Luke Mitcheson

Mephedrone: use, subjective effects and health risks.

AIMS To assess the patterns of use, subjective effect profile and dependence liability of mephedrone, supported by corroborative urine toxicology. DESIGN Cross-sectional structured telephone interview. SETTING UK-based drug users associated with the dance music scene. PARTICIPANTS A total of 100 mephedrone users, recruited through their involvement with the dance music scene. MEASUREMENTS Assessment of pattern of use, acute and after effects, DSM dependence criteria and gas chromatography-mass spectrometry urinalysis. FINDINGS Mephedrone consumption results in typical stimulant-related subjective effects: euphoria, increased concentration, talkativeness, urge to move, empathy, jaw clenching, reduced appetite and insomnia. Thirty per cent of the sample potentially met criteria for DSM-IV dependence and there was evidence of a strong compulsion to use the drug (47% had used the drug for 2 or more consecutive days). Self-reported recent consumption of mephedrone was confirmed by toxicological analysis in all of the 14 participants who submitted a urine sample. CONCLUSION Mephedrone has a high abuse and health risk liability, with increased tolerance, impaired control and a compulsion to use, the predominant reported dependence symptoms.

Mephedrone: still available and twice the price

In April, 2010, the β ketoamfetamine stimulant mephedrone (4-methylmethcathinone) and several similar compounds were classified as Class B substances in the UK under the Misuse of Drugs Act. Legislation was prom pted by public health concerns, with the expectation that these controls would limit availability and use. As part of our group’s ongoing research into new synthetic drugs, we did an online survey of 150 mephedrone users (average age 24 years) in June, 2010. We have compared our fi ndings with those from a previous online survey we did in November, 2009, and a telephone interview of users in 2010 before the legislation. Our key objective in this comparison was to assess whether the new legislative control of mephedrone had aff ected its availability and use. Of the 150 respondents to the 2010 survey, 95 (63%) reported that they had continued to use mephedrone since the law had changed. 52 of these respondents (55%) said that they intended to continue using the same amount of mephedrone, and 38 (40%) reported that they would now use less. 85 respondents (57%) had bought mephedrone from a dealer, an increase of almost 40% from the 41% who had reported purchasing from a dealer in the telephone study of users done before legislation. In the current 2010 survey, the mean price per gram paid for mephedrone was £16 (mode, £20), compared with a mean price of £10 when the drug was obtainable online before legislation. These fi ndings suggest that classifi cation of mephedrone has had a limited eff ect on controlling its availability and use. Before the introduction of the legislation, users generally obtained mephedrone via the internet. Now they buy it from street dealers, on average at double the price. We suspect that, in time, there are likely to be reductions in purity, and increases in health harms.

5-Year Trends in Use of Hallucinogens and Other Adjunct Drugs among UK Dance Drug Users

Aims: To describe and assess trends in the use of hallucinogens and other adjunct drugs over a 5-year period. Design: Repeated-measures cross-sectional survey. Setting and Participants: Annual magazine-based survey targeting people who use drugs in dance contexts. Measurements: Lifetime use prevalence (ever used); age of first use; current use prevalence (any use within the last month), and extent of use within the last month (number of days used) for LSD, psilocybin, ketamine, GHB and nitrates. Findings: Prevalence increases for psilocybin, ketamine, GHB and nitrates use have been detected, with a sharp recent rise in current psilocybin use in 2002–2003 contrasting with more gradual and comprehensive evidence of increased ketamine use throughout the period 1999–2003. The declining prevalence of LSD use in general population surveys is replicated in this sentinel population study. Conclusions: The rise in prevalence of hallucinogen and other adjunct drugs identified among dance drug users may be mirrored by wider prevalence increases among young people with a consequent need to study these trends carefully and to develop effective interventions, where required.

THE PREVALENCE AND NATURAL HISTORY OF URINARY SYMPTOMS AMONG RECREATIONAL KETAMINE USERS

Study Type – Symptom prevalence (prospective cohort)

What should be done about mephedrone

We should focus on crafting the most effective public health response

Randomized trial of training and supervision in motivational interviewing with adolescent drug treatment practitioners

Motivational interviewing is an empirically supported treatment for drug and alcohol problems. Training in this approach is very popular, although previous studies have identified that the acquisition of key skills is challenging and that postworkshop supervision inputs are helpful. This pilot trial investigated the training of adolescent drug treatment practitioners, comparing a group who received immediate training against a delayed training study condition. Training and supervision were found to have no impact upon skill levels as measured by the Motivational Interviewing Treatment Integrity Version 2, with the exception of a very specific effect on motivational interviewing spirit. Motivational interviewing was not easy to learn for these practitioners. Progress made indicates the importance of ongoing supervision, and for high level skill acquisition to occur requires more intensive support of learning from ongoing practice than was used here.

“You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery

Abstract Aims: To explore how service users’ views of measuring addiction recovery differ from those of service providers. Methods: Five focus groups conducted in two English cities with (i) people currently using Class A drugs (n = 6); (ii) people currently using alcohol (n = 12); (iii) individuals in residential detoxification (n = 12); (iv) individuals in residential rehabilitation (n = 7); and (v) people who defined themselves as ex drug or alcohol users (n = 7). Each focus group reviewed 76 measures of recovery previously identified by senior service providers. Findings: Service users identified multiple problems with the 76 measures. Difficulties could be categorized as expecting the impossible of service users; the dangers of progress; the hidden benefits of negative outcomes; outcomes that negate the agency in recovery; contradictory measures; failure to recognise individual differences; entrenched vulnerabilities; the misattribution of feelings and behaviours; and inappropriate language. Conclusions: Service users experience recovery as a process and personal journey that is often more about ‘coping’ than ‘cure’. Involving service users in designing measures of recovery can lessen the likelihood that researchers develop assessment tools that use inappropriate, contradictory or objectionable outcomes, and ambiguous and unclear language. People who have experienced drug or alcohol problems can highlight important weaknesses in dominant recovery discourses.

Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial

BACKGROUND Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy. METHODS In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493. FINDINGS Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12·1, 95% CI 3·7-39·9; p<0·0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14·0, 4·2-46·2; p<0·0001). These differences remained significant with sensitivity analyses. INTERPRETATION Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown. FUNDING National Institute for Health Research (RP-PG-0707-10149).

How should we measure addiction recovery? Analysis of service provider perspectives using online Delphi groups

Aims: To explore ways of measuring addiction recovery and the extent of agreement/disagreement between diverse service providers on potential recovery indicators. Methods: Separate online Delphi groups with (i) addiction psychiatrists (n = 10); (ii) senior residential rehabilitation staff (n = 9); and (iii) senior inpatient detoxification unit staff (n = 6). Each group was conducted by email and followed the same structured format involving three iterative rounds of data collection. Content analyses were undertaken and the results from each group were compared and contrasted. Findings: Indicators of recovery spanned 15 broad domains: substance use, treatment/support, psychological health, physical health, use of time, education/training/employment, income, housing, relationships, social functioning, offending/anti-social behaviour, well-being, identity/self-awareness, goals/aspirations, and spirituality. Identification of domains was very consistent across the three groups, but there was some disparity between, and considerable disparity within, groups on the relative importance of specific indicators. Conclusions: Whilst there is general consensus that recovery involves making changes in a number of broad life areas and not just substance use, there is substantial disagreement on particular measures of progress. Further studies involving other stakeholder groups, particularly people who have personally experienced drug or alcohol dependence, are needed to assess how transferable the 15 identified domains of recovery are.

The rise of Viagra among British illicit drug users: 5-year survey data.

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms.