A protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries.

BACKGROUND: Compared to the general population, people living in prison are at an increased risk to experience negative (mental) health outcomes. Moreover, delinquency and drug use have many risk factors in common. A need exists for increasing the knowledge about health needs, drug use patterns and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study about wellbeing, drug use and related care in prison. METHODS/DESIGN: A multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, the European Questionnaire on Drug use among people living in Prison, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data regarding health and social reintegration measures in prison is collected through a quantitative survey addressed to the prison authorities. DISCUSSION: This study protocol presentes a European study which aims to assess drug use among people living in prison and recently released people who use drugs as well as the existing care services in prisons. Hereby, factors related to the prison environment and their needs, both inside and outside prison are taken into account. Importantly, this study protocol describes a methodology which is developed to be executed in different prison settings within different countries simultaneously. Accordingly, for each country the protocol is adjustable to specific national legal requirements, regional differences and distinct local regulations of prison administrations. However, extensive modularity inevitably comes with significant limitations of comparability and generalizability of the results.

Clients' perceptions of motivational interviewing with couples: A qualitative examination of male couples' statements to counselors in session.

The past two decades have seen expanding interest in the application of Motivational Interviewing (MI) with couples. Thus far, literature detailing the development of MI with couples has focused primarily on elucidating counseling processes and techniques or on evaluating intervention effects. To date no published studies have examined client-perceptions of the counseling process in MI with couples. This study involved qualitative analysis of 55 sessions from 24 couple (48 individuals) who received short (3-session) courses of MI with couples in the context of a randomized controlled trial. All participants identified as cisgender male and were 18 or older. In each couple, at least one partner was aged 18 to 29, HIV negative, and reported drug use in the past 30 days. Analysis revealed that client couples attributed the benefits of MI with couples to the expectancy-related effects s (merely structuring time to talk) and common factors (the presence of the counsellor as a non-judgmental observer). Clients also conveyed appreciation for techniques and activities that enhanced dyadic functioning through communication skill building and the identification of shared values. Finally, clients appreciated the opportunity to discuss drug use and sexual behavior in an integrated way. Findings indicate the utility of counselor-delivered behavioral interventions. They also align with recent formulations of the counselor's role in MI with couples as well as the introduction of facilitating dyadic functioning as a distinct process. Finally, they highlight the potential value of training counselors to address the intersection of drug use, sexual risk, and sexual pleasure in sessions. These dimensions of practice receive inconsistent attention across counseling training program curricula.

Magnitude of multiple drug use and determinants of vulnerability among chronic kidney disease inpatients in Ethiopia: a multi-center study.

BACKGROUND: Patients with chronic kidney disease frequently face various nutritional and metabolic problems that necessitate the use of multiple medications. This multiple drug use can lead to several drug-related problems including adverse drug events, hospital admissions, poor medication adherence, harmful drug interactions, inadequate therapeutic outcomes, and death. Despite these challenges, there is a notable lack of studies on the extent of multiple drug use and its determinants among patients with chronic kidney disease in Ethiopia. This study aims to assess the magnitude of multiple drug use and identify the determinants of vulnerability among patients with chronic kidney disease in Ethiopia. METHOD: A hospital-based cross-sectional study was conducted among patients with chronic kidney disease. Eligible participants were selected using a simple random sampling technique. Frequency and percentage calculations were performed for categorical variables, while means and standard deviations were used for continuous variables. The chi-square test and t-test were used to compare the proportions and means, respectively. Binary logistic regression was used to identify the determinants of multiple drug use, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval. Guidelines and previous literature were utilized to assess the magnitude of multiple drug use. RESULTS: A total of 230 patients were enrolled, with more than half being male. The overall magnitude of multiple drug use was 83.0%. Diuretics being the most frequently prescribed medication class followed by angiotensin converting enzyme inhibitors. Patients aged 65 years and above (AOR = 4.91 (95% CI 1.60-15.03)), CKD stage five (AOR) = 5.48 (95% CI 1.99-15.09)), and the presence of comorbid conditions (AOR) = 3.53 (95% CI 1.55-8.06)) were significantly associated with multiple drug use. CONCLUSION: Chronic kidney disease patients exhibited a high rate of multiple drug use. The presence of comorbid conditions, disease progression and older age are significant determinates of this vulnerability. Health care providers should pay particular attention to these factors to manage and mitigate the risks associated with multiple drug use.

