Marie Claire Van Hout

Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries.

BackgroundAbout a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.MethodsA data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature.ResultsCompleted data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries.ConclusionsIn order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

Plant food for thought: A qualitative study of mephedrone use in Ireland

The synthetic cathinone derivative club drug ‘mephedrone’ [4-methylmethcathinone (4MMC)] has been recognized in the EMCDDA early warning system since 2008 [EMCDDA (2010a). ‘Article 5 of the Council Decision’ council decision 2005/387/JHA of 10 May 2005 on the information exchange, risk assessment and control of new psychoactive substances. Official Journal, L 127. Retrieved from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32005D0387:EN:HTML] and is currently under legislative control in Ireland. Research on this drug remains scant, and primarily UK based. This exploratory research aimed to present a ‘consumptive snapshot’ of this emerging drug in the Irish drug scene, with specific focus on mephedrone user experiences, social situatedness of use and risk discourses. Twenty two in-depth interviews were undertaken with young Irish people aged 18–35 years, who had used mephedrone in the 6 months prior to fieldwork. The resulting narratives were phenomenologically and thematically analysed; and identified unique mephedrone user decision-making processes, particular drug effects and outcomes, socially contextualized mephedrone use and user harm reducing strategies grounded in prior illicit and poly drug taking careers. The research supports UK-based findings, which suggested the presence of drug displacement patterns between licit and illicit, with Irish mephedrone user preferences centralized in mephedrone availability, competitive pricing and general lack of quality illicit stimulants in the street trade. Policy makers and drug educational specialists are dealing with rapid metamorphoses and re-branding of cathinone derivatives circumventing legislation amid widespread internet availability.

‘Heads Held High’: An Exploratory Study of Legal Highs in Pre-Legislation Ireland

The research aimed to present a unique ‘snapshot’ of legal psychoactive drug use prior to legislative control in Ireland, in relation to the types of products used; sourcings; consumptive practices and particular social settings for use; gauging of dosage; licit and illicit drug transitions, individualisation of drug decision-making and experiences; and future intentions regarding drug switching post legislation. Semi-structured in depth interviews (n = 32) were conducted with adults aged 18–33 years who had used legal highs in the 6 months prior to fieldwork. The findings indicate some support for ‘differentiated’ displacement consumptive patterns between illegal and legal drugs, with user pathways grounded in ‘legal high’ availability; perceived user effect, safety, legality, quality and price. Mephedrone emerged as most popular drug of choice. Internet sales, stockpiling and diversion of previously ‘legal highs’ onto the illegal street drug market remain of concern, against a background of emerging new designer drugs in Ireland.

Gamma-Hydroxybutyrate (GHB): A Scoping Review of Pharmacology, Toxicology, Motives for Use, and User Groups

Abstract Gamma hydroxybutyrate (GHB) is a central nervous system depressant with euphoric and relaxant effects. Documentation of GHB prevalence and the underreporting of abuse remains problematic, given the availability of GHB and its precursors γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) and the ease of synthesis from kits available on the Internet. The continued abuse of and dependence on GHB, and associated fatalities, present an on-going public health problem. As the drug GHB remains an underresearched topic, a scoping review was chosen as a technique to map the available literature into a descriptive summarized account. PRISMA was used to assist in data retrieval, with subsequent data charting into three key themes (pharmacology and toxicology, outcomes, and user groups). Administered orally, GHB is dose-dependent and popular for certain uses (therapeutic, body enhancement, sexual assault) and amongst user sub groups (recreational party drug users, homosexual men). Despite the low prevalence of use in comparison to other club drugs, rising abuse of the drug is associated with dependence, withdrawal, acute toxicity, and fatal overdose. Clinical diagnosis and treatment is complicated by the co-ingestion of alcohol and other drugs. Limitations of the scoping review and potential for further research and harm reduction initiatives are discussed.

Curiosity killed M-Cat: A post legislative study on mephedrone use in Ireland.

Mephedrone (4-methylmethcathinone) is a synthetic ‘amphetamine-type stimulant’ (ATS) derived from the Khat plant and collectively known as ‘M-Cats’. Research has indicated the presence of strong displacement patterns in post-legislative timeframes with mephedrone incurred positive effects stimulating user preferences over amphetamine, MDMA and cocaine. The aim of this research was to investigate post-legislative mephedrone consumerist patterns and the presence of (any) incurred displacement patterns, as follow-up to an earlier study on pre-legislative mephedrone use in the Republic of Ireland (Van Hout & Brennan, 2011c. Plantfood for thought: A qualitative study of mephedrone use in Ireland. Drugs Education Prevention and Policy. 1–11. Advance online publication.). A total of 22 in-depth interviews were undertaken with findings indicative of the relative influence of macro- and micro-level club drug markets in determining the continuation of mephedrone use. ‘Temporary displacement’ patterns between mephedrone and club stimulant drugs were observed with 10 users reporting continued use and the remainder reverting back to ‘old favourites’. This was based on user emergent negative psychostimulant experiences with mephedrone, concerns for product contamination and improved quality of club stimulants at that time. The synthetic drug market remains of concern, given the recent evidence for ‘blended’ club drugs using mephedrone, and with the need for continued monitoring on the impact of legislation on drug consumptive patterns and outcomes.

A preference for mephedrone: drug markets, drugs of choice, and the emerging “legal high” scene.

This study focuses on individuals’ preferences for mephedrone, a new psychoactive substance that has emerged in several countries. We examine the reasons for mephedrone preferences, and describe the positive and negative effects of the drug experience, route of administration and consumers’ views about the legality of mephedrone. Data were collected through semi-structured interviews with 45 adults who had used mephedrone since January 2010. Respondents resided in one of two jurisdictions that were characterized by different legislative controls over mephedrone. The findings suggest the importance of macro-level drug market factors that shaped peoples preferences for mephedrone. Additionally, respondents’ preferences were guided by pharmacological properties that helped them conceal the effects of mephedrone in public and semi-public spaces. Respondents were not deterred by the (impending) change from legal to illicit drug. The findings have implications for the study of localized drug markets, and in particular, legislative controls over emerging legal highs.

Word of mouse: indigenous harm reduction and online consumerism of the synthetic compound methoxphenidine.

Abstract Methoxphenidine (MXP) was one of several NMDA antagonists marketed in 2013 to replace the recently controlled compound Methoxetamine (MXE). A steep rise in user interest was recorded, despite vendor cautioning of limited user feedback. The study presented a phenomenological analysis of MXP experiences amongst recreational drug users as posted on public Internet fora. Internet searches were carried out using specific key words; “methoxphenidine,” “MXP” and in combination with “experience,” “report,” “forum,” and “trip.” Seven self-reported experiences and 28 thread discussions relating sole use of MXP were analyzed using the Empirical Phenomenological Psychological method. Five themes and 61 categories emerged. MXP is marketed as a legal replacement for MXE, diphenidine, and ketamine, with a dissociative and stimulant wave outcome often lasting for days. Harm reduction tactics, awareness of prior tolerance to dissociative and optimal settings for use are discussed. Acute side-effects relate to hypertension and seizures. Chronic long-term memory loss and limb numbness is reported. Sense of empowerment occurs in the afterglow experience. Internet drug fora fuel information exchange and informed consumerism of synthetic compounds, and offer viable mechanisms for pre- and post-purchase decision making and indigenous harm reduction. Continued surveillance of synthetic market entries and user trends is warranted.

An Internet Study of User’s Experiences of the Synthetic Cathinone 4-Methylethcathinone (4-MEC)

AbstractA synthetic cathinone called 4-methylethcathinone (4-MEC) emerged online in 2010, and was cyber-marketed to be a replacement for mephedrone. The study aimed to present user experiences of 4-MEC as reported on the Internet, with a focus on user profiles, sourcing and product characteristics, routes of administration, dosage, positive and undesirable effects, and comparisons to mephedrone. Twenty-three individual, anonymous trip reports of the sole use of 4-MEC, and 112 screenshots of general 4-MEC user discussion boards, were taken from a purposeful sample of public drug-related sites. A content textual analysis was conducted on extracted qualitative information and produced 41 categories compiled into five general themes: “Type of 4-MEC user”; “Sourcing, informed decision making, product characteristics, and quality assurance”; “Routes of administration, gauging of dosage, and consumption of other drugs”; “Time course effects and outcomes”; and “Comparisons with mephedrone.” 4-MEC is sold as white...Abstract A synthetic cathinone called 4-methylethcathinone (4-MEC) emerged online in 2010, and was cyber-marketed to be a replacement for mephedrone. The study aimed to present user experiences of 4-MEC as reported on the Internet, with a focus on user profiles, sourcing and product characteristics, routes of administration, dosage, positive and undesirable effects, and comparisons to mephedrone. Twenty-three individual, anonymous trip reports of the sole use of 4-MEC, and 112 screenshots of general 4-MEC user discussion boards, were taken from a purposeful sample of public drug-related sites. A content textual analysis was conducted on extracted qualitative information and produced 41 categories compiled into five general themes: “Type of 4-MEC user”; “Sourcing, informed decision making, product characteristics, and quality assurance”; “Routes of administration, gauging of dosage, and consumption of other drugs”; “Time course effects and outcomes”; and “Comparisons with mephedrone.” 4-MEC is sold as white beads, crystalline shards, or green balls. User motives centered on curiosity, pricing, and ease of web sourcing. Oral, nasal, injecting, eyeball, and rectal routes of administration were described. Testing for purity, “allergy testing,” and gauging of dosage were common. Users described euphoric but short-lived effects, with little comedown. Continued research is vital to inform harm reduction.

