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Background Recreational drug use has increased in recent years, especially among MSM, and has been found to be associated with higher risk of HIV infection. However, there is limited information about current recreational drug use among MSM in Shenzhen which is an international gateway city to China with a rapidly expanding MSM population. Methods A cross-sectional survey among MSM in Shenzhen was conducted and was used to collected information on demographics, sexual behavior and drug use via questionnaires. Serologic results on HIV and syphilis were obtained from laboratory assays. We performed logistic regression analysis to evaluate correlates with drug use. Results Among the 1935 MSM surveyed, 12.7% reported use of recreational drugs in the past six months. Rush poppers had become the most frequently used drug (10.6%). Risk factors associated with the use of recreational drugs included being unmarried, non-Han ethnicity, having high education level, seeking male sex partners via the internet, having multiple male sex partners, performing receptive role during anal sex, and having unprotected anal intercourse. Recreational drug use was significantly associated with higher risk of both HIV and syphilis infections (aOR:1.89, 95% CI:1.28–2.79; aOR:1.79, 95% CI:1.25–2.60, respectively). Conclusions Recreational drug use is associated with increased risk of HIV and syphilis infections among MSM in Shenzhen. Rush poppers were the most popular recreational drug. This finding suggests the need for targeted prevention and behavioral intervention programs to control the recreational drug use, and to reduce HIV and other sexually transmitted diseases among MSM in Shenzhen and internationally.

Background Research suggests that substance use among partnered sexual minority men will be inversely associated with the quality of dyadic functioning. We tested whether dimensions of relationship functioning implied within Couples Interdependence Theory (e.g., rewards, costs, barriers, alternatives, investment, and comparison to an ideal) predicted drug use and problematic alcohol use consistent with this hypothesis. Methods This study utilized baseline data from a sample of 70 couples recruited in the New York City area. All participants were cis-gender male and 18 or older. In each couple, at least one partner reported recent drug use, at least one was aged 18 to 29, and at least one was HIV negative. Participants provided demographic information; completed measures of relationship functioning and problematic alcohol use; and reported recent (past 30 day) drug use. Results Actor-partner interdependence models were calculated. The use of miscellaneous recreational drugs (excluding marijuana) was positively associated with participants’ perception of rewards, costs, and barriers to leaving and negatively associated with comparisons to an ideal, alternatives, and investment. In addition, partner perceptions of rewards were positively associated with this outcome. AUDIT scores were negatively associated with comparison to an ideal; and positively associated with partner perceptions of alternatives. Relationship functioning was unrelated to marijuana use. Conclusions These findings provide support for the hypothesis that relationship functioning and substance use are related. Couples Interdependence Theory implies such an assumption and it underlies many couples-based approaches to drug use intervention. These findings point to the potential utility of integrating relationship skill building into substance use interventions for partnered sexual minority men.

Background Central Asia is culturally and demographically diverse, both between and within its respective countries. That diversity is represented in the range of individual, network, community, and structural risks for female sex workers (FSWs) regionally. FSWs have several risk factors for HIV acquisition and transmission including behavioral, biological, and structural risk factors. Across Central Asia, sexual risks have become conflated with risks associated with injection and non-injection illicit drug use. Methods Peer-reviewed literature databases and gray literature were searched for articles on sex work in Central Asia. The medial subject heading (MeSH) of “sex work” was cross-referenced with terms associated with Uzbekistan, Tajikistan, Turkmenistan, Kazakhstan, Kyrgyzstan, Mongolia, and Afghanistan. Results HIV prevalence data for FSWs suggest sustained or increasing prevalence in the region. There are increasing data directly linking HIV among FSWs to injection drug use; odds of HIV are up to 20 times higher among FSWs reporting injecting drug use. Though injecting drug use among FSWs is rare in some settings, recreational drugs and alcohol use limits other risk reduction behaviors, such as condom use. Conclusions The Central Asian HIV epidemic has traditionally been assumed to be driven nearly exclusively by drug use, resulting in surveillance systems focused on parenteral transmission. The reviewed data highlight limited attention to characterizing the burden of HIV and risk factors for HIV acquisition and transmission among FSWs who use drugs. Moving forward will require enhanced HIV surveillance and research to inform HIV prevention approaches to address all levels of HIV risks affecting FSWs in Central Asia.

