Alcohol, cannabis, ecstasy and cocaine: drugs of reasoned choice amongst young adult recreational drug users in England

This paper describes the current drugs consumption patterns of a cohort of English young adults who have been tracked, longitudinally, since they were fourteen. It compares their tobacco, alcohol and illicit drugs consumption at 22 years (n=465) with when they were 18 years (n=529) using self-report questionnaires and in-depth interviews (n=86). It further explores whether, as a very drugwise/experienced sample of adolescents, this cohort are now beginning to settle down and reduce their substance use. The results suggest that any reductions in recreational drug use are likely to be delayed beyond traditional markers. The cohort have largely maintained their consumption habits with rates for current tobacco smoking (35.5%), regular drinking (82.3%), on-going drug involvement (past year, any drug, 52.1%) and more regular use (past month, any drug, 31.2%) being almost identical to their rates at 18 years. Current drug involvement is increasingly dominated by cannabis however. A minority continue to use ecstasy. LSD and amphetamine use have declined but cocaine trying (lifetime prevalence 5.9% at 18 years up to 24.6%) and use have increased dramatically. Mixing and combining substances is commonplace. Hedonistic motives for these substance use patterns remain but are now joined by the need to use psycho-active repertoires ‘sensibly’ to relax and reduce the stresses of the working week. This style of recreational drug use by generally conforming adults offers a severe challenge to current national drugs strategy.     

Predictors of Illicit Drug Use Among Prisoners

Background: The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. Objectives: To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. Results: Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26–0.98). Participants aged 37–89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19–0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04–5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13–5.69). Conclusions: Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.     

Recent Weapon Carrying and Substance Use among United States Virgin Islands Youth

The objective of the present study was to estimate the strength of the associations between recent weapon carrying and alcohol, cigarette, and illicit drug use among US Virgin Islands (USVI) youth. Data from 1,124 students in Grades 7–12 were analyzed using the conditional form of multiple logistic regression. Compared with youth who did not carry a weapon, youth who carried a weapon were more likely to be male and recent cigarette, alcohol, and illicit drug users. After matching on school and controlling for age, sex, race, neigborhood characteristics, and affiliation with friends who use alcohol and illegal drugs, the associations with cigarette smoking and illicit drug use remained both moderate and statistically significant (odds ratio [OR] =4.31, p <. 001; OR = 2.99, p <.001, respectively). These findings identify a potentially high-risk population that could be targeted for interventions to reduce weapon carrying among youth.     

The Role of Pregnancy Concerns in the Relationship between Substance Use and Unprotected Sex among Adolescents

Background: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents’ attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy (“Getting pregnant would force me to grow up too fast”), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents. Objectives: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students. Method: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6?months (T1–T3). Results: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t?=?2.99, p = .04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b?=?0.10, CI[.01–.41]; direct effect: b?=?0.15, p = .32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = ?0.10, p = .04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = ?1.02, p = .02). Conclusions: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns.     

The Link Between Substance Use and Reproductive Health Service Utilization Among Young US Women

ABSTRACT. Background: The authors sought to investigate associations between young women's use of alcohol and other substances and their sexual and reproductive health (SRH) service utilization. Methods: The authors used data from 4421 young women aged 15–24 years in the nationally representative study, National Survey of Family Growth, 2002–2008. The authors examined associations between frequency of tobacco, alcohol, marijuana, and illicit drug use and SRH service use in the past year using logistic regression. Results: Over half (59%) of the young women used SRH services, including contraception (48%), gynecological examination (47%), and sexually transmitted infection (STI) testing/treatment (17%) services. Proportions of SRH service use increased with higher frequencies of substance use (all P values <.001); service use was particularly common among daily substance users (range: 72% of daily marijuana users to 83% of daily binge drinkers). In multivariable analyses, associations between substance and SRH service use varied by substance and service type: weekly marijuana (odds ratio [OR] = 2.5, 95% confidence interval [95% CI] = 1.4, 4.3, P = .002) and alcohol (OR = 1.7, 95% CI = 1.1, 2.4, P = .01) use were positively associated with gynecological service use. All substances were positively associated with STI service use. However, daily smoking was negatively associated with contraceptive service use (OR = 0.6, 95% CI = 0.4, 0.8, P = .001). Conclusion: SRH service use was common among women reporting frequent substance use. SRH settings provide an opportunity to deliver substance use screening and preventive care to young women.     

