Use Of Other Illicit Substances Research Articles

Cardiovascular and Respiratory Effects of Cannabis Use by Route of Administration: A Systematic Review

Aim: Knowledge of the cardiovascular and respiratory effects of cannabis use by route of administration is unclear. This evidence is necessary to increase clinical and public health awareness given the recent trend in cannabis legalization, normalization, and surge in the availability and usage of various forms of cannabis products. Methods: Search was conducted in Web of Science, ProQuest, Psych INFO, Scopus, Embase, and Medline databases, and subsequently in the references of retrieved articles. Peer-reviewed articles published between 2009 and 2023, that reported on cardiovascular and respiratory effects of cannabis use by route of administration were included. Studies with no report of the route of administration and combined use of other illicit substances were excluded. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Of the 1873 articles retrieved, 42 met inclusion criteria encompassing six case reports, 21 reviews, and 15 empirical studies. Four administration routes were identified: smoking, vaping, oral ingestion, and dabbing. Smoking was the most common route of administration and was associated with both respiratory effects, such as bronchitis, dyspnea, and chronic obstructive lung disease, and cardiovascular effects including tachycardia, ventricular arrhythmias, and myocardial infarction. Cannabis edibles were associated with minimal respiratory effects. Tachycardia was the most common cardiovascular effect and was associated with all routes of administration. Conclusion: Cannabis use does cause cardiovascular and respiratory effects, but the conclusion remains tentative of the cardiovascular and respiratory effects by route of administration due to methodological limitations of the studies.

Nonmedical Use of Stimulants Among Students in Jordan: A Nationwide Study.

Nonmedical use (NMU) of stimulants is an increasingly common phenomenon worldwide. Motivated by enhancing academic performance, peer pressure, and seeking pleasure, students in the Middle East are thought to be a high-risk population. This is especially important in times when the political instability in the region facilitates the production and trafficking of such substances. This study aimed to unveil the burden of NMU of stimulants and examine associated correlates among senior high school and university students in Jordan. We describe a cross-sectional study of senior high school and university students in Jordan assessing NMU of stimulants. Data were collected between January and April of 2022 through a survey, which was distributed online leading to a google forms page. The survey queried sociodemographic characteristics, history of NMU of stimulants, use of other illicit substances, attitudes toward NMU of stimulants, as well as a mental health assessment. A total of 8739 students completed the survey (mean age of 20.40 ± 2.45 years), of which 5.1% reported a lifetime NMU of stimulants. Fenethylline (Captagon) was the most widely reported stimulant (2.6%). Living in the southern region, being diagnosed with a personality disorder, and using concomitant illicit substances were associated with the NMU of stimulants. The NMU of CNS stimulants, especially fenethylline, is prevalent in Jordan. More surveillance ought to be heeded toward the southern borders of Jordan. Students who use stimulants for academic reasons must be made aware of the potential consequences of the NMU of stimulants.

Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation.

Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81-1.92], 1.61 (95% CI 1.55-1.68), 1.74 (95% CI 1.62-1.87), and 1.35 (95% CI 1.30-1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.

Assessment of Cardiovascular Functioning Among Regular Kratom (Mitragyna speciosa Korth) Users: A Case Series.

Multiorgan toxicities have been extensively reported in kratom (Mitragyna speciosa Korth) users in Western countries but not in Southeast Asia. Existing literature argued that this discrepancy may be due to underreporting of kratom-related toxicity cases in Southeast Asia. Hence, this case series filled the research gap by clinically assessing the cardiovascular functioning and serum mitragynine level of regular kratom users in its traditional settings in Malaysia. Nine regular kratom users without history of polysubstance use were recruited from the same community via snowball sampling and were subjected to electrocardiogram (ECG) and echocardiogram assessments. Serum mitragynine analysis was also performed by solid-phase extraction and liquid chromatography-tandem mass spectrometry. The mean serum mitragynine level was 10.3 mg/L (SD = 6.9) and ranged from 2.5 mg/L to 22.4 mg/L. Those who consumed an average daily quantity of four or more glasses of brewed kratom juice (p = 0.045) and those who had prolonged QTc intervals (p = 0.017) had significantly higher serum mitragynine level. Echocardiographic findings of all the respondents were normal except one reported left ventricular hypertrophy and another had trivial tricuspid regurgitation with pulmonary artery systolic pressure (PASP) of 10 + 5 mmHg. Regular kratom use without concomitant use of other illicit substances may not provoke any risk of cardiovascular impairment or toxicity except for prolonged QTc interval, which appeared to be dose dependent. However, as this study was limited by a small sample size, future studies with larger sample size are warranted to confirm our findings.

