Emcdda Documentation Centre s4

EMCDDA DOCUMENTATION CENTRE INFORMATION BULLETIN

GENERAL INFORMATION BULLETIN

5 February 2016 ______

GREY LITERATURE

Impact of the reduction in heroin supply between 2010 and 2011 Ahmad, M; Richardson, A Home Office London: January 2016

Key findings According to Drug and Alcohol Action Teams, changes in heroin supply varied at a local level. Furthermore, differences in supply were not necessarily observed at the same time and were not of the same length compared to the overall national level. There was a lack of availability of heroin reported in many local areas in 2010/11 and a marked fall in the average purity of heroin seizures in November 2010. Although levels generally increased after this, by June 2012 the average purity of heroin seized on the streets did not return to levels previously seen before the reduction in supply. Although wholesale prices of heroin rose substantially, street-level prices remained relatively stable. However, individuals were getting less for their money as the purity levels of heroin dropped markedly. Drug and Alcohol Action Teams and a number of service providers reported that heroin users switched to, or increased their use of, other substances. The most common substances reported by Drug and Alcohol Action Teams as being used alongside or instead of heroin were benzodiazepines and alcohol. The number of new presentations to drug treatment for opiate use in England fell significantly in February 2011 and subsequently did not generally return to previous levels. In contrast, feedback from treatment agencies suggests a more mixed picture. The low heroin purity levels appear to have been a catalyst for some users to tackle their addiction and enter treatment. There were also reports of users substituting heroin for other drugs. There were no significant falls in England in the number of fatal and non-fatal overdoses shown in the quantitative data during the reported period of reduction in heroin supply period. However, some Drug and Alcohol Action Teams did report increases in overdoses in their areas, as well as other side effects, due to the additional adulterants contained in the heroin and/or replacement substances which individuals were using. Overall, no changes were reported in the level of drug-related acquisitive crime6 committed in England and Wales indicating that heroin users are no more likely to offend or, for those who do not offend, to commit further crime during the reduction in supply. However, there was a significant decline in the number of ‘possession’ as well as ‘possession with intent to supply’ offences for heroin, possibly due to individuals being less likely to be caught with the drug when there is a lack of heroin availability/reduced purity. Service providers reported that they increased communication with drug users, colleagues and other services over the period to share information and provide guidance. They recommended that a more reactive and responsive approach should be taken to any future recurrences of a change in drug supply. http://klmsvr.emcdda.org/vlib/Impact_of_the_reduction_in_heroin_supply_bet ween_2010_and_2011.pdf

JOURNAL ARTICLES

Policing, massive street drug testing and poly-substance use chaos in Georgia - a police case study Otiashvili D, Tabatadze M, Balanchivadze N, Kirtadze I Substance Abuse Treatment, Prevention, and Policy, 2016, 11, 4 16 January 2016

Background Since early 2000, intensive policing, wide scale street drug testing, and actions aimed at limiting the availability of specific drugs have been implemented in Georgia. Supporters of this approach argue that fear of drug testing and resulting punishment compels drug users to stop using and prevents youth from initiating drug use. It has been also stated that reduction in the availability of specific drugs should be seen as an indication of the overall success of counter-drug efforts. The aim of the current review is to describe the drug-related law enforcement response in Georgia and its impact on illicit drug consumption and drug-related harm. Method We reviewed relevant literature that included peer-reviewed scientific articles, stand-alone research reports, annual drug situation reports, technical reports and program data. This was also supplemented by the review of relevant legislation and judicial practices for the twelve year period between 2002 and 2014. Results Every episode of reduced availability of any “traditional” injection drug was followed by the discovery/introduction of a new injection preparation. The pattern of drug consumption was normally driven by users’ attempts to substitute their drug of choice through mixing together available alternative substances. Chaotic poly-substance use and extensive utilization of home- made injection drugs, prepared from toxic precursors, became common. Massive random street drug testing had little or no effect on the prevalence of problem drug use. Conclusions Intensive harassment of drug users and exclusive focus on reducing the availability of specific drugs did not result in reduction of the prevalence of injecting drug use. Repressive response of Georgian anti-drug authorities relied heavily on consumer sanctions, which led to shifts in drug users’ behavior. In most cases, these shifts were associated with the introduction and use of new toxic preparations and subsequent harm to the physical and mental health of drug consumers. [FULL TEXT AVAILABLE]

