Jane Carlisle Maxwell

Party Drugs: Properties, Prevalence, Patterns, and Problems

This review summarizes the latest literature on “party” or “club” drugs, defined as MDMA, GHB, ketamine, and Rohypnol, as published from 2002 to early 2005. Club drugs have been categorized as being used at raves and dance parties. The literature shows that each drug has different properties, users, and settings. Each drug has different adverse effects and requires different acute care protocols. Although these drugs were identified early, scientific information about them, including the toxicological tests to identify them, is still evolving. Increasing numbers of studies on the short- and long-term effects of these drugs on humans are being published, but because of limitations on research using human subjects, they may not always be as rigorous as desired and can be cited by drug users to discredit findings of harm. The lack of research-based information on these drugs has led to the emergence of web sites that may or may not provide accurate data. Evaluated chemical dependency treatment protocols using the latest research for each of these different drugs are needed.

Emerging research on methamphetamine

Purpose of review To describe and review the literature published on methamphetamine in 2003–2004, with a particular focus on patterns of use, its effects on the user and society, and progress being made towards effective treatment strategies. Recent findings The methamphetamine epidemic continues to grow, dominating drug use trends in many parts of the world, and signifying an increasing need for effective treatment. In addition to the already-documented physical effects of the drug, preliminary evidence suggests methamphetamine dependence may cause long-term neuronal damage. Recently abstinent users have been found to do poorly on neurocognitive tests of attention and motor skills, both factors that can adversely affect treatment outcomes. Methamphetamine use is also implicated in aggression and violence and there are increasing presentations to emergency rooms. It also affects the developing fetus, as well as children and adults who are exposed to toxic chemicals at laboratory sites. Outpatient programs, such as the Matrix Model, show improved in-treatment performance. Case management was found to be an effective intervention. Agonist-type pharmacotherapy in combination with quality behavioral therapy should produce benefit and a reduction in risks caused by stimulant abuse. Summary The increasing evidence that methamphetamine has adverse effects on the human brain indicates the pressing need for effective prevention and treatment approaches. There is a need to take these findings, particularly those that involve cognitive deficits, into consideration in current treatment programs and when developing new treatments.

Drug use and risk of HIV/AIDS on the Mexico-USA border: a comparison of treatment admissions in both countries

This study analyzes trends in treatment admissions and summarizes HIV/AIDS risk factors along the US-Mexican border. Data are presented at the national level and at the state level for states along the border. Client data also are compared for treatment programs located in sister cities on the Texas-Mexico border. These data show that methamphetamine admissions are increasing nationally and methamphetamine use is a major problem in the western states on both sides of the border. Use of Ice (smoked methamphetamine) has increased significantly. Use of crack (smoked cocaine) is a growing problem on the border, and injection is the primary route for using black tar heroin in this area. Each of these drugs is a risk factor, either from drug-influenced risky sexual behaviors or from sharing injection equipment. In addition, the availability of drugs on the border and patterns of risky behaviors among migrants mean that drug users on the border are at risk of HIV/AIDS, and this risk is expected to increase with the spreading methamphetamine epidemic and smoking of crack cocaine. Comparable data on HIV/AIDS are needed for further studies of the relationship of drug use and HIV/AIDS on the border.

Psychoactive substances—Some new, some old: A scan of the situation in the U.S.

