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CORK Bibliography: Methamphetamine

113 citations. September 2011 to present

Prepared: September 2012

Asanbe CB; Hall C; Bolden C. Mental health disorders in children of non-drug-abusing parents: A sample from a rural community devastated by methamphetamine. Journal of Child Health Care 16(1): 15-25, 2012. (30 refs.)

A representative sample of 58 preschoolers (aged 4 and 5) and 78 school-age children (aged 8 and 9) from methamphetamine-producing (MP) and non-producing (NP) homes was drawn from a rural county in Tennessee, for two separate studies. The researchers assessed the psychological functioning of the children using age appropriate Behavior Assessment System for Children (BASC) forms, and compared the scores of children with NP status with population-based data. The results indicate that in this rural sample, the prevalence of internalizing and externalizing disorders in children from NP homes was higher than in population-based norms. Specifically, the preschoolers showed a higher rate of depression, and the school-age children had higher rates of anxiety, depression, and atypical behaviors than their population-based peers. The results are interpreted in terms of low SES and accessibility to mental health services in rural communities. The authors suggest nurse practitioners include brief psychological screenings in their assessment protocols for this population.

Copyright 2012, Sage Publications

Auten JD; Matteucci MJ; Gaspary MJ; Combs DJ; Clark RF. Psychiatric implications of adolescent methamphetamine exposures. Pediatric Emergency Care 28(1): 26-29, 2012. (27 refs.)

Objectives: Methamphetamine abuse has reached epidemic proportions during the last decade. Abuse among adolescents is linked to increased rates of depression and suicidal ideation. Sources suggest that there is an increase rate of suicide attempts in the methamphetamine-abusing adolescent patient population. Our study seeks to examine adolescent methamphetamine exposures reported to the California Poison Control System during the past decade of suicidal ideation and suicide attempts in comparison to rates reported by population-based surveys. Methods: The records of the California Poison Control System were searched for methamphetamine exposures from 2000 to 2009. All charts of patients identified between the ages of 11 and 18 years were reviewed and abstracted. Results: The records of 293 youth between the ages of 11 and 18 years were identified and assigned levels of severity according to parameters set by the National Poison Data System Medical Outcome Criteria of the American Association of Poison Control Centers. Charts were categorized as follows: 11 as major, 52 as moderate, and 75 as minor. The remainder of the charts were not evaluated because of no effect (n = 13) or unable to follow (n = 142). In this cohort, more females were reported than males (57%). The most common presenting symptom in this patient population was agitation (39%). The most common events were suicidal ideation (31%) and suicide attempts (21%). Conclusions: In this data set, adolescent methamphetamine exposures were associated with increased rates of suicidal ideation and suicide attempts that are disproportionate to population-based surveys during the same period.

Copyright 2012, Lippincott, Williams & Wilkins

Bassindale T. Quantitative analysis of methamphetamine in hair of children removed from clandestine laboratories - Evidence of passive exposure? Forensic Science International 219(1-3): 179-182, 2012. (17 refs.)

In New Zealand many children have been removed from clandestine laboratories following police intervention. In the last few years it has become standard procedure that these children have hair samples taken and these samples are submitted to the laboratory for analysis. There are various mechanisms for the incorporation of drugs into hair. The hair follicle has a rich blood supply, so any drug that may be circulating in the blood can be incorporated into the growing hair. Another mechanism is via external contamination, such as spilling a drug on the hair or through exposure to fumes or vapours. Hair samples were analysed for methamphetamine and amphetamine. From the 52 cases analysed 38 (73%) were positive for methamphetamine (>0.1 ng/mg) and amphetamine was detected in 34 of these cases. In no case was amphetamine detected without methamphetamine. The hair washes (prior to extraction) were also analysed (quantified in 30 of the positive cases) and only 3 had a wash to hair ratio of >0.1 (all were <0.5), which may be indicative of a low level of external contamination. This low level of evidence of external contamination suggests that the children are exposed to methamphetamine and are incorporating it into the hair through the blood stream.

Copyright 2012, Elsevier Science

Beaulieu S; Saury S; Sareen J; Tremblay J; Schutz CG; McIntyre RS et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force recommendations for the management of patients with mood disorders and comorbid substance use disorders. (review). Annals of Clinical Psychiatry 24(1): 38-55, 2012. (128 refs.)

Background: Mood disorders, especially bipolar disorder (BD), frequently are associated with substance use disorders (SUDs). There are well-designed trials for the treatment of SUDs in the absence of a comorbid condition. However, one cannot generalize these study results to individuals with comorbid mood disorders, because therapeutic efficacy and/or safety and tolerability profiles may differ with the presence of the comorbid disorder. Therefore, a review of the available evidence is needed to provide guidance to clinicians facing the challenges of treating patients with comorbid mood disorders and SUDs. Methods: We reviewed the literature published between January 1966 and November 2010 by using the following search strategies on PubMed. Search terms were bipolar disorder or depressive disorder, major (to exclude depression, postpartum; dysthymic disorder; cyclothymic disorder; and seasonal affective disorder) cross-referenced with alcohol or drug or substance and abuse or dependence or disorder. When possible, a level of evidence was determined for each treatment using the framework of previous Canadian Network for Mood and Anxiety Treatments recommendations. The lack of evidence-based literature limited the authors' ability to generate treatment recommendations that were strictly evidence based, and as such, recommendations were often based on the authors' opinion. Results: Even though a large number of treatments were investigated for alcohol use disorder (AUD), none have been sufficiently studied to justify the attribution of level 1 evidence in comorbid AUD with major depressive disorder (MDD) or BD. The available data allows us to generate first-choice recommendations for AUD comorbid with MDD and only third-choice recommendations for cocaine, heroin, and opiate SUD comorbid with MOD. No recommendations were possible for cannabis, amphetamines, methamphetamines, or polysubstance SUD comorbid with MDD. First-choice recommendations were possible for alcohol, cannabis, and cocaine SUD comorbid with BD and only second-choice recommendations for heroin, amphetamine, methamphetamine, and polysubstance SUD comorbid with BD. No recommendations were possible for opiate SUD comorbid with BD. Finally, psychotherapies certainly are considered an essential component of the overall treatment of SUDs comorbid with mood disorders. However, further well-designed studies are needed in order to properly assess their potential role in specific SUDs comorbid with a mood disorder. Conclusions: Although certain treatments show promise in the management of mood disorders comorbid with SUDs, additional well-designed studies are needed to properly assess their potential role in specific SUDs comorbid with a mood disorder.

Copyright 2012, Quadrant Health Com

Bertoni N; Singer M; Silva CMFP; Scott Clair S; Malta M; Bastos FI. Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil. Harm Reduction Journal 8: article 5, 2011. (39 refs.)

Background: Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability. Objective: To assess drug users' knowledge of HIV/AIDS and testing methods for human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Results: Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. Conclusions: IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs.

Copyright 2011, BioMed Central

Blackwell CW; Dziegielewski SF. Using the internet to meet sexual partners: Research and practice implications. Journal of Social Service Research 38(1, special issue): 46, 2012. (49 refs.)

Recent research studies suggest increasingly widespread use of Internet sexual networking sites to initiate sexual relationships among men who have sex with men. Concerns are growing in regard to use of such sites in promoting participation in higher-risk sexual activities by providing easier access to partners who are willing to participate. One such activity surrounds substance abuse including using crystal methamphetamine and is commonly termed "party and play" (PNP) during sexual encounters, particularly unprotected anal sex. Current studies indicate conflicting results on PNP and the meeting of sexual partners from the Internet. A critical examination of these studies is presented along with recommendations designed to support future scholarly inquiry.

Copyright 2012, Taylor & Francis

Borders TF; Booth BM. Stimulant use trajectories and the longitudinal risk of heavy drinking: Findings from a rural population-based study. Addictive Behaviors 37(3): 269-272, 2012. (16 refs.)

The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking. The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use. Participants (n = 710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days. Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a "fast low" trajectory of crack use, those with "steady high" and "declining" trajectories had more heavy drinking days. Compared to those with a "fast low" trajectory of powder cocaine use, those with a "steady moderate" trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days. In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.

Copyright 2012, Elsevier Science

Bowden M; Trevorrow P. BZP and New Zealand's alternative approach to prohibition. (editorial). Drug Testing and Analysis 3(7-8, special issue): 426-427, 2011. (0 refs.)

In this special issue dedicated to New Psychoactive Substances, Journal Editor Paul Trevorrow discusses with Matt Bowden of Stargate, New Zealand, the role of benzylpiperazine (BZP) as a safer alternative to methamphetamine and the Class D approach to the regulation of recreational drugs in New Zealand. The following interview is a fully citable transcript from the podcast published by Drug Testing and Analysis available at http:

Copyright 2011, Wiley-Blackwell

Bowen A; Moring J; Williams M; Hopper G; Daniel C. An investigation of bioecological influences associated with first use of methamphetamine in a rural state. Journal of Rural Health 28(3): 286-295, 2012. (40 refs.)

Purpose: Methamphetamine (MA) addiction is a significant problem in rural areas of the United States. Yet, little theoretically driven formative research has been conducted on the interactions of factors influencing initiation. The study was guided by Bronfenbrenner's bioecological model. Methods: Eighty-three MA users participated in an interview. Quantitative data included sociodemographic characteristics, drug use history, and psychosocial functioning. Semistructured interviews examined MA use histories with a focus on initiation. Transcripts of the interviews were coded for 5 themes related to Bronfenbrenner's influences including individual motivation, family, peers, work or school, or community as factors influencing initiation of MA use. Five dummy variables representing the presence or absence of a mention of Bronfenbrenner's 5 influences were created from the qualitative codes and entered into a hierarchical cluster analysis. Findings: The analyses revealed 4 distinct clusters: (1) predominantly female, influenced by peers and individual curiosity, (2) predominantly female, youngest age of first use, influenced by a family culture of drug use, (3) predominantly male, older age at first use, influenced by work settings and family co-workers, and (4) predominantly male, older age at first use, in the school context with a desire to increase intimacy. Conclusions: Bronfenbrenner's bioecological model was useful for classifying initiating influences and grouping individuals based on different combinations of influences. Identifying combinations of initiating factors such as work and community may facilitate tailoring of prevention programs, which may maximize efficacy and cost-effectiveness.

Copyright 2012, Wiley-Blackwell

Brecht ML; Urada D. Treatment outcomes for methamphetamine users: California proposition 36 and comparison clients. Journal of Psychoactive Drugs 2011(7): 68-76, 2011. (42 refs.)

Methamphetamine (meth) is a major drug of abuse in California and several other states, particularly among criminal offender populations. Over the past decade, substance abuse treatment systems have had to adapt to and accommodate the increasing needs of meth users and, in California, deal with the impact of Proposition 36, which has resulted in a greater number of criminal offenders entering the treatment system. This study examines selected treatment performance and outcome indicators for California Proposition 36 offenders entering substance abuse treatment for meth use and compares their performance and outcomes to other subgroups of California treatment clients differentiated by whether or not they were admitted to treatment through Proposition 36 and whether or not their primary substance was meth. Significant improvements in all outcome domains were seen across the populations, and treatment performance and outcomes were not substantively inferior for the offender or meth-using groups.

Copyright 2011, Haight-Asbury Publishing

Bright DA; Hughes CE; Chalmers J. Illuminating dark networks: A social network analysis of an Australian drug trafficking syndicate. Crime, Law and Social Change 57(2, special issue): 151-176, 2012. (44 refs.)

A small but growing number of analysts of criminal activity have used social network analysis (SNA) to characterise criminal organisations and produce valuable insights into the operation of illicit markets. The successful conduct of SNA requires data that informs about links or relationships between pairs of individuals within the group. To date analyses have been undertaken with data extracted from offender databases, transcripts of physical or electronic surveillance, written summaries of police interrogations, and transcripts of court proceedings. These data can be expensive, time-consuming and complicated to access and analyse. This paper presents findings from a study which aimed to determine the feasibility and utility of conducting SNA using a novel source of data: judges' sentencing comments. Free of charge, publically accessible without the need for ethics clearance, available at the completion of sentencing and summary in nature, this data offers a more accessible and less expensive alternative to the usual forms of data used. The judges' sentencing comments were drawn from a series of Australian court cases involving members of a criminal group involved in the manufacture and distribution of methamphetamine during the 1990s. Feasibility is evaluated in terms of the ability to produce a network map and generate the types of quantitative measures produced in studies using alternate data sources. The utility of the findings is judged in relation to the insights they provide into the structure and operation of criminal groups in Australia's methamphetamine market.

Copyright 2012, Springer

Callaghan RC; Cunningham JK; Allebeck P; Arenovich T; Sajeev G; Remington G et al. Methamphetamine use and schizophrenia: A population-based cohort study in California. American Journal of Psychiatry 169(4): 389-396, 2012. (38 refs.)

Objective: Clinical investigators in Japan have long suggested that exposure to methamphetamine might cause a persistent schizophrenia-like psychosis. This possibility is discounted in the Western literature. To investigate the relationship between drug use and later schizophrenia, the authors conducted a large-scale cohort study of drug users initially free of persistent psychosis. Method: A population-based cohort study was conducted using data from California inpatient hospital discharge records from 1990 through 2000. Patients with methamphetamine-related conditions (N=42,412) and those with other drug use disorders (cannabis, cocaine, alcohol, and opioids) were propensity score-matched to individuals with primary appendicitis who served as a population proxy comparison group; the methamphetamine cohort was also matched to the other drug cohorts. Cox modeling was used to estimate differences between matched groups in the rates of subsequent admission with schizophrenia diagnoses. Results: The methamphetamine cohort had a significantly higher risk of schizophrenia than the appendicitis group (hazard ratio=9.37) and the cocaine, opioid, and alcohol groups (hazard ratios ranging from 1.46 to 2.81), but not significantly different from that of the cannabis group. The risk of schizophrenia was higher in all drug cohorts than in the appendicitis group. Conclusions: Study limitations include difficulty in confirming schizophrenia diagnoses independent of drug intoxication and the possibility of undetected schizophrenia predating drug exposure. The study's findings suggest that individuals with methamphetamine-related disorders have a higher risk of schizophrenia than those with other drug use disorders, with the exception of cannabis use disorders. The elevated risk in methamphetamine users may be explained by shared etiological mechanisms involved in the development of schizophrenia.

Copyright 2012, American Psychiatric Association

Chang YP; Yen CF; Campbell-Heider N. High-risk situations related to relapse of methamphetamine use among Taiwanese adolescents: An instrumentation study. Journal of Addictions Nursing 23(1): 55-64, 2012. (35 refs.)

Methamphetamine is the leading illicit substance used by adolescents in Taiwan and the rise of its production and use is a major public health concern in Southeast and East Asia. The purpose of this study was to develop and test a new instrument to identify high-risk situations related to methamphetamine relapse among incarcerated Taiwanese adolescents. Participants in this study were arrested for methamphetamine use and mandatorily held at an abstinence center. In the instrument development phase, an item pool was generated from a qualitative study and further revised based on content evaluations by 6 clinical content experts. In the instrument analysis phase, the new tool was psychometrically tested. The intra-class correlation coefficient showed high stability of the instrument (r = .92). Factor analysis resulted in a 6-factor solution accounting for 66.68% of the variance in the 16-item model. Although this instrument was developed for use with Taiwanese adolescents, it needs further testing to confirm its usefulness in other cultural groups. The identified risky situations provide a beginning assessment tool that is easy to administer and can be used to identify teens at particular risk for relapse before being released from incarceration or other mandatory treatment programs. More research is needed to target specific and culturally determined triggers that can improve the validity of this tool for non Asian adolescents at risk for methamphetamine relapse.

Copyright 2012, Informa Healthcare

Chiaia-Hernandez AC; Banta-Green CJ; Field JA. Interpreting methamphetamine levels in a high-use community. Environmental Science and Pollution Research 18(9): 1471-1477, 2011. (54 refs.)

Introduction: Illicit drug use is a largely hidden phenomenon, and population measures are notoriously problematic. Reliable and valid data for local, regional, and national public health and other interventions are needed. Methods: To address this information, we examined temporal trends within and across weeks in methamphetamine (MA) in a single location in order to inform a sampling plan for understanding long-term trends in MA use based on sampling raw influent to wastewater treatment plants. The measured concentrations in the wastewater are used to estimate the total mass of MA consumed rather than the number of doses due to the uncertainty surrounding methamphetamine purity, mass of MA per dose, and the number of doses used per day. Results: Results from a region with high levels of MA use indicate that MA levels do not differ significantly between weekdays and weekends (p=0.1), consistent with a predominately regular, daily use pattern use. The potential contribution of legal sales of D- and L-MA to the mass of MA consumed within the community was estimated to range from 3-8%. Limitations and uncertainties associated with estimating the mass of MA consumption include small contributions of prescription and over-the-counter drugs that are metabolized to MA as well as measurement and sampling variability.

Copyright 2011, Springer

Chu M; Gerostamoulos D; Beyer J; Rodda L; Boorman M; Drummer OH. The incidence of drugs of impairment in oral fluid from random roadside testing. Forensic Science International 215(1-3): 28-31, 2012. (31 refs.)

Oral fluid (OF) has become a popular specimen to test for presence of drugs, particularly in regards to road safety. In Victoria, OF specimens from drivers have been used to test for the presence of methylamphetamine (MA) and Delta(9)-tetrahydrocannabinol (THC) since 2003 and 3, 4-methylenedioxy-N-methylamphetamine (MDMA) since 2006. LC-MS/MS has been used to test the most recent 853 submitted OF specimens from Victoria Police for 31 drugs of abuse including those listed in the Australian Standard AS4760-2006. At least one proscribed drug was detected in 96% of drivers, of which MA was the most common (77%), followed by THC (42%), MDMA (17%) and the combination of all three (3.9%). Opioids were detected in 14% of drivers of which 4.8% were positive for 6-acetylmorphine and 3.3% for methadone. The incidence of the opioids tramadol (1.2%) and oxycodone (1.1%) were relatively low. Cocaine (8.0%) was as commonly detected as benzodiazepines (8.0%), and was almost always found in combination with MA (7.9%). Samples positive to benzodiazepines were largely due to diazepam (3.5%) and alprazolam (3.4%), with only 0.2% of drivers combining the two. Ketamine was also detected in 1.5% of cases. While the incidences of the proscribed drugs itself are concerning, it is clear that many drivers are also using other drugs capable of causing impairment.

Copyright 2012, Elsevier Science

Ciketic S; Hayatbakhsh MR; Doran CM; Najman JM; McKetin R. A review of psychological and pharmacological treatment options for methamphetamine dependence. (review). Journal of Substance Use 17(4): 363-383, 2012. (89 refs.)

Methamphetamine (MA) is a public health problem both in Australia and internationally and very little is known about the most cost-effective treatment options. This study is a review of recent studies and an assessment of current treatment options for MA dependence. Treatment options for MA dependence can be divided into outpatient and inpatient modality settings according to the level of drug use. Moderate improvements through higher rates of retention in treatment (especially residential rehabilitation) have been found in individuals who completed either cognitive-behavioural therapy or counselling as a form of outpatient treatment and in those users who completed a residential rehabilitation treatment programme at an inpatient treatment modality. There remains a need for further research to investigate the efficacy of existing treatment options in individuals with MA use problems and to address the economic impact of those interventions in terms of cost-effectiveness/cost utility.

Copyright 2012, Informa Healthcare

Clark T; Marquez C; Hare CB; John MD; Klausner JD. Methamphetamine use, transmission risk behavior and internet use among HIV-infected patients in medical care, San Francisco, 2008. AIDS & Behavior 16(2): 396-403, 2012. (41 refs.)

Methamphetamine use is associated with adverse health outcomes and HIV incidence. Few studies have assessed methamphetamine use, sexual behavior and Internet use among HIV-infected patients. Surveys were administered to a sample of HIV-infected patients seeking medical care in a San Francisco county hospital and university-based clinic. In 2008, 35% of homosexual participants, 26% of heterosexual participants and 11% of female participants reported methamphetamine use in the past year. Of participants, 29% reported using the Internet to find sex partners; Internet-users versus non-Internet-users reported a higher median number of sex partners in 6 months (4 vs. 1), were more likely to report unprotected sex (32 vs. 10%), and higher rates of methamphetamine use in the past 12 months (48 vs. 24%). Given the association among methamphetamine use, increased sex partners and Internet use, the Internet may present a new and effective medium for interventions to reduce methamphetamine-associated sexual risk behavior.

Copyright 2012, Springer

Cloak CC; Alicata D; Chang L; Andrews-Shigaki B; Ernst T. Age and sex effects levels of choline compounds in the anterior cingulate cortex of adolescent methamphetamine users. Drug and Alcohol Dependence 119(3): 207-215, 2011. (55 refs.)

Background: Methamphetamine can be neurotoxic to the adult brain: however, many individuals first use methamphetamine during adolescence, and the drug's impact on this period of brain development is unknown. Therefore, we evaluated young methamphetamine users for possible abnormalities in brain metabolite concentrations. Methods: Anterior cingulate cortex (ACC), frontal white matter (FWM), basal ganglia, and thalamus were studied with localized proton magnetic resonance spectroscopy in 54 periadolescent (ages 13-23 years) methamphetamine users and 53 comparison subjects. The concentrations of major brain metabolites and their associations with age, sex and cognition were assessed. Results: FWM total-creatine correlated with age in methamphetamine-using males and comparison females, but not comparison males or methamphetamine-using females, leading to a drug by sex by age interaction (p = 0.003) and ACC choline-containing compounds (CHO) correlated with age only in comparison males leading to a drug by sex by age interaction (p = 0.03). Higher ACC CHO was associated with faster performance on the Stroop Interference task in the control males. Male methamphetamine users had slowest performance on the Stroop Interference task and did not show age-appropriate levels of ACC CHO. Conclusions: The altered age-appropriate levels of ACC CHO and poorer executive function in male methamphetamine users suggest methamphetamine abuse may interfere with brain maturation. These periadolescents did not have the abnormal neuronal markers previously reported in adult methamphetamine users, suggesting that neuronal abnormalities may be the result of long-term use or interference in normal cortical maturation, emphasizing the need for early intervention for young methamphetamine users.

Copyright 2011, Elsevier Science

Colfax GN; Santos GM; Das M; Santos DM; Matheson T; Gasper J et al. Mirtazapine to reduce methamphetamine use: A randomized controlled trial. Archives of General Psychiatry 68(11): 1168-1175, 2011. (35 refs.)

Context: No approved pharmacologic treatments for methamphetamine dependence exist. Methamphetamine use is associated with high morbidity and is a major cofactor in the human immunodeficiency virus epidemic among men who have sex with men (MSM). Objective: To determine whether mirtazapine would reduce methamphetamine use among MSM who are actively using methamphetamine. Design: Double-blind, randomized, controlled, 12-week trial of mirtazapine vs placebo conducted from September 5, 2007, to March 4, 2010. Setting: San Francisco Department of Public Health. Participants: Participants were actively using, methamphetamine-dependent, sexually active MSM seen weekly for urine sample collection and substance use counseling. Interventions: Random assignment to daily oral mirtazapine (30 mg) or placebo; both arms included 30-minute weekly substance use counseling. Main Outcome Measures: The primary study outcome was reduction in methamphetamine-positive urine test results. Secondary outcomes were study medication adherence (by self-report and medication event monitoring systems) and sexual risk behavior. Results: Sixty MSM were randomized, 85% of follow-up visits were completed, and 56 participants (93%) completed the final visit. In the primary intent-to-treat analysis, participants assigned to the mirtazapine group had fewer methamphetamine-positive urine test results compared with participants assigned to the placebo group (relative risk, 0.57; 95% CI, 0.35-0.93, P=.02). Urine positivity decreased from 67% (20 of 30 participants) to 63% (17 of 27) in the placebo arm and from 73% (22 of 30) to 44% (12 of 27) in the mirtazapine arm. The number needed to treat to achieve a negative weekly urine test result was 3.1. Adherence was 48.5% by medication event monitoring systems and 74.7% by self-report; adherence measures were not significantly different between arms (medication event monitoring systems, P=.82; self-report, P=.92). Most sexual risk behaviors decreased significantly more among participants taking mirtazapine compared with those taking placebo (number of male partners with whom methamphetamine was used, P=.009; number of male partners, P=.04; episodes of anal sex with serodiscordant partners, P=.003; episodes of unprotected anal sex with serodiscordant partners, P=.003; episodes of insertive anal sex with serodiscordant partners, P=.001). There were no serious adverse events related to study drug or significant differences in adverse events by arm (P >=.99). Conclusion: The addition of mirtazapine to substance use counseling decreased methamphetamine use among active users and was associated with decreases in sexual risk despite low to moderate medication adherence.

Copyright 2011, American Medical Association

De La Garza R; Yoon JH. Evaluation of the effects of rivastigmine on cigarette smoking by methamphetamine-dependent volunteers. (review). Progress in Neuro-Psychopharmacology & Biological Psychiatry 35(8): 1827-1830, 2011. (33 refs.)

Compared to smokers alone, smokers with co-morbid substance use disorders are at greater risk of suffering from smoking-related death. Despite this, relatively few studies have examined smoking cessation treatments for those with stimulant dependence. In the current study, we sought to evaluate the effects produced by short-term exposure to the cholinesterase inhibitor rivastigmine (0, 3 or 6 mg) on cigarette smoking in non-treatment-seeking, methamphetamine-dependent volunteers. This was a double-blind, placebo-controlled, crossover study that took place over 9 days. The data indicate that rivastigmine treatment did not alter Fagerstrom Test for Nicotine Dependence scores, carbon monoxide readings, or cigarettes smoked per day, but a trend toward reduced urges to smoke (p<0.09) was detected during treatment with rivastigmine 3 mg. These data, while preliminary, indicate that cholinesterase inhibitors warrant consideration as treatments for nicotine dependence, including use in stimulant-dependent individuals who exhibit significantly higher rates of smoking than the general population.

Copyright 2011, Elsevier Science

Dean AC; Hellemann G; Sugar CA; London ED. Educational attainment is not a good proxy for cognitive function in methamphetarnine dependence. Drug and Alcohol Dependence 123(1-3): 249-254, 2012. (40 refs.)

Background: We sought to test the hypothesis that methamphetamine use interferes with both the quantity and quality of one's education, such that the years of education obtained by methamphetamine dependent individuals serves to underestimate general cognitive functioning and overestimate the quality of academic learning. Methods: Thirty-six methamphetamine-dependent participants and 42 healthy comparison subjects completed cognitive tests and self-report measures in Los Angeles, California. An overall cognitive battery score was used to assess general cognition, and vocabulary knowledge was used as a proxy for the quality of academic learning. Linear regression procedures were used for analyses. Results: Supporting the hypothesis that methamphetamine use interferes with the quantity of education, we found that (a) earlier onset of methamphetamine use was associated with fewer years of education (p < .01); (b) using a normative model developed in healthy participants, methamphetamine-dependent participants had lower educational attainment than predicted from their demographics and performance on the cognitive battery score (p < .01); and (c) greater differences between methamphetamine-dependent participants' predicted and actual educational attainment were associated with an earlier onset of MA use (p <= .01). Supporting the hypothesis that methamphetamine use interferes with the quality of education, years of education received prior to the onset of methamphetamine use was a better predictor of a proxy for academic learning, vocabulary knowledge, than was the total years of education obtained. Conclusion: Results support the hypothesis that methamphetamine use interferes with the quantity and quality of educational exposure, leading to under- and overestimation of cognitive function and academic learning, respectively.

Copyright 2012, Elsevier Science

Dean AC; Sevak RJ; Monterosso JR; Hellemann G; Sugar CA; London ED. Acute modafinil effects on attention and inhibitory control in methamphetamine-dependent humans. Journal of Studies on Alcohol and Drugs 72(6): 943-953, 2011. (55 refs.)

Objective: Individuals who are methamphetamine dependent exhibit higher rates of cognitive dysfunction than healthy people who do not use methamphetamine, and this dysfunction may have a negative effect on the success of behavioral treatments for the disorder. Therefore, a medication that improves cognition, such as modafinil (Provigil), may serve as a useful adjunct to behavioral treatments for methamphetamine dependence. Although cognitive-enhancing effects of modafinil have been reported in several populations, little is known about the effects of modafinil in methamphetamine-dependent individuals. We thus sought to evaluate the effects of modafinil on the cognitive performance of methamphetamine-dependent and healthy individuals. Method: Seventeen healthy subjects and 24 methamphetamine-dependent subjects participated in this randomized, double-blind, placebo-controlled, crossover study. Effects of modafinil (200 mg, single oral dose) were assessed on participants' performance on tests of inhibitory control, working memory, and processing speed/attention. Results: Across subjects, modafinil improved performance on a test of sustained attention, with no significant improvement on any other cognitive tests. However, within the methamphetamine-dependent group only, participants with a high baseline frequency of methamphetamine use demonstrated a greater effect of modafinil on tests of inhibitory control and processing speed than those participants with low baseline use of methamphetamine. Conclusions: Although modafinil produced limited effects across all participants, methamphetamine-dependent participants with a high baseline use of methamphetamine demonstrated significant cognitive improvement on modafinil relative to those with low baseline methamphetamine use. These results add to the findings from a clinical trial that suggested that modafinil may be particularly useful in methamphetamine-dependent subjects who use the drug frequently.

Copyright 2011, Alcohol Research Documentation

Degenhardt L; Bucello C; Calabria B; Nelson P; Roberts A; Hall W et al. What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. (review). Drug and Alcohol Dependence 117(2-3): 85-101, 2011. (92 refs.)

Background: We systematically reviewed availability and quality of data on the prevalence of use and dependence on meth/amphetamine, cannabis, cocaine and opioids. Methods: Multiple search strategies: (a) peer-reviewed literature searches (1990-2008) using methods recommended by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group; (b) systematic searches of online databases; (c) Internet searches to find other published evidence of drug use; (d) repeated consultation and feedback from experts around the globe; (e) a viral email sent to lists of researchers in the illicit drug and HIV fields. Data were extracted and graded according to predefined variables reflecting quality of data source. Results: Qualitative evidence of illicit drug use and dependence was found for most countries, which hold over 98% of the world's population aged 15-64 years. Countries where use was identified but prevalence estimates had not been made (evidence of drug supply, trafficking, reports of use, treatment data) were mainly from Asia, Africa, the Middle East, and Oceania. Estimates of the prevalence of use were located in 77 countries for meth/amphetamine, 95 for cannabis, 86 for cocaine and 89 for opioids. Dependence prevalence estimates existed in very few countries; 9 meth/amphetamine dependence estimates, 7 cannabis dependence estimates, 5 cocaine dependence estimates, and 25 opioid dependence estimates were located. Conclusions: Data on the extent of meth/amphetamine, cannabis, cocaine and opioid use and dependence must be improved in quality and coverage. Dependence estimates are lacking even in high income countries that have required resources. Responses to illicit drug dependence require better estimates of its scale.

Copyright 2011, Elsevier Science

Dentzer S. Substance abuse and other substantive matters. (editorial). Health Affairs 30(8): 1398, 2011. (0 refs.)

This issue opens with a group of articles on substance abuse. As is noted by Jeffrey A. Buck of the Centers for Medicare and Medicaid Services, nearly one in ten Americans over age twelve are substance abusers, while one in four are �binge� drinkers who consume five or more drinks on a single occasion. Overall costs of substance abuse in the United States, including health care spending, loss of productivity and costs related to crime, are estimated to exceed $600 billion annually. There is also attention directed to the extent of methamphetamine addictions that regularly destroy lives as well as producing literally tons of toxic waste from home meth labs. Also of note, substance use is not soley restricted to the young, with an aging population, more older persons use illicit drugs. In thinking of what steps are required the head of NIDA (Nore Volkow) discusses treatment needs, with attention to the types of continuing services required, as are required with other chronic conditions. Among the concerns is that Three-quarters of the funding for substance abuse treatment services now comes from public sources, which have been under severe pressure from fiscal woes nationwide.there is also the reality posed by national financial problems in maintaining health and human services.

Copyright 2011, Project Hope

Dunn M; Thomas JO. A risk profile of elite Australian athletes who use illicit drugs. Addictive Behaviors 37(1): 144-147, 2012. (25 refs.)

Much of the literature investigating the relationship between sports participation and substance use has focused upon student populations, with little focus being given to athletes who participate at elite levels. Identifying why some athletes may be at a greater risk for substance use can help in the design and implementation of prevention initiatives. Data for the current study was from 1684 self-complete surveys with elite Australian athletes. Eight percent (n = 134) of the sample reported the use of at least one of the six illicit drugs under investigation (ecstasy, cannabis, cocaine, meth/amphetamine, ketamine and GHB) in the past year. Having been offered or having had the opportunity to use illicit drugs in the past year, knowing other athletes who use drugs and identifying as a 'full-time athlete' were significant predictors of past-year illicit drug use, while having completed secondary education or a post-school qualification was associated with a lower likelihood of past-year illicit drug use. Athletes are part of a sportsnet that includes family, coaches, support staff and other athletes, and these relationships may encourage the use, supply and demand for drugs. The current findings suggest that relationships with some of those in the sportsnet may play an important role when understanding illicit drug use among elite athletes. As education appears to be associated with a lower likelihood of illicit drug use among this group, initiatives should encourage athletes to engage in off-field pursuits which may also help prepare them for life after sport.

Copyright 2012, Elsevier Science

El Ayadi A; Zigmond MJ. Low concentrations of methamphetamine can protect dopaminergic cells against a larger oxidative stress injury: Mechanistic study. PLoS ONE 6(10): e24722, 2011. (103 refs.)

Mild stress can protect against a larger insult, a phenomenon termed preconditioning or tolerance. To determine if a low intensity stressor could also protect cells against intense oxidative stress in a model of dopamine deficiency associated with Parkinson disease, we used methamphetamine to provide a mild, preconditioning stress, 6-hydroxydopamine (6-OHDA) as a source of potentially toxic oxidative stress, and MN9D cells as a model of dopamine neurons. We observed that prior exposure to subtoxic concentrations of methamphetamine protected these cells against 6-OHDA toxicity, whereas higher concentrations of methamphetamine exacerbated it. The protection by methamphetamine was accompanied by decreased uptake of both [(3)H] dopamine and 6-OHDA into the cells, which may have accounted for some of the apparent protection. However, a number of other effects of methamphetamine exposure suggest that the drug also affected basic cellular survival mechanisms. First, although methamphetamine preconditioning decreased basal pERK1/2 and pAkt levels, it enhanced the 6-OHDA-induced increase in these phosphokinases. Second, the apparent increase in pERK1/2 activity was accompanied by increased pMEK1/2 levels and decreased activity of protein phosphatase 2. Third, methamphetamine upregulated the pro-survival protein Bcl-2. Our results suggest that exposure to low concentrations of methamphetamine cause a number of changes in dopamine cells, some of which result in a decrease in their vulnerability to subsequent oxidative stress. These observations may provide insights into the development of new therapies for prevention or treatment of PD.

Copyright 2011, Public Library of Science

Elkashef A; Kahn R; Yu E; Iturriaga E; Li SH; Anderson A et al. Topiramate for the treatment of methamphetamine addiction: A multi-center placebo-controlled trial. Addiction 107(7): 1297-1306, 2012. (20 refs.)

Aims: Topiramate has shown efficacy at facilitating abstinence from alcohol and cocaine abuse. This double-blind, placebo-controlled out-patient trial tested topiramate for treating methamphetamine addiction. Design: Participants (n = 140) were randomized to receive topiramate or placebo (13 weeks) in escalating doses from 50 mg/day to the target maintenance of 200 mg/day in weeks 612 (tapered in week 13). Medication was combined with weekly brief behavioral compliance enhancement treatment. Setting: The trial was conducted at eight medical centers in the United States. Participants: One hundred and forty methamphetamine-dependent adults took part in the trial. Measurements The primary outcome was abstinence from methamphetamine during weeks 612. Secondary outcomes included use reduction versus baseline, as well as psychosocial variables. Findings: In the intent-to-treat analysis, topiramate did not increase abstinence from methamphetamine during weeks 612. For secondary outcomes, topiramate reduced weekly median urine methamphetamine levels and observer-rated severity of dependence scores significantly. Subjects with negative urine before randomization (n = 26) had significantly greater abstinence on topiramate versus placebo during study weeks 612. Topiramate was safe and well tolerated. Conclusions: Topiramate does not appear to promote abstinence in methamphetamine users but can reduce the amount taken and reduce relapse rates in those who are already abstinent.

Copyright 2012, Wiley-Blackwell

Fakier N; Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. Journal of Adolescence 34(4): 717-726, 2011. (68 refs.)

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.

Copyright 2011, Foundation for Professionals in Services for Adolescents

Forcehimes AA; Venner KL; Bogenschutz MP; Foley K; Davis MP; Houck JM et al. American Indian methamphetamine and other drug use in the Southwestern United States. Cultural Diversity & Ethnic Minority Psychology 17(4): 366-376, 2011. (37 refs.)

To investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region, we developed collaborations with Southwestern tribal entities and treatment programs in and around New Mexico. We held nine focus groups, mostly with Southwestern AI participants (N = 81) from three diverse New Mexico communities to understand community members, treatment providers, and clients/relatives views on methamphetamine. We conducted a telephone survey of staff (N = 100) from agencies across New Mexico to assess perceptions of methamphetamine use among people working with AI populations. We collected and analyzed self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (ASI) in the context of treatment at three diverse addiction treatment programs. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treat methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.

Copyright 2011, American Psychological Association

Gong WD; Ritter A; Bright D; Doran C. How profitable is methamphetamine dealing in Australia? Drug and Alcohol Dependence 122(3): 208-212, 2012. (37 refs.)

Introduction: The illicit drug trade is the largest in value among global illicit commodities, at some $320 billion US dollars, according to the UN World Drug Report. Endeavours to control such a large illicit market would be enhanced by improved understanding of the economics of the trade. However, due to its illicit nature many aspects of the illicit drug market are largely unknown. This study explored one economic aspect of illicit drug dealing, profitability, with the aim of developing a better picture of the financial gains from illicit drug dealing. Methods: Data were obtained from judges sentencing remarks, key informants from law enforcement, and other published reports which detail the prices paid for methamphetamine in Australia. The financial margins attained from non-crystal methamphetamine dealing in Australia were calculated by examining the best fit for the relationship between prices and quantities: in this case a power law. Results: If it is assumed that a single deal is divided ("cut") between 4 times and 20 times before selling to the next customer, the mark-ups can range from 24% to 59%. The mark-ups appear low compared with those found in US research, but similar to those found in UK research. Conclusions: To our knowledge, this is the first attempt to analyse profitability of methamphetamine dealing in Australia. The findings of this study will help in understanding the motivations and decisions of drug dealers, and potentially assist drug law enforcement agencies to design better strategies to dismantle supply chain linkages which generate excessive profits.

Copyright 2012, Elsevier Science

Granado N; Lastres-Becker I; Ares-Santos S; Oliva I; Martin E; Cuadrado A et al. Nrf2 deficiency potentiates methamphetamine-induced dopaminergic axonal damage and gliosis in the striatum. Glia 59(12): 1850-1863, 2011. (51 refs.)

Oxidative stress that correlates with damage to nigrostriatal dopaminergic neurons and reactive gliosis in the basal ganglia is a hallmark of methamphetamine (METH) toxicity. In this study, we analyzed the protective role of the transcription factor Nrf2 (nuclear factor-erythroid 2-related factor 2), a master regulator of redox homeostasis, in METH-induced neurotoxicity. We found that Nrf2 deficiency exacerbated METH-induced damage to dopamine neurons, shown by an increase in loss of tyrosine hydroxylase (TH)- and dopamine transporter (DAT)-containing fibers in striatum. Consistent with these effects, Nrf2 deficiency potentiated glial activation, indicated by increased striatal expression of markers for microglia (Mac-1 and Iba-1) and astroglia (GFAP) one day after METH administration. At the same time, Nrf2 inactivation dramatically potentiated the increase in TNF alpha mRNA and IL-15 protein expression in GFAP+ cells in the striatum. In sharp contrast to the potentiation of striatal damage, Nrf2 deficiency did not affect METH-induced dopaminergic neuron death or expression of glial markers or proinflammatory molecules in the substantia nigra. This study uncovers a new role for Nrf2 in protection against METH-induced inflammatory and oxidative stress and striatal degeneration.

Copyright 2011, Wiley-Blackwell

Grant KM; LeVan TD; Wells SM; Li M; Stoltenberg SF; Gendelman HE. Methamphetamine-associated psychosis. (review). Journal of Neuroimmune Pharmacology 7(1, special issue): 113-139, 2012. (194 refs.)

Methamphetamine (METH) is a frequent drug of abuse in U.S. populations and commonly associated with psychosis. This may be a factor in frequent criminal justice referrals and lengthy treatment required by METH users. Persecutory delusions and auditory hallucinations are the most consistent symptoms of METH-associated psychosis (MAP). MAP has largely been studied in Asian populations and risk factors have varied across studies. Duration, frequency and amount of use as well as sexual abuse, family history, other substance use, and co-occurring personality and mood disorders are risk factors for MAP. MAP may be unique with its long duration of psychosis and recurrence without relapse to METH. Seven candidate genes have been identified that may be associated with MAP. Six of these genes are also associated with susceptibility, symptoms, or treatment of schizophrenia and most are linked to glutamatergic neurotransmission. Animal studies of pre-pulse inhibition, attenuation of social interaction, and stereotypy and alterations in locomotion are used to study MAP in rodents. Employing various models, rodent studies have identified neuroanatomical and neurochemical changes associated with METH use. Throughout this review, we identify key gaps in our understanding of MAP and suggest potential directions for future research.

Copyright 2012, Springer

Heinzerling KG; Shoptaw S. Gender, brain-derived neurotrophic factor Val66Met, and frequency of methamphetamine use. Gender Medicine 9(2): 112-120, 2012. (50 refs.)

Background: Frequency of pretreatment methamphetamine (MA) use is an important predictor of outcomes of treatment for MA dependence. Preclinical studies suggest females self-administer more MA than males, but few clinical studies have examined potential sex differences in the frequency of MA use. Estrogen increases expression of brain-derived neurotrophic factor (BDNF), which has effects on MA-induced striatal dopamine release and protects against MA-induced neurotoxicity. Objective: We examined potential effects of sex, the Val66Met polymorphism in BDNF, and their interaction on frequency of MA use among 60 Caucasian MA-dependent volunteers screening for a clinical trial. Methods: Data was taken from 60 Caucasian MA-dependent volunteers screening for a clinical trial. Results: Females reported significantly more pretreatment days with MA use in the past 30 days than males. There was a significant interaction between sex and BDNF Val66Met, with the highest frequency of MA use among females with Val/Val genotype. Conclusions: These results, although preliminary, add to the literature documenting sexual dimorphism in response to stimulants, including MA, and suggest a potential biological mechanism involving BDNF that might contribute to these differences. Additional research characterizing the biological basis of altered response to MA among females is warranted.

Copyright 2012, Elsevier Science

Herschl LC; Highland KB; McChargue DE. Prenatal exposure to testosterone interacts with lifetime physical abuse to predict anger rumination and cognitive flexibility among incarcerated methamphetamine users. American Journal on Addictions 21(4): 363-369, 2012. (56 refs.)

The present pilot study hypothesized that degree of exposure to prenatal testosterone interacts with a history of lifetime physical abuse (LPA) to predict the cognitive (anger rumination) and behavioral (intimate partner and interpersonal violence) components of aggression within incarcerated methamphetamine (MA) users. In addition, we hypothesized that the degree of exposure to prenatal testosterone interacts with LPA to predict cognitive flexibility (Stroop Color-Word performance). Male inmate MA users (N = 60) completed neuropsychological and paper/pencil tests. Hand photocopies were also obtained to index prenatal testosterone exposure. Five covariate-adjusted moderation models were tested using anger rumination, intimate partner violence (IPV) perpetration, interpersonal violence perpetration (before and while incarcerated), and Stroop Color-Word T-score as the criteria, prenatal testosterone exposure as the predictor, and LPA as the moderator. Results indicated that, in individuals with a history of LPA, exposure to higher levels of prenatal testosterone exposure predicted greater anger rumination, lower Stroop Color-Word test T-scores, and lower frequencies of IPV perpetration. Findings were not significant in individuals without a history of LPA. This research suggests that biochemical and psychosocial vulnerabilities influence anger rumination and cognitive flexibility, which may render incarcerated MA users at greater risk to relapse or recidivate upon release from prison.

Copyright 2012, Wiley-Blackwell

Hondebrink L; Meulenbelt J; van Kleef RGDM; van den Berg M; Westerink RHS. Modulation of human GABA(A) receptor function: A novel mode of action of drugs of abuse. Neurotoxicology 32(6): 823-827, 2011. (30 refs.)

Drugs of abuse are known to mainly affect the dopaminergic and serotonergic system, although behavioral studies indicated that the GABA-ergic system also plays a role. We therefore investigated the acute effects of several commonly used drugs of abuse (methamphetamine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA) and meta-chlorophenylpiperazine (mCPP)) on the function of the human alpha(1)beta(2)gamma(2) GABA(A) receptor (hGABA(A)-R), expressed in Xenopus oocytes, using the two-electrode voltage-clamp technique. Although none of the tested drugs acted as full agonist on the hGABA(A)-R, some drugs induced differential modulation of hGABA(A)-R function, depending on the degree of receptor occupancy. Methamphetamine did not affect the GABA-evoked current at high receptor occupancy, but induced a minor inhibition at low receptor occupancy. Its metabolite amphetamine slightly potentiated the GABA-evoked current. MDMA and its metabolite MDA both inhibited the current at low receptor occupancy. However, MDMA did not affect the current at high occupancy, whereas MDA induced a potentiation. mCPP induced a strong inhibition (max. similar to 80%) at low receptor occupancy, but similar to 25% potentiation at high receptor occupancy. Competitive binding to one of the GABA-binding sites could explain the drug-induced inhibitions observed at low receptor occupancy, whereas an additional interaction with a positive allosteric binding site may play a role in the observed potentiations at high receptor occupancy. This is the first study to identify direct modulation of hGABA(A)-Rs as a novel mode of action for several drugs of abuse. Consequently, hGABAA-Rs should be considered as target for psychiatric pharmaceuticals and in developing treatment for drug intoxications.

Copyright 2011, Elsevier Science

Kang DM; Liao MZ; Jiang ZX; Zhang XJ; Mao WW; Zhang N et al. Commercial sex venues, syphilis and methamphetamine use among female sex workers. AIDS Care 23(1, supplement): 26-36, 2011. (23 refs.)

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.

Copyright 2011, Taylor & Francis

Khajeamiri AR; Faizi M; Sohani F; Baheri T; Kobarfard F. Determination of impurities in illicit methamphetamine samples seized in Iran. Forensic Science International 217(1-3): 204-206, 2012. (21 refs.)

In this study fifty samples of crystalline methamphetamine obtained from antinarcotics police of Iran seized during the year 2010 were analyzed. In order to determine the chemical characteristics of these samples, anion test, Gas Chromatography-Mass Spectrometry (GC-MS) and Liquid Chromatography-Mass Spectrometry (LC-MS) were carried out on the samples. All of the samples containing methamphetamine tested positive for chloride anion. The range of methamphetamine hydrochloride content in these samples was 33-95%. One sample out of 50 contained no methamphetamine. The fact that 1,2-dimethyl-3-phenylaziridine was the most frequently found impurity in the analyzed samples, indicates that most of the methamphetamine samples seized in Iran have been synthesized from pseudoephedrine as starting material.

Copyright 2012, Elsevier Science

Khan U; Nicell JA. Sewer epidemiology mass balances for assessing the illicit use of methamphetamine, amphetamine and tetrahydrocannabinol. Science of the Total Environment 421: 144-162, 2012. (162 refs.)

In sewer epidemiology, mass balances are used to back-extrapolate measurements of wastewater influent concentrations of appropriate drug residues to assess the parent illicit drug's level of use in upstream populations. This study focussed on developing and refining mass balances for the use of illicit methamphetamine, amphetamine and tetrahydrocannabinol. As a first step, a multi-criteria evaluation was used to select unchanged methamphetamine, unchanged amphetamine and 11-nor-9-carboxy-tetrahydrocannabinol as the most appropriate drug residues to track a selected population's use of illicit methamphetamine, amphetamine and tetrahydrocannabinol, respectively. For each of these selected drug residues, mass balances were developed by utilizing all disposition data available for their release from all their respective sources, incorporating route-of-administration considerations where relevant, and accounting for variations in the metabolic capacity of users of the various relevant licit and illicit sources. Further, since the selected drug residues for the use of methamphetamine and amphetamine cannot only result from their use but numerous other licit and illicit sources, comprehensive general source models were developed for their enantiomeric-specific release to sewers. The relative importance of the sources identified in the general source model was evaluated by performing national substance flow analyses for a number of countries. Results suggested that licit sources of methamphetamine are expected to be only of significance in populations where its illicit use is minor. Similarly, in populations where the use of illicitly produced amphetamine is currently of relevance, licit contributions to the sewer loads of amphetamine are likely to be of negligible importance. Lastly, the study of tetrahydrocannabinol back-extrapolation mass balances suggested that further research is required to assess the importance of fecal elimination of 11-nor-9-carboxy-tetrahydrocannabinol.

Copyright 2012, Elsevier Science

Kinner SA; Milloy MJ; Wood E; Qi JZ; Zhang R; Kerr T. Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users. Addictive Behaviors 37(6): 691-696, 2012. (55 refs.)

Background: Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration. Methods: Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months. Results: One third of participants (n = 829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently. Conclusions: Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.

Copyright 2012, Elsevier Science

Kirkpatrick MG; Gunderson EW; Levin FR; Foltin RW; Hart CL. Acute and residual interactive effects of repeated administrations of oral methamphetamine and alcohol in humans. Psychopharmacology 219(1): 191-204, 2012. (38 refs.)