Perceived Devaluation among a Cohort of Street-Involved Youth in Vancouver,Canada

Background: Perceived devaluation is a barrier to seeking mental and physical health services among people who use illicit drugs. Objective: Assessing the prevalence and correlates of perceived devaluation within a cohort of street-involved youth. Methods: Data were drawn from an open prospective cohort of street-involved youth who use illicit drugs (aged 14–26 at study enrollment) between December 2013 and May 2015 in Vancouver, Canada. Perceived devaluation was measured using an adapted version of Perceived Devaluation and Discrimination scale. Multivariable generalized estimating equations were constructed to examine factors independently associated with high perceived devaluation. Results: Among 411 street-involved youth, 95.1% reported high perceived devaluation at some point during the study period. In a multivariable analysis, youth who reported high perceived devaluation were significantly more likely to engage in: unprotected sex (Adjusted Odds Ratio [AOR]?=?1.56, 95% Confidence Interval 1.03–2.37); heavy alcohol use (AOR = 2.31, 95% CI 1.22–4.36); and daily heroin use (AOR = 2.07, 95% CI 1.16–3.70). Youth who resided in the Downtown Eastside neighborhood were significantly less likely to report high perceived devaluation (AOR = 0.41, 95% CI 0.26–0.65). Conclusions: Perceived devaluation was extremely prevalent among street-involved youth in our sample. We also observed that youth most in need of health and social services were significantly more likely to report high levels of perceived devaluation which may result in a reluctance to seek out key services and supports. These findings highlight the need to implement stigma reduction interventions for vulnerable youth in this setting.     

Drug use as a ‘practice of the self’: is there any place for an ‘ethics of moderation’ in contemporary drug policy?

This paper offers a series of critical interrogations of the principles and practice of harm minimisation. This critique draws from Michel Foucault's account of ethics, pleasure and moderation in pointing to some significant gaps and conceptual problems within Australia's National Drug Strategy. I argue that this strategy has had only indirect impacts upon the ways in which illicit drugs are consumed in Australia, and on the behaviour of individual users. Part of this problem lies in the ways in which the cultures and the contexts of illicit drug use have been conceptualised within contemporary drug policy. Following Foucault, I argue that drug use ought to be conceptualised as a distinctive ‘practice of the self’. I argue further that Foucault's work on pleasure and ethics offers important new ways of understanding the changing nature of drug use for young people, as well as providing new conceptual bases for the design and delivery of harm minimisation strategies within those settings and contexts in which drug use takes place.     

2015—2019年天津市胸科医院血流感染多重耐药菌的菌株变迁及危险因素相关性分析

目的 分析天津市胸科医院血流感染多重耐药菌的菌株流行情况和危险因素,为其合理治疗及控制提供循证学依据。方法 收集2015年1月1日—2019年12月31日天津市胸科医院全血标本分离出的菌株,分析各类多重耐药菌株变迁趋势、耐药性,以及医院获得性血流感染的危险因素。结果 5年间全血标本共分离菌株1 207株,检出多重耐药菌134株,检出率11.10%。多重耐药菌株总体数量以及产超广谱β内酰胺酶（ESBLs）肠杆菌、耐碳青霉烯类鲍曼不动菌（CRAB）变化趋势均不大。产ESBLs细菌对头孢菌素类、喹诺酮类、复方新诺明等耐药严重,CRAB对除替加环素、米诺环素、粘菌素外的抗菌药物耐药率均较高。与对照组相比,糖尿病（OR=2.202,P=0.005）、低蛋白血症（OR=9.502,P=0.006）、机械通气（OR=0.051,P=0.002）、行外科手术（OR=8.056,P=0.012）、入住ICU（OR=5.200,P=0.035）是观察组患者发生多重耐药菌感染的独立危险因素。结论 临床医生应严格遵照抗菌药物分级管理制度,合理应用抗菌药,同时,密切关注菌株流行情况,重视感染的早期防控,积极预防和控制多重耐药菌的产生和流行。     

The long-term effects of childhood maltreatment experiences on subsequent illicit drug use and drug-related problems in young adulthood

ObjectivesThe objective of this study was to examine the associations between (a) childhood maltreatment (i.e., physical abuse, sexual abuse, and neglect) and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood.MethodsWave 1 and Wave 3 public-use data from the National Longitudinal Study of Adolescent Health were used. Logistic regressions, controlling for adolescent drug use and other important family and peer contextual processes, were estimated to determine the associations between (a) childhood maltreatment experiences and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood.ResultsAmong the participants, 31.9% reported some form of childhood maltreatment. Childhood physical abuse was associated with a 37% (OR = 1.37; 95% CI = 1.04, 1.80) increase in illicit drug use during the 30 days prior to the Wave 3 survey, a 48% (OR = 1.48; 95% CI = 1.16, 1.89) increase in illicit drug use during the year prior to the Wave 3 survey, and a 96% (OR = 1.96; 95% CI = 1.40, 2.76) increase in drug-related problems in young adulthood. The latter two associations persisted even after controlling for illicit drug use in adolescence. Neglect among females was associated with a higher likelihood of past year illicit drug use in young adulthood (OR = 1.31; 95% CI = 1.002, 1.71). However, this association was not significant once the effect of illicit drug use in adolescence was statistically controlled for.ConclusionsThe present findings suggest that childhood maltreatment is related to subsequent illicit drug use and drug-related problems in young adulthood and that some of these associations differ by gender. Implications for preventive intervention are discussed.     

Internalized Homonegativity and Substance Use Among U.S. Men Who Have Sex with Men Only (MSMO) and Men Who Have Sex with Men and Women (MSMW)

Background: Internalized homonegativity may promote substance use among U.S. men who have sex with men only (MSMO) and men who have sex with men and women (MSMW). However, studies have produced mixed findings, used non-representative samples, and not adequately examined MSMW. Objectives: We investigated (1) internalized homonegativity in relation to substance use and (2) the extent of temporal change in internalized homonegativity among MSMO and MSMW. Methods: Using merged 2002, 2006–2010, and 2011–2013 cycles of the National Survey of Family Growth—a nationally representative U.S. sample of persons aged 15–44 years—we acquired subsamples of MSMO (n = 419) and MSMW (n = 195). Rao-Scott chi-square tests examined internalized homonegativity in relation to past-month binge drinking and use of marijuana. These tests examined past-year use of any illicit substance, cocaine, crack, injection drugs, and methamphetamine. Multivariable logistic regression models controlled for covariates. Rao-Scott chi-square tests examined temporal changes in internalized homonegativity. Results: Among MSMO, internalized homonegativity was associated with increased odds of using any illicit substance, cocaine, and methamphetamine. Among MSMW, however, internalized homonegativity was associated with decreased odds of using any illicit substance, cocaine, crack, injection drugs, and methamphetamine. The proportion of MSMO and MSMW who expressed internalized homonegativity did not significantly change during 2002–2013. Conclusions/Importance: Internalized homonegativity may be positively associated with substance use among MSMO, but negatively associated with substance use among MSMW. Future studies should seek to better understand internalized homonegativity and other determinants of substance use among MSMO and MSMW.     

Public injecting and HIV risk behaviour among street-involved youth

Background

Although street-involved youth who inject illicit drugs are known to be at an increased risk of HIV and other adverse health outcomes, little is known about public injecting among this population and how injecting in public environments may impact HIV risk behaviour.

Methods

We used data derived from a study of 560 street-involved youth in Vancouver, Canada to examine the factors associated with injecting in public environments among youth who reported injecting drugs in the past 6 months.

Results

At baseline, 162 (28.9%) reported injecting drugs in the past 6 months. Among injectors, the 124 (76.5%) participants who reported injecting in public were more likely to be homeless (odds ratio [OR] = 6.39, p < 0.001), engage in unprotected intercourse (OR = 3.09, p = 0.004), deal drugs (OR = 2.26, p = 0.032), smoke crack cocaine (OR = 3.00, p = 0.005), inject heroin (OR = 3.48, p = 0.001), drop used syringes outdoors (OR = 8.44, p < 0.001), share syringes (OR = 4.43, p = 0.004), and were less likely to clean injection sites >75% of the time (OR = 0.36, p = 0.008). The majority (62.1%) reported feeling rushed while injecting in public.

