Smoking Methamphetamine Research Articles

"Maintaining HIV and HCV prevention and care for people who inject drugs despite COVID-19 in Hai Phong, Vietnam".

BackgroundAfter the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected people who inject drugs (PWID) in terms of risk behaviors for HIV and HCV and access to prevention and care in the city of Haiphong, a historic hotspot for HIV and drug use.MethodologyWe carried out a ‘before-after’ study from 2019 to 2020 using respondent-driven sampling method to enroll PWID. They were interviewed on their socioeconomic situation, drug use and sexual behaviors, relations to care services and tested for drugs and methadone in the urine, for HIV, HCV, and HIV plasma viral load when HIV-positive. Changes following the restrictions were assessed by comparing ‘before’ to ‘after’ data.Results780 PWID were enrolled. Mean age was 44 years; 94% were male. All were actively injecting heroin ‘before’, versus 56% ‘after’. Among those, frequency of consumption decreased from 24 to 17 days per month. No changes were observed in the frequency and practices of methamphetamine smoking. The proportion of PWID on MMT increased from 68.7% to 75.3%, and that of PWID engaging in risky behaviors related to drug injection decreased from 6.0% to 1.5%. No HIV seroconversions were observed; HCV incidence was 2.6/100 person-years (95% CI [0.7–6.7]). 9% of PWID reported a monthly income of less than 130USD ‘before’ versus 53% ‘after’.ConclusionThe case of Hai Phong shows that it is possible, during times of COVID-19 pandemic, to maintain access to harm reduction and care and to prevent HIV and HCV transmission among PWID in a resource-limited setting where severe social distancing restrictions are implemented. Further research is needed to assess the consequences of long-term economic difficulties and the impact of actual spread of SARS-Cov2 that has since emerged in Haiphong.

Deposition of methamphetamine residues produced by simulated smoking

In New Zealand, many concerns have been raised over the presence of methamphetamine contamination in households, especially when its provenance is unknown. Previous research found that contamination levels on household surfaces were higher after the premises had been used as a clandestine laboratory. It is believed that the levels of contamination produced from smoking methamphetamine are much less than those produced through manufacture. This study’s aim was to determine the amount of methamphetamine contamination produced, after simulated smoking, on a range of common, smooth surface types. Accumulation over time was also investigated. The experiment, comprising four simulated smoking events (referred to as ‘smokes’) of 0.2 g followed by a fifth simulated smoking event of 1.2 g (a cumulative total of 2 g) of methamphetamine hydrochloride, was carried out in a shipping container. Subsequent swabs were taken from squares of 100 cm2, following the NIOSH 9111 method. Results were quantified using LC-MS/MS. The methamphetamine concentrations measured gave a range from an overall mean of 0.91 µg/100 cm2 after the first smoke and 15.9 µg/100 cm2 after the final smoke. A rate of accumulation for each surface type was established, as well as an order of surfaces showing the most to least observed contamination. A significant reduction in the level of contamination was observed over a short period of time, although a clear rate was not established. Finally, a relationship between the recovered amounts of methamphetamine and amphetamine produced through the pyrolysis (smoking) process was also determined.

Demographic and geographic shifts in the preferred route of methamphetamine administration among treatment cases in the US, 2010–2019

BackgroundMethamphetamine use disorder has increased rapidly in the past decade. Injecting is also increasing and has multifaceted implications for disease severity, overall health, and treatment outcomes, but less is known about where or among whom injecting has shifted the most. This national study assessed temporal changes in the preferred route of methamphetamine administration by race/ethnicity and within urban/rural geographies. MethodsWe used the Treatment Episode Dataset-Discharges (2010–2019) to identify outpatient treatment cases who reported methamphetamine as their primary drug of choice at admission (N = 531,799; 2010 n = 33,744; 2019 n = 81,885). We created a combined variable indicating race/ethnicity and the rural/urban location of treatment, and used logistic regression to model the predicted probability of cases reporting injection, smoking, or snorting as their preferred route of administration. We included an interaction term to determine differences over time (race/ethnicity/rurality*year). ResultsAcross all years, smoking methamphetamine was the most common route of administration (66%), followed by injection (24%) and snorting (10%). Over time and among most sub-groups, the rates of injection increased while the rates of smoking decreased. Compared to 2010, the odds of injecting methamphetamine in 2019 were highest among Black cases in urban areas (aOR = 2.30, 95% CI = 1.76–3.00, p < 0.0001). ConclusionIncreasing methamphetamine injection was most pronounced among Black treatment cases in more urban areas, which is in contrast to the longstanding narrative that methamphetamine is a White and rural drug. Methamphetamine prevention, treatment, and harm reduction should target populations with high injection prevalence and growing incidence.

