Levels Of Polydrug Use Research Articles

New psychoactive substance use among regular psychostimulant users in Australia, 2010–2015

ObjectiveTo examine the rates and patterns of new psychoactive substance (NPS) use amongst regular psychostimulant users (RPU) in Australia. MethodData were obtained from the 2010–2015 Ecstasy and related Drugs Reporting System (EDRS), which comprised a total cross-sectional sample of 4122RPU. ResultsRecent use of ‘any’ NPS increased from 33% in 2010 to 40% in 2015, although trends of use differed significantly across NPS classes. The correlates associated with NPS use also varied across NPS classes: frequent (i.e. weekly or more) ecstasy users were more likely to report recent phenethylamine use; LSD users were more likely to report recent phenethylamine and tryptamine use; and daily cannabis users were more likely to report recent synthetic cannabinoid use than RPU who had not used NPS. ‘Poly’ NPS consumers were found to be a particularly high risk group and were significantly more likely to be younger, male, report daily cannabis use, report weekly or more ecstasy use, report recent LSD use, have higher levels of poly drug use, have overdosed on any drug in the past year, and to have engaged in past month criminal activity. ConclusionNPS use has been established as a significant and ongoing practice amongst our sample of RPU. It appears that RPU seek out NPS with similar properties to the illicit drugs that they are already consuming, with poly NPS consumers found to be a particularly high risk group.

An initial typology of contexts of dyadic sexual encounters between men and associations with sexual risk and pleasure: findings from an observational study.

Background Although many within-subjects comparisons conducted on samples of men who have sex with men have sought to understand the association between specific situational characteristics (e.g. drug use or location of sex) and sexual risk behaviour, none have considered the 'clustering' of patterns of situational characteristics. An initial typology of sexual encounters is derived and the relationship of this typology to condomless anal intercourse (CAI) and pleasure is tested. Data from a longitudinal survey of men who have sex with men living in England were used. Multilevel latent class analyses were estimated to determine an optimal class solution on the situational characteristics, and then pseudo-imputation was used to estimate the association between class and both CAI and pleasure. A three-class solution fit the data best, with a scaled relative entropy of 92.4%. Classes were characterised as featuring: regular steady partners in private locations with low drug use (class 1), casual partners with increased probability of sex occurring in a sex-on-premises venue (class 2), and high levels of polydrug use together with increased probability of casual partners (class 3). Encounters were different both in pairwise comparisons and overall on probability of CAI. They were different overall but not necessarily pairwise on pleasure. These initial findings demonstrate the possibility of understanding sexual encounters in terms of the contexts, or classes, within which they occur. This may have implications for tailoring HIV prevention to specific encounter types. Future research should seek to extend encounter-level typologies to specific drug use variables.

Tobacco and e-cigarette use amongst illicit drug users in Australia

ObjectiveTo examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia. MethodData were obtained from the 2015 Illicit Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System (EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs (PWID) and 763 regular psychostimulant users (RPU). ResultsTobacco was consumed by the majority of both samples, however, use in the 6 months preceding interview was significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86–3.44]). Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28–0.42]) and 18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI 0.35–0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes as a smoking cessation tool (OR 3.09 95% CI 2.03–4.71), but were less likely to use e-liquids that contained nicotine (OR 0.52 95% CI 0.32–0.83). Higher levels of poly drug use, daily tobacco use, recent use of synthetic cannabinoids and employment status were found to be significantly associated with e-cigarette use. ConclusionThe use of e-cigarettes was relatively common amongst Australian samples of PWID and RPU. Whilst the majority of PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using them for experimental or recreational purposes.

Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: Findings of the German randomized controlled trial

Benzodiazepine (BZD) use has been found to be associated with poorer psychosocial adjustment, higher levels of polydrug use and more risk-taking behaviors among opioid dependent patients. The aim of this paper is to analyze the correlation between BZD use, BZD prescription and treatment outcome among participants in the German trial on heroin-assisted treatment. 1015 patients who participated in the study comparing heroin-assisted and methadone maintenance treatment (HAT & MMT) for 12 months were included in the analysis. Analyses were carried out to assess the association of treatment outcome with baseline BZD use, with ongoing BZD use and with different patterns of BZD prescription. Baseline BZD use correlated with lower retention rates but not with poorer outcome. Ongoing BZD use correlated with poorer outcomes. Significantly better outcomes were found in the course of phobic anxiety symptomatology for those with regular prescription of BZD. The percentage of BZD positive urine tests decreased more in HAT than in MMT. Poorer outcome for benzodiazepine users may be mediated by a higher severity of addiction. Cautious prescribing of benzodiazepines may be beneficial due to the reduction of overall illicit use.