Conclusions

Youth who inject in public are significantly more likely to engage in sexual and injection-related risk behaviour. Given the known elevated rates of HIV infection and other harms among this population, youth-focused interventions that target both sexual and drug-related risks associated with public drug-using environments are in urgent need of evaluation.     

How do people with homelessness and alcohol dependence cope when alcohol is unaffordable? A comparison of residents of Canadian managed alcohol programs and locally recruited controls

Introduction and Aims

We investigated coping strategies used by alcohol‐dependent and unstably housed people when they could not afford alcohol, and how managed alcohol program (MAP) participation influenced these. The aim of this study was to investigate potential negative unintended consequences of alcohol being unaffordable.

Design and Methods

A total of 175 MAP residents in five Canadian cities and 189 control participants from nearby shelters were interviewed about the frequency they used 10 coping strategies when unable to afford alcohol. Length of stay in a MAP was examined as a predictor of negative coping while controlling for age, sex, ethnicity, housing stability, spending money and drinks per day. Multivariate binary logistic and linear regression models were used.

Results

Most commonly reported strategies were re‐budgeting (53%), waiting for money (49%) or going without alcohol (48%). A significant proportion used illicit drugs (41%) and/or drank non‐beverage alcohol (41%). Stealing alcohol or property was less common. Long‐term MAP participants (>2 months) exhibited lower negative coping scores than controls (8.76 vs. 10.63, P < 0.001) and were less likely to use illicit drugs [odds ratio (OR) 0.50, P = 0.02], steal from liquor stores (OR 0.50, P = 0.04), re‐budget (OR 0.36, P < 0.001) or steal property (OR 0.40, P = 0.07). Long‐term MAP participants were also more likely to seek treatment (OR 1.91, P = 0.03) and less likely to go without alcohol (OR 0.47, P = 0.01).

Discussion and Conclusions

People experiencing alcohol dependence and housing instability more often reduced their alcohol consumption than used harmful coping when alcohol was unaffordable. MAP participation was associated with fewer potentially harmful coping strategies.

     

应用含胸腺肽方案治疗耐多药肺结核的Meta-分析

目的 系统的评价应用含胸腺肽方案治疗耐多药肺结核（MDR-TB）的有效性及安全性,为优化治疗方案提供参考依据。方法 通过检索Pubmed、Embase、Cochrane Library、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）和万方数据库自建库至2019年5月公开发表的含胸腺肽方案治疗MDR-TB的临床随机对照试验（RCTs）,并根据Cochrane 5.1.0评价手册纳入文献进行质量评价,并使用Review Manager 5.3软件进行Meta-分析。结果 共纳入15个RCTs,计1 457名患者。Meta-分析结果显示：与对照组相比实验组痰菌阴转率[OR=3.24,95%CI（2.49~4.22）,P<0.000 01]、病灶吸收率[OR=3.79,95%CI（2.03~7.05）,P<0.000 1]和空洞闭合率[OR=2.73,95%CI（2.01~3.71）,P<0.0000 1]均明显升高;而在肝功能受损率[OR=0.85,95%CI（0.55~1.34）,P=0.49]、胃肠道反应率[OR=1.03,95%CI（0.62~1.72）,P=0.90]和皮疹发生率[OR=0.77,95%CI（0.26~2.26）,P=0.64]方面差异无统计学意义。结论 应用含胸腺肽联合抗结核药物方案可提高的MDR-TB治愈率,且总体安全性较好。     

Alcohol and Drug Use and Aberrant Drug-Related Behavior Among Patients on Chronic Opioid Therapy

Objective: To better identify individuals on chronic opioid therapy (COT) at high risk for aberrant-drug related behavior (ADRB). We examine whether patients with low level alcohol and drug use have similar characteristics to those with alcohol and drug disorders. We then examined the relationship of alcohol and drug use to ADRBs among COT patients. Methods: The sample was 972 randomly selected COT patients (age 21–80 years old) from a large health system in Northern California, USA, and interviewed in 2009. Logistic regression models were used to model the dependent variables of: alcohol use, illicit drug use, alcohol disorders, illicit drug disorders, and ADRBs. Results: The odds of daily/weekly alcohol use were lower for those with a high daily opioid dose (120+ mg/day vs. <20 mg/day) (OR = 0.32, p < 0.010). Illicit drug disorders were associated with depression (OR = 2.31, p < .001) and being on a high daily opioid dose (OR = 5.51, p < .01). Participants with illicit drug use had higher odds of giving (OR = 2.57, p < 0.01) and receiving opioids from friends or family (OR = 3.25, p < 0.001), but disorder diagnoses were not associated with ADRBs. Conclusions: Findings reinforce that illicit drug use should be of high concern to clinicians prescribing opioids, and suggest it should be considered separately from alcohol use and alcohol disorders in the evaluation of ADRBs. Frequent alcohol use is low, but not uncommon, and suggests a need to discuss specific issues regarding safe use of opioids among persons who use alcohol that may differ from their risk of drug use.     

