Illicit Drug Abuse Research Articles

Financial heist from counterfeit drug: A case study from Delhi, India

Drug abuse has become a severe social-economic problem, which is vulnerably affecting different age groups. All the regulatory bodies involved in strategic reduction in drug abuse need to strengthen to ensure effective implementation for combating illicit drug abuse. Also, many a times people are duped by spurious drugs, which have a stupefying effect on the victim and cheat them of their valuable belongings. The victim reports such cases after the incident to the concerned investigating agencies who subsequently register and strategize to nab the culprit. The seized materials from the culprit/accused persons are subsequently sent for forensic examination. The Forensic Science Laboratory receives many such cases of drug poisoning/overdose, spurious/illicit drugs. A case of a 40-year-old victim/farmer, who was robbed of his belongings at a bus depot, was registered in Forensic Science Laboratory, Delhi. A brief history of the case was that he was waiting to board a bus for a further journey; whereby he met the accused persons who befriended him and together they had some food. Later as there was further delay in the bus, they went to a restaurant at the bus depot, had tea and biscuits and slept. Later, the victim was discovered unconscious by investigating agencies who took him to the hospital. The Medico-Legal Certificate report indicated him to be drowsy and unfit for statement at the time of admission and therefore preserved his blood sample for chemical analysis. The victim later said that the accused had stolen his belongings, especially money. Investigating agencies corroborated small pieces of evidence finally to nab the accused and seized a medicine strip claiming it to be the sedative drug ‘Nitrazepam’ which was administered to the victim. The blood sample of the victim and the strip of tablets seized from the accused were submitted for forensic examination. The samples received in the present case were white coloured tablets and blood sample. On visual examination, the tablets appeared similar to that of manufactured pharmaceutical drug ‘Nitrazepam’. Preliminary examination gave surprising results. Therefore, detailed chemical and instrumental analysis using the techniques gas chromatography mass spectroscopy (GC-MS), high performance thin layer chromatography (HPTLC), Fourier transform infrared spectroscopy (FTIR), and ultra performance liquid chromatography (UPLC) were carried out to ascertain the contents in the tablets, that have stupefying effect. Preliminary screening by thin layer chromatography (TLC) did not indicate the presence of ‘Nitrazepam’ [the separated components did not tally with the certified reference material (CRM) of ‘Nitrazepam’]. GC-MS examination of the sample indicated the probable presence of pheniramine (78%) and chlorpheniramine (83%) using the National Institute of Standard and Technology (NIST) database. Detailed analysis using the techniques HPTLC, FTIR and UPLC was carried out to ascertain the exact components in the tablets and blood sample. They were found to contain ‘Chlorpheniramine’ rather than ‘Nitrazepam’ as imprinted by the manufacturer. It is important to mention here that even Chlorpheniramine has sedative effect, apart from acting as an antihistamine medicine. An interesting case of robbing was deduced; with a simultaneous disclosure of counterfeit drugs, which may be blooming in the market. With the development of modern analytical techniques, even trace samples can be examined and have special significance while dealing with crime and criminals.

5-Year Retrospective Evaluation of Drug Addicts with Psychiatric Problems in the Emergency Department

Introduction: Illicit drug addiction and comorbid psychiatric disorders are among the most complex patient groups in the emergency department. In this study, to share the results of patients who admitted to our emergency department after illicit drug abuse and accepted hospitalization and treatment in the rehabilitation clinic. Methods: The study was planned retrospectively and in two centers. The medical records of patients who were admitted to the emergency department between 1th of January 2015 and 31th of December 2019 and subsequently received addiction treatment in our rehabilitation clinic were examined. Among the patients included in the study, the data of the patients with positive results in the urine drug and alcohol screening were analyzed and the study was completed. Results: In our study, the mean age was 32.09 y. It was observed that 12.5% of the cases had a psychiatric disorder. The most frequently detected illicit drugs are amphetamine and cannabis. The average length of stay was 11.57 days. The average number of admissions to the emergency department was 5.81 ± 3.03. The most common symptoms at admission were injury 114 and muscle pain 94. Conclusion: Especially low socioeconomic level increases susceptibility to illicit drug abuse. In addition, individuals with psychiatric problems also tend to use illicit drugs. With illicit drug abuse, the possibility of being involved in judicial cases also increases. It is appropriate to follow up patients who apply to the emergency department by rehabilitation units for their long-term treatment.