BACKGROUND: Recreational cannabis use and alcohol binge drinking are the most common drug consumption patterns in young adults. Impulsivity and several psychopathological signs are increased in chronic drug users, but the implications of recreational use are still poorly understood. METHODS: We evaluated impulsivity, sensation-seeking traits, impulsive decision-making, inhibitory control and possible symptoms of depression, anxiety and psychosis in three groups of young university adults: recreational cannabis users (N=20), alcohol binge drinkers (N=22) and non-drug users (N=26). RESULTS: The cannabis and binge drinking groups had increased scores for impulsivity and sensation-seeking traits. Both groups also exhibited increased impulsive decision-making on the two-choice task and the Iowa Gambling task; however, only the cannabis group was significantly different from the non-drug group regarding inhibitory control (Go/No-Go and Stop tasks). The cannabis and binge drinking groups did not show differences in the psychopathological symptoms evaluated. CONCLUSIONS: Our observations of this population of non-dependent drug users are consistent with the increased impulsivity traits and behaviors that have been described previously in chronic drug abusers. In this study, compared to no drug use, the recreational use of cannabis was associated with a major dysfunction of the different facets of impulsive behaviors. However, alcohol binge drinking was related only to impulsive decision-making. These results suggest that impulsivity traits and behaviors are present not only in chronic drug abusers but also in recreational drug users. Future work should continue to investigate the long-term effects of these common consumption patterns on various impulsive behaviors and psychopathological symptoms. Language: en

Background Aroma, Spice, K2 and Dream are examples of a class of new and increasingly popular recreational drugs. Ostensibly branded “herbal incense”, they have been intentionally adulterated with synthetic cannabinoids such as JWH-018 in order to confer on them cannabimimetic psychoactive properties while circumventing drug legislation. JWH-018 is a potent cannabinoid receptor agonist. Little is known about its pharmacology and toxicology in humans. This is the first research considering the effects of JWH-018 on a psychiatric population and exploring the relationship between JWH-018 and psychotic symptoms. Method This paper presents the results of semi-structured interviews regarding the use and effects of JWH-018 in 15 patients with serious mental illness in a New Zealand forensic and rehabilitative service. Results All 15 subjects were familiar with a locally available JWH-018 containing product called “Aroma” and 86% reported having used it. They credited the product's potent psychoactivity, legality, ready availability and non-detection in drug testing as reasons for its popularity, with most reporting it had replaced cannabis as their drug of choice. Most patients had assumed the product was “natural” and “safe”. Anxiety and psychotic symptoms were common after use, with 69% of users experiencing or exhibiting symptoms consistent with psychotic relapse after smoking JWH-018. Although psychological side effects were common, no one reported becoming physically unwell after using JWH-018. Three subjects described developing some tolerance to the product, but no one reported withdrawal symptoms. Conclusion It seems likely that JWH-018 can precipitate psychosis in vulnerable individuals. People with risk factors for psychosis should be counseled against using synthetic cannabinoids.

The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

Studying youthful drug involvement in the Republic of Chile, we sought to replicate North American research findings about the earliest stages of drug involvement (e.g., initial opportunities to use tobacco and alcohol, and transitions leading toward illegal drug use).A nationally representative multistage probability sample of middle and high school students was drawn; 30,490 youths completed surveys that assessed age at first drug exposure opportunities and first actual drug use. Cox discrete-time survival models accommodate the complex sample design and provide transition probability estimates.An estimated 39% of the students had an opportunity to use cannabis, and 70% of these transitioned to actual cannabis use. The probability of cannabis use and the conditional probability of cannabis use (given opportunity) are greater for users of alcohol only, tobacco only, and alcohol plus tobacco, as compared to non-users of alcohol and tobacco. Male-female differences in cannabis use were traced back to male-female differences in drug exposure opportunities.In Chile as in North America, when cannabis use follows alcohol and tobacco use, the mechanism may be understood in two parts: users of alcohol and tobacco are more likely to have opportunities to try cannabis, and once the opportunity occurs, they are more likely to use cannabis. Male-female differences do not seem to be operative within the mechanism that governs transition to use, once the chance to use cannabis has occurred.

