Mad Honey Ingestion Leading to Grayanotoxin Poisoning During the Burning Man Music Festival: A Case Series.

This is a case series of three patients who presented to the medical facilities at Burning Man, an annual week-long gathering in the Black Rock Desert of Nevada, for recreational grayanotoxin ingestion. Grayanotoxin, also known as "mad honey," caused the patients to present with varying degrees of dizziness, nausea, vomiting, and diarrhea based on the quantity ingested. Vital signs showed significant bradycardia and hypotension and were successfully treated with atropine and intravenous fluids. Patients were later discharged after a period of observation and resolution of symptoms.

Set and Setting for Psychedelic Harm Reduction.

Set and setting is a fundamental concept in the field of psychedelic studies, denoting the crucial importance of context to determining the character and quality of experiences with psychedelics. This paper suggests a framework for thinking of set and setting and its relevance for psychedelic harm reduction. It discusses how "set," the diverse factors related to an individual's mindset, and "setting," the diverse environmental dimensions, influence the psychedelic experience and its outcomes, and the relevance to the field of harm reduction. It additionally provides an overview of four basic modalities of set and setting, the therapeutic, the clinical trial, the ritualistic, and the recreational, examining the differences in set and setting between each and the other according to several key parameters, the implications of such differences, and the ways in which harm reduction strategies informed by the principles of set and setting can be integrated to increase safety and benefits in each case. The integration of set and setting principles into public health policies, alongside education on their significance, could further the efficacy of harm reduction programs in the field of psychedelics.

Vision Threatening Raised Intracranial Pressure Associated with Recreational Nitrous Oxide Use.

Nitrous oxide is used as an anaesthetic and analgesic agent in the medical setting and is known to cause raised intracranial pressure. The use of nitrous oxide recreationally for the drug's euphoric and relaxant properties has been linked to multiple neurological and psychiatric sequelae including neuropathy, myelopathy, and psychosis. We describe a case of a young person who declared heavy nitrous oxide use resulting in vision-threatening papilloedema secondary to raised intracranial pressure. He underwent emergency lumbar drainage alongside high-dose acetazolamide and parenteral vitamin B12 injections. To our knowledge, there have yet to be other reports of cases where heavy nitrous oxide use has caused secondary pseudotumor cerebri syndrome.

Changing cannabis legislation in Canada and a longitudinal look at "regular" cannabis use in patients with eating disorders.

Regular cannabis use (CU), defined as "weekly or more often", is associated with a number of negative mental health outcomes. In the last decade, Canada legalized first medical and then recreational CU. Despite higher prevalence in mental health populations, little research has documented changes in frequency of CU with progressive legalization of cannabis. This study examined rates of CU in a sample of 843 treatment-seeking patients with eating disorders (ED) in an outpatient setting between 2004 and 2020. Across ED diagnoses, segmented regression indicated a significant break-point in regular CU in 2014, commensurate with the relaxation of medical cannabis laws. Regular CU increased from 4.9 % to 23.7 % from 2014 to 2020; well above the stable 6 % found in the general population. No significant break-point was observed in either alcohol or illicit substance use over the same time period. Significant increases in regular CU were found in patients with anorexia nervosa and binge eating disorder, while regular use remained stable in patients with bulimia nervosa. Comorbid psychiatric diagnoses did not increase odds of regular CU. Findings suggest certain patient groups with mental illness may be at risk of engaging in high frequency use in the context of legislation implying medical benefits of cannabis.

Secondhand harms from cannabis use: Findings from Washington State, United States.

