‘Synthetic cannabis’: A dangerous misnomer

The term 'synthetic cannabis' has been widely used in public discourse to refer to a group of cannabinoid receptor agonists. In this paper we detail the characteristics of these drugs, and present the case that the term is a misnomer. We describe the pharmacodynamics of these drugs, their epidemiology, mechanisms of action, physiological effects and how these differ substantially from delta-9-tetrahydrocannabinol (THC). We argue that not only is the term a misnomer, but it is one with negative clinical and public health implications. Rather, the substances referred to as 'synthetic cannabis' in public discourse should instead be referred to consistently as synthetic cannabinoid receptor agonists (SCRAs), a drug class distinct from plant-derived cannabinoids. SCRAs have greater potency and efficacy, and psychostimulant-like properties. While such terminology may be used in the scientific community, it is not widely used amongst the media, general public, people who use these drugs or may potentially do so. A new terminology has the potential to reduce the confusion and harms that result from the misnomer ‘synthetic cannabis’. The constant evolution of this distinct drug class necessitates a range of distinct policy responses relating to terminology, harm reduction, epidemiology, treatment, and legal status

Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000‒2018

Objectives: To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000–2018. Design, setting: Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999‒2000 to 2017‒18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002–03 to 2017–18), and deaths (National Coronial Information System, 2000–01 to 2016–17). Main outcome measures: Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. Results: We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999‒2000 to 0.14 per 100 000 population in 2017‒18 (AAPC, ‒6.0%; 95% CI, ‒7.2% to ‒4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, ‒5.8%; 95% CI, ‒9.1% to ‒2.4%) and intentional self-harm (AAPC, ‒5.6%; 95% CI, ‒6.9% to ‒4.2%) were each statistically significant. Despite a drop from 0.67 in 2002‒03 to 0.23 per 100 000 in 2003–04, the drug treatment episode rate did not decline significantly (AAPC, ‒6.7%; 95% CI, ‒16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000–01 to 0.19 per 100 000 population in 2016–17 (AAPC, +9.3%; 95% CI, +6.2–12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4–15%), but not that of accidental deaths (AAPC, ‒0.3%; 95% CI, ‒4.1% to +3.8%). Conclusions: While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide

Characteristics and circumstances of death related to gamma hydroxybutyrate (GHB)

Introduction: Gamma hydroxybutyrate (GHB) has gained substantial popularity as an illicit recreational drug. The current study aimed to: (1) determine the characteristics and circumstances of death of all recorded cases of GHB-related death in Australia, 2001–2019; (2) determine the toxicology of cases; and (3) determine major organ pathology. Methods: Retrospective study of all Australian cases in which GHB was a mechanism contributory to death retrieved from the National Coronial Information System (n = 74). Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology. Results: The mean age was 31.5 years and 70.3% were male. The predominant circumstance of death was accidental drug toxicity (79.7%), including five cases attributed to a combination of toxicity and natural disease. Other deaths were due to trauma (12.2%) and suicide (8.2%). The fatal incident overwhelmingly occurred in a home environment (82.4%). In all cases, GHB was consumed orally. The median GHB blood concentration was 210 mg/L (range 13–1350 mg/L), and was significantly higher in toxicity cases than others (258 vs. 98 mg/L, p <.01). Other substances were present in 92.2%, most commonly psychostimulants (64.1%), hypnosedatives (28.2%) and alcohol (20.3%). Resuscitation was attempted in 20.3% of cases. Acute pneumonia (36.7%) and aspiration of vomitus (30.6%) were common. Conclusions: The typical case was a young male, who swallowed GHB and used it with other substances, most commonly at home. While acute drug toxicity was the most common cause of death, there was a substantial minority due to trauma or suicide

Characteristics and circumstances of death related to the self-administration of ketamine