Background: Ecstasy use is prevalent among young people and often co-occurs with other drug use, but little is known about the past 12-month and lifetime psychiatric comorbidity and specific additional drug abuse among young adult ecstasy users in the general population. To provide this information, we compared current ecstasy users to former users, other illicit drug users, and non-illicit drug users. Method: Data were gathered in a face-to-face survey of the United States conducted in the 2001–2002 (NESARC). Participants were household and group quarters residents aged 18–29 years (n = 8666). We measured current ecstasy use defined as any use in the past year; former ecstasy use as use prior to the past year only; other lifetime drug use included any drug other than ecstasy; lifetime non-illicit drug use as no illicit drug use. Associations were determined for nine other classes of illicit drugs, eight personality disorders, and seven mood and anxiety disorders. Results: Of current ecstasy users, 44% used >3 other classes of illicit drugs in the past year, compared to 1.6% of non-ecstasy drug users. Current ecstasy use was associated with current anxiety (OR = 3.7), specifically panic disorder (OR = 7.7) and specific phobia (OR = 4.1), also alcohol abuse (OR = 21.6) and dependence (OR = 4.1) and any personality disorder (OR = 5.1) compared to non-illicit drug users. Conclusions: Results indicate important differences in comorbidities of current and former ecstasy users compared to other drug users and lifetime non-illicit drug users that may affect phenotype definitions and etiologic studies. Ecstasy use may represent a distinct population of drug users for which unique treatments may be necessary. © 2008 Published by Elsevier Ireland Ltd.

Background Perceived risk and attitudes about the consequences of drug use, perceptions of others expectations and self-efficacy influence the intent to try drugs and continue drug use once use has started. We examine associations between adolescents’ attitudes and beliefs towards ecstasy use; because most ecstasy users have a history of marijuana use, we estimate the association for three groups of adolescents: non-marijuana/ecstasy users, marijuana users (used marijuana at least once but never used ecstasy) and ecstasy users (used ecstasy at least once). Methods Data from 5049 adolescents aged 12–18 years old who had complete weighted data information in Round 2 of the Restricted Use Files (RUF) of the National Survey of Parents and Youth (NSPY). Data were analyzed using jackknife weighted multinomial logistic regression models. Results Adolescent marijuana and ecstasy users were more likely to approve of marijuana and ecstasy use as compared to non-drug using youth. Adolescent marijuana and ecstasy users were more likely to have close friends who approved of ecstasy as compared to non-drug using youth. The magnitudes of these two associations were stronger for ecstasy use than for marijuana use in the final adjusted model. Our final adjusted model shows that approval of marijuana and ecstasy use was more strongly associated with marijuana and ecstasy use in adolescence than perceived risk in using both drugs. Conclusion Information about the risks and consequences of ecstasy use need to be presented to adolescents in order to attempt to reduce adolescents’ approval of ecstasy use as well as ecstasy experimentation.

The multiple choice procedure has been used to evaluate preference for psychoactive drugs, relative to money amounts (price), in human subjects. The present re-analysis shows that MCP data are compatible with behavioral economic analysis of drug choices. Demand curves were constructed from studies with intravenous fentanyl, intramuscular hydromorphone and oral methadone in opioid-dependent individuals; oral d -amphetamine, oral MDMA alone and during fluoxetine treatment, and smoked marijuana alone or following naltrexone pretreatment in recreational drug users. For each participant and dose, the MCP crossover point was converted into unit price (UP) by dividing the money value ($) by the drug dose (mg/70 kg). At the crossover value, the dose ceases to function as a reinforcer, so “0” was entered for this and higher UPs to reflect lack of drug choice. At lower UPs, the dose functions as a reinforcer and “1” was entered to reflect drug choice. Data for UP vs. average percent choice were plotted in log–log space to generate demand functions. Rank of order of opioid inelasticity (slope of non-linear regression) was: fentanyl > hydromorphone (continuing heroin users) > methadone > hydromorphone (heroin abstainers). Rank order of psychostimulant inelasticity was d -amphetamine > MDMA > MDMA + fluoxetine. Smoked marijuana was more inelastic with high-dose naltrexone. These findings show this method translates individuals’ drug preferences into estimates of population demand, which has the potential to yield insights into pharmacotherapy efficacy, abuse liability assessment, and individual differences in susceptibility to drug abuse.

Objectives To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). Design We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). Methods We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received $50. Results In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. Conclusions The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.

Tramadol is a mu opioid agonist that also inhibits the reuptake of norepinephrine and serotonin. Because non-medical use of prescription opioids, including tramadol, has increased in the U.S. over the last several years, we sought to profile its subjective, psychomotor, and physiological effects in recreational drug users. Twenty-two subjects received placebo, 50 or 100 mg tramadol, morphine, or 2 mg lorazepam in a randomized, crossover, double-blind design. The last 12 subjects in the study received 25 mg morphine, a dose that is putatively equianalgesic to 100 mg tramadol. In these subjects, morphine induced miosis and several other mu agonist subjective effects; 100 mg tramadol increased “feel drug effect” and drug liking ratings, and decreased pupil size, but the miotic effect was not statistically significant. Lorazepam, but neither tramadol nor morphine, impaired psychomotor performance. When the placebo, tramadol, and lorazepam data from all 22 subjects were analyzed, 100 mg tramadol induced miosis, and several subjective effects were increased significantly, including ratings of drug liking and “want to take again.” The present results indicating that a clinically-prescribed dose of oral tramadol has abuse liability-related effects in recreational drug users suggest the need for further abuse liability testing of the oral formulation in opioid abusers.