Although methamphetamine and alcohol are commonly used together in a binge-like pattern, there is a dearth of empirical data investigating the repeated effects of this drug combination. The current study examined acute and residual mood, performance, and physiological effects of methamphetamine alone, alcohol alone, and the combination. Nine adult male volunteers completed this 20-day within-participant, residential laboratory study. During four 5-day blocks of sessions, participants were administered oral methamphetamine (0, 10 mg) combined with alcohol (0, 0.375, 0.75 g/kg) three times (day 2: AM, day 2: PM, and day 3: PM). Breath alcohol concentrations, cardiovascular, subjective, and cognitive/psychomotor performance effects were assessed before drug administration and repeatedly thereafter. Subjective and objective sleep measures were also assessed; residual effects were assessed on days 3-5 of each block. Following the first drug administration, the methamphetamine-alcohol combination produced greater elevations of heart rate and ratings of "good drug effect" compared to either drug alone. Methamphetamine attenuated alcohol-related performance decrements and feelings of intoxication, whereas alcohol attenuated methamphetamine-related sleep disruptions. By the third administration, many of these effects were significantly diminished, suggesting that participants developed tolerance. Few residual effects were observed. These data show that methamphetamine combined with alcohol produced a profile of effects that was different from the effects of either drug alone. The largely positive effects of the drug combination (i.e., greater euphoria, and fewer performance and sleep disruptions) might explain why these drugs are often used in combination.

Copyright 2012, Springer

Kirkpatrick MG; Gunderson EW; Perez AY; Haney M; Foltin RW; Hart CL. A direct comparison of the behavioral and physiological effects of methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology 219(1): 109-122, 2012. (58 refs.)

Despite their chemical similarities, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) produce differing neurochemical and behavioral responses in animals. In humans, individual studies of methamphetamine and MDMA indicate that the drugs engender overlapping and divergent effects; there are only limited data comparing the two drugs in the same individuals. This study examined the effects of methamphetamine and MDMA using a within-subject design. Eleven adult volunteers completed this 13-day residential laboratory study, which consisted of four 3-day blocks of sessions. On the first day of each block, participants received oral methamphetamine (20, 40 mg), MDMA (100 mg), or placebo. Drug plasma concentrations, cardiovascular, subjective, and cognitive/psychomotor performance effects were assessed before drug administration and after. Food intake and sleep were also assessed. On subsequent days of each block, placebo was administered and residual effects were assessed. Acutely, both drugs increased cardiovascular measures and "positive" subjective effects and decreased food intake. In addition, when asked to identify each drug, participants had difficulty distinguishing between the amphetamines. The drugs also produced divergent effects: methamphetamine improved performance and disrupted sleep, while MDMA increased "negative" subjective-effect ratings. Few residual drug effects were noted for either drug. It is possible that the differences observed could explain the differential public perception and abuse potential associated with these amphetamines. Alternatively, the route of administration by which the drugs are used recreationally might account for the many of the effects attributed to these drugs (i.e., MDMA is primarily used orally, whereas methamphetamine is used by routes associated with higher abuse potential).

Copyright 2012, Springer

Kishi T; Fukuo Y; Okochi T; Kitajima T; Ujike H; Inada T. No significant association between SIRT1 gene and methamphetamine-induced psychosis in the Japanese population. Human Psychopharmacology: Clinical and Experimental 26(7): 445-450, 2011. (36 refs.)

Objectives We previously showed that the sirtuin 1 gene (SIRT1 gene), one of the clock genes, was associated with schizophrenia in a Japanese patient population. Because the symptoms of methamphetamine (METH)-induced psychosis are similar to those of paranoid type schizophrenia and because not every METH user develops psychosis, it is conceivable that METH-induced psychosis and schizophrenia have common susceptibility genes. Therefore, we conducted an analysis of the association of SIRT1 gene with METH-induced psychosis, hypothesizing a significant relationship. Methods This paper presents a case-control study of the SIRT1 gene in 515 Japanese individuals (197 with METH-induced psychosis and 318 age-matched and sex-matched controls) with four tagging single nucleotide polymorphisms (rs12778366, rs2273773, rs4746720, and rs10997875), selected a priori using the HapMap database. Results rs10997875 (located in the 3' flanking region) was associated with METH-induced psychosis (unadjusted p(genotype)=0.0203). However, these results became non-significant after Bonferroni correction (corrected p(genotype)=0.0812). In the all-marker haplotype analysis, the SIRT1 gene was not associated with METH-induced psychosis (p=0.146). Conclusion Our findings suggest that SIRT1 gene does not contribute to the development of METH-induced psychosis in the Japanese population. However, a replication study using larger samples should be conducted to obtain conclusive results.

Copyright 2011, Wiley-Blackwell

Kishi T; Okochi T; Kitajima T; Ujike H; Inada T; Yamada M et al. Lack of association between translin-associated factor X gene (TSNAX) and methamphetamine dependence in the Japanese population. (review). Progress in Neuro-Psychopharmacology & Biological Psychiatry 35(7): 1618-1622, 2011. (30 refs.)

Objectives: Recently, we detected that the prokineticin 2 receptor gene was associated with not only major depressive disorder (MDD) but also methamphetamine dependence. Therefore, it is possible that mood disorders and drug addiction have shared susceptibility genes. The translin-associated factor X gene (TSNAX)/disrupted-in-schizophrenia-1 gene (DISC1) has been associated with psychiatric disorders, including schizophrenia, MDD and bipolar disorder. TSNAX is located immediately upstream of DISC1 and has been shown to undergo intergenic splicing with DISC1. Based on this evidence, we hypothesized that TSNAX might be a good candidate gene for methamphetamine dependence. Methods: We conducted a case-control study of Japanese individuals (215 with methamphetamine dependence and 318 age- and sex-matched controls) with three tagging SNPs (rs1630250, rs766288 and rs6662926) selected by HapMap database. Results: rs1630250 was associated in males with methamphetamine dependence in the allele analysis (P-value: 0.0253). However, these results did not remain significant after Bonferroni correction to adjust for multiple comparisons (corrected P-value: 0.152). Conclusion: Our findings suggest that TSNAX does not play a role in methamphetamine dependence in the Japanese population. A replication study using larger samples needs to be conducted to obtain conclusive results.

Copyright 2011, Elsevier Science

Kosten TR. Diagnosis, symptoms, and assessment. IN: Kosten TR; Newton TF; De La Garza R; Hale CN, eds. Cocaine and Methamphetamine Dependence: Advances in Treatment. Washington DC: American Psychiatric Association, 2011. pp. 85-104

This chapter in considering the symptoms and diagnosis introduces the anticipated changes in the upcoming DSM-V which drops the distinction between abuse and dependence. The subjective and behavioral responses to stimulants, including the phenomena of tolerance and sensitization are discussed. In discussing the process of assessment, the utility of laboratory tests is highlighted given the documented phenomenon of under-reporting. There is also attention to the differing presentation related to gender, developmental stage, and cultural setting. Given the common phenomenon of multiple substance use, the importance of identifying and distinguishing between intoxication and withdrawal.

Copyright 2011, American Psychiatric Association

Kosten TR; Newton TF; De La Garza R; Halle CN, eds. Cocaine and Methamphetamine Dependence: Advances in Treatment. Washington DC: American Psychiatric Association, 2011. (Chapter refs.)

This book sets forth the dimensions of cocaine and methamphetamine use and problems and describes treatment approaches. In this context it describes the epidemiology of use patterns as well as geographic variation. There is also a review of the associated medical problems and mortality resulting. For example cocaine dependence-related medical problems account for a third of all drug-related emergency visits. The book also reviews the rates of co-occurring psychiatric illness. There is also discussion of issues which are now gain attention. These include the changes anticipated in the American Psychiatric Association's diagnostic criteria (DSM-V) which will drop the distinction between abuse and dependence, and introduce craving as a diagnostic criterion. There is also a review of the changes in patterns of use and the increasing abuse of stimulant prescription drugs. In respect to treatment, the emphasis is upon behavioral therapies in conjunction with drug therapy, There is also discussion of amphetamine-induced psychosis and its potential emergence even after periods of abstinence, as well as the need for assessment which includes planning for problematic behaviors associated with abuse/dependence, including intoxication, violence, suicide, impaired cognitive function, and uncontrolled display of affect.

Copyright 2011, Project Cork

Kosten TR; Newton TF. Epidemiology and psychiatric comorbidity. IN: Kosten TR; Newton TF; De La Garza R; Hale CN, eds. Cocaine and Methamphetamine Dependence: Advances in Treatment. Washington DC: American Psychiatric Association, 2011. pp. 1-12

This first chapter in a book dealing with advances in the treatment of cocaine and methamphetamine dependence sets forth the epidemiology of stimulant abuse and dependence, and the related psychiatric comorbidity. Globally there is wide variation in the distribution of these problems. In the United States there has been a growing number of stimulant users and problems associated with abuse and dependence. This is evidenced by emergency room visits as well as increasing presence in the criminal justice system. Frequently occurring psychiatric illnesses include schizophrenia, major depression and post-traumatic stress disorder; smoking is also more common than in the general population.

Copyright 2011, American Psychiatric Association

Kuo CJ; Liao YT; Chen WJ; Tsai SY; Lin SK; Chen CC. Causes of death of patients with methamphetamine dependence: A record-linkage study. Drug and Alcohol Review 30(6): 621-628, 2011. (36 refs.)

Introduction and Aims. Methamphetamine use leads to increased likelihood of premature death. The authors investigated the causes of death and risk of mortality in a large cohort of patients with methamphetamine dependence. Design and Methods. A cohort of 1254 subjects with methamphetamine dependence, admitted to a psychiatric centre in Taiwan from January 1990 to December 2007, was retrospectively studied. Diagnostic and sociodemographic data for each subject were extracted from the medical records based on a chart review process. Mortality data were obtained by linking to the National Death Certification System and standardised mortality ratios (SMRs) were estimated. The risk and protective factors for all-cause deaths were explored by means of survival analyses. Results. During the study period, 130 patients died. Of them, 63.1% died unnatural deaths, while the remaining 36.9% died natural deaths. The 1 year cumulative rates for unnatural and natural deaths were 0.018 and 0.006, respectively, and the 5 year rates were 0.046 and 0.023, respectively. The cohort had excessive mortality (SMR = 6.02), and women had a higher SMR for unnatural deaths than men (26.19 vs. 9.82, P = 0.001). For all-cause deaths, comorbidity with other substance use disorders was associated with increased risk of death, despite that being married was associated with a reduced risk. Discussion and Conclusions. A substantial proportion of the deceased died natural deaths, but most died unnatural deaths. The findings show significant evidence to provide valuable insight into premature deaths among methamphetamine-dependent users. This information is valuable for development of prevention and intervention programs.

Copyright 2011, Wiley-Blackwell

LaGasse LL; Derauf C; Smith LM; Newman E; Shah R; Neal C et al. Prenatal methamphetamine exposure and childhood behavior problems at 3 and 5 years of age. Pediatrics 129(4): 681-688, 2012. (45 refs.)

Objective: We evaluated behavior problems in children who were prenatally exposed to methamphetamine (MA) at ages 3 and 5 years. Methods: The Infant Development, Environment, and Lifestyle study, a prospective, longitudinal study of prenatal MA exposure and child outcome, enrolled subjects postpartum in Los Angeles, California; Honolulu, Hawaii; Des Moines, Iowa; and Tulsa, Oklahoma. Prenatal exposure was determined by maternal self-report and/or meconium results. Exposed and comparison groups were matched on race, birth weight, public health insurance, and education. Mothers in the comparison group denied use and had a negative meconium screen for amphetamines. Prenatal exposures to tobacco, alcohol, or marijuana occurred in both groups. At ages 3 and 5 years, 330 children (166 exposed and 164 comparison) were assessed for behavior problems by using the caregiver report on the Child Behavior Checklist. General linear mixed models were used to determine the effects of prenatal methamphetamine exposure, including heavy exposure (>= 3 days per week), age, and the interaction of exposure and age on behavior problems with adjustment for other drugs of abuse and environmental risk factors. Results: methamphetamine exposure was associated with increased emotional reactivity and anxious/depressed problems at both ages and externalizing and attention-deficit/hyperactivity disorder problems by age 5 years. Heavy exposure was related to attention problems and withdrawn behavior at both ages. There were no effects of MA on the internalizing or total behavior problems scales. Conclusions: This first report of behavior problems in patients as young as 3 years associated with methamphetamine exposure identifies an important public health problem. Continued follow-up can inform the development of preventive intervention programs.

Copyright 2012, American Academy of Pediatrics

Landovitz RJ; Fletcher JB; Inzhakova G; Lake JE; Shoptaw S; Reback CJ. A novel combination HIV prevention strategy: Post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men. AIDS Patient Care and STDS 26(6): 320-328, 2012. (51 refs.)

Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI + 1-+ 3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.

Copyright 2012, Mary Ann Liebert

Lile JA; Stoops WW; Glaser PEA; Hays LR; Rush CR. Physiological and subjective effects of acute intranasal methamphetamine during extended-release alprazolam maintenance. Drug and Alcohol Dependence 119(3): 187-193, 2011. (55 refs.)

Background: Medications development for methamphetamine dependence is ongoing, but no widely accepted, effective pharmacotherapy has been identified. Previous studies have demonstrated neurobiological perturbations to central GABA(A) activity following chronic stimulant use, and that positive modulation of GABA(A) receptors attenuates the neurochemical and behavioral response to stimulant drugs such as methamphetamine. Therefore, GABA(A) modulators could be useful as pharmacotherapies for stimulant-use disorders. Methods: This study tested the hypothesis that intranasal methamphetamine would be safe and well tolerated during maintenance on extended-release alprazolam (XR), and that the effects of methamphetamine would be attenuated. Eight non-treatment-seeking, stimulant-dependent individuals completed an inpatient experiment in which ascending doses of intranasal methamphetamine (0, 5, 10,20 and 30 mg) were administered after four days of alprazolam XR maintenance (0 and 1 mg/day). Results: Intranasal methamphetamine produced prototypical effects (e.g., increased positive subjective ratings and elevated cardiovascular signs). The combination of intranasal methamphetamine and alprazolam XR was safe and well tolerated. Alprazolam XR produced small, but orderly, reductions in some of the subjective effects of methamphetamine, and performance impairment. Conclusions: The present results demonstrate that methamphetamine use during alprazolam XR treatment would not pose a significant safety risk. Given the potential of GABA(A) positive modulators to manage certain aspects of stimulant abuse and dependence (i.e., drug-induced seizures, anxiety and stress), but the relatively small impact on the acute abuse-related effects of methamphetamine observed here, additional research with GABA(A) positive modulators is warranted, but should consider their use as an adjunct component of combination behavioral and/or drug treatment.

Copyright 2011, Elsevier Science

Lindsey WT; Stewart D; Childress D. Drug interactions between common illicit drugs and prescription therapies. American Journal of Drug and Alcohol Abuse 38(4): 334-343, 2012. (51 refs.)

Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Copyright 2012, Informa Healthcare

Mansourian M; Solhi M; Dehdari T; Taghdisi MH; Zamani-Alavijeh F; Ahmadi K et al. Hallucination experiences in crystal meth abusers: A qualitative study. HealthMed 6(4): 1129-1136, 2012. (34 refs.)

Objectives: This study aimed to determine the experience of hallucination in crystal meth users in Ahwaz, Iran. Materials and Methods: This study is part of a qualitative study conducted as a content analysis approach. Data were collected by selective sampling, by holding a 38 semi- constructed in-depth interviews in Drop in Center (DICs) in Ahwaz, Iran. The participants signed testimonials free of will, then the first round of interviews were over the data were analyzed by applying Constant comparative analysis. After data entry, the new interview process was repeated until the data reached saturation. Results: Overall, 35 participants used both crack and Crystal meth, one participant was addict to crack, Crystal meth and marijuana and 2 participants were Crystal meth addicted only. 65.5% of participants were single, 65% of participants had at least one addict person in their family and 85% had a prison record. Six major categories emerged from the data analyses, including: Visual hallucination, Audile hallucination, Cognitive hallucination, Increase empathy, phobic and murder guilt hallucination, Concentration on something and abnormal behavior. Conclusion: Due to negative effects of hallucination on physical and mental health of participants and their family, and given that Crystal is produced in extensive quantities by illegal laboratories and introduced to the market, it seems necessary to give widespread education especially through mass media to all social groups, increasing public awareness would be particularly helpful for youths and teenagers

Copyright 2012, Drunpp-Sarajevo

Marshall BDL; Galea S; Wood E; Kerr T. Injection methamphetamine use is associated with an increased risk of attempted suicide: A prospective cohort study. Drug and Alcohol Dependence 119(1-2): 134-137, 2011. (35 refs.)

