Search

Objective: To investigate whether methamphetamine use is associated with sexual risk behavior among adolescents. Method: A cross-sectional survey of 1,561 male and female high school students in Cape Town (mean age 14.9 years) was conducted using items from the Problem Oriented Screening Instrument for Teenagers (POSIT) HIV Risk Scale. Results: Nine percent of the students had tried methamphetamine and 30% of male and 17% of female students reported sexual debut. Multinomial logistic regression analyses showed that methamphetamine use in the past year was significantly associated with being in a higher HIV/STI risk category (RRR = 2.1, 95% CI: 1.10-4.03, p less than 0.05). Conclusions: Methamphetamine use, coupled with a high HIV prevalence in South Africa, raises serious cause for concern about the potential for methamphetamine to further exacerbate the prevalence and spread of HIV in Cape Town. (Contains 2 tables and 1 figure.)

Methamphetamine use is a global concern, and methamphetamine-associated psychosis (MAP) is a particular harm resulting from regular use of the drug that causes significant distress and burden on health and social services. This paper aims to provide a clinically focussed and up-to-date overview of the prevalence, risk factors, and clinical and cognitive features of MAP. The prevalence of MAP ranges between 15 and 30% in recreational settings and up to 60% in some inpatient treatment settings, with up to a third of people with MAP later diagnosed with persistent psychotic disorders. The frequency of methamphetamine use and severity of dependence are the most consistent risk factors for MAP, but other predictors such as genetic vulnerability, a family history of psychotic illness, or trauma also play a role. People with MAP can vary in their presentation, from brief delusional experiences, to persistent psychosis characterised by first-rank symptoms and cognitive impairment. Contemporary conceptualisations of MAP need to incorporate this spectrum of clinical presentations in order to inform clinical decision-making, service provision, and research directions. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia.Design and Methods: Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate.Results: The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010.Discussion and Conclusions: The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170]. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Binge drinking is elevated among recreational drug users, but it is not clear whether this elevation is related to intoxication with recreational drugs.We examined whether stimulant intoxication and cannabis intoxication were associated with binge drinking among young adults. Design and Methods. An online survey of 18- to 30-year-old Australians who had drunk alcohol in the past year (n = 1994) were quota sampled for: (i) past year ecstasy use (n = 497); (ii) past year cannabis (but not ecstasy) use (n = 688); and (iii) no ecstasy or cannabis use in the past year (alcohol-only group, n = 809). Binge drinking last Saturday night (five or more drinks) was compared for participants who took stimulants (ecstasy, cocaine, amphetamine or methamphetamine) or cannabis last Saturday night. Results. Ecstasy users who were intoxicated with stimulants (n = 91) were more likely to binge drink than ecstasy users who were not (n = 406) (89% vs. 67%), after adjusting for demographics, poly-drug use and intoxication with cannabis and energy drinks (adjusted odds ratio 3.1, P = 0.007), drinking a median of 20 drinks (cf. 10 drinks among other ecstasy users). Cannabis intoxication was not associated with binge drinking among cannabis users (57% vs.55%) or ecstasy users (73% vs.71%).Binge drinking was more common in all of these groups than in the alcohol-only group (34%). Discussion and Conclusions. Stimulant intoxication, but not cannabis intoxication, is associated with binge drinking among young adults, compounding already high rates of binge drinking among people who use these drugs.[McKetin R, Chalmers J, Sunderland M, Bright DA. Recreational drug use and binge drinking: Stimulant but not cannabis intoxication is associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

Introduction and Aims. To determine whether recreational methamphetamine use is associated with an increased risk of psychotic symptoms. Design and Method. A cross-sectional survey of 157 people attending dance events in Sydney, Australia. Participants were assessed for psychotic symptoms in the past year using items from the Psychosis Screen. Participants with and without psychotic symptoms were compared on methamphetamine use, polydrug use and other demographic factors. An ordinal logistic regression was used to determine the probability of psychotic symptoms by methamphetamine use and level of polydrug use. Results. Psychotic symptoms in the past year were predicted by methamphetamine use and heavier polydrug use in the past year, and a history of a psychotic disorder (schizophrenia, schizoaffective or bipolar affective disorder). After removing participants with a history of a psychotic disorder (n = 16) and adjusting for polydrug use, methamphetamine use increased the probability of two or more psychotic symptoms (indicative of psychosis risk) from 9% to 21%. There was a non-significant increase in the risk of psychotic symptoms with higher levels of polydrug use. Methamphetamine use was typically monthly or less often (83%), and most users described their use as recreational (85%). Discussion and Conclusions. Within the context of polydrug use, recreational methamphetamine use is associated with a twofold to threefold increase in the probability of psychotic symptoms.[McKetin R, Hickey K, Devlin K, Lawrence K. The risk of psychotic symptoms associated with recreational methamphetamine use. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR]

