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

Book Revie

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

“Saving Face”: An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits

This study reports on an empirically underdocumented practice in contemporary aesthetic enhancement culture, the self-injection of unregulated DIY Botox and dermal filler kits purchased online. Data were collected from 4 online discussion forums containing disclosures in relation to use of DIY kits and analyzed using ethnographic content analysis. Motivation to source DIY Botox and dermal fillers online was grounded in desire to avoid financial cost of professional services and a lack of confidence in practitioners. Future intentions to order online raw materials and “formulas” to prepare dermal fillers at home were expressed. Individuals taught themselves to inject through watching YouTube tutorials and downloading Botox injection maps from the Internet. Although individuals demonstrated awareness of the health risks involved with self-injection of unregulated products, this was not a deterrent. Future research is warranted to document the injecting practices and health outcomes of individuals who inject DIY Botox and dermal filler kits to inform targeted harm reduction interventions by health-care practitioners. © 2018, The Author(s)

The controversies, challenges and complexities of Lyme disease: implications for medical education, clinical practice and research.

Purpose: Lyme disease has become an increasingly important global public health concern. Method: A narrative review was conducted and designed to present a broad perspective on Lyme disease, and describe its history and development in terms of clinical care and public health implications. A structured literature search was conducted based on the question; what is currently known about Lyme disease? Results: The narrative review is presented in chronological order in terms of a summary of the history of Lyme disease, the complexities of clinical diagnosis, the problematic interpretation of serologic testing, the conflicting guidelines for diagnosis, treatment and management of chronic Lyme, and benefits of antibiotic treatment. Conclusion: Despite growing global incidence of the Lyme disease, treatment has not attracted pharmaceutical investment, and the evidence base and international guidelines for treatment and management of chronic Lyme continue to be conflicting and controversial. The challenges of this immune mediated tick borne disease for public health policy and clinical practice are summarised, alongside directions for future research