Decision Making and Impulsivity in Young Adult Cannabis Users.

Aims: Chronic cannabis users show impairments on laboratory measures of decision making which reflect risk factors for initiation and continued use of cannabis. However, the differential sensitivity of these tasks to cannabis use has not been established. Moreover, studies to date have often lacked assessment of psychiatric histories and use of other illicit substances, both of which may influence decision making outcomes. The current study aimed to address these limitations by (1) including multiple types of decision making tasks, (2) implementing the Probabilistic Reversal Learning Task, a measure of decision making under uncertainty, for the first time in cannabis users, (3) including young adult cannabis users with no other psychiatric disorders, and (4) conducting urinalysis to exclude users of other illicit drugs.Methods: Thirty-three current cannabis users without comorbid psychiatric disorders and 35 cannabis non-users completed behavioral measures of decision-making (Iowa Gambling Task), reward discounting (Delay Discounting Task), choice-outcome learning (the Probabilistic Reversal Learning Task) and a questionnaire assessment of impulsivity (Barratt Impulsiveness Scale).Results: Relative to non-users, cannabis users demonstrated greater preference for immediate vs. delayed rewards on the Delay Discounting Task, made fewer advantageous decisions on the Iowa Gambling Task, and endorsed greater impulsivity on the Barratt Impulsiveness Scale scales. Cannabis users and non-users showed comparable performance on the Probabilistic Reversal Learning Task. Frequency of past-month cannabis use and total years of use did not predict decision making or impulsivity.Conclusions: Young adult cannabis users demonstrated higher discounting rates and impairments in learning cost-benefit contingencies, while reversal learning was unaffected. Self-reported impulsivity was elevated as well. None of these measures correlated with current or lifetime estimates of cannabis use, arguing against a dose-relationship. Interventions that target improvement in affected components of decision making may be helpful in reducing cannabis use and relapse.

Adolescent nicotine and marijuana vaping activity and the use of other illicit substances

PurposePrevious research links cigarette use and marijuana use in adolescence with the use of other illicit substances. Limited research, however, has explored whether vaping nicotine and marijuana, along with using these substances through multiple modes of delivery (traditional cigarette/marijuana use and vaping) is associated with the use of other illicit substances in adolescence. ProceduresThis study addresses this gap in the literature by employing negative binomial regression to examine the relationships between three categories of nicotine users (traditional cigarettes only, nicotine vaping only, and dual mode nicotine use), three categories of marijuana users (traditional marijuana use only, marijuana vaping only, and dual mode marijuana use), and the use of other illicit substances in a sample of Florida middle school and high school students. FindingsOur findings reveal that nicotine vaping and dual mode use of both nicotine and marijuana are associated with the use of a greater variety of illicit substances compared to non-users. ConclusionsIn conclusion, our findings suggest that dual mode use of nicotine and marijuana are associated with greater likelihood of using other illicit substances. The implications of these findings for future research are discussed.

Medicate to Graduate: Academic Strain and Nonmedical Prescription Stimulant Use Among Graduate and Undergraduate Students

The nonmedical use of prescription stimulants has been prevalent on college campuses in recent years. Previously, nonmedical prescription stimulant use (NMPSU) has been associated with increased use of other illicit substances, drug abuse, school dropout, and arrest. It is, therefore, imperative to understand the etiology of NMPSU for prevention, intervention, and harm reduction purposes. This study builds upon previous research on the role of academic strain in NMPSU by (a) considering a measure of strain that is more consistent with strain theory and (b) extending the examination to include graduate students. By utilizing an original data set of 1,121 undergraduate and graduate students at a Southern urban university, our overall results are consistent with general strain theory but mixed with respect to the role of academic strain in particular. The implications of our study for academic strain are discussed.

Detachment, peer pressure, and age of first substance use as gateways to later substance use

BackgroundPrior research using psychosocial developmental models have identified emotional detachment from family and susceptibility to peer pressure as predictors of adolescent substance use. Despite mixed support for the gateway hypothesis, less is known about how these psychosocial developmental factors facilitate adolescent substance use. The purpose of this study was to examine how age of first substance use, emotional detachment from parents, and susceptibility to peer pressure influence the progression from alcohol, marijuana, and tobacco use to other illicit substance use (e.g., cocaine, hallucinogens). MethodData (N = 5792) were collected from high school students across seven semesters. Latent growth curve modeling was used to examine how age of first use of alcohol, marijuana, and tobacco predicted initial levels and changes in emotional detachment, peer pressure, and other illicit substance use. ResultsEarlier age of first use of alcohol, marijuana, and tobacco predicted detachment, peer pressure, and a greater likelihood of initial use of other illicit substances. More initial emotional detachment was associated with increases in other illicit substance use. Earlier ages of first use of alcohol, marijuana, and tobacco had indirect effects on initial use of other illicit substances through initial emotional detachment. ConclusionEmotional detachment from parents and peer pressure impact the likelihood of other illicit substance use across the high school years. Prevention programs may benefit by focusing on delaying the onset of first use of substance use and by preventing emotional detachment from parents and peer pressure.

CASE SERIES OF PATIENTS WITH E-CIGARETTE OR VAPING PRODUCT-ASSOCIATED LUNG INJURY: INSIGHTS FROM A SAFETY NET HOSPITAL

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: E-cigarette or vaping product associated lung injury (EVALI) is a rapidly growing epidemic that has sparked great interest in the past year. As a relatively new clinical phenomenon, EVALI is particularly challenging as it causes a spectrum of pulmonary pathology in an otherwise healthy population. The epidemic is fueled by the rising popularity of e-cigarettes, variability in vaping products, lack of centralized control and thereby ease of access. We report a case series of five adult EVALI patients from an inner city safety-net hospital. METHODS: Cases include patients admitted to our facility between August 2019 to November 2019 either to medicine floors or medical intensive care units and who met CDC criteria for EVALI. Criteria includes e-cigarette or vaping product use within the past three months of symptom onset, positive image findings, and evaluation to rule out infectious etiology. Demographic and clinical Information was obtained via retrospective chart review. RESULTS: Of the five cases, four were male with a median age 29 and no previous cardiac or respiratory pathology. Primary symptoms were altered mental status and agitation in setting of drug overdose with one patient presenting with GI and respiratory symptoms. All patients had self-reported or family-reported confirmation of THC-containing vaping use within 90 days of hospital visit, and all reported vaping within 10 days of admission. All patients had a positive urine toxicology for cannabinoids and half were positive for cocaine. Four out of five patients had elevated WBC, four of five had normal ESR, CRP. Three out of five had classic radiological findings of EVALI, with half positive for lipid-laden macrophages in BAL via Oil-Red-O stain. Four patients required ICU admission with intubation for respiratory failure, and two progressed into ARDS, one requiring pronation and the other requiring ECMO. There was no mortality. The average ICU length-of-stay (LOS) was 6.2 days, average hospital LOS at 7.8 days and no readmission to the same facility in 2 months since discharge. CONCLUSIONS: The increasing use of e-cigarette and vaping products has resulted in deadly outcomes. There are very few case series documenting the manifestations of EVALI since the establishment of the diagnosis in September 2019. We present a case series representing the clinical findings and features of EVALI patients and their management in an inner-city community hospital. All of our patients were found to have a positive toxicology screen to one or more illicit drugs, indicating a relationship between vaping and concomitant use of other illicit substances. CLINICAL IMPLICATIONS: EVALI is a rising trend with devastating effects on otherwise healthy population. This case series hopes to shed light on some demographic and clinical characteristics of these patients. DISCLOSURES: No relevant relationships by Jagadish Akella, source=Web Response No relevant relationships by Fatima Anjum, source=Web Response No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Alejandro Gutierrez, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Hyfaa Mashaal, source=Web Response No relevant relationships by Daniel Meshoyrer, source=Web Response No relevant relationships by Raghavendra Sanivarapu, source=Web Response