Potential years of life lost due to premature mortality among treatment- seeking illicit drug users in Finland Onyeka, I N, Beynon, C M, Vohlonen, I, Tiihonen, J, Föhr, J, Ronkainen, K, Kauhanen, J Journal of Community Health 40 (6), p.1099-1108, 2015

Premature death is a serious public health concern. The primary objective of this study was to examine premature deaths in terms of potential years of life lost (PYLL) in a cohort of 4817 treatment-seeking illicit drug users. Clients' data were linked to the Finnish national cause-of-death register and the follow-up period ranged from 31 January 1997 to 31 December 2010. PYLL before 70 years was calculated for all deaths and cause- specific deaths by gender. We observed 496 deaths (417 males and 79 females) at the end of 2010. The mean age at death was 33.8 years, 34.3 years for males (range 18-68) and 31.4 years for females (range 16-53). Overall, 17,951 life years were lost; 14,898 among males and 3053 among females. The overall PYLL rate for males was more than twice that of females (513.0/1000 vs. 243.7/1000 person-years) but the mean PYLL was higher in females than males (38.6 vs. 35.7 years). Of the total PYLL, 34.8 % was due to accidental overdose, and 24.0 % to suicide. In both genders, accidental overdose and suicide were the two top-ranking causes of PYLL. Premature deaths among drug users are a potential loss to the society. Our findings suggest that measures targeting accidental overdose and suicide are top priorities for reducing preventable loss of life. [FULL TEXT AVAILABLE]

Declining trends in the rates of assisted injecting: a prospective cohort study Pedersen J, Dong H, Small W, Wood E, Nguyen P, Kerr T, Hayashi K Harm Reduction Journal 2016, 13:2 (27 January 2016)

Background: Assisted injecting has been associated with increased risk of blood-borne infections, overdose, and other harms among people who inject drugs (PWID), particularly women. Given the changing availability of relevant harm reduction interventions in Vancouver, Canada, in recent years, we conducted a gender-based analysis to examine changes in rates and correlates of assisted injecting over time among active PWID. Methods: Using data from a prospective cohort of PWID in Vancouver, we employed gender-stratified multivariable generalized estimating equations to examine trends in assisted injecting and identify the correlates during two periods: June 2006–November 2009 and December 2009–May 2014. Results: Among 1119 participants, 376 (33.6 %) were females. Rates of assisted injecting declined between 2006 and 2014 among males (21.9 to 13.8 %) and females (37.0 to 25.6 %). In multivariable analyses, calendar year of interview also remained independently and negatively associated with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95 % confidence interval [CI] 0.92–0.99) and females (AOR 0.93, 95 % CI 0.89–0.97). Syringe borrowing remained independently associated with assisted injecting throughout the study period among females (AOR 1.53, 95 % CI 1.10–2.11 during 2006– 2009; AOR 2.15, 95 % CI 1.24–3.74 during 2009–2014) and during 2009– 2014 among males (AOR 1.88, 95 % CI 1.02–3.48). Conclusions: Our findings demonstrate assisted injecting has significantly decreased for both males and females over the past decade. Nevertheless, rates of assisted injecting remain high, especially among women, and are associated with high- risk behavior, indicating a need to provide safer assisted injecting services to these vulnerable sub-populations of PWID. [FULL TEXT AVAILABLE]

Gender differences in drug abuse in the forensic toxicological approach Buccelli, C; Della Casa, M; Paternoster, M; Niola, M; Pieri, M Forensic Science International 22 January 2016 doi:10.1016/j.forsciint.2016.01.014

Gender differences in substance use/abuse have been the focus of research in the last 15 years. Initiation, use patterns, acceleration of disease course, and help-seeking patterns are known to be influenced by gender differences with regard to biological, psychological, cultural and socioeconomic factors. This paper presents a systematic review of published data on gender differences in the use/abuse of psychoactive and psychotic drugs, focusing on the importance of a multidisciplinary approach. The basis for this paper was obtained by Medline searches using the search terms “human” and “gender”, combined with individual drug names or “drugs of abuse”. The reference lists of these papers were further checked for other relevant studies. The gender difference in drug abuse is more evident in adults than in adolescents (13-19 years): adult men are 2-3 times more likely than women to develop drug abuse/dependence disorders and approximately 4 times as likely to have an alcohol use disorder. Such prevalence rates have not been observed in adolescents. Differences between men and women involve i) the biological response to the drug, ii) the progression to drug dependence, and iii) the comorbid psychiatric diagnoses, which may be due to both sociocultural factors and innate biological differences. A crucial role played by ovarian hormones (oestrogens and progesterone) has been documented in both human and animal model studies. Epidemiological data on how particular psychobiological and physiological characteristics in females influence vulnerability to both drug addiction and toxicological consequences of drugs are still in their infancy. Significant gaps remain in our knowledge, which are primarily attributable to the lack of empirical data that only a systematic and multidisciplinary approach to the topic can generate. The introduction of gender into forensic toxicological evaluations may help elucidate the relationship between the body's absorption of abused drugs (alone or in combination) and the onset of intoxications, both lethal and none.

