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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Recreational Drug Use and Related Social Factors among HIV-Positive Men in Japan

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. 

A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. 

New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. 

Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). 

Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

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By:  Togari T1, Inoue Y1, Takaku Y2, Abe S3, Hosokawa R4, Itagaki T5, Yoshizawa S6, Oki S7, Katakura N8, Yamauchi A9, Wakabayashi C10, Yajima T3,11.

• 1 Faculty of Liberal Arts , the Open University of Japan , Chiba , Japan.
• 2 Japan Network of People Living with HIV/AIDS , Tokyo , Japan.
• 3 Division of Health Management , TIS Inc ., Tokyo , Japan.
• 4 School of Nursing , Nagoya City University , Nagoya , Japan.
• 5 Accelight Inc ., Tokyo , Japan.
• 6 ANGEL LIFE NAGOYA , Nagoya , Japan.
• 7 Faculty of Nursing , Kyorin University , Mitaka , Japan.
• 8 Kobe City College of Nursing , Kobe , Japan.
• 9 School of Nursing , Tokyo Medical University , Tokyo , Japan.
• 10 Department of Health Sciences , Saitama Prefectural University , Koshigaya , Japan.
• 11 PLACE TOKYO , Tokyo , Japan.
• AIDS Care. 2016 Feb 17:1-9. 

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Cathinones Use in Paris

BACKGROUND:

The pattern of recreational drug use has changed over the last decade and now includes a multitude of substances sold as "research chemicals" or new psychoactive substances, "NPS". In France, synthetic cathinones emerged in 2008 (while first mentioned by the French police force in 2007 first alerts among users appeared in 2008) and have grown to be popular drugs of abuse. Under the Official Journal dated 11th June 2010, only mephedrone has been listed as narcotics but "designer drugs" have synthesized new substitute cathinones in order to avoid anti-drug laws. However, since July 2012, in France, all synthetic drugs from the cathinones family have been banned and listed as narcotics following the example of United Kingdom. Despite their recent classification and inclusion on narcotic list, they are readily available on Internet and used widely. Paris Addictovigilance Centre observed a signal of derivate cathinones abuse (21 cases over a two-year period).

OBJECTIVE:

Paris Addictovigilance Centre and Marmottan Hospital wanted to describe the use of cathinones in the Paris area and alert the health care community about the abuse identification and risk assessment problems of these compounds. After a review of derivated cathinone's chemical structure, pharmacology and toxicology, this article seeks to provide patricians with a clinical description and treatment's modality.

RESULTS:

Most users of synthetic cathinones will experience euphoria, increased energy, talkativeness, openness and increased sexual arousal. Signs and symptoms of toxicity are consistent with a sympathomimetic toxidrome. The main reasons for care access are psychiatric (hallucinations, psychotic symptoms, agitation) and addiction disorders. Somatic complications were described with various patterns of symptoms such as headache, tachycardia, confusional states, rhabdomyolysis with renal failure or serotonin syndrome. The most important fact is the apparition of the "slam" phenomenon among men who have sex with men (MSM). The "slam" is a compound of three characteristic elements: injection, sexual party and psychostimulant drug. According to users, "slam" is convenient for group sex and is used it to put them into a good mood and a disinhibition state. These compounds cause fast dependence syndrome with strong craving and prolonged psychiatric symptoms and increase infectious risk (HIV, VHC, VHB…). The cathinones family is not detected in conventional urine drug screenings. We point out the lack of confirmatory analytic testing data which remains the only way to determine the actual etiology of the clinical effects observed since drug users do not always know exactly what they took. These substances can be identified by special analyses using gas chromatography or liquid chromatography and mass spectroscopy technology.

CONCLUSION:

This injection drug is used in order to increase sexual desire, delay orgasm and decrease sexual inhibition and is prevalent in many studies on MSM samples. Cathinones would popularize the "slam". Harm reduction policy requires specific MSM interventions on both sexual and drug addiction networks.

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By:  Batisse A1, Grégoire M2, Marillier M3, Fortias M3, Djezzar S3.

• 1CEIP-Addictovigilance, hôpital Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris cedex 10, France. Electronic address: anne.batisse@lrb.aphp.fr.
• 2Centre Marmottan, 17-19, rue d'Armaillé, 75017 Paris, France. Electronic address: murielgreg@hotmail.com.
• 3CEIP-Addictovigilance, hôpital Fernand-Widal, 200, rue du Faubourg-Saint-Denis, 75010 Paris cedex 10, France. 
• Encephale. 2016 Feb 1. pii: S0013-7006(15)00163-3. doi: 10.1016/j.encep.2015.09.002. 

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Ritualistic Use of Ayahuasca versus Street Use of Similar Substances Seized by the Police: A Key Factor Involved in the Potential for Intoxications and Overdose?

The ritualistic use of ayahuasca is becoming a global phenomenon. This beverage contains a combination of monoamine oxidase inhibitors (harmine, harmaline, and tetrahydroharmine) and N,N-dimethyltryptamine, the main substance responsible for its visionary effect. The recreational use of similar alkaloids and N,N-dimethyltryptamine has increased in recent years, mainly because of their hallucinogenic effects. 

In the present study, the concentrations of psychoactive alkaloids in three powder samples seized by the São Paulo State Police and nine ayahuasca aqueous extracts were analyzed by HPLC-DAD in an attempt to distinguish between illicit drugs and the religious beverage. The alkaloids detected (μg/mL) in the ayahuasca aqueous extracts were N,N-dimethyltryptamine (402-2070.3), harmaline (27.5-181.3), harmine (294.5-2893.8), and tetrahydroharmine (849.5-2052.5), whereas, of the three powder samples, one contained only N,N-dimethyltryptamine (82% and 2% w/w, respectively) while the other contained only harmaline (16%, w/w) and harmine (12%, w/w). 