Alarming Tuberculosis Rate Among People Who Inject Drugs in Vietnam.

BackgroundThe tuberculosis (TB) epidemic is not homogeneous in the general population but presents high-risk groups. People who inject drugs (PWID) are such a group. However, TB among PWID remains largely undocumented. Our goal was to assess the prevalence of TB and the risk factors associated with TB among PWID in Vietnam.MethodsWe implemented a cross-sectional survey among 2 community-based cohorts of human immunodeficiency virus (HIV)-positive and HIV-negative PWID in Hai Phong. Participants were screened for TB using questions on TB symptoms. Those who reported any symptom were accompanied by peers to the TB clinic for chest x-ray. If the latter was abnormal, a sputum was collected to perform an Xpert MTB/RIF test.ResultsA total of 885 PWID were screened for TB. For both cohorts, most PWID were male (>90.0%), with a median age of 42 years. Beside heroin injection, 52.5% of participants reported smoking methamphetamine, and 63.2% were on methadone. Among HIV-positive PWID (N = 451), 90.4% were on antiretroviral therapy and 81.6% had a viral load <1000 copies/mL. Using a complete-case analysis, the estimated TB prevalence was 2.3% (95% confidence interval [CI], 1.0–4.5) and 2.1% (95% CI, 0.8–4.2) among HIV-positive and HIV-negative people, respectively. Living as a couple, arrest over the past 6 months, homelessness, and smoking methamphetamine were independently associated with TB but not HIV infection.ConclusionsIn the context of very large antiretroviral therapy coverage, this extremely high rate of TB among PWID requires urgent actions.

METHAMPHETAMINE-ASSOCIATED PULMONARY HYPERTENSION PRESENTING WITH INTERMITTENT DYSPNEA

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Methamphetamine-associated PAH (Meth-APAH) is a rare subtype of PAH associated with exposure to the highly addictive stimulant drug, methamphetamine. Although Meth-APAH was initially described nearly two decades ago, it is often diagnosed only later in the disease's course. CASE PRESENTATION: A 59 year-old-woman with a history of hypertension, tobacco use (3-4 cigarettes/day) who was sent to the hospital by outpatient cardiology to evaluate for severe pulmonary hypertension seen on transthoracic echocardiogram (TTE). The patient's PCP had referred her to outpatient cardiology to evaluate intermittent dyspnea on exertion. On exam, the patient reported she had been asymptomatic for several weeks. Her physical examination was unremarkable except for poor dentition. Upon additional questioning, the patient revealed that she had been smoking methamphetamine for the past 15 years; a subsequent urine drug screen was positive for amphetamine. TTE showed a moderately dilated right ventricle (RV), moderately reduced RV systolic function, and an estimated pulmonary artery systolic pressure of 105 mmHg. Right heart catheterization demonstrated a pulmonary artery pressure of 80/30 mmHg, a mean pressure of 45 mmHg, a normal right atrial pressure and a normal wedge pressure. Vasoreactivity testing was not done. CTA heart was negative for significant coronary disease. Ventilation perfusion scan was negative. Autoimmune workup was negative. The patient was diagnosed with Meth-APAH and was referred to a PAH specialty care center for further evaluation and treatment. DISCUSSION: This case illustrates the importance of a timely diagnosis of Meth-APAH and emphasizes the need for vigilant screening of patients who use Meth for the early signs and symptoms of PAH. If TTE had not been considered for our patient, the opportunity to slow disease progression would have likely been lost. The potential consequences would have been severe because Meth-APAH is associated with more RV dysfunction and over twice the risk of clinical worsening or death when compared to idiopathic PAH. Current guidelines recommend monitoring asymptomatic patients who use Meth for the development of symptoms of PAH. However, the diagnosis of PAH is often made only in the advanced stages when right heart failure is apparent because the early symptoms of PAH are nonspecific. CONCLUSIONS: Clinicians should ensure a drug history is obtained as part of the workup of pulmonary hypertension regardless of the level of dyspnea or hypoxemia Consider Meth-PAH in patients with a history of methamphetamine use presenting with nonspecific complaints such as dyspnea on exertion, fatigue, or syncope.The diagnosis of Meth-PAH should not be missed as opportunities for counseling and treatment opportunities that may prevent progression of the severity of PAH. There are now numerous therapeutic options for PAH. REFERENCE #1: Zamanian RT, Hedlin H, Greuenwald P, et al. Features and Outcomes of Methamphetamine-associated Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. Mar 15 2018;197(6):788-800. doi:10.1164/rccm.201705-0943OC REFERENCE #2: Klinger JR, Elliott CG, Levine DJ, et al. Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report. Chest. Mar 2019;155(3):565-586. doi:10.1016/j.chest.2018.11.030 REFERENCE #3: Brown LM, Chen H, Halpern S, et al. Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry. Chest. Jul 2011;140(1):19-26. doi:10.1378/chest.10-1166 DISCLOSURES: No relevant relationships by Daniel Antwi-Amoabeng, source=Web Response No relevant relationships by Robert Luong, source=Web Response No relevant relationships by Farah Madhani-Lovely, source=Web Response

UNILATERAL CRYSTAL METHAMPHETAMINE LUNG

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Methamphetamine is a drug manufactured from ephedrine and pseudoephedrine mixed with ingredients such as ammonia, lithium, iodine, and phosphorous but adulterants such as alcohol, acetone, and energy drinks have also been used. Smoking is the most common form of abuse with complications such as eosinophilic pneumonia, alveolar hemorrhage, acute interstitial pneumonia, and pulmonary fibrosis. We present an atypical methamphetamine-induced lung injury. CASE PRESENTATION: A 57-year-old female with a 40-pack year smoking history and polysubstance abuse presented with acute onset shortness of breath. On admission, she was hypoxic requiring 25 liters of high flow oxygen. On examination, the patient was afebrile with normal blood pressure. Chest auscultation revealed wheezing, most prominent in the left lung fields, while the rest of the systemic examination was unremarkable. Laboratories showed leukocytosis, normal liver, and renal function test. Sputum culture had no bacterial growth and Covid-19 PCR negative. Urine toxicology was positive for methamphetamine. Contrast CT chest showed diffuse interstitial thickening and ground-glass opacities throughout the right lung but normal left lung parenchyma with narrowing of the distal left mainstem bronchus by an endobronchial mass. The patient's hypoxemia improved with Methylprednisolone. Bronchoscopy showed a left mainstem lesion with near-complete obstruction of the left upper and lower lobes with biopsy revealing squamous cell carcinoma. There was normal airway mucosa on the right lung segments and scant inflammation without malignant cells on biopsy. The patient underwent successful tumor debulking with follow-up PET CT demonstrating decreased but persistence of alveolar septal thickening on the right lung with FDG positive mediastinal lymph nodes. The patient was weaned off supplemental oxygen 4 weeks later. DISCUSSION: Diagnosis of Methamphetamine-induced lung injury depends on the history of recent use, ground-glass opacities on imaging, and exclusion of other infections which was fulfilled by our patient but with the question of left lung sparing. Crystalline particles range in size from less than 250 nm-10 μm, with clusters as large as 80 μm where the obstructing mass may have prevented the flow of the drug vapor. Methamphetamine has also been postulated to release early response cytokines including TNF-alpha and IL-6 leading to recruitment of neutrophils and free radicals release causing acute lung injury. The management is mainly supportive with empiric steroids with improvement via impeding this inflammatory cascade. CONCLUSIONS: Our case demonstrates multiple learning points including particle size factor in passage through an obstructed airway, response to steroids supporting in settings of acute inflammation, and the persistence of residual lung disease on imaging in contrast to clinical improvement 4 weeks post-exposure. REFERENCE #1: Javed A, Nasrullah A, Malik K (February 08, 2021) A Rare Case of Methamphetamine-Induced Lung Injury During the Ongoing COVID-19 Pandemic. Cureus 13(2): e13215. doi:10.7759/cureus.13215 REFERENCE #2: Kinner SA, Degenhardt L. Crystal methamphetamine smoking among regular ecstasy users in Australia: increases in use and associations with harm. Drug Alcohol Rev. 2008 May;27(3):292-300. doi: 10.1080/09595230801919452. PMID: 18368611. REFERENCE #3: Lin SS, Chen YC, Chang YL, Yeh DY, Lin CC. Crystal amphetamine smoking-induced acute eosinophilic pneumonia and diffuse alveolar damage: a case report and literature review. Chin J Physiol. 2014 Oct 31;57(5):295-8. doi: 10.4077/CJP.2014.BAC201. PMID: 25241990. DISCLOSURES: No relevant relationships by Uchit Thapa, source=Web Response

