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CORK Bibliography: Methamphetamine

69 citations. January 2011 to present

Prepared: September 2011

Benotsch EG; Martin AM; Koester S; Cejka A; Luckman D. Nonmedical use of prescription drugs and HIV risk behavior in gay and bisexual men. Sexually Transmitted Diseases 38(2): 105-110, 2011. (56 refs.)

Background: Previous research has demonstrated associations between substance use and sexual risk behavior in men who have sex with men (MSM). Recent trends in substance use show increasing use of prescription medications (e. g., Vicodin) without a physician's prescription, yet associations between the nonmedical use of prescription drugs (NMUPD) and HIV risk behavior have not been well examined in MSM. Methods: MSM attending a gay pride festival completed a self-report measure assessing NMUPD, motivations for use, use of traditional recreational drugs, and HIV risk behavior. Results: More than one-third of the sample (38%) reported lifetime NMUPD and 17% reported NMUPD in the previous 3 months. The most common class of medications used was prescription analgesics. Men reporting NMUPD also reported higher rates of the use of marijuana, poppers, ecstasy, cocaine, methamphetamine, GHB, ketamine, heroin, and rohypnol, and had significantly higher rates of HIV risk behaviors, including more sexual partners and more unprotected sex. Conclusions: A significant minority of MSM are using prescription medications without a doctor's consent. Men who do so are risking negative consequences of such use, including the potential for addiction, potentially dangerous interactions between prescription and recreational drugs, and greater risk for contracting HIV.

Boshears P; Boeri M; Harbry L. Addiction and sociality: Perspectives from methamphetamine users in suburban USA. Addiction Research & Theory 19(4): 289-301, 2011. (59 refs.)

This article contributes to a growing body of literature that emphasizes the social nature of drug use, abuse and addiction. Current discourses of addiction tend to focus on the individual while limiting attention on the social environment and the role of sociality. We seek to contribute a more intuitive, insiders'' perspective of the drug trajectory and a broader conceptualization of addiction. Drawing from our qualitative study on 100 current and former methamphetamine users in the suburbs of Atlanta, Georgia (USA), we examined the trajectories of methamphetamine use to provide greater insight on what influences drug initiation, progression, cessation and relapse from the users'' perspective. Findings show that the entire drug trajectory is intertwined with, and impacted by, sociality for the majority of drug users in our sample. Moreover, the findings of our study increase our understanding of multiple routes to recovery. We join the call for greater attention to drug use and addiction as a social behavior and future research that focuses more on the role of sociality among drug users.

Braine N; Acker CJ; van Sluytman L; Friedman S; Des Jarlais DC. Drug use, community action, and public health: Gay men and crystal meth in NYC. Substance Use & Misuse 46(4): 368-380, 2011. (49 refs.)

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.

Butler B; Rubin G; Lawrance A; Batey R; Bell J. Estimating the risk of fatal arrhythmia in patients in methadone maintenance treatment for heroin addiction. Drug and Alcohol Review 30(2): 173-180, 2011. (18 refs.)

Aims. To estimate risk of death due to cardiac arrhythmia during methadone maintenance treatment. Background. There is evidence that methadone prolongs the QT interval, and has been associated with ventricular tachycardia in some individuals. Methods. We identified 51 deaths occurring during methadone treatment, occurring in a cohort with a defined exposure to methadone treatment. We obtained consent to access coronial records to investigate these in-treatment deaths in detail, to identify potential cases of fatal arrhythmia-those cases in which sudden death occurred without clear evidence of an alternate cause of death. We obtained consent to access clinic records of dosing. Two physicians reviewed the coronial files and circumstances of death. The total number of person-years exposure to methadone treatment was calculated. Results. There were extensive missing data in coronial and clinic files, making definitive assessment difficult in many cases. No definite case of death due to cardiac arrhythmia was identified. There were two cases in which arrhythmia seemed possible, and 10 cases in which arrhythmia could not be excluded. The study covered 14 500 patient-years (pys) in methadone treatment, yielding an estimate from 0 to 0.069 deaths per 100 pys, with a best estimate of fatal arrhythmia occurring at a rate of 0.014 per 100 pys. Overdose is a more common cause of death. Both potential arrhythmias and overdoses were associated with use of other drugs in addition to methadone-usually, prescription drugs or methamphetamine. Conclusions. The risk of fatal cardiac arrhythmia in methadone maintenance patients appears to be low. The major risk factor for death was use of prescription drugs, and methamphetamine, in addition to methadone.

Cheng MT; Annetta L; Folta E; Holmes SY. Drugs and the brain: Learning the impact of methamphetamine abuse on the brain through a virtual brain exhibit in the museum. International Journal of Science Education 33(2): 299-319, 2011. (79 refs.)

Drugs and the Brain: A Serious Game, a prototype museum exhibit, was designed to employ virtual models of the brain into a video game format. It was done to create a fun and engaging way of conveying knowledge and concepts about neuroscience, as well as the impact of methamphetamine abuse on the brain. The purpose of this study is to evaluate this prototype exhibit that promises to educate participants from various age, ethnicity, and gender backgrounds, and to establish a stronger concept of drug abuse prevention among children. A quantitative methodology using the pre- and post-experimental designs was conducted on 175 museum visitors. A series of two-sample paired t-tests and subsequent ANOVAs were performed to examine the difference between pre- and post-tests and to determine if there was a difference in the results in age, gender, ethnicity, and race. Results showed that both the understanding and attitudes of the participants toward the impact of methamphetamine abuse on the brain improved significantly (p < 0.01).

Darke S; Torok M; McKetin R; Kaye S; Ross J. Patterns of psychological distress related to regular methamphetamine and opioid use. Addiction Research & Theory 19(2): 121-127, 2011. (31 refs.)

In order to determine the independent associations of methamphetamine and heroin use to global psychological distress, symptom patterns and personality disorder, 400 regular users of these drugs were administered the Brief Symptom Inventory. The mean global severity score was 2.39 standard deviations above the population norm, and 24% were classified as cases. After controlling for potential confounders, higher levels of global psychological distress were independently associated with more frequent use of both drug classes. Depression was associated with the frequency of heroin use, but not with methamphetamine use. Phobic anxiety, interpersonal sensitivity and psychoticism were independently related to the frequency of methamphetamine use, but not to heroin use. Neither methamphetamine nor heroin use were independent correlates of a diagnosis of borderline personality disorder or conduct disorder. Whilst higher levels of psychological distress were associated with both methamphetamine and heroin use, symptom patterns were differentially related to the use of these drugs.

Dluzen DE; McDermott JL; Bourque M; Di Paolo T; Darvesh AS; Buletko AB et al. Markers associated with sex differences in methamphetamine-induced striatal dopamine neurotoxicity. Current Neuropharmacology 9(1): 40-44, 2011. (21 refs.)

Three different approaches were employed to assess various markers associated with sex differences in responses to methamphetamine ( MA). Bioassay measures reveal that MA treatment results in significantly greater reductions in body weight and increases in body temperature in male mice. Protein and mRNA determinations show significant increases in Bcl-2 and PAI-1 in male mice, while females show significant increases in GFAP and decreases in IGF-1R following treatment with MA. In mice with a heterozygous mutation of their dopamine transporter (+/- DAT), only female mice show significant differences in dopamine transporter binding and mRNA and associated reductions in striatal dopamine content along with increases in MA-evoked striatal dopamine output. The identification of these sex-dependent differences in markers provides a foundation for more exhaustive evaluation of their impact upon, and treatment of, disorders/neurotoxicity of the nigrostriatal dopaminergic system and the bases for the differences that exist between females and males.

Drew JM. Police responses to the methamphetamine problem: An analysis of the Organizational and regulatory context. Police Quarterly 14(2): 99-123, 2011. (43 refs.)

This article focuses on the operational adoption and implementation of partnership policing strategy as applied to the methamphetamine problem. The study involves drug law enforcement officers employed in State-based, law enforcement agencies across three Australian police organizations. Using innovations and organizational change perspectives, the study examines the contextual factors that influence the translation of partnership strategies into operational drug law enforcement practice. The research found that partnership policing is influenced by factors across organizational, operational, and regulatory contexts. The process of partnership policing implementation can be better understood through an analysis of the legislative- versus voluntary-based operation of police partnerships and the commitment by organizations to providing resources, management support, performance systems, and organizational structure and policies that support these strategies.

Fairbairn N; Kerr T; Milloy MJ; Zhang R; Montaner J; Wood E. Crystal methamphetamine injection predicts slower HIV RNA suppression among injection drug users. Addictive Behaviors 36(7): 762-763, 2011. (10 refs.)

We examined the impact of crystal methamphetamine injection on HIV RNA suppression among a prospective cohort of HIV-positive injection drug users initiating antiretroviral therapy. A multivariate Cox regression analysis found crystal methamphetamine injection to be negatively associated with viral load suppression (RH = 0.63 [95% CI: 0.40-0.98]; p=0.039). This study is the first to our knowledge to demonstrate an association between crystal methamphetamine use and HIV RNA suppression.

Freeman P; Walker BC; Harris DR; Garofalo R; Willard N; Ellen JM; Adolescent Trials Network HIV AIDS. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Archives of Pediatrics & Adolescent Medicine 165(8): 736-740, 2011. (13 refs.)

Objectives: To examine methamphetamine use and its association with sexual behavior among young men who have sex with men. Design: Cross-sectional observational analysis. Setting: Eight US cities. Participants: As part of the Adolescent Trials Network for HIV/AIDS Interventions, adolescent boys and young men who have sex with men, aged 12 to 24 years, were recruited from social venues (eg, clubs, parks, and street corners) between January 3, 2005, and August 21, 2006, to complete a study survey. Main Outcome Measures: Reported methamphetamine use in the past 90 days and reported sexual risk behavior compared with individuals reporting no hard drug use and individuals reporting hard drug use in the past 90 days. Results: Among 595 adolescent boys and young men, 64 reported recent methamphetamine use, and 444 reported no recent hard drug use (87 reported use of hard drugs other than methamphetamine). Recent methamphetamine use was associated with a history of sexually transmitted diseases (51.6%), 2 or more sex partners in the past 90 days (85.7%), sex with an injection drug user (51.6%), and sex with someone who has human immunodeficiency virus (32.8%) compared with individuals reporting no recent hard drug use (21.1%, 63.1%, 10.7%, and 11.1%, respectively; P < .05 for all [n=441]). Recent users of methamphetamine were more likely to have a history of homelessness (71.9%) and were less likely to be currently attending school (35.9%) compared with individuals reporting no recent hard drug use (28.4% and 60.4%, respectively; P < .001 for both). Conclusions: Adolescent boys and young men who have sex with men and use methamphetamine seem to be at high risk for human immunodeficiency virus. Prevention programs among this age group should address issues like housing, polydrug use, and educational needs.

Galloway GP; Buscemi R; Coyle JR; Flower K; Siegrist JD; Fiske LA et al. A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction. Clinical Pharmacology & Therapeutics 89(2): 276-282, 2011. (49 refs.)

