31 1 September 2016

Background South Africa continues to witness an increase in illicit poly-substance use, although a precise measurement continues to be compounded by difficulties in accessing users. In a pilot attempt to use respondent-driven sampling (RDS)—a chain referral sampling method used to access populations of individuals who are ‘hard-to-reach’— this article documents the feasibility of the method as recorded in a simultaneously run, multisite, poly-substance study in Cape Town. Here we aim to a) document the piloting of RDS among poly-substance users in the three socio-economic disparate communities targeted; b) briefly document the results; and c) review the utility of RDS as a research tool. Methods Three cross-sectional surveys using standard RDS procedures were used to recruit active poly-substance users and were concurrently deployed in three sites. Formative research was initially conducted to assess the feasibility of the survey. To determine whether RDS could be used to successfully recruit poly-substance users, social network characteristics, such as network size was determined. Results A 42.5 % coupon return rate was recorded in total from 12 initial seeds. There were vast differences in the recruitment chains of individual seeds—two generated more than 90 recruits, and 2 of the 10 recruitment chains showing a length of more than 10 waves. Findings include evidence of the use of 3 or more substances in all three sites, high levels of unemployment among users, with more than a third of participants in two sites reporting arrest for drug use in the past 12 months. Conclusions Our results indicate that RDS was a feasible and acceptable sampling method for recruiting participants who may not otherwise be accessible. Future studies can use RDS to recruit such cohorts, and the method could form part of broader efforts to document vulnerable populations. [FULL TEXT AVAILABLE]

Interactions between nicotine and drugs of abuse: A review of preclinical findings Kohut, S J American Journal of Drug and Alcohol Abuse 2 September 2016 [Epub ahead of print]

Polysubstance abuse is common among substance-use disorder patients, and nicotine is one of the most commonly co-used substances. Epidemiological and clinical laboratory studies suggest that nicotine, when combined with other drugs of abuse, increases intake of one or both substances. This review focuses on the preclinical literature regarding nicotine's interaction with alcohol, stimulants (i.e., cocaine, amphetamines), opioids (i.e., morphine, heroin), and Δ(9)-tetrahydrocannabinol (THC). The current understanding of how these various classes of abused drugs may interact with nicotine on behavioral, physiological, and pharmacological indices that may be important in maintaining co-use of one or both substances in human populations are highlighted. Suggestions as to future areas of research and gaps in knowledge are offered. Genetics of addiction: future focus on gene × environment interaction? Vink, J M Journal of Studies on Alcohol and Drugs 77, 5, p.684-687, 2016

The heritability of substance use is moderate to high. Successful efforts to find genetic variants associated with substance use (smoking, alcohol, cannabis) have been undertaken by large consortia. However, the proportion of phenotypic variance explained by the identified genetic variants is small. Interestingly, there is overlap between the genetic variants that influence different substances. Moreover, there are sets of "substance-specific" genes and sets of genes contributing to a "vulnerability for addictive behavior" in general. It is important to recognize that genes alone do not determine addiction phenotypes: Environmental factors such as parental monitoring, peer pressure, or socioeconomic status also play an important role. Despite a rich epidemiologic literature focused on the social determinants of substance use, few studies have examined the moderation of genetic influences like gene-environment (G × E) interactions. Understanding this balance may hold the key to understanding the individual differences in substance use, abuse, and addictive behavior. Recommendations for future research are described in this commentary and include increasing the power of G × E studies by using state-of-the-art methods such as polygenic risk scores instead of single genetic variants and taking genetic overlap between substances into account. Future genetic studies should also investigate environmental risk factors for addictive behavior more extensively to unravel the interaction between nature and nurture. Focusing on G × E interactions not only will give insight into the underlying biological mechanism but will also characterize subgroups (based on environmental factors) at high risk for addictive behaviors. With this information, we could bridge the gap between fundamental research and applications for society.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion Tamanini JT, Salzani VT, Tamanini JM, Iessenco F, Reis LO International Brazilian Journal of Urology 1 September 2016 doi: 10.1590/S1677-5538.IBJU.2015.0663 [Epub ahead of print]

Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) • Main Etiologic (testicular torsion) • Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Real-time assessment of alcohol drinking and drug use in opioid- dependent polydrug users Preston KL, Jobes ML, Phillips KA, Epstein DH Behavioral Pharmacology 27, 7, p.579-584, 2016