User Experiences of Development of Dependence on the Synthetic Cannabinoids, 5f-AKB48 and 5F-PB-22, and Subsequent Withdrawal Syndromes

Emergence of synthetic cannabinoids (SCBs) in herbal smoking mixtures is a public health concern. New SCB’s such as 5f-AKB48 and 5F-PB-22 have been detected in French seizures and in sudden death post mortems in the US. The aim was to describe development of dependence on herbal smoking mixtures containing the SCB’s, 5f-AKB48 and 5F-PB-22 and subsequent withdrawal syndromes. Dependent users of herbal smoking mixtures known to contain the SCB’s 5f-AKB48 and 5F-PB-22 with an average Severity of Dependence Score (SDS) of 13 were interviewed using a structured guide (three males/three females). Narratives were analysed using the Empirical Phenomenological Psychological (EPP) five step method. Six themes with 68 categories emerged from the analysis. Themes are illustrated as 1) Networks and Product Availability; 2) Drivers and Motives for Use; 3) Effect and Pathways toward Dependence; 4) Poly Substance Use and Comparisons to Natural Cannabis; 5) Dependence and Withdrawal and 6) Self-detoxification Attempts. Two higher levels of abstraction above these theme-levels emerged from the data, with sole use of herbal smoking mixtures containing 5f-AKB48 and 5F-PB-22 centering on the interplay between intense cravings, compulsive all-consuming seeking, use and re-dose behaviours, and fear of the psychiatric and self-harms caused when in withdrawal. This is the first study describing dependence and withdrawal experiences in users dependent on 5f-AKB48 and 5F-PB-22. Given the potential for adverse psychiatric and physical consequences of dependent use, further development of specific clinical responses and clinical research around toxicity and withdrawal severity are warranted.

The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review.

Injecting use of image and performance-enhancing drugs (IPED) in the general population is a public health concern. A wide and varied range of IPED are now easily accessible to all through the online market. A comprehensive literature review was undertaken according to Critical Appraisal Skills Programme (CASP) guidelines for systematic review, to identify the relevant literature. No date restrictions were placed on the database search in the case of human growth hormone melanotan I and II, and oil and cosmetic injectables. In the case of anabolic androgenic steroids search dates were restricted to January 2014-2015. Publications not in English and with a lack of specificity to the topic were excluded. The review yielded 133 relevant quantitative and qualitative papers, clinical trials, clinical case presentations and editorials/reports. Findings were examined/reviewed under emergent themes which identified/measured extent of use, user profiling, sourcing, product endorsement, risk behaviours and health outcomes in users. Motivation for IPED use may be grounded in appearance, pursuit of health and youth, and body image disturbance. IPED users can practice moderated use, with pathological use linked to high-risk behaviours, which may be normalised within IPED communities. Many IPED trajectories and pathways of use are not scientifically documented. Much of this information may be available online in IPED specific discussion forums, an underutilised setting for research, where uncensored discourse takes place among users. This review underscores the need for future internet and clinical research to investigate prevalence and patterns of injecting use, and to map health outcomes in IPED users. This paper provides community-based clinical practice and health promotion services with a detailed examination and analysis of the injecting use of IPED, highlighting the patterns of this public health issue. It serves to disseminate updated publication information to health and social policy makers and those in health service practice who are involved in harm reduction intervention.