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3.
Tijdschr Psychiatr ; 63(9): 665-672, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34647305

RESUMO

BACKGROUND: MDMA (ecstasy) is a relatively safe drug and induces little dependence, but is nevertheless scheduled as a hard drug (Dutch Opium Act, List 1). Concerns about MDMA-related crime, health incidents and possible inappropriate listing of MDMA on List I have led to an ongoing debate about current Dutch ecstasy policy. AIM: To develop a rational MDMA policy that takes into account all aspects related to production, sale and use of MDMA. METHOD: An interdisciplinary group of 18 experts formulates a science-based MDMA policy by assessing the expected effects of 95 policy options on 25 outcomes, including health, crime, law enforcement and finance. The optimal policy model consists of the combination of the 22 policy options with the highest total score on all 25 outcomes. RESULTS: The optimal policy model consisted of a form of regulated production and sale of MDMA, better quality management of ecstasy tablets and more intensive fight against MDMA-related organized crime. Such a policy would lead to a small increase in the prevalence of ecstasy use, but with less health damage, less MDMA-related crime, and less environmental damage. To increase practicality and political feasibility, the optimal model was slightly modified. CONCLUSION: The developed optimal model offers a politically and socially feasible set of policy instrument options, with which the placement of MDMA on List I can be revised, thereby reducing the damage of MDMA to users and society. For psychiatry, it means promoting therapeutic research and less nuisance from unnecessary stigmatization in the treatment of patients.


Assuntos
Alucinógenos , N-Metil-3,4-Metilenodioxianfetamina , Psiquiatria , Crime , Humanos , Políticas
6.
N Z Med J ; 134(1537): 11-26, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34239158

RESUMO

AIMS: A discrete experiment in wastewater-based epidemiology (WBE) timed to coincide with the census was used to investigate the spatial, temporal and socioeconomic patterns of illicit drug consumption in Auckland, Bay of Plenty and Canterbury. METHODS: For seven consecutive days over census week (6 March 2018), wastewater was sampled from seven wastewater treatment plants and analysed for methamphetamine, cocaine (as benzoylecgonine) and 3,4-methylenedioxymethamphetamine (MDMA). Detailed sewer catchment maps were developed and, together with the data, were used to analyse drug consumption. RESULTS: Methamphetamine (mean 22.9 ± 9.9 doses/day/1000 people) was the most consumed drug, followed by MDMA (mean 1.7 ± 1.5 doses/day/1000 people) and cocaine (mean 0.5 ± 0.3 doses/day/1000 people). Methamphetamine consumption (and to a lesser extent MDMA) was high compared to that reported for Western nations, while cocaine consumption was extremely low. Cocaine and MDMA consumption were higher in cities compared to towns. In contrast, methamphetamine was typically higher in towns. Cocaine and MDMA were consumed more at weekends. Methamphetamine use was more consistent throughout the week. MDMA and cocaine were correlated with socioeconomic advantage, whereas methamphetamine was correlated with disadvantage. CONCLUSIONS: This paper contextualises illicit drug use in three New Zealand regions containing 18.3% of the national population and confirms the pervasiveness of methamphetamine consumption in New Zealand towns. This work demonstrates how WBE can be used to explore the socioeconomic dimensions of drug use when duly combined with other data sources like censuses.


Assuntos
Detecção do Abuso de Substâncias/métodos , Águas Residuárias/química , Vigilância Epidemiológica Baseada em Águas Residuárias , Poluentes Químicos da Água/química , Cocaína/análise , Humanos , Metanfetamina/análise , N-Metil-3,4-Metilenodioxianfetamina/análise , Entorpecentes/análise , Nova Zelândia
7.
Talanta ; 233: 122597, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34215085

RESUMO

1-(3-chlorophenyl) piperazine (mCPP) is a synthetic drug with hallucinogenic effects that has often been found in seized samples. In this context, easy to use point-of-care tests can be of great value in preliminary forensic analysis. Herein, we proposed a simple, fast, and portable electrochemical method for the detection of mCPP in seized samples. The method is based on the use of disposable screen-printed carbon electrodes (SPCE) and rapid screening procedures by square-wave voltammetry using minimal sample sizes (100 µL). mCPP showed an irreversible electrochemical oxidation process at +0.65 V on SPCE (vs Ag) using 0.04 mol L-1 Britton Robinson (BR) buffer solution (pH 7) as the supporting electrolyte. The proposed method exhibited a linear correlation (r = 0.998) between peak current and mCPP concentration in the range of 1-30 µmol L-1 (LOD = 0.1 µmol L-1). Interference studies were performed for adulterants and other classes of drugs of abuse, which can also be found in seized samples containing mCPP, such as caffeine, amphetamine, methamphetamine, 1-benzylpiperazine, 3,4-methylenedioxymethamphetamine, methylone, mephedrone, ethylone and 3, 4-methylenedioxypyrovalerone. The developed method presents great potential as a rapid and simple screening tool to detect mCPP in forensic samples.


