Global Drug Survey Research Articles

Who uses digital drugs? An international survey of ‘binaural beat’ consumers

Digital drugs, or binaural beats claimed to elicit specific cognitive or emotional states, are a phenomenon about which little is known. In this brief report, we describe demographic and drug use correlates of binaural beat use, patterns of use, reasons for use and methods of access. The Global Drug Survey 2021 was translated into 11 languages; 30 896 responses were gathered from 22 countries. The use of binaural beats to experience altered states was reported by 5.3% of the sample (median age 27; 60.5% male), with the highest rates from the United States, Mexico, Brazil, Poland, Romania and the United Kingdom. Controlling for all variables, age and non-male gender predicted binaural beat use, as did the recent use of cannabis, psychedelics and novel/new drugs. Respondents most commonly used binaural beats 'to relax or fall asleep' (72.2%) and 'to change my mood' (34.7%), while 11.7% reported trying 'to get a similar effect to that of other drugs'. This latter motivation was more commonly reported among those who used classic psychedelics (16.5% vs. 7.9%; P < 0.001). The majority sought to connect with themselves (53.1%) or 'something bigger than themselves' (22.5%) through the experience. Binaural beats were accessed primarily through video streaming sites via mobile phones. This paper establishes the existence of the phenomenon of listening to binaural beats to elicit changes in embodied and psychological states. Future research directions include the cultural context for consumption and proximate experiences, including co-use with ingestible drugs and other auditory phenomena.

Associations between mental illness and non-medical use of prescription opioids among a sample of people who use drugs in Australia and New Zealand

Non-medical use of prescription opioids (NUPO) is an increasing public health concern in Australia and New Zealand. In response to a lack of research on NUPO in this setting, we investigated the associations between NUPO, mental illnesses, and other substance use, using data from the 2019 Global Drug Survey (GDS). Strategies to reduce NUPO-related harm were also discussed. Socio-demographic characteristics, mental illnesses, NUPO, and other substance use among 2019 GDS respondents were examined. Logistic regression was used to identify factors associated with past year NUPO. Data from 2752 Australian and New Zealand respondents who used drugs were analysed. Pastyear use of heroin, benzodiazepines, cannabis (containing THC), and ecstasy were associated with a greater odds of NUPO, while bipolar disorder managed with medications was associated with a lower odds of NUPO. All other mental illnesses, including co-morbid mental illnesses, were not associated with NUPO after adjusting for potential confounders. Of respondents who reported NUPO and answered secondary questions, 38.8% obtained opioids from a friend or family member. This study provides a unique understanding of potential risk factors for NUPO among people who report mental illness and drug use in Australia and New Zealand, and establishes a basis for future research that is aimed at reducing NUPO-related harm.

The impact of COVID-19 on psychoactive products consumers

Introduction: The emergence of COVID-19 changed the lifestyle of individuals through the appearance of lockdown. This period seems to have potential effect on some health determinants related to behaviors such as drug addiction. Objectives: compare the prevalence and behavior of drug consumers before and during the lockdown. Methods: A cross-sectional study was carried out on 1001 Moroccan addict between April and July 2020, using the international questionnaire: The global drug survey “Special Edition on COVID-19”. Results: before lockdown, tobacco use (80.2%), alcohol (70.9%), cannabis (46.3%). During lockdown: tobacco consumption remains unchanged (80.7%), alcohol and cannabis consumption reduced significantly, respectively (39.6%) and (40.8%). Results show also the weaning of hallucinogens and solvents. The reasons behind these changes were: 39.8% worried about health issues, 26.6% have less opportunities to consume, 23.7% think that lifestyle make it difficult to use, 23.4% think they have less ability to obtain drugs. Conclusions: The lockdown seems to be an opportunity for addicts to reduce drugs consumption. However, setting up support services with targeted interventions is the best chance to decrease psychological stress and avoid the consequences of this reduction. Keywords: COVID-19, lockdown, drug consumption, online survey.

