‘Surfing the Silk Road’: A study of users’ experiences

IntroductionThe online drug marketplace called ‘Silk Road’ has operated anonymously on the ‘Deep Web’ since 2011. It is accessible through computer encrypting software (Tor) and is supported by online transactions using peer to peer anonymous and untraceable crypto-currency (Bit Coins). The study aimed to describe user motives and realities of accessing, navigating and purchasing on the ‘Silk Road’ marketplace.MethodsSystematic online observations, monitoring of discussion threads on the site during four months of fieldwork and analysis of anonymous online interviews (n = 20) with a convenience sample of adult ‘Silk Road’ users was conducted.ResultsThe majority of participants were male, in professional employment or in tertiary education. Drug trajectories ranged from 18 months to 25 years, with favourite drugs including MDMA, 2C-B, mephedrone, nitrous oxide, ketamine, cannabis and cocaine. Few reported prior experience of online drug sourcing. Reasons for utilizing ‘Silk Road’ included curiosity, concerns for street drug quality and personal safety, variety of products, anonymous transactioning, and ease of product delivery. Vendor selection appeared to be based on trust, speed of transaction, stealth modes and quality of product. Forums on the site provided user advice, trip reports, product and transaction reviews. Some users reported solitary drug use for psychonautic and introspective purposes. A minority reported customs seizures, and in general a displacement away from traditional drug sourcing (street and closed markets) was described. Several reported intentions to commence vending on the site.ConclusionThe study provides an insight into ‘Silk Road’ purchasing motives and processes, the interplay between traditional and ‘Silk Road’ drug markets, the ‘Silk Road’ online community and its communication networks.     

‘Vaping and fidget-spinners’: A qualitative,longitudinal study of e-cigarettes in adolescence

BackgroundWe see the contours of a cigarette-free adolescent cohort in Norway. Simultaneously, increasing use of vaping devices among adolescents internationally, and in the US in particular, has evoked fear of a new nicotine-addicted generation. This longitudinal study explores the vaping phenomenon in a context where nicotine e-liquid is still prohibited.MethodsData are from longitudinal, qualitative interviews with a sizable sample of 12-17 year olds (118 8^th graders from 6 schools/classes at baseline). Four follow-ups were conducted from 2015 to 2019 (a total of 50 semi-structured group and 175 individual interviews). The interviews were coded using HyperResearch software and thematically analysed in the light of actor network and interaction ritual theory.ResultsGradual and collective shifts in vaping practices and in the symbolic meaning of vaping were observed in three phases. First, in 8^th grade, few had tried to vape, even if several were curious about this novel invention, practice and the available flavours. Second, after 9^th grade, one in three reported personal use. They emphasised harmlessness, coolness, performance and accessibility online. However, by the end of middle school, a third phase became visible; vaping had lost status and was described as ‘childish’ and unpopular. Interviewees repeated the lack of relevance in high school, comparing e-cigarettes with the fidget-spinner and reserving vaping for kids and addicted adult smokers. The analysis displays a systematic pattern in which adolescents account for vaping as a time-limited trend.ConclusionE-cigarettes were devalued from novelty and transgression to childish and uninteresting within the same sample over a four-year period. In conclusion, e-cigarettes in the sample represented fashionable experimentation rather than steady user patterns.     

Struggling to achieve a ‘normal life’: A qualitative study of Vietnamese methadone patients

Background:Methadone maintenance treatment, initially introduced in Vietnam for HIV harm reduction, has marked a significant switch in the country’s drug policy – from addiction as a moral issue to addiction as a brain disease. After the some initial outstanding achievements, the programme is facing a high dropout rate that threatens both goals of HIV prevention and drug treatment. This sociological study, as part of an HIV intervention research project, explores the challenges and opportunities that individuals who use drugs are faced with in relation to addiction treatment.Methods:A qualitative study among drug users with and without methadone maintenance treatment experiences recruited by peer outreach workers. We conducted 58 in-depth interviews and 2 focus groups between 2016 and 2017.Results:The start of treatment brought about significant feelings of success as heroin use was no longer compulsive. However, being in treatment programmes is also challenging with respect to continuing the recovery process. Barriers to retention include a popular fear of methadone as another harmful drug, a feeling of dependence related to the current practices of methadone treatment programmes and a poor therapeutic relationship. In the face of such challenges, the two major motivations that keep patients in care come from the desire to completely break up with heroin and the pursuit of family happiness.Conclusion:The current practices of methadone programmes pose challenges to patients’ recovery efforts from addiction and threaten treatment retention. Prompt interventions are needed to help Vietnam attain its objective of providing better care for larger vulnerable populations.     

