Memory performance in polyvalent MDMA (ecstasy) users who continue or discontinue MDMA use

Background:The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine = MDMA) is a serotonergic neurotoxin in animal studies. Several cross-sectional investigations reported low memory and learning performance in ecstasy users, particularly in those reporting heavy patterns of drug use. Since, serotonin has a recognized role in memory processes, these findings were mostly interpreted as evidence for ecstasy-related neurotoxicity in humans. However, studies with user populations and controls suffer from many inherent methodological problems. Moreover, longitudinal data on memory performance after continued or discontinued ecstasy use are scarce.Methods:In the present longitudinal study, we examined memory performance in 38 MDMA users over the course of 18 months.Results:Subjects who stopped MDMA use after the baseline examination (n = 17) did not improve, and subjects who continued MDMA use (n = 21) did not deteriorate in terms of test performance.Conclusions:Our data do not support, but they also do not rule out memory decline following use of the serotonergic neurotoxin MDMA. In light of the popularity of ecstasy among young people, further investigations are needed. In our view, research strategies should now move to prospective designs in order to shed more light on the course of possible adverse cognitive effects of ecstasy use.     

Results of an international drug testing service for cryptomarket users

IntroductionUser surveys indicate that expectations of higher drug purity are a key reason for cryptomarket use. In 2014–2015, Spain's NGO Energy Control conducted a 1-year pilot project to provide a testing service to cryptomarket drug users using the Transnational European Drug Information (TEDI) guidelines. In this paper, we present content and purity data from the trial.Methods219 samples were analyzed by gas chromatography associated with mass spectrometry (GC/MS). Users were asked to report what substance they allegedly purchased.Results40 different advertised substances were reported, although 77.6% were common recreational drugs (cocaine, MDMA, amphetamines, LSD, ketamine, cannabis). In 200 samples (91.3%), the main result of analysis matched the advertised substance. Where the advertised compound was detected, purity levels (m ± SD) were: cocaine 71.6 ± 19.4%; MDMA (crystal) 88.3 ± 1.4%; MDMA (pills) 133.3 ± 38.4 mg; Amphetamine (speed) 51.3 ± 33.9%; LSD 123.6 ± 40.5 μg; Cannabis resin THC: 16.5 ± 7.5% CBD: 3.4 ± 1.5%; Ketamine 71.3 ± 38.4%. 39.8% of cocaine samples contained the adulterant levamisole (11.6 ± 8%). No adulterants were found in MDMA and LSD samples.DiscussionThe largest collection of test results from drug samples delivered from cryptomarkets are reported in this study. Most substances contained the advertised ingredient and most samples were of high purity. The representativeness of these results is unknown.     

Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention

AimsTo investigate whether variation may exist in betel nut- and ecstasy-involved adolescents in terms of sociobehavioral characteristics, the experience of psychoactive substance use, and behavioral/emotional problems.MethodsStudents (n = 53,528) aged 12–18 sampled via stratified, multistage, random cluster sampling in 2004, 2005, and 2006 throughout Taiwan were categorized into four groups: betel nut- and ecstasy-naïve (n = 51,009), betel nut use only (n = 1965), ecstasy use only (n = 196), and use of both (n = 152). Participants completed a questionnaire with information on sociodemographic features, substance-use experiences, and the Chinese adaptation of the Youth Self Report.ResultsHaving a job, a larger weekly allowance, truancy, sexual experience, and externalizing behaviors were all in strong association with the involvement of either betel nut or ecstasy use. Compared with ecstasy-only users, betel nut-only users were more likely to be male, from the Eastern region of Taiwan, with initiation motivated by family members or friends, and having excess risks for Anxiety/Depression, Thought Problems, and Attention Problems. In contrast, ecstasy-only users were more likely to be female and involved in using other illegal drugs, with their initiation motivated by entertainment and with the drug use taking place in such settings.ConclusionsThe variation in the experience of psychoactive substance use and behavioral problems for betel nut and ecstasy users suggests the existence of subgroups of drug-using adolescents in Taiwan. The identification of such heterogeneity may guide the efforts to reduce substance use and develop subgroup-tailored preventive programs.     