Aims To determine the comparative levels of violent offending and victimization among regular methamphetamine and heroin users. Design Cross-sectional Setting Sydney, Australia. Participants A total of 400 regular methamphetamine (METH) and heroin (HER) users (118 methamphetamine users: METH; 161 regular heroin users: HER; 121 regular users of both: BOTH). Findings Eighty-two per cent reported a life-time history of committing violent crime, 41% in the past 12 months. There were no group differences in life-time violence, but the METH group were significantly more likely than the HER group to have committed violence in the past 12 months (odds ratio 1.94). Nearly all (95%) reported that they had been a victim of violent crime, 46% in the preceding 12 months, with no group differences. Those who had committed a violent crime in the past 12 months were 13.23 times more likely to have been a victim in that period. The majority believed it unlikely that they would be a victim of (78%), or commit (87%), a violent crime in the next 12 months. Conclusions Regular methamphetamine use appears to be associated with an increased risk of violent offending, but not victimization, compared with heroin use. [ABSTRACT FROM AUTHOR]

Introduction and Aims. To examine the cost-effectiveness of modafinil (200 mg daily) plus counselling compared with placebo for the treatment of psychostimulant dependence. Design and Methods. Cost and outcome data were collected alongside two randomised controlled trials of modafinil 200 mg daily over 10 weeks for methamphetamine (n = 74) and cocaine dependence (n = 8), respectively. Incremental cost-effectiveness ratios representing the additional costs to achieve a given outcome were calculated for both the change in the number of stimulant-free days and quality-adjusted life years 12 weeks post-treatment. Results. The incremental cost-effectiveness ratio indicated that it would cost an additional $AUD79 to achieve an extra stimulant-free day with modafinil compared with placebo. This result was not statistically significant, but appeared to be a robust estimate after sensitivity analysis. Counselling, whether received within program or from other services, improved the cost-effectiveness of modafinil relative to placebo. Discussion and Conclusions. Strategies to improve the uptake of counselling are recommended as cost-effective.[Shearer J, Shanahan M, Darke S, Rodgers C, van Beek I, McKetin R, Mattick RP. A cost-effectiveness analysis of modafinil therapy for psychostimulant dependence. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR]

Background: This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa. Methods: A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 months later. The questionnaire included questions on substance use, including tobacco, alcohol, methamphetamine and cannabis use, demographic factors, and questions relating to school attendance and performance. Results: Forty-three percent of the students surveyed at baseline did not complete a follow-up questionnaire after 12 months. Compared with students who were not using selected substances, an adjusted logistic regression model showed that life-time methamphetamine use in addition to other substances was significantly associated with non-attendance (OR = 2.58, 95% CI: 1.24 - 5.36) when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. Conclusions: Early identification of students with methamphetamine and other substance use problems, and a supportive rather than punitive school policy, may be valuable in improving high school completion and student retention rates. [ABSTRACT FROM AUTHOR]

Introduction and Aims. To identify the sociodemographic, health, drug use patterns, treatment coverage and barriers to treatment among regular methamphetamine users in rural and regional North Coast of New South Wales. Design and Methods. A structured questionnaire was used to measure sociodemographic factors, health and well-being, drug use patterns, methamphetamine dependence, engagement in methamphetamine treatment and barriers to treatment. Participants were 140 regular methamphetamine users. Dependent and non-dependent participants were compared to identify factors associated with dependence. Results. Participants were predominantly in their thirties, male and had low levels of education, high levels of unemployment and polydrug use. Participants who were dependent on methamphetamine (59%) were more likely to report impaired mental health and to have been diagnosed with depression, anxiety and drug-induced psychosis. One quarter of dependent methamphetamine users had received treatment in the last year and half had ever received treatment. The main barriers to receiving treatment were a lack of perceived need or motivation to seek treatment and concerns about confidentiality. Discussion and Conclusions. Methamphetamine users living on the North Coast of New South Wales require treatment options tailored to address a complex array of physical and psychological problems. The findings highlight the need for psychiatric support and improved coordination between mental health and drug and alcohol services in rural and regional areas.[Wallace C, Galloway T, McKetin R, Kelly E, Leary J. Methamphetamine use, dependence and treatment access in rural and regional North Coast of New South Wales, Australia. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

