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Background: The emergence of New Psychoactive Substances (NPS), including synthetic psilocybin, has raised concern among health experts due to the numerous health and socioeconomic consequences. The current trend is shifting to the hazardous use of synthetic psilocybin in vaping, and little is known about the prevalence of use, specifically among amphetamine-type stimulants (ATS) users., Methods: Interviewer-administered questionnaires were conducted in drug detention centers between March and October 2022. The study was conducted using ASSIST 3.0 and obtained information on the respondents' socio-demographic characteristics and clinical profiles. N  = 355 ATS users were enrolled in this study., Results: The results show a high prevalence of psilocybin vaping among ATS users (182/355, 53.1%). Most of the respondents were males (85.1%) and unmarried (69.3%), with a mean age of 29.2 (SD = 7.3). Across all respondents, five factors were associated with psilocybin vaping: tobacco smoking, aOR =5.790 (95% CI: 1.723, 8.183); cannabis uses, aOR= 9.152 (95% CI: 2.693, 10.396); and alcohol use, aOR= 3.137 (95% CI: 1.461, 5.817). Respondents of the Malay race had higher odds of being involved in psilocybin vaping compared to other races, with aOR= 1.638 (0.043, 2.459). Meanwhile, a reduction in age by 1.9 will increase the likelihood of involvement in psilocybin vaping with aOR = 1.897 (95% CI: 0.857, 1.938)., Conclusion: Psilocybin in vaping is growing among ATS users and across all populations. Unfortunately, knowledge regarding the long-term effects on health is limited. Further studies should highlight the harmful effects of psilocybin and the potential risk of psilocybin vaping among the younger population.

Background: This study investigates the association between Methamphetamine (MA) intoxication and suicidal ideation/behavior in patients presenting to emergency departments. Amidst rising MA use and co-use with opioids, this "twin epidemic" has manifested in increasing admissions for MA intoxication, often accompanied by psychiatric symptoms that can escalate to suicidal behaviors., Method: This retrospective study utilized patient records and analyzed data from 629 patients admitted to a Texas emergency department in 2020, with MA intoxication confirmed via urine tests and patient interviews. The suicidal tendencies were assessed using the Columbia-Suicide Severity Scale. The 629 patients were divided into three groups for analysis: Group I ( n  = 188), MA positive with suicidal ideation (SI) (MA + SI+); Group II ( n  = 202), MA-positive without SI (MA + SI-); and Group III ( n  = 239), MA-negative with SI (MA- SI+). Multiple regression analysis was used to elicit clinical features predicting patients presenting to the emergency department with acute MA intoxication., Results: Results reveal that approximately half of patients with acute MA intoxication reported suicidal thoughts, indicating a significant association between MA use and suicidal tendencies. Females exhibited higher rates of suicidal thoughts, behavior, and subsequent medical attention compared to males. Sociodemographic characteristics and clinical features differed among MA-positive patients with and without SI. Multivariable regression analysis identified factors influencing MA use, including cannabis use, male gender, agitation, and an inverse association with alcohol use. Notably, the severity and potential lethality of suicidal behavior in MA-intoxicated patients paralleled those observed in psychiatric patients without MA use., Conclusion: These results underscore the urgent need for targeted interventions to address the complex interplay between MA use and suicidal risks in the emergency department setting, as well as broader public health strategies to combat the increasing prevalence of MA use.

Background : Psychotropic substance use, for chemsex in particular, is common in gay or bisexual men (GBM) with HIV infection. This case-control study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM. Methods : Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls). The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. Results : Cases had lower level of social support, more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence, weekly methamphetamine use for 2 years or more, using methamphetamine beyond chemsex, duration of HIV diagnosis were significant predictors for psychiatric disorders in the cases. Conclusion : Active psychotropic substance use in HIV-infected gay or bisexual men was associated with an overall 3-fold increase in Axis I psychiatric disorders. Coordinated efforts from HIV, psychiatric and substance use services are needed to prevent harms arising from chemsex and to identify those in need and facilitate treatment access.

Objectives: The purpose of this research was to investigate the effectiveness of the methadone programme in a group of patients taking mephedrone with heroin. Methods: The research involved 230 people who took part in the methadone programme between 2010 and 2019: 101 people on a mephedrone binge and taking heroin and 129 people addicted to heroin. Results: Number of re-hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patients (91.9 vs 79.8%, p  < 0.01). The interaction of the hepatitis C virus (HCV) infection with the dose of methadone taken explains 67.6% of the variance in the frequency of hospitalisation of the patients on a mephedrone binge ( p  < 0.001), and in the case of the dose of methadone alone - only 12% ( p  < 0.001). Regression analysis indicated that statistically significant majority of the subjects ( p  < 0.001) who received the optimal dose of methadone, namely 100-110 ml, were hospitalised once. Conclusions: The interaction of the methadone dose with HCV infection plays a very important role in the frequency of hospitalisation of patients taking mephedrone with heroin on a regular basis.KEY POINTSThe number of hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patientsThe interaction of the sex of the subjects and HCV infection with the dose of methadone taken explains 80.3 and 67.6% of variance in the frequency of hospitalisations, respectivelyThe most optimal dose of methadone in the group of people taking mephedrone with heroin ranges between 100 and 110 ml.

