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1.
Emergencias (Sant Vicenç dels Horts) ; 35(1): 6-14, feb. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-213764

RESUMO

bjetivo. Identificar el perfil epidemiológico, clínico y toxicológico de los pacientes consumidores de ketamina en el contexto de una intoxicación aguda por drogas recreativas.Método. Estudio observacional retrospectivo en pacientes atendidos en varios servicios de urgencias (SU) en Baleares por intoxicaciones agudas por drogas recreativas con exposición a ketamina confirmada analíticamente, entre enero de 2016 y diciembre de 2020. El análisis toxicológico en muestras de orina se realizó mediante inmunoensayo y cromatografía de gases acoplada a espectrometría de masas.Resultados. Se incluyeron 122 pacientes. La edad media fue de 26,7 (DE 6,5) años. La mayoría eran hombres (77,9%) y no residentes en las Islas Baleares (74,6%). Los casos se detectaron mayoritariamente en verano y en Ibiza (84,4%). El uso de ketamina solo fue declarado por el paciente o fue clínicamente sospechado por el médico en el 40,2%. Los signos clínicos más frecuentes fueron taquicardia (43,4%), hipertensión (28,7%), midriasis (27,0%), disminución de la consciencia (25,4%), agitación/agresividad (25,4%) e hipotermia (21,3%). Siete pacientes (5,7%) requirieron ingreso en la unidad de cuidados intensivos (UCI). La cocaína (93,4%) y la 3,4-metilendioximetanfetamina (MDMA) (78,7%) fueron las drogas más detectadas junto con la ketamina. El policonsumo fue habitual (98,4%), combinando ketamina, cocaína y MDMA, en algunos casos asociado a otras sustancias.Conclusiones. La detección de ketamina en intoxicaciones por drogas recreativas se asocia a consumidores con un perfil característico (varones jóvenes, no residentes, asistentes a eventos de música electrónica y policonsumo) y un alto porcentaje desconocen de este consumo. (AU)


Objective. To describe the epidemiologic, clinical, and toxicologic profiles of patients who used recreational ketamine and experienced acute poisoning. Methods. Retrospective observational study of patients attended by several emergency medical services in the Balearic Islands for analytically confirmed acute poisoning after using ketamine between January 2016 and December 2020. Urine samples were analyzed by immunoassay and combined gas chromatography and mass spectrometry. Results. One hundred twenty-two patients were studied. The mean (SD) age was 26.7 (6.5) years. The majority were men (77.9%) and not residents of the Balearic Islands (74.6%). Poisoning cases occurred mainly in the summer and in the island of Ibiza (84.4%). Ketamine use was declared by the patient or clinically suspected in 40.2%. The most common clinical signs were tachycardia (43.4%), hypertension (28.7%), mydriasis (27.0%), altered consciousness (25.4%), agitation/aggressiveness (25.4%), and hypothermia (21.3%). Seven patients (5.73%) required admission to the intensive care unit. The drugs most often detected along with ketamine were cocaine, in 93.4%, and 3,4-methylenedioxymethamphetamine (MDMA), in 78.7%. Multiple-drug use combining ketamine, cocaine, and MDMA, or on occasion additional substances, was detected in 98.4%. Conclusions. Detection of ketamine in urine samples from patients poisoned by recreational drugs is associated with a characteristic profile: young men who are not residents of the Balearic Islands, who attend electronic music. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Ketamina/toxicidade , Drogas Ilícitas , Intoxicação , Serviço Hospitalar de Emergência , Estudos Retrospectivos
2.
Anal Chem ; 95(2): 703-713, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36599091

