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.     

Synthetic cannabinoids are substrates and inhibitors of multiple drug-metabolizing enzymes

Synthetic cannabinoids, a new class of psychoactive substances, are potent agonists of cannabinoid receptors, which mimic the psychoactive effects of the principal psychoactive component of cannabis, ?9-tetrahydrocannabinol. Despite governmental scheduling as illicit drugs, new synthetic cannabinoids are being produced. The abuse of synthetic cannabinoids with several drugs containing different chemical groups has resulted in large numbers of poisonings. This has increased the urgency for forensic and public health laboratories to identify the metabolites of synthetic cannabinoids and apply this knowledge to the development of analytical methods and for toxicity prediction. It is necessary to determine whether synthetic cannabinoids are involved in drug-metabolizing enzyme-mediated drug–drug interactions. This review describes the metabolic pathways of 13 prevalent synthetic cannabinoids and various drug-metabolizing enzymes responsible for their metabolism, including cytochrome P450 (CYP), UDP-glucuronosyltransferases (UGTs), and carboxylesterases. The inhibitory effects of synthetic cannabinoids on CYP and UGT activities are also reviewed to predict the potential of synthetic cannabinoids for drug–drug interactions. The drug-metabolizing enzymes responsible for metabolism of synthetic cannabinoids should be characterized and the effects of synthetic cannabinoids on CYP and UGT activities should be determined to predict the pharmacokinetics of synthetic cannabinoids and synthetic cannabinoid-induced drug–drug interactions in the clinic.     

苯乙胺类物质的滥用危害与管制措施探析

2017年《世界毒品报告》显示:苯乙胺类物质已成为继合成大麻素类、合成卡西酮类之后的第三大合成类毒品.在所有因滥用新精神活性物质导致的临床病例中苯乙胺所占比例高达28.4％[1],苯乙胺类物质因其化学结构灵活多变,由此成为众多非法兴奋剂的演变"载体",加之部分苯乙胺类新精神活性物质兼具兴奋与致幻的双重效应,其危害性较之...     

Drug information libraries on the Internet

In the past several years there has been a dramatic proliferation of drug-related sites on the Internet. This article reviews the information found at selected Internet drug information libraries, and comments on its accuracy and implications. Drug-related sites were found by initially performing an Internet search on "psychoactive drugs" and then exploring links among the sites identified. Sites were chosen on the basis of comprehensiveness of information and positive or tolerant attitude toward drug use. While all classes of drugs are discussed at these sites, the primary foci of interest are synthetic and naturally occurring hallucinogens. Many of the biological materials discussed are legal and readily available. Information surveyed at these sites was largely accurate regarding the effects of various substances and biological sources of psychoactive compounds. CONCLUSIONS: Internet drug information libraries contain large amounts of information about a wide variety of drugs, including previously little-known biological sources of hallucinogens. The availability of this information could have significant effects on patterns of drug use.     

Synthetic cathinones: an evolving class of new psychoactive substances

Abstract

Synthetic cathinones (SCat) are amphetamine-like psychostimulants that emerged onto drug markets as “legal” alternatives to illicit drugs such as ecstasy, cocaine, and amphetamines. Usually they are sold as “bath salts,” “plant food,” or “research chemicals,” and rapidly gained popularity amongst drugs users due to their potency, low cost, and availability. In addition, internet drug sales have been replacing the old way of supplying drugs of abuse, contributing to their rapid spread. Despite the legislative efforts to control SCat, new derivatives continue to emerge on the recreational drugs market and their abuse still represents a serious public health issue. To date, about 150 SCat have been identified on the clandestine drugs market, which are one of the largest groups of new psychoactive substances (NPS) monitored by the United Nations Office on Drugs and Crime and the European Monitoring Center for Drugs and Drug Addiction. Similar to the classical stimulants, SCat affect the levels of catecholamines in the central nervous system, which results in their psychological, behavioral and toxic effects. Generally, the effects of SCat greatly differ from drug to drug and relatively little information is available about their pharmacology. The present work provides a review on the development of SCat as substances of abuse, current patterns of abuse and their legal status, chemical classification, known mechanisms of action, and their toxicological effects.     