Background: Methamphetamine intoxication presentations to emergency departments (EDs) including trauma centres, general EDs and psychiatric emergency services have risen world-wide. Objectives: A review of the clinical characteristics of patients presenting to a trauma centre or ED with methamphetamine intoxication or dependence to aid development of health service policy and training for health personnel. Methods: PubMed, PsycINFO, CINAHL and Scopus (1990-2017) were searched. A systematic review of all clinical characteristics was conducted, and a meta-analysis undertaken for variables with standard measures (prevalence, age, gender); 23 studies met the inclusion criteria of which 17 could be used in the meta-analysis. Results: Methamphetamine-related presentations were characterised by cardiac complications, psychiatric symptoms and aggression with safety risk to health personnel. The pooled prevalence of methamphetamine positive cases in emergency settings was higher in studies using toxicology analysis to determine methamphetamine use (8 studies, 22.8% 95% CI 15.4-32.5) compared to self-reporting (9 studies 5.7%, 95% CI 2.8-11.2, Q = 12.42, p  < 0.001). Pooled variance of methamphetamine positive cases was 57.1% in men and 42.9% in women. The mean age of those who were methamphetamine positive was 28.4 years and for those methamphetamine negative cases it was 38.4 years. Conclusions: In this review, we found a higher prevalence of methamphetamine use amongst males and in the younger demographic. Targeted training programmes for frontline staff and management approaches for prompt multi-disciplinary service engagement are recommended as well as appropriate resourcing, such as mental health staff in EDs or mental health beds to accommodate this subgroup of the patient cohort.

Background: There is scarce research on male sex workers in the context of alcohol use. While heavy alcohol use has been established as a risk factor for HIV and STI infections among men who have sex with men (MSM), men who engage in sex work with other men, particularly from the Global South, have not been included in these studies. Moreover, studies among male sex workers in Asia often do not explore migration contexts of these men., Objectives: The objective of this exploratory study is to examine the prevalence and correlates of heavy alcohol use among migrant and non-migrant male sex workers in Bangkok and Pattaya, Central Thailand., Methods: Between August and October 2015, 18-24 year-old migrant and non-migrant male sex workers (n = 212) were recruited from various male sex work-identified venues (bars, clubs, massage parlors, and go-go bars) to take an interviewer-administered cross-sectional survey in Bangkok and Pattaya, Thailand. Measures were adapted from previous studies in similar populations and included structured questions across four domains, including demographic characteristics, alcohol use, stimulant use, and sexual behaviors. Multivariable logistic regression assessed the independent associations between heavy alcohol use (heavy versus not heavy) and demographic characteristics, stimulant use and sexual behavior., Results: Heavy alcohol use was prevalent among one-third of participants. Heavy alcohol use was positively associated with male sex workers who were non-migrant and Thai, currently using stimulants, having 15 or more male clients in the past month and having first consumed alcohol at age 15 years or younger., Conclusions: Current HIV prevention efforts should consider subpopulations of MSM, including male sex workers and migrants, as well as other risk behaviors like alcohol, as important contexts for HIV and STI risks.

Background: Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors., Objectives: This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners., Methods: From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors., Results: Participants' racial/ethnic identity (χ 2 (6) = 43.5; p < 0.0001), HIV status (χ 2 (6) = 22.0; p = 0.0012), educational attainment level (χ 2 (6) = 13.8; p = 0.0322), and years of age (χ 2 (6) = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ 2 (2) = 7.0; p = 0.0309) and marijuana (χ 2 (2) = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners., Conclusion: Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.

Background: Negative views toward substance use treatment among some rural substance users and limited treatment resources in rural areas likely affect substance use utilization. It is therefore important to determine whether accessing healthcare options other than substance use treatment, specifically outpatient medical care (OMC), is associated with reductions in substance use., Objectives: We examined whether use of OMC was associated with reductions in substance use among rural substance users over a three-year period. We also explored whether substance user characteristics, including substance-use severity and related-problems, moderated this potential relationship., Methods: Data were collected from an observational study of 710 (61% male) stimulant users using respondent-driven sampling. Participants were recruited from rural counties of Arkansas, Kentucky, and Ohio., Results: We found a significant main effect of having at least one OMC visit (relative to none) on fewer days of alcohol, crack cocaine, and methamphetamine use over time. Fewer days of alcohol, crack cocaine, and methamphetamine use were reported in participants with at least one OMC visit (relative to those with none) among those reporting higher Addiction Severity Index employment and psychiatric severity scores, and low education, respectively., Conclusion: Our findings extend the results from prior studies with urban substance users to show that contact with an outpatient medical care clinic is associated with reductions in substance use over time among rural substance users with especially poorer functioning. These findings highlight the potential importance of OMCs in addressing unhealthy substance use in rural communities.

Objective: We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose., Methods: Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012., Results: Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001)., Conclusions: The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.

Background: South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence., Objectives: This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa., Methods: Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women., Results: In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance: The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior.

Background: Studies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness., Objectives: To determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada., Methods: From 2012 to 2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor diagnosed: (1) alcohol/substance use disorder and (2) any other mental health disorder., Results: Of 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR = 0.52, 95% CI [confidence interval]: 0.27-0.99) and an annual income ≥$30,000 CAD (AOR = 0.38, 95% CI: 0.21-0.67) and positively associated with HIV-positive serostatus (AOR = 2.54, 95% CI: 1.63-3.96), recent crystal methamphetamine use (AOR = 2.73, 95% CI: 1.69-4.40) and recent heroin use (AOR = 5.59, 95% CI: 2.39-13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR = 0.25, 95% CI: 0.08-0.81), being a refugee or visa holder (AOR = 0.18, 95% CI: 0.05-0.65), and living outside Vancouver (AOR = 0.52, 95% CI: 0.33-0.82), and positively associated with abnormal anxiety symptomology scores (AOR = 3.05, 95% CI: 2.06-4.51)., Conclusions: Mental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring.

While risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug-using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [95% CI] = 1.12-1.46) and homelessness (AOR = 1.35, 95% CI = 1.19-1.54) were independently associated with hazardous alcohol use (all p < .001). Older age (AOR = 0.95, 95% CI = 0.92-0.99), Caucasian ethnicity (AOR = 0.74, 95% CI = 0.61-0.90), daily heroin use (AOR = 0.53, 95% CI = 0.42-0.67), daily crack cocaine smoking (AOR = 0.73, 95% CI = 0.59-0.91), and daily crystal methamphetamine use (AOR = 0.52, 95% CI = 0.42-0.64) were negatively associated with hazardous alcohol use (all p < .05). In sub-analysis, consistent dose-response patterns were observed between levels of alcohol use and unprotected sex, homelessness, and daily heroin injection. In sum, hazardous alcohol use was positively associated with unsafe sexual behaviour and negatively associated with high-intensity drug use. Interventions to address hazardous alcohol use should be central to HIV prevention efforts for street-involved youth., Competing Interests: statement No potential conflict of interest was reported by the authors.

Objectives: This study aimed to compare the drug addiction process between Chinese heroin- and methamphetamine (MA)-dependent users via a modified 4-stage addiction model (experimentation, occasional use, regular use, and compulsive use)., Methods: A descriptive study was conducted among 683 eligible participants. In the statistical analysis, we selected 340 heroin- and 295 MA-dependent users without illicit drug use prior to onset of heroin or MA use., Results: The addiction process of heroin-dependent users was shorter than that of MA-dependent users, with shorter transitions from the onset of drug-use to the first drug craving (19.5 vs. 50.0 days), regular use (30.0 vs. 60.0 days), and compulsive use (50.0 vs. 85.0 days). However, no significant differences in the addiction process were observed in frequency of drug administration, except that heroin users reported more administrations of the drug (20.0 vs. 15.0) before progressing to the stage of compulsive drug use. A larger proportion of regular heroin users progressed to use illicit drugs recklessly than did MA users. Most heroin and MA users reported psychological dependence as their primary motivation for compulsive drug use, but more heroin users selected uncomfortable symptoms upon ceasing drug use as further reason to continue., Conclusion: Our results suggest that typical heroin and MA users may experience a similar four-stage addiction process, but MA users might undergo a longer addiction process (in days). More research is necessary to further explore factors influencing the drug addiction process.

Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.

Background: Substance abuse worsens the course of schizophrenia, but it is not known whether or not there are differences between specific substances concerning their association with the hospitalizations of patients with schizophrenia., Aims: The primary aims of this study were to examine the possible associations between amphetamine, cannabis, and opioid abuse, and the risk of hospitalizations among patients with schizophrenia., Methods: The study population consisted of 146 patients with ICD-defined schizophrenia from two different geographical sites in Finland, and it included both inpatients and outpatients. Data were collected retrospectively from the patients' medical files. Substance abuse was defined as either harmful use or dependence according to ICD-10., Results: The cumulative prevalence of substance abuse was 10.9% (16/146) for cannabis, 8.9% (13/146) for amphetamine, and 4.1% (6/146) for opioids. Among patients with schizophrenia and abuse of any substance, the number of hospitalizations was about 1.5-fold when compared to those without substance abuse. The incidence rate ratio for hospitalizations was 2.9 (95% CI 2.47-3.63) for opioids, 2.0 (1.71-2.41) for amphetamine, and 1.6 (1.33-1.84) for cannabis, when compared with no abuse of each substance. The risk of hospitalizations was significantly higher for opioids when compared with amphetamine (p < 0.001) or cannabis (p < 0.001)., Conclusions: Harmful use or dependence of opioids among patients with schizophrenia is associated with significantly higher risk of hospitalizations than either harmful use or dependence of amphetamine or cannabis.

Context: Lisdexamfetamine is a pro-drug stimulant that requires the enzymatic hydrolysis of lysine from dexamphetamine for pharmacologic effects. There is limited information comparing non-therapeutic lisdexamfetamine and dextroamphetamine exposures., Objective: The objective was to compare lisdexamfetamine exposures with dextroamphetamine/amphetamine extended release and dextroamphetamine/amphetamine immediate release., Methods: A retrospective observational case series of single-substance exposures to lisdexamfetamine, dextroamphetamine/amphetamine extended release, or dextroamphetamine/amphetamine immediate release reported to the National Poison Data System from 2007 to 2012 was performed. Data were analyzed for demographics, reason, clinical effects, management site, and outcomes., Results: There were 23,553 exposures: lisdexamfetamine (7,113), dextroamphetamine/amphetamine extended release (6,245), and dextroamphetamine/amphetamine immediate release (10,195). The most frequent clinical effects observed for lisdexamfetamine, dextroamphetamine/amphetamine extended release, and dextroamphetamine/amphetamine immediate release were agitation (19.8%, 21.7%, and 25.1%, respectively) and tachycardia (19.2%, 22.8%, and 23.9%, respectively). The reason was most often exploratory (93.4%) in children < 6 years and therapeutic error (65.6%) in children aged 6-12 years. In adolescents and adults most common reasons were suicide attempts (28.4%) followed by abuse (19.5%) and therapeutic errors (18.8%). Overall, 61.6% of cases were managed in a health care facility, with the majority treated in the emergency department only. The majority of cases (76.0%) experienced no or minor effects. More serious outcomes (moderate/major/death) occurred in 21.2% of lisdexamfetamine, 24.7% of dextroamphetamine/amphetamine extended release, and 25.5% of dextroamphetamine/amphetamine immediate release. There were 4 deaths (1 dextroamphetamine/amphetamine extended release and 3 dextroamphetamine/amphetamine immediate release). In patients aged 6 years and more, abuse/misuse was more frequently reported for dextroamphetamine/amphetamine immediate release (32.5%) and dextroamphetamine/amphetamine extended release (23.0%) than that for lisdexamfetamine (13.5%). The odds of abuse/misuse was 2.3 (95% confidence interval [CI]: 2.0-2.4) times higher for dextroamphetamine/amphetamine immediate release than that for lisdexamfetamine and dextroamphetamine/amphetamine extended release combined; the odds of dextroamphetamine/amphetamine extended release abuse/misuse was 1.9 (95% CI: 1.7-2.2) times higher than lisdexamfetamine. In 2011, the number of lisdexamfetamine abuse/misuse cases exceeded dextroamphetamine/amphetamine extended release by approximately 26% and plateaued in 2012, but was significantly lower (∼75%) than dextroamphetamine/amphetamine immediate release., Conclusions: Toxic effects were similar for all three drugs. Although the majority of cases were treated at health care facilities, the majority of patients experienced no effects or minor toxicity. Serious outcomes occurred in approximately 21% of lisdexamfetamine and 25% of dextroamphetamine/amphetamine extended release and dextroamphetamine/amphetamine immediate release. Lisdexamfetamine may have less abuse potential, especially compared with the immediate-release dextroamphetamine/amphetamine formulation.

This study examines causes of death, years of life lost, and health and drug use characteristics associated with mortality over an 8 to 10 year period in a sample of methamphetamine users who had and had not received substance use disorder treatment (N = 563). Decedents reported initiating their methamphetamine use for different reasons than surviving methamphetamine users, and some of these differences varied by treatment status. Study findings provide additional detail on long-term health and mortality outcomes in a diverse sample of methamphetamine users, which may inform public health strategies targeting the comparable and divergent needs of treated and untreated populations.

Objectives: Studies show that illicit cannabis (marijuana) use is related to use of other illicit drugs and that reasons for use are related to frequency of marijuana use. However, research is needed to examine whether specific reasons for marijuana use are associated with use of other illicit drugs., Methods: Data from recent marijuana-using high school seniors were examined from 12 cohorts of Monitoring the Future (Weighted n = 6481) to examine whether reasons for recent marijuana use are associated with use of eight other illicit drugs., Results: Using "to experiment" decreased odds of reporting use of each drug and using to decrease effects of other drugs increased odds of reporting use of each drug. In multivariable models, using marijuana "to experiment" decreased the odds for reporting use of hallucinogens other than LSD and narcotics other than heroin. Using marijuana for "insight" increased the odds for use of hallucinogens other than LSD, and use due to "boredom" increased the odds for reporting use of powder cocaine and hallucinogens other than LSD. Using marijuana to increase effects of other drugs increased odds of reporting use of each of the eight drugs, and using it to decrease other drug effects increased odds of reporting use of crack, hallucinogens other than LSD, and amphetamine/stimulants., Conclusions: This study helped identify illicit marijuana users who are more likely to report use of other illicit drugs. Prevention efforts need to focus on students who report certain reasons for marijuana use as they may be at risk for use of other illicit drugs.

Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance-use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.

Background: Injection drug users (IDUs) are at increased risk of various medical conditions, including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can lead to life-threatening complications, are common but scarcely studied., Objectives: To investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors associated with having ever had an SSTI., Methods: IDUs were recruited from Malmö SEP (N = 80). They participated in a survey with questions about demographics, drug use, and experience of SSTIs. Factors independently associated with self-reported SSTI ever were assessed using logistic regression analysis., Results: The lifetime reported prevalence of SSTI was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08)., Conclusions/importance: SSTI is common among IDUs in Malmö. Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids), are more likely to have had an SSTI.

Background: People who inject drugs (PWID) are a key population engaging in pharmaceutical opioid analgesic (PO) use, yet little is known about patterns of illicit PO use among this group., Objectives: The aims of this research were to measure the prevalence and frequency of lifetime and past-month illicit PO use and injection in a sample of regular PWID, to examine patterns of past-month illicit PO use within individuals over time, and to identify factors independently associated with past-month illicit PO use., Methods: Data were drawn from a prospective cohort study of regular PWID (N = 666) in Melbourne, Australia. Data from five waves of annual data collection (including baseline) were analyzed descriptively and using generalized estimating equations (GEE)., Results: At baseline, 59% of participants reported lifetime illicit PO use and 20% reported past-month use, predominantly through injecting. Most illicit PO users at baseline transitioned to nonuse of illicit POs across the study period. In multivariable GEE analysis, factors associated with past-month illicit PO use included past-year arrest [adjusted odds ratio (AOR): 1.39], opioids other than heroin as drug of choice (AOR: 5.14), experiencing poorer physical health (AOR: 0.98) and a range of other drug use variables., Conclusions: We found little evidence of ongoing illicit PO use among those followed up, with illicit PO use linked to polydrug use more broadly. Nonetheless, trends in illicit PO use among PWID should continue to be monitored and harm reduction interventions implemented to reduce the associated public health risks.