A survey of regular ecstasy users’ knowledge and practices around determining pill content and purity: Implications for policy and practice

ObjectiveTo examine the methods used by a sample of regular ecstasy users to determine the content and purity of ecstasy pills, their knowledge of the limitations of available pill testing methods, and how pill test results would influence their drug use behaviour.MethodData were collected from regular ecstasy users (n = 810) recruited from all eight capital cities of Australia. Data were analysed using multiple logistic regression and chi-square (χ²) tests of association. Open-ended responses were coded for themes.ResultsThe majority of the sample (84%) reported attempting to find out the content and purity of ecstasy at least some of the time, most commonly asking friends or dealers. Less than one quarter (22%) reported personal use of testing kits. There was a moderate level of awareness of the limitations of testing kits among those who reported having used them. Over half (57%) of those reporting personal use of testing kits reported that they would not take a pill if test results indicated that it contained ketamine and over three quarters (76%) reported that they would not take an “unknown” pill (producing no reaction in a reagent test). Finally, a considerable majority (63%) expressed interest in pill testing should it be more widely available.ConclusionsThe majority of regular ecstasy users sampled in this Australian study report previous attempts to determine the content and purity of pills sold as ecstasy. Although only a small proportion have used testing kits, many report that they would do so if they were more widely available. The results of pill tests may influence drug use if they indicate that pills contain substances which ecstasy users do not want to ingest or are of unknown content. More detailed research examining ways in which pill testing may influence drug use is required to inform evidence-based policy.     

Prevalence and correlates of psychological distress among drug users in Phnom Penh,Cambodia

BackgroundCompared to the general population, drug users are at increased risk of both poor mental health and HIV infection. The aim of this study was to determine the prevalence and correlates of high psychological distress among drug users in Cambodia.MethodsIn April 2014, a two-stage cluster sampling method was used to randomly select 169 drug users from hotspots in Phnom Penh. Psychological distress was measured using General Health Questionnaire (GHQ-12). Bivariate and multivariable analyses were conducted to identify factors associated with levels of psychological distress among this population.ResultsOur study found high prevalence of attempted suicide (15.3%), drug related arrests (46.2%), and incarceration (31.4%). Of the 169 participants, 42.0% were found to have high levels of psychological distress, indicating poor mental health. After adjustment, high levels of psychological distress were independently associated with suicidal ideation (p < 0.001), higher frequency of drug use (p = 0.02), sharing of needles or syringes (p = 0.005), and having been sent to a rehabilitation centre (p = 0.02). In addition, participants who perceived their overall health as being poor or very poor were more likely to have high levels of psychological distress (p = 0.002).ConclusionIntegration of mental health within HIV and needle and syringe exchange programmes is required to address psychological distress among drug users in Cambodia. Health system interventions, such as screening, referral, and training of health providers, need to be strengthened. In addition, interventions addressing social determinants of mental health and mitigation of frequent arrests and improving conditions in rehabilitation centres are required.     

Nightlife and Drug Use in Tbilisi,Georgia: Results of an Exploratory Qualitative Study

ABSTRACT

Tbilisi is fast becoming a regional hub for electronic dance music. This study describes the use of illicit psychoactive drugs by frequent nightclub visitors in a club setting. We conducted 16 qualitative in-depth interviews with young nightclubbers with a history of drug use in Tbilisi. The majority of respondents had experience with two or more drugs consumed in a club setting, with the most prevalent substances being MDMA/ecstasy, amphetamines, and synthetic cannabinoids. Most respondents had limited information regarding the drugs they consumed. Often this information was provided by dealers or friends and was limited to the name of the drug (but not the substance) and its expected effects. Receiving often unknown substances from unknown people was prevalent. The majority of respondents reported combining psychoactive substances with alcohol, or mixing the use of other substances. Participants by their own account indicated a lack of knowledge about the adverse effects of drugs, as well as an ignorance of overdose signs and response strategies. Study findings may guide future efforts to investigate the prevalence and context of club drug use in the country, to assess health risks associated with it, and to propose strategies to mitigate those risks.     

An in vitro approach to assessing a potential drug interaction between MDMA (ecstasy) and caffeine

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is a popular recreational drug which causes long-term neurotoxicity and increased risk of fatality. In rats, MDMA toxicity is exacerbated by co-administration of caffeine. The aim of this study was to investigate whether caffeine altered the effects of MDMA in a battery of in vitro tests selected to model some of the known actions of MDMA in vivo. In cytotoxicity studies, caffeine modestly enhanced the effect of MDMA on neuronal N2a cell viability but not that of liver, intestinal or kidney cells. MDMA inhibited the formation of fluorescent metabolites by CYP2D6 ≫ CYP3A4 > CYP1A2 but this was not altered by caffeine. Similarly, the inhibition of synaptosomal [³H] 5-HT uptake by MDMA was not affected by the presence of caffeine. Thus, these in vitro tests failed to detect any substantial interaction between caffeine and MDMA, highlighting the difficulty of modelling in vivo drug interactions using in vitro tests. However, the results show that the inhibition of synaptosomal [³H] 5-HT uptake by MDMA was greater at 41 °C and 25 °C than at 37 °C which raises the possibility that MDMA’s effect on SERT in vivo may be increased as body temperature increases, contributing to its harmful effects in users.     

