Regrets, I've Had a Few: Exploring Factors Associated with Getting Drunk and Regret in an International Study of People Who Drink Alcohol.

BACKGROUND: Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions. METHODS: This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures. RESULTS: In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.Discussion and conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.

The relationship between cryptomarket drug purchase, social networks and adverse drug events: A cross-sectional study.

INTRODUCTION: Drug use and trading are typically social activities; however, supply through cryptomarkets can occur without any in-person social contact. People who use drugs alone may be at higher risk of experiencing harms, for example, due to lack of others who may call for emergency assistance. Alternatively, cryptomarkets may be a source of harm reduction information and drugs with better-known content and dose, potentially reducing the risk of adverse events. This study examines relationships between cryptomarket use, drug-using social networks and adverse drug events for MDMA, cocaine and LSD. METHOD: A subsample of 23,053 respondents from over 70 countries was collected in the 2018 Global Drug Survey. People who reported using MDMA, cocaine or LSD were asked about using cryptomarkets to purchase these drugs; any adverse drug events requiring medical treatment (combining seeking treatment and should have sought treatment but did not); and social networks who they had used the specific drug with. All measures referred to the last 12 months, hereon referred to as 'recent'. Binary logistic regressions examined relationships between cryptomarket use, drug-using social networks, and adverse drug events, controlling for age, gender, and frequency of drug use. RESULTS: Adverse events from any drug type were low (5.2%) and for each drug; MDMA (3.5%); cocaine (3.3%); and LSD (3.5%). After controlling for covariates, recent cryptomarket use was associated with increased likelihood of having no drug-using network for each drug type. People who recently used cryptomarkets were more likely to report adverse cocaine (AOR = 1.70 (1.22-2.37)) and LSD (AOR = 1.58 (1.12-2.09)) events. For those reporting a network size >1, network characteristics did not differ with recent cryptomarket use; however, those reporting recent cryptomarket use were more likely to report adverse LSD events (AOR = 1.86 (0.99-3.51)). CONCLUSION: People who reported purchasing drugs from cryptomarkets more commonly reported having no drug-using network, and cryptomarket purchase was associated with reported adverse events. Our results support the notion that cryptomarket use increases drug-related harm, but further disentanglement of multiple complex mechanisms is needed in future research.

Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020.

BACKGROUND: Growing numbers of people are using psychedelics for personal psychotherapy outside clinical settings, but research on such use is scarce. AIMS: This study investigated the patterns of use, self-reported outcomes and outcome predictors of psychedelic 'self-treatment' of mental health conditions or specific worries/concerns in life. METHODS: We use data from the Global Drug Survey 2020, a large online survey on drug use collected between November 2019 and February 2020. In all, 3364 respondents reported their self-treatment experiences with lysergic acid diethylamide (N = 1996) or psilocybin mushrooms (N = 1368). The primary outcome of interest was the 17-item self-treatment outcome scale, items reflecting aspects of well-being, psychiatric symptoms, social-emotional skills, and health behaviours. RESULTS: Positive changes were observed across all 17 outcome items, with the strongest benefits on items related to insight and mood. Negative effects were reported by 22.5% of respondents. High intensity of psychedelic experience, seeking advice before treatment, treating with psilocybin mushrooms and treating post-traumatic stress disorder were associated with higher scores on the self-treatment outcome scale after averaging values across all 17 items. Younger age, high intensity of experience and treating with LSD were associated with increased number of negative outcomes. CONCLUSIONS: This study brings important insights into self-treatment practices with psychedelics in a large international sample. Outcomes were generally favourable, but negative effects appeared more frequent than in clinical settings. Our findings can help inform safe practices of psychedelic use in the community, and inspire clinical research. Future research can be improved with utilisation of prospective designs and additional predictive variables.

Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis.