Identifying interventions that improve medication safety & rational use of medicines in India.

Background & objectives Medication-related harm is known to be the cause for about 1/10th of hospitalizations. Some estimates from India show that about 90 per cent of medicines consumed are inessential or irrational and contribute towards high out-of-pocket expenditure on health. In this context, the Indian Council of Medical Research in 2022 constituted a National Task Force (NTF) to explore possible solutions that could improve safe and rational use of medicines (SRUMs). The objective of this study was to identify research ideas in the field of SRUM through a survey of relevant stakeholders, and further to prioritize the research ideas using a pre-identified set of criteria. Methods The responses from the identified stakeholders were assessed using the Child Health and Nutrition Research Initiative method, which is an established research priority-setting methodology. First, the NTF asked for two to six research ideas from relevant Indian and global stakeholders on solutions to improve SRUM. The ideas were checked for duplicates, re-phrased where necessary and classified into various sub-themes. Subsequently, the research ideas were scored by Indian experts with relevant technical expertise using a pre-defined set of five criteria: innovativeness, effectiveness, translational value, answerability and applicability. Each research idea received from a stakeholder was assigned a score under each of the five criteria. The overall research priority score was calculated as a mean of all five criteria-specific scores and converted into a percentage. Results The final output of the prioritization process was a list of research ideas or questions, ranked by their scores. Total 209 unique ideas were received from 190 respondents, which were scored by 27 experts. The top three research topics on medication safety focused on cost-effective strategies for improving antimicrobial stewardship, safe use of poly-pharmacy in geriatric patients and drug take-back policy interventions. Regarding the rational use of medicine, the top three topics included testing mobile application-based antimicrobial stewardship interventions, development of diagnostics for antimicrobial resistance, and behavioural interventions. Interpretation & conclusions Several priority ideas found in this study also align with those of global priority, e.g., safe disposal practices and enhanced pharmacovigilance, rational use of medicines. Patient engagement, which underlines many of the top scoring ideas found in this study, is also inclined with the top research priorities reported by the WHO priority exercise on research into the safe use of medicines. However, to the best of our knowledge, this is the first such work from a low- and middle- income country on medication safety and rational use of medicines. The findings of this research priority-setting exercise can help to guide research for the development of policy-relevant and novel interventions to improve SRUM in India.

From Response to Prevention: Enhancing EMS Impact With Harm Reduction and HIV Education.

EMS are crucial not only for immediate life-saving interventions but also for broader public health initiatives, particularly in harm reduction and HIV prevention. However, many EMS training programs lack comprehensive education and training in these areas, resulting in significant gaps in patient care and provider safety. As the opioid epidemic continues to devastate communities, the need for EMS personnel to be trained in harm reduction strategies, such as naloxone administration, and HIV prevention, has become increasingly urgent. Integrating harm reduction and HIV prevention into EMS training is essential for equipping first responders to effectively address the complex needs of individuals affected by addiction. This training is not only vital for improving public health outcomes but also for ensuring the safety and efficacy of EMS providers in their critical roles on the front lines. The evidence strongly supports the immediate inclusion of harm reduction and HIV prevention in EMS curricula to enhance care quality, reduce the spread of HIV, and combat the ongoing opioid crisis.

Application of SBIRT Tools in Managing Alcohol and Drug Use Disorders.

