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Balali-Mood M, Sinclair RD, Darchini-Maragheh E, Etemad L. Mucocutaneous alterations and complications in amphetamine abusers: a narrative review. Cutan Ocul Toxicol 2023; 42:219-231. [PMID: 37450708 DOI: 10.1080/15569527.2023.2235425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Amphetamines are the second most commonly used illicit drug worldwide. Amphetamine use can result in significant cutaneous morbidity. This review highlights the dermatological manifestations of amphetamine abuse.
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Affiliation(s)
- Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Rodney D Sinclair
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Sinclair Dermatology, Melbourne, Australia
| | - Emadodin Darchini-Maragheh
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Sinclair Dermatology, Melbourne, Australia
| | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Drug Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.
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Affiliation(s)
- B P Smyth
- Clinical Senior Lecturer, Department of Public Health & Primary Care, Trinity College Dublin, Dublin, Ireland
- Consultant Child & Adolescent Psychiatrist, Youth Drug & Alcohol Service, HSE Addiction Service, Airton Pk, Tallaght, Dublin, Ireland
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Smyth BP, O'Farrell A, Cullen W. Drug-related medical hospital admissions during and after a period of head shop expansion. Eur J Public Health 2021; 31:285-291. [PMID: 33111134 DOI: 10.1093/eurpub/ckaa171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND New psychoactive substance (NPS) use can negatively impact health and may result in drug-related hospital admissions (DRHAs). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. There was a rapid expansion in specialist shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions would prove futile. We sought to determine if changes in head shop activity coincided with changes in DRHA. METHODS The national database on admissions to general hospitals hospital in-patient enquiry was examined focusing on young adults admitted from 2008 to 2012, and all emergency admissions with an International Classification of Diseases-10 diagnosis of mental disorder related to any drug (F11-F19) were identified. Joinpoint regression analysis was utilized to explore for the presence of trend changes in DRHA. RESULTS Joinpoint regression analysis identified a significant downward trend change which occurred in June 2010 (95% CI February 2010 to January 2011). DRHA increased by 0.5% (95% CI 0.1-0.9) per month prior to this and then fell by 2.6% (95% CI -1.4 to -3.8) per month over the next 16 months. CONCLUSIONS Cessation of NPS sale by head shops coincided with a reversal in the upward trend of emergency hospital admissions related to drugs. Although correlation does not confirm causation, legislation which successfully curtails the commercial sale of NPS may result in reduced hospitalizations.
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Affiliation(s)
- Bobby P Smyth
- Department of Public Health & Primary Care, Trinity College Dublin, Ireland.,Youth Drug & Alcohol Service, HSE Addiction Service, Tallaght, Dublin 24, Ireland
| | - Anne O'Farrell
- Health Intelligence Unit, HSE Health and Wellbeing Directorate, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
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Abstract
CLINICAL ISSUE Illicit drugs can cause a myriad of CNS damages. The toxicity might be caused by the drug itself or by diverse contaminants. The most common changes are ischemic and hemorrhagic stroke as well as subarachnoid hemorrhage and leukoencephalopathies. This article gives a review of the most important morphological imaging findings of the CNS in illicit drug users. PRACTICAL RECOMMENDATIONS In cases of stroke or unclear leukoencephalopathies in young adults, the differential diagnosis of illicit drug use should be considered.
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Affiliation(s)
- A Bachhuber
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
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Oliver CF, Palamar JJ, Salomone A, Simmons SJ, Philogene-Khalid HL, Stokes-McCloskey N, Rawls SM. Synthetic cathinone adulteration of illegal drugs. Psychopharmacology (Berl) 2019; 236:869-879. [PMID: 30338489 PMCID: PMC6472990 DOI: 10.1007/s00213-018-5066-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/03/2018] [Indexed: 01/28/2023]
Abstract
RATIONALE Current prevalence estimates of synthetic cathinone ("bath salt") use may be underestimates given that traditional metrics (e.g., surveys, urinalysis) often fail to capture the emergent issue of synthetic cathinone adulteration of more common illegal drugs, such as ecstasy (3,4-methylenedioxymethamphetamine). OBJECTIVES This review examines the evolution of synthetic cathinones and prevalence of use over the past decade in the United States. We also review methods of self-report and biological testing of these compounds as well as adverse outcomes associated with adulterated drug use. RESULTS Synthetic cathinone use emerged in the United States by 2009 with use associated with tens of thousands of poisonings. Reported poisonings and self-reported use have substantially decreased over the past five years. However, our review suggests that current estimates of use are underestimates due to underreporting stemming primarily from unknown or unintentional use of adulterated formulations of relatively popular illegal drugs, such as ecstasy. CONCLUSIONS While intentional synthetic cathinone use has decreased in recent years, evidence suggests that prevalence of use is underestimated. Testing of drugs and/or biological specimens can improve the accuracy of synthetic cathinone use estimates. Furthermore, we advocate that researchers and clinicians should become better aware that exposure to these potent compounds (e.g., as adulterants) often occurs unknowingly or unintentionally. To improve our understanding of synthetic cathinone adulteration, research utilizing a combinatorial approach (survey and biological testing) will help more accurately estimate the prevalence and impact of this public health issue.
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Affiliation(s)
- Chicora F Oliver
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA.
| | - Joseph J Palamar
- Department of Population Health, 180 Madison Avenue Room 1752, New York, NY, 10016, USA
| | - Alberto Salomone
- Centro Regionale Antidoping "A. Bertinaria", Regione Gonzole 10/1, 10043, Orbassano, Torino, Italy
| | - Steven J Simmons
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, 19104, USA
| | - Helene L Philogene-Khalid
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
- Department of Psychiatry, 100 E. Lehigh Ave, Philadelphia, PA, 19125, USA
| | - Nick Stokes-McCloskey
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
| | - Scott M Rawls
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, 882A, Philadelphia, PA, 19140, USA
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Dunleavy K, Hope V, Roy K, Taylor A. The experiences of people who inject drugs of skin and soft tissue infections and harm reduction: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 65:65-72. [PMID: 30665085 DOI: 10.1016/j.drugpo.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. METHODS Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. RESULTS We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling to inject or when their physical and political environments were compromised there was an increased risk for SSTI and reduced effectiveness of HR. CONCLUSION Compared to HCV and HIV, SSTI as an injecting related harm has received less policy attention. Policy makers need to address SSTI HR within enabling environments, such as 'safer environment interventions'. It is recommended that peer based support, improved NSP provision and medically supervised injecting facilities are needed to deliver SSTI HR.
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Affiliation(s)
- Karen Dunleavy
- School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom.
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Kirsty Roy
- Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, United Kingdom
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom
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Simmons SJ, Leyrer-Jackson JM, Oliver CF, Hicks C, Muschamp JW, Rawls SM, Olive MF. DARK Classics in Chemical Neuroscience: Cathinone-Derived Psychostimulants. ACS Chem Neurosci 2018; 9:2379-2394. [PMID: 29714473 DOI: 10.1021/acschemneuro.8b00147] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cathinone is a plant alkaloid found in khat leaves of perennial shrubs grown in East Africa. Similar to cocaine, cathinone elicits psychostimulant effects which are in part attributed to its amphetamine-like structure. Around 2010, home laboratories began altering the parent structure of cathinone to synthesize derivatives with mechanisms of action, potencies, and pharmacokinetics permitting high abuse potential and toxicity. These "synthetic cathinones" include 4-methylmethcathinone (mephedrone), 3,4-methylenedioxypyrovalerone (MDPV), and the empathogenic agent 3,4-methylenedioxymethcathinone (methylone) which collectively gained international popularity following aggressive online marketing as well as availability in various retail outlets. Case reports made clear the health risks associated with these agents and, in 2012, the Drug Enforcement Agency of the United States placed a series of synthetic cathinones on Schedule I under emergency order. Mechanistically, cathinone and synthetic derivatives work by augmenting monoamine transmission through release facilitation and/or presynaptic transport inhibition. Animal studies confirm the rewarding and reinforcing properties of synthetic cathinones by utilizing self-administration, place conditioning, and intracranial self-stimulation assays and additionally show persistent neuropathological features which demonstrate a clear need to better understand this class of drugs. This Review will thus detail (i) historical context of cathinone use and the rise of "dark" synthetic derivatives, (ii) structural features and mechanisms of synthetic cathinones, (iii) behavioral effects observed clinically and in animals under controlled laboratory conditions, and (iv) neurotransmitters and circuits that may be targeted to manage synthetic cathinone abuse in humans.
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Affiliation(s)
- Steven J. Simmons
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140, United States
| | | | - Chicora F. Oliver
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140, United States
| | - Callum Hicks
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140, United States
| | - John W. Muschamp
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140, United States
| | - Scott M. Rawls
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania 19140, United States
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, Arizona 85281, United States
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A review of illicit psychoactive drug use in elective surgery patients: Detection, effects, and policy. Int J Surg 2017; 48:160-165. [PMID: 29104125 DOI: 10.1016/j.ijsu.2017.10.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/30/2017] [Indexed: 12/30/2022]
Abstract
Limited information is present in literature regarding detection of illicit drug users visiting physicians when planning elective surgery; also, there is no update manuscript that is illustrating the effects of illicit drugs use that require reconstructive surgery interventions. Aims of this manuscript are: 1) to summarize existing knowledge, and give surgeons information how to detect patients who might possible use illicit drugs; 2) to review the effects of illicit drug use that specifically require reconstructive surgery interventions; 3) to assess on existing policies on asymptomatic illicit drug users when planning elective surgery. Studies were identified by searching systematically in the electronic databases PubMed, Medline, The Cochrane Library and SveMed+. Because of the nature of research questions to be investigated (drug policy and surgery), a "systematic review" was not possible. In spite of some existing policies to detect illicit drug use in specific situations such as workplaces or acute trauma patients, there is a lack of data and lack of information, and subsequently no policy has ever been made, for detection and management of illicit drug use asymptomatic patients requesting or referred for plastic surgery interventions. This manuscript poses questions for further ethical evaluations and future policy.
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Romanek K, Stenzel J, Schmoll S, Schrettl V, Geith S, Eyer F, Rabe C. Synthetic cathinones in Southern Germany – characteristics of users, substance-patterns, co-ingestions, and complications. Clin Toxicol (Phila) 2017; 55:573-578. [DOI: 10.1080/15563650.2017.1301463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrin Romanek
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Verena Schrettl
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Katchman E, Ben-Ami R, Savyon M, Chemtob D, Avidor B, Wasserman A, Zeldis I, Girshengorn S, Amitai Z, Sheffer R, Turner D. Successful control of a large outbreak of HIV infection associated with injection of cathinone derivatives in Tel Aviv, Israel. Clin Microbiol Infect 2016; 23:336.e5-336.e8. [PMID: 27876594 DOI: 10.1016/j.cmi.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/05/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Outbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices. METHODS A cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes. RESULTS Forty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p <0.0001). Sixty-nine per cent were hospitalized because of concomitant bacterial infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population. CONCLUSIONS Injectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak.
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Affiliation(s)
- E Katchman
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel.
| | - R Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
| | - M Savyon
- Tel Aviv District Health Office, Israel
| | - D Chemtob
- Tuberculosis & AIDS Department, Ministry of Health, Israel
| | - B Avidor
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
| | - A Wasserman
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
| | - I Zeldis
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
| | - S Girshengorn
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
| | - Z Amitai
- Tel Aviv District Health Office, Israel
| | - R Sheffer
- Tel Aviv District Health Office, Israel
| | - D Turner
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel
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Batisse A, Peyrière H, Eiden C, Courné MA, Djezzar S. [Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers]. Therapie 2016; 71:447-455. [PMID: 27203172 DOI: 10.1016/j.therap.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
The "SLAM" phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of "SLAM" and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to "SLAM" practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n=35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n=32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n=16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use.
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Affiliation(s)
- Anne Batisse
- Centre d'addictovigilance d'Île-de-France, Centre GHU Lariboisière-Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France.
| | - Hélène Peyrière
- Centre d'addictovigilance, hôpital Lapeyronie, 34295 Montpellier, France; UMI 233/Inserm U1175, 34294 Montpellier, France
| | - Céline Eiden
- Centre d'addictovigilance, hôpital Lapeyronie, 34295 Montpellier, France
| | - Marie-Anne Courné
- Agence nationale de sécurité du médicament et des produits de santé, 93285 Saint-Denis, France
| | - Samira Djezzar
- Centre d'addictovigilance d'Île-de-France, Centre GHU Lariboisière-Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris, France
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12
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Staphylococcus aureus bacteraemia associated with injected new psychoactive substances. Epidemiol Infect 2015; 144:1257-66. [PMID: 26548371 DOI: 10.1017/s095026881500271x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Injecting drug use is often associated with deep-seated infection. In Lothian in Scotland there has been a recent increase in the use of injected new psychoactive substances (NPS). Patients who have injected NPS have presented with Staphylococcus aureus bacteraemia (SAB) with life-threatening complications. We describe a unique case-series of 14 episodes of SAB in ten patients. Users of injected NPS had a significantly higher incidence of endocarditis and cavitating pulmonary lesions (P < 0·05) compared to those who inject only opiates. Cases of SAB in people who inject NPS have contributed to a significant rise in the overall incidence of SAB in people who inject drugs (P < 0·05) which has in turn impacted on the ability of Lothian to meet national targets for reducing the incidence of SAB.
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Zawilska JB. "Legal Highs"--An Emerging Epidemic of Novel Psychoactive Substances. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 120:273-300. [PMID: 26070762 DOI: 10.1016/bs.irn.2015.02.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During the last decade, there has been an increase in the availability and use of novel psychoactive substances (NPS), also known as "legal highs," across the world. They include a wide range of products, from natural plant-originated substances to synthetic compounds, that can be purchased both online and from high street retailers. "Legal highs" mimic psychoactive effects of illicit drugs of abuse. However, they are claimed to consist of compounds that are legal to sell, possess, and use, often labeled as "not for human consumption" to circumvent drug abuse legislation. Based on the spectrum of their actions on cognitive processes, mood, and behavior, "legal highs" can be classified into four basis categories: amphetamine- and ecstasy-like stimulants, synthetic cannabinoids (SCs), hallucinogenic/dissociative, and opioid-like compounds. NPS may, however, exhibit a combination of these actions due to their designed chemical structure. Although the prevalence and pattern of NPS use differ between various countries, the most popular groups are SCs and psychostimulants, described in this chapter. Currently, there is limited information available on the potential acute toxicity (harms) associated with the use of these substances. However, the number of intoxicated people presenting with emergencies is constantly increasing, providing evidence that negative health and social consequences may indeed seriously affect recreational and chronic users.
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Affiliation(s)
- Jolanta B Zawilska
- Department of Pharmacodynamics, Medical University of Lodz, Lodz, Poland; Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland.
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14
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Airuehia E, Young Walker L, Nittler J. A Review of “Bath Salts”: Evolving Designer Drugs of Abuse. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015. [DOI: 10.1080/1067828x.2013.803942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wagner KD, Armenta RF, Roth AM, Maxwell JC, Cuevas-Mota J, Garfein RS. Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California. Drug Alcohol Depend 2014; 141:99-106. [PMID: 24916748 PMCID: PMC4114932 DOI: 10.1016/j.drugalcdep.2014.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/22/2014] [Accepted: 05/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Use of synthetic cathinones (SC) and cannabimimetics (i.e., "THC homologues" [TH]) is associated with adverse health effects. We investigated the epidemiology of synthetic drug use among a cohort of injection drug users (IDUs) in San Diego, California. METHODS We used logistic regression analysis to identify correlates of SC and TH use among 485 IDUs enrolled from June 2012 to September 2013. RESULTS Seven percent of participants reported ever using SC and 30% reported ever using TH. In multivariate logistic regression, age and recent hospitalization were significantly associated with odds of SC use (Adjusted Odds Ratio [AOR] 0.93, 95% Confidence Interval [C.I.] 0.90, 0.97; and AOR 2.34 95% C.I. 1.00, 5.49, respectively) and TH use (AOR 0.96, 95% C.I. 0.94, 0.98; and AOR 2.62, 95% C.I. 1.47, 4.68, respectively). Use of methamphetamine (AOR 9.35, 95% C.I. 1.20, 72.79) and club drugs in the past six months (AOR 3.38, 95% C.I. 1.17, 9.76) were significantly associated with SC use. Being on probation/parole (AOR 2.42, 95% C.I. 1.44, 4.07), initiating injection drug use with stimulants (AOR 1.89 95% C.I. 1.13, 3.16), and past six-month marijuana (AOR 9.22, 95% C.I. 4.49, 18.96) and prescription drug use (AOR 1.98, 95% C.I. 1.20, 3.27) were significantly associated with TH use. CONCLUSIONS A considerable proportion of IDU use synthetic drugs and may experience harms associated with their use. Findings have implications for criminal justice system management. Prevention efforts should emphasize the risks associated with rapidly changing synthetic formulations, and the potential harms associated with polydrug use.
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Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States.
| | - Richard F Armenta
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Alexis M Roth
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Jane C Maxwell
- The Center for Social Work Research, School of Social Work, The University of Texas at Austin, 1 University Station D3510, Austin, TX 78712, United States
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0849, La Jolla, CA 92093, United States
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Abstract
PURPOSE OF REVIEW New designer drugs are constantly emerging in the illicit drug market and represent a significant health problem. A very popular class comprises synthetic cathinones, β-keto amphetamine analogues, endowed with psychostimulant properties. The aim of this review is to discuss the recent progress in our understanding of how cathinones act and the health consequences of their use. RECENT FINDINGS Despite being banned, synthetic cathinones are still used, especially by certain sub-populations. The recently observed trend to supplement psychostimulatory drugs of abuse with mephedrone must be considered highly dangerous to the public health. At the molecular level, the drugs act as blockers or substrates for monoamine transporter proteins. In animal studies, cathinones were found to evoke abuse-related behaviors and to have a negative impact on cognitive processes. The increased popularity of mephedrone among men who have sex with men with alarming sexual health consequences warrants the implementation of new treatments and education/training programs. SUMMARY Synthetic cathinones exert similar, but not identical, effects to psychostimulatory drugs of abuse. The use of cathinones may lead to serious psychotic, neurological, cardiovascular, and sexual health consequences. Exposure to these drugs may result in multiorgan failure and death.
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17
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Abstract
Psychoactive bath salts (PABS) comprise a group of highly dangerous designer drugs showing a sharp escalation in reported U.S. exposures from 2010 through 2012, following rapid spread of the drug in Europe. Since a federal ban on the major ingredients in October 2011, numbers have declined. However, evidence from the United Kingdom shows an initial decline after the UK ban in 2010 with a 400 percent increase in reports by 2012. Actual information about the effect of PABS use on pregnant women and fetuses is almost nonexistent. Clinicians should be aware of the potential maternal, fetal and neonatal effects of PABS.
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18
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Viral and bacterial risks associated with mephedrone abuse in HIV-infected men who have sex with men. AIDS 2013; 27:2971-2. [PMID: 25119693 DOI: 10.1097/qad.0000000000000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Substituted cathinone products: a new trend in "bath salts" and other designer stimulant drug use. J Addict Med 2013; 7:153-62. [PMID: 23732954 DOI: 10.1097/adm.0b013e31829084b7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a growing concern about the availability of a new generation of "designer drug" stimulants that are marketed as "bath salts" and other household products. The products are not true bath salts and contain substituted cathinone stimulant substances, such as methylenedioxypyrovalerone (MDPV) and mephedrone. Calls to the American Association of Poison Control Centers regarding "bath salts" consumption began in 2010 and have continued since that time. Few reports of systematic epidemiologic surveillance or definitive clinical effects of toxicity specifically associated with "bath salts" consumption have been reported in the medical literature. The current narrative review describes the growing trend of designer substituted cathinone use, pharmacology, clinical effects, and recent regulatory changes. It is hoped that a greater understanding of the clinical effects and use patterns will help inform policy and practice.
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20
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Johnson LA, Johnson RL, Portier RB. Current “Legal Highs”. J Emerg Med 2013; 44:1108-15. [DOI: 10.1016/j.jemermed.2012.09.147] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/29/2012] [Accepted: 09/09/2012] [Indexed: 11/16/2022]
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21
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Zawilska JB, Wojcieszak J. Designer cathinones--an emerging class of novel recreational drugs. Forensic Sci Int 2013; 231:42-53. [PMID: 23890615 DOI: 10.1016/j.forsciint.2013.04.015] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/05/2013] [Accepted: 04/16/2013] [Indexed: 11/16/2022]
Abstract
A new group of recreational drugs, popularly known as "bath salts", "plant feeders" or "plant food", has recently emerged in numerous countries. Although various products are labeled with warnings "not for human consumption" or "not tested for hazards or toxicity", they are intended to produce a high similar to that obtained with illegal stimulants, such as MDMA, methamphetamine or cocaine. The active compounds in "bath salts" are cathinone derivatives continuously developed and modified by drug designers to avoid detection or legal scrutiny. Around 2010 the most prevalent were mephedrone (4-methylmethcathinone) and MDPV (3,4-methylenedioxypyrovalerone). This review surveys the current state of knowledge regarding the pharmacotoxicological properties of synthetic cathinones, the prevalence and pattern of their use. Special emphasis is given to the negative consequences of using these products including, among others, cardiovascular, psychiatric and neurologic symptoms, dehydration, rhambdomyolysis, renal and liver failure. Case reports on synthetic cathinones-related fatalities are also presented.
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Affiliation(s)
- Jolanta B Zawilska
- Department of Pharmacodynamics, Medical University of Lodz, 1 Muszynskiego St., 90-151 Lodz, Poland.
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22
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Bruno R, Poesiat R, Matthews AJ. Monitoring the Internet for emerging psychoactive substances available to Australia. Drug Alcohol Rev 2013; 32:541-4. [PMID: 23647494 DOI: 10.1111/dar.12049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/11/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Novel psychoactive substances are increasingly available, both in traditional storefronts and via the Internet. While some use of such substances has been captured in Australian consumer surveys and wastewater analyses, there is little information about the products that are available to Australia via the Internet. DESIGN AND METHODS Systematic monthly Internet monitoring for emerging psychoactive substances was conducted between July 2011 and July 2012. Webstores identified through searches were examined to determine if they sold stimulant or psychedelic emerging psychoactive substances to Australia. Internet search numbers for these products were examined over time using commercial tools. RESULTS In 12 months, 43 unique webstores were identified selling to Australia, averaging two new webstores per month; however, two-fifths had closed within six months. Over 200 unique chemically unspecified products sold by purported effect (e.g. 'charge') were identified over 12 months, averaging 10 new products per month. Almost half of these products had disappeared from the market within six months. Eighty-six unique chemically specified products (e.g. methylenedioxypyrovalerone) were identified over 12 months, averaging four new novel substances per month. Once released, these products typically remained available, with almost 90% still available for purchase over a 6-month period. Almost 40 000 searches for these products emanated from Australia per month. DISCUSSION AND CONCLUSION This market is fast paced as retailers strive to beat both regulatory processes and competitors. Ongoing attention to these markets, incorporating surveillance of both Internet and traditional storefronts, is crucial as several of the substances identified have demonstrated potential for health and neurological harm.
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Affiliation(s)
- Raimondo Bruno
- School of Psychology, University of Tasmania, Hobart, Australia
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23
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Belton P, Sharngoe T, Maguire FM, Polhemus M. Cardiac infection and sepsis in 3 intravenous bath salts drug users. Clin Infect Dis 2013; 56:e102-4. [PMID: 23418275 DOI: 10.1093/cid/cit095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The street drug "bath salts" are psychoactive mixtures of cathinone derivatives. We report 3 cases of disseminated Staphylococcus aureus infection with cardiac involvement (2 endocarditis and 1 pericarditis), secondary to intravenous bath salts use.
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Affiliation(s)
- Patrick Belton
- College of Medicine, Upstate Medical University, New York, USA
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24
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Levine M, Levitan R, Skolnik A. Compartment syndrome after "bath salts" use: a case series. Ann Emerg Med 2013; 61:480-3. [PMID: 23318022 DOI: 10.1016/j.annemergmed.2012.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/02/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
In recent years, synthetic cathinones, often labeled as "bath salts" in an attempt to evade drug laws, have emerged as substances of abuse. Sympathomimetic drugs are well known to cause rhabdomyolysis but are rarely associated with acute compartment syndrome. In this case series, we describe 3 patients who presented with sympathomimetic signs or symptoms including hyperthermia and agitation and had confirmed synthetic cathinone use. All 3 patients had severe rhabdomyolysis with delayed development of an acute compartment syndrome. Two patients developed paraspinal compartment syndromes, whereas 1 developed bilateral forearm compartment syndromes. Management included fasciotomy in 2 patients and medical management in the third. Two of the 3 patients made a complete recovery before hospital discharge; the third patient was hemodialysis dependent at 5-month follow-up.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA, USA.
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