Consumption Of Recreational Drugs Research Articles

Post-exposure prophylaxis, STI testing and factors associated with follow-up attendance: a review of 4159 cases of acute post-sexual assault medical care

BackgroundSexual assault (SA) is a prevalent issue with enduring consequences. Post-SA medical care mainly focuses on injuries, sexually transmitted infection (STI) prevention and detection, as well as preventing unwanted pregnancies....

Prevalence and Correlates of Illicit Drug Use among Norwegian Nightlife Patrons

Background Nightclubs and bars are recreational settings with extensive availability and consumption of alcohol and recreational drugs. Objectives This study aims to determine the proportion of nightclub patrons in Norway that tested positive for illicit drugs, moreover, we examined the correlation between positive test results and demographic and substance use characteristics. Methods Patrons were recruited outside nightclubs on Friday and Saturday nights between 10:00 pm and 04:00 am. Substance use was determined by breath testing and oral fluid testing for alcohol and drugs, respectively, using accurate and specific analytical methods. Questionnaires recorded demographic and substance use characteristics. Results Of the 1988 included nightclub patrons, 90% tested positive for alcohol, 14% for illicit drug use, and 3% for two or more illicit drugs. The proportion of patrons who tested positive for illicit drugs was highest in the early hours of the morning. Nine out of ten who tested positive for illicit drugs also consumed alcohol. Testing positive for one or more illicit drugs was most strongly correlated with being male and unemployed, using tobacco or other nicotine products, and early on-set illicit drug use; further the correlations were strongest among those who tested positive for two or more illicit drugs. Conclusions/Importance: Patrons who used illicit drugs before or during nightclub visits most often combined drug use with alcohol consumption. Substituting alcohol with cannabis or other drugs was not common in this cohort. The study results provide evidence to introduce harm-reduction prevention programs to address illicit drug and excessive alcohol consumption.

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs.

Background: First year exams are a major source of stress amongst first-year medical students. Objective: To explore antidepressant and anxiolytic consumption and addictive behavior of medical students before and after exams. Methods: Medical students of the 35 French medical schools were recruited through mailing lists and social networks between December 2016 and May 2017 and completed online Internet anonymized questionnaires. Results: Overall, 4345 medical students were included (3051 first year vs. 1294 second year). In multivariate analyses, compared to those in the first year of medicine, second year students were found to have lower anxiolytic (adjusted odd ratio (aOR)=0.56, p = 0.01) and antidepressant consumption (aOR=0.21, p<0.0001) but higher psychiatric follow-up (aOR=1.95, p<0.0001) after adjustment for age, gender and relationship status. Whilst second year students reported slightly higher quality of life (especially for mental health), they also reported more daily tobacco smoking (aOR=1.78, p<0.0001), more cannabis use disorders (aOR=2.37, p<0.0001), hazardous drinking (aOR=3.61, p<0.0001), and alcohol dependence (aOR=3.66, p<0.0001). Second year medical students reported fewer difficulties relating to studying in comparison to first year students (aOR=0.60, p<0.0001) yet they reported a higher rate of recreational drugs use with a variety of reasons including self-treatment of anxiety; disinhibition and to copy their peers (all p<0.05). Limits: These results should be confirmed by longitudinal studies. Conclusion: First year medical students who are faced with challenges relating to studying consume more antidepressants and anxiolytics, whilst second year students have a higher consumption of recreational drugs for a range of reasons. This suggests that the first two years at medical school are an important contributor to adverse mental health and therefore present a window of opportunity for preventative intervention.