The treatment of chronic cerebrovascular insufficiency. A double-blind study with pentoxifylline (‘Trental’ 400)

Summary

A double-blind study was carried out over a 2-month period to compare the therapeutic efficacy of pentoxifylline (one 400?mg tablet 3-times daily) and placebo in 60 patients with signs of cerebral insufficiency due to old age. The typical clinical target symptoms of the cerebro-organic psychosyndrome were evaluated before, during and after treatment, as were changes on the Plutchik Geriatric Rating Scale (PGRS). Psychometric tests (writing, copying, numeric symbols) were used to assess performance before, during and after treatment. Improvements in clinical symptoms were recorded significantly more frequently with pentoxifylline, and the reductions in severity were also significantly more marked with the test conipound than with placebo. By comparison with placebo, pentoxifylline produced significant improvements in the following factors on the PGRS: ‘social isolation’, ‘overall dysfunction’, and ‘sleep disturbance’. Improvements in the psychometric tests were more marked with pentoxifylline than with placebo. Of 29 patients available for assessment in each group, 27 patients improved on pentoxifylline compared with 6 on placebo. No essential differences were established between pentoxifylline and placebo with regard to laboratory parameters and the incidence of subjective side-effects.     

Conceiving of addicted pleasures: A ‘modern’ paradox

Drawing on research with people who inject drugs in London, UK, this article will explore how participants conceived of pleasure, and try to understand some of the tensions that ensued. There is a strong sense in participants’ accounts that drug use is at points pleasurable but it should not, or rather, could not be conceived of in this way. As such, the article will reflect on several situations in which pleasure came up during fieldwork but was quickly redirected towards addiction using terms such as ‘denial’. Trying to make sense of this seemingly paradoxical dynamic, in which pleasure can be addictive, but addiction cannot be pleasurable, I turn to some of the practices that actively keep pleasure and addiction apart, indeed, in some areas of the addiction sciences, antithetical. That is, a singular account of pleasure is produced as freely chosen (of the ‘free’ subject) in opposition to the determined nature of addiction (of the automated brain or object). These realities materialise in participants’ accounts, but due to their constructed nature they also collapse and multiply. This ‘hybridisation’ is what Bruno Latour refers to as the paradox of the Moderns. Considering pleasure, however, as both natural and cultural, it is better conceived of as always in tension, expressed by participants as ‘mixed feelings’, ‘love/hate’, ‘sweet and sour’, ‘good things and bad things’. Against a backdrop of neglect, especially within the context of injecting drug use, such conceptualisation can help acknowledge pleasure where it is least conceivable and yet perhaps has the most to offer.     

A study of the effect of sulphinpyrazone (‘Antman’) on blood viscosity

Summary

A double-blind, placebo-controlled crossover study oj the effect of sulphinpyrazone on blood viscosity and its determinants (haematocrit, plasma fibrinogen and plasma viscosity) was carried out in 7 healthy male volunteers. Apart from a transient rise in fibrinogen (p<0.05) after 3 days of sulphinpyrazone treatment, no significant change in viscosity factors was seen over a 14-day period.     

