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Copyright of Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) is the property of Universidade Federal do Triangulo Mineiro, Instituto de Ciencias da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Forced mobility among homeless injection drug users and crack smokers in Montréal: This article focuses on the various actors in the urban setting who contribute to the increase in the forced mobility of homeless injection drug users and crack smokers in Montréal, Canada. The objective is to analyze who these actors are and how they contribute to increasing this forced mobility from the perspective of homeless injection drug users and crack smokers in relation to three needs : basic needs, acquisition of financial resources, and drug use. One hundred and six semi‐structured interviews were conducted among this population. The results indicate that various actors—police officers, community organization, peers, municipal administration, storekeepers, and residents—contribute to the forced mobility of this population in their daily activities. As for their needs, it is when they use drugs, sleep, or loiter that they are more likely to experience events of forced mobility. Police officers are by far the actors who contribute the most to this, often in a repressive way. The role of the municipality is also a determining factor in the daily activities of homeless injection drug users and crack smokers. Messages clés: Plusieurs types d'acteurs (policiers, organismes communautaires, pairs, administration municipale, commerçants et résidents) sont impliqués dans des évènements de mobilité forcée.Les policiers sont les plus impliqués dans les évènements de mobilité forcée.Concernant les besoins, consommer, dormir et occuper l'espace public sont à l'origine du plus grand nombre de déplacements forcés. [ABSTRACT FROM AUTHOR]

Levamisole is an anti-helminthic drug with immunomodulatory properties that is added to cocaine to increase its potency and weight. Levamisole-adulterated cocaine (LAC) may cause an antineutrophil cytoplasmic antibody (ANCA)-associated systemic small vessel vasculitis (AAV). We aimed to characterize the phenotype of persons developing pulmonary-renal syndrome (PRS) in LAC-induced AAV and summarize its treatment and outcomes. Pubmed and Web of Science were searched (until September 2022). Reports that described co-existing diffuse alveolar hemorrhage and glomerulonephritis in an adult (age ≥ 18) with confirmed or suspected LAC exposure were included. Reports, demographics, clinical and serologic features, treatment and outcome characteristics were extracted. Of the 280 records identified, eight met the inclusion criteria, including eight unique cases. Persons were aged 22–58 years, and 50% were women. Cutaneous involvement occurred in only half of the cases. Other associated vasculitis findings and serologies were heterogeneous. All patients received immunosuppression with steroids, with cyclophosphamide and rituximab commonly added. We concluded that PRS could occur from LAC-induced AAV. Distinguishing LAC-induced AAV from primary AAV is challenging as clinical and serologic presentations overlap. Asking about cocaine use is requisite in persons presenting with PRS to guide diagnosis and appropriately counsel on cocaine cessation in conjunction with immunosuppression as treatment. [ABSTRACT FROM AUTHOR]

The label "crack user" is profoundly stigmatizing. Such labels are foundational to an individual's identity, affecting how others view them, their self-perceptions, and subsequent behavior. Individuals can also resist labels such as "crack user," creating distinctions for the same behavior. To elucidate characteristics associated with self-application of stigmatizing labels, we use data from individuals (N = 50,721) serviced for smoking cocaine in French drug treatment centers (N = 263) from 2010–2020 to assess who self-labels their behavior "crack use" or does not in favor of "smoked cocaine," which are identical behaviors. Multilevel models reveal higher odds of using the less stigmatizing "smoked cocaine" in earlier years, among those with less risky cocaine use profiles, and among those not using other stimulants. Importantly, this less stigmatizing label is more common among those of high SES and outside the Paris region. An interaction demonstrates that even within Paris, those of high SES have higher odds of using this label than their lower SES Parisian counterparts. Those in privileged positions may use this alternative label to avoid stigmatization of the "crack user" label. Such distinctions potentially perpetuate inequalities associated with the more stigmatized label. We suggest that treatment centers can act as sites to combat these differences. [ABSTRACT FROM AUTHOR]

AimsTo summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs.DesignSystematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525).Setting and participantsPeople who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services.MeasurementsPrimary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).FindingsNinety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.ConclusionsPeople who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

BackgroundVenous access is a priority for people who inject drugs (PWID). Damage and scarring of peripheral veins can exacerbate health harms, such as skin and soft tissue infections (SSTI), and promote transitions to femoral and subcutaneous injecting. Brown heroin available in Europe requires acidification for injection preparation. In this paper, we present mixed-methods data to explore our hypothesis of a link between overly acidic injection solutions, venous damage and SSTI risk.MethodsWe present a structured survey (n = 455) and in-depth qualitative interview (n = 31) data generated with PWID in London for the Care & Prevent study. Participants provided life history data and detail on injecting environments and drug preparation practices, including the use of acidifiers. Bivariate and multivariate analyses were conducted using a logistic regression for binary outcomes to explore associations between outcomes and excessive acidifier use. Grounded theory principles informed inductive qualitative analysis. Mixed-methods triangulation was iterative with results comparison informing the direction and questions asked of further analyses.ResultsOf the 455 participants, most (92%) injected heroin and/or crack cocaine, with 84% using citric as their primary acid for drug preparation. Overuse of acidifier was common: of the 418 who provided an estimate, 36% (n = 150) used more than ½ a sachet, with 30% (n = 127) using a whole sachet or more. We found associations between acidifier overuse, femoral injecting and DVT, but not SSTI. Qualitative accounts highlight the role of poor heroin quality, crack cocaine use, information and manufacturing constraints in acidifier overuse. Painful injections and damage to peripheral veins were common and often attributed to the use of citric acid.ConclusionsTo reduce injecting-related injury and associated consequences, it is crucial to understand the interplay of environmental and practice-based risks underpinning venous damage among PWID. Overuse of acidifier is a modifiable risk factor. In the absence of structural supports such as safe injecting facilities or the prescribing of pharmaceutical diamorphine, there is an urgent need to revisit injecting paraphernalia design and distribution in order to alleviate health harms and distress among the most marginalised.

