The modes of administration of anabolic-androgenic steroid users (AAS): Are non-injecting people who use steroids overlooked?

Introduction: There is increasing public health concern about the use of anabolic-androgenic steroids (AAS). Understanding of drug use patterns and practices is important if we are to develop appropriate risk-reduction interventions. Yet, much remains unclear about the modes of administration adopted by AAS users. Methods: We used data from a sub-sample of participants from the Global Drug Survey 2015; males who reported using injectable or oral AAS in their lifetime (n=1008). Results: Amongst our sample, approximately one third (35.62%) reported using only injectable AAS during their lifetime while 35.84% reported using only oral, with less than one third (28.54%) using both. Conclusion: These findings suggest there may be a sub-population of individuals who only use AAS orally. Needle and syringe programs (NSPs) are currently the primary point of health service engagement; forming the main healthcare environment for medical and harm reduction advice on steroids. Yet, NSP-based resources are unlikely to reach or be appropriate to those who do not inject AAS. While there is a general need for health services to be more accessible when it comes to AAS use, non-injectors are an overlooked group that require attention

Perceptions of alcohol health warning labels in a large international cross sectional survey of people who drink alcohol

Aims: This paper aimed to explore perceptions of alcohol health warning labels among a large international sample of people who drink alcohol. Methods: The Global Drug Survey (GDS) is the world’s largest annual cross sectional survey of drug use. Seven health warning labels were presented (relating to heart disease, liver, cancer, calories, violence, taking two days off and the myth of benefits to moderate drinking). People were asked if they were aware of the information, believed it, if it was personally relevant, and if it would change their drinking. This paper included data from 75,969 respondents from 29 countries/regions who reported the use of alcohol in the last 12 months, collected during November-December 2017 (GDS2018). Results: The fact that drinking less can reduce the risk of seven types of cancer was the least well known, and yet was demonstrated to encourage almost 40% of drinkers to consider drinking less. Women and high risk drinkers were more likely to indicate they would reduce their drinking in response to all labels. Personal relevance was identified as a key predictor of individual responses. Conclusions: Findings highlight the potential of a range of health messages displayed on alcoholic beverages to raise awareness of alcohol related harms and potentially support a reduction in drinking. Further research should explore what influences personal relevance of messages as this may be a barrier to effectiveness

Normative misperceptions about alcohol use in the general population of drinkers: a cross-sectional survey.

Underestimating one's own alcohol consumption relative to others ('normative misperception') has been documented in some college student and heavy-alcohol using samples, and may contribute to excessive drinking. This study aimed to assess how far this phenomenon extends to alcohol users more generally in four English-speaking countries and if associations with socio-demographic and drinking variables exist

Intention to reduce drinking alcohol and preferred sources of support: An international cross-sectional study

Introduction. Drinking alcohol is legal in most countries of the world. Given the social acceptance of this behavior despite potential negative impact on health, help-seeking behavior could differ when compared to other drugs. This paper aimed to assess intentions to reduce drinking and the preferred sources of support among a large international sample of people who drink alcohol. Materials and methods. The Global Drug Survey (GDS) is the world’s largest annual survey of drug use. This paper included data from 82,190 respondents from 12 countries on four continents who reported the use of alcohol in the last 12 months, collected during November 2016 - January 2017 (GDS2017). Results. Overall, 34.8% said they would like to drink less in the following 12 months and 7.6% said they would like help to drink less. Online tools were the preferred source of support to reduce drinking by respondents from Australia, New Zealand, and the UK, those with low AUDIT scores and without a mental health condition. Specialist counselling was most preferred by those from Germany, Switzerland, and Denmark and those with high AUDIT scores, not educated to degree level and with a mental health condition. Conclusion. Interest in online interventions for harmful drinking is significant and highest among people who drink at low risk. Online tools should offer brief screening and feedback, ensuring that people with high risk drinking patterns are referred to more specialist services

Where and what you drink is linked to how much you drink: A survey of alcohol use in 17 countries

