There is significant concern about potential rising harms from gamma-hydroxybutyrate (GHB) but an absence of studies internationally synthesising data across indicators to identify changes in harms and broader patterns of use. This paper contributes to addressing this gap by measuring national trends in GHB use, harms and treatment in Australia. Triangulation of indicators (2013-2024) from Australian triennial population surveys; annual interviews with cross-sectional non-representative samples of people who use illicit stimulants or who inject drugs; and administrative data on GHB-related hospitalisations, GHB-related deaths, and treatment episodes where GHB was the principal drug of concern. Annual trend data were analysed using Joinpoint regression. Survey data were modelled as the annual percent change in the proportion reporting lifetime, past 12-month, and past 6-month use, depending on the survey. Administrative data were modelled as the annual percent change in crude rates per 100 000 population. Lifetime and past 12-month GHB use in the general population remained below 1.2% and 0.2% respectively, but the latter increased from 0.07% in 2013 to 0.19% in 2022-2023 (annual percent change [APC] 9.3; 95% confidence interval [CI]: 5.2, 13.2). The percentage of people who use illicit stimulants reporting past 6-month use increased from 5.7% in 2013 to 7.3% in 2017 (APC 11.6; 95%CI: 0.2, 52.9) and from 5.4% in 2019 to 11.5% in 2024 (APC 17.8; 95%CI: 5.9, 41.1). The proportion of people who inject drugs reporting use varied between 7.2% and 17.5% over the short period studied (2020-2024). There were statistically significant increases in GHB-related hospitalisations from 5.3 in 2012-13 to 19.1 per 100 000 people in 2022-23 (APC 19.0; 95%CI: 11.9, 31.1) and GHB-related deaths from 0.02 in 2013 to 0.24 per 100 000 people in 2022 (APC 36.5; 95%CI: 27.2, 58.1). Treatment episodes also increased across the period, from 0.07 in 2012-13 to 6.0 episodes per 100 000 people in 2020-21 (APC 97.3; 95%CI: 83.5, 830.9), with no subsequent statistically significant change (8.4 per 100 000 people in 2022-23). Gamma-hydroxybutyrate use, harms and treatment engagement increased in Australia from 2013 to 2024. These findings highlight a need to implement acceptable, tailored prevention and harm reduction strategies for key populations, and implement stronger monitoring efforts nationally and internationally.

Limited research has examined the longitudinal interplay of depression, substance use, and immune dysregulation among men with HIV. We analyzed longitudinal data from 100 men who have sex with men (MSM) living with HIV enrolled in the HPTN 063 cohort (2011-2013) in Brazil. Depressive symptom severity, alcohol use severity, and recent illicit stimulant use were assessed quarterly over 12months. Soluble markers of immune activation (sCD14) and inflammation (IL-6) were measured at baseline and at a 12-month visit. Depressive symptom severity and alcohol use severity showed substantial within-person variability across time, whereas stimulant use remained relatively stable. These psychosocial factors were weakly intercorrelated. Controlling for baseline IL-6, the odds of having detectable IL-6 at 12months increased by 2% for each point increase in the proportion of visits with elevated depression, 7% for each point increase in mean depressive severity across visits, 5% for each point increase in depressive severity at nine months, and 6% for each point increase in depressive severity at 12months. Effects persisted after controlling for baseline HIV viral load. Controlling for baseline sCD14, estimated 12-month sCD14 increased 8ng/mL for each point increase in 12-month depressive severity and 20ng/mL for each point increase in 12-month alcohol use severity. The alcohol-sCD14 association was attenuated when adjusting for HIV viral load. Neither baseline IL-6 nor sCD14 strongly predicted future depressive symptoms or substance use. Depressive symptoms predicted future inflammation and current immune activation. Research should examine if interventions to treat depression can improve immune functioning.