This article reviews the literature concerning attention-deficit/hyperactivity disorder (ADHD) medication misuse, abuse, dependence, diversion, and malingering. The review covers nonmedical use (NMU) of both stimulant (methylphenidate and amphetamine) and nonstimulant (α-adrenergic agonists and atomoxetine) prescription medications, and provides a discussion on the relevance for ADHD treatment today. The neural basis for ADHD medication mechanisms of action (increased norepinephrine and dopamine signaling) and their neurobiochemical relationship to the abuse potential is explored. Regionally-specific, stimulant-induced elevations in brain dopamine appear to be integral to both efficacy in ADHD and potential for abuse. In addition to the prevalence of misuse and diversion, additional topics discussed include the potential safety concerns associated with NMU of prescription ADHD medications and the cost to payers of prescription drug diversion (eg, increased emergency department visits associated with misuse). The evidence describing the difficulty in detecting malingering for the purpose of illicit access to ADHD medications for subsequent misuse or diversion is also summarized. Moreover, the effect of ADHD medications in patients with comorbid substance use disorder and the controversial potential linkage of stimulant prescription use with subsequent substance use disorder are explored. Overall, the data suggest that ADHD medication misuse and diversion are common health care problems for stimulant medications, with the prevalence believed to be approximately 5% to 10% of high school students and 5% to 35% of college students, depending on the study. Stimulant effectiveness and speed of action are deemed desirable to enhance attention and focus performance for activities like studying, but stimulants are also misused recreationally. Conversely, the data suggest a lack of abuse potential and lack of actual medication misuse for the nonstimulant medications. Although they can be efficacious for the treatment of ADHD, the nonstimulants lack a mechanism of action linked to the abuse potential and they lack the desirable effects (speed of action, stimulant feel) that make stimulants susceptible to NMU. In light of these findings, the data suggest a need for close screening and therapeutic monitoring of ADHD medication use. In addition, nonstimulants might be an appropriate alternative for patients with concern about abuse and physicians concerned with general misuse and diversion.

Background: The personal and societal effects of methamphetamine abuse are well documented. The ease of accessibility to methamphetamine and the quality of the "high" it produces makes the drug highly desired by its abusers. Over time, many methamphetamine users will also become methamphetamine cooks, where pseudoephedrine in over-the-counter cold products is converted to methamphetamine through a simple, albeit extremely dangerous, process. New laws limiting access to these products have had limited success. No existing commercial pseudoephedrine products offer significant impediments to slow or limit the extraction and conversion of pseudoephedrine in clandestine methamphetamine laboratories., Objective and Methods: A new pseudoephedrine 30 mg tablet product using Impede technology (Nexafed®) to deter methamphetamine production has recently been introduced into the marketplace. Using methods designed to mimic clandestine laboratory processes, the ability of this product to disrupt extraction and conversion of pseudoephedrine to methamphetamine yet provide therapeutic effectiveness was evaluated., Results: Impede™ technology tablets limited the extraction and/or conversion of pseudoephedrine to methamphetamine when compared to a commercially marketed pseudoephedrine product (Sudafed®). Nexafed® tablets were also shown to be bioequivalent to the same control product, thus ensuring therapeutic equivalence., Conclusions: With the advent of new pseudoephedrine products in the marketplace with features to limit the extraction and conversion of pseudoephedrine to methamphetamine, new tools are now available to minimize the clandestine manufacture of the drug and potentially limit its social impact.

Background: An epidemic of methamphetamine use has begun in Iran in recent years and psychiatric emergency services are overloaded with patients with methamphetamine-induced psychosis (MIP)., Aims: To define the clinical features of inpatients with MIP in a psychiatric hospital., Method: The files of all MIP patients admitted to Iran Psychiatric Hospital located in Tehran from April 2008 to April 2010 were assessed. Data related to psychotic episode, substance use, previous psychiatric history and demographic data of 111 MIP patients were extracted and analyzed using descriptive statistical methods., Results: The most prevalent psychotic symptoms were persecutory delusion (82%), auditory hallucination (70.3%), reference delusion (57.7%), visual hallucination (44.1%), grandiosity delusion (39.6%) and jealousy delusion (26.1%). The mean duration of admission and psychotic episode was 21.43 and 17.37 days, respectively. In seven cases (8.75%), symptoms continued for more than one month., Conclusion: Frequency of psychotic symptoms in this study is relatively similar to previous studies. However, some clinical determinants such as latency of psychosis from first use and the course of psychosis are more similar to the first epidemic of methamphetamine in Japan than to more recent epidemics; which could be due to the short history of methamphetamine use in Iran.

The aim of the present study was to report independent correlates of ecstasy use in the Swedish general population. Data were drawn from a Swedish national household survey conducted in 2008-2009 on a random, stratified sample of 58,000 inhabitants of Sweden, aged 15 to 64. The response rate was 38.3%. Logistic regression analysis was used to identify correlates of recent (past-year) and former ecstasy use. Results are discussed and limitations of the study are noted.

Early evidence shows that amphetamine-type stimulant (ATS) use has been rapidly increasing in Vietnam. Female sex workers (FSWs) who use ATSs have increased sexual risks for HIV infection. This paper presents qualitative data from a mixed-method study conducted from 2010 to 2011 that aimed to explore the use of ATS among FSWs in three major cities and to identify HIV-related sexual risks among this group. A total of 37 in-depth interviews were conducted, and thematic analysis was performed using NVIVO 8.0 software. Study participants reported that they perceive ATS to be more 'stylish', 'higher class' and much less 'addictive' than heroin. The study highlights multiple sexual risks among this group, including having prolonged sex; sex with multiple simultaneous partners or clients; lack of negotiation for safe sex; increased likelihood of group sex in the context of drug pooling and extended drug and sexual network; as well as unprotected sex. There is an urgent need to promote contextually appropriate interventions to reduce the HIV-related sexual risks among this group.