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine.

Anxiety and depression are the most common mental health disorders experienced by Australians. These disorders are commonly found in people who use methamphetamine; however, much of this research has involved participants recruited from treatment settings who inject methamphetamine. We therefore explored (1) the prevalence of moderate to severe anxiety and depression in a community-recruited cohort who smoked methamphetamine and (2) examined potential factors associated with moderate to severe anxiety or depression in this cohort. Data were derived from baseline surveys of 725 participants of the prospective 'VMAX' study, recruited from metropolitan and non-metropolitan areas of Victoria, Australia, via snowball and respondent-driven sampling. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 instruments. Independent associations between moderate to severe scores on these measures and demographic, socio-economic, substance use and other health and social characteristics were examined using multivariable logistic regression. More than half (60%) of the participants were classified as experiencing moderate to severe anxiety and/or depression. In the multivariable models, having poor/very poor self-rated health, methamphetamine dependence and being unemployed were associated with higher odds of experiencing both moderate to severe depression and moderate to severe anxiety. Living in a large rural town, identifying as Aboriginal and Torres Strait Islander and smoking methamphetamine were associated with lower odds of experiencing moderate to severe depression. Being female was associated with higher odds of experiencing moderate to severe anxiety. The high rates of anxiety and/or depression found in the VMAX cohort were associated with demographic, socio-economic, substance use and other health and social factors. The prevalence of moderate to severe anxiety is a novel finding that warrants further study. Further work is needed to determine how anxiety and depression change over time among people who smoke methamphetamine, to help identify key intervention points.

Patterns of smoking and injecting methamphetamine and their association with health and social outcomes.

IntroductionWe examine how smoking and injecting methamphetamine change over time and correlate with specific health and social outcomes.MethodsPanel data from a longitudinal cohort dependent on methamphetamine (N = 444; 891 months). Random effects regression models examined the relationship between smoking and/or injecting methamphetamine and past month outcomes (substance use, ≥daily injection, needle/syringe sharing, psychological distress, poor mental and physical health, sexual behaviour, psychotic symptoms, violent behaviour and crime). Effects were adjusted for between‐group differences at baseline.ResultsAt baseline, 56% of participants only injected methamphetamine in the past month, 18% only smoked and 26% both injected and smoked (concurrent injecting and smoking). Compared to injecting only, concurrent injecting and smoking was associated with more days of methamphetamine use (b = 1.3, P < 0.001; adjusted [A] b = 1.2, P < 0.001), more frequent injection [odds ratio (OR) 1.8, P = 0.013; adjusted OR (AOR) 1.6, P = 0.042], violent behaviour (OR 2.1, P = 0.001; AOR 1.8, P = 0.013] and crime (OR 3.1, P < 0.001; AOR 2.5, P < 0.001). Non‐injecting related outcomes did not differ significantly for only smoking versus only injecting. There was no significant transition from injecting methamphetamine at baseline to non‐injecting methamphetamine use at follow up, or from exclusively smoking methamphetamine at baseline to any methamphetamine injection at follow up.Discussion and ConclusionEfforts are needed to address heavier methamphetamine use, more frequent drug injection and elevated violent behaviour and crime among people who concurrently smoke and inject methamphetamine.

Trends in treatment episodes for methamphetamine smoking and injecting in Australia, 2003-2019.