The relationship between cannabis use and cognition in people diagnosed with first-episode psychosis

Cannabis use is highly prevalent among young people diagnosed with first-episode psychosis (FEP), however, its impact on cognition is still unclear. The aim of the present study was to examine the association of cannabis use with cognition in people diagnosed with FEP. We extended previous research findings by operationalising the comorbid cannabis use, considering recency of cannabis use and use of other illicit substances and including people with a broad spectrum of psychotic diagnoses. A total of 89 people diagnosed with FEP were interviewed about their history of substance use and completed a cognitive test battery assessing verbal memory, verbal fluency and attention. Sixty-one participants were lifetime cannabis users (CU; ≥three times per week for ≥four weeks; 68.5%) and 28 were cannabis non-users (CNU; 31.5%). CU were significantly more likely to be male and exhibited significantly more positive symptoms than CNU. In contrast, CNU displayed significantly more negative symptoms than CU. There were no differences between CU and CNU on neurocognitive tasks of verbal memory, verbal fluency and attention. In conclusion, there was no indication that cannabis use was associated with cognitive impairments in people diagnosed with FEP.

Comparing ecstasy users and non-users in a population-based and co-twin control design across multiple traits

ObjectiveEcstasy is one of the most commonly used illicit substances in Western countries. The aim of this study is to identify characteristics of ecstasy users in a large population-based sample of adults aged 18–45 years. MethodWith generalized estimating equation models we explored the association between self-reported lifetime ecstasy use and urbanicity, educational attainment, health, wellbeing, stress, other substance use, personality traits and psychopathology in a Dutch twin sample (N = 9578, 66.8% female, 18–45 years). We also explored the nature of the association (underlying genetic factors, shared environmental factors or a causal relationship) with the co-twin control method. ResultsLifetime ecstasy users (N = 945, 9.9%) were more often male, younger, living more often in urban areas, higher educated, less satisfied with life and more stressed than non-users. Ecstasy users scored differently on most personality and psychopathology scales compared to non-users and were more likely to have used every other substance we investigated. Whereas smoking tobacco and alcohol use often preceded first use of ecstasy, first ecstasy use often preceded first use of other illicit substances. A combination of scenarios (both causal and environmental/genetic) explained the strong associations between ecstasy and substance use. ConclusionsEcstasy users differ on many characteristics from non-users, and especially on illicit substance use. Our results indicate that causal effects may play a role in explaining the relationship between ecstasy use and other illicit substance use.

Expertise psychiatrique : quelle est la responsabilité pénale en cas de consommation de cannabis ?

Resume Introduction La consommation de cannabis est depuis quelques annees un probleme de sante publique en France, notamment par la democratisation de cette drogue chez les jeunes. Bien que la legislation soit claire en ce qui concerne la responsabilite des personnes sous l’emprise de stupefiants en cas d’infractions, il n’est pas rare que les personnes soient reconnues irresponsables ou partiellement responsables. L’objectif de cette etude est de determiner si une consommation de cannabis au moment des faits est retenue par les experts comme un facteur de d’alteration ou d’abolition du discernement. Methode Une etude descriptive retrospective realisee dans la region PACA aupres de six experts a recueilli 96 expertises penales en responsabilite pour des infractions commises sous l’emprise de cannabis entre 2016 et 2018. Le critere d’evaluation principal etait le discernement, defini soit comme aboli, altere ou non modifie. Les objectifs secondaires etaient d’observer les facteurs associes a une modification de celui-ci. Resultats La consommation de cannabis n’a pas d’impact sur le degre de discernement. La dependance au cannabis chez l’auteur des faits n’est pas significativement associee a une atteinte du discernement. En revanche, le sexe masculin, l’existence d’un trouble de la personnalite, une immaturite affective, les antecedents psychiatriques, un suivi psychiatrique ou addictologique au moment des faits et une decompensation psychotique sont significativement associes a une atteinte du discernement. Conclusion Ces resultats soulignent l’importance des mesures de prevention et de reduction des risques lies au cannabis, notamment dans ce contexte de legalisation ou depenalisation du cannabis.