Recent publications claim that the recreational drug ecstasy is considered to be safe by many or most ecstasy users, or by young people or the general public. Unfortunately, there are no references that provide any support for this claim. Previous studies of various populations, including drug users and adolescents in several nations, also failed to support claims of the perceived safety of ecstasy. Epidemiological surveys from the USA and UK consistently report high proportions of young people who perceive great risk in using ecstasy. Studies in ecstasy users show that they are aware of a number of short- and long-term risks of ecstasy use, although, in the absence of actual problems, they evaluate the personal significance of these risks as low. This study further investigated the perceived harmfulness of ecstasy, drawing on an online survey of over 900 drug users. Little support for the claim was found. Seventy-three percent of the participants in the online survey viewed ecstasy as carrying at least 'some risk'. The claim of ecstasy's perceived safety is plausibly based on researchers' assumptions that the continued widespread use of the drug indicates that users are unaware of the associated risks, and that informing them about these risks would lead to a reduction in drug use. We argue that these assumptions are inadequate and that drug information and harm reduction strategies should focus on more affective and personally significant aspects of risk perception.

Drug and Alcohol Dependence 156 (2015) e183–e245 e243 days of consecutive abstinence during treatment and positively associated with reductions in negative affect during treatment. Conclusions: These data suggest neurofunctional differences related to treatment outcomes between individuals with cocaine dependence with and without methadone treatment, which may relate to differences in the efficacies of existing treatments. Financial support: This research was supported by NIH grants from NIDA (P50 DA009241, R01 DA030058). SWY receives support from DA007238-23 (PI: Petrakis). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.653 Eye tracking measures of attentional bias to individually-calibrated marijuana cues Jin H. Yoon ∗, Anka Vujanovic, Mike Weaver, Robert Suchting, C. Green, Joy Schmitz, Scott D. Lane Psychiatry and Behavioral Sciences, University of Texas Health Science Center – Houston, Houston, TX

