A profile of adolescent cocaine use in Northern Ireland

BackgroundThe image of cocaine as a ‘party’ drug used by more affluent members of society has begun to change as the levels of use of the drug rise amongst school aged young people.MethodsCocaine use patterns amongst young people aged 13–16 years who were participating in the Belfast Youth Development Study, a longitudinal study of adolescent drug use was explored. Data was collected through an annual datasweep in participating schools. This paper includes data collected in years 3, 4 and 5 of the study.ResultsThe results show higher levels of cocaine use amongst this age group than reported in much of the existing harm reduction literature. Lifetime use was 3.8% at age 13–14 years, rising to 7.5% at 15–16 years. The profile indicated that adolescent cocaine users were more likely to be female, live in disrupted families and experience social deprivation which is similar to existing adolescent drug use profiles. There was also some evidence of experimental cocaine use amongst the sample.ConclusionsThese findings provide further evidence for the development of age appropriate school focused harm reduction initiatives and continued monitoring of contemporary trends of use of cocaine amongst school aged young people.     

Contextualising psychological distress among regular ecstasy users: The importance of sociodemographic factors and patterns of drug use

Introduction and Aims. Considerable concern has been raised about associations between ecstasy use and mental health. Studies of ecstasy users typically investigate varying levels of lifetime use of ecstasy, and often fail to account for other drug use and sociodemographic characteristics of participants, which may explain mixed findings. The current study aimed to examine the relationship between patterns of recent (last six months) ecstasy use and psychological distress among current, regular ecstasy users, controlling for sociodemographic risk factors and patterns of other drug use. Design and Methods. Data were collected from regular ecstasy users (n = 752) recruited from each capital city in Australia as part of the Ecstasy and related Drugs Reporting System (EDRS). Psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Data were analysed using multinomial logistic regression. Results. Seven per cent of the sample scored in the ‘high’ distress category and 55% in the ‘medium’ distress category. Patterns of ecstasy use were not independently associated with psychological distress. The strongest predictors of distress were female sex, lower education, unemployment, ‘binge’ drug use including ecstasy (use for >48 h without sleep), frequent cannabis use and daily tobacco use. Discussion and Conclusions. Regular ecstasy users have elevated levels of psychological distress compared with the general population; however, ecstasy use per se was not independently related to such distress. Other factors, including sociodemographic characteristics and other drug use patterns, appear to be more important. These findings highlight the importance of targeting patterns of polydrug use in order to reduce drug‐related harm among regular ecstasy users.[George J, Kinner SA, Bruno R, Degenhardt L, Dunn M. Contextualising psychological distress among regular ecstasy users: The importance of sociodemographic factors and patterns of drug use. Drug Alcohol Rev 2010]     

UK addiction research 1994–2001: A profile of studies published in Addiction Abstracts

Introduction: In 2002 the National Treatment Agency for Substance Misuse commissioned a consultation exercise to help identify future research priorities. An overview of UK research published in the journal Addiction Abstracts contributed to this.

Method: Using a Microsoft Access database, two reviewers systematically profiled all 840 UK abstracts published between 1994 and 2001. The database included 72 fields for each abstract and a coding framework of predefined options.

Results: Fifty-seven percent (n?=?482) of the 840 abstracts reported studies involving licit substances, of which 65% discussed alcohol and 30% covered tobacco/nicotine. Sixty-three percent (n?=?530) covered illicit substances, a high proportion of which described non-specific drug use such as ‘general drug use’ (32%) or ‘injecting’ (16%), rather than individual substances. Heroin was the most common substance specified (8%). Few of the 840 abstracts focused upon subjects with predefined demographic characteristics: 8% detailed single gender studies; 2% reported an ethnic focus. Subgroup surveys were the most frequent research method adopted (32%); 15% described literature reviews, and 7% were ‘laboratory experimental’. Two percent of studies were identified as randomized controlled trials.

Conclusion: Our research presents a useful profile of published UK research and provides a focus for reflection and debate on future priorities.     