National Trends in Sexual Behavior, Substance Use and HIV Testing Among United States Men Who have Sex with Men Recruited Online, 2013 Through 2017.

The American Men's Internet Survey (AMIS) is conducted annually with 10,000 men age 15 + who have sex with men (MSM). Modeling was used with 39,863 AMIS surveys from 4 cycles between December 2013 to February 2017 to identify temporal trends in sexual behavior, substance use, and testing behavior (within 12months preceding interview) stratified by participants' self-reported HIV status. HIV-negative/unknown status MSM had significant increases in condomless anal intercourse (CAI), marijuana use, use of other illicit substances, sexually transmitted infection (STI) diagnoses, and HIV or STI testing (testing only increased among MSM age 25 +). HIV-negative/unknown status MSM had significant decrease in CAI with an HIV-positive or unknown status partner. HIV-positive MSM had significant increases in CAI, methamphetamine use, and STI diagnoses/testing. Although encouraging, the few indicators of improvement in HIV/STI sexual health practices are not consistently seen across sub-groups of MSM and may be counteracted by growing proportions of MSM engaging in CAI and acquiring STIs.

Licit and illicit substance use patterns among university students in Germany using cluster analysis

BackgroundThe use of multiple licit and illicit substances plays an important role in many university students’ lives. Previous research on multiple substance use patterns of university students, however, often fails to examine use of different illicit substances and/or hookah. Our objective was to complement and advance the current knowledge about common consumption patterns regarding illicit substances and hookah use in this group.MethodsStudents from eight German universities completed an online survey as part of the INSIST study (‘INternet-based Social norms Intervention for the prevention of substance use among STudents’) regarding their consumption of alcohol, tobacco, hookah, cannabis and other illicit substances. Cluster analysis identified distinct consumption patterns of concurrent and non-concurrent substance use and multinomial logistic regressions described key sociodemographic factors associated with these clusters.ResultsSix homogeneous groups were identified: ‘Alcohol Abstainers’ (10.8%), ‘Drinkers Only’ (48.2%), ‘Drinkers and Cigarette Smokers’ (14.6%), ‘Cannabis and Licit Substance Users’ (11.2%), ‘Hookah Users with Co-Use’ (9.8%) and ‘Illicit Substance Users with Co-Use’ (5.4%). Illicit substance use clustered with the consumption of alcohol, tobacco and cannabis. Hookah use was regularly associated with alcohol consumption, less commonly associated with tobacco or cannabis use and very rarely associated with use of other illicit substances. Individuals consuming licit and illicit substances or hookah were mostly male and lived together with other students. Characteristics such as the number of years an individual had spent studying at a university, subject of study, immigrant background and religious affiliation were less commonly associated with cluster membership.ConclusionsAlthough we found substance use patterns in our sample largely similar to previous reports, we identified an important subgroup of individuals using both illicit and licit substances. These individuals may benefit especially from targeted interventions that focus on modifying addictive behavior patterns.Trial registrationDRKS00007635. Registered 17 December 2014 (retrospectively registered).

Effectiveness of Injectable Extended-Release Naltrexone vs Daily Buprenorphine-Naloxone for Opioid Dependence

