Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern

Objective: We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose. Methods: Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012. Results: Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001). Conclusions: The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.     

A new metabolite of methamphetamine; evidence for formation of N-[(1-methyl-2-phenyl)ethyl]ethanimine N-oxide

1. N-Hydroxyamphetamine and N-hydroxymetharnphetamine, metabolic intermediates of amphetamine and methamphetamine, showed no reactivity towards endogeneous protein, amino acids, nucleic acids and fatty acids. In contrast, formaldehyde, acetaldehyde and propionaldehyde reacted well with N-hydroxyamphetamine and slightly with N-hydroxymethamphetamine under mild conditions (pH 7.4, 37°C).

2. Two products were isolated from the reaction mixture of acetaldehyde and N-hydroxyamphetamine. These were characterized as N-[(1-methyl-2-phenyl)ethyl]ethani-mine N-oxide and N-[(1-methyl-2-phenyl)ethyl]butenimine N-oxide by mass and n.m.r. spectrometries.

3. N-[(1-Methyl-2-phenyl)ethyl]ethanimine N-oxide was formed by incubating methamphetamine with liver 9000 g supernatants of rats and guinea-pigs. The butenimine N-oxide derivative, however, could not be detected as a metabolite of methamphetamine in vitro.

4. N-[(1-Methyl-2-phenyl)ethyl]ethanimine N-oxide was also detected as a urinary metabolite of methamphetamine in rats and guinea-pigs. Thus, the ethanimine N-oxide was established as a novel metabolite of methamphetamine.     

Studies on N-demethylation of methamphetamine by liver microsomes of guinea-pigs and rats: The role of flavin-containing mono-oxygenase and cytochrome P-450 systems

1. Relative participation of flavin-containing mono-oxygenase and cytochrome P-4S0 systems in N-hydroxylation of and formaldehyde release from methamphetamine were studied in vitro using liver microsomes of guinea-pigs and rats. In guinea pigs, only methimazole, an inhibitor of flavin-containing mono-oxygenase, significantly suppressed the above reactions.

2. Formaldehyde release from methamphetamine was significantly inhibited not only by methimazole but also by inhibitors of the cytochrome P-450 system in liver microsomes from rats, but not guinea-pigs.

3. Pretreatment of guinea-pigs with phenobarbital and 3-methylcholanthrene did not enhance the metabolism of methamphetamine.

4. Pretreatment of rats with phenobarbital but not 3-methylcholanthrene increased slightly the N-demethylation of methamphetamine by liver microsomes.

5. The results indicate that a marked species difference exists in the enzymes concerned with N-demethylation of methamphetamine. N-Oxidation predominates in guinea-pigs, whereas in rats, N-oxidation and C-oxidation of the methyl group participate equally as the initial reaction of the N-demethylation pathway.     

Associations Between Religiosity,Perceived Social Support,and Stimulant Use in an Untreated Rural Sample in the U.S.A.

Background: Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults. Objectives: This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users. Methods: Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months. Results: Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use. Conclusions/Importance: Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.     

Factors Influencing Transition to Shisheh (Methamphetamine) among Young People Who Use Drugs in Tehran: A Qualitative Study

Background: Iran has experienced an emerging epidemic of methamphetamine use during recent years which has added to existing non-injecting and injecting opioid use in the country. This study explored factors influencing the initiation into or transition to methamphetamine use among young people who use drugs (PWUD). Methods: We conducted 42 semi-structured, in-depth interviews with young PWUD (n = 35) and health care workers (HCWs) (n = 7) between July and October 2011 in Tehran, Iran. The PWUD were purposefully recruited from different tiers of drug services and lived in geographically diverse areas of Tehran. The HCWs were substance use experts and/or service providers of treatment and harm reduction facilities. All interviews were recorded, transcribed, and coded using OpenCode 3.6 software. Results: The predominant factors for initiation into or transition to methamphetamine use were individual domain factors. The peer domain factors were the second most frequently stated perceived factor category for transition to methamphetamine use. Other perceived factors affecting transition to stimulant use included both family and community domains. Conclusion: Drug prevention programs should consider targeting certain settings, including workplaces and sports clubs, for preventative interventions. Existing opioid treatment and harm reduction services should be adjusted in response to the methamphetamine use epidemic.     