The risk of psychotic symptoms associated with recreational methamphetamine use

To determine whether recreational methamphetamine use is associated with an increased risk of psychotic symptoms. A cross-sectional survey of 157 people attending dance events in Sydney, Australia. Participants were assessed for psychotic symptoms in the past year using items from the Psychosis Screen. Participants with and without psychotic symptoms were compared on methamphetamine use, polydrug use and other demographic factors. An ordinal logistic regression was used to determine the probability of psychotic symptoms by methamphetamine use and level of polydrug use. Psychotic symptoms in the past year were predicted by methamphetamine use and heavier polydrug use in the past year, and a history of a psychotic disorder (schizophrenia, schizoaffective or bipolar affective disorder). After removing participants with a history of a psychotic disorder (n = 16) and adjusting for polydrug use, methamphetamine use increased the probability of two or more psychotic symptoms (indicative of psychosis risk) from 9% to 21%. There was a non-significant increase in the risk of psychotic symptoms with higher levels of polydrug use. Methamphetamine use was typically monthly or less often (83%), and most users described their use as recreational (85%). Within the context of polydrug use, recreational methamphetamine use is associated with a twofold to threefold increase in the probability of psychotic symptoms.

The impact of borderline personality disorder on 12‐month outcomes for the treatment of heroin dependence

To determine the effects of borderline personality disorder (BPD) on 12-month treatment retention and outcomes for the treatment of heroin dependence. Longitudinal cohort study. Setting Sydney, Australia. A cohort of 495 heroin users enrolled in the Australian Treatment Outcome Study. Criteria for BPD were met by 45% of the cohort. At baseline there were no differences in heroin use, but the BPD group had higher levels of polydrug use, crime, needle risk-taking, more injection-related health problems, higher levels of overdose, poorer psychological health and more extensive suicide histories. At 12 months there was no group difference in the cumulative number of treatment days received, but the BPD group had enrolled in more different treatment episodes. Within both groups reductions had occurred in drug use and drug-related problems, with no differences in heroin use, polydrug use or global physical health at 12 months. After taking into account the effects of treatment on outcome, however, BPD was associated independently with a higher level of needle sharing [odds ratio (OR) 3.21], more injection-related health problems (OR 1.90), a higher likelihood of heroin overdose (OR 1.92), poorer global psychological health (OR 2.43), higher levels of current major depression (OR 3.19) and a higher likelihood of attempted suicide (OR 3.89). While BPD participants showed similar reductions in heroin and other drug use to other patients at 12 months, they continued to exhibit higher levels of risk and harm across a range of outcomes. Screening would appear to be warranted to identify a group who may overtly respond to treatment in terms of drug use per se, but remain at substantially greater risk.

Gateway Polydrug Use Among Puerto Rican and Dominican Adolescents Residing in New York City: The Moderating Role of Gender

ABSTRACT Most research of ethnic differences in adolescent drug use resorts to combining all Hispanic individuals into one group. This study focused on polydrug use among adolescents residing in an inner-city region by Hispanic ethnicity (Puerto Rican versus Dominican) and gender. Puerto Rican and Dominican students in 22 New York City middle schools participated. Sixth and seventh graders completed self-report questionnaires with measures of the three gateway drugs (cigarettes, alcohol, and marijuana) at baseline (N = 849) and at a one-year follow-up (N = 678). In the first year of middle school, gender moderated the effect of Hispanic ethnicity on lifetime polydrug use. Specifically, Dominican boys reported greater polydrug use than Dominican girls, but use was similar across gender for Puerto Rican adolescents. In the second year of middle school, this pattern extended to more serious levels of polydrug use as measured by current polydrug use and composite polydrug frequency. Consequently, both Hispanic ethnicity and gender mattered in determining adolescent polydrug use.

The use of antidepressants among injecting drug users in Sydney, Australia.

To ascertain the prevalence and patterns of antidepressant use among IDU in Sydney and to determine any harm associated with antidepressant use. Cross-sectional survey. Sydney, Australia. Two hundred and one Sydney injecting drug users (IDU) recruited through advertisements, needle exchanges, methadone maintenance clinics and by word of mouth. Forty per cent of subjects had used antidepressants, 21% in the preceding 6 months. Similar proportions of subjects had used tricyclics (26%) and selective serotonin reuptake inhibitors (SSRIs) (24%), with 8% reporting use of a monoamine oxidase inhibitor. Recent use favoured the SSRIs; however, there was still widespread use of tricyclics. The injection of antidepressants was rare, with only three subjects reporting ever having injected the drugs. Antidepressant use was associated with higher levels of polydrug use, poorer health, higher levels of psychiatric distress and a greater risk of heroin overdose. The excess risk of overdose was specifically associated with tricyclics, rather than SSRIs. The study confirmed that, like other pharmaceutical products, the use of antidepressants was common among IDU in Sydney. The prescription of tricyclics to heroin users would appear to increase their risk of overdose. If it is considered appropriate to prescribe antidepressants to IDU, it would appear safer to prescribe SSRIs.