2619 Persistently Elevated Intestinal Alkaline Phosphatase in an Individual With AB Blood Group: A Rare Presentation

INTRODUCTION: Elevated alkaline phosphatase (ALP) is seen in hepatobiliary and bone diseases. However, elevated intestinal ALP has been reported in the literature in association with blood group B or O, whose clinical significance is not known. We present a rare case of persistently elevated intestinal ALP in an individual with blood group AB. CASE DESCRIPTION/METHODS: A 56-year-old female presented to our ambulatory clinic to establish health care. Her medical history included peptic ulcer disease and dyslipidemia. She underwent appendectomy in childhood and cholecystectomy around 20 years ago. she denied smoking, alcohol consumption or use of recreational drugs. Family history was significant for type 1 DM in mother and brother. Her only medication included ranitidine. General and systemic examination was normal. Her initial labs were normal except elevated alkaline phosphatase of 359 units/liter. The patient was seen by the gastroenterology team. Further laboratory workup including viral hepatitis, metabolic and autoimmune markers of liver disease were normal. Gamma-glutamyltransferase (GGT), Vitamin D and parathyroid profile were normal. Ultrasound abdomen did not show any significant lesion in the liver or biliary tree. As no evidence of liver disease was noted isoenzyme electrophoresis of ALP was ordered which showed elevated intestinal ALP fraction of 64% (normal 1–24%). Patient blood group was tested which showed group AB. On further follow up in gastroenterology clinic persistently elevated ALP noted. DISCUSSION: Elevated intestinal alkaline phosphatase has been reported in maintaining of gut hemostasis and elevated levels noted in various pathological conditions of the gastrointestinal tract. Meal induced elevation of intestinal ALP has been proposed as a treatment modality to preserve gut hemostasis and minimize inflammation. To the best of our knowledge, our case is an extremely rare presentation of elevated intestinal ALP in an individual with blood group AB. Further molecular and genetic studies in the future may help elaborate functions and therapeutic intervention of intestinal ALP

Safe Injection Sites: A Moral Reflection.

Safe injection sites are morally illicit.

Lifestyle Factors in Late Adolescence Associate With Later Development of Diverticular Disease Requiring Hospitalization

The burden of diverticular disease on society is high and is increasing with an aging population. It is therefore important to identify risk factors for disease development or progression. Many lifestyle behaviors during adolescence affect risk for later disease. We searched for adolescent lifestyle factors that affect risk of diverticular disease later in life. We performed a retrospective analysis of data from 43,772 men (age, 18-20 y) conscripted to military service in Sweden from 1969 through 1970, with a follow-up period of 39 years. All conscripts underwent an extensive mental and physical health examination and completed questionnaires covering alcohol consumption, smoking, and use of recreational drugs; cardiovascular fitness was assessed using an ergometer cycle at the time of conscription. Outcome data were collected from national registers to identify discharge diagnoses of diverticular disease until the end of 2009. We performed Cox regression analysis to determine whether body mass index, cardiovascular fitness, smoking, use of recreational drugs, alcohol consumption, and risky use of alcohol, at time of conscription are independent risk factors for development of diverticular disease. Overweight and obese men had a 2-fold increased risk of diverticular disease compared to normal-weight men (hazard ratio, 2.00; P < .001). A high level of cardiovascular fitness was associated with a reduced risk of diverticular disease requiring hospitalization (P= .009). Smoking (P= .003), but not use of recreational drugs (P= .11), was associated with an increased risk of diverticular disease requiring hospitalization. Risky use of alcohol, but not alcohol consumption per se, was associated with a 43% increase in risk of diverticular disease requiring hospitalization (P= .007). In a retrospective analysis of data from 43,772 men in Sweden, we associated being overweight or obese, a smoker, a high-risk user of alcohol, and/or having a low level of cardiovascular fitness in late adolescence with an increased risk of developing diverticular disease requiring hospitalization later in life. Improving lifestyle factors among adolescents might reduce the economic burden of diverticular disease decades later.

Gender differences in the use of prohibited substances in prison

ObjectivesThe aim of this study is to evaluate the use of both legal and illegal substances, and see the difference in consumption patterns that occur in both men and women.MethodsSurveys have been conducted on consumer habits in the past year among 84 inmates (60 women and 24 men) at the prison Brians 1, interrogating both the consumption of illegal drugs and consumer recreational drugs and routes of administration. Data were analyzed using SPSS program.ResultsA total of 57.1% had used illegal drugs. The most frequent was cannabis, with 54.8% (62.5% men and 51.7% women), followed by heroin, with 23.8% (29.2% in men and 21.7% in women) and cocaine, with 14.3% (20.8% in men and 11.7% women).Use of legal drugs was 45.2% (50% in men and 43.3% women). In this case, the greatest differences were obtained in the use of bupropion (26.7% women versus 0% men), new generation anticonvulsants such as gabapentin and pregabalin (31.7% women and 12.5% men) and the use of intranasal route of administration (31.7% women versus 0% for men). At the other extreme we find more abuse benzodiazepines abuse in men (45.8 versus 20% in women) and sedative antipsychotics (37.5% vs. 8.3%)ConclusionsAlthough there is a serious problem with the misuse of legal psychotropic drugs by inmates in prisons, there is still greater consumption of illegal substances.Men's consumption pattern is more “traditional” (predominance of illegal substances and “classical” legal substances orally).Women's consumption pattern is more experimental at both the use of new psychoactive drugs and the use of alternative routes of administration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

55. Relationship Between Living Situation and Substance Use in an Urban Adolescent Population

55. Relationship Between Living Situation and Substance Use in an Urban Adolescent Population

Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap.

