Does Gender Moderate the Relationship between Polydrug Use & Sexual Risk-Taking among Australian Secondary School Students Under 16 Years of Age?

INTRODUCTION AND AIMS:

This study examines the association of alcohol and polydrug use with risky sexual behaviour in adolescents under 16 years of age and if this association differs by gender.

DESIGN AND METHODS:

The sample consisted of 5412 secondary school students under 16 years of age from Victoria, Australia. Participants completed an anonymous and confidential survey during class time. The key measures were having had sex before legal age of consent (16 years), unprotected sex before 16 (no condom) and latent-class derived alcohol and polydrug use variables based on alcohol, tobacco, cannabis, inhalants and other illegal drug use in the past month.

RESULTS:

There were 7.52% and 2.55% of adolescents who reported having sex and having unprotected sex before 16 years of age, respectively. After adjusting for antisocial behaviours, peers' drug use and family and school risk factors, girls were less likely to have unprotected sex (odds ratio = 0.31, P = 0.003). However, the interaction of being female and polydrug use (odds ratio = 4.52, P = 0.004) was significant, indicating that girls who engaged in polydrug use were at higher risk of having unprotected sex. For boys, the effect of polydrug use was non-significant (odds ratio = 1.44, P = 0.310). Discussion and Conclusions For girls, polydrug use was significantly associated with unprotected sex after adjusting for a range of risk factors, and this relationship was non-significant for boys. Future prevention programs for adolescent risky sexual behaviour and polydrug use might benefit from a tailored approach to gender differences.

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By:  Chan GC1, Kelly AB1, Hides L1,2, Quinn C1,2, Williams JW3,4,5,6.

• 1Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.
• 2Queensland University of Technology, Brisbane, Australia.
• 3School of Health and Social Development, Deakin University, Melbourne, Australia.
• 4Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Australia.
• 5Population Health Studies of Adolescents and Health Services Delivery for Adolescents, Murdoch Children's Research Institute, Melbourne, Australia.
• 6Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
• Drug Alcohol Rev. 2016 Mar 23. doi: 10.1111/dar.12394. 

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Erectile Dysfunction among People Who Use Ketamine and Poly-Drugs

Despite the rise in recreational use of ketamine in Malaysia, there have been no studies of users or of the health-related consequences they face. This study was initiated to examine ketamine use and its health consequences. 

A structured questionnaire was used to elicit information. A final sample of 127 males was divided into persons who used only ketamine and those who were poly-drug users. Each group was further divided into long-period and short-period users. Urine toxicology screening for ketamine and other illicit drugs commonly used in Malaysia was also done. 

Our findings corroborate those of earlier studies that link ketamine use to urological problems such as frequent urination, dysuria, incontinence, painful bladder, nocturia, and urinary urgency. A new finding in this study is the significant association between ketamine use and erectile dysfunction, such that higher odds of reporting erectile dysfunction were linked to long-period users. Our findings strengthen the case for early intervention, as ketamine users are drawn from young and unmarried male participants. 

The association of ketamine use with erectile dysfunction, if substantiated, will help physicians in their diagnosis of erectile dysfunction, particularly among youths.

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By:  Suppiah B1, Vicknasingam B2, Singh D3, Narayanan S4.

• 1 Graduate Student, Centre for Drug Research , Universiti Sains Malaysia , Penang , Malaysia.
• 2 Associate Professor, Centre for Drug Research , Universiti Sains Malaysia , Penang , Malaysia.
• 3 Senior Lecturer, Centre for Drug Research , Universiti Sains Malaysia , Penang , Malaysia.
• 4 Professor, School of Social Sciences , Universiti Sains Malaysia , Penang , Malaysia. 
• J Psychoactive Drugs. 2016 Mar 25:1-7. 

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Pre-Treatment Drug Use Characteristics and Experiences among Patients in a Voluntary Substance Abuse Treatment Center in Malaysia

BACKGROUND:

Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) Centers. To best serve the needs of regional C&Cs, data on drug use are essential among patients accessing treatment. Using a mixed methods approach, we examined pre-treatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan - a religiously conservative state in Northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns.

METHODS:

A mixed methods study utilizing surveys (N = 96) and semi-structured interviews (N = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan.

RESULTS:

Survey results showed 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C on drug rehabilitation.

CONCLUSIONS:

The drug use profile of the Kelantan C&C enrollees shows extensive pre-treatment amphetamine use, polysubstance use, and injection drug use including high-risk behaviors such as sharing needles, syringes and containers. Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

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By:  Krishnan A1, Brown SE2, Ghani M2, Khan F3, Kamarulzaman A2,4, Altice FL2,4,5.