Detectability of new psychoactive substances, ‘legal highs’, in CEDIA,EMIT, and KIMS immunochemical screening assays for drugs of abuse

The increasing number of new psychoactive substances made available for recreational drug use has created a challenge for clinical toxicology and drug testing laboratories. As a consequence, the routine immunoassay drug testing may become less effective due to an increased occurrence of false negative and false positive screening results. This work aimed to extend the knowledge about analytical cross‐reactivity of new substances in selected CEDIA, EMIT, and KIMS immunoassays for drugs‐of‐abuse screening. Urine standards were prepared by spiking blank urine with 45 new substances. Authentic urine samples from intoxication cases identified by liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) were also studied. Several new psychoactive substances were demonstrated to display cross‐reactivity in the immunoassays. CEDIA Amphetamine/Ecstasy and EMIT d.a.u. Amphetamine Class tests showed the highest reactivity towards the new drugs, which was expected since many have amphetamine‐like structure and activity. In the samples from authentic cases, five new substances displayed 100% detection rate in the CEDIA Amphetamine/Ecstasy test. In conclusion, cross‐reactivity data in routine urine drug screening immunoassays for a number of new psychoactive substances not studied before were reported. In both spiked and authentic urine samples, some new substances showed significant cross‐reactivity and are thus detectable in the routine screening methods. Copyright © 2014 John Wiley & Sons, Ltd.     

Drug residues in syringes and other injecting paraphernalia in Hungary

The appearance and spread of new psychoactive substances (NPS) is a phenomenon seen throughout Europe since 2008. Synthetic cathinones, a group of NPS, have been self‐reported as the drug injected by the vast majority of people who inject drugs (PWID) in Hungary. This study aims at updating our knowledge of what exactly are the compounds injected by PWID. This multi‐site study analysed residues from used injecting drug paraphernalia collected from PWID via low‐threshold services and from public places in Budapest, Debrecen, Miskolc, Szeged, Békéscsaba and Pécs between March 2015 and February 2016. The paper describes the results of the chemical analysis of 2985 analytical samples created out of the 22 005 objects collected in this period. Active agents and their occurrences (compound cases) were identified using GC–MS. The study detected 161 different compounds, mostly synthetic cathinones (29%), non‐psychoactive compounds (14%), amines (12%), non‐psychoactive medications (12%) and other substances (32%). Of the 12 762 compound cases, 50% were cathinones, 18% substitution medications, 9% non‐controlled psychoactive substances and 24% other substances. Among compound cases, the most frequent cathinones were pentedrone (21%) and α‐PHP (12%). Among substitution medications, most were methadone (93%), and non‐controlled psychoactive substances were caffeine (74%) and nicotine (21%). Overall, the most prevalent substances were methadone (16%), pentedrone (10%) and caffeine (7%) with considerable variation detected among participating cities. Our results are consistent with previous self‐reported data showing a high prevalence of synthetic cathinone injection among PWID in Hungary. We also detected a large‐scale misuse of methadone by PWID.     

A critical examination of the definition of ‘psychoactive effect’ in Australian drug legislation

As the number of new ‘psychoactive substances’ detected globally has risen exponentially, the policy response of assessing and prohibiting each new substance individually has become increasingly unworkable. In an attempt to disrupt the availability of new as-yet-unscheduled substances, Ireland (2010), Poland (2011), Romania (2012), New Zealand (2013), Australia (2015) and the United Kingdom (2016) have enacted generic or blanket ban legislation that prohibits all ‘psychoactive substances’ that are not already regulated or belong to exempt categories. How such generic legislation defines ‘psychoactive substance’ is therefore crucial. While there is a growing critical literature relating to blanket bans of ‘psychoactive substances’, the Australian legislation is yet to be described or critically analysed. In this commentary, we aim to draw the attention of local and international drug policy scholars to Australia’s newest legislative approach to ‘psychoactive substances’. Using the Australian experience as a case study, we first describe and trace the origins of this generic banning approach, especially focusing on how ‘psychoactive effect’ came to be defined. Then, we critically examine the assumptions underpinning this definition and the possibilities silenced by it, drawing on the work of poststructuralist and critical scholars. In doing so, we explore and raise a series of questions about how this legislation works to stabilise drugs, drug harms and drug effects, as well as addiction realities; how the category of ‘psychoactive substances’ is produced through this legislation; and some of the material-discursive effects which accompany this rendering of the ‘problem’. We offer this commentary not as a comprehensive discussion of each of these elements but rather as a starting-point to promote further discussion and debate within the drug policy field. To this end, we conclude with a suggested research agenda that may help guide such future work.     

Factors contributing to self-reported drug use among London undergraduates 1971–1972

A questionnaire study of drug taking by 1113 London University undergraduates has been undertaken. This paper sets out to relate drug taking to student life.The variables which discriminate those who have tried illicit drugs from those who have not are conceptualised as representing alienation from study, distance from authority, and separation from parents. These variables are consistent with a general factor best labelled “non-conformity”.The variables which seem to discriminate between degrees of involvement in psychoactive substances are ease of obtaining cannabis, estimated percentage of friends who use drugs, use of tobacco, seeing someone inject themselves, operational use of substances (i.e. use for purposes other than recreation or pleasure), and choice of future career. These variables represent four overlapping factors which affect involvement with psychoactive substances: contact with drugs, contact with drug users, identification with the user class, and within-class deviance. While non-conformity appears to be the factor in student life predisposing students to try illicit drugs, the factors which affect the degree of involvement with such substances seem relatively independent of student status.     