Background: Methamphetamine (MA) use is a growing public health concern in many settings around the world. While some physical and mental health effects associated with injection MA use have been well described, little is known about the relationship between injecting MA and suicidal behavior. We sought to determine whether MA injection was associated with an increased risk of attempting suicide among a prospective cohort of injection drug users (IDUs) in Vancouver, Canada. Methods: Between 2001 and 2008, eligible participants enrolled in the Vancouver Injection Drug Users Study (VIDUS) completed semi-annual questionnaires that elicited information regarding sociodemographics, drug use patterns, and mental health problems including suicidal behavior. We used Cox proportional hazards models with time-dependent covariates to determine whether self-reported MA injection was an independent predictor of attempting suicide at subsequent time points. Results: of 1873 eligible participants, 149 (8.0%) reported a suicide attempt, resulting in an incidence density of 2.5 per 100 person-years. Participants who attempted suicide were more likely to be younger (median: 35 vs. 40, p < 0.01), female (48.3% vs. 35.1%, p < 0.01), and of Aboriginal ancestry (43.6% vs. 31.3%, p < 0.01). In a Cox proportional hazards model, MA injection was associated with an 80% increase in the risk of attempting suicide (adjusted hazard ratio = 1.80, 95% CI: 1.08-2.99, p = 0.02). Conclusions: These findings suggest that IDUs who inject MA should be monitored for suicidal behavior. Improved integration of mental health and suicide prevention interventions within harm reduction and drug treatment programs may be fruitful.

Copyright 2011, Elsevier Science

Marshall BDL; Grafstein E; Buxton JA; Qi J; Wood E; Shoveller JA et al. Frequent methamphetamine injection predicts emergency department utilization among street-involved youth. Public Health 126(1): 47-53, 2012. (33 refs.)

Objectives: Methamphetamine (MA) use has been associated with health problems that commonly present in the emergency department (ED). This study sought to determine whether frequent MA injection was a risk factor for ED utilization among street-involved youth. Study design: Prospective cohort study. Methods: Data were derived from a street-involved youth cohort known as the 'At Risk Youth Study'. Behavioural data including MA use were linked to ED records at a major inner-city hospital. Kaplan-Meier and Cox proportional hazards methods were used to determine the risk factors for ED utilization. Results: Between September 2005 and January 2007, 427 eligible participants were enrolled, among whom the median age was 21 (interquartile range 19-23) years and 154 (36.1%) were female. Within 1 year, 163 (38.2%) visited the ED, resulting in an incidence density of 53.7 per 100 person-years. ED utilization was significantly higher among frequent (i.e. >= daily) MA injectors (log-rank P = 0.004). In multivariate analysis, frequent MA injection was associated with an increased hazard of ED utilization (adjusted hazard ratio = 1.84, 95% confidence interval 1.04-3.25; P = 0.036). Conclusions: Street-involved youth who frequently inject MA appear to be at increased risk of ED utilization. The integration of MA-specific addiction treatment services within emergency care settings for high-risk youth is recommended.

Copyright 2012, The Royal Society for Public Health.

Marshall BDL; Shoveller JA; Wood E; Patterson TL; Kerr T. Difficulty accessing syringes mediates the relationship between methamphetamine use and syringe sharing among young injection drug users. AIDS & Behavior 15(7): 1546-1553, 2011. (48 refs.)

Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22-27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.

Copyright 2011, Springer

Martin M; Vanichseni S; Suntharasamai P; Sangkum U; Chuachoowong R; Mock PA et al. Enrollment characteristics and risk behaviors of injection drug users participating in the Bangkok Tenofovir Study, Thailand. PLoS ONE 6(9): e25127, 2011. (44 refs.)

Background: The Bangkok Tenofovir Study was launched in 2005 to determine if pre-exposure prophylaxis with tenofovir will reduce the risk of HIV infection among injecting drug users (IDUs). We describe recruitment, screening, enrollment, and baseline characteristics of study participants and contrast risk behavior of Tenofovir Study participants with participants in the 1999-2003 AIDSVAX B/E Vaccine Trial. Methods: The Bangkok Tenofovir Study is an ongoing, phase-3, randomized, double-blind, placebo-controlled, HIV pre-exposure prophylaxis trial of daily oral tenofovir. The Tenofovir Study and the Vaccine Trial were conducted among IDUs at 17 drug-treatment clinics in Bangkok. Tenofovir Study sample size was based on HIV incidence in the Vaccine Trial. Standardized questionnaires were used to collect demographic, risk behavior, and incarceration data. The Tenofovir Study is registered with, number-NCT00119106. Results: From June 2005 through July 2010, 4094 IDUs were screened and 2413 enrolled in the Bangkok Tenofovir Study. The median age of enrolled participants was 31 years (range, 20-59), 80% were male, and 63% reported they injected drugs during the 3 months before enrollment. Among those who injected, 53% injected methamphetamine, 37% midazolam, and 35% heroin. Tenofovir Study participants were less likely to inject drugs, inject daily, or share needles (all, p<0.001) than Vaccine Trial participants. Discussion: The Bangkok Tenofovir Study has been successfully launched and is fully enrolled. Study participants are significantly less likely to report injecting drugs and sharing needles than participants in the 1999-2003 AIDSVAX B/E Vaccine Trial suggesting HIV incidence will be lower than expected. In response, the Bangkok Tenofovir Study enrollment was increased from 1600 to 2400 and the study design was changed from a defined 1-year follow-up period to an endpoint-driven design. Trial results demonstrating whether or not daily oral tenofovir reduces the risk of HIV infection among IDUs are expected in 2012.

Copyright 2011, Public Library of Science

Matsubara K; Asari M; Suno M; Awaya T; Sugawara M; Omura T et al. Estimation of the duration after methamphetamine injection using a pharmacokinetic model in suspects who caused fatal traffic accidents. Legal Medicine 14(4): 191-196, 2012. (12 refs.)

When the population parameters of drug pharmacokinetics in the human body system are known, the time-course of a certain drug in an individual can generally be estimated by pharmacokinetics. In the present two cases where methamphetamine abusers were suspected to have inflicted mortalities in traffic accidents, the time-elapse or duration immediately after methamphetamine injection to the time when the accidents occurred became points of contention. In each case, we estimated the time-course of blood methamphetamine after the self-administration in the suspects using a 2-compartment pharmacokinetic model with known pharmacokinetic parameters from the literatures. If the injected amount can be determined to a certain extent, it is easy to calculate the average time-elapse after injection by referring to reference values. However, there is considerable individual variability in the elimination rate based on genetic polymorphism and a considerably large error range in the estimated time-elapse results. To minimize estimation errors in such cases, we also analyzed genotype of CYP2D6, which influenced methamphetamine metabolism. Estimation based on two time-point blood samples would usefully benefit legal authorities in passing ruling sentences in cases involving similar personalities and circumstances as those involved in the present study.

Copyright 2012, Elsevier Science

Mattoo SK; Parakh P. Mephentermine dependence: An emerging challenge. CNS Neuroscience & Therapeutics 18(6): 509-510, 2012. (10 refs.)

Structurally similar to methamphetamine, mephentermine has been used as a vasoconstrictor for treating hypotension in acute, emergency or anaesthesia settings, or as a nasal decongestant in inhalers. It has been prohibited by the World Anti-Doping Agency, because as a stimulant it can improve physical performance. Banned in the United States, it is available in many countries illegally or legally, and mainly for veterinary use. Our literature search on mephentermine abuse or dependence produced only six case reports. The first two from the United States report acute psychotic symptoms with misuse of inhalers. The next three reports from India describe chronic psychosis with mephentermine dependence, codependence of intravenous mephentermine, buprenorphine and promethazine, and mephentermine dependence with doses of 60 mg/day. A recent report from Brazil describes mephentermine dependence with daily doses of 120-180 mg routinely, and 420 mg on a single occasion. We present a case of mephentermine dependence who reported using an extremely high dose of 1500 mg/day for 6 months. Over the decades, reports on mephentermine dependence have increased, providing new data on its tolerance, withdrawal, and complications, but the true extent of the problem remains to be documented. There is a lack of awareness of its potential for dependence among not only the public but also the health care professionals, including those dealing with substance abuse

Copyright 2012, Wiley-Blackwell

Maxwell JC. Drunk versus drugged: How different are the drivers? Drug and Alcohol Dependence 121(1-2): 68-72, 2012. (33 refs.)

Background: Driving under the influence (DUI) of drugs is increasing in the U.S., but little is known about the differences based on their patterns of use and abuse of alcohol and other drugs. Methods: This paper uses a large dataset to study patients admitted to Texas substance abuse treatment programs with one or more past-year DUI arrests. t-Tests are used for comparisons between normally distributed continuous data and chi square for categorical data. Results: First-time DUI offenders not only differ from those reporting more than one past-year DUI, but they differ among themselves in terms of demographics, treatment participation, substance use problems, and mental health disorders. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives, and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. Conclusions: The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as female drivers, and the role of acculturation should be recognized in programs for Hispanic drivers. In addition, specific programs should be targeted to young cannabis abusers and underage offenders. All first-time DUI arrestees should be assessed for their levels of impairment.

Copyright 2012, Elsevier Science

Maxwell JC; Brecht ML. Methamphetamine: Here we go again? Addictive Behaviors 36(12): 1168-1173, 2011. (31 refs.)

Following more than two decades of generally increasing trends in the use and abuse of methamphetamine in certain parts of the country, prevalence indicators for the drug began to decrease in the mid-2000's-but was this decrease signaling the end of the "meth problem"? This paper has compiled historical and recent data from supply and demand indicators to provide a broader context within which to consider the changes in trends over the past half decade. Data suggest supply-side accommodation to changes in precursor chemical restrictions, with prevalence indicators beginning to attenuate in the mid-2000's and then increasing again by 2009-2010. Results support the need for continuing attention to control and interdiction efforts appropriate to the changing supply context and to continuing prevention efforts and increased number of treatment programs.

Copyright 2011, Elsevier Science

McCann DJ; Li SH. A novel, nonbinary evaluation of success and failure reveals bupropion efficacy versus methamphetamine dependence: Reanalysis of a multisite trial. CNS Neuroscience & Therapeutics 18(5): 414-418, 2012. (16 refs.)

A multisite, double-blind, placebo-controlled trial of bupropion for methamphetamine dependence was reanalyzed using a novel, nonbinary method of evaluating success and failure. The original analysis focused on a group response endpoint (the change in percentage of participants with methamphetamine-free urines each week over the course of the trial) and no significant bupropion effect was observed in the total population of study participants. In this reanalysis, individual participants were regarded as treatment success if they achieved multiple weeks of abstinence lasting through the end of the study, and their degree of success was quantified by calculating the number of beyond-threshold weeks of success (NOBWOS). Thus, setting the threshold at 1 week of end-of-study abstinence (EOSA), treatment successes were assigned NOBWOS values ranging from 1 to 11, with 1 corresponding to 2 weeks EOSA and 11 corresponding to abstinence throughput the entire 12-week trial. Treatment failures were assigned a value of 0. Comparison of NOBWOS values revealed a significant effect of bupropion to facilitate abstinence (P= 0.0176). In the bupropion group, 20% of participants achieved 2 or more weeks EOSA, 14% achieved 6 or more weeks EOSA, and 6% were abstinent throughout the trial; this compares with 7%, 4%, and 1% in the placebo group, respectively. On the basis of the NOBWOS analysis, bupropion seems to effectively facilitate the achievement of abstinence in methamphetamine-dependent individuals.

Copyright 2012, Wiley-Blackwell

McKetin R; Sutherland R; Bright DA; Norberg MM. A systematic review of methamphetamine precursor regulations. (review). Addiction 106(11): 1911-1924, 2011. (41 refs.)

Aims To assess the effectiveness of methamphetamine precursor regulations in reducing illicit methamphetamine supply and use. Methods A systematic review of 12 databases was used to identify studies that had evaluated the impact of methamphetamine precursor regulations on methamphetamine supply and/or use. The guidelines of the Effective Practice and Organization of Care Group (EPOC) of The Cochrane Collaboration were used to determine which study designs were included and assess their quality. Results Ten studies met the inclusion criteria. These studies evaluated 15 interventions (13 regulations and two related interdiction efforts), all of which were located in North America. Interventions had consistent impacts across various indicators of methamphetamine supply and use. Seven of the 15 interventions produced reductions in methamphetamine indicators (ranging from 12% to 77%). Two of the largest impacts were seen following interdiction efforts, involving the closure of rogue pharmaceutical companies. There was no evidence of a shift into other types of drug use, or injecting use, although the impact on the synthetic drug market was not examined. Null effects were related largely to the existence of alternative sources of precursor chemicals or the availability of imported methamphetamine. Conclusions: Methamphetamine precursor regulations can reduce indicators of methamphetamine supply and use. Further research is needed to determine whether regulations can be effective outside North America, particularly in developing countries, and what impact they have on the broader synthetic drug market. Improved data on precursor diversion are needed to facilitate the evaluation of precursor regulations.

Copyright 2011, Society for the Study of Addiction

Morefield KM; Keane M; Felgate P; White JM; Irvine RJ. Pill content, dose and resulting plasma concentrations of 3,4-methylendioxymethamphetamine (MDMA) in recreational 'ecstasy' users. Addiction 106(7): 1293-1300, 2011. (50 refs.)

Aims: To improve our understanding of the pharmacology of 'ecstasy' in recreational environments; in particular, to describe the composition of ecstasy pills, patterns of ecstasy use and the relationship between dose of 3,4-methylendioxymethamphetamine (MDMA) and resulting plasma concentrations. Design, setting and participants: A naturalistic observational study of 56 experienced 'ecstasy' users in recreational settings in Australia. Measurements: Drug use patterns (number of pills consumed, other drugs consumed). drug content of pills and resultant plasma concentrations of MDMA and related drugs were assessed by gas chromatography/mass spectrometry (GC/MS). Findings: Ecstasy pills generally contained MDMA, but this was often combined with other drugs such as 3,4-methylendioxyethylamphetamine (MDEA) and methamphetamine. The dose of MDMA per pill ranged from 0 to 245 mg and users consumed from one-half to five pills, with the total dose consumed ranging up to 280 mg. Plasma concentrations of MDMA increased with number of pills consumed and cumulative MDMA dose. Use of larger numbers of pills was associated with extended exposure to the drug. Conclusions: MDMA is the major active drug in ecstasy pills, but there is a high degree of variation in doses. Use of multiple pills over the course of one session is common and results in a sustained increase in MDMA plasma concentrations over a number of hours. This is likely to lead to a much greater exposure of the brain to MDMA than would be predicted from controlled single-dose pharmacokinetic studies.

Copyright 2011, Society for the Study of Addiction

Morgan EE; Woods SP; Poquette AJ; Vigil O; Heaton RK; Grant I. Visual memory in methamphetamine-dependent individuals: Deficient strategic control of encoding and retrieval. Australian and New Zealand Journal of Psychiatry 46(2): 141, 2012. (69 refs.)

Objective: Chronic use of methamphetamine (MA) has moderate effects on neurocognitive functions associated with frontal systems, including the executive aspects of verbal episodic memory. Extending this literature, the current study examined the effects of MA on visual episodic memory with the hypothesis that a profile of deficient strategic encoding and retrieval processes would be revealed for visuospatial information (i.e., simple geometric designs), including possible differential effects on source versus item recall. Method: The sample comprised 114 MA-dependent (MA+) and 110 demographically-matched MA-nondependent comparison participants (MA-) who completed the Brief Visuospatial Memory Test - Revised (BVMT-R), which was scored for standard learning and memory indices, as well as novel item (i.e., figure) and source (i.e., location) memory indices. Results: Results revealed a profile of impaired immediate and delayed free recall (p < 0.05) in the context of preserved learning slope, retention, and recognition discriminability in the MA+ group. The MA+ group also performed more poorly than MA- participants on Item visual memory (p < 0.05) but not Source visual memory (p > 0.05), and no group by task-type interaction was observed (p > 0.05). Item visual memory demonstrated significant associations with executive dysfunction, deficits in working memory, and shorter length of abstinence from MA use (p < 0.05). Conclusions: These visual memory findings are commensurate with studies reporting deficient strategic verbal encoding and retrieval in MA users that are posited to reflect the vulnerability of frontostriatal circuits to the neurotoxic effects of MA. Potential clinical implications of these visual memory deficits are discussed.

Copyright 2012, Informa Healthcare

Morrow BA; Roth RH; Redmond DE; Elsworth JD. Impact of methamphetamine on dopamine neurons in primates is dependent on age: Implications for development of Parkinson's disease. Neuroscience 189: 277-285, 2011. (77 refs.)