Understanding Illicit Drug Use Trends During the Carnival Holiday in the Brazilian Capital Through Wastewater Analysis

Cocaine and cannabis consumption during and after the 2019 Carnival holiday were assessed using the wastewater-based epidemiology (WBE) in the capital of Brazil, Brasília. The substances 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH), cocaine (COC), benzoylecgonine (BE), and cocaethylene (COE) were monitored in composite samples (24 h) collected in the entrance of North-Wing (NW) and South-Wing (SW) wastewater treatment plants (WWTP) for 15 consecutive days, including the Carnival holiday. Aliquots (100 ml) were enriched with isotope-labeled standards, solid-phase extracted and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results reveal higher cocaine consumption during the Carnival (average of 2.8 ± 0.7 g/1000inh/day) compared to the subsequent period (average of 1.7 ± 0.3 g/1000inh/day). Cannabis (THC) use was also higher during the holiday (14 ± 5 g/1000inh/day) but differences were not significative (unpaired t-test, 95%) compared to the following days (11 ± 3 g/1000inh/day), where consumption remained relatively constant corroborating that cannabis overall consumption is less affected by occasional abuse. Regarding cocaine, an unusual low consumption was noticed in the weekend immediately after the Carnival Holiday, indicating lower demand or supply issues. Higher cocaine and cannabis use was observed throughout the entire sampling period in the area covered by NW-WWTP, probably due to the higher proportion of young people. This investigation brings the first data on cannabis use in Brazil by WBE and confirms this strategy as a well consolidate tool for estimating illicit drug use and abuse.

Requiem for A Dream: A Lifestyle and Routine Activities Victimological Analysis to Explore the Sexual Victimization of Illicit Drug Users

ABSTRACT This study examines the sexual victimization of illicit drug users. Specifically, this research follows a lifestyle/routine activities framework to examine contexts of victimization associated with illicit drug uses. The sample uses in this study includes 264 cases of sexual offending where illicit drug users were targeted. To conduct a comparison analysis, we made a random selection of 500 cases of sexual offending where victims were not drug users. Bivariate and multivariate analysis are performed to examine the differences between the two groups and latent class analysis is used to generate an empirical classification of victimological processes leading to the sexual victimization of illicit drug users. Findings indicate that lifestyle characteristics and routine activities play an important role in the sexual victimization of illicit drug users. Classification analysis suggests that it exists five different patterns leading to the sexual victimization of illicit drug abusers: non-exposed lifestyle, festive lifestyle, criminal activity lifestyle, marginalized lifestyle, sex-trade worker lifestyle. External validity analysis shows that victimization characteristics are associated with the victimological context.

How to deal with Substance Abuse in a Telepsychiatric Setting

Abstract BodyAlcohol and (illicit) substance abuse are among the most common psychiatric disorders within the general population and their impact can not be underestimated. Reputedly for these disorders, there is a large treatment gap and treatment delay, i.e. large numbers of afflicted individuals never receive appropriate treatment and if they do so often many years after the onset of the disorder. The Covid19 pandemic has only aggravated these gaps. In many countries, due to the Covid 19 pandemic and its associated restriction measures telepsychiatric tools have become increasingly implemented (and funded) as regular parts in the possibilities in delivering interventions. With respect to substance abuse treatment, a vast body of research already showed promises both in the field of telepsychiatry as broader the use of digitalization (e.g. the use of virtual reality designed treatment interventions, digital monitoring). In the current presentation, an overview will be presented of both telemental health interventions and digital tools/interventions in the field of substance abuse treatment.DisclosureNo significant relationships.

A retrospective analysis of data from illicit drug abuse cases in Beijing between 2018 and 2020

