Marta Torrens

Mephedrone (4-methylmethcathinone; 'meow meow'): chemical, pharmacological and clinical issues

BackgroundRecently, those substances deriving from the active ingredient of the Khat plant, cathinone, have been rising in popularity. Indeed, 4-methylmethcathinone (mephedrone; ‘meow meow’ and others) has been seen by some as a cheaper alternative to other classified recreational drugs.AimsWe aimed here at providing a state-of-the-art review on mephedrone history and prevalence of misuse, chemistry, pharmacology, legal status, product market appearance, clinical/management and related fatalities.MethodsBecause of the limited evidence, some of the information here presented has been obtained from user reports/drug user-orientated web sites. The most common routes for mephedrone recreational use include insufflation and oral ingestion. It elicits stimulant and empathogenic effects similar to amphetamine, methylamphetamine, cocaine and MDMA. Due to its sympathomimetic actions, mephedrone may be associated with a number of both physical and psychopathological side effects. Recent preliminary analysis of recent UK data carried out in 48 related cases have provided positive results for the presence of mephedrone at postmortem.Discussion and ConclusionsWithin the UK, diffusion of mephedrone may have been associated with an unprecedented combination of a particularly aggressive online marketing policy and a decreasing availability/purity of both ecstasy and cocaine. Mephedrone has been recently classified in both the UK and in a number of other countries as a measure to control its availability. Following this, a few other research psychoactives have recently entered the online market as yet unregulated substances that may substitute for mephedrone. Only international collaborative efforts may be able to tackle the phenomenon of the regular offer of novel psychoactive drugs.

Structural and Functional Imaging Studies in Chronic Cannabis Users: A Systematic Review of Adolescent and Adult Findings

Background The growing concern about cannabis use, the most commonly used illicit drug worldwide, has led to a significant increase in the number of human studies using neuroimaging techniques to determine the effect of cannabis on brain structure and function. We conducted a systematic review to assess the evidence of the impact of chronic cannabis use on brain structure and function in adults and adolescents. Methods Papers published until August 2012 were included from EMBASE, Medline, PubMed and LILACS databases following a comprehensive search strategy and pre-determined set of criteria for article selection. Only neuroimaging studies involving chronic cannabis users with a matched control group were considered. Results One hundred and forty-two studies were identified, of which 43 met the established criteria. Eight studies were in adolescent population. Neuroimaging studies provide evidence of morphological brain alterations in both population groups, particularly in the medial temporal and frontal cortices, as well as the cerebellum. These effects may be related to the amount of cannabis exposure. Functional neuroimaging studies suggest different patterns of resting global and brain activity during the performance of several cognitive tasks both in adolescents and adults, which may indicate compensatory effects in response to chronic cannabis exposure. Limitations However, the results pointed out methodological limitations of the work conducted to date and considerable heterogeneity in the findings. Conclusion Chronic cannabis use may alter brain structure and function in adult and adolescent population. Further studies should consider the use of convergent methodology, prospective large samples involving adolescent to adulthood subjects, and data-sharing initiatives.

Is There a Recreational Misuse Potential for Pregabalin? Analysis of Anecdotal Online Reports in Comparison with Related Gabapentin and Clonazepam Data

