Novel psychoactive substance use by mental health service consumers: an online survey of inpatient health professionals’ views and experiences

Purpose: There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The aim of the study was to undertake a scoping survey to explore inpatient mental health workers' perceptions of NPS use by consumers. Design/methodology: A cross-sectional online survey of mental health professionals. Participants were opportunistically recruited through social media and professional networks. Findings: A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90% of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. Participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with. Research Limitations/Implications: Whilst we are cautious about the generalizability (due to methodological limitations), our findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding impact on mental and physical health, as well as ease of availability and a need for specific training and guidance. Practical Implications: Mental health professionals require access to reliable and up to date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included. Originality/value: To the best of our knowledge this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS.The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems

Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe : A propensity-score matched analysis of cross-sectional studies

Publisher Copyright: © 2023 Society for the Study of Addiction.Aims: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. Design, Setting and Participants: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). Measurements: Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. Findings: Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09–1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47–2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33–3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16–1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59–2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18–1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76–0.94), male sex (aOR = 0.77, 95% CI = 0.65–0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59–0.88) were associated with lower odds of HIV positivity. Conclusions: A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.Peer reviewe

Psychotropic Medications and Crash Risk in Older Drivers: A Review of the Literature

Objective. An extensive review of Australian and international literature was undertaken,examining the association between psychotropic medications and crash risk involving olderdrivers. Methods. The review summarizes the findings in experimental and epidemiological studiesrelated to (a) prevalence of psychotropic medication use among older drivers; (b) side effectsof driving under the influence of psychotropic medications; and (c) association between psychotropicmedications and crash risk for older drivers. Results. Current evidence indicates that severaltypes of psychotropic medications have the potential to impair driving ability and increasethe risk of crash involvement. A major limitation is that few studies have specifically examinedthe effects on older drivers, despite the fact that the majority of the population using psychotropicmedications are older. Discussion. More knowledge about the safety of therapeutic useof psychotropic medications is needed. Large-scale, whole-population, epidemiological studies,such as data linkage studies, may be the optimal study design

Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers

Aims: To investigate the perspectives and experiences of service providers regarding provision of take-home naloxone to people who use opioids in Victoria, Australia. Methods: Content analysis of qualitative semi-structured interviews with 15 service providers who are either involved with take-home naloxone programs or whose work brings them in contact with people who use opioids. Findings: Statements about take-home naloxone were universally positive. Both direct and indirect benefits of take-home naloxone were described. Alongside potential reductions in opioid overdose-related harms, service providers highlighted the empowering effects of providing people who use opioids with take-home naloxone. No significant risks were described. Service providers supported the expansion of naloxone availability, but also identified several intertwined barriers to doing so. Key among these were costs, current regulations and scheduling, availability of prescribers and stigma related to illicit and injecting drug use. Conclusions: Expanding the availability of naloxone is a key component of strategies to reduce harms associated with opioid overdose. Our article provides Australian evidence of the successful operational implementation of peer-to-peer THN delivery within a range of drug primary health services and needle syringe programs. Further research is required to better understand the implications of and impediments to scale-up of this potentially life-saving public health intervention

A systematic review of the effects of novel psychoactive substances “legal highs” on people with severe mental illness

Introduction: Novel psychoactive substances (NPS) are synthetic substances that have been developed to produce altered states of consciousness and perceptions. People with severe mental illness (SMI) are more likely to use NPS than people without mental illness, but the short and long-term effects of NPS are largely unknown. Method: We systematically reviewed the literature about the effects of NPS on people with SMI. Results: We included 12 case reports, 1 cross-sectional survey and 1 qualitative study. Participants included mostly males aged between 20 and 35 years. A variety of NPS were used, including synthetic cathinones and herbs such as salvia. The most commonly reported effects of NPS were psychotic symptoms (in some cases novel in form and content to the patients’ usual symptoms) and significant changes in behaviour, including agitation, aggression and violence. Patients’ vital signs; blood pressure, pulse rate and temperature were also commonly affected. Conclusion: NPS potentially have serious effects on people with severe mental illness but our findings have limited generalisability due to a reliance on case studies. There is a paucity of evidence about the long-term effects of these substances. Further research is required to provide a better understanding about how different NPS affect patients’ mental and physical health. PROSPERO Identifier: CRD42015026944 Keywords: legal highs, novel psychoactive substances, psychotic disorders, severe mental illness, schizophrenia, systemati

The new psychoactive substances 5-(2-aminopropyl)indole (5-IT) and 6-(2-aminopropyl)indole (6-IT) interact with monoamine transporters in brain tissue

In recent years, use of psychoactive synthetic stimulants has grown rapidly. 5-(2-Aminopropyl)indole (5-IT) is a synthetic drug associated with a number of fatalities, that appears to be one of the newest 3,4-methylenedioxymethamphetamine (MDMA) replacements. Here, the monoamine-releasing properties of 5-IT, its structural isomer 6-(2-aminopropyl)indole (6-IT), and MDMA were compared using in vitro release assays at transporters for dopamine (DAT), norepinephrine (NET), and serotonin (SERT) in rat brain synaptosomes. In vivo pharmacology was assessed by locomotor activity and a functional observational battery (FOB) in mice. 5-IT and 6-IT were potent substrates at DAT, NET, and SERT. In contrast with the non-selective releasing properties of MDMA, 5-IT displayed greater potency for release at DAT over SERT, while 6-IT displayed greater potency for release at SERT over DAT. 5-IT produced locomotor stimulation and typical stimulant effects in the FOB similar to those produced by MDMA. Conversely, 6-IT increased behaviors associated with 5-HT toxicity. 5-IT likely has high abuse potential, which may be somewhat diminished by its slow onset of in vivo effects, whereas 6-IT may have low abuse liability, but enhanced risk for adverse effects. Results indicate that subtle differences in the chemical structure of transporter ligands can have profound effects on biological activity. The potent monoamine-releasing actions of 5-IT, coupled with its known inhibition of MAO A, could underlie its dangerous effects when administered alone, and in combination with other monoaminergic drugs or medications. Consequently, 5-IT and related compounds may pose substantial risk for abuse and serious adverse effects in human users

Over 1200 drugs-related deaths and 190,000 opiate-user-years of follow-up : relative risks by sex and age-group

Heroin users/injectors' risk of drugs-related death by sex and current age is weakly estimated both in individual cohorts of under 1000 clients, 5000 person-years or 50 drugs-related deaths and when using cross-sectional data. A workshop in Cambridge analysed six cohorts who were recruited according to a common European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) protocol from drug treatment agencies in Barcelona, Denmark, Dublin, Lisbon, Rome and Vienna in the 1990s; and, as external reference, opiate-user arrestees in France and hepatitis C diagnosed ever-injectors in Scotland in 1993-2001, both followed by database linkage to December 2001. EMCDDA cohorts recorded approximately equal numbers of drugs-related deaths (864) and deaths from other non-HIV causes (865) during 106,152 person-years of follow-up. External cohorts contributed 376 drugs-related deaths (Scotland 195, France 181) and 418 deaths from non-HIV causes (Scotland 221, France 197) during 86,417 person-years of follow-up (Scotland 22,670, France 63,747). EMCDDA cohorts reported 707 drugs-related deaths in 81,367 man-years {8.7 per 1000 person-years, 95% CI: 8.1 to 9.4} but only 157 in 24,785 person-years for females {6.3 per 1000 person-years, 95% CI: 5.4 to 7.4}. Except in external cohorts, relative risks by current age-group were not particularly strong, and more modest in Poisson regression than in cross-sectional analyses: relative risk was 1.2 (95% CI: 1.0-1.4) for 35-44 year olds compared to 15-24 year 3 olds, but 1.4 for males (95%CI: 1.2-1.6), and dramatically lower at 0.44 after the first year of follow-up (95% CI: 0.37-0.52)

Entertainment starts with an E: the ecstasy market in Greece

The purpose of this article is to provide an account of the social organisation of the ecstasy market in Greece. Concern about ecstasy production, distribution and use in Greece has risen since ecstasy appeared in the country in the early to mid-1990s, and continues to be fuelled by media reports which reinforce the perception that there are huge profits for traders. Moreover, the Greek authorities have adopted a 'war on drug' rhetoric when it comes to ecstasy trafficking. Thus, the fact that such mentalities are commonplace, while the knowledge deficit about the particular market remains gaping, makes it an imperative to examine the structure and dynamics of the ecstasy market in the country. We aim here to provide an account of the 'extent' and nature of the ecstasy market in Greece as well as a presentation of the 'actors' involved. We also explicitly focus on the issue of price of ecstasy tablets in the country, which we regard as key to the understanding of the logic of this particular market. Our investigation of various aspects of the market concludes with a number of more systematic observations regarding the particular business

New psychoactive substances (NPS) on cryptomarket fora: An exploratory study of characteristics of forum activity between NPS buyers and vendors

Background The continual diversification of new psychoactive substances (NPS) circumventing legislation creates a public health and law enforcement challenge, and one particularly challenged by availability on Hidden Web cryptomarkets. Methods This is the first study of its kind which aimed to explore and characterise cryptomarket forum members’ views and perspectives on NPS vendors and products within the context of Hidden Web community dynamics. An internal site search was conducted on two cryptomarkets popular with NPS vendors and hosting fora; Alphabay and Valhalla, using the search terms of 40 popular NPS in the seven categories of stimulant/cathinone; GABA activating; hallucinogen, dissociative, cannabinoid, opioid and other/unspecified/uncategorised NPS. 852 identified threads relating to the discussion of these NPS were generated. Following exclusion of duplicates, 138 threads remained. The Empirical Phenomenological Psychological method of data analysis was applied. Four themes and 32 categories emerged. Results 120 vendors selling NPS were visible on Alphabay, and 21 on Valhalla. Themes were ‘NPS Cryptomarkets and Crypto-community interest in NPS’ ‘Motives for NPS use’ ‘Indigenous Crypto Community Harm Reduction’ and ‘Cryptomarket Characteristics underpinning NPS trafficking’, with two higher levels of abstraction centring on ‘NPS vendor reputation’ and ‘NPS transactioning for personal use’. NPS cryptomarket characteristics centred on generation of trust, honesty and excellent service. Users appeared well informed, with harm reduction and vendor information exchange central to NPS market dynamics. GABA activating substances appeared most popular in terms of buyer interest on cryptomarkets. Interest in sourcing ‘old favorite’ stimulant and dissociative NPS was evident, alongside the sequential and concurrent poly use of NPS, and use of NPS with illicit drugs such as MDMA. Conclusion Continued monitoring of new trends in NPS within Surface Web and cryptomarkets are warranted. A particular focus on the rising market in prescribed benzodiazepine and Z-hypnotic drugs should be included. © 2016 Elsevier B.V