Homeless men on parole are a hard-to-reach population with significant community reintegration challenges. This cross-sectional study describes sociodemographic, cognitive, psychosocial, and drug-related correlates of alcohol and methamphetamine use in 157 homeless male parolees (age range 18-60) enrolled in a substance abuse treatment center in Los Angeles, California. Logistic regression results revealed that being African American and older were negatively related to methamphetamine use, whereas being older and more hostile were related to riskier alcohol abuse. Findings from this study provide a greater understanding of correlates of methamphetamine and alcohol--two of the most detrimental forms of substances abused among currently homeless parolees.

We assessed the types of drugs, the prevalence of HIV, syphilis, and its correlates among Shandong's drug users in China. Two consecutive cross-sectional surveys in 2009 and 2010 provided demographics, types of drugs, sexual and drug-use behaviors, and HIV-related services. Of the 1320 unique, eligible participants, 81.1% were male, two-thirds <35 years of age, 13.0% non-Shandong residents; in the past year, majority (96.4%) reported ever using methamphetamine, 3.4% using heroin, 8.6% using ≥2 types of these drugs and 8.0% injecting drugs, 63.8% having commercial sex. HIV and syphilis prevalence were 0.2% and 8.3%, respectively. In multivariable logistic regression analysis, syphilis was independently associated with female, non-Shandong residents, higher levels of education, and 2010. Synthetic drugs, especially methamphetamine, have become the predominant sources of drug addiction. The emerging epidemic of syphilis potentially driven by methamphetamine use underscored the urgency to implement an effective sex and substance use-related intervention.

Because stimulant use disorders remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with stimulant use disorders. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with stimulant use disorders. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with stimulant use disorders.

This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Nonmedical use data were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Drug Diversion Program and Poison Center Program. Drug diversion trends nearly overlapped for extended-release amphetamine and extended-release oral methylphenidate. Calls to poison centers were generally similar; however, calls regarding extended-release amphetamine trended slightly lower than those for extended-release oral methylphenidate. Data suggest similar diversion and poison center call rates for extended-release amphetamine and extended-release oral methylphenidate.

Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services.

Objectives: The primary goal of this study was to examine the relative differences in the use of illegal substances (i.e., amphetamine, cannabis, opiates) among forensic patients who have committed a violent crime compared with the general population. The aim was also to find out if there were differences in substance use among forensic versus nonforensic patients with psychosis diagnosis., Methods: The study population consisted of 190 persons, who were involuntarily ordered to hospital treatment as forensic patients in Finland. The information was compared with data from the national hospital discharge register. These results were also compared with national statistics from the general population., Results: Among forensic patients, the lifetime prevalence of cannabis use was 2-fold, amphetamine use 40-fold, and opiate use over 60-fold higher than estimated from the general population in Finland. Cannabis use was 1.5-fold more common than amphetamine use among forensic patients and 1.3-fold more common among nonforensic patients. The prevalences of cannabis-related diagnoses were 4.7- and 3.7-fold more common than opiate use among forensic and nonforensic patients, respectively., Conclusions: Cannabis, amphetamine, and opiate use are associated with an increased risk of becoming a forensic psychiatric patient, but no substantial differences were observed among patients with psychosis diagnosis in the relative risk increase for cannabis versus amphetamine versus opiate use, indicating that none of these drugs are uniquely associated with violent offending among mentally ill.

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.

Using aggregate-level data, this study performed cross-sectional analyses on all 1,628 populated California zip code areas and longitudinal analyses on 581 consistently defined zip codes over six years (1995-2000), relating place and population characteristics of these areas to rates of hospital discharges for amphetamine dependence/abuse using linear spatial models. Analyzing the data in two ways, spatial time series cross-sections and spatial difference models, amphetamine dependence/abuse were greatest in rural areas with more young low-income whites, larger numbers of retail and alcohol outlets, and smaller numbers of restaurants. Growth rates of these problems were greater in areas with higher income and larger non-White and Hispanic populations. This suggests that there was some change in the penetration of the methamphetamine epidemic into different population groups during this time. Study implications and limitations are discussed.

Introduction: This investigation utilized spatial scan statistics, geographic information systems, and multiple data sources to assess spatial clustering of statewide methamphetamine-related incidents. Temporal and spatial associations with regulatory interventions to reduce access to precursor chemicals (pseudoephedrine) were also explored., Methods: Four statewide data sources were utilized including regional poison control center statistics, fatality incidents, methamphetamine laboratory seizures, and hazardous substance releases involving methamphetamine laboratories. Spatial clustering of methamphetamine incidents was assessed using SaTScan. SaTScan was also utilized to assess space-time clustering of methamphetamine laboratory incidents, in relation to the enactment of regulations to reduce access to pseudoephedrine., Results: Five counties with a significantly higher relative risk of methamphetamine-related incidents were identified. The county identified as the most likely cluster had a significantly elevated relative risk of methamphetamine laboratories (RR = 11.5), hazardous substance releases (RR = 8.3), and fatalities relating to methamphetamine (RR = 1.4). A significant increase in relative risk of methamphetamine laboratory incidents was apparent in this same geographic area (RR = 20.7) during the time period when regulations were enacted in 2004 and 2005, restricting access to pseudoephedrine. Subsequent to the enactment of these regulations, a significantly lower rate of incidents (RR = 0.111, p = 0.0001) was observed over a large geographic area of the state, including regions that previously had significantly higher rates., Conclusions: Spatial and temporal scan statistics can be effectively applied to multiple data sources to assess regional variation in methamphetamine-related incidents, and explore the impact of preventive regulatory interventions.