The illicit stimulant, β‐keto‐ethylbenzodioxolylbutanamine (βk‐EBDB), has seen widespread abuse in recent years, spurring the need for new on‐site screening tools for accurate and timely identification in forensic investigations. This study sought to develop and evaluate an electrochemical sensing method on screen‐printed carbon electrodes (SPCEs) for the determination of this drug in simulated case samples, human oral fluid and human urine. Analysis was performed under optimised differential pulse voltammetry (DPV) for solid drug material dissolved in 0.10 M borate buffer saline (BBS) at pH 10.0 as the supporting electrolyte. Adsorptive stripping differential pulse voltammetry (AdSDPV) was employed for detection in biological fluids diluted in the same buffer system. βk‐EBDB was profiled in under 4 min with an estimated limit of detection/quantification (LOD/LOQ) of 10 µM and a linear response within the following concentration ranges: 10–100 µM in supporting electrolyte, 10–60 µM in oral fluid and 10–35 µM in urine. Electrochemical signals demonstrated good repeatability in peak potential both within a single day (intraday) and across multiple days (interday), with relative standard deviations for both methods remaining below 1.51% ( N = 36). During the same experiments, peak current relative standard deviations were consistently higher, reaching 24.1% ( N = 36) in some instances. Strong selectivity for βk‐EBDB was observed even in the presence of commonly encountered illicit drugs and cutting agents. This suggests the method's potential for integration into a rapid and cost‐effective drug testing device for forensic science applications.

Diagnoses of stimulant use disorder among adolescents and young adults covered by Medicaid have increased over the past two decades, researchers wrote in the February 2026 issue of JAMA Psychiatry. The prevalence related to stimulants other than cocaine, and raises concerns because of the recent rise in stimulant‐involved overdose deaths, according to the study, “Stimulant Use Disorder Diagnoses in Adolescent and Young Adult Medicaid Enrollees.” The article, by Greta Bushnell, Ph.D., and colleagues, also noted an increasing use of prescription and illicit stimulants.

Intravenous use of methcathinone synthesized at home from over-the-counter medications containing pseudoephedrine or ephedrine poses significant health risks, including neurotoxicity, severe infections, and, in some cases, fatal outcomes. This study explores the public health implications of this hazardous practice. Post-mortem femoral blood and vitreous humor samples were analyzed using UHPLC-QqQ-MS/MS. The method enabled differentiation of ephedrine (a metabolite of methcathinone in this context) from pseudoephedrine (a precursor), along with the identification of relevant metabolites. A literature review was also conducted to contextualize associated health risks. The validated method accurately quantified methcathinone, pseudoephedrine, ephedrine, and identified their metabolites. The simultaneous detection of the final product and unreacted precursor supported the hypothesis of chronic intravenous use of homemade methcathinone. Literature data emphasized the risks of manganese-induced encephalopathy, injection-related infections, and the harmful effects of intravenously administered tablet excipients. These issues disproportionately affect marginalized and high-risk populations. This case highlights the diagnostic value of the method and its importance for monitoring the health impacts of illicit stimulant use. Effective responses should include public education, harm reduction strategies, surveillance of emerging drug trends, and, above all, the application of advanced analytical methods capable of comprehensive evaluation in such cases.

Field Quantification of MDMA in Seized Samples Using Portable NIR Spectroscopy

In the context of growing stimulant use among other vulnerable rural populations, this study examines the prevalence and patterns of stimulant use, particularly methamphetamine and cocaine use, among migrant and seasonal agricultural workers. Surveys were conducted with fifty-five male agricultural workers in tobacco cultivation in Eastern North Carolina. Findings demonstrated high levels of commercial energy drink consumption (29% of participants) and limited consumption of illicit stimulants (4% of participants). Despite low reported prevalence, 18% of participants reported concern regarding illicit stimulant use. These findings underscore the need for more research to address the unique challenges faced by migrant and seasonal agricultural workers regarding substance use. This study contributes to the growing body of literature on occupational health disparities and highlights the urgent need for comprehensive strategies to support this vulnerable patient population.