Sixty treatment-seeking individuals with methamphetamine (MA) dependence entered a randomized, placebo-controlled, double-blind clinical trial of oral dextroamphetamine (d-AMP) as a replacement therapy for MA dependence. The subjects took 60 mg sustained-release d-AMP for 8 weeks, during which time they received eight 50-min sessions of individual psychotherapy. Adverse events and urine toxicology for MA were assessed two times a week. There were no serious adverse events. Urine samples containing < 1,000 ng/ml of MA were classified as negative for MA. The MA-negative scores in the d-AMP group (3.1 +/- SD 4.6) were no higher than those in the placebo group (3.3 +/- SD 5.3; P > 0.05). However, withdrawal and craving scores were significantly lower in the d-AMP group (P < 0.05 for both). Although subjects taking d-AMP did not reduce their use of MA, the significant reductions observed in withdrawal and craving scores in this group support the need for further exploration of d-AMP as a pharmacologic intervention for MA dependence, possibly at higher doses.

Galloway GP; Coyle JR; Guillen JE; Flower K; Mendelson JE. A simple, novel method for assessing medication adherence: Capsule photographs taken with cellular telephones. Journal of Addiction Medicine 5(3): 170-174, 2011. (11 refs.)

Objectives: Medication nonadherence is an important factor in clinical practice and research methodology. Although many methods of measuring adherence have been investigated, there is as yet no "gold standard." We compared the usefulness and accuracy of a novel measure of adherence, photographs taken by cellular telephones with 2 incumbents: capsule count and the Medication Event Monitoring System (MEMS). Method: Twenty subjects participated in a clinical trial of the efficacy of modafinil for the treatment of methamphetamine dependence. Subjects were issued cell phones and medication in MEMS Cap equipped bottles and were instructed to take 1 capsule a day for 8 weeks, recording adherence with both systems. Pill counts were recorded at weekly inpatient visits. Subjects were paid for participation and for each capsule photograph and the returned medication bottle with MEMS Cap. Results: Capsule count-indicated adherence (proportion of prescribed medication taken) was 94.9%. When compared with capsule count, the novel method was found to underestimate adherence, whereas MEMS overestimated adherence. By using the dosing time data collected, we determined that subjects who dosed at a consistent time daily were more likely to adhere to the prescribed regimen. We also detected discrepancies in the timestamps recorded by MEMS. Conclusions: Capsule photographs are a useful measure of adherence, allowing more accurate time measures and more frequent adherence assessment than MEMS or capsule count. Given the ubiquity of cellular telephone use, and the relative ease of this adherence measurement method, we believe it is a useful and cost-effective approach.

Ghahremani DG; Tabibnia G; Monterosso J; Hellemann G; Poldrack RA; London ED. Effect of modafinil on learning and task-related brain activity in methamphetamine-dependent and healthy individuals. Neuropsychopharmacology 36(5): 950-959, 2011. (76 refs.)

Methamphetamine (MA)-dependent individuals exhibit deficits in cognition and prefrontal cortical function. Therefore, medications that improve cognition in these subjects may improve the success of therapy for their addiction, especially when cognitive behavioral therapies are used. Modafinil has been shown to improve cognitive performance in neuropsychiatric patients and healthy volunteers. We therefore conducted a randomized, double-blind, placebo-controlled, cross-over study, using functional magnetic resonance imaging, to examine the effects of modafinil on learning and neural activity related to cognitive function in abstinent, MA-dependent, and healthy control participants. Modafinil (200 mg) and placebo were administered orally (one single dose each), in counterbalanced fashion, 2 h before each of two testing sessions. Under placebo conditions, MA-dependent participants showed worse learning performance than control participants. Modafinil boosted learning in MA-dependent participants, bringing them to the same performance level as control subjects; the control group did not show changes in performance with modafinil. After controlling for performance differences, MA-dependent participants showed a greater effect of modafinil on brain activation in bilateral insula/ventrolateral prefrontal cortex and anterior cingulate cortices than control participants. The findings suggest that modafinil improves learning in MA-dependent participants, possibly by enhancing neural function in regions important for learning and cognitive control. These results suggest that modafinil may be a suitable pharmacological adjunct for enhancing the efficiency of cognitive-based therapies for MA dependence.

Gjerde H; Normann PT; Christophersen AS; Samuelsen SO; Morland J. Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: A case-control study. Accident Analysis and Prevention 43(3): 1197-1203, 2011. (50 refs.)

A case-control study was conducted on 204 drivers fatally injured in road traffic accidents in southeastern Norway during the period 2003-2008. Cases from single vehicle accidents (N = 68) were assessed separately. As controls, 10 540 drivers selected in a roadside survey in the same geographical area during 2005-2006 were used. Blood samples were collected from the cases and oral fluid (saliva) samples from the controls. Samples were analysed for alcohol, amphetamines, cannabis, cocaine, opioid analgesics, hypnotics, sedatives and a muscle relaxant; altogether 22 psychoactive substances. Equivalent cutoff concentrations for blood and oral fluid were used. The risk for fatal injury in a road traffic accident was estimated using logistic regression adjusting for gender, age, season of the year, and time of the week. The odds for involvement in fatal road traffic accidents for different substances or combination of substances were in increasing order: single drug < multiple drugs < alcohol only < alcohol + drugs. For single substance use: medicinal drug or THC < amphetamine/methamphetamine < alcohol. For most substances, higher ORs were found when studying drivers involved in single vehicle accidents than for those involved in multiple vehicle accidents, but confidence intervals were wider.

Gonzales R; Ang A; Glik DC; Rawson RA; Lee S; Iguchi MY. Quality of life among treatment seeking methamphetamine-dependent individuals. American Journal on Addictions 20(4): 366-372, 2011. (50 refs.)

As the number of men and women entering treatment for substance use disorders continues to increase across the country it becomes vitally important to understand their quality of life (QOL) or perceived health status, in order to inform treatment efforts for improving such outcomes. To date, QOL assessments among methamphetamine (MA) dependent users are limited. This paper examines QOL health status among a sample of 838 treatment seeking MA users at admission. Using regression analysis, predictors of QOL are examined among MA users. Predictors of poor QOL among MA users at treatment admission included being female, white, high school educated or more, married, experiencing psychosocial dysfunction (lifetime trauma, suicide, social conflict), reporting a high frequency of both MA and polydrugs for 15 days or more in the past month, chronicity of MA and polydrug use, injection use, and having co-morbid medical and psychiatric impairment. Employment status was the only factor related to better health status perceptions. This study expands the scope of scholarly examination of MA-dependent users entering treatment, as there has not been a development of coherent profiles of QOL among representative samples of clinical MA-abusing populations to date.

Guyll M; Spoth R; Crowley DM. Economic analysis of methamphetamine prevention effects and employer costs. Journal of Studies on Alcohol and Drugs 72(4): 577-585, 2011. (31 refs.)

Objective: The goal of this research was to evaluate economically three interventions designed to prevent substance use in general populations of adolescents, specifically focusing on the prevention of methamphetamine use and its subsequent benefits to employers. Method: In a randomized, controlled trial, three preventive interventions were delivered to 6th- or 7th-grade youth in 58 Iowa school districts, with 905 of these youth (449 girls) providing follow-up assessments as 12th graders. Intervention conditions included the family-focused Iowa Strengthening Families Program (ISFP), the school-based Life Skills Training (LST) program, and a combined condition of both the Strengthening Families Program: For Parents and Youth 10-14 (SFP10-14; an ISFP revision) plus LST (LST + SFP10-14). Analyses based on intervention costs, 12th-grade methamphetamine use rates, and methamphetamine-related employer costs yielded estimates of intervention cost, cost-effectiveness, benefit cost ratio, and net benefit. Results: The ISFP lowered methamphetamine use by 3.9%, cost $25,385 to prevent each case, and had a benefit cost ratio of 3.84, yielding a net benefit of $2,813 per youth. The LST program reduced methamphetamine use by 2.5%, required $5,122 per prevented case, and had a benefit cost ratio of 19.04, netting $2,273 per youth. The combined LST + SFP10-14 prevention condition lowered methamphetamine use rates by 1.8%, cost $62,697 to prevent each case, had a benefit cost ratio of 1.56, and netted $620 per youth. Findings were robust after varying a number of key parameters across a range of plausible values. Conclusions: Substance use prevention programming is economically feasible, particularly for effective interventions that have lower per person treatment delivery costs.

Hadland SE; Marshall BDL; Kerr T; Qi JZ; Montaner JS; Wood E. Depressive symptoms and patterns of drug use among street youth. Journal of Adolescent Health 48(6): 585- 590, 2011. (40 refs.)

Purpose: Rates of depression among street youth are poorly characterized, particularly as they pertain to concurrent drug use. We sought to assess associations between drug type and degree of depression in this population. Methods: Between October 2005 and November 2007, data were collected from a cohort of street-recruited youth aged 14-26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiology Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regression. Logistic regression was also used to assess adjusted odds of CES-D score >= 22. Results: Among 447 youth, mean CES-D score was the highest among heroin users (adjusted mean: 22.7; standard deviation [SD]: 1.2), followed by crystal methamphetamine users (adjusted mean: 21.8; SD: 1.1), then cocaine and/or crack users (adjusted mean: 19.1; SD: 1.0), and finally, marijuana users (adjusted mean: 18.3; SD: 1.1), resulting in a difference that was significant among groups (p < .001). When compared with daily marijuana users, odds of CES-D score >= 22 were higher among heroin users (adjusted odds ratio [AOR]: 2.64; 95% confidence interval [CI]: 1.39-4.99) and crystal methamphetamine users (AOR: 1.88; 95% CI: 1.04-3.42), but not among cocaine/crack users (AOR: 1.41; 95% CI: .79-2.52). Conclusion: To our knowledge, this is the first report of drug use typologies and depression among street youth. Policymakers might heed the apparent vulnerability of heroin and crystal methamphetamine users to even greater degrees of depression than their peers.

Hayashi K; Wood E; Suwannawong P; Kaplan K; Qi JZ; Kerr T. Methamphetamine injection and syringe sharing among a community-recruited sample of injection drug users in Bangkok, Thailand. Drug and Alcohol Dependence 115(1-2): 145- 149, 2011. (36 refs.)

Background: The recent growth in methamphetamine use internationally has raised concerns about the relationship between methamphetamine use and HIV infection. However, the risks associated with methamphetamine injection have not been fully described, particularly outside of Western countries. Therefore, we sought to examine the relationship between methamphetamine injection and syringe sharing among injection drug users (IDU) in Bangkok, Thailand. Methods: Using bivariate statistics and multivariate logistic regression, we examined the prevalence of methamphetamine injection and the relationship between more than weekly methamphetamine injection and syringe sharing among a community-recruited sample of IDU participating in the Mitsampan Community Research Project in Bangkok. Results: During June and July 2009, 311 IDU participated in this study, including 91(29.3%) women. In total, 114 (36.7%) participants reported having injected methamphetamine ("yaba") twice or more per week in the past six months. In multivariate analyses, after adjustment for potential social, demographic and behavioral confounders, syringe sharing remained independently associated with injecting methamphetamine more than once per week (adjusted odds ratio = 2.86, 95% confidence interval: 1.59-5.15). Conclusions: Over one-third of a community-recruited sample of Thai IDU reported more than weekly injection of methamphetamine, and methamphetamine injection was independently associated with syringe sharing. Essential HIV prevention services targeting IDU, such as syringe exchange and evidence-based addiction treatment, should be included in interventional efforts to address methamphetamine use in Thailand.

Henderson T. Neurologyeptic malignant syndrome in adolescents: Four probable cases in the Western Cape. South African Medical Journal 101(6): 405-407, 2011. (11 refs.)

Background. Neurologyeptic malignant syndrome (NMS) is a rare side-effect of neuroleptic medication. Most NMS reports have been on adults, and the incidence in children and adolescents is unknown. Objective. This report reviews cases of NMS to highlight possible risk factors for the development of NMS in adolescents. Method. Four cases of probable NMS in adolescents diagnosed in the Western Cape between February 2009 and March 2010 are presented. Results. Risk factors in the development of the syndrome in adolescents in the Western Cape may be male gender, polypharmacy, the use of zuclopenthixol acetate (clopixol acuphase), a previous history of extra-pyramidal side-effects or NMS, and a history of substance misuse - in particular methamphetamine. Conclusion. Caution must be applied in the apparent overuse of intramuscular antipsychotics, and especially zuclopenthixol acetate (clopixol acuphase), in neuroleptic-naive and agitated psychotic adolescents where the short-term use of benzodiazepines is more appropriate.

Huang KC; Zhang LN; Liu JH. Drug problems in contemporary China: A profile of Chinese drug users in a metropolitan area. International Journal of Drug Policy 22(2): 128- 132, 2011. (14 refs.)

Background: Drug problems are reemerging in China since the nation implemented economic reform and an "open door" policy in the early 1980s. This is causing both national and international concern. However, knowledge and understanding of the Chinese drug problem is fairly limited because of the nation's unique social and political history. In response to this shortage of information, our study presents a profile of Chinese drug users. Methods: Data were collected from a survey of drug users attending mandatory treatment centres in a large city in 2009. We present a demographic profile of the drug users, describe their patterns of drug use, their access to drugs and their history of drug treatment. Results: Chinese drug users, like those from the U.S., are likely to be unemployed and have a low level of education. However, they are more likely than those in the U.S. to use heroin, Bingdu (methamphetamine) and Maguo (a derivative of methamphetamine), and they pay less for their drugs. Conclusion: This profile of drug users is informative and valuable for drug prevention, intervention, and treatment in the Chinese setting because knowing and understanding the drug population is essential for effective control.

Huang YS; Tang TC; Lin CH; Yen CF. Effects of Motivational Enhancement Therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents. Substance Use & Misuse 46(4): 411-416, 2011. (28 refs.)

The aim of this study was to examine the effect of brief modified motivational enhancement therapy (MET) on readiness to change patterns of methylenedioxymethamphetamine (MDMA) and methamphetamine (MAMP) use behaviors in adolescents. A total of 94 adolescents who used MDMA or MAMP were consecutively recruited from a juvenile abstinence center; 46 received a three-session MET intervention (intervention group), and 48 received educational materials only and no MET intervention (control group). Analysis of covariance was performed to examine the effect of motivational interviewing on the readiness of change scores on the University of Rhode Island Change Assessment and on the scores of its subscales. By using the pretreatment scores as covariates, the intervention group demonstrated higher posttreatment scores of readiness to change and of the contemplation subscale on the University of Rhode Island Change Assessment than the control group. The results of this study support the finding that brief modified MET is effective in promoting readiness to change MAMP and MDMA use behaviors in adolescents who receive short-term treatment programs.

Irvine RJ; Kostakis C; Felgate PD; Jaehne EJ; Chen C; White JM. Population drug use in Australia: A wastewater analysis. Forensic Science International 210(1-3): 69-73, 2011. (26 refs.)

Accurate information on drug use in communities is essential if health, social and economic harms associated with illicit drug use are to be addressed efficiently. In most countries population drug use is estimated indirectly via surveys, medical presentations and police and custom seizures. All of these methods have at least some problems due to bias, small samples and/or long time delays between collecting the information and analysing the results. Recently the direct quantification of drug residues in wastewater has shown promise as a means of monitoring drug use in defined geographical areas. In this study we measured 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine and benzoylecgonine in sewage inflows in metropolitan and regional areas of Australia and compared these data with published European data. Cocaine use was small compared to European cities (p < 0.001) but was compensated for by much greater consumption of methamphetamine (p < 0.001) and MDMA (p < 0.05). MDMA was more popular in regional areas (p < 0.05) whereas methamphetamine and cocaine were mainly consumed in the city (p < 0.05). Greater than 5-fold increases in MDMA use were detected on weekends (p < 0.001). This approach has the potential to improve our understanding of drug use in populations and should be further developed to improve prevention and treatment programs.

Kalechstein AD; Yoon JH; Croft DE; Jaeggi S; Mahoney JJ; De la Garza R. Low dose, short-term rivastigmine administration does not affect neurocognition in methamphetamine dependent individuals. Pharmacology, Biochemistry and Behavior 99(3): 423-427, 2011. (27 refs.)

Neurocognitive impairment is a well-documented consequence of methamphetamine addiction. Not surprising, methamphetamine-associated neurocognitive impairment has been identified as an important target of treatment. Thus, this study sought to determine whether rivastigmine, an acetylcholinesterase inhibitor and cognition enhancing agent, could improve neurocognitive performance in a sample of long-term, high-dose methamphetamine addicts who were not seeking treatment at the time of enrollment in the study. This double-blind, placebo-controlled study evaluated whether a daily dose 0, 3, or 6 mg of rivastigmine, administered over six consecutive days, would enhance performance on measures of attention/information processing speed, episodic memory, and executive/frontal lobe functioning relative to test performance at baseline. The results revealed that rivastigmine did not alter neurocognition in this cohort. There are a number of factors that may have mitigated the effects of rivastigmine in this particular study, including especially the short-term, low-dose treatment regimen utilized. The negative findings notwithstanding, the study serves as a springboard for future investigations that will examine whether other medications can alter neurocognition in methamphetamine dependent study participants.

Katz G; Durst R; Shufman E; Bar-Hamburger R; Grunhaus L. A comparative study of psychiatric inpatients in a general hospital and a psychiatric hospital in Israel: Demographics, psychopathological aspects and drug abuse patterns. Israel Medical Association Journal 13(6): 329-332, 2011. (22 refs.)

Background: Some specialists and policy makers advocate progression of the mental health reform in Israel by transferring beds from psychiatric to general hospitals. Objectives: To compare the demographic, diagnostic and psychopathological profiles of psychiatric inpatients hospitalized in psychiatric and general hospitals, as well as their patterns of drug abuse, and to estimate the preparedness of general hospitals for the possible expansion of their psychiatric services. Methods: Between 2002 and 2006 a total of 250 patients were consecutively admitted to the Jerusalem Mental Health Center-Kfar Shaul Hospital and 220 to the psychiatric department of Sheba Medical Center, a general hospital in central Israel; the patients' ages ranged from 18 to 65. The two groups were compared for demographic features, psychiatric diagnoses and severity of psychopathology (utilizing PANSS, HAD-21, YMRS rating scales). Drug abuse was diagnosed by urine analyses and self-report. Results: The patients in the psychiatric hospital were significantly younger, predominantly male, and more dependent on social security payments. In the general hospital, diagnoses of affective and anxiety disorders prevailed, while in the psychiatric hospital schizophrenic and other psychotic patients constituted the majority. The patients in the general hospital were decidedly more depressed; in the psychiatric hospital, notably higher rates of manic symptoms as well as positive, negative and general schizophrenic symptoms were reported. For the most abused substances (opiates, cannabis and methamphetamines) the rates in the psychiatric hospital were significantly higher. Conclusions: The differences between the two groups of inpatients were very pronounced, and therefore, the transferring of psychiatric beds to general hospitals could not be done without serious and profound organizational, educational and financial changes in the psychiatric services of general hospitals. Since each of the two inpatient systems has particular specializations and experience with the different subgroups of patients, they could coexist for a long time.

Kay-Lambkin FJ; Baker AL; Lee NM; Jenner L; Lewin TJ. The influence of depression on treatment for methamphetamine use. Medical Journal of Australia 195(3, supplement): S38-S43, 2011. (22 refs.)

Objective: To determine whether the presence of comorbid depression influences response to psychological treatment for methamphetamine use. Design: Randomised controlled clinical trial. Setting and participants: Our study was conducted between 2001 and 2005 at two sites in Australia: the Hunter Region of New South Wales and the city of Brisbane, Queensland. The 214 participants, who were all using methamphetamine at least once a week in the month prior to the study, were self-referred or referred from health services or drug and alcohol clinical services. Participants were divided into two groups based on whether or not they had depressive symptoms at baseline. Interventions: The control group received only a self-help booklet; the two treatment groups received either two or four, counselling sessions involving cognitive behaviour therapy and motivational interviewing techniques to manage methamphetamine use. Main outcome measures: Changes in methamphetamine use and depression at 5 weeks and 6 months after baseline. Results: Over 70% of participants met criteria for depression at baseline, and depression was associated with significantly greater severity of methamphetamine use and related issues. Benzodiazepine use was significantly higher among depressed than non-depressed participants. Reductions in methamphetamine use between baseline and 5 weeks were independently predicted by comorbid depression, in favour of increased change among those with baseline depression. Depressed participants who received three or four counselling sessions showed a significant reduction in depression at 5 weeks. However, reductions in methamphetamine use and depression compared with baseline were no longer evident at 6 months. Conclusions: Over the short term, comorbid depression did not negatively affect response to treatment, with some evidence of a dose response treatment effect for reduction in depression. This was not maintained at 6 months, indicating that methamphetamine-focused treatment may not enable people with comorbid depression to make sustained improvement at the level of their counterparts without depression.

Kenny P; Harney A; Lee NK; Pennay A. Treatment utilization and barriers to treatment: Results of a survey of dependent methamphetamine users. Substance Abuse, Treatment, Prevention and Policy 6: article 3, 2011. (23 refs.)

Background: Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group. Methods: One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment. Results: Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence). Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group. Discussion and Conclusions: To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users.

Kim YT; Kwon DH; Chang YM. Impairments of facial emotion recognition and theory of mind in methamphetamine abusers. Psychiatry Research 186(1): 80-84, 2011. (45 refs.)