The ritualistic use of ayahuasca involves oral intake and the probability of overdose is minimized by serotonergic stimulation of vagal pathways, leading to vomiting and diarrhea. In contrast, the recreational use of N,N-dimethyltryptamine involves consumption mainly by smoking or inhalation, both of which markedly increase its bioavailability and the potential for intoxications.

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By:   Lanaro R¹, Calemi DB, Togni LR, Costa JL, Yonamine M, Cazenave Sde O, Linardi A.

¹a Researcher, Poison Control Center, Faculty of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , SP , Brazil.

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A Comparison of Recreational Drug Use amongst Sexual Health Clinic Users in London with Existing Prevalence Data

The objective was to give an overview of self-reported recreational drug use amongst attendees of sexual health clinics in London and compare this to existing datasets. Between December 2013 and March 2014, attendees of two sexual health clinics in London were surveyed. Data collected were: sexual history, smoking and alcohol and recreational drug use. 

Data were analysed using SPSS (version 21). A total of 1472 respondents were included; 778 (52.9%) men, 676 (45.9%) women and 3 (0.2%) transgender (15 [1.0%] did not answer). Mean age was 30.6 ± 9.0 years. A total of 339 (43.6%) men were men who have sex with men, and 18 (2.4%) women were women who have sex with women. 

Lifetime prevalence of use was: alcohol 94.1%; cannabis 48.5%; 'poppers' (volatile nitrites) 28.2%; cocaine 26.8% and 3,4-methylenedioxy-methamphetamine pills 23.2%. Our population had higher current popper, methamphetamine and mephedrone use than the Crime Survey of England and Wales but lower use of cannabis, poppers and Viagra than the European MSM Internet Survey. 

Global Drug Survey and Part of the Picture respondents' use were higher than our population for all drugs. Drug use in this population had a different pattern to general population surveys and studies involving only men who have sex with men.

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By:   Thurtle N1, Dargan PI2, Hunter LJ3, Lovett C3, White JA4, Wood DM2.

• 1Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK nat_thurtle@yahoo.com.
• 2Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK Clinical Toxicology Department, King's College London, London, UK.
• 3Clinical Toxicology Department, Guys and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
• 4Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. 

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Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN)

Case reports in medical literature suggest that the atypical antipsychotic quetiapine, a medication not previously considered to have abuse potential, is now being subject to misuse and abuse (MUA; ie, taken when not prescribed for them or used in a way other than instructed by their health professional). Here we present systematic, nationally representative data from the 2005 to 2011 Drug Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits among the U.S. general population involving quetiapine and related to MUA, suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data indicate that when used without medical supervision for recreational/self-medication purposes, quetiapine poses health risks for its users, especially among polydrug users and women. These findings suggest that the medical and public health communities should increase vigilance concerning this drug and its potential for MUA.

Below:  Trends in ED visits involving quetiapine for MUA, suicide attempts, and adverse reactions: 2005–2011. Notes: *Comparing 2005 to 2011, visits are higher in 2011 for total visits at the P < 0.001 level, for suicide attempt visits at the P = 0.03 level, and for adverse reaction visits at the P < 0.001 level.

Full article at:  http://goo.gl/BmJYl6

By:  Mattson ME1, Albright VA2, Yoon J3, Council CL2.

• 1Substance Abuse and Mental Health Services Administration, Rockville, MD, USA.
• 2Research Triangle Institute, Chapel Hill, NC, USA.
• 3Health Resources and Services Administration, Rockville, MD, USA. 

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Problematic Recreational Drug Use: Is There a Role for Outpatient Sexual Health Clinics in Identifying Those Not Already Engaged with Treatment Services?

There is an association between recreational drug use, high-risk sexual activity and sexually transmissible infections. Studies have shown a higher prevalence of drug use in those accessing sexual health services; however, there are minimal data on the proportion with problematic recreational drug use. We aimed to understand whether sexual health clinics could identify problematic drug and alcohol use as a novel referral pathway into treatment services. 

Males attending two sexual health clinics in London completed questionnaires. Data were collected on demographics; gender of sexual partner; use of alcohol and recreational drugs; if they felt they had problematic use of drugs, alcohol or both; and if they had sought help for their problematic use.

In total, 867 males completed the questionnaire; 387 (44.7%) were men who have sex with men (MSM). MSM had significantly higher lifetime use of any drug compared with non-MSM (80.6% vs. 62.5%; P < 0.0001). Thirty-five (4.7%) self-identified problematic drug or alcohol use, with no difference between MSM and non-MSM (6.3% vs. 3.5%; P = 0.08). Of those with problematic drug or alcohol use, 20 were currently or had been engaged with a treatment service and 15 had never engaged with treatment services. MSM were more likely to have ever sought help for drug or alcohol problems compared with non-MSM (P = 0.003). 

Some individuals attending sexual health clinics with problematic drug use have not engaged with treatment services. It is therefore appropriate to develop screening tools for sexual health clinics to identify these individuals and novel referral pathways to engage them in treatment services.

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By: Lovett C, Yamamoto T, Hunter L, White J, Dargan PI, Wood DM.

Clinical Toxicology, Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust and King’s Health Partners, Westminster Bridge Road, London, SE1 7EH, UK. 

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