The market for domestically produced methamphetamine in Australia (sold as 'speed' and 'base') has been recently supplemented with imported crystalline methamphetamine ('ice' or 'crystal'), the supply of which is thought to involve different organized crime groups than those involved with domestic supply. The existence, or otherwise, of distinct retail markets for these different forms of methamphetamine has important implications for police and public health strategies. The aim of this study was to examine whether there was evidence of distinct retail markets for crystalline methamphetamine and domestically produced forms of the drug. A cross-sectional survey of regular methamphetamine users (n = 309) was undertaken in Sydney, Australia to assess the characteristics of the retail market (consumption, price, perceived purity, availability, purchase location and sale from dealers) for crystalline methamphetamine compared with domestically produced forms of the drug (i.e. speed and base). We did not find any clear evidence of a segregated retail market for crystalline methamphetamine. Only 3% of participants were exclusive crystalline methamphetamine users, and both crystalline methamphetamine and other domestically produced forms of the drug were readily available to consumers, being typically purchased from the same dealers, in the same location and at the same price. [ABSTRACT FROM AUTHOR]

Aim. To examine the extent of physical health impairment among a community sample of methamphetamine users in comparison with the general population, and factors associated with impairment among this group. Method. A cross-sectional survey of 309 regular methamphetamine users from Sydney. The Physical Component Scale of the Short Form 12 (SF-12) was used to measure impairment in physical health (score < 40). Age-matched general population data for the SF-12 were derived from the Australian National Survey of Mental Health and Well-Being. Results. Participants had a higher prevalence of impaired physical health compared to the Australian general population (20% vs. 10%, p < 0.05), but this effect occurred among only dependent methamphetamine users over 24 years of age (25 - 34 years, 23% vs. 10%; 35 - 44 years, 41% vs. 12%). Methamphetamine dependence remained significantly predictive of impaired physical health after adjusting for age and other confounding factors. Opioid pharmacotherapy was also related strongly to poor physical health, accounting for 63% of participants with physical impairment. Other factors associated with impaired physical health were being female, having less than 10 years of schooling, and having been diagnosed previously with an anxiety disorder (p < 0.05). Conclusion. Methamphetamine users are more likely to report impaired physical health than the general population, but this impairment is specific to older methamphetamine users who are dependent on the drug, particularly those who are enrolled in opioid pharmacotherapy. [McKetin R, Kelly E, McLaren J, Proudfoot H. Impaired physical health among methamphetamine users in comparison with the general population: the role of methamphetamine dependence and opioid use. Drug Alcohol Rev 2008;27:482-489] [ABSTRACT FROM AUTHOR]

Introduction and Aims. To compare the characteristics and harms associated with injecting and smoking methamphetamine among methamphetamine treatment entrants. Method and design. A structured face-to-face interview was used to assess demographics, drug use patterns and harms [physical and mental health, psychological distress, psychotic symptoms, crime and human immunodeficiency virus (HIV) risk behaviour] among 400 methamphetamine treatment entrants in Sydney and Brisbane, Australia. Participants who had injected but not smoked methamphetamine in the month before treatment (n = 195, injectors) were compared to participants who had either: (a) injected and smoked (n = 90, injectors who smoke), or (b) smoked but not injected (n = 73, smokers), during this time. Results. In comparison with injectors, smokers were primarily non-injecting drug users, who were younger, more likely to be female and use ecstasy rather than heroin. After adjusting for these differences smokers were less dependent on methamphetamine than injectors, but they took the drug as often and had similarly high levels of psychological distress, poor physical and mental health, psychotic symptoms, sexual risk behaviour and criminal involvement. Injectors who smoked had a similar demographic and clinical profile to injectors, including comparable levels of needle sharing, but they used methamphetamine more often and had greater criminal involvement. Conclusion. Within this treatment sample, smoking methamphetamine occurred among both long-standing injecting drug users and a comparatively younger group of non-injecting drug users. It was associated with less severe methamphetamine dependence than injecting, but more intense use patterns and similar levels of other harms. [McKetin R, Ross J, Kelly E, Baker A, Lee N, Lubman DI, Mattick R. Characteristics and harms associated with injecting vs. smoking methamphetamine among methamphetamine treatment entrants. Drug Alcohol Rev 2008;27:277-285] [ABSTRACT FROM AUTHOR]