Metabolism of methamphetamine,amphetamine and p-hydroxymethamphetamine by rat-liver microsomal preparations in vitro

1. Methamphetamine N-demethylation and p-hydroxylation activities of rat liver were located mainly in the microsomal fraction.

2. The K_m values for methamphetamine and p-hydroxymethamphetamine demethyl-ations were 10 and 16mM, respectively. The K_m value for amphetamine p-hydroxylation was 10· μm; substrate inhibition occurred at high substrate concn. Two K_m values were obtained for the aromatic hydroxylation of methamphetamine (10·μM and 2·2mM).

3. N-Demethylation of methamphetamine and p-hydroxymethamphetamine were depressed in rats pretreated with 3-methylcholanthrene, CoCl₂ or SKF 525-A. In rats pretreated with phenobarbital, methamphetamine demethylase was induced and p-hydroxymethamphetamine demethylase was depressed.

4. The p-hydroxylation of methamphetamine and amphetamine in rats pretreated with phenobarbital, CoCl₂, SKF 525-A or iprindole were depressed.     

Self-Reported Oral Health Needs and Dental-Care Seeking Behavior Among Women Who Use Methamphetamine

This study describes the prevalence of self-reported oral health needs and dental care-seeking behavior among women who use methamphetamine, using respondent-driven sampling in San Francisco, California, from 2007 to 2009 (N = 322). The sample had a high prevalence of self-reported dental needs; however, a low proportion of those reporting needs sought care. In bivariate analysis, the preferred route of methamphetamine use and frequency were not associated with self-reported dental needs. Over 90% of the sample used illicit substances in addition to methamphetamine, which may limit our ability to detect an association between methamphetamine use and oral health needs.     

The Stimulant Selective Severity Assessment: A replication and exploratory extension of the Cocaine Selective Severity Assessment

Background: Cocaine and methamphetamine have similar withdrawal symptoms and many individuals concurrently use both substances; however, no measures concurrently assess withdrawal from multiple stimulants. Objectives: This study’s aim was to explore the Stimulant Selective Severity Assessment (SSSA), a modified version of the Cocaine Selective Severity Assessment (CSSA), in a sample of stimulant users to determine if it can assess withdrawal symptoms in users of one or more stimulants. Methods: Baseline data were analyzed from the STimulant Reduction Intervention using Dosed Exercise trial, a multisite randomized clinical trial that evaluated exercise versus health education on drug use outcomes in individuals with stimulant use disorders. Data were analyzed for internal consistency, construct validity, and scale dimensionality. Results: Internal consistency for the full sample was good (α?=?0.81; N?=?302), with similar alphas in Cocaine (0.81; n?=?177) and Cocaine/Other Stimulant (0.82; n?=?92) groups, but with much lower alpha for the group without cocaine use (Other Stimulant, i.e., primarily methamphetamine, α?=?0.66; n?=?32). Support for construct validity was evidenced by significant positive correlations (r?=?0.17 to 0.67) with measures of stimulant craving, depressive symptoms, and pain. Four factors were revealed. Conclusions/Importance: The Stimulant Selective Severity Assessment is a new measure that can be used to assess withdrawal symptoms in users of cocaine or cocaine plus methamphetamine, but it should not be administered to users of methamphetamine only.     

Mortality,Causes of Death,and Health Status Among Methamphetamine Users

This study examines causes of death, years of life lost, and health and drug use characteristics associated with mortality over an 8 to 10 year period in a sample of methamphetamine users who had and had not received substance use disorder treatment (N = 563). Decedents reported initiating their methamphetamine use for different reasons than surviving methamphetamine users, and some of these differences varied by treatment status. Study findings provide additional detail on long-term health and mortality outcomes in a diverse sample of methamphetamine users, which may inform public health strategies targeting the comparable and divergent needs of treated and untreated populations.     

Predictors of Aggressive Behavior While under the Influence of Illicit Drugs among Young Adult Methamphetamine Users

Background: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol and methamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol and methamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users.     