INTRODUCTION New synthetic drugs are appearing as old hallucinogen psychedelic drugs are reappearing. This article combines the findings from a variety of datasets to characterize the users in terms of gender, age, drug use patterns, and adverse results, as well as provide an overview of the changes in formulations of these drugs and the impact of legal controls. Methods. Data from Monitoring the Future and the National Survey on Drug Use and Health are analyzed, along with the national DAWN emergency room admissions, Texas poison control center cases, and Texas treatment data, along with national forensic laboratory results. Results. Users of the synthetic cannabinoids, synthetic cathinones, phenethylamines, tryptamines, LSD, MDMA, and mushrooms tended to be young and male. They differed in terms of race and ethnicity. The effects of the drugs differed in terms of emergency room outcomes and poison center reports, and the treatment data showed they were similar in terms of education level, employment, and legal problems. Conclusion. Combining the different data sources provided a first picture of the characteristics of these users and their needs. Creditable descriptions on the risks of these drugs should be disseminated. Intervention programs should be targeted to these young users and new neuropsychobiological deficits from some of these drugs should be monitored. Because of the ever-changing chemical combinations to stay legal and the need for information on content and dosage, a more effective approach may be needed basing control on the effects of the substances rather than their changing chemical composition.

Profiles of Club Drug Users in Treatment

There is little in the literature about treatment of persons with problems with “club” or “party” drugs. This paper looks at the characteristics of individuals admitted to treatment for primary, secondary, or tertiary problems with club drugs such as ecstasy, gamma-hydroxybutyrate (GHB), ketamine, flunitrazepam (Rohypnol), methamphetamine, and hallucinogens (e.g., LSD) in programs funded by the Texas Commission on Alcohol and Drug Abuse. Some 38,350 unduplicated records from 1988 through 2003 of persons admitted with problems with club drugs were compared against users of alcohol or other drugs. Club drug users were more impaired on five of six Addiction Severity Index (ASI) indices at admission and they were more likely to use multiple substances more often. They were more likely than users of alcohol or other drugs to complete treatment, but this varied by drug. At follow-up 90 days after discharge, club drug users continued to report more ASI problems. Profiles of these clients show that ecstasy use has spread beyond the club culture, as indicated by the changes in client demographics over time. GHB clients presented a mixed picture of severe problems at admission and good response to treatment. Hallucinogen clients were young and less likely to complete treatment, while Rohypnol users were on the Texas-Mexico border. The methamphetamine epidemic has resulted in increased admissions, and the proportion of “Ice” smokers has increased. However, methamphetamine clients were less likely to complete treatment and their higher level of problems at admission and follow-up are of concern. Of special note are the indications of co-occurring problems and the need for both mental health and substance dependence treatment for some clients.

Substance Use among Texas Hispanics and Non-Hispanics: Who's Using, Who's Not, and Why

The prevalence ofpast-yearand lifetime substance use, problem indicators, and the most important reasons for abstaining (among nonusers) were compared between Texas Hispanics and non-Hispanics, as well as among three subgroups of Hispanics who represented different levels of acculturation: Mexican born (i.e., least acculturated), U.S. born but relatively unacculturated, and U.S. born/highly acculturated. In general, prevalence rates among Hispanics increased as a function of U.S. acculturation, with the most acculturated groups rates more closely resembling non-Hispanics than Mexicanborn Hispanics. There were also significant variations by level of acculturation in the reasons given for abstinence. Whereas health was the most commonly cited reason for abstinence regardless of ethnicity, other important reasons (e.g., moral reasons versus influence of family and friends) varied significantly by ethnicity and acculturation. Results are interpreted with special regard to prevention.

the response to club drug use

&NA; The evolving club drug phenomenon must continue to be monitored. Additional research is needed to document effects on humans and to educate clinicians on the unique properties of each drug. Research‐based treatment for dependence on club drugs is needed. Purpose of review Club drugs are a phenomenon that emerged during the past decade, and knowledge about them continues to evolve. The present review summarizes research published in the past year on 3,4‐methylenedioxy‐methamphetamine (‘ecstasy’), &ggr;‐hydroxybutyrate, ketamine, and Rohypnol. These substances are described and the latest epidemiologic information is provided, and reports of patterns of use, adverse effects, pharmacology, toxicology, and management in the acute care setting are reviewed. Recent studies on the presence or absence of neurologic, psychiatric, and psychologic problems related to use of these drugs are also reported. Recent findings An examination of the literature has shown that each of the club drugs has different properties and often different users. Each drug has different adverse effects and requires different acute care protocols. Although club drugs were identified early, scientific information about these drugs is still evolving. There are increasing numbers of studies on the short‐term and long‐term effects of these drugs in humans, but because of limitations on research in humans they may not always be as rigorous as desired, and can be cited by club drug users to discredit findings of harm. This has led to reliance on web‐based sites that may or may not provide accurate data. Evaluated protocols for use in chemical dependency treatment for each of these drugs are still missing.