Although incineration is currently the primary method for the disposal of seized illicit drugs, alternative methods for the disposal of illicit drugs may be necessary to provide safer and more accessible alternatives. Chemical oxidation processes have been identified as a promising alternative method to degrade illicit drugs. Using commercially available reagents and established industry processes, chemical degradation holds potential as an alternative drug disposal technique. This study investigated the oxidants ozone, sodium hypochlorite, trichloroisocyanuric acid, hydrogen peroxide, OXONE, sodium percarbonate, and peracetic acid for their potential to degrade illicit amphetamine-type stimulants using β-phenethylamine (PEA) as an exploratory analog. Oxidants and conditions that showed the highest degradation efficiency with PEA were applied to methamphetamine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyamphetamine (MDA). Transformation products were identified using gas chromatography-mass spectrometry, and degradation was quantified using a fit-for-purpose method via liquid-chromatography quadrupole time-of-flight mass spectrometry. Of the oxidants explored, ozone performed the best, leading to high degradation efficiencies of methamphetamine (95%), amphetamine (86%), MDMA (100%), and MDA (100%) after 72 h of exposure. Sodium hypochlorite was also highly effective for the degradation of methamphetamine and amphetamine, while trichloroisocyanuric acid was particularly effective for MDMA and MDA. All the major transformation products of degradation were tentatively identified, with only one of 10 listed as a controlled, scheduled, or restricted substance. This research demonstrates how chemical degradation can provide a novel alternative to incineration for the destruction of amphetamine-type stimulants, providing a sustainable, long-term, and accessible method of illicit drug disposal.

Abstract Background Cocaine remains the most commonly used illicit stimulant in the United States, with young adults constituting the highest-risk population. This is a known trigger for acute myocardial infarction (AMI), even in individuals without traditional cardiovascular risk factors. Recent epidemiological data highlight an alarming trend: between 2022 and 2023, the rate of deaths involving cocaine rose by 4.9%. This study aims to analyze national inpatient data to assess trends in mortality among young adults hospitalized with AMI and a history of cocaine use. Method This retrospective cohort study used the National Inpatient Sample (NIS) (2016–2022) to analyze young adults 18 to 40 years) hospitalized with a primary diagnosis of acute myocardial infarct (AMI). Patients were categorized into two cohorts: AMI with history of cocaine use and AMI without history of cocaine use, identified using ICD-10 codes. The primary outcome was all-cause inpatient mortality, while secondary outcomes included length of stay (LOS) and total hospital charges. Patient demographics were obtained, and χ² tests were used for categorical variables, while t-tests were applied to continuous variables. Multivariate logistic regression estimated adjusted odds ratios (aORs) for inpatient mortality, adjusting for age, sex, race, insurance type, household income, Charlson Comorbidity Index (CCI), hospital bed size, teaching status, and geographic region. A two-sided p-value < 0.05 was considered statistically significant. Results The mean age of patients was 34 years. Young adults with acute myocardial infarction who use cocaine are more likely to be male (74.6% vs. 65.3%; p < 0.001), African American (40.2% vs. 26.8%; p < 0.001), and from low-income backgrounds. The duration of hospitalization and in-hospital mortality rates were comparable between the two groups, with both averaging around three days (p = 0.297) and having a fatality rate of approximately 1% (p = 0.205). Concerning clinical outcomes and healthcare resource use, cocaine consumption was not a significant determinant of mortality, hospital stay duration, or overall medical expenses. Age was linked to higher hospital expenditures (coefficient: 1200; p < 0.001), while ethnicity also played a role in cost variations, with Hispanic patients incurring greater charges (coefficient: 14,050; p < 0.001) and African American patients having lower expenses (coefficient: -5552; p = 0.011). Conclusion This study suggests that socioeconomic factors, hospital characteristics, and comorbidities, rather than cocaine use itself, play a more prominent role in determining hospital outcomes and costs for young adults with AMI.