Exploring Televend, an innovative combination of cryptomarket and messaging app technologies for trading prohibited drugs

BackgroundDigital technologies continue to facilitate drug trading. Televend was an innovative combination of multiple digital technologies, with its backend hosted on the darknet, while purchases were made through the messaging app Telegram. Here, we provide an initial characterisation of this nascent market. MethodsTelevend and White House Market (WHM) were scraped (Jun–Jul 2021) and a global cross-sectional web survey of 15,513 drug buyers (Global Drug Survey; GDS) was conducted (Dec 2020–Mar 2021). ResultsTelevend was 10% of the size of WHM, the largest drug cryptomarket (4515/44,830 listings per week). Both markets predominantly contained drug-related listings covering similar drug categories, with similar country of origin and destination. Very few GDS drug buyers reported use of Televend (0.73%). Most Televend buyers (68/114) reported buying cannabis, then cocaine (20), MDMA (17), and LSD (12). The Televend and darknet groups had similar demographic and drug use characteristics; whereas compared with app purchasers, older age increased the odds of Televend use (aRRR = 1.06, p < .001), identifying as a cisgender woman decreased the odds (aRRR=0.43, p = .004), while last-year use of a greater number of drug types (aRRR = 1.20, p < .001) and less frequent drug use (aRRR=0.998, p = .032) increased the odds of Televend purchase. ConclusionsWhile smaller, Televend was not noticeably different in its drug offerings to its largest cryptomarket competitor, and it attracted a cohort more similar to darknet than to app drug buyers. Future Televend-like markets may be attractive to people with less specialised technical knowledge who already routinely scroll through social media feeds.

Impacts of changes in alcohol consumption patterns during the first 2020 COVID-19 restrictions for people with and without mental health and neurodevelopmental conditions: A cross sectional study in 13 countries.

BackgroundThe initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and without mental health and neurodevelopmental conditions (MHDCs).MethodsData came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%).ResultsA third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said it affected their physical health negatively (p<.001). Reduced drinking was associated with better mental health among a fifth (21.1%) of respondents with MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living arrangements, employment, coping and distress were significant predictors of increases in drinking.ConclusionAmong people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.

In-home cannabis smoking more prevalent than in-home tobacco smoking among 2019 Global Drug Survey respondents

Purpose of the ResearchEarly evidence from studies of home smoking policies suggests that in-home cannabis smoking is more often allowed than in-home tobacco smoking, but there are not yet data on whether cannabis is more often smoked in the home compared to tobacco, or whether in-home cannabis and tobacco smoking differs by usage status. Using cross-sectional data from over 100,000 sentinel drug users from 17 countries, we compared cannabis and tobacco smoking in the homes of Global Drug Survey 2019 respondents who currently used cannabis only, tobacco only, both tobacco and cannabis, or neither. Principal ResultsComplete data on cannabis and tobacco use and in-home smoking were available for 107,272 adults (average age = 30 ± 12, 34% women, countries with the three highest response rates; Germany = 32%, USA = 10%, New Zealand = 9%). In total, 53.6% and 50.6% of respondents reported past-year cannabis and tobacco smoking in their home respectively. Stratifying respondents into current cannabis-only users, tobacco-only users, dual users, and non-users, past-year in-home cannabis smoking was more prevalent (78.8%) among cannabis-only users than was in-home tobacco smoking (67.9%) among tobacco-only users. Among dual users, past-year in-home cannabis smoking (82.8%; 95%CI = 80%-86%) was higher than in-home tobacco smoking (75.9%; 95%CI = 69%–81%; p < 0.001). In-home cannabis and tobacco smoking was similar among non-users (20.2% and 20.5%, respectively). Major ConclusionsPast-year in-home cannabis smoking was more prevalent than tobacco smoking in the homes of participants who used cannabis and/or tobacco, supporting our speculation that in-home cannabis smoking might be more socially acceptable than in-home tobacco smoking.

Clinical withdrawal symptom profile of synthetic cannabinoid receptor agonists and comparison of effects with high potency cannabis

Synthetic cannabinoid receptor agonists (SCRAs) may be used as an alternative to natural cannabis; however, they may carry a greater risk of problematic use and withdrawal. This study aimed to characterise the withdrawal symptom profile of SCRAs and compare their profile of effect with high-potency herbal cannabis. Global Drug Survey data (2015 and 2016) were used to access a clinically relevant sample of people reporting use of SCRAs >10 times in the past 12-months, a previous SCRA quit attempt, and lifetime use of high-potency herbal cannabis. Participants completed an 11-item SCRA withdrawal symptom checklist and compared SCRAs and high-potency herbal cannabis on their onset and duration of effects, speed of the development of tolerance, severity of withdrawal, and difficulty with dose titration. Participants (n = 284) reported experiencing a mean of 4.4 (95% CI: 4.1, 4.8) withdrawal symptoms after not using SCRAs for >1 day; most frequently reported were sleep issues (59.2%), irritability (55.6%), and low mood (54.2%). Withdrawal symptoms were significantly associated with frequency (>51 vs. 11–50 times per year: IRR = 1.43, 95% CI: 1.16, 1.77, p = 0.005) and quantity (grams per session: IRR = 1.13, 95% CI: 1.05, 1.22, p = 0.001) of SCRA use. Compared to high-potency herbal cannabis, SCRAs were rated as having a faster onset and shorter duration of effects, faster development of tolerance, and more severe withdrawal (p’s < 0.001). In conclusion, SCRA withdrawal symptoms are more likely to occur after greater SCRA exposure. The effects of SCRA indicate a more severe withdrawal syndrome and a greater risk of problematic use than natural cannabis.