Chronic use of methamphetamine is related to behavioral disturbances including depression, aggressive behavior, and social isolation. These alterations of social behavior may be attributable to impairments in social cognition. However, few studies have evaluated social cognition in methamphetamine (MA) abusers. Therefore, the aim of the present study was to investigate whether MA abusers exhibit social cognition deficits in terms of facial emotion recognition and theory of mind (ToM). We also assessed cognitive Flexibility by using the Wisconsin Card Sorting Test (WCST) to evaluate the impact of this function on social cognition. Twenty-eight MA abusers and twenty-seven healthy subjects enrolled in this study. All participants performed the Facial Emotion Recognition Task and advanced ToM tasks such as the Eye Test and Hinting Task. The Korean Wechsler Adult Intelligence Scale Revised and computerized versions of the WCST were also administrated. The performances of MA abusers on the Facial Emotion Recognition Task and Eyes Test were lower than those of healthy subjects. In the WCST, MA abusers completed significantly fewer categories and made more total and perseverative errors than healthy subjects did. In addition, impairments in cognitive flexibility are correlated with impairments in facial emotion recognition and ToM within MA abusers. These findings lend further support to the assertion that the capacity to identify emotions from facial expression and infer mental state of others is impaired in MA abusers. Therefore, treatment and rehabilitation for MA abusers must consider role of social cognition and include relearning social interactions and behaviors.

Korte JE; Hiott FB; Brady KT; Malcolm RJ; See RE. Distinctive characteristics of methamphetamine users presenting at public clinics: Steep rise in South Carolina, United States, 2000-2005. Drug and Alcohol Dependence 115(1-2): 9- 15, 2011. (38 refs.)

Background: Illicit methamphetamine use has risen dramatically over the last decade. We sought to examine methamphetamine use among individuals presenting for drug treatment in South Carolina, USA, to assess trends over time, correlates of methamphetamine use, and the relationship between methamphetamine use and functional/behavioral problems. Methods: Data from 2000 to 2005 were obtained from a state-wide network of substance abuse clinics. We examined time trends, and compared sociodemographic characteristics and problems with daily functioning (Axis IV and Axis V disorders) of methamphetamine users vs. other drug users. Results: Of 235,415 individuals presenting or being admitted to a clinic, 3526 reported illicit methamphetamine use. The prevalence of methamphetamine use as a presenting problem increased dramatically across the six-year period, especially in the rural Upstate region (0.4-6.1%). In comparison to other drug users presenting or admitted to treatment during this same time period, methamphetamine users were more likely to be female, between 20 and 40 years old, and non-Hispanic white ethnicity. In addition, more methamphetamine users had occupational (49% vs. 43%, p < 0.001) or economic problems (41% vs. 35%, p < 0.001), and problems with their primary support group (58% vs. 54%, p < 0.05). However, the prevalence of Axis IV and Axis V problems were not statistically different between the two groups. Conclusions: The rapid escalation of methamphetamine use in South Carolina and elsewhere highlights the need for longitudinal studies to better understand the etiology and characteristics associated with methamphetamine uptake and addiction, and to develop the knowledge base required for more effective prevention and treatment.

Kuo CJ; Tsai SY; Liao YT; Conwell Y; Lin SK; Chang CL et al. Risk and protective factors for suicide among patients with methamphetamine dependence: A nested case-control study. Journal of Clinical Psychiatry 72(4): 487- 493, 2011. (35 refs.)

Objective: Methamphetamine as a recreational drug has undergone cycles of popularity, with a recent surge worldwide since the 1990s. This study aimed to identify clinical characteristics associated with suicide mortality in patients with methamphetamine dependence by means of a nested case-control design. Method: In a consecutive series of 1,480 inpatients with methamphetamine dependence (diagnosed according to DSM-III-R and DSM-IV criteria) admitted to a psychiatric center in northern Taiwan from January I, 1990, through December 31, 2006, 38 deaths due to suicide were identified as cases via record linkage, and 76 controls were randomly selected using risk-set density sampling in a 2:1 ratio, matched for age, sex, and the year of index admission. A standardized chart review process was adopted to collate sociodemographic and clinical information for each study subject. Multivariate conditional logistic regression analysis was used to identify correlates of suicide among these patients. Results: For the sociodemographic and symptom profiles at the latest admission, financial independence lowered the risk for suicide (adjusted risk ratio [ARR] = 0.33, P<.05), whereas visual hallucinations elevated the risk (ARR = 2.57, P<.05) for suicide. For the profiles during the postdischarge period, financial independence (ARR = 0.11, P<.05) remained associated with reduced risk for suicide, whereas suicide attempt (ARR = 8.78, P<.05) and depressive syndrome (ARR = 3.28, P = .059) were associated with increased risk of suicide. Conclusions: Both protective and risk factors for suicide mortality were found among inpatients with methamphetamine dependence, and the findings have implications for clinical intervention and prevention.

Lee S; Han E; In S; Choi H; Chung H; Chung KH. Analysis of pubic hair as an alternative specimen to scalp hair: A contamination issue. Forensic Science International 206(1-3): 19-21, 2011. (8 refs.)

Pubic hair is often analyzed as an alternative to scalp hair to prove previous drug use. However, urine is a potential source of external contamination. In the present study, the concentrations of methamphetamine (MA) and amphetamine (AP) in both scalp and pubic hair from illegal MA users were compared. Furthermore, in order to investigate the external contamination of pubic hair by urine, MA and AP absorbed into pubic hair that had been contaminated with authentic urine from a MA user were measured using a previously validated method. The effect of shampoo-wash on the contaminated pubic hair was also examined. However, no correlation was found in the MA and AP concentrations between scalp and pubic hair from illegal MA users. As the number of contamination events by authentic urine increased, the concentrations of MA and AP in pubic hair increased. Both MA and AP were detected in the first methanol washes of the contaminated hair samples but were not detected in the second methanol washes. As the number of shampoo-washes of the contaminated pubic hair increased, the concentrations of MA and AP gradually decreased. Even though pubic hair can be used as an alternative to scalp hair to prove previous drug use, it should be avoided when estimating drug use history. It should be also noted that higher quantitative results in pubic hair do not necessarily represent heavier drug use.

Li LH; Galloway GP; Verotta D; Everhart ET; Baggott MJ; Coyle JR; Lopez JC; Mendelson J. A method to quantify illicit intake of drugs from urine: Methamphetamine. Journal of Pharmacology and Experimental Therapeutics 338(1): 31-36, 2011. (16 refs.)

Qualitative urinalysis can verify abstinence of drug misuse but cannot detect changes in drug intake. For drugs with slow elimination, such as methamphetamine (MA), a single episode of abuse can result in up to 5 days of positive urine drug screens. Thus, interventions that produce substantial decreases in drug use but do not achieve almost complete abstinence are classified as ineffective. Using nonpharmacologic doses of deuterium-labeled /-methamphetamine (/-MA-d(3)) we have developed a simple, robust method that reliably estimates changes in MA intake. Twelve subjects were dosed with 5 mg of /-MA-d(3) daily and challenged with 15, 30, and 45 mg of nonlabeled d-MA (d-MA-d(0)) after reaching plasma steady status of /-MA-d(3). Urinary concentration ratios of d-MA-d(0) to l-MA-d(3) provided clear separation of the administered doses with as little as 15-mg dose increments. Administered doses could not be resolved using d-MA-d(0) concentrations alone. In conclusion, the urinary [d-MA-d(0)]:[/-MA-d(3)] provides a quantitative, continuous measure of illicit MA exposure. The method reliably detects small, clinically relevant changes in illicit MA intake from random urine specimens, is amenable to deployment in clinical trials, and can be used to quantify patterns of MA abuse.

Liao MZ; Jiang ZX; Zhang XJ; Kang DM; Bi ZQ; Liu XZ et al. Syphilis and methamphetamine use among female sex workers in Shandong Province, China. Sexually Transmitted Diseases 38(1): 57-62, 2011. (31 refs.)

A study of female sex workers in China, found alarmingly high prevalence of methamphetamine use. Methamphetamine users were more likely to be single, younger, inconsistent condom users, and have syphilis.

Mancino MJ; Gentry BW; Feldman Z; Mendelson J; Oliveto A. Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: A pilot field study. American Journal of Drug and Alcohol Abuse 37(2): 131-136, 2011. (27 refs.)

Background: Methamphetamine dependence has become a significant problem, but methamphetamine withdrawal symptoms have not been well studied. Methods: This prospective observational pilot study was designed to examine withdrawal symptoms, mood, anxiety, cognitive function, and subjective measures of sleep over a 4-week period in six patients entering residential treatment for methamphetamine dependence. Results: Methamphetamine withdrawal symptoms, mood, and anxiety symptoms all resolve fairly quickly within 2 weeks of cessation of methamphetamine. Sleep was disrupted over the course of the 4-week study. No clinically significant alterations in blood pressure or heart rate were identified. This study did not demonstrate any alterations in cognitive function over the 4 weeks of the residential stay. Conclusions: This pilot study points toward the need for a double-blind, placebo-controlled amphetamine withdrawal paradigm in humans where changes in sleep, cognitive function, and withdrawal measures can be explored more fully. Scientific significance: This study extends the literature by pointing toward a methamphetamine withdrawal syndrome that includes alterations in measures of sleep quality and refreshed sleep, early improvement in depression and anxiety symptoms, most striking during the first week, but persisting into the second week.

Marshall BDL; Wood E; Shoveller JA; Buxton JA; Montaner JSG; Kerr T. Individual, social, and environmental factors associated with initiating methamphetamine injection: Implications for drug use and HIV prevention strategies. Prevention Science 12(2): 173-180, 2011. (65 refs.)

The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study's commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study's conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95-0.98), female sex (aHR: 0.58, 95%CI: 0.41-0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18-2.23), using drugs in Vancouver's drug scene epicentre (aHR: 2.15 95%CI: 1.49-3.10), homelessness (aHR: 1.43, 95%CI: 1.01-2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36-3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03-6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city's open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.

Marshall BDL; Wood E; Shoveller JA; Patterson TL; Montaner JSG; Kerr T. Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: A multi-cohort gender-based analysis. BMC Public Health 11: e-article 20, 2011. (51 refs.)

Background: Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users. Methods: Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth. Results: At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027). Conclusions: Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.

Matsusue A; Hara K; Kashiwagi M; Kageura M; Sugimura T; Kubo S. Genetic analysis of the rhabdomyolysis-associated genes in forensic autopsy cases of methamphetamine abusers. Legal Medicine 13(1): 7-11, 2011. (44 refs.)

Methamphetamine (MA) use sometimes causes rhabdomyolysis, which has been associated with mortality. We analyzed potential rhabdomyolysis-susceptibility genes from autopsy samples of 18 methamphetamine abusers. We examined mutations in the ryanodine receptor 1 (RYR 1), carnitine palmitoyl-transferase II (CPT II), very long-chain acyl-CoA dehydrogenase (VLCAD), and cytochrome P450 (CYP) 2D6 genes. Different RYR1 mutations that caused amino acid substitutions ((612)Ala > Thr and (4295)Ala > Val) were identified in 2 cases. In the CPT II gene, there was a new mutation ((545)Glu > Ala) in 1 case and there were mutations that did not change activity in 17 cases. In the VLCAD gene, there were mutations that did not change activity in 6 cases. In the CYP2D6 gene, homozygosity for CYP2D6*10, which is associated with significantly reduced metabolic activity, was found in 3 cases, while 2 cases carried a different previously unreported missense mutation ((344)Arg > Gln and (48)His > Tyr). RYR1 mutations and the new CPT II mutation identified in this study were not observed in a control group. Eighteen cases that were genetically analyzed were also investigated immunohistochemically to diagnose the possibility of rhabdomyolysis. However, there were no significant mutations that reduced enzyme activity in the suspected cases of rhabdomyolysis. These data suggested no obvious relationship between the genetic mutations observed in this study and rhabdomyolysis.