‘Silk Road’, the virtual drug marketplace: A single case study of user experiences

Background: The online promotion of ‘drug shopping’ and user information networks is of increasing public health and law enforcement concern. An online drug marketplace called ‘Silk Road’ has been operating on the ‘Deep Web’ since February 2011 and was designed to revolutionise contemporary drug consumerism. Methods: A single case study approach explored a ‘Silk Road’ user's motives for online drug purchasing, experiences of accessing and using the website, drug information sourcing, decision making and purchasing, outcomes and settings for use, and perspectives around security. The participant was recruited following a lengthy relationship building phase on the ‘Silk Road’ chat forum. Results: The male participant described his motives, experiences of purchasing processes and drugs used from ‘Silk Road’. Consumer experiences on ‘Silk Road’ were described as ‘euphoric’ due to the wide choice of drugs available, relatively easy once navigating the Tor Browser (encryption software) and using ‘Bitcoins’ for transactions, and perceived as safer than negotiating illicit drug markets. Online researching of drug outcomes, particularly for new psychoactive substances was reported. Relationships between vendors and consumers were described as based on cyber levels of trust and professionalism, and supported by ‘stealth modes’, user feedback and resolution modes. The reality of his drug use was described as covert and solitary with psychonautic characteristics, which contrasted with his membership, participation and feelings of safety within the ‘Silk Road’ community. Conclusion: ‘Silk Road’ as online drug marketplace presents an interesting displacement away from ‘traditional’ online and street sources of drug supply. Member support and harm reduction ethos within this virtual community maximises consumer decision-making and positive drug experiences, and minimises potential harms and consumer perceived risks. Future research is necessary to explore experiences and backgrounds of other users.     

Comparison of ‘Duphalac’ and ‘irritant’ laxatives during and after treatment of chronic constipation : a preliminary study

Summary

A multi-centre trial was carried out to compare the effectiveness in the treatment of chronic constipation of a lactulose preparation (‘Duphalac’) and ‘irritant’ laxatives containing senna, anthraquinone derivatives or bisacodyl. The results, in 164 patients, indicate that the lactulose preparation was more effective than the ‘irritant’ laxatives. By Day 7, 58 % of the lactulose-treated group were passing a normal stool whereas only 42 % of the patients receiving an ‘irritant’ laxative did so at the same stage in treatment. The lactulose preparation was shown to have a persistent ‘carry-over’ effect, and this effect was seen in significantly more patients receiving ‘Duphalac’ than in the ‘irritant’ laxative group.     

Ayahuasca’s entwined efficacy: An ethnographic study of ritual healing from ‘addiction’

BackgroundA range of studies has demonstrated the efficacy of the psychoactive Amazonian brew ayahuasca in addressing substance addiction. These have revealed that physiological and psychological mechanisms are deeply enmeshed. This article focuses on how interactive ritual contexts support the healing effort. The study of psychedelic-assisted treatments for addiction has much to gain from ethnographic analyses of healing experiences within the particular ecologies of use and care, where these interventions are rendered efficacious.MethodsThis is an ethnographically grounded, qualitative analysis of addiction-recovery experiences within ayahuasca rituals. It draws on long-term fieldwork and participant observation in ayahuasca communities, and in-depth, semi-structured interviews of participants with histories of substance misuse.ResultsAyahuasca’s efficacy in the treatment of addiction blends somatic, symbolic and collective dimensions. The layering of these effects, and the direction given to them through ritual, circumscribes the experience and provides tools to render it meaningful. Prevailing modes of evaluation are ill suited to account for the particular material and semiotic efficacy of complex interventions such as ayahuasca healing for addiction. The article argues that practices of care characteristic of the ritual spaces in which ayahuasca is collectively consumed, play a key therapeutic role.ConclusionThe ritual use of ayahuasca stands in strong contrast to hegemonic understandings of addiction, paving new ground between the overstated difference between community and pharmacological interventions. The article concludes that fluid, adaptable forms of caregiving play a key role in the success of addiction recovery and that feeling part of a community has an important therapeutic potential.     

A brief appraisal of computational modeling of antimicrobial peptides’ activity

We present a brief overview of computer simulations over the span of last two decades that have made some serious attempts in providing key insights toward the mechanistic aspects of antimicrobial peptides and biomimetic peptides. We review some of the success stories of computational modeling of antimicrobial activity and also point toward the present shortcomings of the current approaches. Finally, we shed light upon the future potential directions that computational approach can adopt toward direct and closer comparisons with experiments on antimicrobial activity.     

A controlled study of benzydamine oral rinse (‘Difflam’) in general practice

Summary

Fifty-two patients suffering from presumed viral pharyngeal infection or tonsillitis were treated with either benzydamine or placebo oral rinse as a gargle at 3-hourly intervals in a randomized double-blind study. Patients on the active preparation experienced faster resolution of pain and dysphagia and at 7 days 88% were symptom-free compared with 38% on placebo.     