Where and What You Drink Is Linked to How Much You Drink: An Exploratory Survey of Alcohol Use in 17 Countries

Background This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type. Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage. Results: Drink type affected grams of alcohol reported to reach the tipping point: 109 gm wine, 127 gm alcopops, 133 gm of beer, and 134 gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations. Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking.

Comparing intentions to reduce substance use and willingness to seek help among transgender and cisgender participants from the global drug survey

AimsTo describe and compare psychoactive substance misuse help-seeking among transgender (trans) and cisgender (cis) participants from a large multi-national cross-sectional survey.BackgroundTrans people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cis participants from a large multi-national cross-sectional survey.MethodOver 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey (GDS) - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1,857 non-binary people) were compared, using Chi-square and z-tests with Bonferroni correction, on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. Respondents from GDS 2018 were also assessed for substance dependence. Binary logistic regression was used to compare gender groups on self-reported substance dependence to frame the help-seeking analyses.ResultTrans respondents (n = 1,710) to GDS 2018 were significantly more likely than cis respondents to report use of illicit substances (OR = 1.66-2.93) and dependence on cannabis (OR = 2.39), alcohol (OR = 3.28) and novel psychoactive substances (OR = 4.60). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2,579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, non-binary people and trans women were most likely to want help to achieve this.ConclusionTrans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

The impact of COVID-19 on psychoactive products consumers

IntroductionThe emergence of COVID-19 changed the lifestyle of individuals through the appearance of lockdown. This period seems to have potential effect on some health determinants related to behaviors such as drug addiction.ObjectivesCompare the prevalence and behavior of drug consumers before and during the lockdown.MethodsA cross-sectional study was carried out on 1001 Moroccan addict between April and July 2020, using two international questionnaires: The global drug survey “Special Edition on COVID-19” and the survey on impact of COVID-19 on patients and families.Resultsbefore lockdown, tobacco use (80.2%), alcohol (70.9%), cannabis (46.3%). During lockdown: tobacco consumption remains unchanged (80.7%), alcohol and cannabis consumption reduced significantly, respectively (39.6%) and (40.8%). Results show also the weaning of hallucinogens and solvents. 76.3% decreased their use, the raisons behind these changes were: 39.8% worried about health issues, 26.6% have less opportunities to consume, 23.7% think that the current life style make it difficult to use, 23.4% think they have less ability to obtain drugs.ConclusionsThe lockdown seems to be an opportunity for addicts to reduce drugs consumption. However, setting up support services with targeted interventions is the best chance to decrease psychological stress and avoid the consequences of this reduction.

Microdosing psychedelics: Subjective benefits and challenges, substance testing behavior, and the relevance of intention.

Microdosing psychedelics is the practice of taking small, sub-hallucinogenic doses of lysergic acid diethylamide or psilocybin-containing mushrooms. Despite its surging popularity, little is known about the specific intentions to start microdosing and the effects of this practice. First, we aimed to replicate previous findings regarding the subjective benefits and challenges reported for microdosing. Second, we assessed whether people who microdose test their substances before consumption. Third, we examined whether having an approach-intention to microdosing was predictive of more reported benefits. The Global Drug Survey runs the world's largest online drug survey. Participants who reported last year use of lysergic acid diethylamide or psilocybin in the Global Drug Survey 2019 were offered the opportunity to answer a sub-section on microdosing. Data from 6753 people who reported microdosing at least once in the last 12 months were used for analyses. Our results suggest a partial replication of previously reported benefits and challenges among the present sample often reporting enhanced mood, creativity, focus and sociability. Counter to our prediction, the most common challenge participants associated with microdosing was 'None'. As predicted, most participants reported not testing their substances. Counter to our hypothesis, approach-intention - microdosing to approach a desired goal - predicted less rather than more benefits. We discuss alternate frameworks that may better capture the reasons people microdose. Our results suggest the perceived benefits associated with microdosing greatly outweigh the challenges. Microdosing may have utility for a variety of uses while having minimal side effects. Double-blind, placebo-controlled experiments are required to substantiate these reports.