OBJECTIVE: There are few studies on harms attributed to others' cannabis use. We assessed individual- and contextual-level correlates of secondhand harms from cannabis use and considered whether cannabis legalization support, along with cannabis user status, predicted such harms. METHOD: Data were from five repeated cross-sectional, state-representative telephone surveys of Washington State residents ages 18 and over, years 2014-2016. For four surveys, outcome variables were past 12-month reports of experiencing any of five harms (family, traffic-related, vandalism, physical or financial), and in 2016 only, three harm types separately: 1) harassment, 2) safety-related (traffic, vandalism, physical), 3) family or financial, attributed to another's cannabis use. All models included a three-category typology comprised of participants' own cannabis use and whether they supported cannabis use legalization (user supporter, non-user non-supporter, non-user supporter). We estimated logistic regression models for the full sample and by gender, adjusting for individual- and Census tract-level covariates. RESULTS: Compared to non-cannabis-users supporting legalization, nonusers who did not support legalization reported significantly greater odds of perceiving secondhand cannabis harms. Cannabis users supporting legalization did not differ from nonuser supporters. Predictors of reported harms also differed by gender. While current drinkers had lower odds of reporting any harm from others' cannabis use overall, heavy drinking women but not men reported greater odds of any cannabis secondhand harm. CONCLUSIONS: Augmenting research on individual harms associated with cannabis use by including secondhand impacts such as social and family problems, along with safety risks, provides a more comprehensive picture of the effects of cannabis use.

Behavioral economic analysis of legal and illegal cannabis demand in Spanish young adults with hazardous and non-hazardous cannabis use.

BACKGROUND: In October 2021, a legal framework that regulates cannabis for recreational purposes in Spain was proposed, but research on its potential impacts on cannabis use is currently limited. This study examined the reliability and discriminant validity of two Marijuana Purchase Tasks (MPTs) for measuring hypothetical legal and illegal cannabis demand, and to examine differences in demand of both commodities in young adults at hazardous vs. non-hazardous cannabis use risk levels. METHODS: A total of 171 Spanish young adults [Mage = 19.82 (SD = 1.81)] with past-month cannabis use participated in a cross-sectional study from September to November 2021. Two 27-item MPTs were used to estimate hypothetical demand for legal and illegal cannabis independently. The Cannabis Use Disorder Identification Test (CUDIT-R) was used to assess hazardous cannabis use and test for discriminant validity of the MPTs. Reliability analyses were conducted using Classical Test Theory (Cronbach's alpha) and Item Response Theory (Item Information Functions). RESULTS: The MPT was reliable for measuring legal (α = 0.94) and illegal (α = 0.90) cannabis demand. Breakpoint (price at which demand ceases), and Pmax (price associated with maximum expenditure) were the most sensitive indicators to discriminate participants with different levels of the cannabis reinforcing trait. No significant differences between legal and illegal cannabis demand in the whole sample were observed, but hazardous vs. non-hazardous users showed higher legal and illegal demand, and decreased Breakpoint and Pmax if cannabis were legal vs illegal. CONCLUSION: The MPT exhibits robust psychometric validity and may be useful to inform on cannabis regulatory science in Spain.

Impacto de la legalización del consumo recreativo del cannabis / Impact of the legalisation of recreational cannabis use

En los últimos años se han producido importantes cambios legislativos en numerosos países respecto al consumo de cannabis con fines medicinales y/o recreativos, que han facilitado su accesibilidad. Actualmente, Uruguay, Canadá y algunos estados de EE.UU. han legalizado el consumo recreativo, aplicando distintos modelos legislativos. El objetivo de la presente revisión es analizar los efectos que ha tenido la legalización del cannabis recreativo sobre su consumo y sus consecuencias. En general, las evidencias indican que la legalización se ha asociado a un descenso en el precio, mayor concentración de THC (potencia), mayor diversidad de presentaciones para su consumo, una menor percepción de riesgo y un incremento en el consumo en adultos y de forma moderada en adolescentes (aunque sea ilegal el consumo para ellos), así como un aumento de las consecuencias adversas derivadas del consumo en la salud pública. Se ha producido un descenso en los arrestos relacionados con el consumo, pero el mercado ilegal sigue utilizándose de forma habitual. No se ha detectado un incremento de la demanda de tratamiento por este consumo. Por el momento, estos cambios legislativos no han conseguido alcanzar sus objetivos principales que eran suprimir el mercado ilegal y proteger a los grupos más vulnerables, mientras que, por el contrario, parecen implicar un incremento de algunos aspectos negativos asociados al consumo de cannabis. Sin embargo, teniendo en cuenta que la mayoría de estos cambios legislativos han entrado en vigor hace relativamente poco tiempo, se requiere un periodo de seguimiento mayor para poder extraer conclusiones definitivas. (AU)