IntroductionEpilepsy is the most common of serious neurological disorders, yet despite considerable efforts, good access to medication, appropriate social and societal acceptance and acceptable quality of life (QoL) are difficult to achieve especially in developing countries. It is estimated that over 500,000 people suffer from epilepsy in the DRC. There is no report, in our knowledge on the epilepsy in Lubumbashi.MethodsA descriptive study was undertaken in individuals with a clinical diagnosis of epilepsy who presented at the CNPJG outpatient clinic in Lubumbashi over a 12 months period. A 64-item questionnaire was used to collect information from the patients. Case records were reviewed and relevant demographic, social, professional, medical history, medical condition data were extracted.ResultsAmong 3,540 patients who presented to a neuropsychiatric clinic run by the Fracarita charity over a 1-year period, 423 (11.9%) were identified as having epilepsy, and 179 were subsequently included in the survey after they (or their parent/guardian) provided informed consent and completed an EEG investigation. Data were collected using a standardized, 64-item questionnaire. Epilepsy had negative impact on the lives of individuals with the condition; 40.8% had either no education or had completed primary education only, 38.0% were unemployed and the majority (64.6%; n = 113) were unmarried or divorced. Family history of epilepsy (first or second degree) was present in 23.5% of cases. Other reported factors that could potentially precipitate epilepsy included obstetric and perinatal factors (15.1%) and central nervous system infections during infancy (8.4%). Consumption of alcohol or recreational drugs accounted for 10.6%. The treatment gap was above 67% and the delay between first seizure and first consultation was 15 months. When asked to describe their condition, or its cause, 55.3% of participants (or their families) considered epilepsy to be of spiritual/ religious origin, while 25.1% had almost no insight and could not provide any description.ConclusionThis first epidemiological study shows a high prevalence of epilepsy among patients presenting to the clinic in Lubumbashi, DRC, and reveals a significant treatment gap.

Kvaišalų geografija posovietiniame mieste: nelegali narkotinių medžiagų apyvarta ir narkomanija Klaipėdoje, 1990-2010 m.

This study explores transformations of local drug geography in Klaipeda, 1990-2010. Using spatial analysis of geocoded data about 1351 cases of drug crime (manufacturing, storing, possession, and sale) and 1510 registered drug users, we researched spatial-temporal patterns of drug crime and drug abuse in changing post-soviet urban environment. Data for this study was provided by Klaipeda Police Headquarters and Klaipeda Centre for Addictive Disorders. We found, that key changes within local drug geography started in 1997-1999 and were caused by development of new economy expanding drug sale to anonymous customers. Since the collapse of the Soviet regime, drugs were mostly manufactured, circulated and used within underground social networks of drug users. The main features of those networks were trust and direct communication among drug users and dealers, who regularly were drug users also. Therefore drugs were locally produced, stored, sold and used in the same places; places of drug abuse and drug crime regularly overlapped. Nevertheless spatial patterns of such underground networks were more accidental in their nature, they had not clear attributes of spatial identify within urban environment. But newly emerging drug economy was based on commodity-money relations between drug dealers and drug users and new market regime clearly differentiated places of drug sale and drug use. Drug sale moved from blocks to the night clubs, marketplaces and surroundings of huge shopping centres. Sociologically such change within drug economy of post-soviet city might be interpreted as a shift from subcultural networks, where local knowledge and practices of street pharmacology were transmitted to new users, to the conspicuous consumption of branded and recreational drugs.

Observational study on the consumption of recreational drugs and alcohol by Swiss travelers.