Background: Cardiac dysrhythmias (CDs) are serious cardiovascular complications increasingly observed in association with illicit stimulant use. Methamphetamine and cocaine are known to exert cardiotoxic effects, yet national trends and demographic disparities in CD-related hospitalizations among users remain underexplored. Objective: To assess national trends and demographic disparities in cardiac dysrhythmia hospitalizations among methamphetamine and cocaine users in the U.S. from 2008 to 2020. Methods: We used data from the National Inpatient Sample (2008–2020). We used ICD-9 (427) and ICD-10 (I46, I48, I48) codes to identify adult hospitalizations with a primary diagnosis of cardiac dysrhythmias who were also diagnosed as methamphetamine or cocaine users. National estimates were generated using sampling weights. Linear trend analysis and Cochran-Armitage trend tests assessed annual changes. Subgroup analyses were conducted by sex, race/ethnicity, age, region, and mortality status. Results: The overall number of cardiac dysrhythmia (CD) hospitalizations remained stable at ~5 million annually (p = 0.95), but significant increases were observed among males (p = 0.03), non-Hispanic Whites (p = 0.02), Hispanics (p = 0.02), and Asians (p < 0.01). In contrast, CD-related hospitalizations among methamphetamine and cocaine users rose sharply, increasing by 105% from 2008 to 2020 (p < 0.01). Male admissions increased by 122% (p < 0.01) and female admissions by 72% (p < 0.01). Asian and Hispanic populations saw the most significant increases (481% and 189%, respectively (p < 0.01)), followed by Whites (192%) (p < 0.01), African Americans 80% (p < 0.01), Native Americans 360% (p < 0.01), and other races 300% (p < 0.01). Admissions in the 26–40 age group rose 23.8% (p < 0.01), while the 41–64 and 65+ age groups increased by 110% and 230%, respectively (p < 0.01). Regionally, the West experienced the most significant rise 319% (p < 0.01), though the South consistently had the highest number of cases. The Midwest and Northeast saw increases of 93% and 32%, respectively (p < 0.01). In-hospital mortality for this group rose 283% over the study period (p < 0.01). Conclusions: Cardiac dysrhythmia hospitalizations related to methamphetamine and cocaine use have risen sharply across all major demographic groups. Despite stable overall incidence, mortality has significantly increased, highlighting a growing clinical burden and urgent need for targeted prevention strategies.

Molecularly imprinted polymers for illicit drug detection: A review of computational and synthesis methods.

Stimulant use disorders in the young adult Medicaid population have increased dramatically over the past two years, and this is possibly associated with an increasing use of both prescription and illicit stimulants. Because of the rise in stimulant‐involved overdose deaths, there is a need for treatments for stimulant use disorder for young people, researchers urge. Currently, 4.5 million individuals in the United States meet the criteria for stimulant use disorder, with the highest prevalence in young adults, leading the researchers to conduct this study. They used administrative health care claims data from Medicaid, covering adolescents and young adults, in three age ranges ‐‐ 13‐17 years old, 18‐24 years old, and 25‐29 years old. They compared 2001 (5.7 million Medicaid enrollees in the sample) to 2020 (16.1 enrollees). From 2001 to 2020, the proportion diagnosed with stimulant use disorders increased from 0.09% to 0.49% in those aged 18 to 24 years, from 0.13% to 1.63% for ages 25 to 29 years, and from 0.10% to 0.91% among young adults aged 18 to 29 years. Among adolescents, the proportion diagnosed with stimulant use disorders varied between 0.03% and 0.07%. The proportion diagnosed with cocaine use disorders was stable in young adults (range, 0.17%‐0.79%) and declined in adolescents (from 0.04% to 0.01%). Cocaine and non‐cocaine psychostimulant use disorders were 2 to 4 times more common in patients with an ADHD diagnosis or stimulant prescription. Most patients diagnosed with a stimulant use disorder in 2020 were also diagnosed with a mental health disorder or other substance use disorder. Bushnell G, Keyes KM, Zhu Y, et al: Stimulant Use Disorder Diagnoses in Adolescent and Young Adult Medicaid Enrollees. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2025.2864 Published online October 15, 2025.

Introduction Metamfetamine has long been the primary illicit stimulant in the western United States and has become increasingly available in the South, the Midwest, and more recently in the Northeast. With increasing prevalence, we sought to examine whether symptomatic pediatric exposures to metamfetamine have changed over the past 20 years. Methods We analyzed the National Poison Data System® database for pediatric (<6 years old) single substance exposures to metamfetamine (generic code 0201127) from 1 January 2004 to 31 December 2023. Inclusion criteria were single substance oral exposures with symptoms (National Poison Data System® outcomes = mild, moderate, major, or death). Definitions of “severe toxicity” and “substantial toxicity” are based on coded clinical effects. We report rates of symptomatology, clinical interventions, medical outcomes, ingestion location, and overall frequency of exposure. Exposures were further analyzed by geographic location based on United States Environmental Protection Agency regions: West (regions 8, 9, & 10), Midwest (regions 5 & 7), South (regions 4 & 6), Northeast (regions 1, 2, & 3). Results We identified 2,862 cases over the 20-year study period with the majority (61%, n = 1,626) of children 2 years of age or younger, and with most exposures occurring at home (80%, n = 2,153). There was a 267% increase over the 20-year study period; however, the proportion of exposures reported with severe toxicity was similar. Discussion Reported pediatric exposures to metamfetamine increased over the study period. Clinical effects and interventions were consistent with stimulant toxicity. The West accounted for the majority of cases, however, the South and the Midwest had the largest increase of cases over the study period. Conclusion Reported cases of symptomatic pediatric exposures to metamfetamine have increased over the past two decades and are associated with severe clinical effects.