In recent years, there have been important legislative changes in many countries regarding the use of cannabis for medicinal and/or recreational purposes, which have facilitated access to it. Uruguay, Canada and some of the US states are the only jurisdictions that have legalised recreational consumption, applying different legislative models. The aim of this review is to analyse the effects that the legalisation of recreational cannabis has had on its use and its consequences. In general, the evidence accumulated to date indicates that the legalisation of cannabis has been associated with a decrease in the price of the substance, higher concentration of THC (potency), greater diversity of presentations for consumption, lower risk perception and an increase in consumption in adults and moderately in adolescents (even though it is illegal for them to consume), as well as an increase in the adverse consequences derived from cannabis consumption on public health. There has been a decrease in drug-related arrests, but the illegal market continues to be frequently used. No increase in the demand for treatment due to cannabis consumption has been detected. Therefore, these legislative changes have so far failed to achieve their main objectives, which were to suppress the illegal market and protect the most vulnerable groups, while on the contrary, they seem to imply an increase in some of the negative aspects associated with cannabis consumption. However, taking into account that most of these legislative changes have entered into force relatively recently, a longer follow-up period is required to be able to draw definitive conclusions. (AU)

Riesgo sanitario por sustancias tóxicas en aguas superficiales de Tres Arroyos, Argentina / Health risk by toxic substances in freshwater of Tres Arroyos, Argentina / Risco sanitário por substâncias tóxicas em águas superficiais de Tres Arroyos, Argentina

En cursos de agua del partido de Tres Arroyos (provincia de Buenos Aires, Argentina) se encontraron sustancias tóxicas (metales pesados, nitratos, nitritos, fluoruros, sustancias fenólicas y pesticidas organoclorados). El objetivo del trabajo fue estimar el riesgo sanitario para el baño recreativo en esas aguas. El análisis se basó en el modelo USEPA probabilístico para riesgo agregado y acumulativo, tanto para efectos no carcinogenéticos (ENC) como carcinogenéticos (EC), considerando la ingesta accidental de agua y el contacto dérmico. Se planteó un escenario de exposición basado en datos propios y de la literatura para un niño de 10 años como representativo de la población expuesta. Los resultados indican que no existiría riesgo relevante para la actividad recreativa para las concentraciones consideradas. De todos los cuerpos de agua el de mayor riesgo es el Arroyo Claromecó, pero sólo alcanza al 20% del valor limitante. Los metales contribuyen con un 82 y 99% del riesgo total acumulado por ENC y EC, respectivamente, seguidos por las sustancias inorgánicas. Y de los metales, el mayor contribuyente al riesgo es el arsénico, quien aporta el 78 y 99% del riesgo agregado y acumulado por todas las sustancias para ENC y EC, respectivamente.

Toxic substances (heavy metals, nitrate, nitrite, fluoride, phenolic substances and organochlorine pesticides) were detected in Tres Arroyos county freshwaters (Buenos Aires province, Argentina). The aim of this study was estimate the human health risk (HR) associated with these substances during recreational bathing. The probabilistic HR assessment was based on aggregated and cumulative USEPA models. Cancer (CE) and non-cancer (NCE) risk were estimated for accidental drinking and dermal contact during the recreational activity. The exposure scenario considered was based on own and literature data, and a ten year-old child was selected as representative of the exposed population. The results indicated that surveyed substances do not generate any health risk for recreational bathing with direct contact at the specified concentrations and exposure conditions. Claromecó creek station was the riskiest point of whole water bodies, but it reaches only 20% of the limitating value. Metals were the major contributors to overall aggregated and cumulative risk (82% for NCE and 99% for CE), followed by inorganic substances. Arsenic was the most dangerous metal, responsible for the 78 and 99% of the aggregate and cumulative risks for all substances for NCE and CE, respectively.