Inhaling alcohol vapour or mist: An international study of use, effects and harms

ObjectivesTo determine the prevalence, patterns of use and consequences of inhaling alcohol vapour or mist. DesignCross-sectional survey recruiting an international non-probability sample of people who use alcohol and other drugs as part of the annual Global Drug Survey (GDS). SettingOnline questionnaire translated into 19 languages. Participants110,557 people took part in GDS2020 and 88,124 completed a question about inhaling alcohol in the last 12 months. The focus of this study is GDS2020 respondents who reported inhaling alcohol mist/vapour from a balloon in the last 12 months. Main outcomesLast 12-month use of alcohol vapour, onset duration, intensity of effects, value for money compared with alcohol, and incidence of falls/injuries. ResultsA total of 803 people reported the use of alcohol vapour in the last 12 months, with 51% of the sample coming from 3 countries: Australia, Denmark and England. Two-thirds were male, and they were more likely to be under 25. 45.7% reported that they were a bit/very drunk before they inhaled alcohol. 51.3% reported that the effects lasted for less than 5 mins. Both the intensity of effect and perceived value for money showed a normal distribution on a 10-point scale. 12.7% of respondents reported falling/injuring themselves. ConclusionInhaling alcohol vapour appears to be more common amongst younger, higher-risk drinkers. The rapid onset of action and inability to titrate consumption to effect is a risk for acute injury. We consider that alcohol is harmful enough through oral consumption without adding to the risk of injury by offering such a potentially risky additional administration method.

Drinking to excess and the tipping point: An international study of alcohol intoxication in 61,000 people

BackgroundPeople who drink alcohol often seek to manage their intake in order to maximise the pleasurable effects, such as feelings of sociability and relaxation, without reaching their ‘tipping point’, where they feel out of control, or unwell. This paper aimed to explore three stages of intoxication; feeling the effects; being as drunk as you would like to be; and reaching the tipping point (feeling more drunk than you want to be) in a large international sample. MethodsThe Global Drug Survey (GDS) is an annual, cross-sectional, online survey of drug use. This paper draws on data from 61,043 respondents (63.7% male) from 21 countries who took part in GDS2015 collected in November 2014 to January 2015. Respondents reported their usual type of drink; how many drinks they would require to reach each stage of intoxication and how frequently they reached each stage. Alongside socio-demographic measures, they also completed the Alcohol Use Disorders Identification Test (AUDIT). ResultsMale respondents reported consuming 87.55 gm to be as drunk as they want to be and female respondents reported 70.16 gm, on average. The tipping point was reached at 138.65 gm for male respondents and 106.54 gm for female respondents. Overall 20.3% reported reaching their tipping point at least once a month. Being male, aged under 25 and at higher risk for alcohol use disorder was associated with reporting reaching the tipping point more frequently. ConclusionsThe amount of alcohol being consumed to reach a desired point of intoxication is much higher than the maximum daily, and sometimes weekly, amount recommended by country guidelines. Encouraging people to avoid reaching their tipping point may be a useful intervention point alongside better communication of low risk drinking guidelines.

Perceptions of cannabis health information labels among people who use cannabis in the U.S. and Canada

BackgroundThe emergence of legal cannabis industries poses a new public health challenge. Health information labels are part of the public health strategy for tobacco and alcohol, but there is limited research on cannabis-related messaging. This study explored perceptions of cannabis health information labels among people who used cannabis in the last 12 months residing in the U.S. and Canada. MethodsThe Global Drug Survey (GDS) is a large anonymous cross-sectional web-survey. In GDS2019, respondents were presented with six labels with cannabis-related health information (dependence; driving stoned; harms of smoking; harms to developing brain; lack of motivation; effects on memory), and asked if information was new, believed, would it change behavior, and about acceptability of having health labels on legal products. This paper includes 1,275 respondents from Canada and 2,224 from U.S. states where cannabis was legal at the time of the survey, and 5,230 from other U.S. states. ResultsFew respondents said that the information was new (6.6-24.6%). Most said the information was believable (63.5-72.0%) other than for the dependence message (28.1% new, 56.8% believed), which was perceived to be the least likely to change behavior (10.2%). Driving stoned was the message perceived to be the most likely to change behavior (58.5%). Respondents living in Canada were less likely to say information was new and rated most messages more believable than those in the U.S. Respondents from legal U.S. states were less likely to say information was new compared to other states. Respondents who used cannabis daily rated acceptability of labels lower (27.8%) than those using 1-48 days (40.6%). ConclusionsNovel, believable information may be more effective at changing behavior. Regular consumers may be less susceptible to messages. Information focusing on safer use strategies and benefits of reducing use may be more acceptable and should be assessed in future research.