Cannabis, a widely used psychoactive substance, can trigger acute cannabis-associated psychotic symptoms (CAPS) in people who use cannabis (PWUC). To assess rates and correlates of CAPS requiring emergency medical treatment, we analyzed data from an international sample of PWUC (n = 233,475). We found that 0.47% (95%CI 0.42; 0.52) PWUC reported lifetime occurrence of CAPS, defined as the occurrence of hallucinations and/or paranoia requiring emergency medical treatment following the use of cannabis. A range of factors correlated with risk of CAPS in the last year: higher rates were observed in young individuals [risk ratio (RR) 2.66, compared to older PWUC] and those residing in Denmark (RR 3.01, compared to PWUC from other countries). Furthermore, risk was elevated in those using predominantly high-potency resin (RR 2.11, compared to PWUC using herbal cannabis), those mixing cannabis with tobacco (RR 2.15, compared to PWUC not mixing with tobacco) and those with a diagnosis of psychosis (RR 14.01), bipolar (RR 4.30), anxiety (RR 2.92) and depression (RR 2.68), compared to individuals without a mental health diagnosis. Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC's lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities. In light of the movements towards legalization of recreational cannabis, more research should focus on the potential harms related to cannabis use, to educate PWUC and the public about risks related to its use.

Differences in Alcohol and Other Drug Use and Dependence Between Transgender and Cisgender Participants from the 2018 Global Drug Survey.

Purpose: The purpose of this study was to compare five gender groups (cisgender women, cisgender men, transgender women, transgender men, people with nonbinary/other identities) on measures of use of and dependence on seven substances. Methods: A two-stage approach to assessing gender allowed 126,648 participants from the 2018 Global Drug Survey (GDS) to be classified to one of these five gender groups. Participants were asked to disclose use of each substance in the preceding 12 months. The Alcohol Use Disorders Identification Test and the Severity of Dependence Scale were used to assess dependence. Multivariable logistic regression generated odds ratios (ORs) to measure the association between gender and each substance use/dependence outcome, with cisgender women as the reference group. Results: The sample comprised 43,331 cisgender women, 81,607 cisgender men, 215 transgender women, 254 transgender men, and 1241 people with nonbinary/other identities. Relative to cisgender women, nonbinary/other participants reported greater odds of last 12-month use of all substances (adjusted odds ratio [AOR] = 1.66-2.30), except alcohol (lower odds; AOR = 0.42), and greater odds of dependence on cannabis (AOR = 2.39), 3,4-methylenedioxymethamphetamine (AOR = 1.64) and alcohol (AOR = 3.28), adjusting only for age (all p < 0.05). Conclusion: Transgender 2018 GDS respondents, particularly those with nonbinary/other identities, had greater odds of reporting most substance use outcomes than cisgender women. These findings suggest that a nuanced approach to gender reporting in surveys and treatment centers is required to understand the needs of transgender people who use substances.

Adverse experiences resulting in emergency medical treatment seeking following the use of lysergic acid diethylamide (LSD).

BACKGROUND: Recreational lysergic acid diethylamide (LSD) use is growing in popularity amid increasing research interest on psychedelics and their possible therapeutic potential yet; the potent psychotropic effects of LSD may result in adverse reactions and behaviour. AIMS: This study aimed to investigate the 12-month incidence and nature of LSD-related adverse experiences resulting in emergency medical treatment (EMT) seeking in an international sample of people reporting LSD use. METHODS: We use data from the 2017 Global Drug Survey - a large anonymous online survey on patterns of drug use conducted between November 2016 and January 2017. RESULTS: Out of 10,293 past-year LSD users, 102 (1.0%) reported seeking EMT, with a per-event risk estimate of 0.2%. Younger age, comorbid mental health conditions and higher frequency of use were associated with increased risk of EMT seeking. The most common symptoms were psychological, including anxiety, panic and confusion, with the most common explanatory factors cited by respondents being poor 'setting' and 'mindset'. Most responders reported feeling back to normal within 24 h, but 11 participants experienced persistent issues after 4 weeks. CONCLUSION: The results suggest that LSD is a relatively safe drug in recreational settings. Adverse reactions are typically short-lived, self-limiting and psychological in nature. Sub-optimal set and setting were commonly reported as suspected contributory factors. Within clinical settings, patient screening, preparatory sessions and supervision should reduce these acute risks considerably.

Global comparisons of responses to alcohol health information labels: A cross sectional study of people who drink alcohol from 29 countries.

AIMS: The aim of this paper was to explore responses to alcohol health information labels from a cross sectional survey of people who drink alcohol from 29 countries. DESIGN: This paper draws on findings from the Global Drug Survey (GDS) - an annual cross sectional online survey. PARTICIPANTS: 75,969 (64.3% male) respondents from 29 countries were included in the study. MEASURES: Respondents were shown seven health information labels (topics were heart disease, liver, cancer, calories, violence, taking two days off and myth of benefits of moderate drinking). They were asked if the information was new, believable, personally relevant, and if it would change their drinking. A multivariate multilevel Bayesian logistic regression model was used to estimate predicted probabilities for newness, believability, relevance and if messages would change drinking behaviour by country and information label. FINDINGS: Predicted probabilities showed substantial variability in responses across countries. Respondents from Colombia, Brazil and Mexico were more likely to consider drinking less as well as have lower levels of previous awareness. Those from Denmark and Switzerland were not as likely to say the labels would make them consider drinking less. The cancer message was consistently the newest and most likely to make people consider drinking less across countries. CONCLUSIONS: Country differences in responses to messages can be used to create targeted harm reduction measures as well as inform what should be on labels. The provision of such health information on alcohol product labels may play a role in raising awareness of the risk of drinking. Global comparisons of responses to alcohol health information labels: a cross sectional study of people who drink alcohol from 29 countries.

Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms.

BACKGROUND: Psilocybin-containing mushrooms are used for recreational, spiritual, self-development and therapeutic purposes. However, physiologically relatively nontoxic, adverse reactions are occasionally reported. AIMS: This study investigated the 12-month prevalence and nature of magic mushroom-related adverse reactions resulting in emergency medical treatment seeking in a global sample of people reporting magic mushroom use. METHODS: We use data from the 2017 Global Drug Survey - a large anonymous online survey on patterns of drug use conducted between November 2016 and January 2017. RESULTS: Out of 9233 past year magic mushroom users, 19 (0.2%) reported having sought emergency medical treatment, with a per-event risk estimate of 0.06%. Young age was the only predictor associated with higher risk of emergency medical presentations. The most common symptoms were psychological, namely anxiety/panic and paranoia/suspiciousness. Poor 'mindset', poor 'setting' and mixing substances were most reported reasons for incidents. All but one respondent returned back to normality within 24 h. CONCLUSIONS: The results confirm psilocybin mushrooms are a relatively safe drug, with serious incidents rare and short lasting. Providing harm-reduction information likely plays a key role in preventing adverse effects. More research is needed to examine the detailed circumstances and predictors of adverse reactions including rarer physiological reactions.

Who uses digital drugs? An international survey of 'binaural beat' consumers.

INTRODUCTION: Digital drugs, or binaural beats claimed to elicit specific cognitive or emotional states, are a phenomenon about which little is known. In this brief report, we describe demographic and drug use correlates of binaural beat use, patterns of use, reasons for use and methods of access. METHODS: The Global Drug Survey 2021 was translated into 11 languages; 30 896 responses were gathered from 22 countries. RESULTS: The use of binaural beats to experience altered states was reported by 5.3% of the sample (median age 27; 60.5% male), with the highest rates from the United States, Mexico, Brazil, Poland, Romania and the United Kingdom. Controlling for all variables, age and non-male gender predicted binaural beat use, as did the recent use of cannabis, psychedelics and novel/new drugs. Respondents most commonly used binaural beats 'to relax or fall asleep' (72.2%) and 'to change my mood' (34.7%), while 11.7% reported trying 'to get a similar effect to that of other drugs'. This latter motivation was more commonly reported among those who used classic psychedelics (16.5% vs. 7.9%; P < 0.001). The majority sought to connect with themselves (53.1%) or 'something bigger than themselves' (22.5%) through the experience. Binaural beats were accessed primarily through video streaming sites via mobile phones. DISCUSSION AND CONCLUSIONS: This paper establishes the existence of the phenomenon of listening to binaural beats to elicit changes in embodied and psychological states. Future research directions include the cultural context for consumption and proximate experiences, including co-use with ingestible drugs and other auditory phenomena.