Background: Brass screens are considered an essential part of the safer drug smoking/inhalation supplies and are widely distributed by harm reduction programs in Canada. However, the use of commercially available steel wools as screens for smoking crack cocaine remains a common practice among people who smoke drugs in Canada. Use of these steel wool materials is associated with different adverse effects on health. This study aims to determine what changes folding and heating have on several filter materials, including brass screens and commercially available steel wool products, and examine the implications of these changes on health of people who smoke drugs. Methods: This study investigated the microscopic differences, studied by optical and scanning electron microscopy, between four screen and four steel wool filter materials used in a simulated drug consumption process. New materials were manipulated, compacted into its own Pyrex® straight stem using a push stick and then heated with a butane lighter simulating a common method in preparing drugs for consumption. The materials were studied in the as-received (new), as-pressed (compressed and inserted into the stem tube but without heating) and as-heated (compressed and inserted into the stem tube and heated with a butane lighter) conditions. Results: The steel wool materials with the smallest wire thicknesses were found to be the easiest to prepare for pipe use, but degrade significantly during shaping and heating, making them wholly unsuitable as a safe filter material. In contrast the brass and stainless steel screen materials remain mostly unchanged by the simulated drug consumption process. After the stainless steel pellet screen, the Brass Impact 2.0 screen material had the best characteristics of the materials tested due to its mesh wire diameter, pitch, alloy choice and its pre-strained state. Conclusion: Commonly used steel wool alternatives degrade during the handling and stem insertion, and heating the screens in the stem. Debris is generated by wool deformation on insertion and after heating that easily separates from the screen and can be inhaled during drug consumption. The brass and stainless steel screen materials are safer to use as they remain mostly stable during the simulated drug consumption process. [ABSTRACT FROM AUTHOR]

Throughout the mid-1980s, the Nation of Islam—via its newspaper the Final Call —condemned American expansion of empire in the circum-Caribbean. Domestically, articles focused on President Ronald Reagan's War on Drugs, characterizing it as a farce justifying the imprisonment and genocide of Black people. These were not separate thought experiments, however. For the Nation of Islam, the same racist, imperialist justifications served as the basis of both occupations, one foreign and one domestic. American military action abroad was simply a precursor to subjugation of Black America with tanks, guns, and bombs. This article explores this intellectual and internationalist discourse and the real solutions that emerged from it through the Nation of Islam's Dopebusters program, which fought drugs and violence in Black communities. I argue that these tactics were a religio-political response, combining Islam, Black nationalism, internationalism, and anti-imperial discourses to translate theory and rhetoric into community action. [ABSTRACT FROM AUTHOR]

Copyright of SMAD Revista Electronica Salud Mental, Alcohol y Drogas is the property of Universidade de Sao Paulo, Escola de Enfermagem de Ribeirao Preto and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Crack cocaine has been associated with a variety of pulmonary manifestations. We report a 44-year-old man been diagnosed with severe acute respiratory syndrome coronavirus 2 infection, presenting shortness of breath, non-productive cough, chest pain, headache, dizziness, and fever lasting for 2 days. At first, all findings of our patient called for an impression of coronavirus disease 2019. During admission, he presented with acute respiratory symptoms, patchy ground-glass opacities, and laboratory abnormalities, such as elevated acute phase response and lymphopenia. After, the presence of transient lung infiltrations in the follow-up triggered the cause for a re-evaluation of the diagnosis of coronavirus disease 2019. After a detailed inquiry, it was revealed that he had had a history of intense inhaled cocaine use 2 days before hospitalization. We speculate that the crack lung should also be considered in the differential diagnosis in patients with suspected coronavirus disease 2019 pneumonia. [ABSTRACT FROM AUTHOR]

This article discusses the social harms arising out of stigma experienced by people who use drugs (PWUD), and how stigmatisation compromises 'human flourishing' and constrains 'life choices'. Drawing on Wellcome Trust qualitative research using in-depth, semi-structured interview data (N = 24) with people who use heroin, crack cocaine, spice and amphetamine, this article firstly provides insight into how stigma is operationalised relationally between people via a lens of class talk and drug use predicated on normative ideas of 'valued personhood'. Secondly, it turns to how stigma is weaponised in social relations to keep people 'down', and thirdly, it shows how stigma is internalised as blame and shame and felt deeply 'under the skin' as 'ugly feelings'. Findings from the study show that stigma harms mental health, inhibits access to services, increases feelings of isolation, and corrodes a person's sense of self-worth as a valued human being. These relentless negotiations of stigma are painful, exhausting and damaging for PWUD, culminating in, as I argue, everyday acts of social harm that come to be normalised. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare results from five commercial hair testing laboratories conducting workplace drug testing with regard to bias, precision, selectivity and decontamination efficiency. Nine blind hair specimens, including cocaine-positive drug user specimens (some contaminated with methamphetamine) and negative specimens contaminated with cocaine, were submitted in up to five replicates to five different laboratories. All laboratories correctly identified cocaine in all specimens from drug users. For an undamaged hair specimen from a cocaine user, within-laboratory Coefficients of Variation (CVs) of 5–22% (median 8%) were reported, showing that it is possible to produce a homogenous proficiency testing sample from drug user hair. Larger CVs were reported for specimens composed of blended hair (up to 29%) and curly/damaged hair (19–67%). Quantitative results appeared to be method-dependent, and the reported cocaine concentrations varied up to 5-fold between the laboratories, making interlaboratory comparisons difficult. All laboratories reported at least one positive result in specimens contaminated with cocaine powder, followed by sweat and shampoo treatments. Benzoylecgonine, norcocaine, cocaethylene and hydroxylated cocaine metabolites were all detected in cocaine powder-contaminated specimens. This indicates that current industry standards for analyzing and reporting positive cocaine results are not completely effective at identifying external contamination. Metabolite ratios between meta - or para -hydroxy-cocaine and cocaine were 6- and 10-fold lower in contaminated specimens compared to those observed in cocaine user specimens, supporting their potential use in distinguishing samples positive due to contamination and drug use. [ABSTRACT FROM AUTHOR]

Illegal wildlife trade can threaten biodiversity and economic development. Criminal enterprises may add wildlife products to their list of illicit goods by using established trade routes, networks, and individuals. On the Caribbean coast of Costa Rica, killing of sea turtles and removal of their eggs is commonplace. However, beyond conservation NGOs reporting evidence of illegal take, little is known about this activity. Through semi-structured interviews with law enforcement, community members, NGOs, and illegal harvesters, alongside anecdotal information and observations, we aimed to understand the motivations for illegal take. To cross-reference these findings, we assessed sensitivities surrounding illegal harvesting by asking the general public sensitive questions using the randomized response technique; a method used to elicit sensitive information whilst insuring the anonymity of respondents. We included a questionnaire to establish if differences in demographics affected the probability respondents would admit to a turtle-related crime. Our findings identified a rare example of illegal extraction of a wildlife product driven by motivations that were not exclusively livelihood based. We found the majority of illegal take was undertaken by relatively few individuals, dependent on narcotics. The most cited reason for illegal take was that turtle eggs could be used to procure drugs. Law enforcement was under resourced, and informants reported that prosecutions were rare. Local people preferred to purchase rather than harvest eggs suggesting the trade is supply-driven. Those interviewed did not generally regard the subject of illegal harvest as sensitive. Low education levels, high unemployment rates, and marginalization of certain groups may increase susceptibility to narcotics. Although substance misuse and addiction appear to drive illegal trade, associated poverty and marginalization may explain why drug dependency is so prevalent in Caribbean Costa Rica. Increased work opportunities and drug rehabilitation programs may assist in reducing illegal take of turtle eggs on nesting beaches.

Abstract The use of cocaine and its main derivative, crack, can cause some systemic effects that may lead to the development of some oral disorders. Objective To assess the oral health of people with a crack cocaine use disorder and identify salivary protein candidates for biomarkers of oral disorders. Methodology A total of 40 volunteers hospitalized for rehabilitation for crack cocaine addiction were enrolled; nine were randomly selected for proteomic analysis. Intraoral examination, report of DMFT, gingival and plaque index, xerostomia, and non-stimulated saliva collection were performed. A list of proteins identified was generated from the UniProt database and manually revised. Results The mean age (n=40) was 32 (±8.88; 18–51) years; the mean DMFT index was 16±7.70; the mean plaque and gingival index were 2.07±0.65 and 2.12±0.64, respectively; and 20 (50%) volunteers reported xerostomia. We identified 305 salivary proteins (n=9), of which 23 were classified as candidate for biomarkers associated with 14 oral disorders. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n=7) and nasopharyngeal carcinoma (n=7), followed by periodontitis (n=6). Conclusions People with a crack cocaine use disorder had an increased risk of dental caries and gingival inflammation; less than half had oral mucosal alterations, and half experienced xerostomia. As possible biomarkers for 14 oral disorders, 23 salivary proteins were identified. Oral cancer and periodontal disease were the most often associated disorders with biomarkers.

In Brazil, transgender people are most affected by HIV, and crack cocaine addiction may contribute to social vulnerability and exposure to sexual and violence-related risks. This cross-sectional study comprised 2393 individuals seeking addiction treatment, consisting of 43 trans women, 1995 cisgender men, and 355 cisgender women. Records of rapid test results for HIV and syphilis and screening responses of trans women were compared to both cisgender groups using a logistic regression model to identify associated risk factors. HIV prevalence was higher in the transgender group (39.5%) than in cis women and men (5.9% and 3.6%, respectively). Our study showed an eightfold higher chance of a positive HIV test among transgender individuals who used drugs (OR: 8.79, p <.01, 95% CI: 3.90–19.78) compared to cisgender people who used drugs. A lifetime history of syphilis infection was more common in transgender people (60.0%) and cis women (32.8%) than in cis men (9.5%). Active syphilis was also more common in the transgender population (OR: 5.46, p <.01, 95% CI: 2.63 11.32). In our sample, 44.2% of transgender individuals had a history of at least one suicide attempt in their lifetime. Our results showed that transgender women were at higher risk of crack cocaine use (OR: 5.51, p <.01, 95% CI: 2.16–14.06) than cisgender men and women. The study showed that trans women had a higher prevalence of syphilis and HIV, and a greater chance of being homeless. The synergy of these vulnerabilities may have led to our findings of high psychotic symptoms and a history of suicide attempts in transgender individuals. [ABSTRACT FROM AUTHOR]

Introduction: Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. Objectives: To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. Methods: Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). Results: Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). Discussion: Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies. [ABSTRACT FROM AUTHOR]

Introduction: High rates of early hospital discharge are often observed in crack cocaine users and are related to adverse outcomes and increased public spending. This study evaluated clinical and sociodemographic factors associated with early treatment discharge among crack users. Methods: The sample comprised 308 men diagnosed with crack cocaine use disorder (crack only), aged 18 to 65 years, admitted between 2013 and 2017 to a male-only hospital unit to treat substance use disorders. Sociodemographic and clinical data were obtained using the Addiction Severity Index, 6th version, and a Sociodemographic Questionnaire. Results: Early discharge (within 7 days) was significantly associated with lack of own income, insufficient family support, being single, and recent homelessness. Regarding drug use, lower treatment retention was related to younger age of crack use onset, recent alcohol use, and nicotine use. Factors such as age, skin color, and educational level showed no relation to the outcome. Conclusion: Our findings suggest that presence of characteristics verifiable at the time of admission may be related to crack users' treatment retention. Identification of these factors can contribute to target interventions in order to improve treatment adherence in crack cocaine users. [ABSTRACT FROM AUTHOR]

Background: Fentanyl adulteration of illicit drugs is a major driver of opioid-involved overdose in the USA. Fentanyl test strips are increasingly used by people who use drugs to check for fentanyl. However, little is known about factors that influence test strip use in this population. Methods: In this mixed-methods study employing semi-structured open-ended interviews (n = 29) and a structured survey (n = 341), we examined characteristics associated with test strip use, characteristics of test strip use, and situational, logistical and psychosocial factors influencing test strip use. Respondents were recruited from a syringe service program in southern Wisconsin. Bivariate tests of association and multivariable logistic regression examined the relationship between respondent characteristics and test strip use. Summary statistics were used to describe how situational, logistical and psychosocial factors impact test strip use. Results: Most respondents were male (59.6%), non-Hispanic white (77.4%), young (mean 35.7 years), reported heroin as their primary drug (70.7%), injection as their primary route (87.9%), and use ≥ 3 times daily (78.6%). In multivariable models, site, race and ethnicity, drug of choice, and seeking fentanyl were associated with test strip use. Among test strip users, 36.5% use them most of the time or more and 80.6% get positive results half the time or more. Among individuals reporting heroin, fentanyl, methamphetamine, or cocaine or crack cocaine at least once per month, 99.1%, 56.8%, 42.2%, and 55.7% reported testing these drugs, respectively. Test strip use is supported by information from suppliers, regular transportation, diverse distribution locations, recommendations from harm reduction staff, and having a safe or private place to use. Conclusions: We found that individuals who use fentanyl test strips are more often non-Hispanic white, use heroin, and seek drugs with fentanyl relative to individuals without test strip use. Findings confirm high fentanyl penetration in the Wisconsin drug supply. Low rates of stimulant testing suggest inadequate awareness of fentanyl penetration. Findings support outreach to key populations, increased diversity of distributing locations, efforts to correct misperceptions about drug wasting, emphasis on pre-consumption testing, and the importance of adjunct behaviors to prevent overdose given high rates of intentional fentanyl use. [ABSTRACT FROM AUTHOR]

[Display omitted] • The reduction sensitivity of the DDMSNs was higher than the oxidation sensitivity. • DDMSN 2 and DDMSN 3 had high sulfur contents and the cracking process followed an S-curve, which was significantly different than that of DDMSN 1. • The sulfoxide groups significantly increased the hydrophilicity of the DDMSNs and promoted secondary cracking of the carriers. • The drug release of the DDMSNs varied significantly due to the cracking diversity and macromolecular drug species. To further develop intracellular delivery systems of macromolecular drugs, understanding the cracking mechanisms and drug release behaviors of environment-responsive carriers, as well as their intrinsic linkages, is essential for achieving personalized or diversified delivery of macromolecular drugs. Herein, we designed a class of degradable dendritic mesoporous nanoparticles (DDMSNs), utilizing very large cavities and tetrasulfide bonds in the skeleton to achieve high drug loading and release within tumor cells. To comprehensively understand and develop intracellular drug delivery systems, this study delved deeper into the delivery of tetrasulfide-bonded DDMSNs, including chemical reactions, cracking kinetics, and release kinetics. First, the drug release of the DDMSNs within the cytoplasm was closely related to the chemical reaction of tetrasulfide bonds. Thus, based on experiments, the oxidation–reduction mechanism of tetrasulfide-bonded DDMSNs was explained, and the relationship was elaborated between cracking and drug release of the DDMSNs with different sulfur contents. To further explore this relationship, the cracking behavior, drug-loading capacity and release capacity of the DDMSNs was investigated with the different sulfur contents in different simulated environments, and in MDA-MB-231 cancer cells. Inspired by the reaction kinetic calculations, we analyzed the cracking and drug release behavior of the DDMSNs, and ultimately achieved dual cracking secondary drug release of the carriers by controlling the content of sulfur elements. Here, we report improved biomedical materials for advanced, customized, and intentional intracellular delivery of therapeutic macromolecules, in which theoretical calculations and experimental components were combined to study the mechanism of drug release influenced by carrier cracking, providing essential guidance for designing advanced drug delivery systems through a chemical engineering method. [ABSTRACT FROM AUTHOR]

The increasing oceanic uptake is a direct response to the increasing atmospheric burden of CO2. Oceans are experiencing both physical and biogeochemical changes. This increase in CO2 hosts in oceans promotes changes in pH and seawater chemistry that can modify the speciation of compounds, largely due to dependent element speciation on physicochemical parameters (salinity, pH, and redox potential). So, ocean acidification can trigger enhanced toxicity of illicit drugs to non-target marine organisms due to the combined effects of crack cocaine and low pH (from 8.3 to 7.0 pH values) on the reproduction of the marine mussel Perna perna. Fertilization rate and embryo–larval development were used as endpoints to assess the effects of crack-cocaine concentrations (6.25, 12.5, 25, 50, and 100 mg L−1) and its association with pH values variation (8.3, 8.0, 7.5, and 7.0). The IC50 was calculated from the results of an embryo–larval assay in different methods of acidification (CO2 and HCl), which evidenced that HCl treatment was more toxic than CO2 treatment for the same drug concentrations. Results showed that the gametes of P. perna react to acidification when exposed to crack-cocaine concentration and pH reductions. [ABSTRACT FROM AUTHOR]