1 „ReDNet‟ and „Psychonaut Web Mapping‟ Projects; University of Hertfordshire School of Pharmacy, Hatfield, UK 2 Psychiatry and Clinical Psychology Department, Umberto I, “La Sapienza” University of Rome Medical School, Rome, Italy; Viale Regina Elena 244, 00161, Rome,Italy; doffizi.stefano@gmail.com; michele.piccione@uniroma1.it 3 Psychonaut Web Mapping Project; National Addiction Centre, Institute of Psychiatry, Kings College London, London, UK; 4 Windsor Walk; SE5 AF; paolo.deluca@kcl.ac.uk; zoe.davey@kcl.ac.uk 4 Psychonaut Web Mapping Project; Servizio Salute Regione Marche, Ancona, Italy; Assessorato Salute Regione Marche. Address. Via Gentile da Fabriano 3. Ancona 60100; lucia.difuria@regione.marche.it; stefy.pagani@gmail.com 5 Psychonaut Web Mapping Project; IAPS-IMIM-Hospital del Mar-UAB, Barcelona, Spain; Passeig Maritim 25-29. Barcelona 08003; MTorrens@imim.es; Mfarre@imim.es 6 Psychonaut Web Mapping Project; Bergen Clinics Foundation, Centre of Competence, Bergen, Norway; Vestre Torggate 11 5015 Bergen; arvid.skutle@bergenclinics.no; liv.holmefjord.flesland@bergenclinics.no 7 Psychonaut Web Mapping Project; A-Clinic Foundation, Department of Communications, Helsinki, Finland; Paasivuorenkatu 2A; 00530; Helsinki; teuvo.peltoniemi@a-klinikka.fi; aino.majava@a-klinikka.fi; miia.mannonen@a-klinikka.fi 8 Psychonaut Web Mapping Project; Addiction Research Group at the Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Hospital of the University Duisburg-Essen, Germany; Virchowstrase 174. D-45122 Essen; norbert.scherbaum@uni-due.de; holger.siemann@lvr.de 9 Psychonaut Web Mapping Project; De Sleutel Technische Bedrijfseen heid Provincialaat der Broeders van Liefde, Merelbeke, Jozef Guislainstraat 43 a; B-9000; Gent Belgium; peer.van.der.kreeft@fracarita.org

Phenomenon of new drugs on the Internet: The case of ketamine derivative methoxetamine

On the basis of the material available both in the scientific literature and on the web, this paper aims to provide a pharmacological, chemical and behavioural overview of the novel compound methoxetamine. This is a dissociative drug related to ketamine, with a much longer duration of action and intensity of effects. A critical discussion of the availability of information on the web of methoxetamine as a new recreational trend is here provided. Those methodological limitations, which are intrinsically associated with the analysis of online, non‐peer reviewed, material, are here discussed as well. It is concluded that the online availability of information on novel psychoactive drugs, such as methoxethanine, may constitute a pressing public health challenge. Better international collaboration levels and novel forms of intervention are necessary to tackle this fast‐growing phenomenon. Copyright

Psychiatric comorbidity in illicit drug users: substance-induced versus independent disorders

BACKGROUND Few studies have differentiated between independent and substance-induced psychiatric disorders. In this study we determine the risks associated with independent and substance-induced psychiatric disorders among a sample of 629 illicit drug users recruited from treatment and out of treatment settings. METHODS Secondary analysis of five cross-sectional studies conducted during 2000-2006. Independent and substance-induced DSM-IV psychiatric diagnoses were assessed using the Psychiatric Research Interview for Substance and Mental Disorders. RESULTS Lifetime prevalence of Axis I disorders other than substance use disorder (SUD) was 41.8%, with independent major depression being the most prevalent (17%). Lifetime prevalence of antisocial or borderline personality disorders was 22.9%. In multinominal logistic regression analysis (SUD only as the reference group), being female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group with independent disorders. In the group with substance-induced disorders, being recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female (OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57) remained significant in the model. These variables were also significant in the group with both substance-induced and independent disorders, together with borderline personality disorder (OR 2.53; 95% CI 1.03, 6.27). CONCLUSIONS Illicit drug users show high prevalence of co-occurrence of mainly independent mood and anxiety psychiatric disorders. Being female, recruited from an out of treatment setting and the number of SUD, are risk factors for substance-induced disorders.

Characteristics of Heroin Addicts Entering Methadone Maintenance Treatment: Quality of Life and Gender

Study objective. To provide information on MMP patients characteristics, particularly those related with Health Related Quality of Life (HRQoL) and gender. Design. Cross-sectional study. Data were collected on socio-demographic, toxicological variables, HIV risk behaviors, and HRQoL through the Nottingham Health Profile (NHP). Patients and setting. Over a 30-month period (1996–1999) Barcelonas Municipal Drug Care Centres recruited 586 patients. Main results. Mean age of patients was 31 years, 70% were males and 25% were HIV-infected. Rates of unemployment, criminal records and low educational level were high. Most poly-drug users used cocaine. NHP mean score was related with poly-drug use, educational level and HIV status. Consistent condom use was related with HIV status. Females’ route of administration was less likely to be injection, even though they were more frequently HIV-positive and manifested contemporary poorer general health. Conclusions. Patients QoL was poor. Nowadays harm reduction health strategies would need to face cocaine use, and sexual risk behaviors mainly among females and sexual partners.