RESUMO

With synthetic cannabinoid receptor agonist (SCRA) use still prevalent across Europe and structurally advanced generations emerging, it is imperative that drug detection methods advance in parallel. SCRAs are a chemically diverse and evolving group, which makes rapid detection challenging. We have previously shown that fluorescence spectral fingerprinting (FSF) has the potential to provide rapid assessment of SCRA presence directly from street material with minimal processing and in saliva. Enhancing the sensitivity and discriminatory ability of this approach has high potential to accelerate the delivery of a point-of-care technology that can be used confidently by a range of stakeholders, from medical to prison staff. We demonstrate that a range of structurally distinct SCRAs are photochemically active and give rise to distinct FSFs after irradiation. To explore this in detail, we have synthesized a model series of compounds which mimic specific structural features of AM-694. Our data show that FSFs are sensitive to chemically conservative changes, with evidence that this relates to shifts in the electronic structure and cross-conjugation. Crucially, we find that the photochemical degradation rate is sensitive to individual structures and gives rise to a specific major product, the mechanism and identification of which we elucidate through density-functional theory (DFT) and time-dependent DFT. We test the potential of our hybrid "photochemical fingerprinting" approach to discriminate SCRAs by demonstrating SCRA detection from a simulated smoking apparatus in saliva. Our study shows the potential of tracking photochemical reactivity via FSFs for enhanced discrimination of SCRAs, with successful integration into a portable device.


Assuntos
Agonistas de Receptores de Canabinoides , Drogas Ilícitas , Humanos , Agonistas de Receptores de Canabinoides/química , Sistemas Automatizados de Assistência Junto ao Leito , Detecção do Abuso de Substâncias/métodos
3.
Forensic Toxicol ; 41(1): 151-157, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36652056

RESUMO

PURPOSE: Methyl-2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (4F-MDMB-BINACA) is a newly emerging synthetic cannabinoid receptor agonists (SCRA) first described in 2018 in both Europe and the United States. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol. METHODS: The victims were brothers who were both found deceased after consuming 4F-MDMB-BINACA and ethanol. Post-mortem toxicological analyses of blood and urine were carried out by supercritical fluid chromatography tandem mass spectrometry (SFC-MS/MS) and headspace gas chromatography with flame ionization detection (HS-GC-FID). RESULTS: The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. CONCLUSION: According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The threshold SCRA concentration for fatal overdose can be estimated ng/mL level (0.37-4.1 ng/mL according to the reported cases) in cases in which 1.5-2.5 g/L of ethanol is present in the blood.


Assuntos
Canabinoides , Drogas Ilícitas , Masculino , Humanos , Estados Unidos , Canabinoides/análise , Espectrometria de Massas em Tandem , Drogas Ilícitas/análise , Cromatografia Gasosa-Espectrometria de Massas , Etanol/análise , Concentração Alcoólica no Sangue , Agonistas de Receptores de Canabinoides/análise
4.
Harm Reduct J ; 20(1): 8, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670386

RESUMO

Drug use is a critical behavioral disorder or a delinquency behavior (in the judiciary system's words) that comes with a burden at multiple levels: individual, community, public, and global. These social structures apply different interventions to reduce this burden in their field. Given the society as a whole, these structures must be harmonious and synergistic to optimize these endeavors in terms of cost-benefit. In practice, however, reducing the burden of addiction is followed by conflicting approaches by different organizations, in terms such as "eradicating drugs," "eliminating drug users," "obliterating addiction," and ultimately, drug use harm reduction. In the harm reduction philosophy, drug use is recognized as an inescapable fact in human societies, and tries to control its personal and public consequences in different dimensions (health, economic, and social). Therefore, this approach includes broad measures such as: changing the pattern of consumption (from high-risk substances to less dangerous substances) through modification of the laws and law enforcement measures, distributing disposable syringes to prevent HIV transmission, providing basic life needs such as shelter for street-based drug users to reduce the social consequences like homelessness, prescribing substitute agonists to reduce the committing crime to obtain the needed drugs, and even the drug court program, which prevents the exacerbation of complications in a person with a chronic and relapsing disorder, due to the imposition of inappropriate sentences (like incarceration in unacceptable conditions). It is contrary to the approaches that aim to reduce the drug supply rate and drug use incidence and prevalence to zero. As a result of the conflict of interests, goals discrepancies, and differences in organizational culture, these approaches may contrast with each other. We see this in the harm reduction between the health system and law enforcement. Different factors affect the harmony or conflict between these two structures. This article addresses the impact of ideology, social conditions, and bureaucratic administration on the relationship between the health system and the police in drug use harm reduction in Iran.


Assuntos
Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Polícia , Redução do Dano , Irã (Geográfico) , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Política Pública
5.
Am J Public Health ; 113(S1): S43-S48, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36696623

RESUMO

The US overdose crisis continues to worsen and is disproportionately harming Black and Hispanic/Latino people. Although the "War on Drugs" continues to shape drug policy-at the disproportionate expense of Black and Hispanic/Latino people-states have taken some steps to reduce War on Drugs-related harms and adopt a public health-centered approach. However, the rhetoric regarding these changes has, in many cases, outstripped reality. Using overdose Good Samaritan Laws (GSLs) as a case study, we argue that public health-oriented policy changes made in some states are undercut by the broader enduring environment of a structurally racist drug criminalization agenda that continues to permeate and constrict most attempts at change. Drawing from our collective experiences in public health research and practice, we describe 3 key barriers to GSL effectiveness: the narrow parameters within which they apply, the fact that they are subject to police discretion, and the passage of competing laws that further criminalize people who use illicit drugs. All reveal a persisting climate of drug criminalization that may reduce policy effectiveness and explain why current reforms may be destined for failure and further disadvantage Black and Hispanic/Latino people who use drugs. (Am J Public Health. 2023;113(S1):S43-S48. https://doi.org/10.2105/AJPH.2022.307037).


Assuntos
Overdose de Drogas , Drogas Ilícitas , Humanos , Racismo Sistêmico , Overdose de Drogas/prevenção & controle , Overdose de Drogas/tratamento farmacológico , Polícia , Política Pública
6.
BMC Infect Dis ; 23(1): 16, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624391

RESUMO

BACKGROUND: To evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France. METHODS: A multi-centric, cross-sectional analysis was conducted in 2018-19 in the QuAliV study-ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio. RESULTS: 660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; ~ 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users' CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] - 0.383, - 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI - 0.343, 0.012] in multivariable analysis (p = 0.068). CONCLUSIONS: Mean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation. TRIAL REGISTRATION NUMBER: NCT03296202.


Assuntos
Fármacos Anti-HIV , Cannabis , Infecções por HIV , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Linfócitos T CD8-Positivos , Estudos Transversais , Etanol , Infecções por HIV/tratamento farmacológico , Inflamação/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Tabaco , Carga Viral , Adulto , Pessoa de Meia-Idade , Idoso
7.
Drug Alcohol Depend ; 243: 109741, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36630807

RESUMO

BACKGROUND: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.


Assuntos
Infecções por HIV , Drogas Ilícitas , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Masculino , Humanos , Homossexualidade Masculina , Sexo sem Proteção , Teorema de Bayes , Estudos Transversais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Ásia/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Comportamento Sexual
8.
Forensic Toxicol ; 41(1): 47-58, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36652054

RESUMO

PURPOSE: Methyl (S)-2-(1-7 (5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMA-PICA) intoxication in 1.5-year-old child was presented, together with diagnostic parameters discussion and 5F-MDMB-PICA determination in biological material. Furthermore, 5F-MDMB-PICA metabolites were identified in a urine sample as markers of exposure in situation when a parent compound is not present in specimens. METHODS: Drugs and metabolites were extracted from serum and urine with ethyl acetate both under alkaline (pH 9) and acidic (pH 3) conditions. Hair, after decontamination and pulverization, were incubated with methanol (16 h, 60 °C). The analysis was carried out using ultra-high-performance liquid chromatography-tandem mass spectrometry. For the identification of 5F-MDMB-PICA metabolites, an urine sample was precipitated with cold acetonitrile. Analysis was performed using ultra-high-performance liquid chromatograph with quadrupole time-of-flight mass spectrometer. RESULTS: 5F-MDMB-PICA was determined only in serum sample at concentration of 298 ng/mL. After 1 year, when analysis was repeated, concentration of synthetic cannabinoid in the same sample was only 17.6 ng/mL which revealed high instability of 5F-MDMB-PICA in serum sample. Eight 5F-MDMB-PICA metabolites were identified in urine sample, including two potentially new ones with m/z 391.18964 and m/z 275.14016. CONCLUSIONS: Toxicological analysis confirmed a 1.5-year-old boy intoxication with 5F-MDMB-PICA. Besides the parent drug, metabolites of 5F-MDMB-PICA were identified, including two potentially new ones, together with possible metabolic reactions which they resulted from. Metabolites determination could serve as a marker of 5F-MDMB-PICA exposure when no parent drug is present in biological material.