BACKGROUND: To evaluate the eligibility and feasibility of the "Voice Modules in Narcology" (VMIN) program. MATERIAL AND METHODS: We developed a computer program to screen for risky alcohol or drug use, utilizing an interactive voice assistant as a motivational component. Given the low detection of such risks during population health examinations and medical check-ups, this program could allow the primary healthcare sector to expand screening coverage for risky alcohol and drug use without additional medical personnel. VMIN includes an anonymous short questionnaire (CAGE) and a question about drug use, offering a short (3-4 minutes) voice file with motivational information encouraging specialist consultation if risks are detected. The program also assesses the usefulness of the information received and the readiness to consult a narcologist for diagnosing substance use disorders. 51 outpatients under treatment at Samara State Medical University Hospital were included in the pilot project for evaluation the eligibility and feasibility program. RESULTS: 11 patients (21.6%) who were identified as at risk of alcohol or drug consumption listened to the voice modules after screening. Among these, 8 (72.7%) respondents provided feedback: 8 (72.7%) respondents found the information useful, 5 (45.5%) expressed willingness to change their behavior to reduce substance or alcohol use, 2 (18.2%) expressed readiness to seek specialized help, and 1 (9.1%) provided contact information for follow-up assessment of substance or alcohol use risk. CONCLUSIONS: A significant proportion of patients in multi-profile hospitals' cardiology and gastroenterology units (21.6%) reported risky alcohol consumption; drug use was reported by one man (1.9%). The majority of respondents who listened to the voice modules considered the provided information useful, but only one (1.9%) shared contact information for the follow-up assessment, and 3 (27.3%) did not give feedback. The high proportion of individuals giving positive feedback provides preliminary support for the feasibility of the method.

Frustrative Nonreward: Behavior, Circuits, Neurochemistry, and Disorders.

The surprising omission or reduction of vital resources (food, fluid, social partners) can induce an aversive emotion known as frustrative nonreward (FNR), which can influence subsequent behavior and physiology. FNR is an integral mediator of irritability/aggression, motivation (substance use disorders, depression), anxiety/fear/threat, learning/conditioning, and social behavior. Despite substantial progress in the study of FNR during the twentieth century, research lagged in the later part of the century and into the early twenty-first century until the National Institute of Mental Health's Research Domain Criteria initiative included FNR and loss as components of the negative valence domain. This led to a renaissance of new research and paradigms relevant to basic and clinical science alike. The COVID-19 pandemic's extensive individual and social restrictions were correlated with increased drug and alcohol use, social conflict, irritability, and suicide, all potential consequences of FNR. This article highlights animal models related to these psychiatric disorders and symptoms and presents recent advances in identifying the brain regions and neurotransmitters implicated.

Atypical Infective Endocarditis Presenting With Euthermia and Right Lower Quadrant Abdominal Pain.

Infectious endocarditis (IE) is an infection of the heart's endothelial lining, often stemming from an underlying bacteremia. High-risk populations include intravenous substance users, individuals with structural heart disease, those with intravascular devices, and those with prosthetic heart valves. In the emergency department, IE is often suspected in patients with a fever, known risk factors, and unexplained systemic symptoms due to systemic thromboemboli. We present a case of atypical IE occurring in an afebrile 38-year-old woman with a remote history of intravenous drug use. The patient's clinical presentation was characterized by systemic inflammatory response syndrome, stabbing-like right lower quadrant abdominal pain radiating to the right lower back and the rest of the abdomen, malaise, fatigue, and an absence of a fever. A CT scan revealed a right renal embolism and an infarcted right kidney, prompting a bedside point-of-care echocardiogram that showed a large vegetation on the mitral valve, suggestive of IE with systemic thromboembolic disease. The patient received broad-spectrum antibiotics and antipyretics and ultimately underwent mitral valve replacement, with good recovery upon discharge. Patients with IE are at high risk for life-threatening complications due to tissue damage from systemic microemboli and sepsis. It is important to identify IE's atypical presentation and risk factors for early recognition, prompt point-of-care echocardiogram, and initiation of treatment. This is particularly important in the era of increased opioid use among our patient population which could potentially conceal an underlying fever.

"A way to liberate myself": A qualitative study of perceived benefits and risks of chemsex among gay, bisexual, and other men who have sex with men in Almaty, Kazakhstan.