Exploring Televend, an innovative combination of cryptomarket and messaging app technologies for trading prohibited drugs.

BACKGROUND: Digital technologies continue to facilitate drug trading. Televend was an innovative combination of multiple digital technologies, with its backend hosted on the darknet, while purchases were made through the messaging app Telegram. Here, we provide an initial characterisation of this nascent market. METHODS: Televend and White House Market (WHM) were scraped (Jun-Jul 2021) and a global cross-sectional web survey of 15,513 drug buyers (Global Drug Survey; GDS) was conducted (Dec 2020-Mar 2021). RESULTS: Televend was 10% of the size of WHM, the largest drug cryptomarket (4515/44,830 listings per week). Both markets predominantly contained drug-related listings covering similar drug categories, with similar country of origin and destination. Very few GDS drug buyers reported use of Televend (0.73%). Most Televend buyers (68/114) reported buying cannabis, then cocaine (20), MDMA (17), and LSD (12). The Televend and darknet groups had similar demographic and drug use characteristics; whereas compared with app purchasers, older age increased the odds of Televend use (aRRR = 1.06, p < .001), identifying as a cisgender woman decreased the odds (aRRR=0.43, p = .004), while last-year use of a greater number of drug types (aRRR = 1.20, p < .001) and less frequent drug use (aRRR=0.998, p = .032) increased the odds of Televend purchase. CONCLUSIONS: While smaller, Televend was not noticeably different in its drug offerings to its largest cryptomarket competitor, and it attracted a cohort more similar to darknet than to app drug buyers. Future Televend-like markets may be attractive to people with less specialised technical knowledge who already routinely scroll through social media feeds.

Clinical withdrawal symptom profile of synthetic cannabinoid receptor agonists and comparison of effects with high potency cannabis.

Synthetic cannabinoid receptor agonists (SCRAs) may be used as an alternative to natural cannabis; however, they may carry a greater risk of problematic use and withdrawal. This study aimed to characterise the withdrawal symptom profile of SCRAs and compare their profile of effect with high-potency herbal cannabis. Global Drug Survey data (2015 and 2016) were used to access a clinically relevant sample of people reporting use of SCRAs >10 times in the past 12-months, a previous SCRA quit attempt, and lifetime use of high-potency herbal cannabis. Participants completed an 11-item SCRA withdrawal symptom checklist and compared SCRAs and high-potency herbal cannabis on their onset and duration of effects, speed of the development of tolerance, severity of withdrawal, and difficulty with dose titration. Participants (n = 284) reported experiencing a mean of 4.4 (95% CI: 4.1, 4.8) withdrawal symptoms after not using SCRAs for >1 day; most frequently reported were sleep issues (59.2%), irritability (55.6%), and low mood (54.2%). Withdrawal symptoms were significantly associated with frequency (>51 vs. 11-50 times per year: IRR = 1.43, 95% CI: 1.16, 1.77, p = 0.005) and quantity (grams per session: IRR = 1.13, 95% CI: 1.05, 1.22, p = 0.001) of SCRA use. Compared to high-potency herbal cannabis, SCRAs were rated as having a faster onset and shorter duration of effects, faster development of tolerance, and more severe withdrawal (p's < 0.001). In conclusion, SCRA withdrawal symptoms are more likely to occur after greater SCRA exposure. The effects of SCRA indicate a more severe withdrawal syndrome and a greater risk of problematic use than natural cannabis.

Microdosing psychedelics: Subjective benefits and challenges, substance testing behavior, and the relevance of intention.

BACKGROUND: Microdosing psychedelics is the practice of taking small, sub-hallucinogenic doses of lysergic acid diethylamide or psilocybin-containing mushrooms. Despite its surging popularity, little is known about the specific intentions to start microdosing and the effects of this practice. AIMS: First, we aimed to replicate previous findings regarding the subjective benefits and challenges reported for microdosing. Second, we assessed whether people who microdose test their substances before consumption. Third, we examined whether having an approach-intention to microdosing was predictive of more reported benefits. METHODS: The Global Drug Survey runs the world's largest online drug survey. Participants who reported last year use of lysergic acid diethylamide or psilocybin in the Global Drug Survey 2019 were offered the opportunity to answer a sub-section on microdosing. RESULTS: Data from 6753 people who reported microdosing at least once in the last 12 months were used for analyses. Our results suggest a partial replication of previously reported benefits and challenges among the present sample often reporting enhanced mood, creativity, focus and sociability. Counter to our prediction, the most common challenge participants associated with microdosing was 'None'. As predicted, most participants reported not testing their substances. Counter to our hypothesis, approach-intention - microdosing to approach a desired goal - predicted less rather than more benefits. We discuss alternate frameworks that may better capture the reasons people microdose. CONCLUSION: Our results suggest the perceived benefits associated with microdosing greatly outweigh the challenges. Microdosing may have utility for a variety of uses while having minimal side effects. Double-blind, placebo-controlled experiments are required to substantiate these reports.

Impacts of changes in alcohol consumption patterns during the first 2020 COVID-19 restrictions for people with and without mental health and neurodevelopmental conditions: A cross sectional study in 13 countries.

BACKGROUND: The initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and without mental health and neurodevelopmental conditions (MHDCs). METHODS: Data came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%). RESULTS: A third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said it affected their physical health negatively (p<.001). Reduced drinking was associated with better mental health among a fifth (21.1%) of respondents with MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living arrangements, employment, coping and distress were significant predictors of increases in drinking. CONCLUSION: Among people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.

Where and What You Drink Is Linked to How Much You Drink: An Exploratory 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: 109 gm wine, 127 gm alcopops, 133 gm of beer, and 134 gm 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.

Perceptions of cannabis health information labels among people who use cannabis in the U.S. and Canada.

BACKGROUND: The emergence of legal cannabis industries poses a new public health challenge. Health information labels are part of the public health strategy for tobacco and alcohol, but there is limited research on cannabis-related messaging. This study explored perceptions of cannabis health information labels among people who used cannabis in the last 12 months residing in the U.S. and Canada. METHODS: The Global Drug Survey (GDS) is a large anonymous cross-sectional web-survey. In GDS2019, respondents were presented with six labels with cannabis-related health information (dependence; driving stoned; harms of smoking; harms to developing brain; lack of motivation; effects on memory), and asked if information was new, believed, would it change behavior, and about acceptability of having health labels on legal products. This paper includes 1,275 respondents from Canada and 2,224 from U.S. states where cannabis was legal at the time of the survey, and 5,230 from other U.S. states. RESULTS: Few respondents said that the information was new (6.6-24.6%). Most said the information was believable (63.5-72.0%) other than for the dependence message (28.1% new, 56.8% believed), which was perceived to be the least likely to change behavior (10.2%). Driving stoned was the message perceived to be the most likely to change behavior (58.5%). Respondents living in Canada were less likely to say information was new and rated most messages more believable than those in the U.S. Respondents from legal U.S. states were less likely to say information was new compared to other states. Respondents who used cannabis daily rated acceptability of labels lower (27.8%) than those using 1-48 days (40.6%). CONCLUSIONS: Novel, believable information may be more effective at changing behavior. Regular consumers may be less susceptible to messages. Information focusing on safer use strategies and benefits of reducing use may be more acceptable and should be assessed in future research.

Patterns of methamphetamine production among an international sample of methamphetamine 'cooks'.

INTRODUCTION AND AIMS: The illicit manufacture of methamphetamine in clandestine laboratories is associated with significant risks to the community and environment. Currently little is known about clandestine laboratories or the individual 'cooks' who operate them; current research directly engaging with cooks is limited to three qualitative studies with small samples (n < 24) of cooks based in the USA. This descriptive brief report starts to address this knowledge gap by exploring characteristics of an international sample of self-identified methamphetamine cooks. DESIGN AND METHODS: Using data from the 2017 and 2018 Global Drug Surveys, we identified 125 individuals from 24 countries who reported past manufacture of methamphetamine. We explored respondents' socio-demographic characteristics and patterns of methamphetamine production using descriptive statistics. RESULTS: The majority of methamphetamine cooks were male (82%) and Caucasian (70%) and, contrary to previous studies, 43% were employed and 51% had at least a high school certificate. Cooks most commonly sourced precursors from pharmacies (50%), followed by friends (24%). Almost half of the cooks (47%) produced methamphetamine exclusively for self-consumption. DISCUSSION AND CONCLUSIONS: The heterogeneous nature of the sample and varying precursor sources reflect the limitations of existing regulations aimed at limiting methamphetamine production. These findings point to the need for innovative and multi-faceted efforts aimed at reducing and preventing the harms associated with methamphetamine manufacture.

Inhaling alcohol vapour or mist: An international study of use, effects and harms.

OBJECTIVES: To determine the prevalence, patterns of use and consequences of inhaling alcohol vapour or mist. DESIGN: Cross-sectional survey recruiting an international non-probability sample of people who use alcohol and other drugs as part of the annual Global Drug Survey (GDS). SETTING: Online questionnaire translated into 19 languages. PARTICIPANTS: 110,557 people took part in GDS2020 and 88,124 completed a question about inhaling alcohol in the last 12 months. The focus of this study is GDS2020 respondents who reported inhaling alcohol mist/vapour from a balloon in the last 12 months. MAIN OUTCOMES: Last 12-month use of alcohol vapour, onset duration, intensity of effects, value for money compared with alcohol, and incidence of falls/injuries. RESULTS: A total of 803 people reported the use of alcohol vapour in the last 12 months, with 51% of the sample coming from 3 countries: Australia, Denmark and England. Two-thirds were male, and they were more likely to be under 25. 45.7% reported that they were a bit/very drunk before they inhaled alcohol. 51.3% reported that the effects lasted for less than 5 mins. Both the intensity of effect and perceived value for money showed a normal distribution on a 10-point scale. 12.7% of respondents reported falling/injuring themselves. CONCLUSION: Inhaling alcohol vapour appears to be more common amongst younger, higher-risk drinkers. The rapid onset of action and inability to titrate consumption to effect is a risk for acute injury. We consider that alcohol is harmful enough through oral consumption without adding to the risk of injury by offering such a potentially risky additional administration method.

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 87.55 gm to be as drunk as they want to be and female respondents reported 70.16 gm, on average. The tipping point was reached at 138.65 gm 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.

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users.

BACKGROUND: Nitrous oxide (N2O) has been used in clinical and recreational settings for over 150 years. Through inactivation of the Vitamin B12 dependent enzyme, methionine synthase, N2O can lead to the development of peripheral neuropathy. This study sought to determine the relationship between the exposure and risk of neurological symptoms in the largest ever sample of users. DESIGN: Data are drawn from the Global Drug Survey (GDS) over three consecutive years (2014-2016). The Global Drug Survey is an online, cross-sectional survey of substance use, translated into multiple languages. PARTICIPANTS: Respondents to the Global Drug Survey who provided details on N2O use and the experience of paraesthesia in the previous 12 months. MEASUREMENTS: Questions relating to N2O use, peripheral neuropathy, age and gender were explored among last year's users. FINDINGS: Of 241,566 respondents, 41,181 (17.0%) indicated that they had ever used nitrous oxide; of these, 42.1% had used in the last 12 months. For the final model, data from 16,124 participants who had used N2O in the last 12 months and had provided responses on age, dose, gender and paraesthesia were used. Of these, the number of respondents reporting persistent numbness/tingling (paraesthesia) in their hands or feet was 537 (3.3%). Although the risk was very low among infrequent users, there was a strong dose-response relationship. For people indicating one or two doses per session, the probability of reporting paraesthesia was approximately 0.018 by comparison; for people indicating 100 doses per session the probability was approximately 0.085. The association, between dose and paraesthesia was influenced by gender and age. CONCLUSION: While infrequent, episodic users are not at risk, a minority of heavy users are at dose-dependent risk of developing serious neurological consequences. Better education and raised awareness of early symptoms are required.