Unraveling the complexity of driving while intoxicated: A study into the prevalence of psychiatric and substance abuse comorbidity

OBJECTIVE Research is beginning to provide an indication of the co-occurring substance abuse and mental health needs for the driving under the influence (DUI) population. This study aimed to examine the extent of such psychiatric problems among a large sample size of DUI offenders entering treatment in Texas. METHODS This is a study of 36,373 past year DUI clients and 308,714 non-past year DUI clients admitted to Texas treatment programs between 2005 and 2008. Data were obtained from the States administrative dataset. RESULTS Analysis indicated that non-past year DUI clients were more likely to present with more severe illicit substance use problems, while past year DUI clients were more likely to have a primary problem with alcohol. Nevertheless, a cannabis use problem was also found to be significantly associated with DUI recidivism in the last year. In regards to mental health status, a major finding was that depression was the most common psychiatric condition reported by DUI clients, including those with more than one DUI offence in the past year. This cohort also reported elevated levels of Bipolar Disorder compared to the general population, and such a diagnosis was also associated with an increased likelihood of not completing treatment. Additionally, female clients were more likely to be diagnosed with mental health problems than males, as well as more likely to be placed on medications at admission and more likely to have problems with methamphetamine, cocaine, and opiates. CONCLUSIONS DUI offenders are at an increased risk of experiencing comorbid psychiatric disorders, and thus, corresponding treatment programs need to cater for a range of mental health concerns that are likely to affect recidivism rates.

Indicators of buprenorphine and methadone use and abuse: what do we know?

Abuse of prescription opioids is a growing problem. The number of methadone pain pills distributed now exceeds liquid methadone used in opioid treatment, and the increases in buprenorphine indicators provide evidence of the need to monitor and intervene to decrease the abuse of this drug. The need for additional and improved data to track trends is discussed, along with findings as to the characteristics of the users and combinations of drugs. Data on toxicities related to methadone or buprenorphine, particularly in combination with other prescribed drugs, are presented and clinical implications and considerations are offered. These findings underscore the need for physicians to be aware of potential toxicities and to educate their patients regarding these issues.

What do we know now about the impact of the laws related to marijuana

Objectives:This study presents information on the status and impact of medical and legalized marijuana, and the latest data on attitudes and prevalence of use since implementation of these laws. Recent reports from epidemiologists in Denver and Seattle are summarized to give the readers a sense of the changes as these laws have taken effect in their communities. Methods:The status of these laws is reviewed and the results of surveys taken before and after the laws were enacted are presented, along with data on changing potency and driving under the influence of marijuana. Summary:Prevalence of use by youths has not increased, but their negative attitudes towards the risk of using marijuana have decreased, and use by adults has increased. Potency continues to increase, as has the proportion of drivers testing positive for use of the drug. Data from Denver show increases in hospital admissions, emergency department visits, and calls to poison centers, with decreasing arrests and admissions to substance abuse treatment programs. Data from the Seattle area show similar decreases in treatment admissions and police involvement, but also increased prevalence of more frequent use. Conclusions:Current data suggest that increases in marijuana use preceded legalization in 2012. Treatment admissions were declining before these laws, but some indicators of morbidity seem to be increasing subsequent to legalization, with modest increases in poison center calls in both states and increases in acute medical visits in Denver. Data are needed to understand the relationship between the patterns and amounts of use in terms of consequences, and data on the health conditions of those receiving medical marijuana and the impact of higher potency.