BackgroundStudies carried out on specific travelers’ groups such as students describe an increase in the consumption of alcohol and drugs during travel and vacation time. The present study investigates the risk behaviors (alcohol and drugs) in a general adult population in Switzerland travelling abroad who visited a travel clinic before departure.MethodsThis retrospective study was conducted in a travel clinic between January 2006 and December 2008. 14,496 patients came to the clinic for a pre-travel consultation. 3,537 of them answered a questionnaire about their life habits in Switzerland and during their last trip. The only exclusion criterion was an age inferior to 18 years old.The consumption habits of drugs and at-risk alcohol intake (8 standard drinks (SD) per week for women and 15 SD for men) was analyzed according to gender, sex, destination and profession. Predictors of adopting a risky behavior between habits in Switzerland and during their previous trip were also analyzed.Results7% (229/3477) of participants declared having at-risk alcohol consumption in Switzerland and 14% (473/3275 [95% CI 13–16]) during their trip. 9% (332/3527) of the participants used drugs in Switzerland and 5% (178/3481) during their trip. Risk factors for at-risk alcohol consumption during a trip were: at-risk alcohol consumption in Switzerland (OR 31[95% CI 21–45]), smoking (1.7 [95% CI 1–2]), use of drugs in Switzerland (OR 2.2 [95% CI 2–3]), leisure travel (OR 1.6 [95% CI 1–2]) and managerial professions (OR 1.8 [95% CI 1–3]). Risk factors for the use of drugs during a trip were: alcohol consumption in Switzerland (OR 2.1 [95% CI 1–4]), smoking (OR 1.9 [95% CI 1–3]), and use of drugs in Switzerland (OR 29.7 [95% CI 19–45]).ConclusionsAt-risk alcohol consumption and, to a lesser extent, use of drugs, affect a large number of travelers which expose them to health problems during a trip. Exploring the alcohol and drugs consumption patterns of people visiting a travel clinic should be part of the pre-travel routine consultation and would allow to identifying people who would benefit most from a specific prevention.

Trend Analysis of Anonymised Pooled Urine from Portable Street Urinals in Central London Identifies Variation in the Use of Novel Psychoactive Substances: Archer J, Dargan P, Lee H, Hudson S, Wood DM. Clin Toxicol (Phila) 2014;52:160–5.

To combat recreational drug use, there must be an understanding of the nature and pattern of both classic recreational drug and novel psychoactive substance (NPS) use. Collecting data on trends in consumption of NPS and classical recreational drugs is challenging. Traditional methods, such as surveys and waste-water analysis, have their flaws. The aim of this study was to determine trends in patterns of drugs detected using samples of urine collected from portable street urinals in London. In this study, 12 four-bay stand-alone urinals were placed in a busy nightlife area of London for a 12-h period each Friday and Saturday night.

P46: Interest of analyzing dry toilets and urinal waste collected during an electronic music festival to monitor the use of recreational drugs

Introduction Various tools are used to monitor the supply of illicit drugs: police and custom seizures, self-reported user surveys, and analysis of biological samples from users and of waste water. Results from analysis of biological samples are interesting, as they prove actual use rather than merely supply of a drug. To increase sensitivity of such tool, it is important to target a population considered as potential users of a given drug type. The aim of the present study was to assess the interest of analyzing dry toilet residue and urine from urinals, collected during an electronic music festival, to monitor use of 20 recreational drugs: amphetamine, methamphetamine, MDA, MDMA, methylone, mephedrone, 4-MEC, MDPV, ketamine, methoxetamine, N, N-dimethyltryptamine, 2C-P, 25I-NBOMe, ecgonine methylester, morphine, codeine, pholcodine, dextromethorphan, JWH-073 and UR-144. Methods Samples (n=11) were collected during a psychedelic trance music festival (2013): 3 pools of urine from 3 urinals and solid and liquid (leachate) waste from 4 dry toilets. Solid waste from dry toilets was analyzed before and after drying (2 days at 40 °C). Samples (500±5mg for solid residues and 1mL for liquids) were analyzed on GC-MS/MS after liquid/liquid extraction. Semiquantification was performed by internal calibration using codeined3, ketamine-d4 and amphetamine-d5 as internal standards (IS). Resultats Amphetamine, MDMA, MDA, ketamine, morphine and codeine were detected in all samples. Methamphetamine was detected in all samples except in leachate from the 4 dry toilets. None of the other 13 drugs were detected. Comparing analyte/IS ratios in the various samples, increasing concentrations were found in leachate, urine, wet solid waste and dry solid waste. Conclusion This study demonstrates the interest of analyzing dry toilet residue and urine from urinals to monitor drug used. Analysis of solid waste from dry toilets seems more effective than analysis of leachate or urine for detecting consumption of recreational drugs in samples collected during a festival. Dry solid waste proved to be the most suitable samples for analysis, due to higher concentration in compounds and, from a practical point of view, easier storage and conservation. MDMA was the drug detected in the greatest amounts; ketamine seemed more widely used than methoxetamine, despite the increasing interest declared by consumers for the latter. A striking point is the absence of detection of the new psychoactive substances include in the study. It can reflect either the limits of the assay or the consumption pattern of this festival.