• 1 University at Albany, State University of New York , Department of Communication , Albany , New York , USA.
• 2 Yale University School of Medicine, Department of Internal Medicine , Section of Infectious Diseases, AIDS Program , New Haven , Connecticut , USA.
• 3 Icahn School of Medicine at Mount Sinai , New York , New York , USA.
• 4 Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur , Malaysia.
• 5 Yale University School of Public Health, Division of Epidemiology of Microbial Diseases , New Haven , Connecticut , USA. 

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Verbal Memory Impairment in Polydrug Ecstasy Users: A Clinical Perspective

Background

Ecstasy use has been associated with short-term and long-term memory deficits on a standard Word Learning Task (WLT). The clinical relevance of this has been debated and is currently unknown. The present study aimed at evaluating the clinical relevance of verbal memory impairment in Ecstasy users. To that end, clinical memory impairment was defined as decrement in memory performance that exceeded the cut-off value of 1.5 times the standard deviation of the average score in the healthy control sample. The primary question was whether being an Ecstasy user (E-user) was predictive of having clinically deficient memory performance compared to a healthy control group.

Methods

WLT data were pooled from four experimental MDMA studies that compared memory performance during placebo and MDMA intoxication. Control data were taken from healthy volunteers with no drug use history who completed the WLT as part of a placebo-controlled clinical trial. This resulted in a sample size of 65 E-users and 65 age- and gender-matched healthy drug-naïve controls. All participants were recruited by similar means and were tested at the same testing facilities using identical standard operating procedures. Data were analyzed using linear mixed-effects models, Bayes factor, and logistic regressions.

Results

Findings were that verbal memory performance of placebo-treated E-users did not differ from that of controls, and there was substantial evidence in favor of the null hypothesis. History of use was not predictive of memory impairment. During MDMA intoxication of E-users, verbal memory was impaired.

Conclusion

The combination of the acute and long-term findings demonstrates that, while clinically relevant memory impairment is present during intoxication, it is absent during abstinence. This suggests that use of Ecstasy/MDMA does not lead to clinically deficient memory performance in the long term. Additionally, it has to be investigated whether the current findings apply to more complex cognitive measures in diverse ‘user categories’ using a combination of genetics, imaging techniques and neuropsychological assessments.

Below:  Frequency distribution of the raw IR (left panel) and DR (right panel) scores in the Ecstasy users during MDMA intoxication and placebo, and healthy controls

Full article at:   http://goo.gl/KprKVF

By:  Kim P. C. Kuypers, Eef L. Theunissen, Janelle H. P. van Wel, Elizabeth B. de Sousa Fernandes Perna, Anke Linssen, Anke Sambeth, Benjamin G. Schultz, Johannes G. Ramaekers

Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands

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Dual Diagnosis and Suicide Probability in Poly-Drug Users

OBJECTIVE:

To determine the frequency of suicidal thoughts and suicidal probability among poly-substance abusers in Saudi population, and to examine the relation between dual diagnosis and suicidal thoughts.

STUDY DESIGN:

Case control study.

PLACE AND DURATION OF STUDY:

Al-Baha Psychiatric Hospital, Saudi Arabia, from May 2011 to June 2012.

METHODOLOGY:

Participants were 239 subjects, aged 18 - 45 years. We reviewed 122 individuals who fulfilled the DSM-IV-TR criteria of substance abuse for two or more substances, and their data were compared with that collected from 117 control persons.

RESULTS:

Suicidal cases were highly present among poly-substance abusers 64.75%. Amphetamine and cannabis were the most abused substances, (87.7% and 70.49%, respectively). Astatistically significant association with suicidality was found with longer duration of substance abuse (p < 0.001), using alcohol (p=0.001), amphetamine (p=0.007), volatile substances (p=0.034), presence of comorbid psychiatric disorders (dual diagnosis) as substance induced mood disorder (p=0.001), schizo-affective disorder (p=0.017), major depressive disorders (p=0.001), antisocial (p=0.016) and borderline (p=0.005) personality disorder. Suicidal cases showed significant higher scores (p < 0.001) of suicide probability scale and higher scores in Beck depressive inventory (p < 0.001).

CONCLUSION:

Abusing certain substances for long duration, in addition to comorbid psychiatric disorders especially with disturbed-mood element, may trigger suicidal thoughts in poly-substance abusers. Depression and suicide probability is common consequences of substance abuse.

Full PDF article at:   http://goo.gl/4PcIgV

By:  Youssef IM1, Fahmy MT1, Haggag WL1, Mohamed KA1, Baalash AA2.

• 1Department of Neuropsychiatry, Suez Canal University, Ismailia, Egypt.
• 2Department of Psychiatry, Psychiatric Hospital, Al-Baha, Saudi Arabia. 
• J Coll Physicians Surg Pak. 2016 Feb;26(2):130-3. doi: 02.2016/JCPSP.130133.