Correlates of Validity of Self-Reported Methamphetamine Use among a Sample of Dependent Adults

Background: Self-reported data are widely used in substance-use research, yet few studies have assessed the validity of self-reported methamphetamine use compared to biological assays. Objectives: We sought to assess the validity and correlates of validity of self-reported methamphetamine use compared to urine toxicology (UTOX). Methods: Using a sample of methamphetamine-dependent individuals enrolled in a randomized controlled pharmacotherapy trial in the United States (n = 327 visits among 90 participants), we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the kappa coefficient of self-reported methamphetamine use in the past 3 days compared to UTOX, as well as the NPV of self-reported methamphetamine use over an extended recall period of 1 month. We used multivariable logistic regression models to assess correlates of concordance between self-reported methamphetamine use and UTOX. Results: The sensitivity of self-reported methamphetamine use in the past 3 days was 86.7% (95% confidence intervals (95%CI): 81.4%–91.4%), the specificity was 85.3% (77.7–91.3), the PPV was 91.5% (86.9–94.8), and the NPV was 78.0% (69.4–86.1), compared to UTOX (kappa = 0.71). The NPV over the extended recall period was 70.6% (48.0–85.7). In multivariable analyses, validity of self-reported methamphetamine use was higher for older participants but lower during follow-up compared to baseline and when polysubstance use or depressive symptoms were reported. Conclusions/Importance: Our sample of methamphetamine-dependent adults reported recent methamphetamine use with high validity compared to UTOX. Validity increased with age but decreased when participants reported depressive symptoms or polysubstance use as well as later in the study timeline and during longer recall periods.     

Living ‘good lives’: using mentoring to support desistance and recovery

Abstract

In recent years, a proliferation of mentoring projects have been established in England and Wales, targeted at both offenders and drug users. This is, in part, a consequence of high-level encouragement to establish such schemes. Mentoring features throughout the Ministry of Justice’s Transforming Rehabilitation strategy as a tool to support offenders to ‘get their lives back on track’, and the 2017 drug strategy highlights the importance of peer mentoring for those engaged in treatment services. Using Kingdon’s multiple streams approach, the article accounts for the popularity of mentoring within criminal justice and drug policy despite a less than convincing evidence-base. His model is based upon an appreciation of three streams (problem, policies and politics) which coincide when a compelling problem is linked to a plausible solution that meets the test of political feasibility. It is argued that mentoring has come to be viewed as a cost-effective solution to reduce reoffending and improve drug treatment outcomes despite a lack of conclusive evidence. It has garnered support because of its fit with dominant political discourses around citizenship and civil society. Mentoring has received support from within and without government but its inherent appeal overshadows a lack of clarity of what mentoring is and insufficient theoretical understanding of why it might be effective. Consequently, it is proposed that the Good Lives Model, a strengths-based rehabilitation theory, might provide an appropriate theoretical base and inform discussions about the role of mentoring within desistance and recovery journeys.     

Plasma and urinary concentrations of methamphetamine after oral administration of famprofazone to man

1. To obtain further evidence for the metabolic formation of methamphetamine from famprofazone in man, concentrations of methamphetamine in plasma, as well as in urine, were measured by g.l.c. In addition, intact famprofazone and famprofazone N-oxide were analysed in the urine.

2. Methamphetamine appeared in plasma 1 h after a single 100mg dose of the drug to two male subjects, and the concentration maintained between 24 and 44ng/ml over 2-12 h, declining to 10ng/ml and an undetectable level respectively after 24 h.

3. Total urinary excretion of methamphetamine over 72 h was 1·9mg for a 25 mg dose and 2·2mg for a 50mg dose. After a 100mg dose, 4·6 mg of methamphetamine was excreted over 36h. Neither intact famprofazone nor famprofazone N-oxide were detected when the urine samples after the 100mg dose were examined.

4. The results provide further evidence that methamphetamine is a bona fide human metabolite of famprofazone and suggest that at least 20% dose may be broken down via the pathways leading to the formation of methamphetamine. This could have significant clinical implications as the result of pharmacological activity of this metabolite.     