Motives and Correlates of Anabolic-Androgenic Steroid Use With Stimulant Polypharmacy

Individuals who use anabolic-androgenic steroids (AAS) may engage in concurrent psychoactive drug use recreationally and/or as an additional training aid. Aside from cannabis, individuals who use AAS most commonly report concurrent use of stimulants such as amphetamines and cocaine. In this study, we examine demographic characteristics, frequency of heavy drinking, and nightclubbing in a sample of 993 men from the Global Drug Survey 2015 who reported both AAS and psychoactive drug use before exploring the relationship between motivation for AAS use and the propensity to concurrently engage with stimulant-type substances. Results of a logistic regression analysis suggest that the propensity for concurrent use of AAS and stimulants is greater when AAS use is motivated by weight loss goals, while performance goals are associated with reduced odds of concurrent stimulant use. Identifying individuals who are at risk of polydrug use and associated harms can inform targeted harm reduction strategies.

Comparing intentions to reduce substance use and willingness to seek help among transgender and cisgender participants from the Global Drug Survey

IntroductionTransgender (trans) people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cisgender (cis) participants from a large multi-national cross-sectional survey. MethodsOver 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1857 non-binary people) were compared on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. ResultsTrans respondents (n = 1710) to GDS 2018 were significantly more likely to report use of illicit substances (OR = 1.66–2.93) and dependence on cannabis (OR = 2.39) and alcohol (OR = 3.28). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, trans participants were more likely to want help to achieve this. ConclusionTrans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.

Improved colour blindness symptoms associated with recreational psychedelic use: Results from the Global Drug Survey 2017

It is well documented that psychedelic drugs can have a profound effect on colour perception. After previous research involving psychedelic drug ingestion, several participants had written to the authors describing how symptoms of their colour blindness had improved. The Global Drugs Survey runs the world’s largest annual online drug survey. In the Global Drugs Survey 2017, participants reporting the use of lysergic acid diethylamide or psilocybin in the last 12 months were asked, We have received reports from some people with colour-blindness that this improves after they use psychedelics. If you have experienced such an effect can you please describe it in the box below, say what drug you took and how long the effect lasted. We received 47 responses that could be usefully categorised of which 23 described improved colour blindness. Commonly cited drugs were LSD and psilocybin; however, several other psychedelic compounds were also listed. Some respondents cited that the changes in colour blindness persisted, from a period of several days to years. Improved colour blindness may be a result of new photisms experienced in the psychedelic state aligning with pre-existing concepts of colour to be ascribed a label. Connections between visual and linguistic cortical areas may be enhanced due to disorder in the brain’s neural connections induced by psychedelics allowing these new photisms and concepts to become linked. This paper provides preliminary data regarding improved colour blindness accompanying recreational psychedelic use which may be further investigated in future iterations of the Global Drugs Survey or in a stand-alone Global Drugs Survey-managed psychedelics survey.

Perceptions of Alcohol Health Warning Labels in a Large International Cross-Sectional Survey of People Who Drink Alcohol.

This paper aimed to explore perceptions of alcohol health warning labels amongst a large international sample of people who drink alcohol. The Global Drug Survey (GDS) is the world's largest annual cross sectional survey of drug use. Seven health warning labels were presented (relating to heart disease, liver, cancer, calories, violence, taking two days off and the myth of benefits to moderate drinking). People were asked if they were aware of the information, believed it, if it was personally relevant, and if it would change their drinking. This paper included data from 75,969 respondents from 29 countries/regions who reported the use of alcohol in the last 12months, collected during November-December 2017 (GDS2018). The fact that drinking less can reduce the risk of seven types of cancer was the least well known, and yet was demonstrated to encourage almost 40% of drinkers to consider drinking less. Women and high risk drinkers were more likely to indicate they would reduce their drinking in response to all labels. Personal relevance was identified as a key predictor of individual responses. Findings highlight the potential of a range of health messages displayed on alcoholic beverages to raise awareness of alcohol-related harms and potentially support a reduction in drinking. Further research should explore what influences personal relevance of messages as this may be a barrier to effectiveness.