Current literature has shown that heroin addiction is characterized by long periods of regular use persisting over the life course, whereas the course of stimulant use is less understood. The current study examined long-term trajectories of drug use for primary heroin, cocaine (crack/powder cocaine), and methamphetamine (meth) users. The analyses used data from five studies that collected longitudinal information using the Natural History Instrument, including 629 primary heroin users, 694 cocaine users, and 474 meth users. Drug use trajectories over the 10 years since initiation demonstrated the persistence of use over time for all three drugs, with heroin use at the highest level (13 to 18 days per month), cocaine at the lowest level (8 to 11 days), and meth in between (approximately 12 days per month). Application of growth mixture models revealed five distinctive groups: Consistently High Use (n = 545), Increasing Use (n = 260), Decreasing Use (n = 254), Moderate Use (n = 638), and Low Use (n = 100). Heroin users were disproportionately overrepresented in the Consistently High Use group and underrepresented in the Low Use group; cocaine and meth users were mostly in the Moderate Use group. Users in the High Use group also had earlier onsets of drug use and crime, longer incarceration durations, and were the least employed. Clinical/service policy and practice need to recognize and adapt to the specific patterns and needs of users of different drugs while being mindful of the stage drug users are at in their life course.

A 2004-2005 survey among 503 men who have sex with men who attend public venues in New York City was used to examine the relationship of amphetamine use with sexual risk behaviors. Among the men recruited, 51.1% were under 30 years of age, 27.4% were Latino, and 23.3% were African American. Most identified as either gay (78.9%) or bisexual (18.1%). A standardized questionnaire collected data on demographics, sexual risk behaviors, drug and alcohol use, history of HIV testing, and occurrences of sexually transmitted infections. Amphetamine use in the past year was reported by 13.8%. Of those, 71.0% used amphetamines with sex. Amphetamine use was associated with unprotected receptive anal intercourse with non-main partners. In event-specific analysis, amphetamine use was higher with unprotected encounters compared with protected encounters. This study confirms the association between amphetamine use and sexual risk furthers our understanding of risky circumstances and lays the groundwork for the design of interventions.

Studies have found that young injection drug users (IDUs) may be at elevated risk for blood-borne infection transmission, however few studies have evaluated risk longitudinally. We compared variables between younger (>or= 29 years) and older (or= 1 daily) injection of heroin, cocaine, and speedballs. Additionally, younger IDUs were less likely to access drug treatment or methadone maintenance therapy (MMT) and test HIV and HCV-positive. Younger IDUs have lower HIV and HCV prevalence, but a higher risk profile and lower uptake of drug treatment. These factors underscore the need to target this age group and develop youth friendly interventions to minimize drug-related harms.

The purpose of this study was to examine the associations of early-onset methamphetamine (MAMP) use in early adolescence with psychiatric morbidity in adolescents with MAMP use by gender. A total of 299 adolescents with MAMP use in Taiwan were recruited from two juvenile detention centers in Kaohsiung and Taipei from September 1998 to March 2002. Using the Kiddie epidemiological version of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E), each adolescent was interviewed by a child psychiatrist to determine what psychiatric conditions, including substance use disorders (SUDs) and other psychiatric comorbidities might be associated with the early-onset (15 years old or below) MAMP use according to gender. In females, early-onset MAMP use was significantly associated with the diagnoses of depressive disorder, conduct disorder and amphetamine use disorder. In males, however, early-onset MAMP use was only significantly associated with amphetamine use disorder. Gender differences exist in the association between early-onset MAMP use and psychiatric morbidity. The association between early-onset MAMP use and psychiatric morbidity may have important implications for public health policy and treatment for adolescents with MAMP use.

Methamphetamine-dependent inpatients (N = 51) were screened for childhood attention deficit hyperactivity disorder (ADHD) using the Wender Utah Rating Scale upon admission to 30-day inpatient treatment. Baseline assessments included neuropsychological tests of executive function, memory, information processing, verbal fluency, attention, motor skills, and the Brief Symptom Inventory (BSI), a measure of psychiatric symptomatology. The thirty-six participants (70.6%) screening positive for ADHD reported significantly more frequent methamphetamine use prior to baseline. Baseline cognitive functioning was similar between groups, but the presumptive ADHD participants exhibited significantly worse psychiatric symptomatology. At three-week follow- up, 41 participants (80.4%) repeated the neuropsychological battery and BSI. All 10 non-completers screened positive for ADHD. The entire sample improved with abstinence in most neuropsychological domains except memory. The presumptive ADHD group failed to improve on tests of attention. All participants demonstrated significant reductions in psychiatric symptoms with abstinence. Methamphetamine-dependent individuals with ADHD symptoms are common and pose a significant treatment challenge.

The association between former amphetamine dependence and cognitive performance was studied in a sample of 12 individuals with former amphetamine dependence who had been abstinent for at least 1 year and in 12 age-, gender- and verbal IQ-matched controls. The groups were compared by cognitive tests on attention, memory, executive function and fluid intelligence. Individuals with former amphetamine dependence performed significantly poorer than controls in memory domain. Follow-up analysis of variance showed minor deficits in tests of delayed verbal memory. The results remained essentially the same when participants with current DSM-IV axis I diagnosis were excluded from the analysis. It is concluded that individuals with former amphetamine dependence have normal cognitive function with the possible exception of verbal memory. Thus, if widespread cognitive deficits are found in individuals with former amphetamine dependence, etiologies other than amphetamine abuse as such should be carefully investigated.