Methamphetamine is a CNS stimulant with limited therapeutic indications, but is widely abused. Short-term exposure to higher doses, or long-term exposure to lower doses, of methamphetamine induces lasting damage to nigrostriatal dopamine neurons in man and animals. Strong evidence indicates that the mechanism for this detrimental effect on dopamine neurons involves oxidative stress exerted by reactive oxygen species. This study investigates the relative susceptibility of dopamine neurons in mid-gestation, young, and adult (not aged) monkeys to four treatments with methamphetamine over 2 days. Primate dopamine neurons undergo natural cell death at mid-gestation, and we hypothesized that during this event they are particularly vulnerable to oxidative stress. The results indicated that at mid-gestation and in adults, dopamine neurons were susceptible to methamphetamine-induced damage, as indicated by loss of striatal tyrosine hydroxylase (TH) immunoreactivity and dopamine concentration. However, dopamine neurons in young animals appeared totally resistant to the treatment, despite this group having higher brain levels of methamphetamine 3 h after administration than the adults. As a possible explanation for the protection, striatal glial-derived neurotrophic factor (GDNF) levels were elevated in young animals 1 week after treatment, but not in adults following methamphetamine treatment. Implications of these primate studies are: (1) the susceptibility of dopamine neurons at mid-gestation to methamphetamine warns against the risk of exposing pregnant women to the drug or oxidative stressors, and supports the hypothesis of Parkinson's disease being associated with oxidative stress during development, (2) elucidation of the mechanism of resistance of dopamine neurons in the young animals to methamphetamine-induced oxidative stress may provide targets for slowing or preventing age- or disease-related loss of adult nigrostriatal dopamine (DA) neurons, and (3) the increased striatal production of GDNF in young animals, but not in adults, in response to methamphetamine, suggests the possibility of an age-related change in the neurotrophic capacity of the striatal dopamine system.

Copyright 2011, Elsevier Science

Mugele J; Nanagas KA; Tormoehlen LM. Serotonin syndrome associated with MDPV use: A case report. Annals of Emergency Medicine 60(1): 100-102, 2012. (15 refs.)

Serotonin syndrome is associated with use of certain street drugs, including methamphetamine, cocaine, and ecstasy. We describe a case of a woman who developed clinical findings consistent with serotonin syndrome after insufflation of 3,4-methylenedioxypyrovalerone (MDPV), a synthetic amphetamine. MDPV belongs to a group of substances called phenylethylamines, which are beta-ketone analogs of other drugs of abuse, such as amphetamines and 3,4-methylenedioxymethamphetamine. She also received fentanyl initially during her hospitalization, which has also been associated with serotonin syndrome. In addition to benzodiazepines and supportive care, she was treated with cyproheptadine for 8 days, with slow resolution of her symptoms.

Copyright 2012, Elsevier Science

Nakanishi K; Miki A; Zaitsu K; Kamata H; Shima N; Kamata T et al. Cross-reactivities of various phenethylamine-type designer drugs to immunoassays for amphetamines, with special attention to the evaluation of the one-step urine drug test Instant-View (TM), and the Emit (R) assays for use in drug enforcement. Forensic Science International 217(1-3): 174-181, 2012. (35 refs.)

Cross-reactivities of 76 kinds of phenethylamine-type designer drugs and related compounds to the urine drug tests Instant-View (TM) (IV) (the Methamphetamine (MA) test, the Amphetamine 300 test, and the MDMA test) have been investigated. An on-site urine test kit consisting of these three IV tests has been evaluated for the on-site screening of MA users, and the kit has been found to have satisfactory specificity for drug enforcement purposes by separately detecting both MA and its metabolite amphetamine. The cross-reactivity profiles of Emit (R) II Plus Amphetamines Assay, Emit (R) II Plus Ecstasy assay, and Emit (R) d.a.u.(R) Amphetamine Class assay have also been investigated and discussed.

Copyright 2012, Elsevier Science

Noffsinger S; Clements-Nolle K; Bacon R; Lee W; Albers E; Yang W. Substance use and fighting among male and female high school youths: A brief report. Journal of Child & Adolescent Substance Abuse 21(2): 105-116, 2012. (42 refs.)

While previous studies have investigated the relationship between substance use and violent behaviors among youths, the individual influence of specific drugs among males and females is poorly understood. Using the Nevada 2005 Youth Risk Behavior Surveillance (YRBS) Survey (N = 1,556), weighted logistic regression was used to assess the independent substance use correlates of physical fighting among males and females. Final models controlled for sociodemographics, gang membership, parental monitoring, and other drugs. Our data suggest that there are gender differences in the individual drugs that are correlated with fighting among high school students. For males, binge drinking was independently associated with fighting, while for females, marijuana and methamphetamine were independent correlates.

Copyright 2012, Taylor & Francis

Novak SP; Kral AH. Comparing injection and non-injection routes of administration for heroin, methamphetamine, and cocaine users in the United States. Journal of Addictive Diseases 30(3): 248-257, 2011. (38 refs.)

Research examining the demographic and substance use characteristics of illicit drug use in the United States has typically failed to consider differences in routes of administration or has exclusively focused on a single route of administration-injection drug use. Data from National Survey on Drug Use and Health were used to compare past-year injection drug users and non-injection drug users' routes of administration of those who use the three drugs most commonly injected in the United States: heroin, methamphetamine, and cocaine. Injection drug users were more likely than those using drugs via other routes to be older (aged 35 and older), unemployed, possess less than a high school education, and reside in rural areas. IDUs also exhibited higher rates of abuse/dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems. Fewer differences between IDUs and non-IDUs were observed for heroin users compared with methamphetamine or cocaine users.

Copyright 2011, Taylor & Francis

Nyamathi A; Hudson A; Greengold B; Leake B. Characteristics of homeless youth who use cocaine and methamphetamine. American Journal on Addictions 21(3): 243-249, 2012. (44 refs.)

This cross-sectional hepatitis health promotion study (N = 156) was designed to identify correlates of cocaine and methamphetamine use among young, homeless persons living in Los Angeles County. Structured questionnaires were administered at baseline to assess sociodemographic characteristics, drug history, and social support. Unadjusted analysis showed that older age, having a history of incarceration, injection drug use (IDU), 10 or more sexual partners, and sex for money were associated with both cocaine and methamphetamine use. Logistic regression results showed that injection drug users had over seven times greater odds of using each stimulant compared with nonusers of injection drugs; those reporting at least 10 sexual partners and alcohol use in the past 6 months were more likely to use cocaine than their respective counterparts. African Americans were also less likely than Whites to report cocaine use. Understanding of these relationships can guide interventions targeting the multiple challenges faced by this population.

Copyright 2012, Wiley-Blackwell

O'Neill TB; Rawlins JM; Rea S; Wood FM. Methamphetamine laboratory-related burns in Western Australia: Why the explosion? Burns 37(6): 1044-1048, 2011. (19 refs.)

Introduction: With increasing numbers of illicit drug users in both urban and rural communities, users and producers are becoming increasingly enterprising in their sourcing of mind altering drugs. An example of this is the 'amateur' production of methamphetamine in domestic dwellings. We describe the mechanism of burn seen in methamphetamine production, the pattern of clinical injury, and the difficulties in treating these patients. Methods: A 12 month retrospective study of five patient groups presenting to our burn service with injuries following methamphetamine laboratory explosion. Results: Out of five patient groups we have treated 9 individual patients (with one patient presenting on two different occasions) with burns following methamphetamine laboratory explosion. All patients were male and required hospital admission. The cause of the explosive injury was initially reported as barbeque or oven related, :assault, or accident in all patients. Two patients (in separate events) required intubation for associated inhalation injury. Burn size varied from 1% to 40% BSA. 7 patients required surgical debridement and skin grafting. Injury type was thermal and chemical. All patients had difficult follow-up due to low levels of clinic attendance. Conclusion: Methamphetamine laboratory explosion burns are difficult injuries from the start. Invariably the true circumstances surrounding the injury are not clear, and clinicians should be suspicious of a meth lab explosion in suspect individuals with burns plus airway injury. Patient management is complex and often requires substantial analgesic and anxiolytic medication in conjunction with clinical psychology and psychiatry as an inpatient.

Copyright 2011, Elsevier Science

Orikabe L; Yamasue H; Inoue H; Takayanagi Y; Mozue Y; Sudo Y et al. Reduced amygdala and hippocampal volumes in patients with methamphetamine psychosis. Schizophrenia Research 132(2-3): 183-189, 2011. (57 refs.)

The similarity between psychotic symptoms in patients with schizophrenia such as hallucinations and delusions and those caused by administration of methamphetamine has been accepted. While the etiology of schizophrenia remains unclear, methamphetamine induced psychosis, which is obviously occurred by methamphetamine administration, had been widely considered as a human pharmaceutical model of exogenous psychosis. Although volume reductions in medial temporal lobe structure in patients with schizophrenia have repeatedly been reported, those in patients with methamphetamine psychosis have not yet been clarified. Magnetic resonance images (MRI) were obtained from 20 patients with methamphetamine psychosis and 20 age, sex, parental socio-economic background, and IQ matched healthy controls. A reliable manual tracing methodology was employed to measure the gray matter volume of the amygdala and the hippocampus from MRIs. Significant gray matter volume reductions of both the amygdala and hippocampus were found bilaterally in the subjects with methamphetamine psychosis compared with the controls. The degree of volume reduction was significantly greater in the amygdala than in hippocampus. While the total gray, white matter and intracranial volumes were also significantly smaller-than-normal in the patients; the regional gray matter volume reductions in these medial temporal structures remained statistically significant even after these global brain volumes being controlled. The prominent volume reduction in amygdala rather than that in hippocampus could be relatively specific characteristics of methamphetamine psychosis, since previous studies have shown significant volume reductions less frequently in amygdala than in hippocampus of the other psychosis such as schizophrenia.

Copyright 2011, Elsevier Science

Pasche S; Myers B. Substance misuse trends in South Africa. Human Psychopharmacology: Clinical and Experimental 27(3): 338-341, 2012. (21 refs.)

This paper, the first in a series related to the Joint European South African Research Network in Anxiety Disorders programme, examines substance use trends in South Africa. Alcohol remains the substance with the greatest burden of harm. Yet, trends vary by region, with for example methamphetamine being a major driver of psychiatric and substance abuse treatment demand in the Western Cape province. Heroin use is increasing in several provinces, where rapid intervention is required to avoid an epidemic. In particular, the state (the main funder of drug services) urgently needs to provide opioid substitution treatment. Apart from an inadequate number of treatment services, barriers to treatment are high. Barriers are predominantly cost, transport and resource related. Services are also impacted by a small and inadequately trained workforce and poor integration with mental health services. To adequately intervene with substance use disorders, South Africa needs an evidence-based policy and service planning framework that forges linkages with the mental health service system.

Copyright 2012, Wiley-Blackwell

Pluddemann A; Flisher AJ; McKetin R; Parry CD; Lombard CJ. Methamphetamine use and sexual risk behavior among high school students in Cape Town, South Africa. Journal of Child & Adolescent Substance Abuse 21(2): 181-191, 2012. (13 refs.)

Objective: To investigate whether methamphetamine use is associated with sexual risk behavior among adolescents. Method: A cross-sectional survey of 1,561 male and female high school students in Cape Town (mean age 14.9 years) was conducted using items from the Problem Oriented Screening Instrument for Teenagers (POSIT) HIV Risk Scale. Results: Nine percent of the students had tried methamphetamine and 30% of male and 17% of female students reported sexual debut. Multinomial logistic regression analyses showed that methamphetamine use in the past year was significantly associated with being in a higher HIV/STI risk category (RRR = 2.1, 95% CI: 1.10-4.03, p < 0.05). Conclusions: Methamphetamine use, coupled with a high HIV prevalence in South Africa, raises serious cause for concern about the potential for methamphetamine to further exacerbate the prevalence and spread of HIV in Cape Town.

Copyright 2012, Taylor & Francis

Pottiez G; Jagadish T; Yu F; Letendre S; Ellis R; Duarte NA et al. Plasma proteomic profiling in HIV-1 infected methamphetamine abusers. PLoS ONE 7(2): e-article 31031, 2012. (47 refs.)

We wanted to determine whether methamphetamine use affects a subset of plasma proteins in HIV-infected persons. Plasma samples from two visits were identified for subjects from four groups: HIV+, ongoing, persistent METH use; HIV+, short-term METH abstinent; HIV+, long term METH abstinence; HIV negative, no history of METH use. Among 390 proteins identified, 28 showed significant changes in expression in the HIV+/persistent METH+ group over the two visits, which were not attributable to HIV itself. These proteins were involved in complement, coagulation pathways and oxidative stress. Continuous METH use is an unstable condition, altering levels of a number of plasma proteins.

Copyright 2012, Public Library of Science

Price KL; DeSantis SM; Simpson AN; Tolliver BK; McRae-Clark AL; Saladin ME et al. The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina. American Journal on Addictions 20(5): 447-455, 2011. (63 refs.)

Inconsistencies in reports on methamphetamine(METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.

Copyright 2011, Wiley-Blackwell

Rajasingham R; Mimiaga MJ; White JM; Pinkston MM; Baden RP; Mitty JA. A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine. (review). AIDS Patient Care and STDs 26(1): 36-52, 2012. (75 refs.)

Men who have sex with men (MSM) have the highest incidence of HIV infection in the United States. One of the contributing factors to HIV spread among this group is the use of crystal methamphetamine ("meth''). The objective was to review the behavioral impact of crystal meth use in HIV-infected MSM and potential treatment options. A systematic review of MEDLINE identified studies that evaluated the clinical effects of crystal meth on the HIV-infected MSM population. Search terms included HIV, methamphetamine, MSM, antiretroviral therapy, adherence, resistance, and treatment. U. S. citations in the English language in peer-reviewed journals until December 2010 were included. The primary author reviewed eligible articles, and relevant data including study design, sample, and outcomes were entered into an electronic data table. The 61 included studies highlight that HIV-infected MSM who use crystal meth are more likely to report high-risk sexual behaviors, incident sexually transmitted infections, and serodiscordant unprotected anal intercourse, compared to HIV-infected MSM who do not use crystal meth. Medication adherence in this population is notably low, which may contribute to transmission of resistant virus. No medications have proven effective in the treatment of crystal meth addiction, and the role of behavioral therapies, such as contingency management are still in question. HIV-infected MSM who abuse crystal meth have worse HIV-related health outcomes. Behavioral interventions have shown variable results in treating crystal meth addiction, and more investigation into rehabilitation options are needed. The results presented support efforts to develop and implement novel interventions to reduce crystal meth use in HIV-infected MSM.

Copyright 2012, Mary Ann Liebert

Reback CJ; Peck JA; Fletcher JB; Nuno M; Dierst-Davies R. Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM. Journal of Psychoactive Drugs 44(2): 166-172, 2012. (36 refs.)

Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p<.05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p <=.05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p<.05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.

Copyright 2012, Haight-Ashbury Publishing

Reid MJ; Langford KH; Morland J; Thomas KV. Quantitative assessment of time dependent drug-use trends by the analysis of drugs and related metabolites in raw sewage. Drug and Alcohol Dependence 119(3): 179-186, 2011. (62 refs.)

Background: Accurate and timely information on the scale and dynamics of drug consumption is important for assessing the needs of law enforcement and public health services in a community. Aims: This paper presents a detailed examination of a comprehensive sewage-sampling campaign for the purposes of increasing an understanding of the dynamics of drug-flows in sewage streams, and developing new methodology by which this technique can support traditional drug-use surveys. Methods: A total of 104 sewage samples were collected from a treatment plant servicing approximately 500000 people and analysed for levels of methamphetamine, cocaine and cocaine metabolites. Careful examination of the kinetics of drug-flow profiles was then performed in order to identify trends or patterns of use within the community. Results: Results were validated against identical measurements of pharmaceutical reference compounds. Consumption profiles for cocaine and methamphetamine were found to differ in terms of frequency and timing of use. The majority of cocaine consumption occurs during the evening hours and 45% of consumption of this drug occurs in weekend periods. The flow of methamphetamine in the sewage system appears more evenly spread throughout the week. Conclusions: This result is consistent with both an extended excretion half-life and a pattern of use that is more evenly balanced across all days of the week. Comprehensive investigation in to the scale and kinetics of drug flow in a sewage stream can therefore provide valuable information, not only in terms of the volume of drug consumed, but also in terms of identifying differing usage-patterns over daily and weekly time-scales.

Copyright 2011, Elsevier Science

Salo R; Gabay S; Fassbender C; Henik A. Distributed attentional deficits in chronic methamphetamine abusers: Evidence from the Attentional Network Task (ANT). Brain and Cognition 77(3): 446-452, 2011. (66 refs.)