To date, extended-release naltrexone hydrochloride has not previously been compared directly with opioid medication treatment (OMT), currently the most commonly prescribed treatment for opioid dependence. To determine whether treatment with extended-release naltrexone will be as effective as daily buprenorphine hydrochloride with naloxone hydrochloride in maintaining abstinence from heroin and other illicit substances in newly detoxified individuals. A 12-week, multicenter, outpatient, open-label randomized clinical trial was conducted at 5 urban addiction clinics in Norway between November 1, 2012, and December 23, 2015; the last follow-up was performed on October 23, 2015. A total of 232 adult opioid-dependent (per DSM-IV criteria) individuals were recruited from outpatient addiction clinics and detoxification units and assessed for eligibility. Intention-to-treat analyses of efficacy end points were performed with all randomized participants. Randomization to either daily oral flexible dose buprenorphine-naloxone, 4 to 24 mg/d, or extended-release naltrexone hydrochloride, 380 mg, administered intramuscularly every fourth week for 12 weeks. Primary end points (protocol) were the randomized clinical trial completion rate, the proportion of opioid-negative urine drug tests, and number of days of use of heroin and other illicit opioids. Secondary end points included number of days of use of other illicit substances. Safety was assessed by adverse event reporting. Of 159 participants, mean (SD) age was 36 (8.6) years and 44 (27.7%) were women. Eighty individuals were randomized to extended-release naltrexone and 79 to buprenorphine-naloxone; 105 (66.0%) completed the trial. Retention in the extended-release naltrexone group was noninferior to the buprenorphine-naloxone group (difference, -0.1; with 95% CI, -0.2 to 0.1; P = .04), with mean (SD) time of 69.3 (25.9) and 63.7 (29.9) days, correspondingly (P = .33, log-rank test). Treatment with extended-release naltrexone showed noninferiority to buprenorphine-naloxone on group proportion of total number of opioid-negative urine drug tests (mean [SD], 0.9 [0.3] and 0.8 [0.4], respectively, difference, 0.1 with 95% CI, -0.04 to 0.2; P < .001) and use of heroin (mean difference, -3.2 with 95% CI, -4.9 to -1.5; P < .001) and other illicit opioids (mean difference, -2.7 with 95% CI, -4.6 to -0.9; P < .001). Superiority analysis showed significantly lower use of heroin and other illicit opioids in the extended-release naltrexone group. No significant differences were found between the treatment groups regarding most other illicit substance use. Extended-release naltrexone was as effective as buprenorphine-naloxone in maintaining short-term abstinence from heroin and other illicit substances and should be considered as a treatment option for opioid-dependent individuals. clinicaltrials.gov Identifier: NCT01717963.

Developing a scale of domains of negative consequences of chronic heroin use

BackgroundChronic use of heroin typically leads to numerous negative life consequences and serious clinical impairment. Increased negative consequences can result in poor treatment outcomes as well as adverse health effects and impaired social functioning. Certain risk factors, including early substance use initiation, concurrent use of other illicit substances, and injection drug use are associated with an increase in negative consequences. This study examined whether there are unique domains of heroin consequences and, if so, whether these domains are related to specific substance use characteristics. MethodsData regarding substance use characteristics were collected from 370 non-treatment seeking, heroin-using, 18 to 55year-old participants from the Detroit metropolitan area. Principal component analysis (PCA) was used to analyze the factor structure of 21 negative heroin consequence items. ResultsPCA demonstrated that heroin consequences could be divided into 5 unique domains. These unique domains were related to specific substance use characteristics and heroin consequence domains. Injection heroin use was significantly associated with increased Factor 1 consequences (primarily acute medical problems) but not with consequences in other domains. Certain substance use characteristics, such as injection status and earlier onset of marijuana use, were associated with increased consequences in specific domains. ConclusionsThese findings support the existence of unique domains of negative consequences, and indicate that some risk factors (e.g. injection use) may be specific to these domains. Potential tailored-treatment strategies aimed at improving treatment engagement and reducing harm for heroin use based on person-specific risks and negative consequences are discussed.

Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: a significant public health hazard.

Caffeinated energy drinks (EDs) are increasingly popular among adolescents despite growing evidence of their negative health effects. The consumption of EDs has seen a substantial increase during the past few decades, especially in the Western and Asian countries. EDs contain high levels of caffeine, sugar, and novel ingredients, and are often marketed through youth-oriented media and venues. The known and unknown pharmacology of the constituents of EDs poses a risk of caffeine toxicity and other ill effects when consumed by young people. Caffeine intoxication may result in tachycardia, vomiting, cardiac arrhythmias, seizures, and even death. Other health concerns related to consumption of EDs include obesity and dental enamel erosion resulting from the acidity of EDs. Coingestion of caffeine and ethanol has been associated with increased risk-taking behaviors in adolescent users, impaired driving, and increased use of other illicit substances. Several researchers have demonstrated that consuming alcohol mixed with energy drinks leads to altered subjective states including decreased perceived intoxication, enhanced stimulation, and increased desire to drink/increased drinking compared to consuming alcohol alone. Caffeine’s effect on intoxication may be most pronounced when mixers are artificially sweetened, that is, lack sucrose which slows the rate of gastric emptying of alcohol. In conclusion: 1) health care providers should educate youth and their parents about the risks of caffeinated drinks; 2) emergency department clinicians should consider asking patients about ED and traditional caffeine usage and substance use when assessing patient symptoms; 3) policy makers should increase their attention on introducing regulatory policies on television food advertising to which youth are exposed; 4) failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, need to be addressed and 5) further studies must be done to improve our understanding of potential negative consequences of caffeinated energy drinks on health. (www.actabiomedica.it)