s / Drug and Alcohol Dependence 146 (2015) e34–e117 e79 reductions inwithdrawal and urges frombaseline through the final treatment week. Conclusions: Depressed and non-depressed smokers differed onpatterns ofwithdrawal andurges to smoke,with those reporting depression showing increased withdrawal and urges when they initially reduced smoking. Financial support: NIH R21DA021839, R01DA034537, Helene Lycacki/Joe Young, Sr. Funds (Michigan). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.582 Incentives in public addiction treatment payment systems: Intended and unintended effects Sharon Reif, Maureen Stewart, Constance M. Horgan, B. Mohr Institute for Behavioral Health, The Heller School, Brandeis University, Waltham, MA, United States Aims: Innovative ways are needed to improve the quality of treatment for drug use disorders. Performance-based contracting (PBC) aims to align program incentives and purchaser goals, yet is uncommon indrugabuse treatment systems. In2007,Maine implemented a second-generation PBC systemwith financial incentives, for outpatient programs, addressing problems identified with its previous PBC. This study aims to (1) determine whether rewarded measures and outcomes changed under the PBC, (2) examine whether there was client selection due to the PBC and (3) explore possible unintended effects of the PBC. Methods: We use state administrative data from 2005 to 2011 andmultilevelmodeling techniqueswithadifference-in-difference approach, and a non-PBC comparison group, to determinewhether the 2007 PBC resulted in improved access and retention in treatment and whether positive or negative unintended effects stemmed from it. Results: Preliminary analyses (N=25,105 admissions) indicated that the probability of receiving four or more outpatient treatment sessions did not change significantly between the 2005–2007 preperiod and the 2008–2011 post-period (OR .9, p= .16) and was not significantly different in the PBC agencies from the non-PBC agencies. Similarly there was no significant change in the probability of remaining in treatment for 90 days or more. The most significant predictors of retention were client characteristics (previous treatment, criminal justice involvement and homelessness). Client selection problems were not identified in an analysis of admission rates for individualswith diagnosedmental disorders.We continue to refine these models and examine the impact of the PBC on other factors and client outcomes. Conclusions: Introduction of a PBC is a significant change in payment design that may affect how drug treatment services are delivered, thus increasing our understanding of its effects is critical. Inpreliminary analyseswefind theoverall net effect of incentivized contract very small and not significant. Financial support: NIDA R01 DA033402. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.583 A comparison of drug-related deaths in Florida, 2007–2012 C.J. Reissig, J.M. Vojtech Health and Human Services, U.S. Food and Drug Administration, Silver Spring, MD, United States Aims: The state of Florida maintains extensive and publicly available death records data tracking a variety of prescription and recreational drugs of abuse. The aim of this study was to examine the most frequently occurring drug-related deaths in Florida from 2007 to 2012. Conclusions: Drug-related death data were obtained from the state of Florida for the years 2007–2012. The leading causes of drug-related deaths in Florida from 2007 to 2012 involved opioids and benzodiazepines. The Florida death data were sorted by the type of drug(s) involved in death: amphetamines, ethanol, benzodiazepines, inhalants, opioids or “other.” Preliminary analyses examined specific drugs that were present at death including hydrocodone, oxycodone, alprazolam, and carisoprodol. Data were sorted to observe the numbers of deaths per year, and the number of deaths classified as “causal” or “present.” Finally, we examined the number of deaths that occurred when each drug was used in combination with one or more other drugs. The majority of deaths occurred when oxycodone and hydrocodone were used in combination with at least one other substance. Alprazolam was the most common drug found in combination with hydrocodone or oxycodone. Financial support: N/A. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.584 Sex and drugs in the lives of minority women: A multi-level analysis of smartphone-based daily diary data Grace L. Reynolds1, Dennis G. Fisher1, Jean-Philippe Laurenceau2 1 California State University, Long Beach, Long Beach, CA, United States 2 University of Deleware, Newark, DE, United States Aims: African American and Latina women are at increased risk of HIV infection through heterosexual contact. Daily smartphonebased diaries can provide event-level information about the context of sex and drug use behaviors that may help in our understanding of why heterosexual contact is so risky for minority women. Theaimof this researchwas to investigatedruguse and sex risk through the use of electronic daily diary collection methods. Methods: 189 women were recruited into a smartphone daily diary study for a 12-week (84 days) diary period. Baseline interviews were completed and women consented to completing a data collection “app” using Samsung Android smartphones with unlimited text, Internet and voice capability provided by the study. Weekly incentiveswere provided for daily diary completion.Mplus was used for the multi-level analysis which specified a withinsubjectsprocesswherewepredicted thathigh-risk sexwouldoccur on days on which women also used illicit drugs.

Aims: To assess the impact of THC on subjects’ ability to discriminate in HAL study. Methods:To fulfillHALmethodology, subjectswith recreational drug experience commonly are recruited and then required to demonstrate they can discriminate between active test opioid and placebo. A positive drug screen serves as a routine exclusion for study participation to eliminate potential bias or risk of pharmacodynamic carryover. However, THC is usually exempt in HAL methodology from this exclusion, in part to improve recruitment and retention of subjects. The impact of THC on pharmacodynamic assessments in drug discrimination is typically considered insignificant but is not well characterized or understood. In 64 subjects in a single HAL study, investigators examined the potential influence of THC, including quantitative levels where applicable, on ability to discriminate between 20mg of intranasal oxycodone and placebo. Results: Of 64 subjects, 31 (48%) were positive for THC prior to drug discrimination. Ten subjects did not complete drug discrimination and were excluded from analysis due to emesis (5), withdrawn consent (3), and inability to complete study meal (2). Of 10 excluded subjects, 60% were positive for THC. The remaining 54 patients completed drug discrimination: 39 passed and were randomized to treatment;15didnot successfullydiscriminate. Positive urine drug screen rate for THCwas 48.7% for discriminators vs. 40% for non-discriminators (p=0.5650) with corresponding mean urine carboxy-THC concentrations of 705 vs. 417ng/mL, respectively (p=0.2797). Conclusions: Successful opioid discriminators were associated with a higher positive THC drug screen rate and mean carboxyTHC urine concentrations when compared to non-discriminators but differences were not statistically significant. The objective measurements of THC do not correlate with subjects’ ability to discriminate between active drug and placebo in this intranasal opioid HAL study. Further research is necessary to fully elucidate the influence of THC in HAL studies. Financial support: HAL data provided by Collegium Pharma.