Relapsing multiple times back into opiate and crack cocaine misuse significantly increases the risk for overdose death, of which rates continue to soar worldwide. This study aims to provide an in‐depth understanding of opiate and crack relapse from the lived experience perspectives of people in recovery from substance misuse. Semi‐structured interviews were held, and interpretative phenomenological analysis was used to analyze the data. Findings revealed two superordinate themes which highlighted the impact of relapse on an individual's sense of self, their conceptualizations of relapse, and their approach to recovery thereafter. The study offers implications and future directions for mental health authorities and addiction professionals. [ABSTRACT FROM AUTHOR]

Initiatives have been implemented to reduce the federal sentencing disparity between crack and powder cocaine offenses. The current study investigated the impact of the Fair Sentencing Act 2010 (FSA) on sentencing outcomes for females convicted of federal cocaine offenses. Specifically, the study examined the influence of race, ethnicity, and drug-related factors on presentence detention, downward departures, and sentence length before and after FSA. Using federal sentencing data, results revealed a substantial decrease in the number of crack cocaine offenses and average sentence length after FSA. Additionally, results revealed that there were racial and ethnic differences in sentencing outcomes. [ABSTRACT FROM AUTHOR]

We sought to evaluate the effect of crack cocaine use frequency on HIV disease severity among HIV-positive people who use unregulated drugs (PWUD). We analyzed data from the ACCESS study, an open prospective cohort of HIV-positive PWUD including comprehensive HIV clinical monitoring in a setting with no-cost healthcare. Multivariable generalized linear mixed-effects models were used to estimate the independent effect of time-updated crack cocaine use frequency on HIV disease severity, adjusting for ART exposure and relevant confounders. In multivariable adjusted models, daily or greater frequency of crack cocaine use was significantly associated with higher VACS Index scores (β = 0.8, 95% confidence interval: 0.1, 1.5) as compared to none. Our finding suggests that daily or greater frequency of crack cocaine use exacerbates HIV disease severity independent of ART exposure. The observed effect may reflect an underlying biological mechanism or other factors linked with crack cocaine use; further investigation is warranted. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate histopathological and inflammatory response in liver and kidney of rats after crack exposure. For this purpose, a total of 32 male Wistar rats were distributed into four groups: (G1) and (G2): received 18 mg/kg of body weight (b.w) of crack cocaine, but Group G2 remained 72 h without exposure after the experimental period (5 days). Experimental group 3 (G3): received 36 mg/kg of body weight (b.w) of crack cocaine. Control Group (CTRL): received only the vehicle (DMSO) administered by intraperitoneal (i.p) route for 5 days. The results showed that crack cocaine induced histopathological changes in liver and kidney. Immunohistochemistry data revealed that G2 group showed a higher immunoexpression of Ki-67 in hepatic and renal tissues. Regarding inflammation, the results showed that all groups exposed to crack cocaine decreased the expression of TNF-α, IL-6, and IL-10 in liver and kidney. In summary, our results showed that the subacute doses of crack cocaine used in this study had cytotoxic, and immunosuppressive effects in liver and kidney of rats, especially at 36 mg/kg dose. Since cellular death and inflammation participates in the multi-step process of chemical carcinogenesis, these data offer new insights into potential ways to understand the pathobiological mechanisms induced by crack cocaine in several tissues and organs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics. [ABSTRACT FROM AUTHOR]

Bacterial drug resistance is rapidly developing as one of the greatest threats to human health. Bacteria will adopt corresponding strategies to crack the inhibitory effect of antibiotics according to the antibacterial mechanism of antibiotics, involving the mutation of drug target, secreting hydrolase, and discharging antibiotics out of cells through an efflux pump, etc. In recent years, bacteria are found to constantly evolve new resistance mechanisms to antibiotics, including target protective protein, changes in cell morphology, and so on, endowing them with multiple defense systems against antibiotics, leading to the emergence of multi-drug resistant (MDR) bacteria and the unavailability of drugs in clinics. Correspondingly, researchers attempt to uncover the mystery of bacterial resistance to develop more convenient and effective antibacterial strategies. Although traditional antibiotics still play a significant role in the treatment of diseases caused by sensitive pathogenic bacteria, they gradually lose efficacy in the MDR bacteria. Therefore, highly effective antibacterial compounds, such as phage therapy and CRISPER-Cas precision therapy, are gaining an increasing amount of attention, and are considered to be the treatments with the moist potential with regard to resistance against MDR in the future. In this review, nine identified drug resistance mechanisms are summarized, which enhance the retention rate of bacteria under the action of antibiotics and promote the distribution of drug-resistant bacteria (DRB) in the population. Afterwards, three kinds of potential antibacterial methods are introduced, in which new antibacterial compounds exhibit broad application prospects with different action mechanisms, the phage therapy has been successfully applied to infectious diseases caused by super bacteria, and the CRISPER-Cas precision therapy as a new technology can edit drug-resistant genes in pathogenic bacteria at the gene level, with high accuracy and flexibility. These antibacterial methods will provide more options for clinical treatment, and will greatly alleviate the current drug-resistant crisis. [ABSTRACT FROM AUTHOR]

• Physical aggressiveness sub score was negatively correlated with the C allele of −819 C/T (IL-10). • T allele of the SNP −786T/C of the ENOS gene positively predicts traits of physical aggressiveness. • GA genotype and the A allele of −308 G/A SNP of the TNFA were positively correlated with aggressiveness physical. • GA genotype was positively correlated with aggressiveness verbal. Cytokines and nitric oxide have been associated with impulsive and aggressive personality traits. We conducted the first study that investigated the role of SNPs in cytokines and nitric oxide genes and the influence in the progression of aggressive and impulsive behavior in 107 of cocaine and crack users. In this case-control, IL-10 (−819C/T), TNFA (−308G/A) and ENOS (−786T/C) polymorphisms were determined by Real-Time PCR. In addition, the relationship between these polymorphisms and Impulsivity and Aggression was determined. We found that the physical aggressiveness sub score was negatively correlated with the C allele of −819C/T polymorphism of the IL-10 (b = −0.14; p = 0.04). The T allele of the SNP −786T/C of the ENOS gene positively predicts traits of physical aggressiveness (b = 0.14; p = 0.04). The GA genotype (b = 0.22; p = 0.01) and the A allele (b = 0.15; p = 0.02) of −308 G/A polymorphism of the TNFA were positively correlated with aggressiveness physical. The GA genotype (b = 0.20; p = 0.03) was positively correlated with aggressiveness verbal. IL-10 (−819C/T), TNFA (−308G/A) and ENOS (−786T/C) polymorphisms might be associated with high risk of aggressive and impulsive behavior. [ABSTRACT FROM AUTHOR]

Passage of the Fair Sentencing Act (FSA) in 2010 reduced the 100-to-1 powder-crack cocaine quantity ratio to 18-to-1 to lessen the disparity between powder and crack cocaine sentences. Prior to FSA, individuals sentenced for 5 g of crack cocaine received similar sentences to those sentenced for 500 g of powder cocaine. The current study examined federal cocaine sentences both before and after the FSA. Specifically, it explored if the FSA has an impact on the influence of race/ethnicity and drug-related variables on the decision to incarcerate, incarceration length, and receiving a downward departure. Using data from the United States Sentencing Commission (USSC) for the years 2005–2009 (pre-FSA) and 2011–2015 (post-FSA), results showed an overall decrease in the number of federal cocaine cases and average incarceration length after passage of the FSA. These findings revealed that FSA is continuing the efforts to reduce the sentencing disparity between federal crack and powder cocaine offenses. However, results seemed to suggest that the policy may exacerbate racial and ethnic disparity in federal cocaine cases through use of downward departures. [ABSTRACT FROM AUTHOR]

Alcohol and substance use has been a long-standing public health challenge across the globe, including in Africa. Research evidence attests that there is no singular approach to the prevention of this problem. This study used a scoping review to systematically appraise existing research evidence on the prevention of alcohol and substance use in Africa. A systematic search for literature on alcohol and substance use prevention between 2008 and 2018 in African countries was done in PubMed, EBSCOhost, and Web of Science databases. The study employed Arksey and O'Malley scoping review framework. Search terms included those relevant to the prevention of alcohol and substance use. Abstracted data were synthesized, thematically analyzed, and presented in a narrative format. A total of 34 peer-reviewed studies were selected for the final review in the current study. Alcohol is the predominantly used substance in Africa, among many other substances. A wide spectrum of factor risk and protective factors were reported. Prevention interventions were categorized as individual, family, school, workplace, environmental, media, as well as community-based prevention interventions. While a variety of targeted prevention interventions have been implemented in the African continent, their effectiveness remains to be further elucidated, explored, and tested. [ABSTRACT FROM AUTHOR]

Levamisole is a common adulterant of cocaine and has been associated with reversible leukoencephalopathy in cocaine users. We report a case of two episodes with severe neurological symptoms and multifocal white matter lesions with brainstem and cerebellar involvement in a 29-year-old man after sporadic cocaine consumption. A urinalysis was positive for levamisole. Neurological deficits as well as MRI presentation improved after cessation of levamisole exposure and two courses of intravenous high-dose glucocorticoid therapy. Early diagnosis of levamisole-induced multifocal leukoencephalopathy and treatment with corticosteroids without delay is essential for a good recovery from neurological symptoms. Although cocaine is one of the most prevalent abused illicit drugs, cocaine- and levamisole-induced multifocal leukoencephalopathy is underdiagnosed as this disorder is not often described in the literature and anamnesis of drug abuse is not admitted by the patient. Therefore, an additional screening for cocaine and levamisole in clinical practice is useful in similar cases to support the diagnosis. [ABSTRACT FROM AUTHOR]

In the United States, African Americans (AAs) have greater risk for Class III obesity and cardiovascular disease (CVD). Previous reports suggest that AAs have a different immune cell profile when compared to Caucasians. The immune cell profile of AAs was characterized by flow cytometry using two experimental setups: ex vivo (N = 40) and in vitro (N = 10). For ex vivo experiments, PBMC were treated with participant serum to understand how lipid contents may contribute to monocyte phenotypic differences. For in vitro experiments, monocytes were low-density lipoprotein (LDL)- or vehicle-treated for four hours and subsequently analyzed by flow cytometry and RT-qPCR. When PBMCs were treated with participant sera, subsequent multivariable regression analysis revealed that serum triglycerides and LDL levels were associated with monocyte subset differences. In vitro LDL treatment of monocytes induced a phenotypic switch in monocytes away from classical monocytes accompanied by subset-specific chemokine receptor CCR2 and CCR5 expression changes. These observed changes are partially translation-dependent as determined by co-incubation with cycloheximide. LDL treatment of monocytes induces a change in monocyte subsets and increases CCR2/CCR5 expression in a subset-specific manner. Understanding the molecular mechanisms could prove to have CVD-related therapeutic benefits, especially in high-risk populations with hyperlipidemia and increased risk for CVD. LDL associated changes on monocyte subsets and CCR2/5 expression. [Display omitted] • Little is known about the impact of LDL cholesterol on monocytes in African Americans. • LDL cholesterol is associated with monocyte phenotypes in African Americans. • LDL promotes monocyte subsets and monocyte chemokine receptor expression in a subset-specific way in vitro. • LDL-induced changes are partly mediated by translation in a subset-specific manner. [ABSTRACT FROM AUTHOR]

The use of drugs of abuse has grown significantly in recent decades. In forensic chemistry, methods of identifying and characterizing illicit drugs contribute to the interests of researchers, experts, and public security authorities. Among existing methods, portable Raman spectroscopy is notable for performing rapid, non‐destructive, and highly selective analysis in the laboratory or on‐site. When the resulting spectral data are paired with chemometric tools, methods of exploratory analysis and multivariate calibration can be developed. Thus, this work describes the application of Raman spectroscopy associated with principal component analysis (PCA) and interval principal component analysis (iPCA) to assessing trends in samples of cocaine (n = 40), crack (n = 33), and their main adulterants (n = 5) and diluents (n = 5), tablets of ecstasy (n = 14), designer drugs papers (n = 27), and alcoholic solutions adulterated with benzodiazepines (alprazolam and diazepam). In addition, competitive adaptive reweighted sampling (CARS) combined with partial least squares (PLS) regression (CARSPLS) was used to quantify adulterants (benzocaine, lidocaine, and procaine) in binary mixtures with crack (n = 21) and solutions of cachaça adulterated with bromazepam (n = 11). [ABSTRACT FROM AUTHOR]

Objective: To investigate characteristics of cocaine exposures reported to US Poison Control Centers. Methods: Data from the National Poison Data System regarding cocaine-related calls to regional poison control centers from January 1, 2000 to December 31, 2020 were analyzed. Results: There were 59,466 first-ranked cocaine-related calls managed by poison control centers during the study period. Males accounted for more than two-thirds (70.3%) of these cases. The 20–29-year-old age group had the highest cocaine exposure rate, followed by 30–39-year-olds. Admission to a health care facility (HCF) occurred in 38.9% of cases and 41.1% of individuals had a serious medical outcome. Serious medical outcome (OR: 1.50, 95% CI: 1.39–1.61) and admission to a HCF (OR: 1.12, 95% CI: 1.06–1.19) were more likely to occur among individuals 13 years or older than among individuals <13 years old. Cocaine exposures involving additional substances were more likely to lead to a serious medical outcome (OR: 2.22, 95% CI: 2.14–2.29) and admission to a HCF (OR: 2.52, 95% CI: 2.43–2.61) than exposures to cocaine alone. Overall, the proportion of exposures resulting in a serious medical outcome increased from 39.9% in 2000 to 60.4% in 2020 (p < 0.0001). Likewise, the proportion of exposures resulting in admission to a HCF increased from 49.1% in 2000 to 54.4% in 2020 (p < 0.0001). There was also an increase in the rate of fatal cocaine cases from 2012 to 2020, driven by multiple-substance exposures. Conclusions: Cocaine exposures are a serious public health problem associated with substantial morbidity and mortality. The severity of cocaine exposures increased during the study period, reflected in an increased rate of fatal cocaine exposures since 2012 and increased proportions of serious medical outcomes and cases requiring admission to a health care facility. Additional efforts to prevent initiation of cocaine use and treat addiction among high-risk groups should be undertaken. [ABSTRACT FROM AUTHOR]

We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.

The Therapeutic Community Model narrows the gap in substance use disorder's network of assistance in Brazil by offering residential treatment to socially vulnerable populations. Due to a historical lack of evidence-based approaches, the government has established treatment guidelines and has been trying to implement training and monitoring methods. This study analysed real-world data from the monitoring system implemented in the largest network of institutions receiving public funds in the State of Sao Paulo. Data came from 8109 records of individuals admitted between 2014 and 2016 in 48 institutions. Results showed that less than half of the sample was exposed to at least one therapeutic activity from each of the recreational, spiritual, educational and selfcare intervention domains, as proposed by the national guidelines. Social rehabilitation outcome (SRO) defined by housing and self-support at discharge was reported by 21 % of the sample, who stayed in residential treatment for 82.6 days in average. More than half completed the therapeutic programme while 27.3 % dropout. Treatment duration and the diversity of the interventions offered were significantly associated with SRO when mutually adjusted. Chances of SRO increased nearly 5 times when residents were offered the full range of intervention domains, even when controlling for treatment duration. Treatment duration increased chances of SRO in a dose-response manner with a threefold increase for stays up to 90 days and over 9 times for stays longer than 90 days. Our findings offer evidence to promote treatment guidelines compliance and to pave the way for the implementation of monitoring systems for this modality of treatment in Brazil and abroad. • 21 % achieved stable housing and income upon discharge of residential treatment. • Following therapeutic communities intervention guidelines improves social rehabilitation outcomes (SRO) • Chances of SRO increased 5× when staying up to 90 days and 9× for 90+ days. • Urgency to enhance residential treatment policies and enforce regulatory compliance • Results affirm the feasibility of monitoring a network of Therapeutic Communities. [ABSTRACT FROM AUTHOR]