We examined trends in Australian treatment episodes for smoking and injecting methamphetamine from 2003 to 2019. Data from the Alcohol and Other Drug Treatment National Minimum Data Set, where amphetamines were the principal drug of concern, were analysed from 2003 to 2019. Rates were calculated per 100 000 population aged 10-100 years. Joinpoint software was used to identify changepoints and estimate the annual percentage change (APC) in the rate of treatment episodes. Treatment episode characteristics were compared for smoking versus injecting in 2019. The rate of treatment episodes for methamphetamine increased from 77 to 262 per 100 000 population between 2003 and 2019 (average APC 8%, P < 0.001), this being due to treatment episodes for smoking methamphetamine (average APC 32%, P < 0.001) with no significant increase in treatment episodes for injecting methamphetamine (average APC 3%). Treatment episodes for smoking increased sharply from 2003 to 2008 (APC 72%, P < 0.001) and again from 2010 to 2016 (APC 46%, P < 0.001), this upward trend being attenuated between 2016 and 2019 (APC 7%, P=0.012). Treatment episodes for methamphetamine smoking (cf. injecting) involved younger clients (median age 30 vs. 35 years, P < 0.001) who were more likely to receive assessment or case management only (37% vs. 29%, P < 0.001). Increased methamphetamine treatment episodes in Australia since 2003 are due mostly to smoking the drug, this occurring among younger cohort who receive less substantive treatment than clients who inject methamphetamine.

PNEUMOMEDIASTINUM IN PATIENTS WITH SUBSTANCE ABUSE: A CASE SERIES

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumomediastinum (PM) is the presence of air in the mediastinum. PM is associated with asthma exacerbation, severe cough or vomiting, and other activities associated with breathing maneuvers. Although the majority of cases could be managed conservatively, PM could be potentially fatal if it progresses to malignant PM, which requires thoracotomy or video-assisted thoracoscopy for management. Therefore closely monitoring the patient is necessary. CASE PRESENTATION: Case 1: A 20-year-old male who uses marijuana, was admitted due to 3 days of intractable nausea, vomiting, and right-side anterior pleuritic chest pain. Vital signs were normal. Abdominal exam showed epigastric tenderness, without guarding or rebound. Laboratory showed leukocytosis. CXR revealed subcutaneous emphysema in the left supraclavicular region without PM. Chest CT showed free air in posterior mediastinum (Figure 1). Evaluation did not demonstrate esophageal rupture. He was treated conservatively. The symptoms improved and he was discharged. Case 2: A 20-year-old male with marijuana use for 4 years presented with shortness of breath, intractable vomiting, bloody emesis, chest pain, and shortness of breath. Vital signs were normal. Examination showed subcutaneous emphysema along anterior chest up to neck, with clear and equal breath sound. Laboratory showed leukocytosis. CXR and chest CT showed subcutaneous emphysema and PM (Figure 2). With investigation, there was no evidence of esophageal rupture. The symptoms resolved and he was discharged. Case 3: An 18-year-old male with type 1 diabetes mellitus and polysubstance abuse history presented with sudden severe right-side chest pain, mild shortness of breath, and nausea over 2 days. He admitted smoking methamphetamine prior to his symptoms. Vital signs were normal. Examination was notable for moderate dehydration. Laboratory revealed leukocytosis, elevated blood glucose, and wide-anion gap metabolic acidosis with elevated acetone. Urine drug screen was positive for methamphetamine. CXR showed PM and left supraclavicular subcutaneous emphysema. Chest CT showed isolated PM (Figure 3). The patient was given pain medication and was treated for DKA. He improved and was discharged. DISCUSSION: PM among substance users is believed to be a result from barotrauma during breathing maneuvers. An increase in alveolar pressure with development of a pressure gradient between alveoli and surrounding blood vessels leads to increased alveolar pressure, rupture of the alveolar septa, collapse of the adjacent vascular structures, and air dissection around the peribronchial and perivascular sheaths. Conservative management is sufficient for the majority of PM. CONCLUSIONS: Pneumomediastinum is a rare condition that could be potentially life threatening. PM should be considered in patients with history of inhaled drug use who develop sudden chest pain. Reference #1: Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis 2015;7(Suppl 1):S44–S49. Reference #2: Weiss ZF, Gore S, Foderaro A. Pneumomediastinum in marijuana users: a retrospective review of 14 cases. BMJ Open Respir Res. 2019 Feb 12;6(1):e000391. doi: 10.1136/bmjresp-2018-000391. Reference #3: Miller WE, Spiekerman RE, Hepper NG. . Pneumomediastinum resulting from performing Valsalva maneuvers during marijuana smoking. Chest. 1972 Aug;62(2):233-4. DISCLOSURES: No relevant relationships by Amr Ismail, source=Web Response No relevant relationships by Passisd Laoveeravat, source=Web Response No relevant relationships by Arunee Motes, source=Web Response No relevant relationships by Victor Test, source=Web Response