Legal or illegal, cannabis is still addictive Piomelli, D; Haney, M; Budney, A J; Vincenzo, P P Cannabis and Cannabinoid Research, 2016, 1, 1, p.47-53 [FULL TEXT AVAILABLE]

Understanding addiction as a developmental disorder: an argument for a developmentally informed multilevel approach McCrory, E J; Mayes, L Current Addiction Reports, 2015, 2, 4, p.326–330

Substance abuse and drug addiction are two of the most common psychopathologies among the general population. While a host of risk factors are associated with the onset of drug abuse and drug addiction, there is a growing body of evidence pointing to the powerful influence of early adverse experiences, both child neglect and maltreatment, as well as drug use and abuse in parents and/or primary caretakers. We consider the case for drug addiction as a developmental disorder, outlining the need to consider the role of genetic, epigenetic, and neurobiological factors alongside experiences of adversity at key stages of development. Such a multilevel approach within a developmental framework has the potential to reframe our understanding of how addiction emerges and is maintained, and is essential if we are to identify the mechanisms underlying this disorder to better inform effective treatment and prevention across the generations. [FULL TEXT AVAILABLE]

Reduced volume of the nucleus accumbens in heroin addiction Seifert CL, Magon S, Sprenger T, Lang UE, Huber CG, Denier N, Vogel M, Schmidt A, Radue EW, Borgwardt S, Walter M European Archives of Psychiatry and Clinical Neuroscience 265(8):637-45, 2015

The neural mechanisms of heroin addiction are still incompletely understood, even though modern neuroimaging techniques offer insights into disease- related changes in vivo. While changes on cortical structure have been reported in heroin addiction, evidence from subcortical areas remains underrepresented. Functional imaging studies revealed that the brain reward system and particularly the nucleus accumbens (NAcc) play a pivotal role in the pathophysiology of drug addiction. The aim of this study was to investigate whether there was a volume difference of the NAcc in heroin addiction in comparison to healthy controls. A further aim was to correlate subcortical volumes with clinical measurements on negative affects in addiction. Thirty heroin-dependent patients under maintenance treatment with diacetylmorphine and twenty healthy controls underwent structural MRI scanning at 3T. Subcortical segmentation analysis was performed using FMRIB's Integrated Registration and Segmentation Tool function of FSL. The State-Trait Anxiety Inventory and the Beck Depression Inventory were used to assess trait anxiety and depressive symptoms, respectively. A decreased volume of the left NAcc was observed in heroin-dependent patients compared to healthy controls. Depression score was negatively correlated with left NAcc volume in patients, whereas a positive correlation was found between the daily opioid dose and the volume of the right amygdala. This study indicates that there might be structural differences of the NAcc in heroin-dependent patients in comparison with healthy controls. Furthermore, correlations of subcortical structures with negative emotions and opioid doses might be of future relevance for the investigation of heroin addiction.

Prevalence and differential profile of patients with drug addiction problems who commit intimate partner violence Arteaga A, Fernández-Montalvo J, López-Goñi JJ American Journal on Addictions 24(8):756-64, 2015

Background and Objectives: The objectives of this study were, first, to explore the prevalence of aggressors with lifetime intimate partner violence (IPV) among patients in the Proyecto Hombre of Navarra (Spain) addiction treatment programme; and second, to know the specific and differential characteristics of patients presenting IPV as aggressors. Methods: A sample of 162 patients (119 men and 43 women) was assessed. Data on socio-demographic and substance consumption characteristics, IPV variables, psychopathological symptoms, and personality variables were obtained. The profiles of patients in addiction treatment with and without a history of violence towards their partners were compared. Results: The results showed that 33.6% of people in treatment for addiction had committed violence against their partners. This prevalence was significantly higher (χ(2) = 15.6, p < .001) in women (63.3%) than in men (24.2%). In the 98.4% of the cases the IPV was bidirectional. Patients with a history of IPV perpetration showed greater severity in substance consumption variables, psychopathological symptoms, and personality traits. Gender, the family scale on the European version of the Addiction Severity Index (EuropASI), and the aggressive-sadistic scale on the Millon Clinical Multiaxial Inventory (MCMI-III) were the main variables related to the presence of IPV as aggressors. Conclusions and Scientific Significance: There was a differential profile in patients with IPV perpetration, showing more psychopathological and personality symptoms. Moreover, in this study being a woman was one of the main predictors of committing IPV.

