Stephen E. Lankenau

Patterns of Polydrug Use Among Ketamine Injectors in New York City

Polydrug use is an important public health issue since it has been linked to significant adverse health outcomes. Recently, club drugs, including ketamine and other drugs used in dance/rave scenes, have been identified as key substances in new types of polydrug using patterns. While seemingly a self-explanatory concept, “polydrug” use constitutes multiple drug using practices that may impact upon health risks. Ketamine, a club drug commonly administered intranasally among youth for its disassociative properties, has emerged as a drug increasingly prevalent among a new hidden population of injection drug users (IDUs). Using an ethno-epidemiological methodology, we interviewed 40 young (< 25 years old) ketamine injectors in New York during 2000–2002 to describe the potential health risks associated with ketamine and polydrug use. Findings indicate that ketamine was typically injected or sniffed in the context of a polydrug using event. Marijuana, alcohol, PCP, and speed were among the most commonly used drugs during recent ketamine using events. Polydrug using events were often quite variable regarding the sequencing of drug use, the drug combinations consumed, the forms of the drug utilized, and the modes of administrating the drug combinations. Future research should be directed towards developing a more comprehensive description of the risks associated with combining ketamine with other drugs, such as drug overdoses, the transmission of bloodborne pathogens, such as HIV and HCV, the short- and long-term effects of drug combinations on cognitive functioning, and other unanticipated consequences associated with polydrug use.

“Research Chemicals”: Tryptamine and Phenethylamine Use Among High-Risk Youth

Tryptamines and phenethylamines are two broad categories of psychoactive substances with a long history of licit and illicit use. Profiles of users of recently emerging tryptamines and phenethylamines are nonexistent, however, since surveillance studies do not query the use of these substances. This manuscript describes the types, modes of administration, onset of use, and context of use of a variety of lesser known tryptamines and phenethylamines among a sample of high-risk youth. Findings are based upon in-depth interviews with 42 youth recruited in public settings in Los Angles during 2005 and 2006 as part of larger study examining health risks associated with injecting ketamine. Youth reported that their use of tryptamines and phenethylamines was infrequent, spontaneous, and predominately occurred at music venues, such as festivals, concerts, or raves. Several purchased a variety of these “research chemicals” from the Internet and used them in private locations. While many described positive experiences, reports of short-term negative health outcomes included nausea, vomiting, diarrhea, disorientations, and frightening hallucinations. These findings, based upon pilot study data, move toward an epidemiology of tryptamine and phenethylamine use among high-risk youth.

Patterns of Ketamine Use Among Young Injection Drug Users

Abstract Ketamine is a dissociative anesthetic that has emerged as an increasingly popular choice among young drug users. Recent research indicates the presence of hidden populations of young people who inject ketamine in New York and other U.S. cities. Applying an ethno-epidemiological approach, the authors recruited 40 young injection drug users (IDUs) (< 25 years old) in New York City to explore health risks associated with ketamine use. This analysis looks at the varying patterns and frequencies of ketamine injection by examining personal, social, and cultural aspects of these young peoples lives. We learned that drug-using histories, experiential dimensions, sociocultural characteristics, and associations with other young people help account for the different patterns of injecting ketamine within the sample. In particular, these findings indicate that young people who were more frequent ketamine injectors had the following characteristics: initiated injection drug use with ketamine; enjoyed the effects of ketamine, were stably housed; lived in the vicinity of New York City; and associated with others who also injected ketamine.

Drug Injection Practices Among High-Risk Youths: The First Shot of Ketamine

Ketamine, a “club drug” commonly administered intranasally among youths for its disassociative properties, has emerged as a drug increasingly common among a new hidden population of injection drug users. Because of a scarcity of epidemiological data, little is known about ketamine injection practices, associated risk behaviors, or the demographic characteristics of ketamine injectors. Using an ethno-epidemiological methodology, we interviewed 40 young (<25 years old) ketamine injectors in New York during 2000–2002 and asked detailed questions about ketamine injection initiation as well as histories of other injection drug use and involvement in the street economy. Our analysis, utilizing descriptive statistics and narrative accounts, compared two groups: ketamine initiates (youths who initiated injection drug use with ketamine) and other initiates (youths who initiated injection drug use with another drug, such as heroin, and later transitioned into ketamine injection). Results indicated that intramuscular injections were more common among ketamine initiates, whereas intravenous injections were more common among other initiates. Drug form and local knowledge within injection groups were important factors underpinning this relationship: liquid ketamine was injected primarily intramuscularly; powder ketamine was injected primarily intravenously virtually irrespective of injection drug use history. In addition, the comparison between ketamine initiates and other initiates revealed differences regarding knowledge about injecting drugs; risk behaviors at initiation; involvement in the street economy, including homelessness and experience dealing drugs; and city or location of ketamine injection initiation. These findings suggest that ketamine injection is an emerging practice among a new hidden population of injection drug users in cities throughout North America.