Introduction and Aims. Southeast and East Asia has become a global hub for methamphetamine production and trafficking over the past decade. This paper describes the rise of methamphetamine supply and to what extent use of the drug is occurring in the region. Method and Design. The current review uses data collected through the Drug Abuse Information Network for Asia and the Pacific (DAINAP) and other available sources to analyse retrospectively methamphetamine trends within Southeast and East Asia. Results. Southeast and East Asia has experienced a methamphetamine epidemic in the past decade which began around 1997 and peaked in 2000 - 2001. While the situation has since stabilised in many countries, methamphetamine trafficking and use are still increasing in parts of the Mekong region and there is evidence of large-scale manufacture in Cambodia, Indonesia, Malaysia and the Philippines. Methamphetamine is typically smoked or ingested, but injection of the drug is apparent. Conclusion. While the peak of the methamphetamine epidemic has passed in parts of Southeast and East Asia, attention is needed to minimise the potential consequences of spreading methamphetamine production, trafficking and use in the Mekong region and in the peninsular and archipelago of Southeast Asia. [McKetin R, Kozel N, Douglas J, Ali R, Vicknasingam B, Lund J, Li J-H. The rise of methamphetamine in Southeast and East Asia. Drug Alcohol Rev 2008;27:220-228] [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of the current study was to determine whether crystalline methamphetamine users are more dependent on methamphetamine than people who use other forms of the drug, and if so, whether this could be accounted for by their methamphetamine use history. Method: A structured face-to-face interview was used to assess drug use patterns and demographics among a convenience sample of 309 regular methamphetamine users from Sydney, Australia. Dependence on methamphetamine in the past year was measured using the Severity of Dependence Scale. The use of crystalline methamphetamine in the past year was confirmed using a photographic identification sheet. Results: Participants who had used crystalline methamphetamine in the past year were significantly more likely to be dependent on methamphetamine than participants who took only other forms of methamphetamine during this time (61% versus 39%). Methamphetamine dependence was also associated with injecting or smoking methamphetamine (67% and 58%, respectively versus 30% for intranasal or oral use), using methamphetamine more than weekly (68% versus 34%), having used the drug for more than 5 years (61% versus 36%), and having used ‘base’ methamphetamine in the past year (59% versus 39%). Crystalline methamphetamine use remained significantly associated with methamphetamine dependence after adjusting for these patterns of methamphetamine use. Conclusions: Methamphetamine users who took crystalline methamphetamine in the past year were more likely to be dependent than methamphetamine users who had not taken the crystalline form of the drug during this time. [Copyright &y& Elsevier]

The purpose of this study was to examine the types of treatment services provided for amphetamine use, the characteristics of amphetamine treatment clients and the geographic areas most affected by amphetamine treatment provision within New South Wales (NSW), Australia. Data on completed amphetamine treatment episodes were extracted from the NSW Minimum Data Set for Alcohol and Other Drug Treatment Services for the year 2002/03 ( n = 4337). The geographic area of treatment presentations was based on the location of the treatment service, and was categorized as metropolitan, regional or rural. Treatment disproportionately affected regional and rural NSW, and treatment clients often presented with concurrent cannabis and/or alcohol problems. Clients were overwhelmingly injecting drug users with poor socio-demographic characteristics. Counselling was the most common treatment service provided, followed by detoxification and residential rehabilitation. Detoxification was usually provided in an in-patient setting, particularly within metropolitan NSW. Compliance with residential rehabilitation was notably poor. In conclusion, the development of appropriate interventions for amphetamine use needs to consider that the majority of treatment recipients will be based in a regional or rural setting, and treating amphetamine users will often involve treatment of concurrent cannabis and alcohol problems. The nature and appropriateness of treatment services provided for amphetamine use needs to be reviewed in detail, and further research is needed into the nature of problematic amphetamine use and factors affecting treatment demand in regional and rural NSW. [McKetin R, Kelly E, Indig D. Characteristics of treatment provided for use of amphetamines in New South Wales, Australia . Drug Alcohol Rev 2005;24:433–436] [ABSTRACT FROM AUTHOR]

The author focuses on methamphetamine use. Particular attention is given to methamphetamine precursor regulation and whether or not that controls or diverts the drug problem. The author reports that in 2007, the United Nations estimated that 2.5 million people used methamphetamine or related amphetamine derivatives each year. The production of these drugs is difficult to regulate, as they can be made from chemicals that are contained in everyday products. Regulating supply involves balancing the need for these chemicals to be made available for legitimate purposes, while preventing their diversion into drug manufacture.