A New Stimulant of Abuse: 5-(2-aminopropyl)indole

Back to table of contents Previous article Next article Communications and UpdatesFull AccessA New Stimulant of Abuse: 5-(2-aminopropyl)indoleM. Coppola, M.D., and R. Mondola, M.D.M. CoppolaSearch for more papers by this author, M.D., and R. MondolaSearch for more papers by this author, M.D.Published Online:1 Feb 2013https://doi.org/10.1176/appi.ajp.2012.12091168AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In recent years, an increasing demand for legal substances of abuse that mimic the effects of traditional and illicit drugs has resulted in the appearance of several new compounds in the recreational drug market. These new substances, generally marketed as “legal highs,” are synthetic products and vegetable derivatives sold online or in specialized street shops known as “head” or “smart” shops. In particular, many research compounds, generally marketed by specialized suppliers and labeled “not for human consumption,” have become popular among drug users for their strong psychotropic effects. The growing phenomenon of legal highs has resulted in numerous confirmed cases of severe intoxication and fatalities related to the consumption of new recreational drugs in many countries. A potential recreational drug of abuse named 5-(2-aminopropyl)indole (also known as 5-API or 5-IT) has been recently flagged in Sweden. In 2012, the Swedish Poisons Information Center reported several cases of severe intoxication related to the consumption of 5-IT. In addition, the National Laboratory of Forensic Toxicology has analytically confirmed the presence of 5-IT in 14 postmortem examinations. The postmortem blood concentration range was between 0.7 and 5.2 µg/g in 10 cases; no quantitative data were reported in the other four cases. The femoral blood concentration was 18.6 µg/g in one individual, and 5-IT was the single substance found and was identified as the cause of death in two others (1). Furthermore, 5-IT was found in combination with other drugs in postmortem blood samples of two young adults in the United Kingdom (2).5-IT is a little-known 5-positional isomer of α-methyltryptamine, a synthetic indole analog of amphetamine. This molecule shows a bicyclic structure consisting of a six-membered benzene ring fused with a five-membered nitrogen-containing pyrrole ring, and it is considered the only psychoactive α-methyltryptamine positional isomer (3). To our knowledge, no formal study has investigated the pharmacological and toxicological properties of this substance. Users have reported that the desired effects include mild euphoria, mood enhancement, greater sociability and energy, and intensification of sensory experience. Users have also reported untoward effects such as anxiety, psychomotor agitation, confusion, insomnia, sweating, restlessness, tremors, jaw clenching, dilated pupils, and increases in heart rate, blood pressure, and body temperature. 5-IT is generally consumed intranasally or orally, and the dosage range reported by users is between 50 mg and 120 mg. The onset of action occurs within 30 minutes to 1 hour of ingestion, and the effects may last up to 10 hours (1, 4).In conclusion, 5-IT appears to be a strong stimulant producing amphetamine-like effects. International cooperation is of great importance in monitoring and preventing the spread of this dangerous recreational substance.From the Department of Addiction, ASL CN2, Viale Coppino 46, Alba, Italy, and the Department of Mental Health, ASL CN1, Via Torino 70/B, Saluzzo, Italy.The authors report no financial relationships with commercial interests.References1 Belgian Early Warning System on Drugs (BEWSD): 5-IT deaths in Sweden, 2012. http://ewsd.wiv-isp.be/Main/5-IT%20deaths%20in%20Sweden.aspxGoogle Scholar2 Seetohul LN, Maskell PD, De Paoli G, Pounder DJ: Deaths associated with new designer drug 5-IT. BMJ 2012; 345:e5625Crossref, Medline, Google Scholar3 ChemSpider: 5-(2-aminopropyl)indole, 2012. www.chemspider.com/Chemical-Structure.25991467.html?rid=0e042821-856d-4b35-b481-53e1a57e692aGoogle Scholar4 ReDNet Research Group: 5-IT full report. London, Institute of Psychiatry, King’s College London, 2012 (https://www.rednetproject.eu/groups/5it/)Google Scholar FiguresReferencesCited byDetailsCited by(2-Aminopropyl)benzo[β]thiophenes (APBTs) are novel monoamine transporter ligands that lack stimulant effects but display psychedelic-like activity in mice8 November 2021 | Neuropsychopharmacology, Vol. 47, No. 4Designer drugs: mechanism of action and adverse effects6 April 2020 | Archives of Toxicology, Vol. 94, No. 4A new synthetic drug 5-(2-aminopropyl)indole (5-IT) induces rewarding effects and increases dopamine D1 receptor and dopamine transporter mRNA levelsBehavioural Brain Research, Vol. 341Neuropharmacology, Vol. 1015-(2-aminopropyl)indole: A new player in the drama of ‘legal highs’ alerts the community18 March 2014 | Drug and Alcohol Review, Vol. 34, No. 1Clinical Toxicology, Vol. 52, No. 6 Volume 170Issue 2 February 2013Pages 226-226 Metrics PDF download History Accepted 1 December 2012 Published online 1 February 2013 Published in print 1 February 2013