Assuntos
Canabinoides , Drogas Ilícitas , Masculino , Humanos , Pré-Escolar , Lactente , Cromatografia Líquida de Alta Pressão , Espectrometria de Massas em Tandem/métodos , Drogas Ilícitas/metabolismo , Canabinoides/análise , Indóis
10.
Forensic Toxicol ; 41(1): 25-46, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36652065

RESUMO

PURPOSE: The emergence of novel psychoactive substances (NPS) has been being a continuous and evolving problem for more than a decade. Every year, dozens of new, previously unknown drugs appear on the illegal market, posing a significant threat to the health and lives of their users. Synthetic cathinones are one of the most numerous and widespread groups among NPS. The purpose of this work was to identify and summarize available data on newly emerging cathinones in very recent years. METHODS: Various online databases such as PubMed, Google Scholar, but also databases of government agencies including those involved in early warning systems, were used in search of reports on the identification of newly emerging synthetic cathinones. In addition, threads on various forums created by users of these drugs were searched for reports on the effects of these new substances. RESULTS: We have identified 29 synthetic cathinones that have been detected for the first time from early 2019 to mid-2022. We described their structures, known intoxication symptoms, detected concentrations in biological material in poisoning cases, as well as the countries and dates of their first appearance. Due to the lack of studies on the properties of the novel compounds, we compared data on the pharmacological profiles of the better-known synthetic cathinones with available information on the newly emerged ones. Some of these new agents already posed a threat, as the first cases of poisonings, including fatal ones, have been reported. CONCLUSIONS: Most of the newly developed synthetic cathinones can be seen as analogs and replacements for once-popular compounds that have been declining in popularity as a result of legislative efforts. Although it appears that some of the newly emerging cathinones are not widely used, they may become more popular in the future and could become a significant threat to health and life. Therefore, it is important to continue developing early warning systems and identifying new compounds so that their widespread can be prevented.


Assuntos
Alcaloides , Drogas Ilícitas , Drogas Ilícitas/efeitos adversos , Psicotrópicos/efeitos adversos , Gerenciamento de Dados
11.
Harm Reduct J ; 20(1): 3, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624508

RESUMO

BACKGROUND: Drug alerts designed for health and community workforces have potential to avert acute harms associated with unpredictable illicit drug markets, by preparing workers to respond to unusual drug-related events, and distribute information to service users. However, the design of such alerts is complicated by diverse needs of individuals, and broader socio-political contexts. Here, we discuss the tensions that arose in the process of co-designing drug alert templates with health and community workers. METHODS: We conducted five in-depth digital co-design workshops with 31 workers employed in alcohol and other drug and urgent care settings. Our approach to analysis was informed by Iterative Categorisation and reflexive thematic analysis methods. RESULTS: We identified five key tensions. First, there is a need to provide comprehensive information to meet the information needs of a diverse group of workers with varying knowledge levels, while also designing alerts to be clear, concise, and relevant to the work of individuals. Second, it is important that alerts do not create 'information overload'; however, it is also important that information should be available to those who want it. Third, alert design and dissemination must be perceived to be credible, to avoid 'alert scepticism'; however, credibility is challenging to develop in a broader context of criminalisation, stigmatisation, and sensationalism. Fourth, alerts must be carefully designed to achieve 'intended effects' and avoid unintended effects, while acknowledging that it is impossible to control all potential effects. Finally, while alerts may be intended for an audience of health and community workers, people who use drugs are the end-users and must be kept front of mind in the design process. CONCLUSIONS: The co-design process revealed complexities in designing drug alerts, particularly in the context of stigmatised illicit drug use, workforce diversity, and dissemination strategies. This study has highlighted the value of developing these important risk communication tools with their target audiences to ensure that they are relevant, useful, and impactful. The findings have informed the development of our drug alert prototypes and provide local context to complement existing best-practice risk-communications literature.


