[Chemsex : A new challenge in addiction medicine and infectious diseases]. / Chemsex : Eine neue Herausforderung der Suchtmedizin und Infektiologie.

BACKGROUND: Recently there has been an increase in reports of the phenomenon called chemsex, a subform of sexualized substance use. Chemsex is a neologism consisting of the two terms "chemicals" and "sex". It describes the use of methamphetamine, γ­hydroxybutyrate/γ-butyrolactone (GHB/GBL), mephedrone and sometimes other substances in a sexual context, especially by men who have sex with men (MSM). Chemsex has been described as a significant risk factor for mental and physical diseases. OBJECTIVE: Due to the increasing importance of the phenomenon and the significantly increased number of publications on the subject, this article provides an overview of the current and relevant literature. The aim is to raise awareness on this topic among practitioners and researchers and thus to facilitate access to the help system for those affected. METHOD: A literature search was conducted in PubMed/Medline, Cochrane and Embase for the terms "chemsex", "sexualized drug use" and "slamming. A total of 22 articles were identified as being relevant. RESULTS: In the published literature on chemsex the current focus lies on somatic comorbidities. There is a significantly increased risk of sexually transmitted diseases. Mental illnesses such as depression, substance-induced psychosis and addiction also appear to be a significant consequence of chemsex. An individualized and specialized treatment approach is not yet established. DISCUSSION: The complexity of chemsex with its psychiatric and somatic aspects does not yet appear to be sufficiently reflected by the current data situation; however, due to the mutual influence of these different comorbidities, this patient clientele appears to be particularly at risk in the absence of a specialized treatment option, which is why further research on this topic is needed.

Cardiovascular functions and arterial stiffness after JUUL use.

INTRODUCTION: The rapid growth in the e-cigarette market after the launch of JUUL e-cigarettes led to much discussion on the potential benefits and risks of pods, JUUL devices, and conventional e-cigarettes compared with combustible cigarettes. Independent data are required to assess the effects of these products on cardiovascular surrogate parameters and cardiovascular risk. METHODS: We conducted a single-center three-arm study comparing combustible cigarettes with JUUL e-cigarettes with the old and new technology. We recruited 32 participants who were active smokers (n=15) or vapers (n=17) and performed a total of 39 measurements before and 5, 15, and 30 minutes, after participants smoked a combustible cigarette or vaped a JUUL e-cigarette with the new or old technology. Measurements included peripheral and central blood pressures and parameters of arterial stiffness, including pulse wave velocity and augmentation index. RESULTS: Peripheral systolic blood pressure, central blood pressure, and peripheral pulse rate increased significantly in all three groups (each p<0.05). Heart rate (HR) changes lasted significantly longer than blood pressure changes. The augmentation index and pulse wave velocity increased in all three groups, and a multivariate analysis of variance showed that the increases were independent of systolic blood pressure, sex, age, device, and HR. CONCLUSIONS: Changes in blood pressure and arterial stiffness are similar after cigarette smoking and JUUL use. These changes may be associated with an increased cardiovascular risk compared with no product use. However, a long-term follow-up evaluation of JUUL use and a head-to-head comparison with conventional e-cigarettes are still needed.

We Have a Lot to Do: Lack of Sexual Protection and Information-Results of the German-Language Online Survey "Let's Talk About Chemsex".

Background: The prevalence of chemsex and sexualized substance use is increasing in several European countries, particularly among men who have sex with men. In this subgroup, illegal substance use is associated with increased sexual risk behavior, which can result in severe physical and psychological impairments. The present study examined the incidence and prevalence of chemsex in German-speaking countries. Methods: To further describe the high-risk group of Chemsex users, participants (N = 429) were asked about their psychotropic substance use, sexual and health-related behavior, health status, and socio-demographic information by using an online questionnaire. Whether Chemsex has negative effects on well-being was measured with the WHO well-being index. Of additional interest was how informed Chemsex users are about the topic and what needs are placed on the practitioners. The online questionnaire consisted of 105 items, and data was collected from March to May 2019. Thousand forty seven datasets were saved with a dropout rate of 59%, 123 completed questionnaires fulfilled the criteria for chemsex users (n =123). Results: There were no significant differences in well-being between chemsex users and non-users. All participants protected themselves against sexually transmitted diseases irregularly or not at all. The majority of chemsex users reported intermittently using illegal substances (ketamine, methamphetamine, mephedrone, γ-butyrolactone/γ-hydroxy butyric acid). They viewed their sexual and substance use behavior as problematic, but few showed motivation for behavior change. Chemsex users clearly expressed a need for more information and advice centers. Conclusion: The results provide information on chemsex users that can be used for the future development of a therapy manual and thus contribute to improving health care for this group. The prevalence of chemsex is increasing and urgently needs more research to protect clients from health impairments and stigmatization.

Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification.

The emergence of e-cigarettes on the consumer market led to a tremendous rise in e-cigarette consumption among adolescents in the United States. The success of JUUL and other pod systems was linked to its high nicotine delivery capacity. In compliance with the European Tobacco Product directive, liquid nicotine contents in the European JUUL variants are limited to 20 mg/mL or below. A short time after launching the initial version in Europe, JUUL pods have been modified in terms of the wick material used. This modification has been demonstrated previously to lead to an elevated aerosol generation, consequently, to a larger amount of nicotine per puff generated. The present study was designed to assess whether the mentioned differences between the "initial" and "modified" JUUL versions may cause a significant difference during consumption, and how nicotine delivery compares with tobacco cigarettes. In this single-center three-arm study, nicotine pharmacokinetics and influence on urge to smoke/vape were compared for tobacco cigarettes, the "initial" version of the European JUUL, and the "modified" version of the European JUUL. Participants, 15 active smokers and 17 active e-cigarette users, were instructed to consume their study product according to a pre-directed puffing protocol. Venous blood was sampled for nicotine analysis to cover the acute phase and the first 30 min after starting. Nicotine delivery and the reduction of urge to smoke/vape upon usage of both European JUUL variants were lower in comparison to tobacco cigarettes. This suggests a lower addictive potential. Modification of the pod design did not result in significant differences at the first ten puffs, as confirmed by a vaping machine experiment. Apparently, the limitations by the initially used wick material only come into effect after longer usage time.