Impact of a transient instability of the ecstasy market on health concerns and drug use patterns in The Netherlands

BackgroundA recent decline in MDMA-like substances in ecstasy tablets has been reported by a number of countries in the European Union. This study describes the instability of the ecstasy market in The Netherlands during 2008 and 2009, and investigates whether this had any impact on drug testing or patterns of drug use.MethodsThe health concerns of drug users handing in drug samples at drug testing facilities was measured using intervention time-series analysis. In addition, these ecstasy users were asked about changes in their drug use.ResultsNationally, the unstable market situation for ecstasy has increased the number of users handing in ecstasy tablets for testing because of health concern. There was no change in the number of users handing in cocaine or gamma hydroxybutyrate (GHB). Respondents reported no major changes in their drug use resulting from the shortage of MDMA-like substances.ConclusionsThese findings provide further insight in drug policy based on both harm reduction and use reduction. In the event of reduced ecstasy quality, ecstasy users in The Netherlands have increasingly used drug testing as a potential harm reduction tool, rather than changing their patterns of drug use. This might indicate that a transient reduction of drug quality does not serve as a good drug use reduction strategy for ecstasy users.     

Drug interactions with new oral anticoagulants in elderly patients

Introduction: This review attempts to summarise what is known about Drug-drug interactions (DDIs) of the new oral anticoagulants (NOACs) in elderly patients. The literature was searched for: ‘CYP3A4’, ‘CYP2C9’, ‘P-glycoprotein’, ‘acetylsalicylic-acid’, ‘non-steroidal anti-inflammatory’, ‘clopidogrel’, ‘ticagrelor’, ‘prasugrel’ and ‘dabigatran’, ‘rivaroxaban’, ‘edoxaban’, or ‘apixaban’. ‘Elderly’ was defined as ≥75 years.

Areas covered: Publications about DDIs of NOACs were found for 35% of 140 potentially interacting drugs. Reports about DDIs of cardiovascular drugs, were most frequent, followed by anti-infective and nervous system drugs. Reports about elderly were found for only 47 patients. DDIs were reported most frequently in association with dabigatran. Dabigatran is the only NOAC interacting with proton-pump-inhibitors.

Expert commentary: Dabigatran was the first NOAC approved, so it is not possible to determine whether the higher number of reports about DDIs with dabigatran compared with other NOACs is due to a higher rate of DDIs or to the length of time during which this drug has been in use. Most of the data is derived from subgroup-analyses of trials, sponsored by NOAC manufacturers, consequently there is a lack of independent data. Because of the scarcity of data, the clinical relevance of DDIs of NOACs is uncertain at present, especially in elderly patients.     

New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice.

Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors.

Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: ‘the general results of dispensing methadone to opioid misusers’; ‘the effect of opioid-dependent clients on a pharmacy’; ‘reducing harm associated with drug use’; and ‘engaging with drug users’. Training (having it or wanting to have it) was positively associated with the four attitude factors.

Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.     

From ecstasy to MDMA: Recreational drug use,symbolic boundaries,and drug trends

BackgroundEcstasy pills with MDMA as the main ingredient were introduced in many European countries in the 1980s, and were often linked to the rave and club scenes. However, use gradually levelled off, in part as a response to increased concerns about possible mental health consequences and fatalities. Extensive use of MDMA now seems to be re-emerging in many countries. In this study, we investigated the cultural and social meaning associated with MDMA use in Oslo, Norway, with an emphasis on how users distinguish MDMA crystals and powder from “old ecstasy pills”.MethodsQualitative in-depth interviews (n = 31, 61,3% males) were conducted with young adult party-goers and recreational MDMA/ecstasy users (20–34 years old, mean age 26.2 years).ResultsResearch participants emphasised three important perceived differences between the MDMA crystals and ecstasy pills: (i) The effects of MDMA were described as better than ecstasy; (ii) MDMA was regarded as a safer drug; (iii) Users of MDMA crystals were described as more distinct from and less anchored in out-of-fashion rave culture than those using ecstasy. These differences were an important part of the symbolic boundary work MDMA users engaged in when justifying their drug use.ConclusionMDMA has re-emerged as an important psychoactive substance in Oslo’s club scene. One important reason for this re-emergence seems to be its perceived differentiation from ecstasy pills, even though the active ingredient in both drugs is MDMA. This perceived distinction between MDMA and ecstasy reveals the importance of social and symbolic meanings in relation to psychoactive substance use. Insights from this study can be important in terms of understanding how trends in drug use develop and how certain drugs gain or lose popularity.     

Pharmacological management of osteoporosis – when to treat and when to stop

Introduction: Bisphosphonates are antiresorptive drugs of proven efficacy which are widely used for osteoporosis. After stopping bisphosphonate therapy, residual therapeutic effects persist for an undefined period; thus, some osteoporotic patients could benefit from a temporary discontinuation, the so called ‘drug holiday’.

Areas covered: We reviewed the effects of discontinuing various anti-fracture treatments in order to clarify both clinical features of patients for whom a drug holiday from an initial bisphosphonate treatment period could be offered and a possible approach to the management of the drug holiday. A PubMed search was undertaken using the following main search terms: ‘bisphosphonates’, ‘drug holiday’, ‘treatment discontinuation’, ‘anti-fracture drugs’.

Expert commentary: After an initial bisphosphonate treatment period of 3–5 years, fracture risk should be reassessed in order to decide if a drug holiday could be offered to patients. Those at high fracture risk should continue treatment; those at moderate-mild fracture risk could temporarily discontinue treatment.     

Enlightened hedonism? Independent drug checking amongst a group of ecstasy users.

BackgroundResearch indicates that a body of ecstasy users across the globe employ ‘home’ drug testing technologies to learn more about the content of their drugs – a process referred to throughout this article as independent drug checking (IDC). Whilst a small number of studies offer accounts of this process, they do so through a narrow lens of harm reduction, potentially overlooking wider socio-cultural factors which may affect this. In response, this article draws on Slavoj Žižek's political theory of the cultural injunction to enjoy, situating IDC in the wider political economy of neoliberal consumer capitalism to contextualise and interpret its use as integral to pleasure and leisure.MethodsThis empirical study documents the thoughts and experiences of a group of UK ecstasy users who independently use a privately owned drug-testing kit. Drawing on qualitative data generated through 20 semi-structured interviews, the article considers two research questions; what role did drug checking play in the group's drug journeys and leisure activities?; and is drug checking thought to be purposeful?FindingsFor this group of ecstasy users, issues of safety and self-responsibility interweaved with the pursuit of pleasure as they sought to enjoy their drug consumption, but in a way that navigated potential harms. IDC therefore served to maximise pleasure via its ‘guarantee’ of a prolonged, enjoyable, authentic consumer experience whilst simultaneously safeguarding wellbeing via its premise of more responsible and controlled consumption practices.ConclusionIDC allowed this group of drug consumers to partake in ‘enlightened hedonism’ – demonstrating their conformity to the imperatives of capitalism and its social norms. Despite recognising the limitations of IDC and disclosing potentially harmful outcomes, the group's engagement with capitalist markets provided a belief that investment in your consumer experience can both improve it and make it safer – premises that belie the empirical reality.     

Cannabis use and 'safe' identities in an inner-city school risk environment

BackgroundDespite evidence of school effects on drug use, little is known about the social and institutional processes through which these may occur. This study explores how school experiences may shape young people’s drug-related attitudes and actions and adds to existing evidence highlighting the importance of drug use in young people’s identity construction and group bonding.MethodsCase study qualitative data were collected through semi-structured interviews supplemented with observations. Fourteen students aged 14–15 were interviewed in autumn 2006 and again in summer 2007. Five teachers were interviewed.ResultsInner-city secondary schools may constitute risky and insecure environments, and thereby act as structural forces in shaping how students form peer groups and respond to feelings of insecurity. Cannabis use – and identities constructed in relation to this – appeared to play a key role in how students manage insecurity. Black and dual-heritage students formed large, ‘safe’ ethno-centric school social networks and smoking ‘weed’ appeared to be an important source of bonding and identity. For some students, a vicious circle may exist whereby the process of ‘fitting in’ exacerbates difficult and conflicting relationships with teachers and parents, entrenches disengagement from education and leads to further cannabis use. There also appeared to be a diffusion of this ‘safe’ identity construction beyond these disengaged students. Cannabis and other drug use may also be an important safety strategy and source of bonding for pro-education students who need to be seen ‘getting high’ as well as ‘aiming high’. While some students constructed ‘safe’ and ‘sweet’ identities others were constrained by their position and resources at school.ConclusionInner-city schools may both reflect and reproduce existing patterns of drug use. The concept of risk hierarchies may be important when designing and evaluating school-based drug-prevention strategies.     

Examining the Prevalence and Perceived Harm of Ecstasy and Other Drug Use Among Juvenile Offenders

ABSTRACT

To date, few studies have examined the use of 3,4 methylenedioxymethamphetamine (MDMA or “ecstasy”) among criminal populations. In the current study, self-report drug use data and urine specimens were collected from 86 male juvenile offenders surveyed through Maryland's Offender Population Urinalysis Screening (OPUS) Program. Prevalence estimates of ecstasy use were generated and associations between ecstasy use, demographic characteristics, and alcohol and other drug (AOD) use were explored. Nineteen percent of the sample reported lifetime ecstasy use, 14% within the past 12 months, and 8% within the past 30 days. One percent of the sample reported ecstasy use in the two days preceding the interview, and none tested positive for MDMA via urinalysis. Compared to non-users, past-year ecstasy users were significantly more likely to be white and to have used alcohol, marijuana, powder cocaine, and heroin within the 12 months preceding the interview. The use of marijuana once or twice and regularly was associated with the least amount of risk of physical and/or psychological harm for both the past-year ecstasy users and the non-users in the sample. Policy implications are discussed.     

Safety of botulinum toxin type A: a systematic review and meta-analysis

SUMMARY

Objective: To define quantitatively the safety and tolerability profile of botulinum toxin type A (BTX-A) across all common therapeutic indications. The review was limited to the evaluation of the safety profile of one preparation of BTX-A (Botox*) because distinct formulations of BTX-A are associated with different clinical profiles, requiring separate consideration for an analysis of safety.

Research design and methods: We identified randomized controlled trials of BTX-A through searches of the MEDLINE, EMBASE, and Cochrane Controlled Trial databases for the years 1966–2003. Studies were double-blind, randomized, crossover, or of parallel group design. The search strategy included the terms ‘botulinum toxin’, ‘therapeutic use’, ‘randomized controlled trial’, ‘controlled clinical trial’, ‘randomized clinical trial’, and ‘placebo controlled trial’. Only randomized controlled trials of at least 7?days duration that reported adverse events were included in the analysis.

Main outcome measure: Safety was assessed by means of a meta-analysis of the number and frequency of adverse events.

Results: Thirty-six studies involving 2309 subjects met the inclusion criteria. These reported on 1425 subjects receiving BTX-A treatment. No study reported any severe adverse events. The meta-analysis of any mild to moderate adverse events showed a rate of roughly 25% in the BTX-A-treated group (353/1425 patients) compared with 15% in the control group (133/884 patients, p < 0.001). Focal weakness was the only adverse event that occurred significantly more often with BTX-A treatment than control.

Conclusion: The results of this meta-analysis and experience from long-term, open-label investigations demonstrate that the formulation of BTX-A evaluated here has a favorable safety and tolerability profile across a broad spectrum of therapeutic uses.     

Predictors of using social media to purchase drugs in New Zealand: Findings from a large-scale online survey

BackgroundThere are increasing reports of social media being used to buy and sell illegal drugs internationally. Studies of social media drug markets to date have largely involved general explorations of social media drug transactions in select countries. Social media drug markets may operate differently for different drug types and in different country contexts.AimsTo identify predictors of the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA in New Zealand using a large-scale online survey sample.MethodsThe annual New Zealand Drug Trends Survey (NZDTS), an online convenience survey promoted via targeted Facebook™ campaign, was completed by 23,500 respondents aged 16+. Logistic regression models were fitted to identify demographic, drug use and drug market predictors of reporting the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA.ResultsFifty-one percent of the sample had purchased cannabis, methamphetamine, ecstasy/MDMA or LSD in the past six months, of which 22% had done so via social media (n = 2,650). Cannabis was the drug type most purchased from social media among drug purchasers (24%), followed by ecstasy/MDMA (13%). Sixty percent of social media purchasers had used Facebook™, 48% Snapchat™, and 20% Instagram™. The leading advantages of social media purchasing were “high convenience” (74%), and “fast transaction speed” (43%). Younger age was a significant predictor of social media purchasing for all drug types (particularly among 16–17 year olds). Purchasing from someone identified as a “drug dealer” was a predictor of social media purchasing among respondents for all drug types.ConclusionSocial media drug markets may have significant implications for drug purchasing by youth through providing greater access to supply and breaking down age-related barriers between social supply and commercial drug markets. Our findings highlight the importance of incorporating social media platforms into youth drug prevention and harm minimisation strategies.     

Engagement with different nightlife venues and frequent ecstasy use in a young adult population

Abstract

Aims: Little is known about the possible influence of different social settings on changes in patterns of ecstasy use over time. This study explores the relationship between engagement with different types of nightlife venues and subsequent frequent ecstasy use in an Australian young adult population sample. Methods: Longitudinal data are from a population-derived sample of Australian young adult ecstasy users (n?=?265). Attendance at four types of venues (nightclubs, electronic dance music events/music festivals, venues playing live music, and pubs/bars) was measured at 6 months. Frequency of recent ecstasy use (last 12 months) was measured at 12 and 30 months. A prediction model of frequent ecstasy use at 30 months was developed using Poisson regression reporting adjusted relative risk. Findings: Regular attendance at nightclubs (≥monthly, adjusted relative risk 6.21, confidence interval 2.30–16.76) was associated with frequent ecstasy use at 30 months, independently of ecstasy use expectancies, ecstasy availability, ecstasy and methamphetamine dependence, frequent use of methamphetamine and alcohol, and other dimensions of ecstasy involvement (i.e. length of ecstasy use career and lifetime ecstasy consumption). Conclusions: Compared with attendees of other venues, nightclub attendees may be a special priority group for ecstasy harm and demand reduction interventions.     

Famciclovir: a focus on efficacy and safety

Importance of the field: Famciclovir is the prodrug of penciclovir, a guanosine analogue that inhibits viruses of the α sub-family of the Herpesviridae, as well as hepatitis B virus. It is indicated for management of mucocutaneous herpes simplex virus disease and acute herpes zoster, and has been investigated for management of hepatitis B virus infection.

Areas covered in this review: Data for this review were identified by searches of papers published in English on Medline and Scopus, spanning the years 1975 through 1 February 2010 with the key words: ‘famciclovir’, ‘famvir’, ‘penciclovir’, ‘herpes’, ‘oral’, ‘genital’, ‘varicella’, ‘zoster’ and ‘virus’ in association with ‘safety’, ‘toxicity’, ‘tolerability’, ‘efficacy’ and ‘indications’. Relevant references were also obtained from articles acquired through the search strategy.

What the reader will gain: Readers are also provided with up-to-date information on the use of famciclovir for infections due to herpes simplex, varicella zoster and hepatitis B viruses. Clinical data pertaining to the safety and tolerability of famciclovir are also reviewed.

Take home message: Famciclovir is a safe, convenient, and well-tolerated drug when used for its approved indications. The most common side effects indicated in the majority of studies were headache and nausea. Data for its use in childhood and pregnancy are limited.     

Adalimumab in children and adolescents with severe plaque psoriasis: a safety evaluation

ABSTRACT

Introduction: Psoriasis is a chronic inflammatory systemic disease that affects 2% of the population and is associated with an important physical and physiological burden. About 0.5–2% of psoriatic cases onset during the pediatric age range, and often it’s not diagnosed until adulthood. Adalimumab is an antitumor necrosis factor monoclonal antibody approved for use in children in 2008 and now it was used in several diseases in rheumatology, gastroenterology, and in dermatology.

Areas covered: The purpose of this article was to summarize what has been described in the literature so far, about safety in the use of adalimumab in pediatric psoriasis. The presented data was extrapolated from a literature review from PubMed searches (using words ‘pediatric psoriasis,’ ‘adalimumab children,’ ‘adalimumab safety,’ ‘pediatric psoriasis treatment,’ ‘adalimumab clinical trial’), treatment guidelines, and reports from European and United States regulatory agencies.

Expert opinion: Actually there are some biologic agents for the treatment of pediatric psoriasis, but the lack of safety data from controlled trials is evident. The safety data on the use of adalimumab in pediatric psoriasis was taken from long-term studies in the adult population. These studies confirm the data on the safety of the drug as it is also supported by several works on real-life.