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users.

Nitrous oxide (N2O) has been used in clinical and recreational settings for over 150 years. Through inactivation of the Vitamin B12 dependent enzyme, methionine synthase, N2O can lead to the development of peripheral neuropathy. This study sought to determine the relationship between the exposure and risk of neurological symptoms in the largest ever sample of users. Data are drawn from the Global Drug Survey (GDS) over three consecutive years (2014-2016). The Global Drug Survey is an online, cross-sectional survey of substance use, translated into multiple languages. Respondents to the Global Drug Survey who provided details on N2O use and the experience of paraesthesia in the previous 12 months. Questions relating to N2O use, peripheral neuropathy, age and gender were explored among last year's users. Of 241,566 respondents, 41,181 (17.0%) indicated that they had ever used nitrous oxide; of these, 42.1% had used in the last 12 months. For the final model, data from 16,124 participants who had used N2O in the last 12 months and had provided responses on age, dose, gender and paraesthesia were used. Of these, the number of respondents reporting persistent numbness/tingling (paraesthesia) in their hands or feet was 537 (3.3%). Although the risk was very low among infrequent users, there was a strong dose-response relationship. For people indicating one or two doses per session, the probability of reporting paraesthesia was approximately 0.018 by comparison; for people indicating 100 doses per session the probability was approximately 0.085. The association, between dose and paraesthesia was influenced by gender and age. While infrequent, episodic users are not at risk, a minority of heavy users are at dose-dependent risk of developing serious neurological consequences. Better education and raised awareness of early symptoms are required.

Substance-Linked Sex in Heterosexual, Homosexual, and Bisexual Men and Women: An Online, Cross-Sectional “Global Drug Survey” Report

IntroductionSubstance use in sexual contexts has received recent attention, but it has mostly been restricted to men who have sex with men and the so-called “chemsex” phenomenon. AimTo explore the use of licit and illicit substances in combination with sex in heterosexual, homosexual, and bisexual men and women; to explore substance-linked sex (SLS) differences across sexual orientation and sexes. MethodsAn international online self-selecting cross-sectional drugs survey, the Global Drug Survey 2013 (n = 22,289), was conducted. Respondents were asked about which drugs (including alcohol) they had had sex while on; how frequently they used drugs to enhance sex; and how different drugs changed different aspects of the sexual experience. We report descriptive statistics and test differences between men and women and between different sexual orientations. Main Outcome MeasuresThe following outcome measures were recorded: (i) Percentage of each group reporting last-year use of each drug with sex, (ii) Mean subjective rating (−10 to +10) from each group for each drug on each aspect of the sexual experience. ResultsSLS occurred across sexual orientations and in both men and women. All groups reported that alcohol, cannabis, and 3,4-methylenedioxymethamphetamine (MDMA) were the most while commonly used drugs with sex. Larger proportions of homosexual and bisexual men had sex while on most drugs than heterosexual men (P < .001); and larger proportions of bisexual women had sex while on most drugs than heterosexual women (P < .004). ≥20% of each group reported having used drugs with the intention of enhancing a sexual experience; larger proportions of homosexual and bisexual men reported this behavior than heterosexual men (P < .001). There were clear dissociations between the effects of different drugs on different aspects of the sexual experience; although γ-hydroxybutyric acid/γ-butyrolactone and MDMA were rated consistently highly. Clinical ImplicationsMen and women of different sexual orientations must be considered when forming harm reduction and treatment strategies. However, “chemsex” drugs were most commonly used by homosexual men; targeted messages to this group should continue. Strength & LimitationsOur study is highly novel; no previous study has investigated the combination of sex with this range of drugs. However, our survey is self-selecting, and some groups have a small sample size. ConclusionsAll groups reported SLS to some degree. However, differences in SLS between men and women and sexual orientations were found. Alcohol, cannabis, and MDMA were most commonly used with sex. “Chemsex” drugs were more commonly used by homosexual and bisexual men than heterosexual men.Lawn W, Aldridge A, Xia R, et al. Substance-Linked Sex in Heterosexual, Homosexual, and Bisexual Men and Women: An Online, Cross-Sectional “Global Drug Survey” Report. J Sex Med 2019;16:721–732.