McKetin R; Lubman DI; Lee NM; Ross JE; Slade TN. Major depression among methamphetamine users entering drug treatment programs. Medical Journal of Australia 195(3, supplement): S51-S55, 2011. (18 refs.)

Objective: To determine the prevalence of major depression among people entering treatment for methamphetamine use. Design, setting and participants: The study was a cross-sectional survey involving 41 specialised drug and alcohol treatment agencies in Brisbane and Sydney. Services provided by these agencies included residential rehabilitation, detoxification and counselling. Participants were 400 people entering treatment for methamphetamine use who were recruited from participating treatment agencies between January 2006 and November 2007. Participants underwent a structured, face-to-face, 1.5-hour interview. Assessment instruments included the Composite International Diagnostic Interview and the Short Form 12. Main outcome measure: Diagnosis of a major depressive episode in the year prior to the study. Results: The prevalence of major depression in the year prior to the study was 40% (95% Cl, 35%-44%). A noteworthy post-hoc observation was that a further 44% of participants met the symptom criteria for major depression but were excluded from a diagnosis because their symptoms were better accounted for by psychoactive substance use. Both major depression and these latter cases of "substance-induced depression" were associated with severe symptoms of depression, high levels of disability and suicidal ideation. Conclusion: Most people entering treatment programs for methamphetamine use have levels of depression that require clinical management. Making a diagnosis of major depression in the context of heavy methamphetamine use is problematic because of substance-induced symptoms of depression.

Mendelson J; Baggott MJ; Flower K; Galloway G. Developing biomarkers for methamphetamine addiction. Current Neuropharmacology 9(1): 100-103, 2011. (29 refs.)

There are an estimated 11.7 million methamphetamine (MA) abusers in the United States and epidemics of MA addiction are occurring worldwide. In our human laboratory and outpatient clinical trials we use innovative methods to quantify the severity of MA addiction and test biomarkers that may predict response to therapy or risk of relapse. One potential biomarker of addiction is the quantity of abused drug intake. Qualitative urinalysis is used in clinical trials and during treatment but provides only a binary outcome measure of abuse. Using non-pharmacologic doses of deuterium labeled l-MA we have developed a continuous quantitative measure to estimate the bioavailable amount of MA addicts ingest. Brain Derived Neurotrophic Factor is a neurotrophin that encourages growth and differentiation of new neurons and synapses. Low BDNF levels are seen in many addictive disorders and BDNF is elevated in recovering MA addicts, suggesting BDNF may be a marker of MA addiction. We are investigating the effects of controlled doses of MA on BDNF levels and gene regulation and measuring BDNF in our clinical trials. We believe both patients and clinical researches will benefit from the addition of new, objective and quantifiable outcome measures that reflect disease severity and recovery from addiction.

Montanari L; Serafini M; Maffli E; Busch M; Kontogeorgiou K; Kuijpers W. Gender and regional differences in client characteristics among substance abuse treatment clients in the Europe Union. Drugs: Education, Prevention and Policy 18(1): 24-31, 2011. (24 refs.)

Aims: To assesses the extent of the gender gap among the treated population of drug users across Europe. Methods: This analysis reports data on 363,170 clients from 4647 treatment units in 23 countries (22 European Union member states and Switzerland). Findings: Overall, males outnumber females by four, but the gender ratio varies not only by geographical region/country, but also by drug. In the majority of countries, the most common primary problem drug is opioids, and the overall gender ratio mirrors the gender ratio of opioid users. In some countries, a considerable proportion of treated drug users have cannabis and stimulants (cocaine/amphetamines/methamphetamines) as primary problem drugs. Stimulants other than cocaine and other drugs have lower, while cannabis has a higher than overall male-to-female gender ratio. Conclusions: The very high male-to-female gender ratios may reveal differential access to treatment. Our findings highlight the need to assess access to treatment for women problem drug users and to make women-focussed programmes more available to increase the proportion of women in drug treatment programmes across Europe.

Mravcik V; Skarupova K; Orlikova B; Zabransky T; Karachaliou K; Schulte B. Use of gelatine capsules for application of methamphetamine: A new harm reduction approach. International Journal of Drug Policy 22(2): 172- 173, 2011. (10 refs.)

Background: In order to reduce injecting drug use, low-threshold facilities in the Czech Republic have started to distribute empty gelatine capsules as an oral alternative of drug application for those injecting methamphetamine. This report reviews implementation of this intervention and its possible benefits and limitations. Methods: Between December 2008 and January 2009,109 low-threshold facilities were asked to complete a questionnaire about the capsule programmes. Two focus groups were conducted, one with professionals involved in distribution and one with peer outreach workers who were interviewed on their experience of using the capsules. Results: A total of 50 facilities (46%) responded to the questionnaire; 16 (32%) distributed the capsules regularly and 19(38%) were planning to introduce this practice. The main target groups were injecting users of methamphetamine whose veins had been damaged, and methamphetamine users wishing to reduce injecting. The advantages of capsules, as perceived by service staff and peer outreach workers, were their easy use and the satisfactory effect of the oral application; health risks related to the oral use of methamphetamine were considered drawbacks. Conclusion: Capsule distribution is a promising harm reduction approach for injectors of methamphetamine or other stimulants; nonetheless its benefits and limitations should be further analysed in an in-depth longitudinal study.

Nakamura N; Semple SJ; Strathdee SA; Patterson TL. HIV risk profiles among HIV-positive, methamphetamine-using men who have sex with both men and women. Archives of Sexual Behavior 40(4): 793-801, 2011. (38 refs.)

This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.

Nonnemaker J; Engelen M; Shive D. Are methamphetamine precursor control laws effective tools to fight the methamphetamine epidemic? Health Economics 20(5): 519-531, 2011. (27 refs.)

One of the most notable trends in illegal substance use among Americans over the past decade is the dramatic growth and spread of methamphetamine use. In response to the dramatic rise in methamphetamine use and its associated burden, a broad range of legislations has been passed to combat the problem. In this paper, we assess the impact of retail-level laws intended to restrict chemicals used to manufacture methamphetamine (methamphetamine precursor laws) in reducing indicators of domestic production, methamphetamine availability, and the consequences of methamphetamine use. Specifically, we examine trends in these indicators of methamphetamine supply and use over a period spanning the implementation of the federal Methamphetamine Anti-Proliferation Act (MAPA) (October 2000) and a more stringent state-level restriction enacted in California (January 2000). The results are mixed in terms of the effectiveness of legislative efforts to control methamphetamine production and use, depending on the strength of the legislation (California Uniform Controlled Substances Act versus federal MAPA), the specification of the comparison group, and the particular outcome of interest. Some evidence suggests that domestic production was impacted by these legislative efforts, but there is also evidence that prices fell, purities rose, and treatment episodes increased.

Okahisa Y; Kodama M; Takaki M; Inada T; Uchimura N; Yamada M et al. Association study of two cannabinoid receptor genes, CNR1 and CNR2, with methamphetamine dependence. Current Neuropharmacology 9(1): 183-189, 2011. (41 refs.)

Several studies have suggested that the endocannabinoid system plays significant roles in the vulnerability to psychiatric disorders including drug abuse. To examine the possible association of the CNR1 and CNR2 genes, which encode cannabinoid receptors CB1 and CB2, with methamphetamine dependence, we investigated three single nucleotide polymorphisms (SNPs) (rs806379, rs1535255, rs2023239) in intron 2 of the CNR1 gene and a nonsynonymous SNP, Q63R, in the CNR2 gene. The study samples consisted of 223 patients with methamphetamine dependence and 292 age-and sex-matched controls. There were no significant differences between the patients and controls in genotypic or allelic distribution of any SNP of the CNR1 and CNR2 genes. We also analyzed the clinical features of methamphetamine dependence. Rs806379 of the CNR1 gene showed a significant association with the phenotype of latency of psychosis after the first consumption of methamphetamine. Patients with the T allele or T-positive genotypes (T/T or A/T) may develop a rapid onset of psychosis after methamphetamine abuse. The present study suggests a possibility that genetic variants of the CNR1 gene may produce a liability to the complication of psychotic state after abuse of methamphetamine; however, our findings need to be confirmed by future replications.

Okochi T; Kishi T; Ikeda M; Kitajima T; Kinoshita Y; Kawashima K et al. Genetic association analysis of NOS3 and methamphetamine-induced psychosis among Japanese. Current Neuropharmacology 9(1): 151-154, 2011. (15 refs.)

Endothelial nitric oxide synthase (NOS3) is one of the enzymes influencing nitric oxide (NO) function in the human brain. NO is a gaseous neurotransmitter that is involved in a variety of mechanisms in the central nervous system, such as N-methyl-D-aspartate receptor activation and oxidative stress. The evidence from animal pharmacological studies and postmortem studies supports an association between NO and psychotic disorders. Methamphetamine (METH) use disorder is a known psychotic disorder, and we therefore conducted a gene-based case-control study between tagging single nucleotide polymorphisms (SNPs) (rs2070744, rs1799983) in NOS3 and METH-induced psychosis in Japanese subjects (183 with METH-induced psychosis and 267 controls). Written informed consent was obtained from each subject. No significant association was found between any tagging SNP in NOS3 and METH-induced psychosis in the allele/genotype-wise or haplotype-wise analyses. In conclusion, we suggest that NOS3 might not contribute to the risk of METH-induced psychosis in the Japanese population.

Okumura T; Okochi T; Kishi T; Ikeda M; Kitajima T; Kinoshita Y et al. Genetic association analysis of NOS1 and methamphetamine-induced psychosis among Japanese. Current Neuropharmacology 9(1): 155-159, 2011. (18 refs.)

The neuronal nitric oxide synthase gene (NOS1) is located at 12q24, a susceptibility region for schizophrenia, and produces nitric oxide (NO). NO has been reported to play important roles as a gaseous neurotransmitter in brain. NO is a second messenger for the N-methyl-D aspartate (NMDA) receptor and is related to the dopaminergic system. Because the symptomatology of methamphetamine (METH) use disorder patients with psychosis is similar to that of patients with schizophrenia, NOS1 is a good candidate gene for METH-induced psychosis. Therefore, we conducted a case-control association study between NOS1 and METH-induced psychosis with Japanese subjects (183 with METH-induced psychosis patients and 519 controls). We selected seven SNPs (rs41279104, rs3782221, rs3782219, rs561712, rs3782206, rs6490121, rs2682826) in NOS1 from previous reports. Written informed consent was obtained from each subject. This study was approved by the Ethics Committee at Fujita Health University School of Medicine and each participating institute of the Japanese Genetics Initiative for Drug Abuse (JGIDA). No significant association was found between NOS1 and METH-induced psychosis in the allele/genotype-wise or haplotype-wise analyses. In conclusion, we suggest that NOS1 might not contribute to the risk of METH-induced psychosis in the Japanese population.

