Drugs on the Dark Net: How Cryptomarkets Are Transforming the Global Trade in Illicit Drugs (Martin, J, 2014).

Book Revie

Pregabalin Misuse and Abuse in Jordan: a Qualitative Study of User Experiences

Pregabalin is currently approved for the treatment of epilepsy, generalized anxiety disorder, neuropathic pain, and fibromyalgia. A qualitative study was undertaken in Jordan, where concerns have been raised about its unprescribed availability in community pharmacies and thereby its abuse. Semi-structured interviews were conducted with all patients with a history of pregabalin use in two Jordanian addiction treatment centers. All were male patients aged 21–30 years (n = 11). The majority was poly-drug abusers and had a previous history of substance abuse (tramadol, Captagon, synthetic cannabinoids, and marijuana). Six key themes emerged from a content textual analysis which centered on pregabalin and other drugs; the pregabalin effect; poly-pharming and pregabalin intoxication; trajectories, patterns, and routes of administration; dependence and withdrawal; and sourcing of pregabalin. The study underscores the need for continued pharmacovigilance to manage and address suspected abuse, along with community pharmacist and patient education regarding abuse liability and related harms

Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in Sub Saharan Africa: A scoping review of extant literature.

Background Sub Saharan African (SSA) prisons have seen a substantial increase in women prisoners in recent years. Despite this increase, women prisoners constitute a minority in male dominated prison environments, and their special health needs are often neglected. Research activity on prison health remains scant in SSA, with gathering of strategic information generally restricted to infectious diseases (human immunodeficiency virus infection HIV/tuberculosis TB), and particularly focused on male prisoners. Health care provisions for women (and pregnant women) in SSA prisons are anecdotally reported to fall far short of the equivalence care standards mandated by human rights and international recommendations, and the recent agreements set out in the Southern African Development Community (SADC) Minimum Standards for HIV in Prisons. Methods A scoping review mapped what is currently known about women prisoners’ health experiences, unique prison health care needs and health care outcomes in SSA. A systematic search collected and reviewed all available and relevant published and grey literature (2000–2017). Following removal of duplicates and application of exclusion measures, 46 records remained, which represented 18 of the 49 SSA countries. These records were subsequently charted and thematically analysed. Results Three themes were generated; ‘The Prison Regime’; ‘Navigating inside the Prison Health Infrastructure’ and ‘Accessing the outside Community and Primary Care Health Services’. Women in SSA prisons experience the same substandard nutrition, overcrowding and unhygienic conditions which exacerbate poor health and infectious disease transmission as males. Human rights abuses, substandard prison conditions and poor access to prison based and community clinical care, along with the invisible nature of women and that of their unique health needs are deplorable. Conclusions The review has highlighted the dearth of gender specific strategic information on women prisoners in the region, appalling environmental conditions and prison health care provision, and violation of human rights for those incarcerated. Enhanced donor support, resource allocation, prison health and population health policy reform, health systems surveillance and gender sensitive prison health service provision is warranted. This will help address women prisoners’ conditions and their specific health needs in SSA prisons, and ultimately bridge the gap between prison and population health in the region

Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: A systematic review

Background: Opioid dependence is common amongst the prison population, with increased risk of fatal overdose in the immediate post-release period. Aim: The study aimed to review the effectiveness of pharmacotherapies (Methadone (METH), Buprenorphine (BUP), levo-alpha acetyl methadol (LAAM), Naltrexone (NLT) and Naloxone (NLX)) in reducing overdose deaths and increasing treatment retention in opioid dependent prisoners on release. Methods: A systematic review of studies on recently discharged opioid dependent prisoners receiving METH, BUP, LAAM, NLT and/or NLX was conducted. Factors of interest regarded post-release treatment retention, non-fatal overdoses (NFODs), overdose mortality, and continued heroin and/or other illicit drug use. Searches were conducted using MESH terms; opioid related disorder, prisoner, NLT, NLX, METH, BUP, LAAM, overdose. Exclusion criteria were applied as per PRISMA guidelines. Quality, outcome and risk of bias assessments were applied across studies. Results: Eight randomised control trials (RCT), one non-randomised trial and five observational studies formed the data set. Agonist Opioid Treatment (AOT) (METH, BUP, LAAM) initiated pre-release was associated with significant post-release treatment retention on discharge into the community, and post-release reduction in heroin use. Prisoners on BUP or METH on discharge had significantly reduced mortality risks in the immediate four weeks post-release. There was insufficient evidence supporting a reduction in NFODs and continued other illicit drug use. Conclusions: The review underscores the need for prisoners on AOT to be supported with continued treatment on release into the community. Further research is warranted to investigate potential utility of long-acting NLT formulations and take-home NLX (THN) in pre-release opioid dependant prisoners. © 2017, Pacini Editore S.p.A. All rights reserved