BackgroundIn Australia, methamphetamine use is a significant public health concern, and is common among people involved with the criminal justice system. This study aimed to investigate the prevalence and correlates of adult imprisonment history among adults who primarily smoke methamphetamine.MethodsA cross-sectional study was conducted using baseline data from ‘VMAX’, a cohort of adults who regularly use methamphetamine. Data were collected between June 2016 and March 2020 from 718 participants. Sampling methods included convenience and respondent-driven sampling. Prison exposure was measured by asking if participants had ever been imprisoned due to a conviction (and was distinguished from juvenile detention). Logistic regression was used to examine how this correlated with socio-demographics, drug use, mental health, and criminogenic characteristics.ResultsNearly one-third (30%) of 718 participants reported having been imprisoned. Increased odds of reporting a history of imprisonment were found for participants reporting older age, male gender, non-metropolitan residential location, past-year homelessness, not being currently employed, schooling ≤ Year 9, ≥ weekly methamphetamine use, past-year illicit opioid use, injecting drug use history, and juvenile detention history. In contrast, participants reporting past-year other illicit stimulant (cocaine, ecstasy, illicit pharmaceutical stimulant) use were less likely to report a history of imprisonment.ConclusionsSocial characteristics, patterns of drug use, and juvenile detention history were found to be correlated with imprisonment history. These findings point to the importance of providing targeted services to address characteristics of social disadvantage and drug use behaviours among people who use drugs, including among people who primarily smoke methamphetamine.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12954-025-01307-8.

5.4 Stimulant Therapy for ADHD and Illicit Stimulant Use During Adolescence and Young Adulthood

ABSTRACTIntroductionIncreasing harms associated with nitrous oxide use have raised concerns, but limited evidence exists to inform harm reduction. This study aimed to identify how nitrous oxide is sourced, the products/forms used, awareness of health risks, engagement in harm reduction and experience of neurological symptoms.MethodsData were collected via annual interviews (2021–2023) with cross‐sectional convenience samples of Australians who regularly used ecstasy/MDMA and/or other illicit stimulants and reported past 6‐month use of nitrous oxide (2021 n = 379; 2022 n = 315; 2023 n = 284).ResultsThe most commonly reported source of nitrous oxide in the past 6 months was convenience stores, followed by 24/7 delivery services. Sourcing from these retailers was also associated with heavier use. Reported use of larger cylinders (> 8 g) increased from 6% in 2021 to 26% in 2023. While most respondents demonstrated awareness of neurological risk (e.g., brain damage 63%; nerve damage 20%), only one‐fifth identified the risk of Vitamin B12 depletion and 17% were unaware of any risks. Almost one‐third (30%) reported limiting use per session, 36% limited frequency and 36% took no precautions. Reports of neurological symptoms rose from 5% in 2021 to 14% in 2023 among cross‐sectional samples, with few (n ≤ 5) receiving treatment.Discussion and ConclusionsFindings suggest increasing use of larger cylinders, alongside increasing neurological harms. Given the evolving regulatory and risk environment, close surveillance of usage and market trends is needed. The findings reinforce the need for balanced regulation and targeted education of retailers, clinicians and consumers to reduce harmful patterns of use and encourage early intervention.

Longitudinal associations between frequency and recency of nonmedical prescription stimulant use in adolescence and cocaine use in young adulthood.

Longitudinal patterns of opioid and stimulant use by route of administration among people who inject drugs in the South Atlantic Fentanyl Test Strip Study: A latent transition analysis.

Suspect screening of emerging organic micropollutants using high-resolution mass spectrometry: case of the Litani River in Lebanon.

Association of fentanyl test strip results and change in drug use behaviors: A multi-state, community-based observational study.