Oser C; Leukefeld C; Staton-Tindall M; Duvall J; Garrity T; Stoops W et al. Criminality among rural stimulant users in the United States. Crime & Delinquency 57(4): 600- 621, 2011. (47 refs.)

Despite the increase in media attention on "meth cooking" in rural areas of the United States, little is known about rural stimulant use-particularly, the criminality associated with stimulant use. Data were collected from community stimulant users in rural Ohio, Arkansas, and Kentucky (N = 709). Findings from three logistic regression models indicate that younger stimulant users (M = 32.55, SD = 10.35), those with more convictions, and those who used crack frequently were significantly more likely to have been arrested for committing a substance-related crime, a property crime, or another crime in the 6 months before entering the study. Implications include the need for longitudinal studies to further understand rural stimulant use, as well as increased community and corrections-based drug abuse prevention and treatment interventions for stimulant users who live in rural areas.

Parrott AC; Gibbs A; Scholey AB; King R; Owens K; Swann P et al. MDMA and methamphetamine: Some paradoxical negative and positive mood changes in an acute dose laboratory study. Psychopharmacology 215(3): 527- 536, 2011. (58 refs.)

This study investigated the acute mood effects of oral MDMA, methamphetamine, and placebo in a double-blind laboratory study. Fifty-two healthy participants comprised abstinent recreational users of stimulant drugs, 27 female and 25 male, mean age 24.8 years. Three test sessions involved acute 100 mg oral 3.4-methylendioxymethamphetamine (MDMA), 0.42 mg/kg oral methamphetamine, and matching placebo. Drug administration was counterbalanced, testing was double-blind, and medical supervision was present throughout. Car-driving performance on a laboratory simulator was assessed after 3 and 24 h, with the findings being presented elsewhere. Positive and negative moods (PANAS self-ratings) were completed before drug administration, 3, 4.5, and 24 h later. Blood samples were taken to monitor drug plasma levels. Following MDMA, there were no significant increases in positive moods, whereas negative moods were significantly higher than under placebo. Methamphetamine led to significant increases in both positive and negative moods. The MDMA findings contrast with the elated moods, typically noted by dance clubbers on Ecstasy. However, they are consistent with some previous laboratory findings, since a wide array of positive and negative mood changes have been demonstrated. One possible explanatory factor was the neutral environmental situation, particularly if a primary action of MDMA is to intensify ongoing psychological states. Other explanatory factors, such as dosage, gender, post-drug timing, neurohormonal aspects, and social factors, are also discussed. In the laboratory, acute methamphetamine led to significantly higher positive moods. However, against expectations, MDMA did not generate a significant increase in positive moods.

Pennay AE; Lee NK. Putting the call out for more research: The poor evidence base for treating methamphetamine withdrawal. (review). Drug and Alcohol Review 30(2): 216-222, 2011. (57 refs.)

Issues. Treatment seeking for methamphetamine withdrawal is low in Australia. Insufficient knowledge regarding the withdrawal syndrome of methamphetamine and the appropriate management of these symptoms may be a contributing factor to the low treatment attendance. Approach. A systematic review was performed using a range of electronic databases. Key Findings. Common methamphetamine withdrawal symptoms include symptoms relating to depression, agitation, cognitive impairment and fatigue. These symptoms may last anywhere from a few days to a few months. Methamphetamine withdrawal is most commonly undertaken in an outpatient setting, and psychosocial interventions remain the primary treatment approach in Australia. Two withdrawal scales (Amphetamine Withdrawal Questionnaire and Amphetamine Cessation Symptom Assessment) have been validated for the assessment of methamphetamine withdrawal. Only a small number of medications for methamphetamine withdrawal have been investigated, and to date no medications stand out over the others. Implications. Current recommendations for methamphetamine withdrawal tend to be based on clinical opinion and subsequently vary between settings. More research in the area is essential to ensure the development of more targeted, timely and effective withdrawal treatment interventions. Conclusion. The review exposed a lack of well-conducted research targeted towards the management of methamphetamine withdrawal. Further research is essential, and should focus on understanding the nature of methamphetamine withdrawal, its duration, course and effective treatment.

Postigo C; de Alda ML; Barcelo D. Evaluation of drugs of abuse use and trends in a prison through wastewater analysis. Environment International 37(1): 49-55, 2011. (26 refs.)

Illicit drugs and metabolites have been recognized recently as a group of emerging contaminants of concern, as a consequence of their high volumes of use and production. Drug residue levels in the aquatic environment have also been pointed out as good indicators of illicit drug abuse. The present work assesses for the first time drug abuse in a penal complex from the levels of different drug residues measured in the prison sewage waters and evaluates the suitability of this approach to track and control illicit drug usage in such facilities. The presence of various drugs of abuse and metabolites in sewage waters from a penal complex was determined by an analytical method based on on-line solid phase extraction-liquid chromatography-tandem mass spectrometry. Levels of consumption indicators measured in this water were used to back-calculate drugs usage in the penal complex. Daily use was observed for methadone (average of 156 doses/day/1000 inh), alprazolam (129 doses/day/1000 inh), ephedrine (46 doses/day/1000 inh), cannabis (33 doses/day/1000 inh.) and cocaine (3 doses/day/1000 inh). Sporadic consumption was observed for heroin, amphetamine, methamphetamine, and ecstasy. In spite of the fact that this and other sewage epidemiological approaches described may suffer from bias that still need to be investigated and refined, it provides near "real-time" information on collective drug use in an anonymous way and constitutes a very useful, economic and fast tool to evaluate the efficiency of measures adopted to control and track drug abuse in this type of facilities (or any other provided that has a STP associated or an accessible collector system).

Roettger ME; Swisher RR; Kuhl DC; Chavez J. Paternal incarceration and trajectories of marijuana and other illegal drug use from adolescence into young adulthood: Evidence from longitudinal panels of males and females in the United States. Addiction 106(1): 121-132, 2011. (52 refs.)

Aims: One-eighth of young adults in the United States report that their biological father has ever been incarcerated (FEI). This study is the first to examine associations between FEI and trajectories of substance use during the transition from adolescence into young adulthood for the US population. Design: Using multi-level modeling techniques, trajectories of marijuana and other illegal drug use are examined, with FEI as the primary independent variable. Setting: Data are from the first three waves of the National Longitudinal Study of Adolescent Health, a nationally representative sample of US adolescents beginning in 1995. Participants: Panels of 7157 males and 7997 females followed from adolescence (7th-12th grades) into early adulthood (ages 18-27 years). Measurements: Dependent variables included an ordinal measure of marijuana frequency of use in last thirty days, and a dichotomous measure for whether respondent had any use in the last thirty days of illegal drugs such crystal meth, cocaine, heroin, hallucinogens, PCP, LSD, speed, and ecstasy. Findings: Among males and females, respectively, FEI is associated with an increased frequency of marijuana use, and increased odds of any other illegal drug use. Interactions between FEI and age further reveal that FEI is associated with an accentuated trajectory (i.e. a steeper slope) of marijuana use, and an elevated risk (i.e. higher mean level) of other illegal drug use. Conclusions: Analysis provides some of the first evidence that paternal incarceration is significantly associated with drug use among U.S. males and females, even after controlling for a number of family background, parental, and individual characteristics.

Rush CR; Stoops WW; Lile JA; Glaser PEA; Hays LR. Subjective and physiological effects of acute intranasal methamphetamine during d-amphetamine maintenance. Psychopharmacology 214(3): 665-674, 2011. (37 refs.)

Methamphetamine abuse and dependence are significant public-health concerns. Behavioral therapies are effective for reducing methamphetamine use. However, many patients enrolled in behavioral therapies are unable to achieve significant periods of abstinence, suggesting other strategies like pharmacotherapy are needed. This experiment determined the subjective and physiological effects of intranasal methamphetamine during d-amphetamine maintenance in eight non-treatment-seeking stimulant-dependent participants. We predicted d-amphetamine maintenance would attenuate the acute subjective effects of intranasal methamphetamine. We also predicted intranasal methamphetamine would be well tolerated during d-amphetamine maintenance. After at least 7 days of maintenance on sustained-release d-amphetamine (0 and 45 mg/day), participants were administered ascending doses of intranasal methamphetamine (0, 2.5, 5, 10, and 20 mg) across two experimental sessions. Intranasal methamphetamine doses were separated by 90 min. Intranasal methamphetamine produced prototypical subjective and physiological effects (e.g., increased ratings of Like Drug; increased heart rate, blood pressure, and body temperature). The acute effects of intranasal methamphetamine were significantly diminished during d-amphetamine maintenance relative to placebo maintenance. These results are concordant with those of clinical trials and provide further support for the use of agonist replacement therapy to manage methamphetamine dependence. Additional research in humans is needed to determine the effectiveness of d-amphetamine under different experimental conditions that more closely reflect use in the natural environment (e.g., higher methamphetamine doses) and behavioral arrangements that are predictive of pharmacotherapy effectiveness (e.g., drug self-administration).

Salo R; Buonocore MH; Leamon M; Natsuaki Y; Waters C; Moore CD et al. Extended findings of brain metabolite normalization in MA-dependent subjects across sustained abstinence: A proton MRS study. Drug and Alcohol Dependence 113(2-3): 133-138, 2011. (40 refs.)

Objective: The goal of the present study was to extend our previous findings on long-term methamphetamine (MA) use and drug abstinence on brain metabolite levels in an expanded group of MA-dependent individuals. Methods: Seventeen MA abusers with sustained drug abstinence (1-5 years), 30 MA abusers with short-term drug abstinence (1-6 months) and 24 non-substance using controls were studied using MR spectroscopy (MRS). MRS measures of NAA/Cr, Cho/Cr and Cho/NAA were obtained in the anterior cingulate cortex (ACC) and in the primary visual cortex (PVC). Results: ACC-Cho/NAA values were abnormally high in the short-term abstinent group compared to controls [F(1,52)=18.76, p < 0.0001]. No differences were observed between controls and the long-term abstinent group [F(1,39) = 0.97, p = 0.97]. New evidence of lower ACC-NAA/Cr levels were observed in the short-term abstinent MA abusers compared to controls [F(1,52)= 23.05, p < 0.0001] and long-term abstinent MA abusers [F(1,45) = 7.06, p = 0.01]. No differences were observed between long-term abstinent MA abusers and controls [F(1,39) = 0.48, p = 0.49]. Conclusions: The new findings of relative NAA/Cr normalization across periods of abstinence suggest that adaptive changes following cessation of MA abuse may be broader than initially thought. These changes may contribute to some degree of normalization of neuronal function in the ACC.