Background:  This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type. Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage. Results: Drink type affected grams of alcohol reported to reach the tipping point: 109gm wine, 127gm alcopops, 133gm of beer, and 134gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations. Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking

Drinking to excess and the tipping point: An international study of alcohol intoxication in 61,000 people

Background: People who drink alcohol often seek to manage their intake in order to maximise the pleasurable effects, such as feelings of sociability and relaxation, without reaching their ‘tipping point’, where they feel out of control, or unwell. This paper aimed to explore three stages of intoxication; feeling the effects; being as drunk as you would like to be; and reaching the tipping point (feeling more drunk than you want to be) in a large international sample. Methods: The Global Drug Survey (GDS) is an annual, cross-sectional, online survey of drug use. This paper draws on data from 61,043 respondents (63.7% male) from 21 countries who took part in GDS2015 collected in November 2014 to January 2015. Respondents reported their usual type of drink; how many drinks they would require to reach each stage of intoxication and how frequently they reached each stage. Alongside socio-demographic measures, they also completed the Alcohol Use Disorders Identification Test (AUDIT). Results: Male respondents reported consuming 87.55gm to be as drunk as they want to be and female respondents reported 70.16gm, on average. The tipping point was reached at 138.65gm for male respondents and 106.54 gm for female respondents. Overall 20.3% reported reaching their tipping point at least once a month. Being male, aged under 25 and at higher risk for alcohol use disorder was associated with reporting reaching the tipping point more frequently. Conclusions: The amount of alcohol being consumed to reach a desired point of intoxication is much higher than the maximum daily, and sometimes weekly, amount recommended by country guidelines. Encouraging people to avoid reaching their tipping point may be a useful intervention point alongside better communication of low risk drinking guidelines

Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report

BACKGROUND: “Legal highs” are novel psychoactive substances that have evaded statutory control. Synthetic cannabinoid compounds with adamantane moieties have recently been identified, which have high potency at target receptors and are undetectable on conventional toxicology testing. However, little is known about any harmful effects, and their potential to cause serious ill health. We describe a case of myocardial infarction following the use of this class of drug. CASE PRESENTATION: We report the case of a 39-year-old man admitted after an out-of-hospital cardiac arrest, in whom ECG and elevated cardiac enzymes confirmed ST-elevation myocardial infarction. Normal coronary perfusion was restored after thrombectomy and coronary artery stenting. In the hours preceding his admission, the patient is known to have consumed the legal high product “Black Mamba”. Subsequent urine testing confirmed the presence of an adamantyl-group synthetic cannabinoid, whilst cannabis, cocaine, amphetamines and other drugs of abuse were not detected. CONCLUSION: The use of legal highs is being increasingly recognised, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. Synthetic cannabinoids, rarely identified on toxicological testing, can be linked to serious adverse cardiovascular events. This case highlights the importance of testing for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions

Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory

Abstract: Background and aims: Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial‐standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption. Design: A between‐subjects randomised experiment with three groups was conducted: group 1: image‐and‐text HWL; group 2: text‐only HWL; group 3: no HWL. Setting: A commercial‐standard naturalistic shopping laboratory in the United Kingdom. Participants: Adults (n = 399, 55% female) over the age of 18 years, who purchased beer or wine weekly to drink at home. Interventions: Participants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: (i) image‐and‐text HWL (n = 135); (ii) text‐only HWL (n = 129); (iii) no HWL (n = 135). Participants completed a shopping task, selecting items from a range of alcoholic and non‐alcoholic drinks, and snacks. Measurement: The primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability. Findings: There was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image‐and‐text HWL: 46% (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.82, 1.42); text‐only HWL: 41% (OR = 0.87, 95% CI = 0.67, 1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (P < 0.001) and acceptability lower (P < 0.001) in the image‐and‐text HWL group, compared to the text‐only HWL group. Conclusions: In a naturalistic shopping laboratory, there was no evidence that health warning labels describing the adverse health consequences of excessive alcohol consumption changed selection behaviour