Determination of peripheral plasma prostanoid concentration: An unreliable index of ‘in vivo’ prostanoid activity

Summary Plasma concentrations of PGE₂, PGF₂, 6-keto-PGF₁ and TxB₂ were determined in 4 healthy volunteers by gas chromatography-negative ion chemical ionization mass spectrometry. TxB₂ concentrations in all volunteers increased with time during blood collection, increases occurred more sporadically in the case of PGE₂, PGF₂ and 6-keto-PGF₁. Rapid changes in plasma prostanoid concentrations within a sampling series were unpredictable and were inexplicable. The measured plasma prostanoid concentrations apparently depended on the sampling conditions, which could not be adequately standardized and controlled. However, very short term changes in plasma prostanoid levels cannot be excluded.     

Labetalol (‘Trandate’) in hypertension: A multicentre study in general practice

Summary

A study was carried out in 1286 hypertensive patients seen in general practice to evaluate the effectiveness of labetalol given for periods of up to 24 months. Initial dosage was 300?mg per day. The results showed that blood pressure was readily controlled and maintained by labetalol alone in the majority of patients. Pulse rate, vision andfundi were unchanged. There was little difference between the supine and upright blood pressures, confirming the clinical finding that postural hypotension was not a problem. The incidence of side-effects leading to withdrawal was small (7.2%), most side-effects being minor and transient. No drug interactions with concomitant therapy were apparent and the incidence of bronchospasm was very low. The incidence of myocardial infarction and cerebrovascular accident in the population studied was lower than expected.     

‘Synthetic cannabis’: A dangerous misnomer

The term 'synthetic cannabis' has been widely used in public discourse to refer to a group of cannabinoid receptor agonists. In this paper we detail the characteristics of these drugs, and present the case that the term is a misnomer. We describe the pharmacodynamics of these drugs, their epidemiology, mechanisms of action, physiological effects and how these differ substantially from delta-9-tetrahydrocannabinol (THC). We argue that not only is the term a misnomer, but it is one with negative clinical and public health implications. Rather, the substances referred to as 'synthetic cannabis' in public discourse should instead be referred to consistently as synthetic cannabinoid receptor agonists (SCRAs), a drug class distinct from plant-derived cannabinoids. SCRAs have greater potency and efficacy, and psychostimulant-like properties. While such terminology may be used in the scientific community, it is not widely used amongst the media, general public, people who use these drugs or may potentially do so. A new terminology has the potential to reduce the confusion and harms that result from the misnomer ‘synthetic cannabis’. The constant evolution of this distinct drug class necessitates a range of distinct policy responses relating to terminology, harm reduction, epidemiology, treatment, and legal status.     

A multi-centre pilot study of tri-potassium di-citrato bismuthate (‘De-Nol’) in general practice

Abstract

A multi-centre uncontrolled assessment of tri-potassium di-citrato bismuthate in the treatment of 161 ambulatory peptic ulcer patients (26 gastric, 114 duodenal, and 21 'indefinable’) was carried out under the conditions of general practice. The intensity of pain and vomiting were assessed before and after a 28-day course of treatment, as was the degree of overall symptomatic relief.

Full or great symptomatic relief was reported in 96.3% of patients, many of whom had failed previously to respond adequately to antacid or other forms of treatment.     

Use of a sustained-release formulation of oxprenolol and cyclopenthiazide (‘Trasidrex’) in the management of hypertension: A general practice study

Summary

An open study was carried out in general practice on 678 hypertensive patients being treated with a beta-blocker but who still had resting diastolic blood pressures greater than 100 mmHg. Previous treatment was stopped and substituted with I or 2 tablets daily of a fixed combination product containing 160?mg oxprenolol hydrochloride in a sustained-release formulation plus 0.25?mg cyclopenthiazide per tablet. After 4-weeks treatment on this regimen, blood pressure levels fell significantly, from 179/108 mmHg to 155/93 mmHg, without any increase in the reporting of unpleasant side-effects.