Sawyer-Kurian KM; Browne FA; Carney T; Petersen P; Wechsberg WM. Exploring the intersecting health risks of substance abuse, sexual risk, and violence for female South African teen dropouts. Journal of Psychology in Africa 21(1): 15- 25, 2011. (41 refs.)

The study sought to better understand the cultural contexts of the risks for adolescent females who have dropped out of school. Focus groups were conducted with 37 Black and Coloured females aged 13 to 17 in Cape Town, South Africa. Data were analysed using content analysis. Methamphetamine, cannabis, and alcohol were used by both, however, Black teens also used methaqualone and Coloured teens used heroin and ecstasy. Some teens traded sex for drugs and others did so at the request of their drug-addicted mothers. Teens revealed high rates of violence, including rape, and many myths and barriers about condom use, revealing risky sex behaviours. Conclusion: Cultural nuances between the two groups will help inform the adaptation of an HIV prevention intervention.

Semple SJ; Strathdee SA; Zians J; Patterson TL. Correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual methamphetamine users. Journal of Psychoactive Drugs 43(2): 79-88, 2011. (66 refs.)

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, hinging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.

Sevak RJ; Vansickel AR; Stoops WW; Glaser PEA; Hays LR; Rush CR. Discriminative-stimulus, subject-rated, and physiological effects of methamphetamine in humans pretreated with aripiprazole. Journal of Clinical Psychopharmacology 31(4): 470-480, 2011. (39 refs.)

Methamphetamine is thought to produce its behavioral effects by facilitating release of dopamine, serotonin (5-HT) and norepinephrine. Results. from animal studies support this notion, whereas results from human laboratory studies have not consistently demonstrated the importance of monoamine systems in the behavioral effects of methamphetamine. Human drug-discrimination procedures are well suited to assess neuropharmacological mechanisms of the training drug by studying pharmacological manipulation. In this human laboratory study, 6 participants with a history of recreational stimulant use learned to discriminate 10 mg oral methamphetamine. After acquiring the discrimination (ie, >= 80% correct responding on 4 consecutive sessions), the effects of a range of doses of methamphetamine (0, 2.5, 5, 10, and 15 mg), alone and in combination with 0 and 20 mg aripiprazole (a partial agonist at D-2 and 5-HT1A receptors), were assessed. Methamphetamine alone functioned as a discriminative stimulus, produced prototypical stimulant-like subject-rated drug effects (eg, increased ratings of Good Effects, Talkative-Friendly, and Willing to Pay For) and elevated cardiovascular indices. These effects were generally a function of dose. Aripiprazole alone did not occasion methamphetamine-appropriate responding or produce subject-rated effects but modestly impaired performance. Administration of aripiprazole significantly attenuated the discriminative-stimulus and cardiovascular effects of methamphetamine, as well as some of the subject-rated drug effects. These results indicate that monoamine systems likely play a role in the behavioral effects of methamphetamine in humans. Moreover, given the concordance between past results with D-amphetamine and the present findings, D-amphetamine can likely serve as a model for the pharmacological effects of methamphetamine.

Shannon K; Strathdee S; Shoveller J; Zhang R; Montaner J; Tyndall M. Crystal methamphetamine use among female street-based sex workers: Moving beyond individual-focused interventions. Drug and Alcohol Dependence 113(1): 76-81, 2011. (34 refs.)

Given growing concern of the sexual risks associated with crystal methamphetamine use and the dearth of research characterizing the use of methamphetamine among street-based sex workers (FSWs), this study aimed to characterize the prevalence and individual, social, and structural contexts of crystal methamphetamine use among FSWs in a Canadian setting. Drawing on data from a prospective cohort, we constructed multivariate logistic models to examine independent correlates of crystal methamphetamine among FSWs over a two-year follow-up period using generalized estimating equations. Of a total of 255 street-based FSWs, 78 (32%) reported lifetime crystal methamphetamine use and 24% used crystal methamphetamine during the two-year follow-up period, with no significant associations between methamphetamine use and sexual risk patterns. In a final multivariate GEE model, FSWs who used crystal methamphetamine had a higher proportional odds of dual heroin injection (adjOR = 2.98, 95%Cl: 1.35-5.22), having a primary male sex partner who procures drugs for them (adjOR = 1.79, 95%Cl: 1.02-3.14), and working (adjOR = 1.62, 95%Cl: 1.04-2.65) and living (adjOR = 1.41, 95%Cl: 1.07-1.99) in marginalized public spaces. The findings highlight the crucial need to move beyond the individual to gender-focused safer environment interventions that mediate the physical and social risk environment of crystal methamphetamine use among FSWs.

Shannon LM; Havens JR; Oser C; Crosby R; Leukefeld C. Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky. American Journal of Drug and Alcohol Abuse 37(2): 98-104, 2011. (40 refs.)

Background: Previous research suggests gender differences exist in types of substances used and age of first use. Recent studies exploring contextual differences in substance use between rural Appalachian and urban environments show different patterns of substance use in rural environments. Objective: This study explores whether previously established differences in gender and age of first use exist within a rural Appalachian environment. Methods: Data are from a community-based study of drug users in rural Appalachia (N = 400). Self-reported substance use was recorded using an interviewer-administered questionnaire with questions from the Addiction Severity Index (ASI). Results: On average, participants were 32 years old ((X) over bar = 32.33; median = 31.00; interquartile range (IQR) = 12) and the majority were male (59%). Examining the past 30-day substance use, more males reported alcohol (adjusted odds ratio (AOR): 2.11, 95% CI: 1.36, 3.23; p = .001) and any illegal drug use (AOR: 1.85, 95% CI: 1.16, 2.95; p = .010), which included heroin, cocaine, crack cocaine, methamphetamine, marijuana, and hallucinogens, after controlling for sociodemographic characteristics. ANCOVA analyses showed that males reported the use of alcohol (p = .000), marijuana (p = .007), and hallucinogens (p = .009) at a significantly younger age than females. Conclusion: Findings: suggest more men report the use of alcohol and "street" drugs, including heroin, crack cocaine, methamphetamine, marijuana, and hallucinogens. Furthermore, males report the use of alcohol, marijuana, and hallucinogens at a significantly younger age. Scientific Significance: Understanding gender differences in substance use as well as other differences among individuals living in rural Appalachia presents important opportunities to incorporate this knowledge into substance abuse early intervention, prevention, and treatment efforts.

Smith RC; Crim D. The world of the Haight-Ashbury speed freak. Journal of Psychoactive Drugs 43(2): 165-171, 2011. (0 refs.)

This article, reprinted from the Spring 1969 issue of the Journal (vol. 2, issue 2) when it was still the Journal of Psychedelic Drugs-is among the first to describe high-dose, intravenous methamphetamine abuse in the Haight-Ashbury District of San Francisco. Methamphetamine use was increasing in 1967 and 1968, sometimes orally as an adulterant of psychedelic drugs or as a primary drug of abuse, but it was increasingly being abused in an intravenous, high-dose binge pattern that proved pernicious, not only to the users, but to the hippies and other members of the Haight-Ashbury community. Even among drug-using Haight-Ashbury subcultures, the high-dose methamphetamine abuser was marginalized, but became increasingly visible and unavoidable because of violence associated with dealing methamphetamine and because of the users' hyperactivity and paranoia. Methamphetamine was not a new drug. Oral methamphetamine, under the pharmaceutical trade name of Desoxyn (R), and methamphetamine, in oral tablets and in ampoules for intravenous administration under the trade name of Methedrine (R), had been available for years. Injectable Methedrine was prescribed for treatment of heroin addiction by a few San Francisco physicians and that created concern among San Francisco's medical community and law enforcement. Clearly, prescribing a stimulant for treatment of heroin dependence was not a good idea, repeating Sigmund Freud's misadventure treating his friend's morphine addiction with cocaine. But there was little evidence that prescription methamphetamine use was creating a major public health problem. Increasing restrictions on methamphetamine's medical use and eventual withdrawal of Methedrine from the pharmaceutical market decreased availability of prescription methamphetamine and increased the market for illicit methamphetamine, known variously as "meth," "crank" or "speed." In the late '60s, Dr. Roger Smith, a criminologist who was the Director of the Amphetamine Research Project at the University of California Medical Center, led a team of researchers who conducted interviews with drug users in the Haight-Ashbury. In this important early paper, he clearly describes the social contexts of intravenous methamphetamine use and the recruitment of new users by friends. This presages later waves of methamphetamine abuse within the gay community and the otherwise inexplicable continued abuse of methamphetamine to the present despite its obvious destructiveness to users. The article is being reprinted here because of its historic importance.

Srisurapanont M; Arunpongpaisal S; Wada K; Marsden J; Ali R; Kongsakon R. Comparisons of methamphetamine psychotic and schizophrenic symptoms: A differential item functioning analysis. (review). Progress In Neuro-Psychopharmacology & Biological Psychiatry 35(4): 959-964, 2011. (27 refs.)

The concept of negative symptoms in methamphetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Methamphetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.

Tabibnia G; Monterosso JR; Baicy K; Aron AR; Poldrack RA; Chakrapani S et al. Different forms of self-control share a neurocognitive substrate. Journal of Neuroscience 31(13): 4805-4810, 2011. (58 refs.)

Psychological and neurocognitive studies have suggested that different kinds of self-control may share a common psychobiological component. If this is true, performance in affective and nonaffective inhibitory control tasks in the same individuals should be correlated and should rely upon integrity of this region. To test this hypothesis, we acquired high-resolution magnetic resonance images from 44 healthy and 43 methamphetamine- dependent subjects. Individuals with methamphetamine dependence were tested because of prior findings that they suffer inhibitory control deficits. Gray matter structure of the inferior frontal gyrus was assessed using voxel-based morphometry. Subjects participated in tests of motor and affective inhibitory control (stop-signal task and emotion reappraisal task, respectively); and methamphetamine- dependent subjects provided self-reports of their craving for methamphetamine. Performance levels on the two inhibitory control tasks were correlated with one another and with gray matter intensity in the right pars opercularis region of the inferior frontal gyrus in healthy subjects. Gray matter intensity of this region was also correlated with methamphetamine craving. Compared with healthy subjects, methamphetamine- dependent subjects exhibited lower gray matter intensity in this region, worse motor inhibitory control, and less success in affect regulation. These findings suggest that self-control in different psychological domains involves a common substrate in the right pars opercularis, and that successful self-control depends on integrity of this substrate.

Timmermans S. The joy of science: Finding success in a "failed" randomized clinical trial. Science Technology & Human Values 36(4): 549-572, 2011. (32 refs.)

Sociologists of science have argued that due to the institutional reward system negative research results, such as failed experiments, may harm scientific careers. We know little, however, of how scientists themselves make sense of negative research findings. Drawing from the sociology of work, the author discusses how researchers involved in a double-blind, placebo, controlled randomized clinical trial for methamphetamine dependency informally and formally interpret the emerging research results. Because the drug tested in the trial was not an effective treatment, the staff considered the trial a failure. In spite of the disappointing results, the staff involved in the daily work with research subjects still reframed the trial as meaningful because they were able to treat people for their drug dependency. The authors of the major publication also framed the results as worthwhile by linking their study to a previously published study in a post hoc analysis. The author concludes that negative research findings offer acollective opportunity to define what scientific work is about and that the effects of failed experiments depend on individual biography and institutional context.