Identifying the Perceived and Diagnosed Prevalence of Ecstasy Dependence Among Club Rave Attendees

ABSTRACT

The “rave” phenomenon has been a major element in the resurgence of psychedelic drug use in Western society. Purportedly central to raves is the use of “club drugs,” such as 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”). To date, however, no studies have attempted to estimate MDMA dependence among rave attendees. In the current study, personal drug data were collected from 154 adult “club rave” attendees along the Baltimore-Washington corridor between September and November 2002. The Center for Substance Abuse Research (CESAR) Arrestee Drug Screener (CADS) was used to screen for ecstasy dependence. Seventeen percent of the sample was diagnosed with probable MDMA-dcpendencc. MDMA-dependent rave attendees were significantly more likely than non-dependents to be male, white, and to have used most illicit drugs during the 12 months preceding the interview. Logistic regression identified that gender, race, and past-year use of marijuana and PCP were the strongest predictors of MDMA dependence. Implications for these findings are discussed. /Article copies available for a fee from The Haworth Document Delivery Service: 1- 800-HA WORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> © 2004 by The Haworth Press. Inc. All rights reserved.]     

A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006-2007

BackgroundThe purpose of this paper was to examine the context of injection drug use in Kabul, Afghanistan among injection drug users (IDUs) utilising and not utilising needle and syringe programmes (NSPs).MethodsFollowing identification of themes from eight focus group discussions, free-lists were used for further exploration with both NSP using (n = 30) and non-NSP using (n = 31) IDUs.Results All participants were male, had been injecting for 5 years (mean), and most (95%) had been refugees in the past decade. Main reasons for sharing syringes were convenience and lack of availability and did not vary based on NSP use. Drug users perceived alienation from the community, evidenced by names used for drug users by the community which convey social stigma and moral judgment. Health risks were the principal stated risk associated with drug use, which was mentioned more frequently by NSP users. Harm reduction services available in Kabul are perceived to be insufficient for those in need of services, resulting in under utilisation. The limited scope and distribution of services was frequently cited both as an area for improvement among NSP using IDU or as a reason not to use existing programmes.ConclusionsWhile some positive differences emerged among NSP-using IDU, the current context indicates that both rapid scale-up and increased variety of services, particularly in the realm of addiction treatment, are urgently needed in this setting.     

Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu,Nepal

BackgroundIn Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk.MethodsWe collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n = 202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n = 167).ResultsRoughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p = 0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p < 0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting.ConclusionTreatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk.     

"Rollin' on E": a qualitative analysis of ecstasy use among inner city adolescents and young adults

Ecstasy use has spread beyond the rave and club scenes into other arenas of party culture, and from middle-class America to working-class and low-income neighborhoods of large cities. In order to explore ecstasy use among inner city adolescents and young adults, we conducted in-depth interviews with 23 poly-drug users who had used ecstasy, in Hartford, CT. Most users reported positive experiences while on the drug. Negative experiences were most often related to poly-drug mixing. However, heavy users (40+ times ever used) experienced negative aftereffects, which led them to decide to decrease or halt their use. Some participants discussed using ecstasy during sex, and irregular use of condoms. These findings point to the need for more in-depth research on MDMA use within inner city settings, with a particular focus on ethnic and cultural context, self-controlled drug use, poly-drug mixing, and sex risk behaviors.     

Longitudinal trajectories of ketamine use among young injection drug users

BackgroundKetamine is a dissociative anaesthetic that became increasingly popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use.MethodsYoung IDUs aged 16–29 with a history of injecting ketamine (n = 101) were recruited from public locations in Los Angeles and followed during a 2-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews (n = 66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group.ResultsIDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: “Moderates,” who injected ketamine several times per year (n = 5); “Occasionals,” who injected ketamine approximately once per year (n = 21); and “Abstainers,” who did not inject any ketamine during follow-up (n = 40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally.ConclusionReducing ketamine injection among young IDUs may best be accomplished by targeting particular groups of IDUs identified in this study, such as homeless youth and homeless travellers.     

Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States of America

AimsA prior study concluded that drug treatment coverage, defined as the percentage of injection drug users in drug treatment, varied from 1 percent to 39 percent (median 9 percent) in 96 metropolitan statistical areas (MSAs) in the United States. Here, we determine which metropolitan area characteristics are associated with drug treatment coverage.MethodsWe conducted secondary analysis of official data, including the number of injection drug users in treatment and other variables, for 94 large US MSAs. We estimated the number of injection drug users in these metropolitan areas using previously described methods. We used lagged cross-sectional analyses where the independent variables, chosen on the basis of a Theory of Community Action, preceded the dependent variable (drug treatment coverage) in time. Predictors were determined using ordinary least squares multiple regression and confirmed with robust regression.ResultsIndependent predictors of higher drug treatment coverage for injectors were: presence of organisations that support treatment (unstandardized beta = 1.64; 95 percent CI .59 to 2.69); education expenditures per capita in the MSA (unstandardized beta = .12; 95 percent CI −.34 to 2.69); lower percentage of drug users in treatment who are non-injection drug users (unstandardized beta = −0.18; 95 percent CI −0.24 to −0.12); higher percentage of the population who are non-Hispanic White (unstandardized beta = .14; 95 percent CI .08 to .20); lower per capita long-term debt of governments in the metropolitan area (unstandardized beta = −0.93; 95 percent CI −1.51 to −0.35).ConclusionsIn conditions of scarce treatment coverage for drug injectors, an indicator of epidemiologic need (the per capita extent of AIDS among injection drug users) does not predict treatment coverage, and competition for treatment slots by non-injectors may reduce injectors’ access to treatment. Metropolitan finances limit treatment coverage. Political variables (racial structures, the presence of organisations that support drug treatment, and budget priorities) may be important determinants of treatment coverage for injectors. Although confidence in these results would be higher if we had used a longitudinal design, these results suggest that further research and action that address structural, political, and other barriers to treatment expansion are sorely needed.     

Polydrug use and its association with drug treatment outcomes among primary heroin,methamphetamine, and cocaine users

BackgroundPolydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users.MethodsData were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1 day in a month), primary drug use (≥1 day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively.ResultsIncluded in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types.ConclusionThis study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.     

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty,Kazakhstan: Implications for HIV prevention,research, and policy

BackgroundKazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission.MethodsThis paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics.ResultsThe prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR = 3.03; 95% CI = 1.78, 5.18) and HCV seropositive than non-IDU females (aRR = 6.05; 95% CI = 4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR = 1.67; 95% CI = 1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR = 17.45; 95% CI = 8.01, 38.01).ConclusionGiven the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.     

Recreational ecstasy/MDMA and other drug users from the UK and Italy: psychiatric symptoms and psychobiological problems

RATIONALE: Recreational drug use is increasingly widespread amongst young people, but there are concerns that psychoactive drugs may be associated with psychiatric symptoms or psychobiological problems. OBJECTIVES: To assess the psychiatric health status of a large, non-clinical sample of young adults from Italy and the UK, and relate it to their use of ecstasy/MDMA and other recreational drugs. METHODS: The UEL Recreational Drug Use Questionnaire was completed by 768 young people (mean age 21.7 years) from four European cities. The subjects comprised 150 non-drug users, 185 alcohol/tobacco users, 97 cannabis and alcohol/tobacco users, 102 illicit polydrug but not ecstasy users, 115 light (<20 times) ecstasy polydrug users, and 119 heavy (>20 times) ecstasy polydrug users. The unpaid volunteers completed the SCL-90 self-rating inventory for psychiatric symptoms when off drug, with 30 additional questions covering positive moods and life experiences. RESULTS: Heavy ecstasy polydrug users reported significantly higher scores than non-drug users on several SCL-90 factors, including phobic anxiety, obsessive-compulsive behaviour, anxiety, psychoticism, somatisation, and significantly higher rates of 'loss of sex interest or pleasure'. Self-rated symptom scores increased in line with greater drug use, so that polydrug users who had never taken ecstasy also reported a variety of psychobiological impairments. In contrast, positive moods and life experiences were broadly similar across subgroups. CONCLUSIONS: The recreational use of ecstasy/MDMA is associated with a range of psychiatric symptoms and psychobiological problems. However, these problems are not specific to ecstasy users but are also evident in other recreational polydrug users.     

The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand

BackgroundAlthough Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU.MethodsUsing Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok.Results435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR] = 1.60; 95% confidence interval [CI]: 1.16–2.21), having been refused healthcare (APR = 3.46; 95% CI: 2.61–4.60), and experiencing shame associated with one's drug use (APR = 1.93; 95% CI: 1.21–3.09).ConclusionExposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU.