Emerging trends in drugs, addictions, and health最新文献

Γ-Valero-lactone (GVL) is a freely marketed organic solvent and food additive. GVL is also an underrated legal substitute for γ-hydroxybutyric acid (GHB), and it is sold under the trade name "Tranquili-G". GVL is usually not included in forensic drug testing, even though it has been reported in drug-facilitated sexual assaults (DFSA).

To date, few studies verified the effectiveness of GVL as a hypnotic/narcotic substance, and no data are available on its urinary excretion profile. This work aims to fill this knowledge gap and lead to the introduction of GVL in forensic drug testing, especially when DFSA is suspected.

To monitor the timeframe of GVL activity in vivo, we have assessed the effects on sensorimotor responses in visual placing tests carried out on CD-1 mice at a dose of 400 mg/kg of GVL, administered by gastric gavage. In parallel, samples of the in vitro and in vivo metabolism studies were analyzed using a rapid and cost-effective analytical procedure based on gas chromatography coupled to mass spectrometry. Our data confirmed that GVL impairs visual placing response in mice in the first 4 h after the intake, and they also show that GVL is a less potent substitute of GHB. The urinary excretion profile of GVL is consistent with the results of the behavioral study, with a maximum of excretion in the first 5 h after the intake. GVL is only detectable in the first 0–8 h after the intake. Our data confirmed the same rapid urinary excretion rate of GHB in urine and the related forensic implications, with the risk of possible false-negative results, especially when DFSA is suspected.

Introduction

Novel psychoactive substances (NPS) continue to pose challenges to law enforcement authorities, public health officers and policymakers as suppliers continuously adapt to control measures, thus remaining highly dynamic in introducing unpredictable and potentially toxic new substances into the drug market. Using a legal epidemiology approach, the aim of this study was to assess the effectiveness of NPS legal measures in preventing NPS use (legal prevention and control), as well as NPS-related intoxications and deaths (legal aetiology).

Methods

We conducted a comparative analysis of legal instruments adopted at national level as a response to NPS by ten European countries between 2008 and 2019. The data collection process encompassed (i) a scoping review aimed at mapping out the current state of NPS-related legal measures, and (ii) the collection of nationally produced health data on three NPS-related health indicators (prevalence of use, acute intoxications and deaths).

Results

Based on both the legal approaches and the regulatory model adopted by countries a five-elements typology was elaborated. Implemented measures – particularly individual listing – may be relatively effective in preventing NPS use, at least in the short-term. However, they are also very likely to affect the purity and potency of substances, which may have an indirect negative impact on users’ health. In fact, an increase in NPS-related poisoning episodes and deaths has been observed in most of the countries having introduced control measures, regardless the regulatory model adopted.

Conclusions

Policy responses to NPS implemented across Europe have not been markedly effective in deterring their use nor in preventing health harms. Therefore, there is a need for innovative initiatives to regulate drug markets that go beyond law enforcement. Considering scientific evidence on underlying factors leading to the use of psychoactive substances may better inform policy responses to address users’ motivations while reducing their exposure to health risks.

COVID-19 is imposing an extremely serious challenge to individuals’ physical and mental health. The enforcement of lockdown, restriction on public gathering, social distancing strategy, and unprecedented quarantine measures has affected many aspects of peoples’ lives in Bangladesh with potential consequences on their mental and physical health. This study aimed to assess the psychological states and their related factors among general people in Bangladesh during the COVID-19 outbreak. An e-questionnaire-based cross-sectional survey was conducted among 565 Bangladeshi general people between April and May, 2020. Measures included socio-demographics, chronic disease-related variables, the Self-Rating Depression Scale (SDS), and the Self-Rating Anxiety Scale (SAS). Descriptive analysis and bivariate linear regression with “depression” and “anxiety” as the dependent variables were carried out to identify the factors associated with these. Results showed that 30.1% and 32.6% of participants had mild to extremely severe levels of anxiety and depression, respectively. Females were 2.3 (OR = 2.26; 95% CI = 1.58-3.25, p < 0.001) and 2.2 (OR = 2.19; 95% CI = 1.51-3.16, p < 0.001) times more likely to have depression and anxiety, respectively compared to males. In contrast, the odds of depression and anxiety were 2.9 (OR = 2.85; 95% CI = 1.66-4.90, p < 0.001) and 2.0 (OR = 2.00; 95% CI = 1.20-3.36, p = 0.008) times higher, respectively among individuals aged above 40 years than those aged between 18-40 years. The healthcare authority should take necessary steps considering the psychological problems of the general people during the health emergency.

Twenty-six adolescent/young adult patients with opioid use disorder smoked marijuana in an attempt to avoid relapse to opiate use. In each case, smoking marijuana increased cravings and urges for opiates and promoted opiate relapse. These clinical case reports show that smoking marijuana was not helpful as a harm reduction strategy to prevent return to opioids in young people with OUD.

Social networking sites have changed the concept of social interaction and communication. There is increasing evidence of using Facebook to express suicidal ideas and feelings, predominantly among young people. Here, we report a series of cases where victims committed suicide after sharing their thoughts and feelings on Facebook posts or live-streaming. In the present case series, we observed most of the victims were teenagers and young adults. Usually, this group is unwilling to share their suicidal thoughts with physicians or other family members. At the same time, they like to share those factors on Facebook or other social networking sites. So, Facebook can be a potential tool to predict and prevent such suicide cases. A better understanding and quick response to suicidal notes on Facebook can prevent many lives. The present study suggests ensuring the active participation of Facebook users in suicide prevention programs. We can work together with suicide prevention tools and strategies of social networking sites to save many unwanted departures.

Recent interest has emerged regarding the use of several short-acting pharmacotherapies that may be explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders. Our objective in this narrative review is to highlight the potential of medically-assisted psychotherapy by outlining the current state of research on some of these drugs, including d-cycloserine, propranolol, and psychedelics, and describing the basic science that supports their use. The neurobiological learning and memory theories that correspond to the manner in which these drugs function are also discussed. Although the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments for many reasons, including the presence of fewer chronic side effects, as well as a lesser toxicity and abuse potential. Furthermore, some clinical research suggests that adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes for this reason, alone. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, mental health patients will benefit from having more treatment options available to them in the future.

Novel psychoactive substances (NPS) threaten public health and safety while also straining the limited resources of forensic laboratories. To efficiently allocate the finite resources available, we propose a new strategy for prioritizing NPS with abuse liability testing using a preclinical behavioral procedure in rats known as intracranial self-stimulation (ICSS). To validate this assay, the recently-scheduled synthetic cathinone α-PHP was compared to cocaine, a mechanistically similar drug of abuse, as a positive control and saline as a negative control. Male Sprague-Dawley rats (n=6) were implanted with electrodes targeting the medial forebrain bundle and trained to respond by lever-press for electrical brain stimulation. The rats were tested with doses of 0.32, 1.0, and 3.2 mg/kg α-PHP as well as 10 mg/kg of cocaine and saline administered by intraperitoneal injection. Neither saline nor 0.32 mg/kg α-PHP altered ICSS response rates compared to baseline levels of responding; however, doses of 1.0 and 3.2 mg/kg α-PHP and 10 mg/kg cocaine facilitated ICSS responding. This ICSS profile suggests that α-PHP has high abuse potential, with a rapid onset of effects and a long duration of action, and supports the decision to schedule this compound. This study demonstrates the ability of ICSS to distinguish between compounds of low and high potential for abuse. A strategy is proposed here to screen NPS using ICSS and classify emerging drugs into four priority categories for further analysis.

Sourcing and self-medication of medicinal pharmaceuticals including those containing opioids obtained from non-regulated online suppliers is a serious public health issue. The main concerns include a lack of quality control, drug side effects, drug interactions, diversion and possible pathway to drug dependence. The internet offers increased availability and accessibility of these medicines through both legal routes obtaining pharmaceuticals on prescription and illegal routes via websites on both the surface and Dark Web. The impact of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic reduced face-to face access for non-COVID-19 related health conditions and to drug treatment services. This study provides an overview of the extent of online sourcing of UK controlled medicines (opioids, sedatives and GABA drugs) from unregulated suppliers and estimates of customer interest, in particular focusing on the COVID-19 lockdown period in the UK, where access to some healthcare services was limited. Whilst it was not possible to identify an increase for online searches for controlled medicines over the past five years, or during the COVID-19 period, searches remained plentiful, in particular for oxycodone, morphine and diazepam. This study highlights the need for enhanced pharmacovigilance of non-regulated online suppliers and the imperatives of continued health messaging around the potential abuse of these controlled drugs and the dangers of using sites purporting to be regulated pharmacies.

The Knowledge about the use of counterfeit medicines in Lebanon is still very limited. Thus, the objective of this study was to evaluate the degree of awareness of counterfeit medicines among the Lebanese population and the harm associated with their consumption. A cross-sectional study based on a questionnaire survey has been applied where a semi-structured survey questionnaire was distributed, between June 2017 and May 2018, among 750 participants from 98 Lebanese areas to assess their awareness regarding counterfeit medicines. Seven hundred and four participants completed the questionnaire. 55.4% purchased medicines regularly. The main sources of medicines were pharmacies (52.6%), government clinics (16.3%) and private clinics (8.7%). The most common purchased medicines were lifesaving ones (80%). In the majority of cases (71.9%), participants could not identify the manufacturer country. Overall, 46.2% of the participants were aware of counterfeit medicines. 5.4% of the participants experienced self-reporting adverse effects, among which 89.5% of cases were reported to pharmacists or other authorities. Despite the risk, 4.7% of participants were willing to buy a potential counterfeit medicine. In fact, 56. 4% of the participants associated low harm level with the use of counterfeit medicines. Despite their awareness of counterfeit drugs-associated risks, the majority of participants tend to buy them again. Informative public health campaign and health professionals training, to prevent counterfeit medicines-associated harms, should be implemented.

Background-Aims

New psychoactive substances (NPS) are new narcotic or psychotropic drugs that are not controlled by the drug conventions of the United Nations. In the last 10 years, numerous NPS have been identified in Europe but there is no comprehensive overview of mortality related to them. This study aims to estimate the mortality related to NPS in Europe in 2016 and 2017.

Methods

The number of drug-related deaths (DRD) 2016-2017 was retrieved from a) the annual national reports of European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) countries (Statistical Bulletin (2018/2019) and ‘Harms and harm reduction workbooks’ (2017/2018)) and b) EMCDDA Risk Assessment Reports of the EU Early Warning System on several specific NPS (2017-2018). Population data was retrieved from Eurostat (2016/2017). Incidence of DRD and of DRD involving at least one NPS was calculated.

Findings

Of all DRD recorded in Europe, 11.7% in 2016 and 18.1% in 2017 involved at least one NPS (NPS-DRD), from 2.7 to 4.9 deaths per million of 15 to 64-year-old inhabitants. Between 2016 and 2017, a significant increase was observed (30%, odds ratio 1.33, CI95% 1.26-1.45, p < 0.0001) and in particular, DRD involving novel benzodiazepines, novel opioids and synthetic cannabinoids (p < 0.0001). In 2016 and2017, 72.8% and 76.8% of cases were concentrated in the UK and Turkey (combined), related mainly to Etizolam and synthetic cannabinoids respectively.

Interpretation

In 2017, one in six drug-related deaths in Europe involved NPS, and the proportion and numbers increased from 2016 levels, although three out of four cases were concentrated in only two countries and a few substances. To fully understand the public health implications of NPS, further monitoring on NPS-DRD and their distribution in Europe is needed.