Assuntos
N-Metil-3,4-Metilenodioxianfetamina , Anfetaminas , Eletrodos , Piperazinas
8.
J Acad Consult Liaison Psychiatry ; 62(4): 460-471, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34210406

RESUMO

BACKGROUND: Psychedelic compounds such as lysergic acid diethylamide (LSD), psilocybin, and 3,4-Methylenedioxymethamphetamine (MDMA) share a long and complex history with psychiatry. A half century ago, psychedelics were widely employed by psychiatrists in investigational and clinical settings, with studies demonstrating promising findings for their use in the treatment of mental illness and substance use disorders. However, concerns were also raised about their abuse potential and other adverse effects. Owing to these worries and psychedelics' association with the counterculture movement, psychedelics were largely outlawed in the United States in 1970, bringing research on their therapeutic potential to a halt. However, in recent years, a resurgence of psychedelic research has revealed compelling, though early, evidence for the use of psychedelic-assisted therapy in treating alcohol use disorder, nicotine use disorder, posttraumatic stress disorder, and depression. OBJECTIVE: Here we provide an overview of psychiatry's complicated relationship with psychedelics, while reviewing contemporary findings on psychedelic-assisted therapy, safety of psychedelic-assisted therapy, and risks of nonmedical use. We also make the case that psychiatry should consider preparing now for the possibility of Food and Drug Administration approval of psychedelic-assisted therapies in the near future. We conclude by discussing how growing societal interest in psychedelics could impact the work of consult-liaison psychiatrists, while also exploring how consult-liaison psychiatrists might contribute to future delivery of psychedelic treatments. METHODS: We reviewed literature on psychedelic-assisted therapies and adverse events resulting from nonmedical psychedelic use. RESULTS: We found a small, but rapidly growing literature indicating that psychedelic-assisted therapies may have treatment potential for mental illness and addiction. Our search also revealed a variety of rare adverse events stemming from nonmedical psychedelic use. CONCLUSIONS: Despite past concerns about psychedelics, current data indicate psychedelic-assisted therapy may potentially reduce suffering owing to mental illness and addiction if administered thoughtfully and cautiously by trained professionals in medical settings.


Assuntos
Alucinógenos , N-Metil-3,4-Metilenodioxianfetamina , Psiquiatria , Alucinógenos/efeitos adversos , Dietilamida do Ácido Lisérgico , Psilocibina/efeitos adversos , Estados Unidos
9.
Int Rev Psychiatry ; 33(3): 229-249, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34121583

RESUMO

This review examines the role of trauma in psychiatric morbidity and analogous psychoneurobiological changes. Trauma is a necessary criterion for Post-Traumatic Stress Disorder (PTSD), however, trauma history is highly correlated with a variety of psychiatric conditions. Some evidence suggests that Major Depressive Disorder (MDD) is the most common psychiatric condition that arises following trauma. Approximately 50% of PTSD cases present with co-morbid MDD. Overlapping symptomatology and neurobiology between these conditions underlie the debate over whether these phenomena result from problematic nosology or whether comorbid MDD + PTSD is a distinct phenotype of trauma-related psychopathology. Regardless, similar treatment approaches have been employed historically, with varying success. The drug-assisted psychotherapy treatment model, which combines pharmacological and psychotherapeutic approaches, is currently being trialled as a novel treatment approach in psychiatry. Both psilocybin- and 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy have received Food and Drug Administration 'breakthrough therapy' designation for the treatment of resistant MDD and PTSD, respectively. This paper reviews the therapeutic rationale of both psilocybin and MDMA for treating both trauma-related MDD and PTSD.