BACKGROUND: In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty. METHODS: We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks. RESULTS: Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal. CONCLUSIONS: The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex.

Examining Daily Self-Efficacy, Minority Stressors, and Alcohol and Other Drug Use Among Trauma-Exposed Sexual Minority Women and Transgender and Gender-Diverse People.

BACKGROUND AND PURPOSE: This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations. METHODS: Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as "same-day"). RESULTS: Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking. CONCLUSIONS: Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma.

This study explored how confidence in resisting alcohol and other drug (AOD) use relates to daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We also assessed whether experiences of minority stress, such as discrimination or stigma, influenced these relationships. Fifty-seven SMW and TGD individuals participated in a 14-day daily diary study. Results showed that higher self-efficacy was linked to lower AOD use and reduced unhealthy drinking risk. However, for those who experienced greater levels of minority stress over the 2 weeks, the protective effect of self-efficacy was weaker. In these cases, even high self-efficacy was less effective at reducing unhealthy drinking on stressful days. These findings suggest that interventions aimed at improving self-efficacy in resisting AOD use in SMW and TGD populations should address minority stressors, and policies need to focus on reducing stigma to improve health outcomes in these communities.

Classics in Chemical Neuroscience: Deliriant Antihistaminic Drugs.

Antihistaminic drugs are widely used clinically and have long been primarily known for their use to treat severe allergic conditions caused by histamine release. Antihistaminic drugs also exert central nervous system (CNS) effects, acting as anxiolytics, hypnotics, and neuroleptics. However, these drugs also have multiple serious neuropharmacological side-effects, inducing delirium, hyperarousal, disorganized behavior, and hallucinations. Due to their robust CNS effects, antihistamines are also increasingly abused, with occasional overdoses and life-threatening toxicity. Here, we discuss chemical and neuropharmacological aspects of antihistaminic drugs in both human and animal (experimental) models and outline their current societal and mental health importance as neuroactive substances.

Five-year trend analysis of drug use among individuals 16 years of age and older injured in non-fatal motor vehicle crashes in the US.

OBJECTIVE: To examine the prevalence of drug use among individuals (age 16+) injured in non-fatal motor vehicle crashes (MVCs) from 2019 to 2023 and assess regional differences based on US Census regions (i.e., West, Midwest, Northeast, and South), and thereby contribute to a comprehensive understanding of drug-related MVCs. METHODS: We examined emergency medical services data from 19 US states (January 2019 to December 2023) to determine the annual mean drug use prevalence among individuals (age 16+) injured in non-fatal MVCs. Differences in drug use prevalence were assessed using ANOVA with the Tukey-Kramer test for year-to-year comparisons. Adjusted Poisson regression models with random effect for states were used to compare trends to the baseline (i.e., 2019) and to assess regional differences. RESULTS: Among individuals (age 16+) injured in non-fatal MVCs, 62,310 had reported drug use. ANOVA results showed significant year-to-year differences in the prevalence of drug use among individuals injured in non-fatal MVCs, with an increase from 2019 to 2020 and a subsequent decrease from 2020 to 2023 (p < 0.05). Compared to the baseline year of 2019, the prevalence in 2020 was 1.34 times (95% confidence interval [CI]: 1.12, 1.61) the prevalence in 2019. The prevalence in 2022 and 2023 were similar to the 2019 prevalence. Although no significant associations were found between US regions and the overall mean prevalence from 2019 to 2023; there was a difference in the average annual rate of change in prevalence by region, with a 4.0% lower rate in the Midwest compared to the Northeast (p < 0.001). This signifies a need to monitor future trends for potential regional differences. CONCLUSIONS: Drug use prevalence among individuals (age 16+) injured in non-fatal MVCs increased from 2019 to 2020; then decreased to levels reflecting baseline prevalence in 2019; with no significant regional differences in the overall mean crash-related drug use prevalence. These findings highlight the need for continuous surveillance across the US over an extended period. They also underscore the potential impact of environmental risk factors, such as the COVID-19 pandemic, and the necessity to monitor how drug use prevalence related to non-fatal MVCs changes in the coming years.