A survey study on the associations between misperceptions on substance use by peers and health and academic outcomes in university students in North-West Europe

Introduction: The basis of Social Norms Theory is that behavior is influenced by the perception of peer behavior. This implies that an overestimation (misperception) of substance use by peers would lead to an increase in personal substance use. It is hypothesized that the misperception of substance use by peers is negatively associated with health and academic performance, and that this association can be explained by an increase in personal substance use. The aim of this study is to investigate the associations of misperception of consumption of tobacco, alcohol, and recreational drugs with health and academic performance, and to test whether or not this association could be explained by substance use in a sample of university students. Methods: Data of 6403 university students in five European countries were gathered through a questionnaire about substance use by themselves and by peers, physical and mental health, and academic functioning. Misperception is defined as an overestimation of the estimated prevalence of substance use among students. Multivariate models are built with misperception regarding tobacco, alcohol and recreational drugs, and personal use of substances as independent variables, and health and academic performance as dependent variables. Results: Misperception is significantly associated with health and academic functioning. This association could not be explained by personal substance use. Conclusions: This study subscribes to an earlier work on the importance of social norms, which indicates a negative influence of misperceptions on health and academic outcomes.

Consumption of tobacco, alcohol, and recreational drugs in university students in Belgium and the Netherlands: The role of living situation

Studying at university/college is associated with consumption of tobacco, alcohol and recreational drugs. This lifestyle may be associated with moving outside parental control. The aim of this study was to investigate differences between students living with their parents and students living alone or with peers regarding substance use in Belgium (Antwerp) and The Netherlands (Amsterdam). The results of two separate surveys, one in Amsterdam (8,258 students) and one in Antwerp (27,210 students) were compared. Both questionnaires contained items about consumption of tobacco, alcohol and recreational drugs, and whether students considered their consumption as a problem and relevant confounders. Students living with their parents were compared with students living alone or with peers, using multivariate logistic regression analyses, separate for Antwerp and Amsterdam. Consumption of tobacco was associated with living with peers. Similar patterns were shown for consumption of alcohol and recreational drugs. Living with peers rather than living with family or alone was a determinant of problematic substance use as well. Patterns were similar for both universities in two different countries. Students living alone or with peers in Amsterdam and Antwerp may be at risk for problems concerning their consumption of recreational drugs. These findings may have implications for targeted prevention programs.

Neuropharmacology of drugs and alcohol in mother and fetus

Epidemiological evidence suggests that an adverse prenatal environment can have profound long-term health consequences throughout postnatal life. This chapter discusses the underlying mechanisms implicated in the consumption of mood-altering recreational drugs and teratogenicity in the fetus. The way metabolic parameters in pregnancy influence the pharmacokinetic characteristics of drugs and alcohol and the developmental stage of neurotoxicity are reviewed. The general underlying mechanisms that link multifaceted interactions between drug characteristics, gene polymorphisms, dietary deficiencies, changed endocrine indices and fetal programming are outlined, with specific examples throughout the text. As developmental injury is of significant social concern, the final section questions whether society provides adequate support for making appropriate and informed lifestyle choices to alleviate preventable transgenerational harm.