Objective: The goal of the present study was to examine distributed attentional functions in long-term but currently abstinent methamphetamine (MA) abusers using a task that measures attentional alertness, orienting, and conflict resolution. Methods: Thirty currently abstinent MA abusers (1 month-5 years) and 22 healthy non-substance using adults were administered a multimodal version of the Attentional Network Task (ANT-I). In this task subjects identified the direction of a centrally presented arrow using a key press. Analyses examined the interaction between alerting tones, location cueing and congruency between the target arrows and flanking distracter stimuli. Results: All participants were faster when an auditory tone preceded the trial onset (p < 0.001), on trials in which a valid cue preceded the location of the target arrow (p < 0.001), and on congruent trials (i.e., when all display arrows faced in the same direction) (p < 0.001). Of primary interest was the finding that MA abusers were more influenced by the conflict between the peripheral arrows and the central target arrow (p = 0.009). There were also correlations between length of drug sobriety and executive function as well as between drug-induced psychiatric symptoms and alertness. Conclusions: These results suggest that chronic MA abusers display cognitive deficits that may reflect a specific vulnerability to distraction on a task of executive function. These findings are consistent with other studies that have reported deficits in anterior attentional systems and top-down cognitive control.

Copyright 2011, Elsevier Science

Semple SJ; Strathdee SA; Zians J; Patterson TL. Methamphetamine-using parents: The relationship between parental role strain and depressive symptoms. Journal of Studies on Alcohol and Drugs 72(6): 954-964, 2011. (79 refs.)

Objective: The methamphetamine epidemic in the United States involves a large number of men and women with dependent-age children. However, we know little about the parenting strains experienced by methamphetamine-using mothers and fathers and the relationship of these parenting strains to mental health outcomes, specifically depressive symptoms. Method: The primary goal of this study was to examine five dimensions of parental role strain in relation to depressive symptoms in a sample of 180 methamphetamine-using parents of dependent-age children in San Diego, CA. Dimensions of parental role strain included child emotional and behavioral problems, child physical health problems, child-related financial strain, interpersonal conflict involving children, and intrapsychic strain related to children. Results: Methamphetamine using mothers reported significantly more child-related emotional and behavioral problems compared with methamphetamine-using fathers (7.9 vs. 6.8; t = 2.5, p < .05). In multiple regression analysis, higher Beck depression scores were associated with being a mother (beta = .186, p < .05), having more children younger than 18 years old (beta =.165, p < .05), less emotional support (beta = -.230, p < .01), and higher scores on intrapsychic parental role strain related to children (beta = .288,p < .01). Conclusions: These findings suggest the importance of considering the multidimensional nature of parenting strain in the development of drug treatment and counseling programs for methamphetamine-using parents.

Copyright 2011, Alcohol Research Documentation

Serrano KA; Martyny JW; Kofford S; Contreras JR; Van Dyke MV. Decontamination of clothing and building materials associated with the clandestine production of methamphetamine. Journal of Occupational and Environmental Hygiene 9(3): 185-197, 2012. (26 refs.)

This study was designed to determine how easily methamphetamine can be removed from clothing and building materials, utilizing different cleaning materials and methods. The study also addressed the penetration of methamphetamine into drywall and the ability of paints to encapsulate the methamphetamine on drywall. Clothing and building materials were contaminated in a stainless steel chamber by aerosolizing methamphetamine in a beaker heater. The amount of methamphetamine surface contamination was determined by sampling a grid pattern on the material prior to attempting to clean the materials. After cleaning, the materials were again sampled, and the degree of decontamination noted. We found that household clothing and response gear worn by first responders was easily decontaminated using a household detergent in a household washing machine. A single wash removed over 95% of the methamphetamine from these materials. The study also indicated that methamphetamine-contaminated, smooth nonporous surfaces can be easily cleaned to below detectable levels using only mild cleaners. More porous surfaces such as plywood and drywall were unlikely to be decontaminated to below regulatory levels even with three washes using a mild cleaner. This may be due to methamphetamine penetration into the paint on these surfaces. Evaluation of methamphetamine contamination on drywall indicated that approximately 40% of the methamphetamine was removed using a wipe, while another 60% remained in the paint layer. Stronger cleaners such as those with active ingredients including sodium hypochlorite or quaternary ammonia and commercial decontamination agents were more effective than mild detergent-based cleaners and may reduce methamphetamine contamination to below regulatory levels. Results from the encapsulation studies indicate that sprayed on oil-based paint will encapsulate methamphetamine on drywall and plywood surfaces up to 4.5 months, while latex paints were less effective.

Copyright 2012, Taylor & Francis

Shabani S; McKinnon CS; Reed C; Cunningham CL; Phillips TJ. Sensitivity to rewarding or aversive effects of methamphetamine determines methamphetamine intake. Genes, Brain and Behavior 10(6): 625-636, 2011. (35 refs.)

Amphetamines have rewarding and aversive effects. Relative sensitivity to these effects may be a better predictor of vulnerability to addiction than sensitivity to one of these effects alone. We tested this hypothesis in a dose-response study in a second replicate set of mouse lines selectively bred for high vs. low methamphetamine (MA) drinking (MADR). Replicate 2 high (MAHDR-2) and low (MALDR-2) MA drinking mice were bred based on MA consumption in a two-bottle choice procedure and examined for novel tastant drinking. Sensitivities to the rewarding and aversive effects of several doses of MA (0.5, 2 and 4 mg/kg) were measured using a place conditioning procedure. After conditioning, mice were tested in a drug-free and then drug-present state for time spent in the saline-and MA-paired contexts. Similar to the first set of MADR lines, by the end of selection, MAHDR-2 mice consumed about 6 mg MA/kg/18 h, compared to nearly no MA in MALDR-2 mice, but had similar taste preference ratios. MAHDR-2 mice exhibited place preference in both the drug-free and drug-present tests, and no significant place aversion. In contrast, MALDR-2 mice exhibited no place preference or aversion during the drug-free test, but robust place aversion in the drug-present test. These data extend our preliminary findings from the first set of MADR lines and support the hypothesis that the combination of greater sensitivity to the rewarding effects of MA and insensitivity to the aversive effects of MA is genetically associated with heightened risk for MA consumption.

Copyright 2011, Wiley-Blackwell

Shah R; Diaz SD; Arria A; LaGasse LL; Derauf C; Newman E et al. Prenatal methamphetamine exposure and short-term maternal and infant medical outcomes. American Journal of Perinatology 29(5): 391-400, 2012. (37 refs.)

Objective: Examine maternal and infant medical outcomes of prenatal exposure to methamphetamine (MA). Study Design: Four hundred and twelve mother-infant pairs (204 MA-exposed and 208 unexposed matched comparisons) were enrolled in the Infant Development, Environment and Lifestyle (IDEAL) study. Exposure was determined by maternal self-report during this pregnancy and/or positive meconium toxicology. Maternal interviews assessed prenatal drug use, pregnancy course, and sociodemographic information. Medical chart reviews provided medical history, obstetric complications, infant outcomes, and discharge placement. Results: MA-using mothers were more likely to be poor, to have a psychiatric disorder/emotional illness and less prenatal care, and to be less likely to breast-feed their infant than comparison mothers. After adjusting for covariates, MA-exposed infants were more likely to exhibit poor suck, to have smaller head circumferences and length, to require neonatal intensive care unit (NICU) admission, and to be referred to child protective services (CPS). Several outcomes previously reported from studies that lacked adequate control groups or adjustment for covariates were not significantly different in this study. Conclusion: Prenatal MA exposure is associated with maternal psychiatric disorder/emotional illness, poor suck, NICU admission, and CPS involvement, and MA-exposed infants were less likely to be breast-fed; however, the absence of many serious complications, such as fetal distress, chronic hypertension, preeclampsia, placenta previa, abruptio placentae, and cardiac defects, suggests confounding variables influenced prior studies.

Copyright 2012, Thieme Medical Publishing

Sheridan K; Haight WL; Cleeland L. The role of grandparents in preventing aggressive and other externalizing behavior problems in children from rural, methamphetamine-involved families. Children and Youth Services Review 33(9): 1583-1591, 2011. (71 refs.)

Preventive interventions are urgently needed for children from rural, methamphetamine-involved families, who are at risk for the development of aggressive and other externalizing behavioral problems. This mixed method study explored naturally occurring sources of protection and considers the implications for targeted interventions. Participants were 41 children aged six to 14 years from rural families involved with methamphetamine and the public child welfare system, their primary caregivers, and 19 parents recovering from methamphetamine addiction. When invited during semi-structured interviews to talk about their families, 48% of children spontaneously described socially and emotionally supportive relationships with healthy grandparents. Children's reports of support from grandparents were associated with lower scores on CBCL Social Problems, [t(37) = 2.23, p<.05]; externalizing behaviors, [t(37) = 2.07, p<.05]; and aggressive behaviors, [t(37) = 2.75. p<.01]. When asked to talk about their families, 58% of parents spontaneously described the support their children received from grandparents, and 26% also described the support that they had received from their own grandparents. Children's and parents' descriptions of grandparent support suggest how grandparents may protect children from the development of aggressive and other externalizing behavior problems. First, grandparents may prevent obstacles to healthy development by providing their grandchildren with safe shelter and basic child care when parents are incapacitated from substance misuse. Second, they may promote their grandchildren's positive social-emotional development through supportive relationships. Third, they may promote social competence through enjoyable leisure activities with healthy adults and non-delinquent peers. Understanding naturally occurring sources of protection for children can inform the development of interventions by identifying strengths on which to build, and suggesting culturally sensitive approaches when children are struggling.

Copyright 2011, Elsevier Science

Shiotsuki T; Yoshitome K; Moriya F. Use of on-site immunoassay devices to screen urine absorbed in disposable diapers for methamphetamine: A preliminary study with artificial urine. Forensic Toxicology 30(2): 162-167, 2012. (22 refs.)

The aim of this preliminary study was to establish a simple, rapid method for recovering urine absorbed in disposable diapers in order to test for methamphetamine (MAP) using the Instant-View (TM) M-1 and Triage(A (R)) DOA on-site immunoassay devices. A 4-ml aliquot of drug-free artificial urine was absorbed into a disposable diaper (Pampers(A (R))) that had been cut into 3 x 3 cm pieces. Further addition of 4 ml of saturated KCl solution to the piece of diaper led to the recovery of substantial amounts (c.a. 2 ml) of fluid sample within 3-5 min. After diluting recovered fluids two-fold with distilled water, both immunoassays showed all samples were negative for all drug classes. After absorption of artificial urine containing 500-5,000 ng/ml of MAP in similar-sized pieces of diaper using the identical processing method, positive results were observed with Instant-View (TM) M-1 for artificial urine containing 2,000 ng/ml or more of MAP and with Triage(A (R)) DOA for urine containing 4,000 ng/ml or more of MAP. Diapers dosed with artificial urine containing 500, 2,500, and 5,000 ng/ml of MAP were further examined by gas chromatography-mass spectrometry, with recoveries of MAP of 98.6 +/- A 36.7 % (n = 6), 115 +/- A 22.4 % (n = 6), and 102 +/- A 15.1 % (n = 6), respectively. Use of this new sample preparation method may be applicable for analyzing infant urine absorbed in disposable diapers. Additionally, the sensitivity of the method along with the availability of Instant-View (TM) M-1 screening suggests the potential usefulness of this technique in clinical settings.

Copyright 2012, Springer

Silber BY; Croft RJ; Downey LA; Camfield DA; Papafotiou K; Swann P et al. The effect of d,l-methamphetamine on simulated driving performance. Psychopharmacology 219(4): 1081-1087, 2012. (26 refs.)

Rationale Illicit drugs such as methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. The exact effect of methamphetamine or its specific isomers on driving and driving behaviour have yet to be thoroughly investigated. Methods: Twenty healthy recreational illicit stimulant users (ten males, ten females), aged between 21 and 34 years (mean=24.3 years, SD=3.4 years), attended two testing sessions involving oral consumption of 0.42 mg/kg d,l-methamphetamine or a matching placebo. The drug administration was counterbalanced, double-blind, and medically supervised. At each session, driving performance was assessed 2.5 h post-drug administration. Results: Mean blood and saliva d,l-methamphetamine concentrations of approximately 90 and 400 ng/ml, respectively, at 2 h and 95 and 475 ng/ml at 3 h were observed. These levels of d,l-methamphetamine were found not to significantly impair, or improve, driving performance at the 2.5-h post-drug administration time point. Conclusions: The findings of this study illustrate that d,l-methamphetamine has no significant effect on simulated driving performance.

Copyright 2012, Springer

Silber BY; Croft RJ; Downey LA; Papafotiou K; Camfield DA; Stough C. The effect of d-methamphetamine on simulated driving performance. Human Psychopharmacology: Clinical and Experimental 27(2): 139-144, 2012. (23 refs.)

Objectives: Methamphetamine is considered to be one of the most popularly abused drugs by drivers; however, its exact effect on driving and driving behaviour has yet to be thoroughly investigated. This being despite methamphetamine's increased prevalence in injured and deceased drivers. Methods Twenty healthy recreational illicit stimulant users (10 male and 10 female), aged between 21 and 32 years (mean = 25.4 years, SD = 3.3 years) attended two testing sessions involving oral consumption of 0.42 mg/kg d-methamphetamine or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 2.5 h post drug administration. Results: d-methamphetamine (0.42 mg/kg) did not significantly impair overall simulated driving performance 2.5 h post drug administration. At the individual driving variable level, participants in the d-methamphetamine condition were observed to be driving slower when an emergency situation occurred (T = 44, p < 0.05), but interestingly, participants in both conditions recorded average speeds in excess of the speed limit (100 km/h) when the emergency situations occurred. The d-methamphetamine condition did also produce four times more infringements where participants did not stop at red traffic light in comparison to the placebo, but this effect was only evident at a trend level (T = 7, p = 0.11). Conclusions: The findings presented herein suggest that d-methamphetamine administered at the levels supplied did not impair driving performance in a manner consistent with epidemiological evidence. Further research is certainly required to elucidate the effects of various doses of methamphetamine, alone and in combination with other legal and illicit substances.

Copyright 2012, Wiley-Blackwell

Sinchai T; Plasen S; Sanvarinda Y; Jaisin Y; Govitrapong P; Morales NP et al. Caffeine potentiates methamphetamine-induced toxicity both in vitro and in vivo. Neuroscience Letters 502(1): 65-69, 2011. (25 refs.)

Ya-Ba, a combination of the two potent psychostimulants methamphetamine (METH) and caffeine (CAF), is commonly used by drug abusers in Thailand and neighboring countries. While the neurotoxic effects of METH are well documented, the toxicity of this combination is mostly unknown. This study aimed to elucidate the effects of this particular drug combination using both in vitro and in vivo models. We found that combined treatment of METH and CAF at individually non-toxic concentrations significantly decreased viability of human neuroblastoma SK-N-SH cells. The reduction in cell survival was accompanied by an increase in reactive oxygen species (ROS) formation and the Bax/Bcl-2 ratio. In vivo data showed that combined administration of METH and CAF increased the mortality rate of rats, with an increase in the level of thiobarbituric acid reactive substances (TBARS), the indicator of oxidative stress, in striatal tissues. The results indicate that caffeine potentiates the toxic effects of methamphetamine, possibly via a mechanism involving an increase in dopamine release and excess ROS generation.

Copyright 2011, Elsevier Science

Smith LM; Paz MS; LaGasse LL; Derauf C; Newman E; Shah R et al. Maternal depression and prenatal exposure to methamphetamine: Neurodevelopmental findings from the infant development, environment, and lifestyle (ideal) study. Depression and Anxiety 29(6): 515-522, 2012. (48 refs.)

Background: Maternal depression is associated with a higher incidence of behavioral problems in infants, but the effects of maternal depression as early as 1 month are not well characterized. The objective of this study is to determine the neurobehavioral effects of maternal depression on infants exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS). Methods: Four hundred twelve mother-infant pairs were enrolled (MA = 204) and only biological mothers with custody of their child were included in the current analysis. At the 1-month visit (n = 126 MA-exposed; n = 193 MA-unexposed), the Beck Depression Inventory-II (BDI-II) was administered, and the NNNS was administered to the infant. Exposure was identified by self-report and/or gas chromatography/mass spectroscopy confirmation of amphetamine and metabolites in newborn meconium. Unexposed subjects were matched, denied amphetamine use, and had negative meconium screens. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS, with significance accepted at P < .05. Results: The MA group had an increased incidence of depression-positive diagnosis and increased depression scores on the BDI-II. After adjusting for covariates, MA exposure was associated with increased arousal and handling scores, and a decreased ability to self-regulate. Maternal depression was associated with higher autonomic stress and poorer quality of movement. No additional differences were observed in infants whose mothers were both depressed and used MA during pregnancy. Conclusions: Maternal depression is associated with neurodevelopmental patterns of increased stress and decreased quality of movement, suggesting maternal depression influences neurodevelopment in infants as young as 1 month.

Copyright 2012, Wiley-Blackwell

Snelders S; Pieters T. Speed in the Third Reich: Methamphetamine (Pervitin) use and a drug history from below. Social History of Medicine 24(3): 686-699, 2011. (62 refs.)