The opioid crisis continues to evolve with increasing opioid-related overdose deaths among under-represented minorities. A better understanding of substance use differences in the route of administration for people using heroin and other opioids can lead to targeted strategies and interventions. Using the 2015–2019 Treatment Episode Data Set - Admissions (TEDS-A), a multinomial logistic regression model examined the relationship between race/ethnicity and secondary substance use with route of administration in a subset of 591,078 admissions. For individuals reporting heroin as their primary substance, minoritized clients were both more likely to smoke (NH Blacks RR: 2.28, 95 % CI 2.16–2.41; Hispanic RR: 1.80, 95 % CI: 1.74, 1.87; Other RR: 2.09, 95 % CI: 2.00, 2.20) or inhale heroin (Hispanic RR: 1.82, 95 % CI 1.78–1.85; Other RR: 1.30, 95 % CI 1.25, 1.34) compared to non-Hispanic (NH) Whites. NH Black clients were nearly seven and a half times more likely to report inhaling (RR: 7.45, 95 % CI 7.28, 7.62) heroin over injecting it. Clients were more likely to smoke heroin compared to injection if they reported secondary drug use of methamphetamines (RR: 2.28, 95 % CI 2.21, 2.35) and other opioids (RR: 1.21, 95 % CI 1.15, 1.28). For clients reporting other opioids as their primary substance, Hispanic (RR: 1.33, 95 % CI 1.19, 1.47) and other racial/ethnic minority clients (RR: 2.50, 95 % CI 2.23, 2.79) were more likely to smoke opioids vs take it orally compared to their NH White counterparts. Individuals who reported methamphetamine use as a secondary substance were significantly more than three times as likely to smoke (RR: 3.07, 95 % CI 2.74, 3.45) or inject (RR: 3.36, 95 % CI 3.17, 3.57) compared to orally ingesting opioids, while those who reported cocaine or crack cocaine use were more than twice as likely to inject (RR: 2.22, 95 % CI 2.09–2.36) opioids than taking them orally. Findings demonstrate significant racial and ethnic differences in the route of administration. This work expands on the understanding of the complex nature of polysubstance use in the evolving opioid crisis and the secondary substance use of clients on routes of administration of opioids and heroin, highlighting the need for tailored interventions to address the treatment needs of under-represented minorities. • Route of administration varies by the type of opioid when comparing heroin to other opioids. • Racial and ethnic differences exist in route of administration of heroin and other opioids among those entering treatment. • Route of administration varies with secondary substance use of methamphetamine and cocaine. [ABSTRACT FROM AUTHOR]

• H-PILO + CRACK administration increases the frequency of epileptic seizure. • AChE levels increase after H-PILO + CRACK exposure. • Brain redox balance remains unchanged following H-PILO + CRACK exposure. • Exposure to crack cocaine increases vertical locomotor activity. • Short-term memory consolidation remains unchanged following H-PILO + CRACK exposure. Crack cocaine is a highly addictive and potent stimulant drug. Animal studies have shown that the cholinergic system plays a role in neurotoxicity induced by cocaine or its active metabolites inhalation. Behavioral alterations associated with crack cocaine use include hyperactivity, depressed mood, and decreased seizure threshold. Here we evaluate the acetylcholinesterase (AChE) and reactive oxygen species (ROS) activity, behavioral profile, and the threshold for epileptic seizures in rats that received intrahippocampal pilocarpine (H-PILO) followed by exposure to crack cocaine (H-PILO + CRACK). Animals exposed to H-PILO + CRACK demonstrated increased severity and frequency of limbic seizures. The AChE activity was reduced in the groups exposed to crack cocaine alone (CRACK) and H-PILO + CRACK, whereas levels of ROS remained unchanged. In addition, crack cocaine exposure increased vertical locomotor activity, without changing water and sucrose intake. Short-term memory consolidation remained unchanged after H-PILO, H-PILO + CRACK, and CRACK administration. Overall, our data suggest that crack cocaine inhalation reduced the threshold for epileptic seizures in rats submitted to low doses of pilocarpine through the inhibition of AChE. Taken together, our findings can be useful in the development of effective strategies for preventing and treating the harmful effects of cocaine and crack cocaine on the central nervous system. [ABSTRACT FROM AUTHOR]

Meshless or meshfree methods (MMs) are practical and excellent numerical techniques for solving crack problems. With the inherent limitations of mesh-based methods such as the finite element method (FEM) in modeling cracks, MMs have captivated the attention of researchers worldwide because of their conspicuous merits, including mesh independence and higher-order continuity. However, the most recent review literature on MMs in crack problems is only available until 2018, and no relevant analyses have been reported in detail since then. To fill this gap, this state-of-the-art review explores the novel potential and advancements of MMs in crack problems. Generally, eight approaches are implemented with MMs to reproduce crack behaviors. To improve efficiency and stability, the existing strategies are explored in terms of numerical integration, method coupling, and adaptive analysis. Based on these techniques, 82 highly cited and influential articles are analyzed to determine the specific MMs, simulation techniques, and the enhanced strategies that have been adopted. According to existing studies, various novel MMs have been proposed to analyze cracks. Furthermore, flexible coupling of multiple techniques to simulate cracks can be applied to different forms of cracks in various materials. However, adaptive analysis still needs to be widely performed in the MMs for crack problems due to the absence of a solid mathematical foundation for error estimators. This paper presents the research gaps and the future prospect of MMs in the application of crack problems. It should be stated that significant works on numerical methods for modeling cracks predating 1994 are not cited in this paper, a decision considered by the authors to be non-essential to its scope and objectives. [Display omitted] • Summarize 8 techniques for meshless methods to simulate cracks. • Analyze methods to enhance the efficiency of meshless methods for crack simulation. • Review 222 high-cited papers in this field and focus on 82 papers from 2018–2023. • Propose research gaps and future direction for meshless methods to model cracks. [ABSTRACT FROM AUTHOR]

Notably, in France, crack cocaine has not been framed as a public health epidemic, even with the trend of crack cocaine use and the rise of open drug scenes in Paris and its suburbs [[6]]. The French approach to crack cocaine shares commonalities and differences with the U.S. In France, crack cocaine is mostly smoked but more recently is also being injected intravenously and the spike of increased crack cocaine use in France did not occur until the 2000s [[5]]. Keywords: Crack cocaine; Harm reduction; Racial issues; Structural vulnerability; Drug policy; Population health EN Crack cocaine Harm reduction Racial issues Structural vulnerability Drug policy Population health 1 5 5 05/18/22 20220512 NES 220512 Andrew Goulian and Marie Jauffret-Roustide have contributed equally Introduction Crack cocaine refers to a derivative of powder cocaine. [Extracted from the article]