Effect of fentanyl on HIV expression in peripheral blood mononuclear cells.

Introduction: Illicit drug use, particularly the synthetic opioid fentanyl, presents a significant global health challenge. Previous studies have shown that fentanyl enhances viral replication; yet, the mechanisms by which it affects HIV pathogenesis remain unclear. This study investigated the impact of fentanyl on HIV replication in CD4+ T lymphocytes. Methods: CD4+ T lymphocytes from HIV-negative donors were activated, infected with HIVNL4-3, and treated with fentanyl. HIV proviral DNA and p24 antigen expression were quantified using real-time PCR and ELISA, respectively. Single-cell RNA libraries were analyzed to identify differentially expressed genes. Results: Results indicated that fentanyl treatment increased HIV p24 expression and proviral DNA levels, and naltrexone mitigated these effects. Single-cell RNAseq analysis identified significantly altered gene expression in CD4+ T lymphocytes. Discussion: The results of our findings suggest that fentanyl promotes HIV replication ex vivo, emphasizing the need for a deeper understanding of opioid-virus interactions to develop better treatment strategies for individuals with HIV and opioid use disorder.

Chemsex and its impact on gay and bisexual men who have sex with men: Findings from an online survey in Belgium.

OBJECTIVES: The study aimed to estimate the prevalence of sexualized drug use, or chemsex, in a wide group of gay, bisexual and other men who have sex with men (gbMSM) in Belgium. It examined which drugs gbMSM used before and during sex, the frequency with which they used it, whether they experienced non-consensual sex, and evaluated the impact of chemsex on the health and professional and social lives of respondents. METHODS: We conducted an online survey among Belgian gbMSM. Five specific questions on chemsex were included in the survey. These questions assessed whether gbMSM engaged in chemsex. If they did, they were asked to provide information on which drugs they had used and how often. We asked whether their and their partners' boundaries had been respected and whether and how engaging in chemsex had affected a range of life domains. RESULTS: Of 836 respondents, 258 (30.9%) self-reported having had sex under the influence of substances ("chemsex") in the previous 6 months. Of these, 227 (88%) were considered chemsex users according to the definition used for the analysis. Poppers (73%), gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL; 69%) and cathinones (68%) were the most commonly reported substances. Almost half of respondents (45%) engaging in chemsex were high on drugs during at least half of their sexual encounters. Nearly 1 in 10 (9%) reported that boundaries had not been respected, suggesting non-consensual sexual activities. The 82 respondents experiencing negative impacts from their chemsex use reported that mental health (65%), physical health (40%) and sexual health (38%) were most impacted. DISCUSSION: Our findings provide a snapshot of the current chemsex situation in Belgium. The frequency of chemsex is concerning because several health, professional and social aspects are impacted. Almost 1 in 10 respondents using chemsex reported that chemsex impacted consent around sex, requiring additional efforts to eradicate these non-consensual sexual experiences. Therefore, larger scale research focusing on respected boundaries and consent during chemsex and the frequency of drug use for sex seems required. Additionally, sensitisation, as well as care and support programmes are critical.

Influence of perceived harm due to substance use on the relationships between positive psychotic experiences and suicidal experiences in people with non-affective psychosis.

BACKGROUND: The ways in which perceived harm due to substance use affects relationships between psychotic and suicidal experiences are poorly understood. The goal of the current study was to redress this gap by investigating the moderating effects of harm due to substance use on pathways involving positive psychotic symptoms, the perceived cognitive-emotional sequelae of those symptoms, and suicidal ideation. METHOD: The design was cross-sectional. Mediation and moderated mediation pathways were tested. The predictor was severity of positive psychotic symptoms. Cognitive interpretative and emotional characteristics of both auditory hallucinations and delusions were mediators. Suicidal ideation was the outcome variable. General symptoms associated with severe mental health problems were statistically controlled for. RESULTS: There was evidence of an indirect pathway between positive psychotic symptom severity and suicidal ideation via cognitive interpretation and emotional characteristics of both auditory hallucinations and delusions. Harm due to drug use, but not alcohol use, moderated the indirect pathway involving delusions such that it was most prominent when harm due to drug use was at medium-to-high levels. The components of suicidal ideation that were most strongly affected by this moderated indirect pathway were active intent, passive desire, and lack of deterrents. CONCLUSIONS: From both scientific and therapy development perspectives, it is important to understand the complex interplay between, not only the presence of auditory hallucinations and delusions, but the ensuing cognitive and emotional consequences of those experiences which, when combined with harm associated with substance use, in particular drug use, can escalate suicidal thoughts and acts.