Psychiatric comorbidity in young cocaine users : induced versus independent disorders

AIMS To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions. DESIGN Cross-sectional study. SETTING Barcelona, Spain. PARTICIPANTS A cohort of 139 young (18-30 years) adult current regular cocaine users. MEASUREMENTS The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders). FINDINGS Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders. CONCLUSIONS This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.

Identification of new putative susceptibility genes for several psychiatric disorders by association analysis of regulatory and non-synonymous SNPs of 306 genes involved in neurotransmission and neurodevelopment†‡

A fundamental difficulty in human genetics research is the identification of the spectrum of genetic variants that contribute to the susceptibility to common/complex disorders. We tested here the hypothesis that functional genetic variants may confer susceptibility to several related common disorders. We analyzed five main psychiatric diagnostic categories (substance‐abuse, anxiety, eating, psychotic, and mood disorders) and two different control groups, representing a total of 3,214 samples, for 748 promoter and non‐synonymous single nucleotide polymorphisms (SNPs) at 306 genes involved in neurotransmission and/or neurodevelopment. We identified strong associations to individual disorders, such as growth hormone releasing hormone (GHRH) with anxiety disorders, prolactin regulatory element (PREB) with eating disorders, ionotropic kainate glutamate receptor 5 (GRIK5) with bipolar disorder and several SNPs associated to several disorders, that may represent individual and related disease susceptibility factors. Remarkably, a functional SNP, rs945032, located in the promoter region of the bradykinin receptor B2 gene (BDKRB2) was associated to three disorders (panic disorder, substance abuse, and bipolar disorder), and two additional BDKRB2 SNPs to obsessive‐compulsive disorder and major depression, providing evidence for common variants of susceptibility to several related psychiatric disorders. The association of BDKRB2 (odd ratios between 1.65 and 3.06) to several psychiatric disorders supports the view that a common genetic variant could confer susceptibility to clinically related phenotypes, and defines a new functional hint in the pathophysiology of psychiatric diseases.

Promoting innovation and excellence to face the rapid diffusion of Novel Psychoactive Substances in the EU: the outcomes of the ReDNet project

The recent emergence of new psychoactive compounds (novel psychoactive substances (NPS)) has raised prominent challenges in the fields of drug policy, substance use research, public health and service provision. The Recreational Drugs European Network project, funded by the European Commission, was implemented to improve the information stream to young people and professionals about effects/risks of NPS by identifying online products and disseminating relevant information through technological tools.

Staff regard towards working with substance users: a European multi-centre study

AIMS To compare regard for working with different patient groups (including substance users) among different professional groups in different health-care settings in eight European countries. DESIGN A multi-centre, cross-sectional comparative study. SETTING Primary care, general psychiatry and specialist addiction services in Bulgaria, Greece, Italy, Poland, Scotland, Slovakia, Slovenia and Spain. PARTICIPANTS A multi-disciplinary convenience sample of 866 professionals (physicians, psychiatrists, psychologists, nurses and social workers) from 253 services. MEASUREMENTS The Medical Condition Regard Scale measured regard for working with different patient groups. Multi-factor between-subjects analysis of variance determined the factors associated with regard for each condition by country and all countries. FINDINGS Regard for working with alcohol (mean score alcohol: 45.35, 95% CI 44.76, 45.95) and drug users (mean score drugs: 43.67, 95% CI 42.98, 44.36) was consistently lower than for other patient groups (mean score diabetes: 50.19, 95% CI 49.71, 50.66; mean score depression: 51.34, 95% CI 50.89, 51.79) across all countries participating in the study, particularly among staff from primary care compared to general psychiatry or specialist addiction services (P<0.001). After controlling for sex of staff, profession and duration of time working in profession, treatment entry point and country remained the only statistically significant variables associated with regard for working with alcohol and drug users. CONCLUSIONS Health professionals appear to ascribe lower status to working with substance users than helping other patient groups, particularly in primary care; the effect is larger in some countries than others.