Assuntos
Redução do Dano , Drogas Ilícitas , Humanos , Comunicação
12.
East Mediterr Health J ; 29(1): 24-32, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36710611

RESUMO

Background: Drug use disorders are significant social and public health concerns in the Islamic Republic of Iran; however, little is known about drug-related mortality. Aims: We quantified the spatial and age distribution of direct illicit-drug-related mortality in the Islamic Republic of Iran, to inform harm reduction policies and interventions. Methods: We modelled and mapped registered illicit-drug-related deaths from March 2016 to March 2017. Data were obtained from the Iranian Forensic Medicine Organization. Besag-York-Mollie models were fitted using Bayesian spatial analysis to estimate the relative risk of illicit-drug-related mortality across different provinces and age groups. Results: There were 2203 registered illicit-drug-related deaths during the study period, 1289 (58.5%) occurred in people aged 20-39 years and among men (n = 2013; 91.4%). The overall relative risk (95% credible interval) of illicit-drug-related mortality in the provinces of Hamadan (3.37; 2.88-3.91), Kermanshah (1.90; 1.55-2.28), Tehran (1.80; 1.67-1.94), Lorestan (1.71; 1.37-2.09), Isfahan (1.40; 1.21-1.60), and Razavi Khorasan (1.18; 1.04-1.33) was significantly higher than in the rest of the country. Conclusion: We found evidence of age differences and spatial variations in illicit-drug-related mortality across different provinces in the Islamic Republic of Iran. Our findings highlight the urgent need to revisit existing drug-use treatment and harm reduction policies and ensure that overdose prevention programmes are adequately available for different age groups and settings.


Assuntos
Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Masculino , Humanos , Drogas Ilícitas/efeitos adversos , Irã (Geográfico)/epidemiologia , Teorema de Bayes , Análise Espacial
13.
Appetite ; 182: 106446, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36592797

RESUMO

The impact of exercise on food reward is increasingly being discussed as an interplay between executive function (EF), homeostasis and mechanisms promoting or undermining intentional behaviour change. Integrating current knowledge of neurocognitive processes encompassing cognitive and affective networks within an energy balance framework will provide a more comprehensive account. Reward circuitry affected by recreational drugs and food overlap. Therefore the underlying processes explaining changes in drug-taking behaviour may offer new insights into how exercise affects the reward value of recreational drugs and food. EF is important for successful self-regulation, and training EF may boost inhibitory control in relation to food- and drug-related reward. Preclinical and clinical observations suggest that reward-seeking can transfer within and between categories of reward. This may have clinical implications beyond exercise improving metabolic health in people with obesity to understanding therapeutic responses to exercise in people with neurocognitive deficits in non-food reward-based decision making such as drug dependence.


Assuntos
Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Função Executiva/fisiologia , Alimentos , Recompensa
15.
Int J Drug Policy ; 111: 103929, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36529032

RESUMO

Overdose Prevention Sites (OPS) are low-barrier services where people may use illicit drugs under the monitoring of staff trained to provide life-saving care in the event of an overdose. In British Columbia (BC), Canada, OPS have been rapidly scaled-up as a community-based response to the overdose crisis and are staffed primarily by community members who are also people who use drugs (PWUD). While it is known that PWUD perform vital roles in OPS and other community-based overdose interventions, the expertise and expert knowledge of PWUD in this work remains under-theorised. This study draws on 20 months of ethnographic fieldwork in Vancouver, BC (July 2018 to March 2020), to explore how OPS responders who are PWUD developed and enacted expertise in overdose response. Ethnographic fieldwork focused on four OPS located in Vancouver's Downtown Eastside (DTES) and Downtown South neighbourhoods. Methods included 100 hours of observation in the sites and surrounding areas, three site-specific focus groups with OPS responders (n=20), and semi-structured interviews with OPS responders (n=14) and service users (n=23). Data was analysed with the aim of characterizing the knowledge underpinning responders' expertise, and the arrangements which allow for the formation and enactment of expertise. We found that OPS responders' expertise was grounded in experiential knowledge acquired through their positionality as PWUD and members of a broader community of activists engaged in mutual aid. Responders became skilled in overdose response through frequent practice and drew on their experiential and embodied knowledge of overdose to provide care that was both technically proficient and responsive to the broader needs of PWUD (e.g. protection from criminalization and stigmatizing treatment). Responders emphasized that the spatial arrangements of OPS supported the development of expertise by facilitating more specialized and comprehensive overdose care. OPS became sites of collective expertise around overdose management as responder teams developed shared understandings of overdose management, including processes for managing uncertainty, delegating team responsibilities, and sharing decision-making. This research re-situates theoretical understandings of expertise in community-based overdose response with implications for overdose prevention interventions. Findings underscore the experiential and embodied expertise of PWUD as community-based responders; the importance of supportive environments and team-based approaches for overdose response; and the benefits of community-driven training that extends beyond technical skills of overdose identification and naloxone administration.