This paper examines medical and psychiatric symptoms and disorders associated with reported HIV serostatus among methamphetamine-dependent, treatment-seeking men who have sex with men (MSM) in Los Angeles. Baseline data from a NIDA-funded, randomized clinical trial of behavioral drug abuse therapies included medical examinations and behavioral interviews of the 162 randomized participants. Variables identified as significantly associated with HIV infection were entered into a multivariate, hierarchical logistic regression analysis to optimally predict HIV serostatus. The disturbingly high 61% of the sample with reported HIV-seropositive status represents 3-4 times the prevalence for all MSM in Los Angeles County. HIV infection status strongly associated with prior treatment for methamphetamine dependence; unprotected receptive anal intercourse; history of sexually transmitted infections; and health insurance status. Findings demonstrate the powerful connection between methamphetamine dependence and HIV infection, and strongly suggest a need for development of interventions that function as both substance abuse treatment and HIV prevention for this population.

Club drug use, MDMA in particular, appeared as a growing problem in the Seattle area in the late 1990s. To understand more about the patterns of MDMA use and to evaluate the current state of MDMA use, multiple data sources were examined. The seven data sources utilized included local community-based club drug surveys collected in 2003 at raves, treatment agencies, and gay-oriented bars and sex clubs; school surveys (collected in 2002); mortality data (deaths between 2000 and 2002); data from the sexually transmitted disease clinic (October 2002 to October 2003); focus groups (2003) with men who have sex with men; emergency department drug mentions (1995 to 2002); and drug treatment admissions (1999 to 2003). Taken together, these data indicate moderate levels of MDMA use and relatively low levels of mortality and acute morbidity. However, there are several areas of concern including possible mental health effects and high levels of suspected adulteration of MDMA. Some data point to a relationship between MDMA use and risky behaviors including unprotected sex. Implications for prevention, intervention, and treatment are discussed.

Polydrug use is an important public health issue since it has been linked to significant adverse health outcomes. Recently, club drugs, including ketamine and other drugs used in dance/rave scenes, have been identified as key substances in new types of polydrug using patterns. While seemingly a self-explanatory concept, "polydrug" use constitutes multiple drug using practices that may impact upon health risks. Ketamine, a club drug commonly administered intranasally among youth for its disassociative properties, has emerged as a drug increasingly prevalent among a new hidden population of injection drug users (IDUs). Using an ethno-epidemiological methodology, we interviewed 40 young (<25 years old) ketamine injectors in New York during 2000-2002 to describe the potential health risks associated with ketamine and polydrug use. Findings indicate that ketamine was typically injected or sniffed in the context of a polydrug using event. Marijuana, alcohol, PCP, and speed were among the most commonly used drugs during recent ketamine using events. Polydrug using events were often quite variable regarding the sequencing of drug use, the drug combinations consumed, the forms of the drug utilized, and the modes of administrating the drug combinations. Future research should be directed towards developing a more comprehensive description of the risks associated with combining ketamine with other drugs, such as drug overdoses, the transmission of bloodborne pathogens, such as HIV and HCV, the short- and long-term effects of drug combinations on cognitive functioning, and other unanticipated consequences associated with polydrug use.

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2=7.4, p=0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.

In this paper the epidemiology of club drug use in Germany, including the use of 3,4-methylendioxy-N-methamphetamine (MDMA) known as 'ecstasy' and related substances such as speed, amphetamines, hallucinogens, and cannabis is described on the basis of five different surveys. Two of them are representative household surveys to monitor the licit and illicit drug use behavior of the German population. The third one is a longitudinal study aimed at exploring comorbidity and posited risk and protective factors in adolescents and young adults with specific emphasis on substance use-related disorders. Since ecstasy seemed to be associated with a new music culture of the '90s called "techno," two studies investigating the relationship of using ecstasy and related substances in the techno party scene are additionally presented. The question of the clinical impact of using ecstasy and related substances is raised in terms of substance use-related and mental disorders associated with the use of ecstasy. Finally, the motivation for using and stopping the use of ecstasy is addressed. It is shown that ecstasy has reached the second place (after cannabis) in illegal drug preferences of adolescents and young adults in Germany. Evidence is found that ecstasy use as well as ecstasy use-related disorders such as "abuse" and "dependence" are of a transient, "youth-limited" nature.

Objective: This study assessed the need over time for treatment of personal adjustment and substance abuse problems among chronic drug using and other recipients of Temporary Assistance for Needy Families (TANF)., Methods: Participants were administered the personal adjustment problems and substance abuse problems scales contained in the Multidimensional Addictions and Personality Profile (MAPP) at intake, one-year, and two-year interviews., Results: Most participants who were not chronic users had total scale scores that would indicate no recommended referral or a referral to outpatient treatment. Approximately one-third of chronic users had scores that would indicate referral to inpatient treatment. Many chronic users had comorbid conditions but reported receiving no psychological or substance abuse treatment., Conclusions: Many TANF recipients may be experiencing coexisting personal and substance abuse related problems that are going untreated.

One hundred consecutive juvenile drug offenders with amphetamine use in a remand center were assessed for extent of substance use and psychiatric morbidity by a psychiatrist from 1998 to 1999. They were monitored for one year after discharge. The "risk" of being recommitted to the remand center against use of various drugs and psychiatric morbidity was determined. Amphetamine-use disorder was more prevalent in those who were recommitted than those who were not, while no significant difference was found with licit substances, psychiatric morbidity, or the number of substances used between these two groups. In view of the high dependency properties of amphetamine, early intervention is suggested to prevent reuse.