Trujillo KA; Smith ML; Guaderrama MM. Powerful behavioral interactions between methamphetamine and morphine. Pharmacology, Biochemistry and Behavior 99(3): 451-458, 2011. (50 refs.)

Use of drugs of abuse in combination is common among recreational users and addicts. The combination of a psychomotor stimulant with an opiate, known as a 'speedball,' reportedly produces greater effects than either drug alone and has been responsible for numerous deaths. Historically, the most popular speedball combination is that of cocaine and heroin. However, with the growing popularity of methamphetamine in recent years, there has been increased use of this drug in combination with other drugs of abuse, including opiates. Despite this, relatively little research has examined interactions between methamphetamine and opiates. In the current research, behavioral interactions between methamphetamine and the prototypical opiate, morphine, were examined across a variety of dose combinations in Sprague-Dawley rats. The combination of methamphetamine and morphine produced stimulation of behavior that was dramatically higher than either drug alone; however, the magnitude of the interaction was dependent on the dose of the drugs and the specific behaviors examined. The results demonstrate complex behavioral interactions between these drugs, but are consistent with the idea that this combination is used because it produces a greater effect than either drug alone.

van Nuijs ALN; Mougel JF; Tarcomnicu I; Bervoets L; Blust R; Jorens PG et al. Sewage epidemiology: A real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium. Environment International 37(3): 612-621, 2011. (33 refs.)

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium. The consumption of cocaine (COC), amphetamine (AMP). methylenedioxymethamphetamine (MDMA). methamphetamine (METH), methadone (MTD) and heroin (HER) was evaluated based on measured concentrations of the parent compound and/or metabolites in daily 24-hour composite influent wastewater samples. The inevitable back-calculations used in the sewage epidemiology approach were adapted to newly available information regarding the stability of the compounds in wastewater and the excretion pattern of illicit drugs. For COC, three different back-calculation approaches were evaluated. In addition, for the first time, efforts were made to calculate the number of inhabitants living in the catchment area of the WWTP in a real-time and dynamic way, based on concentrations of nitrogen, phosphorus and oxygen in the wastewater samples. Clear variations in the amount of inhabitants in the catchment area of the WWTP were observed. For COC, AMP and MDMA a significant higher weekend use was observed while for HER and MTD no significant daily variations could be found. METH consumption was negligible. Generally, the sewage epidemiology calculations were in agreement with official statistics. This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations. Therefore, efforts should be made to further optimize this approach in the future.

Westhaver R. "A kind of sorting out": Crystal methamphetamine, gay men, and health promotion. Science Technology & Human Values 36(2): 160-189, 2011. (124 refs.)

In the face of what has been referred to as a crystal methamphetamine (CMA) "epidemic" among gay men in North America, a number of health promotion efforts have been developed. While these efforts vary in approach, a core feature is the assumption that a user's health depends on distinguishing accurate truths about CMA from inaccurate beliefs about CMA. Drawing on insights developed by Bruno Latour, this article unravels how this distinction plays out in the context of one expression of CMA health promotion. I suggest that CMA health promotion may be more usefully understood as form of collective work in which various players (subjects as well as objects) throw up different knowledge practices for debate rather than an effort to mark the difference between truth and belief. In doing so, I suggest that of Latour, and science studies more generally, offers an opportunity for rethinking the nature of health promotion writ large.

Wilkins C; Sweetsur P. The association between spending on methamphetamine/amphetamine and cannabis for personal use and earnings from acquisitive crime among police detainees in New Zealand. Addiction 106(4): 789-797, 2011. (47 refs.)

Aims: Few studies have examined the statistical association between methamphetamine/amphetamine use and acquisitive crime. Both methamphetamine/amphetamine and cannabis use have been implicated by New Zealand Police as factors in acquisitive offending among active criminal populations. The aim of our study was to examine the statistical association between spending on methamphetamine/amphetamine and cannabis and earnings from acquisitive crime among police detainees in New Zealand. Setting: Four police stations in different regions. Participants: A sample of 2125 police detainees were interviewed about their drug use and acquisitive crime. Design: Statistical models were developed to predict involvement in acquisitive crime using spending on methamphetamine/amphetamine and cannabis for personal use, and to examine associations between the level of spending on methamphetamine/amphetamine and cannabis for personal use and level of dollar earnings from acquisitive crime. Measurements: Self-reported spending on drug use and self-reported earnings from acquisitive crime in the past 30 days. Findings: Spending on cannabis and methamphetamine/amphetamine could predict involvement in acquisitive crime. Level of spending on methamphetamine/amphetamine and cannabis was associated positively with the level of earnings from property crime. Level of spending on methamphetamine/amphetamine was also associated positively with level of earnings from drug dealing. There was a largely negative association between level of spending on cannabis and level of earnings from drug dealing. Conclusions: High spending on methamphetamine/amphetamine is associated statistically with higher earnings from acquisitive crime among police detainees. Further research into this association, and in particular the causal nature of the association, is required to obtain clear policy recommendations.

Wilkins C; Sweetsur P; Griffiths R. Recent trends in pharmaceutical drug use among frequent injecting drug users, frequent methamphetamine users and frequent ecstasy users in New Zealand, 2006-2009. Drug and Alcohol Review 30(3): 255- 263, 2011. (22 refs.)

Aims. To examine the rates of pharmaceutical drug use, and level of prescription use and injection of pharmaceutical drugs, by frequent injecting drug users (IDU), frequent methamphetamine users and frequent ecstasy users in New Zealand for 2006-2009. Design: and method. The paper draws on findings from the 2006, 2007, 2008 and 2009 Illicit Drug Monitoring System (IDMS). The IDMS interviews three groups of frequent illegal drug users (i.e. IDU, methamphetamine users and ecstasy users) from the three main cities of New Zealand using purposive sampling and 'snowballing'. Results. Pharmaceutical morphine rather than heroin was the principal opioid used by the IDU. Few of the IDU or frequent methamphetamine users had prescriptions to use morphine. A lower proportion of the IDU had a prescription to use morphine in 2009 compared to 2008. The injection of methadone by IDU and methamphetamine users was common. A higher proportion of the IDU had injected methadone in 2009 compared to previous years. A higher proportion of the IDU had used oxycodone in 2009 compared to 2008 and prescription use of oxycodone by IDU was very low. All three groups of frequent drug users were involved in the extra-medical use of methylphenidate and benzodiazepines. Discussion and conclusion. Extra-medical use of pharmaceuticals occurred among all three groups of frequent illegal drug users to varying degrees. Differences between the three groups in the level and type of extra-medical pharmaceutical drug use suggest that different control strategies may be effective for each group.

Wimmer K; Schneider S. Screening for illicit drugs on Euro banknotes by LC-MS/MS. Forensic Science International 206(1-3): 172-177, 2011. (22 refs.)

A method for the simultaneous quantification of illicit drugs on Euro banknotes, using an ultra-performance liquid chromatography tandem mass spectrometry, was developed and validated. The method included cocaine, benzoylecgonine, MDMA, MDEA, MDA, methamphetamine, diacetylmorphine, 6-MAM, morphine and Delta(9)-THC. Drug residues were monitored and quantified via positive ESI mode using multiple reaction monitoring. Banknotes were extracted with methanol by vigorous shaking. Recovery rates were in the range of 60-80%. Calibration was performed with spiked banknotes in the range of 10-100 ng/note (R-2 0.98-0.99). Intra-day analysis showed fair precision and accuracy (<= 15%). Matrix effects were in the range from 27% to 235%. 7-15 samples of each denomination were analyzed. The calculated median values per note were 106 ng cocaine, 43 ng benzoylecgonine, 41 ng heroin, 15.5 ng 6-MAM, 16.5 ng morphine, 9 ng MDMA and 7 ng methamphetamine. Delta(9)-THC was detected on 4 banknotes. MDEA and MDA were not detected on any note. A widespread background contamination for cocaine and opiates was demonstrated.

Yoshimura T; Usui H; Takahashi N; Yoshimi A; Saito S; Aleksic B et al. Association analysis of the GDNF gene with methamphetamine use disorder in a Japanese population. (review). Progress In Neuro-Psychopharmacology & Biological Psychiatry 35(5, special issue): 1268-1272, 2011. (32 refs.)

Methamphetamine (MAP) dependence is a highly heritable and aberrant dopaminergic signaling that has been implicated in the disease. Glial cell line-derived neurotrophic factor (GDNF), which plays an important role in the survival of dopaminergic neurons, may be involved in this disorder. In this study, we examined the association between GDNF and MAP dependence using a Japanese population-based sample. We selected eight single nucleotide polymorphisms (SNPs) in the GDNF locus for the association analysis. When patients with MAP dependence were divided into two subgroups consisting of multi-substance and MAP-only users, we detected a significant association between these two groups and the tagging SNP, rs2910704 (after Bonferroni's correction; allele P = 0.034). Thus, GDNF is likely to be related to the severity of MAP use in the Japanese population.

Zorick T; Mandelkern MA; Lee B; Wong ML; Miotto K; Shahbazian J; London ED. Elevated plasma prolactin in abstinent methamphetamine-dependent subjects. (review). American Journal of Drug and Alcohol Abuse 37(1): 62-67, 2011. (24 refs.)

Background: Methamphetamine (MA) use disorders are pervasive global social problems that produce large medical and public health burdens. Abnormalities in pituitary hormonal regulation have been observed in preclinical models of substance abuse and in human substance abusers. They have, however, not been studied before in MA-dependent human subjects. Objectives: To determine if MA-dependent research volunteers differ from healthy control subjects in plasma levels of adrenocorticotropic hormone (ACTH), cortisol, or prolactin, or in pituitary dopamine D-2 receptor availability during early abstinence from MA. Methods: MA-dependent subjects (N = 31), who were not seeking treatment, resided on an inpatient ward for up to 5 weeks. Abstinence was confirmed by daily urine drug screening. Venous blood was sampled for plasma hormone levels, and positron emission tomography with [F-18] fallypride was performed to determine dopamine D-2 receptor availability during the first week of abstinence. Venous blood was sampled again for hormone levels during the fourth week of abstinence. Matched healthy volunteers (N = 23) participated as a comparison group. Results: MA-dependent and healthy comparison subjects did not differ in plasma ACTH or cortisol levels, but had an elevated plasma prolactin at both the first week and fourth week of abstinence. There was no group difference in pituitary dopamine D-2 receptor availability. Conclusion: MA-dependent individuals have abnormalities in prolactin regulation, which is not likely due to alterations in pituitary dopamine D-2 receptor availability. Scientific significance: MA dependence is associated with elevated prolactin levels, which may contribute to medical comorbidity in afflicted individuals.