The overall number of drug abuse cases has been on the rise around the world, causing it a disaster in many countries. In this retrospective study, we analyzed the characteristics of 11,903 drug abuse cases in Beijing, the capital of China, in the perspective of age, gender, nationality, region, season, type of specimens and various drugs, respectively. The case information was collected by the national-level forensic toxicology laboratory, which belongs to the China University of Political Science and Law. It was shown that the overall number of drug abuse cases had increased sharply from 2018 to 2019 and had a decrease of 25% in 2020. The incidence of drug abuse cases involving men was much higher than that of the cases involving women. The adolescents and young adults accounted for the largest share of drug abusers in our study. Haidian, as a national center of scientific and technological innovation with global influence, had the largest percentage of toxic substance-related cases, and the change was more pronounced than other districts during the 3-year-period. Chaoyang was second to Haidian in the number toxic substance-related cases. As a key window of economic, Chaoyang had the highest number of foreigner drug cases. June to August had the highest number of drug abuse cases, while amphetamines, opioids, cannabis and cocaine were the most common toxic substances involved in the cases we detected. To our knowledge, this is the first study to provide an overall analysis of drug abuse cases in Beijing, China. The study indicated the presence of a wide number of drug abuse cases in the capital city and confirmed the threat for the public safety and health. Such forensic information can assist the government to devise intelligence-based preventive and repressive measures and policies.

Increased length of stay following total joint arthroplasty based on insurance type.

Increased length of stay after total joint arthroplasty has been shown to be a risk factor for peri-operative complications. The purpose of this study was to determine if Medicaid insurance would be a risk factor for increased length of stay after total joint arthroplasty. We retrospectively reviewed a single surgeon's practice of 428 total hip and total knee arthroplasties who had insurance status of Medicaid, Medicare, Private or none. After exclusion criteria there were 400 patients. Patients with insurance status of Medicaid, Medicare or Private were then compared based on length of stay ≤ 2days and length of stay > 2days and then further analyzed using demographic, operative data, and total length of stay. Medicaid patients had an increased length of stay compared to patients with Medicare or Private insurance [1.98days versus 1.73days, p = .037, 95% confidence intervals (1.78-2.18) and (1.61-1.85), respectively]. The greatest predictor of a less than two-night stay post-operatively was private insurance status (p = 0.001). Medicaid patients had a higher incidence of prescribed narcotic use pre-operatively (p = 0.013). Although not significant, a trend was noted in the Medicaid population with higher incidence of smoking (p = 0.094) and illicit drug abuse (p = 0.099) pre-operatively in this sample subset. Patients with Medicaid insurance undergoing total joint arthroplasty have increased length of stay compared to patients with Medicare or Private insurance and have higher incidence of pre-operative narcotic use.

Cannabinoids and Myocardial Ischemia: Novel insights, Updated Mechanisms, and Implications for Myocardial Infarction.

Cannabis is the most widely trafficked and abused illicit drug due to its calming psychoactive properties. It has been increasingly recognized as having potential health benefits and relatively less adverse health effects as compared to other illicit drugs; however, growing evidence clearly indicates that cannabis is associated with considerable adverse cardiovascular events. Recent studies have linked cannabis use to myocardial infarction (MI); yet, very little is known about the underlying mechanisms. A MI is a cardiovascular disease characterized by a mismatch in the oxygen supply and demand of the heart, resulting in ischemia and subsequent necrosis of the myocardium. Since cannabis is increasingly being considered a risk factor for MI, there is a growing need for better appreciating its potential health benefits and consequences. Here, we discuss the cellular mechanisms of cannabis that lead to an increased risk of MI. We provide a thorough and critical analysis of cannabinoids' actions, which include modulation of adipocyte biology, regional fat distribution, and atherosclerosis, as well as precipitation of hemodynamic stressors relevant in the setting of a MI. By critically dissecting the modulation of signaling pathways in multiple cell types, this paper highlights the mechanisms through which cannabis may trigger life-threatening cardiovascular events. This then provides a framework for future pharmacological studies which can identify targets or develop drugs that modulate cannabis' effects on the cardiovascular system as well as other organ systems. Cannabis' impact on the autonomic outflow, vascular smooth muscle cells, myocardium, cortisol levels and other hemodynamic changes are also mechanistically reviewed.

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department.

Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.