Background and aims: Ketamine is used for anaesthesia, sedation and the treatment of mood disorders, but is also widely used for non-medical purposes. This study aimed to: (1) determine the characteristics and circumstances of all recorded cases of self-administered ketamine-related death in Australia, 2000–19 and (2) determine the toxicology and major organ pathology of cases. Design: Retrospective study of all Australian cases in which self-administered ketamine was a mechanism contributory to death, retrieved from the National Coronial Information System. Setting: Australia-wide. Cases: Sixty-eight cases, with a mean age of 35.2 years (standard deviation = 11.5, range = 16–63), 76.5% male. Measurements: Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology. Findings: Death was attributed to toxicity in 82.3% of cases (accidental, 58.8%; deliberate, 23.5%), suicide by violent means (8.8%) and traumatic accident (8.8%). In six cases the decedent had been prescribed ketamine. In 32.4% the final route of ketamine administration was by injection. The fatal incident predominantly occurred in a private environment (72.1%). Ketamine was present in the blood of 90.1% and other biomarkers in the remainder. The median blood ketamine concentration was 0.2 mg/l (0.02–6.9 mg/l). Other drugs were detected in 95.5% of cases: opioids (59.1%), hypnosedatives (57.6%), psychostimulants (50.0%), alcohol (27.3%), Δ-9-tetrahydrocannabinol (18.2%), antidepressants (28.8%) and antipsychotics (9.1%). Pulmonary oedema was present in 82.2% of cases that underwent autopsy and pneumonia in 26.7%. Conclusions: The typical case of self-administered ketamine-related death in Australia, 2000–19, was a male in his mid-30s who had used multiple drugs, with the fatal incident most commonly occurring in a private setting. Death due to accidental drug toxicity was the most common manner of death, but suicide was highly prevalent

Addiction's policy on publishing effectiveness studies of involuntary treatment of addiction and its variants

Addiction has updated its policy on effectiveness evaluations of coercive ‘treatment’ approaches to addressing drug and alcohol dependence. We will not automatically exclude studies that evaluate the effectiveness of time‐limited involuntary treatment of addiction (e.g. 72 hours to 90 days) that occurred under judicial or quasi‐judicial oversight. We will have a presumption against publishing effectiveness studies involving the incarceration of people in detention camps for drug use

Laser Ablation System for Solid Sample Analysis by Inductively Coupled Plasma Atomic Emission Spectrometry

A laser ablation sample introduction system, based on a Nd : YAG laser with an X-Y-Zdirectional sampling head, has been designed and constructed for use with inductively coupled plasma optical emission spectrometry. A study has been made of a number of parameters which affect the performance of the system to establish the optimum operating conditions. South African Reference Material (SARM) rock samples have been analysed using the system, and the results obtained have been compared with the certificate values. The importance of using closely matrix-matched samples and standards is demonstrated. Precision studies on SARM 5 (pyroxenite) show that both intra- and inter-sample precisions are typically 10% (relative standard deviation )

A Study of Laser Ablation and Slurry Nebulisation Sample Introduction for the Analysis of Geochemical Materials by Inductively Coupled Plasma Spectrometry

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Mitigating and learning from the impact of COVID‐19 infection on addictive disorders

The COVID‐19 pandemic and the measures required to address it are cutting a swathe through people's lives and the global economy. People with addictive disorders are particularly badly affected as a result of poverty, physical and mental health vulnerabilities and disruption of access to services. The pandemic may well increase the extent and severity of some addictive disorders. Current research is suffering from the termination of face‐to‐face data collection and other restrictions. There is an urgent need to coordinate efforts nationally and internationally to mitigate these problems and to find innovative ways of continuing to provide clinical and public health services to help people with addictive disorders

From Service to Experience: Understanding and Defining the Hospitality Business

Failure adequately to define or understand hospitality as a commercial phenomenon has created a fragmented academic environment and a schizophrenia in the industry that has the potential to limit its development as a global industry. This article suggests that, by redefining hospitality as behaviour and experience, a new perspective emerges that has exciting implications for the management of hospitality businesses. A framework to describe hospitality in the commercial domain is proposed. This framework suggests a focus on the host–guest relationship, generosity, theatre and performance, ‘lots of little surprises’, and the security of strangers – a focus that provides guests with experiences that are personal, memorable and add value to their lives