Shake ‘N Bake: the Migration of ‘Pervitin’ to Ireland

Home manufactured methamphetamine known as ‘Pervitin’ has historically dominated the drug market in the Czech and Slovak Republics. Seizures and surveillance data indicate some displacement of ‘Pervitin’ across Europe to areas of low reported prevalence (Nordic countries, Germany, Cyprus, Greece and Portugal). We present the first single case study of clandestine production of ‘Pervitin’ to Ireland, a country with low reporting history of methamphetamine. Content analysis yielded three descriptive themes; ‘Pervitin’ use, Decisions to Use and Effects; Legality and Hazards; and ‘Clandestine Manufacture.’ The study yielded unique insight into migration of this culturally specific drug, and how continued cultural contexts for use and ‘cooking’ remain intact when residing in the host country. Given its unique cultural nature and national characteristics, continued migration of Eastern European citizens across Europe, diffusion of clandestine production warrants continued surveillance. Appropriate service responses require culturally appropriate information and outreach services to Eastern European service users. © 2016 Springer Science+Business Media New Yor

An exploratory study of image and performance enhancement drug use in a male British South Asian community

Background: Consumerism of image and performance enhancement drugs (IPEDs) is a world-wide public health concern. Given anecdotal reporting of increased normalisation of IPED use and uptake of British South Asian male IPED users at UK needle and syringe exchange services, the study aimed to explore use of IPEDs among this under-researched ethnic group. Methods: 20 in depth interviews were conducted with a purposive sample of British South Asian males attending harm reduction outreach in the North East of England. The interviews explored motives for use of IPEDs, sourcing routes, information seeking, injecting behaviours and cultural and community sensitivities around IPED use among this group. The data was collected and analysed using the Interpretative Phenomenological Analysis approach (IPA). Results: Motives for use centred on the achievement of enhanced definition and density of muscle, and improved recovery from training and injuries. All participants reported initial stimulation of interest and triggers to seek information on IPEDs due to social media, community and peer messages. Diverse forms of IPED use were described, with rational and moderated use common among older participants. In contrast younger participants adopted more excessive use in seeking short cuts to attaining muscle size. Sourcing of androgenic–anabolic steroids (AAS) and growth hormones from originating countries (Pakistan, India) was reported, along with diversification of entrepreneurial activity into IPED dealing networks. Sellers were generally reported to provide effective and reliable products and mentoring to inexperienced users. Group injecting practices were common. IPED use was observed by some as health promotion medium within religious contexts. Crime deterrence and drug abstinence occurred for some while involved in AAS cycles. Conclusions: The study is intended to contribute to health policy and practice debate around the targeting of dedicated education, outreach and harm reduction for ethnic groups engaged in IPED use

“Bursting the Lyrica bubble”: experiences of pregabalin use in individuals accessing opioid substitution treatment in Dublin.

Background: Pregabalin, also known by a brand name of Lyrica, is a prescription only gamma-aminobutyric acid (GABA) analogue and licensed for a range of medical conditions, e.g. chronic pain, generalised anxiety and epilepsy. In recent years, pregabalin has attracted clinical and research attention due to an increase in its association with overdose fatalities. Individuals with opiate use and those in opioid agonist treatment are an identified at risk group for problematic pregabalin use and overdose. As such, research focusing on pregabalin use in individuals accessing opioid agonist treatment is highly relevant. Aim: This study aims to add to the evidence base on diverted pregabalin use in the OAT cohort in Ireland. Methods: Fifteen semi structured interviews were conducted and analytically coded using thematic analysis with software programme NVivo12. Results: Individuals on OAT may use Lyrica to self-regulate negative emotions; Lyrica use in this population is embedded in a polydrug use culture of “tablet taking”; participants illustrated concerning reports of inappropriate prescribing and described psychiatric symptoms occurring during withdrawal. Conclusions: We report here on the first study in Ireland investigating the experiences of individuals who access opioid agonist treatment (OAT) and reported current or recent pregabalin use. Increased pharmaco-vigilance amongst medical practitioners is warranted when prescribing Lyrica to individuals with vulnerabilities such as a history of problematic drug use. Trauma informed interventions in addition to pragmatic harm reduction information for poly drug users to prevent cross tolerance, dependence and overdose deaths should be part of the healthcare and policy response

The Dynamic Landscape of Novel Psychoactive Substance (NPS) Use in Ireland: Results from an Expert Consultation

In Ireland, legislators encountered a new phenomenon in 2005 onwards with the advent of ‘legal highs’ sold in headshops. Use of ‘legal highs’ containing herbal and synthetic new psychoactive substances (NPS) was not confined to problematic drug users, and included social recreational users. Legislative controls were enacted in 2010, 2011 and 2015. The study aimed to investigate expert perspectives on the NPS situation with regard to changing and emergent trends in use, health and social consequences and service implications. This brief report presents descriptive findings from a national consultation using a structured guide with experts in 2016. Four themes emerged and centred on; ‘Definitions of NPS used within Professional Roles’; ‘Professional Experiences of NPS‘; ‘Types of NPS Users, Sourcing and Consequences of Use’; and ‘Service Response.’ Findings underscored the mental health and addiction related consequences of NPS use, with prevention, clinical and treatment services ill- equipped to deal with the particular characteristics of this form of drug abuse. Enhanced strategies, services and clinical responses are warranted to address the challenges encountered. © 2016 Springer Science+Business Media New Yor