Portable nanoelectrospray periodic focusing differential ion mobility spectrometer for the rapid screening of illicit drugs

The spread of illicit drug abuse is a major public health issue in most countries. Law enforcement personnel on drug abuse need a tool to confiscate and block illicit trade of illicit drug or monitoring drug impaired driving. Therefore, affordable and portable instruments for illegal drug detection are in critical need. In this study, we developed a portable periodic focusing differential ion mobility (PFDMA) spectrometer for in situ motoring illicit drugs. The device comprised an ionization source, drift cell, air blower, voltage divider board and electronic control board. In general, an ion mobility spectrometer (IMS) is able to work with air as a buffer gas at atmospheric pressure. There is no need to install heavy mechanical and/or expensive turbo molecular pumps. For our instrument, a small air blower was used to generate laminar counterflow. The whole device is compact with a size of 150 × 200 × 280 (WLH, mm) and a weight of 2.5 kg. In general, most commercial drift tube ion mobility spectrometers use radioactive or corona discharge ionization. In this work, we utilized a different approach to analyze liquid samples. The device was equipped with a nanoelectrospray ionization source. To avoid memory effects, a disposable micropipette was used. An aluminum-coated tip with an ID of 2 μm was applied with a high voltage to achieve nanoelectrospray ionization without sheath gas. Advantages of PFDMA are to isomer separation and better sensitivity compared to other types of ion mobility spectrometers. Most illicit drugs could be detected by this homemade device. The detection limit is lower than the level allowed by law. With our device, the detection limit of methamphetamine is ∼10 ng/ml.

Attitudes and Associated Demographic Factors Contributing towards the Abuse of Illicit Drugs: A Cross-Sectional Study from Health Care Students in Saudi Arabia.

Background and objective: The purpose of this study is to compare the attitudes, views, and factors that influence drug abuse among pharmacy and nursing students at a Saudi Arabian university. Materials and Methods: A cross-sectional study, was conducted among pharmacy and nursing students who are currently enrolled in the respective courses at the study site. The data were collected over 4 months from August to November 2019 using structured self-administered paper-based questionnaires. Results: Among the participants, pharmacy students accounted for 184 (58.2%) while 132 (41.8%) of the students were from nursing. More than a third of the students 129, (40.8%) smoked cigarettes. The majority of pharmacy (80.4%) and nursing students (67.4%) reported having undertaken a drug misuse course in college. Among the participants, 132 (41.7%) stated that an offer from friends, followed by joy seeking 129 (40.8%), parents’ divorce 126 (39.8%), having access to drugs 125 (39.5%), family issues 110 (34.8%), 66 (20.8%) having a family member who is addicted, and 101 (31.9%) reported curiosity to be the factors regarding the use of abusive drugs. Transient euphoria (75.9%) followed by depression 197 (62.3%) was the most prevalent physical or psychological change that occurred following drug use. The family size and father’s education have significantly affected the attitudes scores of the students (F = 5.188; p = 0.0001). Conclusion: In this study, joy-seeking, access to drugs, and family issues were found to be the major factors listed as reasons for drug abuse, with some of them being controllable or reversible. Educating about the adverse outcomes of abused drugs is warranted.

Sensory sparing does not change long-term outcomes in motor complete spinal cord injuries

BACKGROUND CONTEXTIn the acute postinjury setting, the prognostic value of sensory sparing among motor complete spinal injury patients has been well demonstrated. However, once final AIS grade is achieved 1 year postinjury, the value of sensory sparing alone has not been elucidated. We hypothesized that sensory sparing would lead to better outcomes in AIS B over AIS A patients at long-term, postrecovery follow-up. PURPOSETo evaluate for differences in medical, Physical and Social outcomes between AIS A and B patients at least 1 year postinjury. STUDY DESIGNRetrospective Cohort. PATIENT SAMPLEAdults over the age of 18 with AIS A or B spinal cord injury sustained between January 1, 1995 and September 13, 2019. Data Collected from the Spinal Cord Injury Model Systems Database. OUTCOME MEASURESSelf-reported Measures: PHQ-9 score; SCI-QOL Resilience Short Form score; VAS pain score; Life Satisfaction Score; Self-reported depression and sleep disturbances.Physiologic Measures: Body Mass Index, Diabetes Mellitus, Hypertension, Hyperlipidemia, Mortality, Incidence of Pressure Sores.Functional Measures: Bowel and Bladder Management; Illicit Substance use; Level of Education; Marital Status; Rehospitalization Rate. METHODSPatient data from the Spinal Cord Injury Model Systems Database were extracted for patients with a final, recovered American Spinal Injury Association Impairment Scale (AIS) grade of A or B at 1-year postinjury. Variables related to physical, mental and social functioning were compared between the two groups. RESULTSA total of 2,562 AIS A and 675 AIS B patient met inclusion criteria. Occurrence of pressure ulcers was 7% less in AIS B versus A (34.5% vs. 41.9%, p=.003). There were no statistical differences between groups in pain, bowel or bladder accidents, urinary tract infections, or the level of assistance for bowel or bladder management. There was no statistical difference for PHQ-9 depression scores, SCI-QOL Resilience Scores, rates of suicidality or sleep disturbance. There was no difference for illicit drug or alcohol abuse, life satisfaction scores, perceived health, and marriage or divorce rates. CONCLUSIONSExcept for a 7% reduction in pressure ulcer occurrence, there is no apparent long-term outcome advantage for motor complete spinal cord injury patients with AIS B sensory sparing over AIS A sensory complete. All other physical function domains were not different, nor were mental and social outcomes.