Natural antibiotic susceptibility of strains of the Enterobacter cloacae complex

The natural susceptibility to 70 antibiotics of 104 strains of the Enterobacter cloacae complex was examined using a microdilution procedure in Isosensitest broth. One hundred and one clinical strains designated as ‘E. cloacae’ were identified as E. hormaechei (n=65), E. asburiae (n=20) and E. cloacae genospecies 1 or 2 (n=16). Apart from fosfomycin susceptibility, there were only minor differences in natural antibiotic susceptibility patterns. All species were naturally sensitive or naturally sensitive and intermediate to numerous β-lactams (e.g. carbapenems, aztreonam, acylaminopenicillins, ticarcillin, and some ‘modern’ cephalosporins), quinolones, aminoglycosides, tetracyclines, antifolates, chloramphenicol, and nitrofurantoin. Uniform natural resistance was found in benzylpenicillin, oxacillin, amoxycillin, amoxycillin/clavulanate, cefoxitin, rifampicin, lincosamides, glycopeptides, streptogramins and fusidic acid. Enterobacter hormaechei was the species most susceptible to fosfomycin. β-Lactam susceptibility patterns pointed to the presence of chromosomally-encoded AmpC enzymes in all taxa of the E. cloacae complex.     

沙利度胺联合其他药品治疗类风湿关节炎的系统评价

目的 系统评价沙利度胺联合其他药品治疗类风湿关节炎的有效性与安全性。方法 检索2017年9月1日前发表在PubMed、Medline、Web of Science及中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普数据库（VIP）、万方数据库中相关的随机对照试验（RCTs）,应用State 14.0软件进行Meta-分析。结果 共纳入15篇相关文献,累计1 246例患者。Meta-分析结果显示,联用沙利度胺组在有效率（OR=2.71,95% CI=1.87~3.93,P<0.05）、关节肿胀数（OR=1.68,95% CI=0.99~2.37,P<0.05）、关节压痛数（OR=2.22,95% CI=1.31~3.14,P<0.05）、红细胞沉降率（OR=12.93,95% CI=10.26~15.60,P<0.05）等方面疗效均优于对照组。在不良反应发生率方面,联用沙利度胺组与对照组比较无显著性差异（OR=0.93,95% CI=0.66~1.32,P>0.05）。结论 联用沙利度胺在类风湿关节炎的治疗中有积极作用。     

Binge Drinking and Unsafe Sex: A Study of Narcology Hospital Patients from St. Petersburg,Russia

ABSTRACT

The purpose of this study was to assess the association between binge alcohol use and unprotected sex in Russian substance users. Participants (N = 181) were narcology hospital patients assessed on demographics, alcohol use, risky sex, and sexually transmitted disease/human immunodeficiency virus (STD/HIV) diagnoses. Adjusted generalized estimating equations (GEEs) logistic regression analysis examined the association between binge drinking and same-day unprotected sex across each of the past 30 days, per participant (N = 5430 observations). Participants were age 18 to 55 years, 75% male, and 64% binge drinking. Sex trade was reported by 27%; history of STDs by 43%; and HIV by 15%. One fourth of daily observations included sex; 88% of these involved unprotected sex. Binge drinking was not associated with same-day unprotected sex (adjusted odds ratio [OR_adj] = 1.0, 95% confidence interval [CI] = 0.7–1.4, χ²(1, N = 5219) = 0.01, ns). Findings document substantial HIV/STD risk and prevalence among Russian narcology patients, but no link between binge drinking and unprotected sex in this population, possibly due to very low rates of condom use generally.