Em cursos d´água da localidade de Tres Arroyos (Província de Buenos Aires, Argentina) foram encontradas substâncias tóxicas (metais pesados, nitratos, nitritos, fluoretos, substâncias fenólicas e pesticidas organoclorados). O objetivo do trabalho foi calcular o risco sanitário para o banho com fins recreativos nessas águas. A análise foi realizada com base no modelo USEPA probabilístico para risco agregado e acumulativo, tanto para efeitos não carcinogênicos (ENC) como carcinogênicos (EC), considerando a ingestão acidental de água e o contato dérmico. Foi apresentado um cenário de exposição com base em dados próprios e da literatura para um menino de dez anos como representativo da população exposta. Os resultados indicam que não existiria risco relevante para a atividade recreativa para as concentrações consideradas. De todos os corpos de água aquele de maior risco é o Arroyo Claromecó mas só atinge 20% do valor limitante. Os metais contribuem com 82 e 99% do risco total acumulado por ENC e EC, respectivamente, seguidos pelas substâncias inorgânicas. E dos metais, o maior contribuinte ao risco é o arsênico, que oferece 78 e 99% do risco agregado e acumulado por todas as substâncias para ENC e EC, respectivamente.

Salvia divinorum Epling & Játiva (Maria Pastora) e Salvinorina A: crescente uso recreacional e potencial de abuso / Salvia divinorum Epling & Játiva (ska María Pastora) and Salvinorin A: increasing recreational use and abuse potential

A planta Salvia divinorum Epling & Játiva (SDI), da família Lamiaceae, tem sido usada por séculos pela cultura mazateca e vem ganhando popularidade como droga recreacional nos últimos anos. Seu princípio ativo - Salvinorina A (SA) - é agonista dos receptores opióides kappa, com potencial psicotrópico. A utilização da planta vem crescendo na Europa e na América do Norte, apesar de ainda não existirem provas concretas sobre abuso. A presente revisão da literatura contemporânea aborda as evidências sobre o potencial de abuso de SDI, bem como o crescente uso recreacional, ainda que seja alucinógeno permitido legalmente e de fácil compra em muitos países.

The plant Salvia divinorum Epling & Játiva (SDI), of the Lamiaceae family, has been used for centuries by the Mazateca culture and has gained popularity as a recreational drug in the last years. Its active principle, Salvinorin A (SA), is a potentially psychotropic agonist of the kappa opioid receptors. The use of SDI has increased in Europe and North America, although there are no concrete proofs about abuse. The present review discusses current evidence on potential SDI abuse, as well as its increasing recreational use, although it is considered a legalized hallucinogen easily acquired in many countries.

Aspectos médico-legales de la ley que reprime el tráfico de estupefacientes (Ley 23.737) / Substance use disorder: forensic issues in Argentina

La ley de estupefacientes promulgada el 11 de octubre de 1989 describe una serie de tipos penales que comprenden distintas conductas relacionadas con el tráfico de estupefacientes a los cuales castiga con un sistema mixto que incluye la aplicación de penas y de medidas de seguridad. El presente artículo reseña los aspectos jurídicos de la ley que convocan conocimientos psicopsiquiátricos y que incluyen una terminología específica (v.g. usador, habitualidad, experimentador, principiante, dependiente, estupefaciente, medida de seguridad) como así también los principios teóricos básicos subyacentes y las principales discusiones suscitadas acerca de los mismos

This article is a review of the main legal issues in illegal drug traffic in Argentina. The penal law includes corrective punishment, educational activities and forced treatment. Forensic issues and legal controversies are discussed