Comments on the concerns for developing a global perspective on drug information systems to adress drug problems in the U.S. Increase of illicit drug use; Appearance of comprehensive systems to assess drug use patterns; Highlights of the meeting hosted by the European Monitoring Center for Drugs and Drug Addiction on January 2000.

Abstract: Aim and background. We estimated health service utilisation attributable to methamphetamine use, its national impact and examined other predictors of health service utilisation among dependent methamphetamine users. Method. Past year rates of health service utilisation (number of attendances for general hospitals, psychiatric hospitals, emergency departments, general practitioners, psychiatrists, counsellors or psychologists, and dentists) were estimated for three levels of methamphetamine use (no use, < weekly, ≥ weekly) using panel data from a longitudinal cohort of 484 dependent methamphetamine users from Sydney and Brisbane, Australia. Marginal rates for methamphetamine use were multiplied by 2013 prevalence estimates from the National Drug Strategy Household Survey. Covariates included other substance use, demographics, mental disorders and drug treatment. Findings. Health service use was high. More frequent methamphetamine use was associated with more frequent presentations to emergency departments (incidence rate ratios 1.3–2.1) and psychiatric hospitals (incidence rate ratios 5.3–8.3) and fewer presentations to general practitioners, dentists and counsellors. We estimate methamphetamine use accounted for between 28 400 and 80 900 additional psychiatric hospital admissions and 29 700 and 151 800 additional emergency department presentations in 2013. More frequent presentations to these services were also associated with alcohol and opioid use, comorbid mental health disorders, unemployment, unstable housing, attending drug treatment, low income and lower education. Conclusions. Frequent methamphetamine use has a significant impact on emergency medical and psychiatric services. Better provision of non‐acute health care services to address the multiple health and social needs of dependent methamphetamine users may reduce the burden on these acute care services. [McKetin R, Degenhardt L, Shanahan M, Baker AL, Lee NK, Lubman DI. Health service utilisation attributable to methamphetamine use in Australia: patterns, predictors and national impact. Drug Alcohol Rev 2017;00:000–000] [ABSTRACT FROM AUTHOR]

Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants’ satisfaction with their assigned interventions. Participants ( N = 174; M age = 23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use ( n = 85) or a 50-minute session of MET that included an educational component ( n = 89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks postbaseline, while the secondary outcome measure was assessed 4-weeks postbaseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both intervention groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9%–17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes. Australia and New Zealand Clinical Trial Registry: ACTRN12611000136909 [ABSTRACT FROM AUTHOR]

In recent years, recreational use of Salvia divinorum (Lamiaceae), a herbal drug that contains a hallucinogenic ingredient, salvinorin A, has become a new phenomenon among young drug users. In Taiwan, as in many other countries, dry leaves of S. divinorum and its related concentrated extract products are available via the Internet. Besides S. divinorum, there are many endemic Salvia species whose salvinorin A content is yet unknown. To understand the abuse liability of these products, the aim of this study was to assess the concentration of salvinorin A in endemic Salvia species and Internet-available salvinorin A-related products. Samples of S. divinorum were purchased via the Internet and samples of eight endemic species of Salvia were collected in Taiwan, including S. arisanensis Hayata, S. coccinea Juss. ex Murr, S. hayatana Makino ex Hayata, S. japonica Thumb. ex Murr, S. nipponica Miq. Var. formosana (Hayata) Kudo, S. scapiformis Hance, S. tashiroi Hayata. Icon. PI. Formosan, and S. keitaoensis Hayata. The content of salvinorin A was determined by high performance liquid chromatography (HPLC). Salvinorin A was extracted from the dry leaves of S. divinorum and endemic species of Salvia with methanol and analyzed on a C-18 column by isocratic elution with a mobile phase of acetonitrile--water. Salvinorin A was detected in S. divinorum, but not in the endemic Salvia species of Taiwan. Therefore, endemic species of Salvia in Taiwan may not possess hallucinogenic potential. However, the potential harm from S. divinorum available via the Internet should be thoroughly assessed in Taiwan, and control measures similar to those implemented in many other countries should be considered. [ABSTRACT FROM AUTHOR]