The risk of psychotic symptoms associated with recreational methamphetamine use

Introduction and Aims. To determine whether recreational methamphetamine use is associated with an increased risk of psychotic symptoms. Design and Method. A cross‐sectional survey of 157 people attending dance events in Sydney, Australia. Participants were assessed for psychotic symptoms in the past year using items from the Psychosis Screen. Participants with and without psychotic symptoms were compared on methamphetamine use, polydrug use and other demographic factors. An ordinal logistic regression was used to determine the probability of psychotic symptoms by methamphetamine use and level of polydrug use. Results. Psychotic symptoms in the past year were predicted by methamphetamine use and heavier polydrug use in the past year, and a history of a psychotic disorder (schizophrenia, schizoaffective or bipolar affective disorder). After removing participants with a history of a psychotic disorder (n = 16) and adjusting for polydrug use, methamphetamine use increased the probability of two or more psychotic symptoms (indicative of psychosis risk) from 9% to 21%. There was a non‐significant increase in the risk of psychotic symptoms with higher levels of polydrug use. Methamphetamine use was typically monthly or less often (83%), and most users described their use as recreational (85%). Discussion and Conclusions. Within the context of polydrug use, recreational methamphetamine use is associated with a twofold to threefold increase in the probability of psychotic symptoms.[McKetin R, Hickey K, Devlin K, Lawrence K. The risk of psychotic symptoms associated with recreational methamphetamine use. Drug Alcohol Rev 2010]     

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana,Mexico: A Latent Class Analysis

Background: Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Methods: Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Results: Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Conclusions: Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.     

A Randomized Controlled Trial of Brief Cognitive Behavioral Therapy for Regular Methamphetamine Use in Methadone Treatment

ABSTRACT

This study evaluated the efficacy of brief cognitive behavioral therapy (BCBT) for regular methamphetamine use among methadone-maintained women. A randomized controlled trial was conducted in four methadone treatment services. Eligible women were assigned to receive either BCBT or drug education. Five questionnaires were used to assess the research hypotheses at weeks 0, 4, and 12. Urinalysis was used to verify self-reported methamphetamine use at week 0. Urinalyses were used for those participants who reported abstinence from methamphetamine at weeks 4 and 12. Overall, 120 women were enrolled. Sixteen participants were lost to follow-up. Compared with the control group, the treatment group showed significant reductions in frequency of methamphetamine use (p < 0.001), severity of methamphetamine dependence (p < 0.001), and number of days of methamphetamine use (p < 0.001) at weeks 4 and 12. Significant improvements in readiness to change (p < 0.001), psychological well-being (p < 0.001), and social functioning (p = 0.001) were found in the treatment group at weeks 4 and 12. Nineteen urine specimens (31.66%) in the treatment group were negative for methamphetamine use at post-treatment and follow-up, while no change was found in the control group (0.00%). The study supported the efficacy of BCBT for methamphetamine use and associated harms.     

A New Survey of Methamphetamine Users in Treatment: Who They are,Why They Like “Meth,” and Why They Need Additional Services

The quality and quantity of illicit methamphetamine has recently increased due to introduction of a new precursor, 1-phenyl-2-propanone (P2P). This paper updates the problems associated with methamphetamine use. Methamphetamine-using clients (N = 222) entering a Texas program participated in computer-assisted interviews in 2010 and 2011 about routes of administration, other drugs used, severity of dependence, mental and physical health, perceived risks and benefits of use, family history, and abuse and neglect experienced as children and adults. Special needs of this population include therapies for trauma, gender-focused counseling, safe housing, and prevention messages to discourage use of the drug.     

Exploring the New Phenomena of Home-Made Extraction and Injection of Ephedra Plant Product in Georgia

Background: Since the end of 2015, reports by service providers have indicated a new trend in kitchen (homemade) production of an injection drug prepared from an ephedrine-containing conifer bush that is indigenous to the region. Objective: The aim of this report is to describe an emerging new homemade psychoactive drug synthesized from the ephedra plant, and the drug consumption methods associated with its' use in the Eurasia. Methods: Focus groups conducted with 16 people, self-identified as injection drug users (IDU's) who reported at least one incidence of ephedra preparation injection during the previous 30-days. Results: Participants were male, mean age of 43 and mean length of drug use of 22.2 years. Participants identified “conifer vint” as the most frequently injected drug during the 30-day period preceding the focus group. The source plant of the drug identified, as “conifer vint” is plant-based ephedra extracted from a common conifer bush that grows wild and is pervasive in the region. The process of synthesis resembles the production of “vint” (conversion of ephedrine to methamphetamine by reduction) and involves several legal and widely available chemical precursors. The final product of the synthesis is a strong injectable CNS stimulant solution. Conclusions/Importance: The production and use of raw ephedra from a pervasive indigenous plant reflect a new trend in psychoactive drug preparation and use that warrants international attention and has global implications for emerging trends in drug use.