We investigated relationships between drinking, other drug use, and drug craving, using ecological momentary assessment (EMA), in a sample of polydrug users who were not heavy drinkers. In a prospective longitudinal cohort study, 114 heroin and cocaine users on methadone-maintenance treatment carried handheld electronic diaries during waking hours and were screened for drug and alcohol use for up to 25 weeks. Individuals who fulfilled the Diagnostic and Statistical Manual of Mental Disorders criteria for alcohol abuse or dependence were excluded. Participants responded to 2-5 random prompts per day to report on their moods, cravings, and activities and initiated entries when they used or acutely craved heroin or cocaine. Drinking alcohol was assessed in both types of entries. Breath alcohol was measured three times weekly. Participants reported drinking alcohol in 1.6% of random-prompt entries, 3.7% of event-contingent entries when craving cocaine and/or heroin, and 11.6% of event-contingent entries when using cocaine and/or heroin. Alcohol drinking was also associated with higher craving ratings and prestudy alcohol use. More drinking was detected by ambulatory self-report than by in- clinic breath testing. Even though we had screened out heavy drinkers from our sample of polydrug users, drinking was associated with heroin and cocaine craving and actual use.

Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity Liakoni E, Walther F, Nickel CH, Liechti ME Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 24, 1, p.107, 2016

Background: γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity. Methods: Retrospective case series of GHB intoxications seen in an urban ED. Results: From January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71 % male patients). The mean ± SD age was 29 ± 8 years. The co-use of alcohol and/or other illicit drugs was reported in 65 % of the cases. Neurological symptoms other than central nervous system depression included agitation (40 %) and clonus (21 %). The most frequent reasons for admission were coma (64 %) and agitation (23 %). The median time to regain consciousness was 90 min (range, 3-400 min). Sudden recovery was reported in 25 cases (32 %). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale = 3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47 %), with additional quantitative analysis in 20 cases. The median GHB concentration was 240 mg/L (range, 8.3- 373 mg/L). Intoxication was severe in 72 % of the cases. No fatalities occurred, and 72 % of the patients were discharged directly home from the ED. Discussion: There were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity. Conclusion: Impaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study. [FULL TEXT AVAILABLE]

Co-citation analysis of articles published in substance abuse journals: intellectual structure and research fields (2001-2012) González-Alcaide G, Calafat A, Becoña E, Thijs B, Glänzel W Journal of Studies on Alcohol and Drugs 77, 5, p.710-722, 2016

Objective: The purpose of this study is to introduce a new methodology in the field of substance abuse, namely, co-citation analysis, which uses the bibliographic references of publications to establish the main thematic areas being researched and to identify the seminal documents that have contributed to establishing the intellectual foundation of the discipline at the present time. Method: We identified all bibliographic references that were cited in documents published in the substance abuse journals included in the Journal Citation Reports in the 2001-2012 period, generating a co-citation matrix. This matrix was used to perform a co-citation network analysis. Results: The co-citation network analysis led to the identification of 56 prominent research clusters that bring together 698 documents; their subject matter constitutes the foundation of the discipline in the field's journals. Conclusions: Substance abuse research is dominated by a few core topics; chief among them are tools for measuring and diagnosing dependence, as well as therapeutic approaches to treat alcohol abuse and nicotine addiction. Other areas of note include epidemiological studies, research on drug user motivation (particularly among young people), binge drinking, social support mediators and networks, opioid dependence, consumption and effects of cannabis, basic research on brain damage, genetic factors associated with substance use, and the physiological and neurological determinants of abstinence syndrome. The main works of reference that we identified were published in a small number of journals, which establish the intellectual, conceptual, and methodological basis of the discipline.

Driving under the effect of drugs: Hair analysis in order to evaluate recidivism Tassoni G, Cippitelli M, Mirtella D, Froldi R, Ottaviani G, Zampi M, Cingolani M Forensic Science International 267, p.125-128, 2016

Under Italian law drug addiction and regular drug abuse are incompatible with driving ability. One important problem with the enforcement of the impaired driving law is the large number of people that re-offend. To regain their license, offenders must be drug-free for the duration of an observation period, according to the judgement of a medical commission. The exclusion of illicit drug use is determined by toxicological analysis. A few studies exist that have used a hair matrix to monitor recidivism. Hair is an attractive matrix for monitoring drug recidivism, due to the large time window for drug detection, and to the non-alterability of this matrix. We report the results of several years of experience at our forensic toxicology laboratory in the use of hair analysis for the assessment of past exposure to drugs in persons suspected of driving under the influence of drugs. 5592 subjects were analyzed for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ(9)-THC) using a GC/MS method. 1062 (19.0%) subjects resulted positive. From this group, the individuals that resulted positive at least at the second control were considered recidivists (243, 22.9%). 79.7% of recidivist subjects were positive for cocaine and metabolites, 14.9% for morphine and metabolites, 5.4% for Δ(9)-THC. We also studied the time frame of the abuse, as well as gender and age distribution of recidivist subjects. Furthermore, we analyzed risk factors associated with recidivist behaviour. Our results show that cocaine consumption was the only factor that showed significance with regard to increased likelihood of being a recidivist.

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