Contribution of Illicit Drug Use to Pharmaceutical Load in the Environment: A Focus on Sub-Saharan Africa.

Illicit drug abuse and addiction are universal issues requiring international cooperation and interdisciplinary and multisectoral solutions. These addictive substances are utilized for recreational purposes worldwide, including in sub-Saharan Africa. On the other hand, conventional wastewater treatment facilities such as waste stabilization ponds lack the design to remove the most recent classes of pollutants such as illicit drug abuse. As a result, effluents from these treatment schemes contaminate the entire ecosystem. Public health officials are concerned about detecting these pollutants at alarming levels in some countries, with potential undesirable effects on aquatic species and increased health hazards through exposure to contaminated waters or recycling treated or untreated effluents in agriculture. Contaminants including illicit substances enter the environment by human excreta following illegal intake, spills, or through direct dumping, such as from clandestine laboratories, when their manufacturer does not follow accepted production processes. These substances, like other pharmaceuticals, have biological activity and range from pseudopersistent to highly persistent compounds; hence, they persist in the environment while causing harm to the ecosystem. The presence of powerful pharmacological agents such as cocaine, morphine, and amphetamine in water as complex combinations can impair aquatic organisms and human health. These compounds can harm human beings and ecosystem health apart from their low environmental levels. Therefore, this article examines the presence and levels of illicit substances in ecological compartments such as wastewater, surface and ground waters in sub-Saharan Africa, and their latent impact on the ecosystem. The information on the occurrences of illicit drugs and their metabolic products in the sub-Saharan Africa environment and their contribution to pharmaceutical load is missing. In this case, it is important to research further the presence, levels, distribution, and environmental risks of exposure to human beings and the entire ecosystem.

Social Factors Contributing to Students’ Substance Abuse in Dire Dawa University

The objective of this study was to assess Social Factors Contributing to Students‟ Substance Abuse in Dire Dawa University. this study employed descriptive survey design. The study employed descriptive survey research design and stratified random sampling and purposive sampling techniques to select students and key informants respectively. The data were collected by questionnaire, interview and document review. Questioner and interview respectively collected the data from students and key informants. To analyze the collected data frequency, percentage, mean, standard deviation, chi-square test, binomial logistic regression and narrative description were applied. The finding of the study revealed that 66.6% of respondents abused substance. Male students (62.8%) were highly abuse substance than female students (37.2%). Besides, khat was highly abused substance (56%). Khat is frequently abused substance (M=4.78, SD= 0.57) followed by alcohol (M=4.23, SD = 0.68) and cigarette (M=4.01, SD =0.81). Higher numbers of the respondents abuse substance (CAGE > 2 = 39%). In addition, the study revel that substance abuse was a leading factor toward illicit drug abuse. Furthermore, the study indicates that among social factors availability of substance in cloth distance around the campus was highly predictor of substance abuse (COR=6.52:95% CI 2.76,6.92) followed by family substance abuse history (COR= 3.07:95% CI 1.74,5.41) social acceptance (COR=3.04:95% CI 4.56,5.21) and, peer pressure (COR=2.30:95% CI 1.79,5.22) among students. The study also revealed there is no significant preference on substance abuse among male and female students ( 2 (1) = 3.514, P > 0.05, one-tailed). whereas café utilization (café or non-café) ( 2 (1) = 10.84, P < 0.05, one-tailed) and place of origin (urban or rural) 2 (2) = 8.41, P < 0.05, one-tailed) has significant preference on substance abuse. Therefore, the study, recommend the city administration and other stakeholders should have to design regulatory law to avoid substance selling out around the campus with cloth distance and further study should have to conduct on illicit drug abuse. DOI: 10.7176/RHSS/12-1-02 Publication date: January 31 st 2022

Cerebral Venous Thrombosis as The Sole Presenting Manifestation of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection.

Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection. Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India. A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful recovery of the condition (CVT) following the institution of conventional anticoagulation therapy alongside anti-retroviral therapy. Whether illicit drug abuse or HIV/HBV infection itself or all in combination led to this thrombotic event cannot be precisely established. Notwithstanding, we recommend serologic testing for HIV and HBV in patients suffering from CVT with high-risk behavior.

Effectiveness of interventions to address obesity and health risk behaviours among people with severe mental illness in low- and middle-income countries (LMICs): a systematic review and meta analysis.

People with severe mental illness (SMI) are more likely to have obesity and engage in health risk behaviours than the general population. The aims of this study are (1) evaluate the effectiveness of interventions that focus on body weight, smoking cessation, improving sleeping patterns, and alcohol and illicit substance abuse; (2) Compare the number of interventions addressing body weight and health risk behaviours in low- and middle-income countries (LMICs) v. those reported in published systematic reviews focusing on high-income countries (HICs). Intervention studies published up to December 2020 were identified through a structured search in the following database; OVID MEDLINE (1946-December 2020), EMBASE (1974-December 2020), CINAHL (1975-2020), APA PsychoINFO (1806-2020). Two authors independently selected studies, extracted study characteristics and data and assessed the risk of bias. and risk of bias was assessed using the Cochrane risk of bias tool V2. We conducted a narrative synthesis and, in the studies evaluating the effectiveness of interventions to address body weight, we conducted random-effects meta-analysis of mean differences in weight gain. We did a systematic search of systematic reviews looking at cardiometabolic and health risk behaviours in people with SMI. We compared the number of available studies of LMICs with those of HICs. We assessed 15 657 records, of which 9 met the study inclusion criteria. Six focused on healthy weight management, one on sleeping patterns and two tested a physical activity intervention to improve quality of life. Interventions to reduce weight in people with SMI are effective, with a pooled mean difference of -4.2 kg (95% CI -6.25 to -2.18, 9 studies, 459 participants, I 2 = 37.8%). The quality and sample size of the studies was not optimal, most were small studies, with inadequate power to evaluate the primary outcome. Only two were assessed as high quality (i.e. scored 'low' in the overall risk of bias assessment). We found 5 reviews assessing the effectiveness of interventions to reduce weight, perform physical activity and address smoking in people with SMI. From the five systematic reviews, we identified 84 unique studies, of which only 6 were performed in LMICs. Pharmacological and activity-based interventions are effective to maintain and reduce body weight in people with SMI. There was a very limited number of interventions addressing sleep and physical activity and no interventions addressing smoking, alcohol or harmful drug use. There is a need to test the feasibility and cost-effectiveness of context-appropriate interventions to address health risk behaviours that might help reduce the mortality gap in people with SMI in LMICs.

Analysis of illicit pills and drugs of abuse in urine samples using a 3D-printed open port probe hyphenated with differential mobility spectrometry-mass spectrometry.

The present work describes the application of an in-house developed 3D-printed open port probe (3DP-OPP) with differential ion mobility spectrometry (DMS) mass spectrometry. Targeted quantitative analysis in urine was performed with a triple quadrupole mass spectrometer in the selected reaction monitoring mode (OPP-DMS-SRM/MS) and illicit pill screening using data independent acquisition (OPP-DMS-SWATH/MS). The combination of compensation voltage (CoV) scanning in DMS using modifiers with SWATH/MS acquisition for MS/MS spectrum generation enabled the differentiation of isobaric signals with a large dynamic range and enhance the information contained in the screening of illicit ecstasy pills. As for any direct MS introduction technique where no chromatographic separation is applied DMS with acetonitrile as a modifier allows the separation of cocaine and tramadol, and their isomeric metabolites in urine samples. Quantitative application using OPP-DMS-SRM/MS is presented without the need for sample preparation with a lower limit of quantification at 10-25 ng mL-1 for the analytes and less than 40 seconds for sample to sample analysis.