Self-reported cue-induced physical symptoms of craving as an indicator of cocaine dependence Vorspan F, Fortias M, Zerdazi el-H, Karsinti E, Bloch V, Lépine JP, Bellivier F, Brousse G, van den Brink W, Derks EM American Journal on Addictions 24(8):740-743, 2015

Background: The presence of cocaine dependence is under-recognized by cocaine users and requires a careful standardized interview to be ascertained by clinicians. Objective: To test if past experiences of cue-induced physical symptoms of craving (nausea, vomiting, sweating, shaking, nervousness) before cocaine use could be a useful way to boost the diagnosis of cocaine dependence. Methods: A cross-sectional study of 221 cocaine users from several outpatient addiction treatment services in France, addressing the most severe period of cocaine use. DSM-IV cocaine dependence was determined with the MINI International Neuropsychiatric Interview (MINI). Physical symptoms before using cocaine were retrospectively assessed with a single item rated on a 0-5 scale. Results: The prevalence of DSM-IV cocaine dependence was 84.6%. The mean score on the physical symptoms item was 1.3 (SD 1.3). A cut-off score of ≥ 1 on this item alone resulted in a sensitivity of 62%, a specificity of 88.2%, a positive predictive value of 96.6% and a negative predictive value of 29.7% to detect DSM IV cocaine dependence in this sample. Adding this item to a model with the frequency of cocaine use significantly increased the predictive power: Nagelkerke's R(2) increased from .149 to .326 (p < .001). Discussion and Conclusion: Recalling past experiences of cue-induced physical signs of cocaine craving is associated with a clinical diagnosis of lifetime cocaine dependence and could be a simple way to improve its detection in clinical settings.

NEWS STORIES

The new war on drugs: harm reduction, needle exchange used more in fight against heroin http://www.medicaldaily.com/new-war-drugs-harm-reduction-needle- exchange-used-more-fight-against-heroin-371608

Perverse incentives: are needle exchanges good policy? To most people, it is a matter of common sense and good policy that governments should not subsidize illegal or immoral activities on the part of their citizens | Law Street, UK http://lawstreetmedia.com/issues/health-science/perverse-incentives-needle- exchanges-good-policy/

Floria Relief: Cannabis vagina suppositories which 'eases period pain' sold in US But the treatment is not yet approved by the US' drug regulatory body | Independent, UK http://www.independent.co.uk/life-style/health-and-families/health- news/women-putting-cannabis-in-their-vaginas-to-ease-period-pain- a6848626.html

You might want to think twice about putting weed in your vagina to ease cramps When it comes to sticking drugs up your vagina, I recommend erring on the side of caution. There’s been a lot of talk (https://broadly.vice.com/en_us/article/period-cramps-foria-relief-weed-lube) lately about inserting weed in your vagina to alleviate menstrual cramps | Motherboard, UK http://motherboard.vice.com/en_uk/read/you-might-want-to-think-twice-about- putting-weed-in-your-vagina-to-ease-cramps-marijuana-medical-cannabis-pot- foria

Risk of premature death nine-fold among illicit drug users Premature deaths are almost nine times more common among illicit drug users than among the general Finnish population, shows a new study from the University of Eastern Finland | Medical Xpress, USA http://medicalxpress.com/news/2016-02-premature-death-nine-fold-illicit- drug.html

Justice Minister reveals UK is trialling Portuguese approach to drugs “These services place health professionals at police stations and courts to assess suspects for a range of health problems, including drug misuse, and make referrals to treatment and support. Information shared with the criminal justice system can be used to inform decisions, supporting diversion into treatment as part of an alternative to charge or to custody where appropriate..." | CLEAR Blog, UK http://clear-uk.org/justice-minister-reveals-uk-is-trialling-portuguese-approach- to-drugs/

The impact of a shortage of heroin The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reported that a small group of European countries, including the UK, appeared to have experienced a reduced supply of heroin in 2010/11. The Home Office research unit saw this change in the availability of heroin as a unique opportunity to expand the currently limited evidence base on the impacts of reduced supply | Russell Webster, UK http://www.russellwebster.com/impact-heroin-shortage/