Current practices underestimate environmental exposures to methamphetamine: inhalation exposures are important

Current practice for determining the exposure to methamphetamine in contaminated homes relies on the analysis of surface wipe sample to address direct contact exposures. The movement of methamphetamine into the air phase, and the potential for inhalation exposures to occur within residential homes contaminated from former clandestine manufacture or smoking of methamphetamine has been generally poorly characterised and understood. All available risk-based guidelines for determining safe levels of methamphetamine in residential properties do not include any consideration of the inhalation pathway as an exposure route. This study showed that methamphetamine can readily move from contaminated materials in a home into the air phase. This movement of methamphetamine into the air phase provides both an exposure pathway and a mechanism for the transfer of methamphetamine throughout a property. The inhalation exposure pathway has the potential to result in significant intake of methamphetamine, adding to dermal absorption and ingestion exposure routes. Guidelines that are established for the assessment of methamphetamine contaminated properties that ignore inhalation exposures can significantly underestimate exposure and result in guidelines that are not adequately protective of health. This study also demonstrates that sampling methamphetamine in air can be undertaken using commercially available sorption tubes and analytical methods.

Household Contamination with Methamphetamine: Knowledge and Uncertainties.

Contamination of residential homes with methamphetamine is an emerging issue of significant concern to public health. Cooking or smoking methamphetamine in a residential property contaminates the house, furnishings and personal possessions within it, with subsequent exposure through ingestion, dermal absorption and/or inhalation causing adverse health effects. Current guidelines identifying levels of methamphetamine contamination that require remediation vary between countries. There is also no international standard protocol for measuring levels of contamination and research has shown that different materials give rise to different recovery rates of methamphetamine. There are a number of currently used remediation methods; however, they have varying levels of success with limited studies comparing their long-term efficacies. Most importantly, there are few guidelines available that are based on a transparent, health risk-based approach, and there are many uncertainties on exposures and health effects, making it difficult to ensure the health of people residing in homes that have been used to cook or smoke methamphetamine are sufficiently protected. This manuscript presents the current state of knowledge regarding the contamination of residential homes with methamphetamine and identifies the current gaps in knowledge and priority areas for future research. The current regulatory approach to public health protection associated with exposure to residential premises contaminated with methamphetamine in Australia, New Zealand and the USA is also discussed.

Assessment of contamination levels in methamphetamine-tested properties in New Zealand

In November 2016, whilst in draft, the New Zealand Standard (NZS8510:2017) for the “Testing and Decontamination of Methamphetamine-Contaminated Properties” considered two acceptable post-decontamination re-occupancy methamphetamine levels; 1.5μg/100cm2 if the contamination was caused by smoking methamphetamine and 0.5μg/100cm2 if the contamination was caused by the manufacture of methamphetamine. In response to this, research carried out at this laboratory included the analysis of data obtained from over a thousand pre-decontamination property test reports with the aim of understanding the variation in the levels of contamination, that could be expected, among the wider New Zealand (contaminated) housing stock. The vast majority of the reports originated from public sector agency properties where methamphetamine was suspected to have been used. Although it could not be ruled-out, none of the properties had been associated with any suspicion of drug production. Thus, a further intention of the study was to assess and portray the levels of contamination that would be expected to be produced through methamphetamine use, commonly smoking. As such, it is expected that the data might be useful from an environmental exposure perspective and inform further research in this area. The assessment also discusses its potential as evidence in criminal cases where there may be discrepancies concerning the source of the methamphetamine contamination in relation to “Use of premises” and associated charges under Section 12 of the Misuse of Drugs Act (New Zealand) 1975. Regardless, the final New Zealand standard, released in June 2017, set a single decontamination level for ‘high-use areas’ of 1.5μg/100cm2 and a less stringent decontamination level for ‘limited-use areas’ of 3.8μg/100cm2, with no requirement to determine the origin of the contamination.