Assuntos
N-Metil-3,4-Metilenodioxianfetamina/uso terapêutico , Psilocibina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Resultado do Tratamento
10.
Exp Clin Psychopharmacol ; 29(5): 539-554, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34096755

RESUMO

Emerging evidence from randomized, double-blind, placebo-controlled clinical trials suggests psychedelic compounds such as 3,4-methylenedioxymethamphetamine (MDMA), psilocybin, and lysergic acid diethylamide (LSD), when administered as an adjunct to psychotherapy, that is, psychedelic-assisted psychotherapy (PAP), may be beneficial for treating substance use disorders, posttraumatic stress disorder (PTSD), depression, anxiety, and other psychiatric conditions. Previous ethnopsychopharmacological research has identified ethnoracial differences in the metabolism, safety, and efficacy of psychotropic drugs, yet no studies have directly investigated the impact of ethnoracially based differences in psychedelic drug pharmacology. Although there is an extensive global history of psychedelic use among peoples of various cultures, ethnicities, and intersectional identities, psychedelic research has been conducted almost exclusively on White populations in North America and Western Europe. The failure to include Black, Indigenous, and People of Color (BIPOC) in psychedelic research trials neglects the ethnic, racial, and cultural factors that may impact individual responses to PAP and thereby prevents generalizability of findings. This article investigates the impact of biological and social factors related to culture, ethnicity, and race on pharmacological responses to PAP, as well as clinical outcomes. The limitations of ethnopsychopharmacology are discussed, and the authors present expected cultural, clinical, and public health benefits of expanding funding for this area. This work will draw attention to the unique and individualized needs of ethnoracially diverse clients in therapeutic settings and is intended to inform future PAP trials. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Alucinógenos , N-Metil-3,4-Metilenodioxianfetamina , Humanos , Dietilamida do Ácido Lisérgico , Psilocibina , Psicoterapia
11.
Artigo em Inglês | MEDLINE | ID: mdl-33946164

RESUMO

Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18-34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.


Assuntos
Alucinógenos , Drogas Ilícitas , N-Metil-3,4-Metilenodioxianfetamina , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Suécia/epidemiologia , Adulto Jovem
13.
Photodiagnosis Photodyn Ther ; 35: 102359, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34048970

RESUMO

This report presents the clinical and optical coherence tomography (OCT) and OCT angiography (OCTA) findings from a case of acute and chronic solar retinopathy (SR) caused by sun gazing while under the influence of the hallucinogenic drug methylenedioxymethamphetamine, which is commonly known as ecstasy. This retrospective and observational case report involves a 16-year-old male patient who developed disruption of all foveolar layers two days after using ecstasy and subsequently gazing at the sun. The patient underwent visual acuity testing, dilated fundus examination, visual field analysis, OCT, and OCTA imaging. He exhibited visual recovery with the permanent disruption of the photoreceptor outer layers, and demonstrated enlargement in the deep foveal avascular zone areas during later follow-up periods, from one month to two years. This report aims to draw attention to SR that may occur after sun gazing while using hallucinogenic drugs and the importance of OCT and OCTA imaging in follow-up exams in such cases.


Assuntos
N-Metil-3,4-Metilenodioxianfetamina , Fotoquimioterapia , Doenças Retinianas , Adolescente , Angiofluoresceinografia , Humanos , Masculino , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Estudos Retrospectivos , Luz Solar , Tomografia de Coerência Óptica
15.
Nat Med ; 27(6): 950-951, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34031606
16.
Eur J Pharmacol ; 903: 174156, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-33971177

RESUMO

3,4-methylenedioxymethamphetamine or MDMA (known as "ecstasy") is a recreational drug of abuse, popular worldwide for its distinctive psychotropic effects. Currently, the therapeutic potential of MDMA in psychotherapy has attracted a lot of interest from the scientific community, despite the multitude of effects that this drug of abuse elicits on the human body. While neuronal effects have been the most studied, cardiovascular effects have also been described, as increased blood pressure and heart rate are the most recognizable. However, other effects have also been described at the cardiac (impaired cardiac contractile function, arrhythmias, myocardial necrosis and valvular heart disease) and vascular (vasoconstriction, disruption of vascular integrity and altered haemostasis) levels. Several mechanisms have been proposed, from the interaction with monoamine transporters and receptors to the promotion of oxidative stress or the activation of matrix metalloproteinases (MMPs). This review provides an overview of the cardiovascular implications of MDMA intake and underlying mechanisms, relevant when considering its consumption as drug of abuse but also when considering its therapeutic potential in psychiatry. Moreover, the risk/benefit ratio of the therapeutic use of MDMA remains to be fully elucidated from a cardiovascular standpoint, particularly in patients with underlying cardiovascular disease.