Health disparities and injection drug use behaviors among adults with and without disabilities in the National Survey on drug use and health, 2015-2019.

BACKGROUND: Little is known about the prevalence of injection drug use in people with disabilities (PWD) when compared by disability type and to other adults without disabilities. OBJECTIVE OR HYPOTHESIS: The prevalence of past-year injection drug use will be higher in adults with a reported disability than adults without any reported disability. METHODS: This study consisted of secondary analyses of data from the 2015-2019 National Survey of Drug Use and Health. The analytic sample comprised 214,505 US adults. Self-reported past-year injection drug use represented the outcome of interest. Disability status and socioeconomic characteristics were conceptualized as predictors, and sex and age were used as controls. RESULTS: Past-year prevalence of self-reported injection drug use was 0.24 % (95 % CI, 0.22-0.27) in adults without a disability but 0.66 % (95 % CI, 0.59-0.73) in adults with a disability. All disability types examined were associated with increased odds of reporting past-year injection drug use, but the strongest association was observed for disability related to difficulty concentrating (AOR, 4.90; 95 % CI, 3.92-6.14). Adjusted odds of past-year methamphetamine injection were more than three times as high in adults with a disability, compared to those without a disability (AOR, 3.21; 95 % CI, 2.37-4.33) and more than two times as high in adults with a disability for cocaine injection (AOR, 2.77; 95 % CI, 1.84-4.15). CONCLUSION: Disability status is associated with injection of various types of drugs, and a variety of disability types are associated with higher odds of injection drug use.

Diversity of Chemsex Experiences among Men Who Have Sex with Men: Results from the French ANRS PaacX Study Using Q-Methodology.

Chemsex is mostly approached through the prism of risk-taking, neglecting the pleasure and social linking dimensions. However, feedback from the field and few studies highlights a diversity of chemsex practices and relationships to chemsex (RtC). Using Q-methodology, we identified the main RtC and their divergences and convergences, to help develop tailored prevention and care programs. Q-methodology enables the exploration of complex subjective structures and provides a multifaceted picture of a phenomenon. In 2019-2020, we asked 126 men who have sex with men living in France and practicing chemsex to rank order 37 statements. RtC were defined through by-person factor analysis and interpreted using a holistic process. Five RtC emerged, highlighting various motivations for practicing chemsex, relationships to substance use and to sexuality, and regulation strategies implemented: (1) From compensation to fulfillment; (2) The pleasure-seeking manager; (3) Between addiction and management; (4) From curiosity to the destruction of sexuality; and (5) From the hope of compensation to disillusion. Respondents all agreed on two statements: the need to first accept oneself as a drug user in order to be able to manage drug use, and the possibility of harm reduction during chemsex sessions. Our results are the first to elicit the main RtC and the intricacies between the dimensions at stake. The five analysis-based narratives derived from RtC might facilitate discussion during interviews or support groups on chemsex, and could serve as a standardized survey tool. Our findings advocate longitudinal studies to identify factors associated with shifting from one RtC to another.

Examining the association between psychological resilience and chronic versus discrete stressors among individuals who use opioids in Baltimore, Maryland.