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Patterns of Drug Use and Drug-Related Hospital Admissions in HIV-Positive and -Negative Gay and Bisexual Men

We aimed to compare rates of illicit drug-related hospitalisations in HIV-negative (HIV-ve) (n = 1325) and HIV-positive (HIV+ve) (n = 557) gay and bisexual men (GBM) with rates seen in the general male population and to examine the association between self-reported illicit drug use and drug-related hospitalisation. 

Participants were asked how often they used a range of illicit drugs in the previous 6 months at annual interviews. Drug-related hospital admissions were defined as hospital admissions for mental or behavioural disorders due to illicit drug use, drug poisoning or toxic effect of gases. 

Drug-related hospitalisations were 4.8 times higher in the HIV-ve cohort and 3.5 times higher in the HIV+ve cohort compared with the general population. Periods of weekly drug use, poly-drug use and cannabis use were associated with drug-related hospitalisation in both cohorts, as was being a consistently high meth/amphetamine user throughout follow-up and being an inconsistent or consistent injecting drug user throughout follow-up. 

Other risk factors for drug-related hospitalisation indicated the likelihood of comorbid drug and mental health issues in GBM hospitalised for drug use.

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By:  Moore CL1, Gidding HF2, Jin F3, Mao L4, Petoumenos K3, Zablotska IB3, Poynten IM3, Prestage G3,5, Law MG3, Grulich AE3, Amin J3.

• 1The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia. cmoore@kirby.unsw.edu.au.
• 2School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
• 3The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
• 4Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
• 5Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
• AIDS Behav. 2016 Feb 2. 

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Polydrug Use among Nightclub Patrons in a Megacity: A Latent Class Analysis

Highlights

• Three groups of drug users were found in São Paulo nightclubs.
• It is more likely to find high level polydrug users in electronic or hip-hop nightclubs.
• Frequency of attendance, gender and age are associate to the two polydrug groups.
• Binge drinking was a predominant behaviour in all groups.

Abstract

Background

Nightclubs are places with a high prevalence of binge drinking and illicit drug use. The aim of this study was to evaluate the characteristics of polydrug use, including licit and illicit drugs, among 2420 nightclub patrons in a probabilistic sample in the city of São Paulo, Brazil,

Methods

The study was conducted in 2013. A latent class analysis (LCA) of polydrug use, accounting for binge drinking (BD) and other drug use (cannabis, cocaine, ecstasy, tobacco, ketamine, inhalants and hallucinogens) in the past 12 months was performed using Mplus. Multinomial logistic regression was used to evaluate latent class associations with sociodemographic characteristics and variables that characterise type of nightclub and frequency of attendance.

Findings

A three-class LCA model best described polydrug use patterns. We found a “no polydrug use” class (55%), a “moderate polydrug use” class (35%) and a “high level polydrug use” class (10%). Compared to “no polydrug use”, patrons in the two “polydrug use classes” were more likely to be men, young adults (<34 years), have attended nightclubs three times or more per month and have attended hip-hop and rock music nightclubs. Patrons in the “high level polydrug use” class were more likely to attend electronic (aOR = 9.9, 95% CI: 5.4–8.1, p < 0.001) and hip-hop music nightclubs (aOR = 10.1, 95% CI: 6.2–16.5, p < 0.001).

Conclusion

LCA is a useful method to identify groups of polydrug users among nightclub patrons. The three groups identified represented the diversity of patrons of São Paulo nightclubs. Frequency of attendance and the nightclub's musical style were highly correlated with polydrug use.

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By:  Adriana Sañudo^,, Solange Andreoni^a Zila M. Sanchez^b, , 

^a Department of Preventive Medicine, Section of Biostatistics, Universidade Federal de Sao Paulo, Rua Botucatu, 740, São Paulo, SP, Brazil

^b Department of Preventive Medicine, Section of Epidemiology, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, Brazil

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Policing, Massive Street Drug Testing & Poly-Substance Use Chaos in Georgia

BACKGROUND:

Since early 2000, intensive policing, wide scale street drug testing, and actions aimed at limiting the availability of specific drugs have been implemented in Georgia. Supporters of this approach argue that fear of drug testing and resulting punishment compels drug users to stop using and prevents youth from initiating drug use. It has been also stated that reduction in the availability of specific drugs should be seen as an indication of the overall success of counter-drug efforts. The aim of the current review is to describe the drug-related law enforcement response in Georgia and its impact on illicit drug consumption and drug-related harm.

METHOD:

We reviewed relevant literature that included peer-reviewed scientific articles, stand-alone research reports, annual drug situation reports, technical reports and program data. This was also supplemented by the review of relevant legislation and judicial practices for the twelve year period between 2002 and 2014.

RESULTS:

Every episode of reduced availability of any "traditional" injection drug was followed by the discovery/introduction of a new injection preparation. The pattern of drug consumption was normally driven by users' attempts to substitute their drug of choice through mixing together available alternative substances. Chaotic poly-substance use and extensive utilization of home-made injection drugs, prepared from toxic precursors, became common. Massive random street drug testing had little or no effect on the prevalence of problem drug use.

CONCLUSIONS:

Intensive harassment of drug users and exclusive focus on reducing the availability of specific drugs did not result in reduction of the prevalence of injecting drug use. Repressive response of Georgian anti-drug authorities relied heavily on consumer sanctions, which led to shifts in drug users' behavior. In most cases, these shifts were associated with the introduction and use of new toxic preparations and subsequent harm to the physical and mental health of drug consumers.

Below:  Trends in drugs injected in Georgia in 2002–2014 based on BBSS data (percentages exceed 100 % due to multiple responses, depending on a current poly-substance use by respondents)

Below:  Trends in injecting drug use in Georgia 2007–2014 based on GHRN data (percentages exceed 100 % due to multiple responses, depending on a current poly-substance use by respondents)

Below:  Number of patients treated for substance use disorders in 2003–2013

Below:  Number of individuals tested for drugs and number of positive results, 2006–2013

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By:  Otiashvili D1, Tabatadze M2,3, Balanchivadze N4, Kirtadze I5,6.

• 1Addiction Research Centre - Alternative Georgia, 14a Nutsubidze Str., Office 2, 0177, Tbilisi, Georgia. dato@altgeorgia.ge.
• 2Addiction Research Centre - Alternative Georgia, 14a Nutsubidze Str., Office 2, 0177, Tbilisi, Georgia. mzia@altgeorgia.ge.
• 3Business School, Ilia State University, Tbilisi, Georgia. mzia@altgeorgia.ge.
• 4National Centre for Commercial Law, Free University, Tbilisi, Georgia. balanchivadzenino@gmail.com.
• 5Addiction Research Centre - Alternative Georgia, 14a Nutsubidze Str., Office 2, 0177, Tbilisi, Georgia. Irma@altgeorgia.ge.
• 6Business School, Ilia State University, Tbilisi, Georgia. Irma@altgeorgia.ge.
• Subst Abuse Treat Prev Policy. 2016 Jan 16;11(1):4. 

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Sexual Initiation and Complex Recent Polydrug Use Patterns among Male Sex Workers in Vietnam: A Preliminary Epidemiological Trajectory

Little is known about the age of onset of sexual and drug risk and their association with complex patterns of recent drug use among male sex workers (MSW) in a developing country, such as Vietnam. 

The aim of this study was to determine whether latent class analysis (LCA) would aid in the detection of current individual and polydrug use combinations to predict how different trajectories of sexual and drug initiation contribute to different patterns of current illicit drug use. Data were collected from a cross-sectional survey administered to young MSWs between 2010 and 2011 in Vietnam (N = 710). LCA clustered participants into recent drug use groups, incorporating both the specific types and overall count of different drugs used. Men reported drug use within a 1 month period from an 11-item drug use list. LCA identified three distinct drug use classes: (1) alcohol use, (2) alcohol and tobacco use, and (3) high polydrug use. 

The current drug use classes are associated with sex worker status, housing stability, income level, educational attainment, marital status, sexual identity, and sexual preferences. High levels of drug use are strongly associated with being a recent sex worker, not having recent stable housing, higher than median income, more than a high school education, less likely to be currently in school and more likely to have non-homosexual preferences and heterosexual partners. An event history analysis approach (time-event displays) examined the timing of the age of onset of drug and sexual risks. Early ages of drug and sexual initiation are seen for all three classes. High current drug users show earlier onset of these risks, which are significantly delayed for moderate and low current drug users. LCA incorporating an overall count of different drugs detected three distinct current drug use classes. 

The data illustrates that the complexity of drug factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of drug use and the use of drug and sexual risk initiation data to predict current drug use subtypes among high-risk populations.

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By:  Yu G1, Goldsamt LA2, Clatts MC3, Giang LM4.

• 1New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. gy9@nyu.edu.
• 2New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
• 3School of Public Health, University of Puerto Rico Medical Science Center, San Juan, PR, USA.
• 4Center for Research and Training on HIV/AIDS, Hanoi Medical University, 1 Tôn Thất Tùng Street, Room 601, Building A1, Hanoi, Vietnam.

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A More In‐Depth Look at Prescription Opioids

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