Strengths, weaknesses, opportunities and threats (SWOT) analysis of reinitiation into methamphetamine abusers: qualitative findings from an exploration of methamphetamine abusers in Shanghai, China

BackgroundDespite high relapse rate among methamphetamine (MA) abusers, there still have been little empirical data to date detecting the risk factors related to craving and relapse from the perspective of...

Effects of alcohol, cigarettes, methamphetamine and marijuana exposure during pregnancy on maternal serum alpha-fetoprotein levels at 20-24 weeks’gestation

To examine the effects of cigarette, marihuana and methamphetamine smoking and consumption of alcohol during pregnancy on maternal serum alpha-fetoprotein (MSAFP) levels at 20-24 weeks. In the Safe Passage Study (SPS) more than 12,000 pregnant women were prospectively followed up during pregnancy and until the infant was one year old to examine the effects of exposure to alcohol during pregnancy on stillbirth and sudden infant death syndrome. The present study is a cross-sectional secondary analysis of MSAFP analyses done at 20-24 weeks gestation in 1,679 SPS participants, recruited at the Bishop Lavis Community Health Centre, Cape Town, South Arica. Low or moderate alcohol consumption with or without smoking, nor methamphetamine or marihuana use affected mean MSAFP levels. High MSAFP levels were associated with high alcohol consumption, young age, low body mass index (BMI) (<18 kg/m2) or small mid upper arm circumference (MUAC) (<230mm). High MSAFP levels were associated with stillbirth, preterm birth, abruption and a birth weight z-score of less than -1. The study confirms the association between high MSAFP levels and adverse pregnancy outcomes but, although exposure to smoking or drinking is associated with adverse pregnancy outcomes including stillbirth, MSAFP levels were not affected by any of these exposures except for continued high consumption of alcohol. The observed association between higher MSAFP levels and maternal nutritional status (as demonstrated by the lower MUAC and BMI) could explain some of the correlations of poor socioeconomic conditions with higher stillbirth rates effect.

Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico.

Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.

Amphetamine-Induced Delusional Infestation

Amphetamine-Induced Delusional Infestation

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

BackgroundInjection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.MethodsWe conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.ResultsFindings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.ConclusionsTo reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis

Background: Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Methods: Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Results: Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Conclusions: Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.

Boundary conditions of methamphetamine craving.

Methamphetamine use has increased significantly and become a global health concern. Craving is known to predict methamphetamine use and relapse following abstinence. Some have suggested that cravings are automatic, generalized, and uncontrollable, but experimental work addressing these claims is lacking. In 2 exploratory studies, we tested the boundary conditions of methamphetamine craving by asking: (a) is craving specific to users' preferred route of administration?, and (b) can craving be regulated by cognitive strategies? Two groups of methamphetamine users were recruited. In Study 1, participants were grouped by their preferred route of administration (intranasal vs. smoking), and rated their craving in response to photographs and movies depicting methamphetamine use (via the intranasal vs. smoking route). In Study 2, methamphetamine smokers implemented cognitive regulation strategies while viewing photographs depicting methamphetamine smoking. Strategies involved either focusing on the positive aspects of smoking methamphetamine or the negative consequences of doing so-the latter strategy based on treatment protocols for addiction. In Study 1, we found a significant interaction between group and route of administration, such that participants who preferred to smoke methamphetamine reported significantly stronger craving for smoking stimuli, whereas those who preferred the intranasal route reported stronger craving for intranasal stimuli. In Study 2, participants reported significantly lower craving when focusing on the negative consequences associated with methamphetamine use. Taken together, these findings suggest that strength of craving for methamphetamine is moderated by users' route of administration and can be reduced by cognitive strategies. This has important theoretical, methodological, and clinical implications.