INTRODUCTION: Psychological resilience has emerged as a key construct of interest in the study of substance use. However, very few studies have examined resilience among individuals who are actively using drugs. Furthermore, many studies of psychological resilience have focused on individual-level factors. This study addresses the call for a more 'ecological' approach to the study of resilience by exploring how socio-structural vulnerabilities may shape individuals' assessment of their own ability to cope. METHODS: The Peer Harm Reduction of Maryland Outreach Tiered Evaluation study conducted a cross-sectional survey of people who used opioids in Baltimore, Maryland, USA (n = 565). Resilience was measured using the 10-item Connor-Davidson Resilience Scale. We used linear regression to examine the association between resilience and stressors commonly encountered by individuals who use drugs, including both chronic, enduring stressors (e.g., homelessness, food insecurity) and discrete, event-based stressors (e.g., overdose, arrest). RESULTS: We observed a negative relationship between self-reported resilience and chronic stressors. Specifically, individuals who reported experiencing three (ß = -4.08; p = 0.002) or four (ß = -4.67; p = 0.008) types of chronic stress had significantly lower resilience scores. Additionally, we found that an unmet need for mental health treatment was associated with reduced resilience (ß = -1.74; p = 0.040) and greater educational attainment was associated with increased resilience (ß = 2.13; p = 0.005). DISCUSSION AND CONCLUSIONS: Overlapping experiences of socio-structural vulnerability, as well as access to mental health care, may influence how individuals who use drugs evaluate their own resilience. Interventions that seek to promote the resilience of this population should focus on addressing structural drivers of marginalisation and barriers to mental health treatment.

Emerging Illicit Drug "2C": A Case Report on Its Hallucinogenic and Stimulant Properties.

"2C," formally known as 4-bromo-2,5-dimethoxyphenethylamine, is an illicit drug that combines elements of ketamine, MDMA (ecstasy), methamphetamine, cocaine, and opioids. This report highlights the emergence of 2C compounds, a new class of illicit drugs recognized for their distinctive blend of hallucinogenic and stimulant properties. We present the case of a 22-year-old female who was admitted to the psychiatric emergency department with a history of bipolar I disorder and recent use of various illicit substances, including the drug known as 2C. The patient exhibited symptoms such as visual hallucinations, euphoria, and an increased heart rate. Laboratory tests and toxicology screens were performed to confirm the presence of the components associated with the 2C compound. Her management involved admission to an acute inpatient psychiatric unit for medication stabilization. This case underscores the critical need for healthcare providers to recognize the signs and symptoms of 2C compound intoxication and to provide timely, appropriate intervention. With the rise in recreational use of such substances, further research and public health initiatives are essential to address the associated risks.

Microbes Causing Spinal Epidural Infection in Patients Who Use Drugs.

Background: The incidence of spine infections has increased due to the surge in injection drug use driven by the opioid epidemic. Few recent studies have evaluated the microbiology of spinal epidural infections among people who inject drugs compared to the microbiology of such infections among the general population. Methods: We performed a retrospective chart review to identify patients with a spinal epidural abscess or phlegmon unrelated to recent spine surgery between 2015 and 2023. Results: Of 346 initial records, 277 met inclusion criteria for demographic analyses. Of the 229 patients with microbiologic results, details regarding possible drug use were available in 227 patients. Patients with no documented history of drug use were categorized as non-PWUD, while patients who use drugs (PWUD) were separated based on whether drug use was active or not. Patients with prior histories of injection or noninjection drug use were categorized as nonactive PWUD, while those with injection or snorting drug use reported in the past 3 months were categorized as active PWUD. Thirty-nine percent of patients with spinal epidural infection had substance use disorder. Most patients with monomicrobial cultures were infected with gram-positive, aerobic bacteria (86%). Active PWUD were more likely to have methicillin-resistant Staphylococcus aureus compared to non-PWUD (36% vs 13%, respectively, P = .002). Nonactive PWUD were more likely to have non-Escherichia coli gram-negative bacterial infections than non-PWUD (18% and 4.4%, respectively, P = .01). Conclusions: More than 1 in 3 patients with a spinal epidural infection unrelated to recent surgery had substance use disorder. These patients are more likely to have infections due to MRSA and gram-negative bacteria other than E coli such as Serratia marcescens.