The pharmaceutical industry has made substantial innovations in the area of targeted drug delivery and optimization of pharmacokinetics for existing drugs to try to maximize therapeutic effect while simultaneously minimizing adverse consequences of medication abuse. These innovations, however, have not come without a price. Designer drugs and high content modified release formulations have been exploited both in casual recreational drug abuse as well as, on a much larger scale, by the criminal diversion of these products for profit. In this paper we will consider the challenges before manufacturers and regulators as they approach the problem of abuse potential of these new drug products and some of the solutions specifically designed to counteract abuse.

The magnitude of non-therapeutic use, or misuse of prescription pharmaceuticals now rivals that of illicit drug abuse. Drug and formulation tampering enables misusers to administer higher doses by intended and non-intended routes. Perceived motives appear to be a combination of interests in achieving a faster onset and enhancing psychoactive effects. Narcotic analgesics, stimulants, and depressants are widely sought, examined, and tampered with for recreational use. This review examines tampering methods reported on the Internet for selected pharmaceutical products. The Internet provides broad and varied guidance on tampering methods that are specific to drug classes and unique formulations. Instructions are available on crushing, separating, purifying and chemically altering specific formulations to allow changes in dosage, route of administration, and time course of effects. Many pharmaceutical formulations contain features that serve as "barriers" to tampering. The nature and effectiveness of formulation barriers vary widely with many being overcome by adventurous misusers. Examples of successes and failures in tampering attempts are frequently described on Internet sites that support recreational drug use. Successful tampering methods that have widespread appeal evolve into recipes and become archived on multiple websites. Examples of tampering methods include: (1) how to separate narcotic drugs (codeine, hydrocodone, oxycodone) from excipients and non-desirable actives (aspirin, acetaminophen, ibuprofen); (2) overcoming time-release formulations (beads, layers, matrices); (3) removal of active drug from high-dose formulations (patches, pills); (4) alteration of dosage forms for alternate routes of administration. The development of successful formulations that inhibit or prevent drug/formulation tampering with drugs of abuse should take into consideration the scope and practice of tampering methods available to recreational drug users on the Internet.

The present study investigated characteristics of recreational drug users, especially 'ecstasy' (MDMA) users, in 254 undergraduates. All participants completed a drug history questionnaire (DHQ), the impulsiveness venturesomeness and empathy questionnaire, a novel risk-taking task (Bets16), and 59 also completed the tri-dimensional personality questionnaire (TPQ). DHQ responses allocated participants to five groups: non-drug controls, cannabis users, polydrug (no ecstasy) users, low (20 occasions) ecstasy users and high (20 occasions) ecstasy users. Eighteen percent of the sample had used ecstasy and of the ecstasy users, only one had not used other substances. A larger proportion of high ecstasy users had also used amphetamines, cocaine and LSD in comparison to the low ecstasy and non-ecstasy polydrug users. High ecstasy users typically took significantly more ecstasy tablets compared with low ecstasy users. Impulsiveness, venturesomeness and novelty seeking behaviour increased from the non-drug users to high ecstasy users. Ecstasy users (low and high) and polydrug (non-ecstasy) users had higher levels of impulsivity, venturesomeness and novelty seeking behaviour compared with non-drug users. Furthermore, high ecstasy users scored higher on the Bets16 risk-taking measure than non-drug users, cannabis users and low ecstasy users. The findings are discussed in relation to: (i) the possibility that increased impulsivity pre-dated drug use; and (ii) the possible link between impulsivity and the putative serotonergic neurotoxicity of ecstasy.

The subjective, psychomotor and cognitive effects of oral doses of lorazepam (0, 1.5, 3 and 6 mg) and diazepam (0, 10, 20 and 40 mg) were studied under double-blind conditions in 14 volunteers with histories of ‘recreational’ benzodiazepine use/abuse. For each subject, drug was administered over 4 test days in a 2 (drug) by 4 (dose level) mixed design. Drug was the between-groups factor while dose was the within-subjects factor. Test days were separated by at least 1 week. The results showed that subjective ratings of drug ‘liking’ and the psychomotor and cognitive effects of lorazepam were generally similar to those of diazepam over the range of doses studied. Lorazepam, however, tended to produce effects of longer duration than diazepam. Since previous studies have shown that diazepam has a relatively high abuse liability among the benzodiazepines, the present findings suggest that lorazepam shares this property with diazepam is subjects with a history of ‘recreational’ drug use/ abuse.