‘There is no profile it is just everyone’: The challenge of targeting hepatitis C education and prevention messages to the diversity of current and future injecting drug users

This paper investigates drug use, knowledge of hepatitis C, and risk minimisation amongst participants of the Sydney inner city dance party/club scene. The aim is to identify factors that contribute to the limited success of hepatitis C education and prevention efforts in Australia and to suggest ways in which they might be improved. The method used was a thematic analysis of 31 semi-structured qualitative interviews with people drawn from the Sydney inner city dance party/club scene. This is a scene where the consumption of recreational drugs is normalised, and where the practice of injecting takes place, albeit less commonly to other routes of administration. In the material presented here, drugs are seen as sources of enjoyment and experimentation, but are not seen as necessary to the functioning of daily life. Indeed, dependency on drugs is largely seen as undesirable. Most participants consider themselves to be both well informed about the drugs they use, and in control of their drug use. Whilst participants in this scene are generally well informed about drugs (and deploy harm reduction strategies to avoid such things as overdose), their knowledge of hepatitis C is limited and vague. The marginal and stigmatised status of injecting both inside and outside the scene appears to contribute to an absence of information and communication about safer injecting and hepatitis C within the scene. Often information about safe injecting is perceived to lack relevance to scene participants and to be aimed at ‘other’ injecting drug users (IDU). The material discussed confirms the diversity of IDU and the crossover between social, sexual and drug networks. Whilst this poses challenges for education and prevention, the exploration of these networks or scenes has the potential to inform the content of education and prevention materials as well as identifying contexts for dissemination.

Neuropsychiatric problems in 2,500 long-term young travelers to the tropics.

The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use have not been adequately studied. A two-phase postal and telephone survey has been conducted among 2,500 young travelers to tropical countries. We measured the rate and duration of NPP, characterized their features, and their association with previous psychological profiles, itinerary, type of travel, consumption of recreational drugs, and malaria prophylaxis. First phase: Out of 1,340 respondents, 151 (11.3%) indicated that they had NPP during travel, in contrast with 2.3% who needed psychological consultation before travel (p<.001). Second phase: 117 of 151 responded to the study questionnaire. The mean age of the respondents was 24.4 years, 54.7% were female, and the mean stay abroad was 5.3 months. The most common NPP were sleeping disturbances (52.1%), fatigue (48.7%) and dizziness (39.3%). Thirty-three travelers (2.5%) had severe symptoms, and 16 (1.2%) had symptoms lasting more than 2 months. Seven travelers had pure or mixed depressive symptoms. Consumption of recreational drugs was admitted by 22.2%. Mefloquine was used significantly more often by those who suffered NPP, than by the entire cohort (98.2% vs. 70.7%; p<.001). Long-term travel to the tropics was associated, in this cohort, with a considerable rate of neuropsychiatric symptoms. The majority of the responding travelers were females, used mefloquine as prophylaxis, and at least one fifth used recreational drugs.

From Harm to Robustness: A Principled Approach to Vice Regulation

John Stuart Mill's harm principle maintains that adult behavior cannot justifiably be subject to social coercion unless the behavior involves harm or a significant risk of harm to non-consenting others. The absence of harms to others, however, is one of the distinguishing features of many manifestations of vices such as the consumption of alcohol, nicotine, recreational drugs, prostitution, pornography, and gambling. It is therefore with respect to vice policy that the harm principle tends to be most constraining, and some current vice controls, including prohibitions on prostitution and drug possession, violate Mill's precept. In the vice arena, we seem to be willing to accept social interference with what Mill termed self-regarding behavior. Does consistency then imply that any popular social intervention into private affairs is justifiable, that the government has just as much right to outlaw skateboarding, or shag carpets, or spicy foods, as it does to outlaw drugs? In this paper I argue that advances in neuroscience and behavioral economics offer strong evidence that vices and other potentially addictive goods or activities frequently involve less-than-rational choices, and hence are exempt from the full force of the harm principle. As an alternative guide to vice policy, and following some direction from Mill, I propose the robustness principle: public policy towards addictive or vicious activities engaged in by adults should be robust with respect to departures from full rationality. That is, policies should work pretty well if everyone is completely rational, and policies should work pretty well even if many people are occasionally (or frequently) irrational in their vice-related choices. The harm and robustness principles cohere in many ways, but the robustness principle offers more scope for policies that try to direct people for their own good, without opening the door to tyrannical inroads upon self-regarding behavior.