Sex-dependent Effects of the Drugs of Abuse Amphetamine and the Smart Drug 3,4-Methylenedioxypyrovalerone on Fear Memory Generalization in Rats

In recent years there has been an increase in the development of new synthetic drugs, among which the “bath salt” 3,4-methylenedioxypyrovalerone (MDPV), a psychostimulant with a mechanism of action similar to those of cocaine and amphetamine, stands out. Drugs of abuse have been consistently shown to affect memory function in male rodents. We have recently shown that amphetamine and MDPV induce generalization of fear memory in an inhibitory avoidance discrimination task in male rats. Although abuse of illicit drugs is more prevalent in men than in women, several studies have demonstrated that females are more vulnerable to the effects of drugs of abuse than males and the effects caused by substance dependence on memory in females are still under-investigated. Thus, we examined the effects of subchronic amphetamine or MDPV administrations on memory in a contextual fear conditioning/generalization paradigm in adult male and female rats. Animals were given daily subchronic injections of the drugs, starting 6 days prior to the beginning of the behavioral procedures until the end of the paradigm. On day 1 of the experimental protocol, all rats were exposed to a safe context and, the day after, to a slightly different chamber where they received an unsignaled footshock. Twenty-four and forty-eight hours later, freezing behavior and emission of 22 kHz-ultrasonic vocalizations (USVs) were measured in the two different contexts to assess fear memory retention and generalization. Our results indicate that MDPV treatment altered freezing in both sexes, USVs were affected by amphetamine in males while by MDPV in females.

UPLC-MS/MS method for the simultaneous quantification of caffeine and illicit psychoactive drugs in hair using a single-step high-speed grinding extraction – Insights into a cut-off value for caffeine abuse

Caffeine is a commonly consumed psychoactive substance whose addictive potential has long been reported. Excessive caffeine intake may lead to severe health damage or drug addiction problems; however, studies on the surveillance of caffeine abuse by the Chinese population are lacking. This study aimed to propose a concentration value for caffeine based on hair analysis to distinguish excessive intake from normal consumption, and provide an analytical tool for forensic toxicology investigations of caffeine and other frequently abused drugs. A sensitive and accurate ultra-high performance liquid chromatography-tandem mass spectrometry method was developed to detect caffeine and 13 illicit drugs and their metabolites in hair. Thereafter, this method was employed to test 479 real samples. Briefly, the hair samples were washed with water and acetone, and subsequently extracted by one-step high-speed grinding with acetonitrile-buffer solution. The lower limit of quantifications of 0.05 ng/mg for caffeine and THC, and 0.005 ng/mg for others, were achieved for all substances. The results revealed a mean caffeine concentration of 0.78 (range 0.008–3.5 ng/mg) based on 24 healthy volunteers, 55.0 (range 3.07–292.2 ng/mg) based on 52 self-reported caffeine abuse participants, and 5.78 (range 0–140.34 ng/mg) based on 403 drug addicts. The mean caffeine concentration in hair from self-reported caffeine abusers was 70-fold higher than that in hair from healthy volunteers. A tentative cut-off level of 5.5 ng/mg as an indicator of excessive caffeine consumption was developed based on receiver operating characteristic analysis. Additionally, the assessment of 403 hair samples from drug addicts indicated that illicit drug abusers had potential for caffeine abuse, especially polydrug users. This hair analysis method serves as a useful tool for the large-scale surveillance of caffeine and illicit drug abuse.

Illicit drug use in Reykjavik by wastewater-based epidemiology

Estimation of illicit drug use on a community level by wastewater-based epidemiology (WBE) is both an objective and reliable way to establish near real-time results. Wastewater samples were collected at eleven timepoints in Reykjavik from 2017 to 2020. The use of commonly abused illicit drugs in Iceland (amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine, and cannabis) was estimated. Solid phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry was used for analysis. Estimated amphetamine and methamphetamine use showed signs of an increase from 2017 to 2020 with amphetamine being the dominant stimulant on the market. MDMA use remained stable from 2017 to 2020. Results showed a large increase in cocaine use from 2017 to 2019 but interestingly, a marked decrease in 2020 during the COVID-19 pandemic. Cannabis use was stable from 2017 to 2019 but showed signs of an increase during the pandemic in 2020. Results by WBE corresponded with data based on two other indicators of drug use, seizure data and driving under the influence cases. Both temporal and spatial trends in illicit drug use were successfully estimated by using WBE, complimenting other indicators which provided a comprehensive picture of drug abuse in Reykjavik.