Ketamine Injection among High Risk Youth: Preliminary Findings from New York City

Ketamine, a synthetic drug commonly consumed by high risk youth, produces a range of experiences, including sedation, dissociation, and hallucinations. While ketamine is more typically sniffed, we describe a small sample of young ketamine injectors (n=25) in New York City and highlight risks associated with this emerging type of injection drug use. Our findings indicate that the injection practices, injection groups, and use norms surrounding ketamine often differ from other injection drug use: intramuscular injections were more common than intravenous injections; injection groups were often large; multiple injections within a single episode were common; bottles rather than cookers were shared; and the drug was often obtained for free. Our findings suggest that the drug injection practices exercised by ketamine injectors place them at risk for bloodborne pathogens, such as HIV, HBV, and HCV. We conclude that ketamine injectors represent an emerging, though often hidden, population of injection drug users, particularly among high risk, street-involved youth.

Multiple Drug Use and Polydrug Use Amongst Homeless Traveling Youth

Abstract Diverse forms of drug use are an emerging theme within research on young people and substance use. This manuscript, based on a three city study of health risks amongst young injection drug users, explores multiple drug use and polydrug use amongst a subset of homeless youth referred to as “travelers.” In particular, we outline characteristics of homeless traveler youths and the various ways in which they practiced multiple drug use and polydrug use. From here, we discusssome theoretical and public health implications of multiple drug use and polydrug use amongst this particular population.

Pregnancy and sexual health among homeless young injection drug users

Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting.

Gang youth as a vulnerable population for nursing intervention.

BACKGROUND Gang youth often come from socially and economically marginalized communities. Such youth report significantly higher rates of participation in violence, substance use, and risky sexual behaviors than their nongang peers. AIMS This manuscript argues that gang-identified youth constitute a vulnerable population. MATERIALS AND METHODS Data are drawn from the general research literature and a case example of how a nurse in Los Angeles partnered with law enforcement to provide preventive health care to gang youth and youth at-risk for joining gangs. CONCLUSION Gang youth are a vulnerable population amenable to nursing intervention. Gang youth may have particular health care needs and may need special access to health care.

Migration Patterns and Substance Use among Young Homeless Travelers

Homeless youth are a diverse population of at risk adolescents and young adults who experience various negative health outcomes, including drug dependence, drug overdose, infectious diseases, and victimization. Previous studies have been directed toward understanding subgroups of homeless youth, such as injection drug users (IDUs) and young men who have sex with men (YMSM); yet limited research has focused on describing homeless “travelers,” a migratory subgroup of homeless youth who move from city to city. Based upon a larger three site study of young IDUs recruited in Los Angeles, New Orleans, and New York, a total of 133 travelers were identified. A subsample of 56 travelers participated in follow-up interviews, and provided data points for mapping. Travelers in all sites had extensive histories of criminal justice involvement and injection drug use. Four common traveling routes within and across the United States were identified. Reasons for traveling often related to drug use, money-making opportunities, and law enforcement. Risk-reduction services, such as shelters, syringe exchanges, or HIV/HCV testing, were used infrequently or occasionally. Mapping data documents the mobility of young IDUs across both urban and rural areas, which suggests that migration among IDUs across broad geographic regions may be a factor in the spread of blood-borne viruses.

Crack Cocaine Injection Practices and HIV Risk: Findings from New York and Bridgeport

This article examines the behavioral practices and health risks associated with preparing crack cocaine for injection. Using an ethno-epidemiological approach, injection drug users (n=38) were recruited between 1999 and 2000 from public settings in New York City and Bridgeport, Connecticut and responded to a semistructured interview focusing on crack injection initiation and their most recent crack injection. Study findings indicate that methods of preparing crack for injection were impacted by a transforming agent, heat applied to the “cooker,” heroin use, age of the injector, and geographic location of the injector. The findings suggest that crack injectors use a variety of methods to prepare crack, which may carry different risks for the transmission of bloodborne pathogens. In particular, crack injection may be an important factor in the current HIV epidemic.