Comparison of the degree of discriminability of various drugs using the T-maze drug discrimination paradigm

This paper reports preclinical data that may predict the amount of state-dependent learning likely to be produced in humans by various psychoactive drugs. In a T-maze, rats were required to turn right when drugged and left when not drugged to escape from electric shock. The number of training sessions required to learn this drug versus no drug discrimination was used as an indicator of the degree of discriminability of the training drug. Using this procedure, the discriminability of more than 100 common psychoactive drugs was determined at one or more doses. Sessions to criterion usually decreased as dosage was increased. Maximum discriminability occurred at the highest usable dose in most cases, and differed considerably for drugs of various types. The results suggest that the majority of psychoactive drugs can be investigated by use of the drug discrimination technique, and that state-dependent learning effects will not accompany clinical use of most psychoactive drugs unless intoxicating doses are used.     

Psychiatric diagnoses and perceived health problems in a sample of working Swedes treated with psychoactive medications

Findings of formal and subjective mental health problems among Swedish employees are presented as well as reviews of current Swedish policies on substance abuse and drug screening in the workplace. The focus is on the potential violation of medical confidentiality for employees with legitimate psychoactive drug medications and the lack of evidence linking the detection of various substances with impaired work performance. Data are drawn from a study of a sample of working Swedes, which revealed that approximately 3% reported taking psychoactive medications regularly. This was correlated with increases in long-term sick leave, periods of unemployment, and frequent job changes by both sexes. These workers also scored high for neuroticism, and had high rates of inpatient psychiatric treatment and suicide. With these high rates of formal mental health problems among employees who self-medicate with psychoactive drugs, discriminatory personnel management, including drug screening, jeopardizes confidentiality of treatment and civil rights.     

Drug Prohibition and the Treatment System: Perfect Together

The “War on Drugs” in the U.S. is consistent with the predominance of the abstinence model for treatment and helps legitimate compulsory treatment. Alternative public health approaches such as harm reduction are suspect and devalued. The mission of treatment risks becoming trivialized, primarily focusing on separating individuals from “illicit” psychoactive substances, in perfect accord with current drug policy. The current policy breeds disrespect for law and imposes enormous social and economic costs on society, without demonstrable effects on the availability or costs of “illicit” drugs. Maintaining the policy has become an end in itself, as shown in the disproportionate campaign against marijuana use, but there are signs that the policy is becoming vulnerable. Similarities to the situation at the time of the repeal of alcohol prohibition in 1933 are discussed.     

Drug prohibition and the treatment system: perfect together

The "War on Drugs" in the U.S. is consistent with the predominance of the abstinence model for treatment and helps legitimate compulsory treatment. Alternative public health approaches such as harm reduction are suspect and devalued. The mission of treatment risks becoming trivialized, primarily focusing on separating individuals from "illicit" psychoactive substances, in perfect accord with current drug policy. The current policy breeds disrespect for law and imposes enormous social and economic costs on society, without demonstrable effects on the availability or costs of "illicit" drugs. Maintaining the policy has become an end in itself, as shown in the disproportionate campaign against marijuana use, but there are signs that the policy is becoming vulnerable. Similarities to the situation at the time of the repeal of alcohol prohibition in 1933 are discussed.     

Prevalence of new psychoactive substances: A retrospective study in hair

New psychoactive substances are conquering the drug scene. Police seize different colourful packages with exceptional names. They are declared as ‘bath salts’, ‘plant food’, or ‘research chemical powders’. Little is known about the actual prevalence of these drugs. Reanalysis of hair samples from routine cases concerning the presence of new psychoactive substances or ‘smart drugs’ should provide insight into changing patterns of designer drugs. All hair samples from 2009 and 2010 that originally tested positive for amphetamines or MDMA (N = 325) were reanalyzed for new or smart drugs such as 4‐fluoroamphetamine, piperazines (BZP, mCPP and TFMPP), cathinones (4‐MMC (mephedrone), methylone, butylone, ethylone, MDPV, methcathinone and cathinone), methylphenidate and ketamine. Hair snippets were extracted using a two‐step extraction procedure. The analytes were analyzed using liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) (electrospray ionization; multiple‐reaction‐monitoring mode – information dependent acquisition – enhanced product ion scan). New psychoactive substances were found in 120 cases (37%). Concerning the piperazine drugs, mCPP was positive in 34 (10.5%) cases and TFMPP in one case. Five mCPP cases were also positive for trazodone, an antidepressant which is metabolized to mCPP. In 11 (3%) cases, 4‐MMC was detected. Concerning the smart drugs, methylphenidate was found in 16 (5%). Ketamine was found in 45 (14%) cases. 4‐Fluoroamphetamine was identified in 12 (4%) cases and methylone in one case.In conclusion, there is a high prevalence of these drugs. Consequently, at least the most common ones (e.g. mCPP, KET, 4‐MMC and 4‐FA) should be included in screening procedures in clinical and forensic toxicology. Copyright © 2012 John Wiley & Sons, Ltd.     

The dilemma of new psychoactive substances: A growing threat

New psychoactive substances (NPS) pose a major public threat and are a growing problem worldwide. They were designed to replace banned or controlled drugs while escaping quality control measures. Their chemical structure is constantly changed which imposes a major forensic challenge, and makes it difficult for law enforcement measures to track and ban them. Hence, they are called “legal highs” as they replicate illicit drugs whilst remaining legal.Low cost, easy accessibility and less legal liability are the main factors that contribute to the popularity of NPS among the public. This is particularly with the lack of knowledge of the health risks and harms associated with NPS not only amongst the public, but healthcare professionals as well, which further constitutes a challenge for preventative and treatment measures.Further medico-legal investigation, extensive laboratory and non-laboratory analyses, and advanced forensic measures are necessary to identify, schedule and control new psychoactive substances. Besides, additional efforts are required to educate the public and increase their awareness regarding NPS and their potential harms.     

A calibration friendly approach to identify drugs of abuse mixtures with a portable near-infrared analyzer

Both the increasing number and diversity of illicit-drug seizures complicate forensic drug identification. Traditionally, colorimetric tests are performed on-site, followed by transport to a laboratory for confirmatory analysis. Higher caseloads increase laboratory workload and associated transport and chain-of-evidence assurance performed by police officers. Colorimetric tests are specific only for a small set of drugs. The rise of new psychoactive substances therefore introduces risks for erroneous results. Near-infrared (NIR)-based analyzers may overcome these encumbrances by their compound-specific spectral selectivity and broad applicability. This work introduces a portable NIR analyzer that combines a broad wavelength range (1300–2600 nm) with a chemometric model developed specifically for forensic samples. The application requires only a limited set of reference spectra for time-efficient model training. This calibration-light approach thus eliminates the need of extensive training sets including mixtures. Performance was demonstrated with 520 casework samples resulting in a 99.6% true negative and 97.6% true positive rate for cocaine. Similar results were obtained for MDMA, methamphetamine, ketamine, and heroin. Additionally, 236 samples were analyzed by scanning directly through their plastic packaging. Also here, a >97% true positive rate was obtained. This allows for non-invasive, operator-safe chemical identification of potentially potent drugs of abuse. Our results demonstrate the applicability for multiple drug-related substances. Ideally, the combination of this NIR approach with other portable techniques, such as Raman and IR spectroscopy and electrochemical tests, may eventually eliminate the need for subsequent laboratory analysis; therefore, saving tremendous resources in the overall forensic process of confirmatory illicit drug identification.     

Risk of caffeine toxicity associated with the use of ‘legal highs’ (novel psychoactive substances)

Purpose  

Caffeine has desired stimulant effects similar to but weaker than both classical recreational drugs and novel psychoactive substances. This study was undertaken to determine the caffeine content of a sample of novel psychoactive substances, and we discuss the implications for the management of acute recreational drug toxicity.     

Drugs and homicide: A theory

In this paper we report our experience with 24 cases in which there was a homicide or homicides committed in association with use of large amounts of psychoactive drugs. Many, if not most of these homicides, would not have occurred without drug effects, for frequently there was evidence of grossly illogical thinking in close temporal association with use of intoxicants and in many cases there was no previous history of violence, no evidence of premeditation, no plan to avoid arrest and little or no discernible motivation. Usually there were multiple losses or other severe stress in the lives of the persons committing the homicide in the months preceding the crime. The stress increase was accompanied by increased and extraordinary intake of psychoactive substances. We theorize that high doses of psychoactive drugs impaired severely the brain systems upon which the mental functions of reality testing and judgment depend. Drug induced impairment of reality testing and judgment is frequently uncritically equated with hallucinations, disorientation, changes in time perception or other drug induced mental phenomena. Impairment of reality testing and judgment are basic criteria for linking drug effects with the behavior of homicide in the cases reviewed.