Assuntos
Sistema Cardiovascular/efeitos dos fármacos , N-Metil-3,4-Metilenodioxianfetamina/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Vasos Sanguíneos/efeitos dos fármacos , Coração/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , N-Metil-3,4-Metilenodioxianfetamina/uso terapêutico
17.
Int J Drug Policy ; 95: 103293, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34052555

RESUMO

BACKGROUND: Drug checking services (DCS) provide information about drug content and purity, alongside personalized feedback, to people who use drugs; however, the demographic and drug use characteristics of DCS clients are rarely reported. This paper describes these characteristics for clients of the Dutch DCS, the Drug Information and Monitoring System (DIMS). METHODS: 1,530 participants completed a pen-and-paper questionnaire at one of eight participating DCS in the Netherlands in 2018. RESULTS: The participants were mostly highly educated males in their twenties with no migration background. Experience with drugs prior to coming to the DCS was common. Only 0.7% indicated they had never used any of the twenty drugs studied. 93% of participants reported use of ecstasy or MDMA with an average of 6.3 years since first use. CONCLUSIONS: These results indicate that drug checking can be a valuable tool for public health services as it facilitates access to more difficult-to-reach communities who use drugs. It is unlikely that DCS encourage drug initiation, since almost all people who visit the Dutch DCS already report experience with drugs. However, DCS should be aware that their services might not be easily accessible or attractive to all demographic groups.


Assuntos
Drogas Ilícitas , N-Metil-3,4-Metilenodioxianfetamina , Transtornos Relacionados ao Uso de Substâncias , Contaminação de Medicamentos , Humanos , Masculino , Países Baixos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários
18.
Nat Med ; 27(6): 1025-1033, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33972795

RESUMO

Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are modestly effective. We report the findings of a randomized, double-blind, placebo-controlled, multi-site phase 3 clinical trial (NCT03537014) to test the efficacy and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of patients with severe PTSD, including those with common comorbidities such as dissociation, depression, a history of alcohol and substance use disorders, and childhood trauma. After psychiatric medication washout, participants (n = 90) were randomized 1:1 to receive manualized therapy with MDMA or with placebo, combined with three preparatory and nine integrative therapy sessions. PTSD symptoms, measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5, the primary endpoint), and functional impairment, measured with the Sheehan Disability Scale (SDS, the secondary endpoint) were assessed at baseline and at 2 months after the last experimental session. Adverse events and suicidality were tracked throughout the study. MDMA was found to induce significant and robust attenuation in CAPS-5 score compared with placebo (P < 0.0001, d = 0.91) and to significantly decrease the SDS total score (P = 0.0116, d = 0.43). The mean change in CAPS-5 scores in participants completing treatment was -24.4 (s.d. 11.6) in the MDMA group and -13.9 (s.d. 11.5) in the placebo group. MDMA did not induce adverse events of abuse potential, suicidality or QT prolongation. These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adulto , Terapia Combinada , Método Duplo-Cego , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/patologia , Resultado do Tratamento
19.
J Stud Alcohol Drugs ; 82(2): 188-196, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33823965

RESUMO

OBJECTIVE: Ketamine is a dissociative anesthetic used in medical practice, used recreationally since the mid-1960s. This study describes trends in ketamine use in sentinel cross-sectional samples of Australians who regularly use illicit stimulants, along with characteristics of consumers. METHOD: Data on trends in recent ketamine use (i.e., use in past 6 months) were drawn from annual interviews (approximately 800/year) with cross-sectional samples of people recruited from Australian state capitals from 2009 to 2019 as part of the Ecstasy and Related Drugs Reporting System (EDRS) study. Characteristics of those reporting recent use were examined in the 2019 EDRS data set (n = 728) using logistic regression. RESULTS: Recent ketamine use increased between 2009 and 2019 (10% to 41%, respectively, p < .001), primarily driven by use among participants recruited in Melbourne (21% to 84%, p < .001) and Sydney (19% to 68%, p < .001). However, frequency of use remained low. In 2019, consumer characteristics associated with use included being born outside of Australia and residing in Sydney or Melbourne (compared with Canberra). CONCLUSIONS: Among EDRS participants in Australia, we observed an increase in recent ketamine use between 2009 and 2019, although indicators of potential problematic use remained low. The increase in recent ketamine use was largely driven by increases in Melbourne and Sydney. Further research on drivers of use in these cities is required to effectively inform harm-reduction strategies.


Assuntos
Ketamina/administração & dosagem , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Austrália , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estudos Transversais , Feminino , Redução do Dano , Humanos , Drogas Ilícitas , Masculino , Adulto Jovem
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