Patterns of ecstasy use amongst club-goers on the UK ‘dance scene’

A variety of sources indicate that substantial numbers of young people have experimented with the drug ecstasy (Leitner M, Shapland J, Wiles P. Drug Usage and Prevention: the Views and Habits of the General Public. HMSO: London, 1993; Balding J. Young People and Illegal Drugs, 1989–1995, Facts and Predictions. Schools Health Education Unit, University of Exeter, 1994; Balding J. Young People and Illegal Drugs in 1996. Schools Health Education Unit, University of Exeter, 1996; Mott J, Mirlees-Black C. Self reported drug misuse in England and Wales: findings from the 1992 British Crime Survey. Research and Planning Unit paper 89. London: Home Office, 1992; McMiller P, Plant M. British Medical Journal, 1996;313:394–397; Parker H, Measham F, Aldridge J. Drug futures: Changing patterns of drug abuse amongst English youth. London: Institute for the Study of Drug Dependence, 1995; Ramsay M, Percy A. Drug misuse declared: Results of the 1994 British Crime Survey. Research findings No. 33. London: Home Office, 1996). Although a substantial amount has been written about ecstasy, there is very little data which centres specifically on those who use the drug and hence we know very little about patterns of use amongst those who use the drug. A number of known fatalities and casualties associated with it’s use (Chadwick IS, Linsley A, Freemont AJ, Doran B, Curry PD. Journal of the Royal Society of Medicine 1991;85; Henry J, Jeffreys K, Dawling S. The Lancet, 1992;340:384–386; Milroy CM, Clarke JC and Forrest ARW. Journal of Clinical Pathology 1996;49:149–153) suggest that ecstasy is not always a safe drug to use in recreational circumstances. It is important that we begin to understand more about use patterns and their possible relationship to the number of accidents amongst ecstasy users. In order to examine these patterns, a survey was administered in one of the monthly dance music magazines, to which 4042 ecstasy users responded. The questionnaire examined; who uses ecstasy, their patterns of use and normative influences over use. Respondents were most likely to be male (63.7%), spanned a wide age range and were engaged in a variety of occupations. Respondents reported a range of different use patterns, with high levels of poly-drug use. Normative influences were found to play a significant role in the uptake and maintenance of ecstasy use. Results are discussed with reference to their implications for the design of health education materials.

Levels and correlates of polydrug use among heroin users and regular amphetamine users

Data from a sample of 329 primary heroin users and from a sample of 301 regular amphetamine users were analysed in order to determine the extent and correlates of polydrug use among illicit drug users. Both samples exhibited high levels of polydrug use, with means of 5.2 (heroin) and 6.3 (amphetamines) drug classes used in the preceding 6 months. Multi-variate analyses indicated that being younger, being male, not being in treatment, being an injector, having recently borrowed injecting equipment and being from the regular amphetamine using sample were independently associated with higher levels of polydrug use. Rather than increasing levels of polydrug use being associated with age, illicit drug users appear to reduce their range of drugs as they get older. The ‘pure’ heroin or amphetamine user was extremely rare. It is concluded that to characterise drug users as ‘heroin’ or ‘amphetamine’ users misses the context in which these drugs are used.

Injecting and sexual risk-taking behaviour among regular amphetamine users.

A sample of 301 regular amphetamine users were interviewed regarding injecting and sexual risk-taking behaviours. Two-thirds of subjects were injecting the drug, with males being 1.8 times more likely to do so. Nearly half (41%) of injectors had shared injecting equipment in the preceding month. Females were twice as likely as males to report recent needle sharing. Having a regular sexual partner who injects amphetamines, using benzodiazepines and experiencing higher levels of psychopathology were independently associated with needle sharing. The number of sexual partners in the preceding six months was independently associated with having had paid sex in that period, and higher levels of polydrug use.

The use of benzodiazepines among regular amphetamine users

The relationship between benzodiazepine and regular amphetamine use was examined in a sample of 301 regular amphetamine users. Benzodiazepine use was widespread, with 37% of subjects having used them in the month preceding interview, and 55% in the preceding 6 months. Injectors of amphetamines were more likely to have ever used, and to be currently using, benzodiazepines. Comparisons of benzodiazepine users with other subjects indicated that benzodiazepine users had higher levels of polydrug use and psychopathology, as well as poorer health and social functioning than non-users. The odds of benzodiazepine using injectors having injected with a borrowed used needle in the preceding month were 3.8 times of those of non-benzodiazepine-using injectors. These results are consistent with studies of other groups of illicit drug users, such as heroin users, in indicating that benzodiazepine use is associated with greater levels of risk and psycho-social dysfunction.