Substance Use Among Medical Students in Greece

Introduction Limited research exists worldwide on medical students’ substance use patterns including alcohol and marijuana use. Aim The aim of the study was to examine the prevalence of substance use, including marijuana, alcohol and other illicit substances (i.e. cocaine, hallucinogens and ecstasy) in a sample of medical students in Greece. Methods 655 students from the School of Medicine of Thessaloniki completed an anonymous, web-based survey including the CAGE questionnaire for alcohol abuse. Students were asked to report the frequency (lifetime, past year, past month) and the motive of the use. Results 72% percent of the students reported having never used any illegal substance and 21% reported marijuana use at least once in their lifetime. 20.9 % were nicotine smokers. No gender difference regarding marijuana use was observed. Marijuana users underestimated the risk of marijuana use on their health compared to non users. Although the relative mean Cage scores are low indicating a lack of severe alcohol related problems in our sample, there is a significantly higher mean CAGE score in students who use marijuana. The use of other illicit substances was rare (3% used inhalers, 2.3 % cocaine, 2.3% ecstasy, 2% ketamine, 1.8% amphetamines and 1.7% mephedrone). However, the use of marijuana was significantly correlated with use of cocaine, LSD, ecstasy, ketamine, amphetamine and mephedrone. Conclusions The findings represent initial data on the prevalence of substance use among Greek medical students. Nationwide studies are needed further investigating the prevalence, the motivation and the impact of this risky behaviour among this population.

Nicotine enhances the expression of a sucrose or cocaine conditioned place preference in adult male rats

Nicotine has been shown to enhance the motivational properties of non-nicotine stimuli. This reinforcement-enhancing property of nicotine has the potential to promote the use of other illicit substances as well as maladaptive patterns of food intake. Therefore, the current study aimed to examine whether nicotine enhances preference for contexts paired with cocaine or sucrose utilizing a place conditioning procedure. Separate groups of adult male rats were administered sucrose or cocaine in one of two compartments of a standard CPP chamber on four consecutive days. Preference was then assessed following no injection, a single subcutaneous (s.c.) injection of nicotine, and a s.c. saline injection. The animals preferred the chamber paired with either sucrose or cocaine, as evident from an increased time spent in the paired chamber compared to baseline. Nicotine further increased the time spent in the sucrose- or cocaine-paired chamber, consistent with a reinforcement-enhancement effect. Previous results demonstrate an interaction between nicotine and intake of other drugs or food. The present findings provide an additional mechanism that may underlie these effects and which may have implications for drug dependence and obesity.

An Episodic Analysis of Substance Use and Risky Sexual Behavior in a Racially Diverse Sample of Young Men Who Have Sex with Men

Many studies have examined the relations between drug use and sexual behaviors; however, few have utilized episodic data to examine the co-occurrence of both behaviors within the same episode. This study surveyed 403 racially and ethnically diverse gay, bisexual, and other young men who have sex with men (YMSM; ages 18–29) in New York City. Men were surveyed about their sexual behavior and concurrent use of illicit substances and alcohol during their most recent sexual encounter with their main and/or casual partner(s). Logistic regression models were built to analyze predictors of unprotected oral and anal intercourse with main and casual partners. Results suggest that use of inhalant nitrates and alcohol increased the odds of men engaging in unprotected receptive anal intercourse (URAI) and men who identified as middle or high socioeconomic status (SES) were at lower odds of engaging in URAI with their main partner. Use of other illicit substances was not associated with unprotected sexual intercourse. These findings indicate a need to further consider the role of licit substances used by YMSM as a means of further reducing the incidence of HIV infection in this population. In addition, the high rates of unprotected anal intercourse among men reporting a main partner has the potential to be a significant source of HIV risk, and should be further explored among YMSM.