Assuntos
Overdose de Drogas , Drogas Ilícitas , Humanos , Overdose de Drogas/prevenção & controle , Overdose de Drogas/tratamento farmacológico , Canadá , Colúmbia Britânica , Naloxona/uso terapêutico , Antropologia Cultural
16.
Int J Drug Policy ; 111: 103933, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36529033

RESUMO

The overdose crisis in Canada has continuously evolved and is increasingly challenging to contain, while efforts from governments and policymakers to address it have often fallen short and resulted in unintended consequences. One of the main repercussions has been an unprecedented rise in adulterants in the illegal drug supply, including a wide array of pharmacological and psychoactive compounds and chemicals, which has resulted in a progressively toxic drug supply. Most recently, there has been a stark increase in synthetic benzodiazepine-laced opioids (i.e., 'benzodope') in some Canadian jurisdictions. This unique combination carries distinct and amplified risks for people who use drugs including fatal and non-fatal overdoses, increased dependence and withdrawal symptoms, and places them in extremely vulnerable positions. The emergence of benzodiazepines within the illicit drug supply has substantially contributed to drug-related morbidity and mortality in Canada, and has further complicated current public health initiatives and overdose prevention efforts. This reality underscores the need for effective and sustainable policy solutions to address the evolving overdose epidemic including increased knowledge and education on the specific harms of opioid and benzodiazepine co-use (especially in regards to the complexity of opioid/benzodiazepine overdoses), scaling-up harm reduction measures, and eliminating the toxic drug supply altogether.


Assuntos
Overdose de Drogas , Drogas Ilícitas , Humanos , Analgésicos Opioides , Canadá/epidemiologia , Benzodiazepinas/efeitos adversos , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Risco
17.
Ir J Med Sci ; 191(4): 1701-1710, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34545479

RESUMO

BACKGROUND: Festival drug-related deaths are a growing public health concern. AIM: To examine drug use and related harm-reduction practices and attitudes towards utilisation of drug safety testing services. METHODS: Data collection took place over the 2019 festival season (June-October). The questionnaire was self-reported. Data was gathered via the online survey, which was promoted through online and social media platforms and outlets. Social media communication methods were used to reach the targeted population more effectively. RESULTS: A total of 1193 Irish festival attendees over the age of 18 completed an anonymous online survey. Alcohol, MDMA powder/crystals, ecstasy pills and cocaine were the highest reported drugs used by Irish festival attendees. The vast majority of participants reported polysubstance use (86.8%/n = 1036). Forty percent of participants (39.98%/n = 477) reported having had sex following the use of a drug at a festival; of these, 66% (n = 316) said that the sex was unprotected. Most participants (84.0%/n = 1003) engaged in some form of harm reduction when taking drugs at festivals. Overwhelmingly, participants reported a willingness to engage with drug-checking services. The vast majority (96.3%; n = 1149) and would use drug checking services more than three-quarters (75.1%/n = 897) reported that they would use an 'amnesty bin' for drugs if it were part of an alert system to notify if dangerous drugs are in circulation. A chi-square test of Independence was conducted to examine whether age and utilisation of drug safety testing service a festival were independent. Moreover, when all cases are taken together, the difference between testing modalities (onsite, offsite and amnesty bin) shows a significant difference p < 001 between those who would use onsite and offsite drug testing facilities. CONCLUSION: The evidence from this survey indicates that those young people who use drugs at festivals would be prepared to utilise drug checking services and amnesty bins should help inform the public health response to this important area.


Assuntos
Drogas Ilícitas , Música , N-Metil-3,4-Metilenodioxianfetamina , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Atitude , Redução do Dano , Férias e Feriados , Humanos , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/química , Pessoa de Meia-Idade , Autorrelato
18.
Forensic Toxicol ; 40(2): 349-356, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36454409

RESUMO

PURPOSE: The number of benzodiazepines appearing as new psychoactive substances (NPS) is continually increasing. Information about the pharmacological parameters of these compounds is required to fully understand their potential effects and harms. One parameter that has yet to be described is the blood-to-plasma ratio. Knowledge of the pharmacodynamics of designer benzodiazepines is also important, and the use of quantitative structure-activity relationship (QSAR) modelling provides a fast and inexpensive method of predicting binding affinity to the GABAA receptor. METHODS: In this work, the blood-to-plasma ratios for six designer benzodiazepines (deschloroetizolam, diclazepam, etizolam, meclonazepam, phenazepam, and pyrazolam) were determined. A previously developed QSAR model was used to predict the binding affinity of nine designer benzodiazepines that have recently appeared. RESULTS: Blood-to-plasma values ranged from 0.57 for phenazepam to 1.18 to pyrazolam. Four designer benzodiazepines appearing since 2017 (fluclotizolam, difludiazepam, flualprazolam, and clobromazolam) had predicted binding affinities to the GABAA receptor that were greater than previously predicted binding affinities for other designer benzodiazepines. CONCLUSIONS: This work highlights the diverse nature of the designer benzodiazepines and adds to our understanding of their pharmacology. The greater predicted binding affinities are a potential indication of the increasing potency of designer benzodiazepines appearing on the illicit drugs market.


Assuntos
Drogas Ilícitas , Receptores de GABA-A , Benzodiazepinas/farmacologia , Plasma , Ácido gama-Aminobutírico
20.
Forensic Toxicol ; 40(2): 234-243, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36454418

RESUMO

PURPOSE: Since the appearance of fentanyl followed by its many kinds of analogues around 1988, North America has been exposed to fierce synthetic opioid pandemic resulting in more than 130,000 deaths due to their overdoses until May 2019, when China declared to prohibit the licit fentanyl analog production. However, the Chinese announcement did not go into force in USA due to the adroit strategies of tough traffickers. Thus, contrary to the expectation, the number of synthetic opioid products and their poisoning cases in USA has increased by about 30%; especially, various benzimidazole synthetic opioids have revived on the illicit drug market during a recent few years. In this article, the recent abrupt changes in the situations of illicit synthetic opioid market and their current abuses are described. METHODS: Various databases, such as SciFinder, Google, and Google Scholar, were utilized to collect relevant reports referring old but newly appearing synthetic opioids. RESULTS: At the present time, there are several families of new synthetic opioids, which are not fentanyl derivatives; MT-45 and its analogs, benzamide and 2-phenylacetamide opioids (U-series opioids), and benzimidazole opioids. Most of the above substances had been developed in 1950s to 1970s, but had never been used as analgesic medicines, because of their severe adverse effects, such as respiratory depression, physical dependence, and resulting deaths. However, there is possibility that these drugs will become main illicit synthetic opioids in place of the fentanyl analogs during coming several years from this time. CONCLUSIONS: All of the above non-fentanyl-derived families had been developed 50-70 years ago to establish them as analgesic medicines, but had been unsuccessful. These drugs largely appeared in the illicit drug markets in North America, Europe, and Australia, during recent years. Pharmacological, toxicological, and metabolic studies are insufficient for benzamide and 2-phenylacetamide opioids, and are very scant especially for benzimidazole opioids. This time we should start studying pharmacotoxicology of the newly emerging synthetic opioids to alert forensic toxicologists in the world and to suppress their rapid and wide spread in the world.


Assuntos
Benzenoacetamidas , Drogas Ilícitas , Fentanila/efeitos adversos , Analgésicos Opioides/efeitos adversos , Benzamidas , Benzimidazóis
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