This article is an analysis of the use of Pervitin (methamphetamine) in National Socialist Germany after the introduction of the drug in 1938. Whereas earlier studies have focused on the supply of the drug, this study focuses on demand. Both an iatrogenic and a 'Nazigenic' interpretation of the history of methamphetamine use are reviewed. It is concluded that the use of Pervitin in the Third Reich was not only 'pushed' on the population by the Nazi political and military authorities, but also became endemic in German society as it addressed the needs and problems of various users including employees, housewives, and soldiers. The drug was a cultural ambiguity of life in Nazi Germany, integrated in everyday life, notwithstanding its regulation by drug laws.

Copyright 2011, Oxford University Press

Solomon TM; Halkitis PN; Moeller RW; Pappas MK. Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men. Addiction Research & Theory 20(1): 21-29, 2012. (54 refs.)

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.

Copyright 2012, Informa Healthcare

Tolliver BK; Price KL; Baker NL; LaRowe SD; Simpson AN; McRae-Clark AL et al. Impaired cognitive performance in subjects with methamphetamine dependence during exposure to neutral versus methamphetamine-related cues. American Journal of Drug and Alcohol Abuse 38(3): 251-259, 2012. (41 refs.)

Background: Chronic methamphetamine abuse is associated with cognitive deficits that may impede treatment in methamphetamine-dependent patients. Exposure to methamphetamine-related cues can elicit intense craving in chronic users of the drug, but the effects of exposure to drug cues on cognitive performance in these individuals are unknown. Objectives: This study assessed whether exposure to methamphetamine-related visual cues can elicit craving and/or alter dual task cognitive performance in 30 methamphetamine-dependent subjects and 30 control subjects in the laboratory. Methods: Reaction time, response errors, and inhibition errors were assessed on an auditory Go-No Go task performed by adult participants (total N = 60) while watching neutral versus methamphetamine-related video cues. Craving was assessed with the Within-Session Rating Scale modified for methamphetamine-dependent subjects. Results: Exposure to methamphetamine-related cues elicited craving only in methamphetamine-dependent subjects. Even in the absence of methamphetamine cues, methamphetamine-dependent subjects exhibited slower reaction times and higher rates of both inhibition and response errors than control subjects did. Upon exposure to methamphetamine cues, rates of both response errors and inhibition errors increased significantly in methamphetamine-dependent subjects. Control subjects exhibited no increase in inhibition errors and only slightly increased rates of response errors upon exposure to methamphetamine cues. Response error rates, but not inhibition error rates or reaction times, during methamphetamine cue exposure were significantly associated with craving scores in methamphetamine-dependent subjects. Conclusions and Significance: Methamphetamine-dependent individuals exhibit cognitive performance deficits that are more pronounced during exposure to methamphetamine-related cues. Interventions that reduce cue reactivity may have utility in the treatment of methamphetamine dependence.

Copyright 2012, Informa HealthCare

Tompkins-Dobbs K; Schiefelbein J. Emergency department policies and procedures for treatment of patients abusing methamphetamine. Journal of Emergency Nursing 37(5): 437-443, 2011. (13 refs.)

An investigative descriptive research case study design was used to explore the following questions: �Do hospital emergency departments in 2 rural, 2 suburban, and urban Kansas hospitals address a patient�s drug abuse even when the presenting complaint is unrelated to drug abuse?" and "Do emergency departments in 2 rural, 2 suburban, and 2 urban Kansas hospitals have policies and procedures available to their staff that provide guidance in caring for patients addicted to methamphetamine?" Telephone survey interviews were conducted. Consistency in themes was found among rural, suburban, and urban Kansas hospital emergency departments without regard to the size and location of the facilities. Data show that policies and procedures are not available and that treatment of patients addicted to methamphetamine is inconsistent within a single facility and across facilities in the same state. Treatment of methamphetamine addicts in the absence of policies and procedures set in place by the facility is based on the individual determination of the primary care provider and is subject to individual bias or lack of knowledge

Copyright 2011, Elsevier Science

Tsujikawa K; Mikuma T; Kuwayama K; Miyaguchi H; Kanamori T; Iwata YT et al. Profiling of seized methamphetamine putatively synthesized by reductive amination of 1-phenyl-2-propanone. Forensic Toxicology 30(1): 70-75, 2012. (21 refs.)

We report a case of seized methamphetamine (MA) samples showing unique drug profiles. Conventional drug profiling such as impurity profiling and chiral analysis as well as stable isotope ratio mass spectrometry (IRMS) was performed on seven MA-HCl samples. The results of impurity profiling suggested that the samples were synthesized by reductive amination. The high enantiomeric purities of the samples suggested that the samples were optically resolved. The delta C-13 and delta N-15 values gave different grouping patterns from conventional drug profiling. This is the first case report of the use of IRMS with seized MA samples presumptively synthesized by reductive amination.

Copyright 2012, Springer

Verdichevski M; Burns R; Cunningham JK; Tavares J; Callaghan RC. Trends in primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005-2006 and 2009-2010. Canadian Journal of Psychiatry 56(11): 696-700, 2011. (12 refs.)

Objective: During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005-2006 that 21% of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005-2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009-2010, as well as important trend information for these periods. Method: We developed a comprehensive list of all Canadian residential youth substance abuse treatment facilities. The executive director of each facility was asked about the site's annual caseload, and the proportion of cases primarily due to methamphetamine abuse within the past 12 months. Results: Our survey data for the periods of 2005-2006 and 2009-2010 show marked reductions in admissions. In 2009-2010, we found that about 6% of all admissions were due primarily to methamphetamine abuse, a substantial drop from the 21% reported in our 2005-2006 study. Conclusions: Our data show a significant national reduction in methamphetamine-related admissions. Other reports show that methamphetamine-related treatment admissions in the United States and Mexico declined sharply during 2005-2008, reportedly in association with Mexico's methamphetamine precursor chemical controls, raising the possibility that the controls may also be associated with the declines reported here.

Copyright 2011, Canadian Psychiatric Association

Vila-Rodriguez F; MacEwan GW; Honer WG. Methamphetamine, perceptual disturbances, and the peripheral drift illusion. American Journal on Addictions 20(5): 490-490, 2011. (3 refs.)

Vilke GM; Bozeman WP; Dawes DM; DeMers G; Wilson MR. Excited delirium syndrome (ExDS): Treatment options and considerations. (review). Journal of Forensic and Legal Medicine 19(3): 117-121, 2012. (24 refs.)

The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation. Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, noncompliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment. In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication. Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options.

Copyright 2012, Faculty of Forensic and Legal Medicine

Vilke GM; Payne-James J; Karch SB. Excited delirium syndrome (ExDS): Redefining an old diagnosis. Journal of Forensic and Legal Medicine 19(1): 7-11, 2012. (37 refs.)

Recently, the National Institute of Justice (NIJ) of the United States of America convened a meeting of experts in the area of Excited Delirium Syndrome (ExDS). The history of ExDS, the clinical presentation, the pathophysiology, differential diagnoses and management options were discussed. Though the specific pathophysiological pathways of ExDS have yet to be formally defined, considerable research has been undertaken on this topic. It is important for law enforcement, medical and other healthcare professionals to be familiar with current knowledge about the syndrome. This paper summarizes the current state and knowledge of ExDS. Traditionally, the forensic medical community has classified patients who presented with altered sensorium and aggressive agitated behavior, and a combination of other symptoms including �superhuman� strength, diaphoresis, hyperthermia, propensity to break glass, attraction to light or lack of willingness to yield to overwhelming force, who then died with a positive drug screen for sympathomimetic agent, and no other anatomic cause of death, as an �Excited Delirium� death. In recent years, it has become increasingly clear that many patients with this constellation of symptom�s and signs have been managed in emergency departments for decades and in only a small minority of cases is the outcome fatal. The clinical phenomenon was described in the 1800s, but only in recent years has a clearer understanding developed about this syndrome and a recognition that research needs to be directed to identifying the underlying pathophysiological and cellular mechanisms. Note: The argument about whether ExDS is an actual diagnosis mainly centers on the issue that certain organized medical associations, particularly the American Medical Association (AMA) and the American Psychiatric Association (APA) do not recognize ExDS as a diagnosis.12 Their failure to do so hinges on the fact that the medical coding reference materials, including the International Classification of Disease, Ninth Revision (ICD-9), do not recognize the exact term �excited delirium� or �excited delirium syndrome.�13 However, the National Association of Medical Examiners (NAME) and the American College of Emergency Physicians (ACEP), the most likely physicians to encounter these patients, do recognize ExDS as a discrete diagnostic entity.

Copyright 2012, Faculty of Forensic and Legal Medicine

Volkmann T; Lozada R; Anderson CM; Patterson TL; Vera A; Strathdee SA. Factors associated with drug-related harms related to policing in Tijuana, Mexico. Harm Reduction Journal 8: article 7, 2011. (41 refs.)

Objective: To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. Methods: IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling questionnaires and testing for HIV. Methods: Human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Results: Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. Conclusions: IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs.

Copyright 2011, BioMed Central

Wada M; Sugimoto Y; Ikeda R; Isono K; Kuroda N; Nakashima K. Determination of methamphetamine in neonatal hair and meconium samples: Estimation of fetal drug abuse during pregnancy. Forensic Toxicology 30(1): 80-83, 2012. (11 refs.)

Determination of methamphetamine (MP) and its metabolite amphetamine (AP) in hair and meconium samples from a neonate was performed to estimate the fetal abuse of MP during pregnancy. Five hundred micrograms of the neonate's hair spiked with 1-methyl-3-phenylpropylamine (internal standard) were used for the determination. After digestion with 1 M NaOH for 20 min, the resultant was extracted with heptane and the organic layer was evaporated and labeled with 4-(N,N-dimethylaminosulfonyl)-7-fluoro-2,1,3-benzoxadiazole. The MP in 10 mg of the neonate's meconium was determined using the standard addition method. The determination of MP and AP in the hair was performed by a semi-micro-HPLC-peroxyoxalate chemiluminescence method. The hair sample (total length = ca. 3 cm) was divided into two fragments (the root and the tip). The concentrations of MP in the fragments were 1.68 +/- A 0.18 ng/mg (root) and 1.29 +/- A 0.03 ng/mg (tip). AP was not found in either of the fragments. The concentrations of MP and AP in meconium, based on measurements performed in triplicate, were 0.27 +/- A 0.04 ng/mg and 0.16 +/- A 0.03 ng/mg, respectively. As a result, fetal abuse of MP during the pregnancy was confirmed.

Copyright 2012, Springer

Walter AW; Bachman SS; Reznik DA; Cabral H; Umez-Eronini A; Nath A. Methamphetamine use and dental problems among adults enrolled in a program to increase access to oral health services for people living with HIV/AIDS. Public Health Reports 127(supplement 2): 25-35, 2012. (24 refs.)

Objective. We examined the association between methamphetamine (meth) use and dental problems in a large sample of HIV-positive adults. Methods. We gathered data from 2,178 interviews across 14 sites of the U.S. Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative from May 2007 to August 2010. We used multivariate generalized estimating equations to test the association between meth use and dental problems, adjusting for potential confounders. Results. Past and current meth use was significantly associated with more dental problems. The study also found that poor self-reported mental health status, fewer years since testing positive for HIV, a history of forgoing dental care, less frequent teeth brushing, poor self-reported oral health status, oral pain, grinding or clenching teeth, some alcohol use, more years of education, and self-reported men-who-have-sex-with-men HIV risk exposure (compared with other exposure routes) were significantly associated with dental problems. Conclusion. Individuals who are HIV-positive with a history of meth use experience access barriers to oral health care and more dental problems. Our study demonstrated that it is possible to recruit this population into dental care. Findings suggest that predisposing, enabling, and need factors can serve as demographic, clinical, and behavioral markers for recruiting people living with HIV/AIDS into oral health programs that can mitigate dental problems.

Copyright 2012, Association of Schools of Public Health

Wang LJ; Chiang SC; Su LW; Lin SK; Chen CK. Factors associated with drug-related psychiatric disorders and suicide attempts among illicit drug users in Taiwan. Substance Use & Misuse 47(10): 1185-1188, 2012. (16 refs.)

Illicit drug users, entering a detention center and two psychiatric hospitals in Northern Taiwan, were interviewed for lifetime drug-use-related psychiatric disorders and suicide attempts. Among 197 participants, 17.3%, 16.8%, and 14.2% had a drug-induced psychotic disorder (DIP), a drug-induced mood disorder (DIM), and a history of suicide attempts, respectively. Continuous use of methamphetamine and joblessness were associated with DIP and DIM, accordingly. Polysubstance use was collectively correlated with DIP and DIM. Female gender and history of having any mood disorder were predictors of suicide. These results provide useful clues for detecting drug-related psychiatric disorders and suicide among illicit drug users. The study's limitations are noted.

Copyright 2012, Informa Healthcare

Washton A. Clinical aspects of cocaine and methamphetamine dependence. (Chapter 15). IN: Brizer D; Castandea R, eds. Clinical Addiction Psychiatry. New York: Cambridge University Press, 2011

This book is described as an anthology of essays setting forth the most current and authoritative information on addiction theory, practice and research. Each chapter is authored by a recognized authority in the field. The volume covers diverse material, from the environment, to genetics, culture and spirituality, treatment and pharmacology. The book, with 24 essays, is organized in three parts. This chapter is part of Part II, a section with the title "The Real World." The chapters in this section focus on particular drugs. This chapter deals with the clinical care of those with cocaine and methamphetamine dependence. Other chapters in this section deal with twelve step approaches; alcohol; alcohol's presentation and treatment in primary care; clinical approaches in working with cocaine and methadone dependence; methadone maintenance for opiate dependence; and prescription drug abuse.

Copyright 2012, Project Cork

Whaley RB; Smith JM; Hayes-Smith R. Teenage drug and alcohol use: Comparing individual and contextual effects. Deviant Behavior 32(9): 818-845, 2011. (30 refs.)

While both macro- and micro-level studies have identified important correlates of substance use, multi-level models may explain more than each level alone. Drawing on extant research and Akers' (1998) Social Structure-Social Learning model, we offer hypotheses about the relationship between contextual-and individual-level explanatory variables and substance use. The sample included 85,000 students in 202 school districts. Hierarchical linear modeling revealed low socioeconomic status, percent rural, and racial composition directly affected use of some substances net individuals' characteristics. Further, the effects of gender, age, and class were substantially mediated by differential association and school bonds, which significantly influenced alcohol, marijuana, ecstasy, and methamphetamine use.

Copyright 2011, Taylor & Francis

Winchell C; Rappaport BA; Roca R; Rosebraugh CJ. Reanalysis of methamphetamine dependence treatment trial. CNS Neuroscience & Therapeutics 18(5): 367-368, 2012. (10 refs.)

Researchers working in the field of clinical trials for addictive disorders have discussed whether the use of responder analyses (analyses which compare the proportion of patients in each treatment arm who achieve the desired response) in these trials represents �setting the bar too high.� These discussions involve assumptions about the relative ease or difficulty of establishing a treatment effect using group means versus doing so using responder analyses. In the paper by McCann DJ and Li SH, the authors have shown that using a responder analysis identified a treatment effect in methamphetamine dependence, which an initial analysis of group means did not. This demonstrates that responder analysis may be a more appropriate approach, and depending on the study design, may demonstrate differences not appreciated by group means. Other authors have also identified situations in which a responder approach demonstrates an effect where group means did not, or where a comparison of means yielded equivocal results of uncertain clinical significance. In addition, Falk et al. recently compared the use of a responder analysis to customarily used group mean comparisons in alcoholism trials and found that their responder definition was as sensitive as customary measures in detecting treatment effects.

Copyright 2012, Wiley-Blackwell

Wright TE; Schuetter R; Fombonne E; Stephenson J; Haning WF. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women. Harm Reduction Journal 9: e-article 5, 2012. (55 refs.)

Background: Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program. Methods: Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies. Results: Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, > 90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (> 50%) repeat pregnancy rate at 9 months post delivery. Conclusion: Methamphetamine use during pregnancy doesn't exist is isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.

Copyright 2012, BioMed Central

Wu E; El-Bassel N; McVinney LD; Hess L; Remien RH; Charania M et al. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, Black men who have sex with men. AIDS & Behavior 15(8): 1745-1754, 2011. (35 refs.)

Accumulating evidence supports couple-based approaches for HIV/STI preventive interventions. Yet, to date, no studies have examined couple-based sexual risk reductions intervention specifically for men who have sex with men (MSM) from populations with elevated rates of HIV/STI transmission, such as black MSM and methamphetamine-involved MSM. We pilot tested-using a pre-/post-test design-a seven-session couple-based intervention for black, methamphetamine-using, black MSM couples engaging in sexual risk. Feasibility was assessed via recruitment and retention rates; potential efficacy relied on self-reported sexual risk and drug use prior to and two months following intervention delivery. We enrolled 34 couples (N = 68 men). Over 80% attended all seven intervention sessions, and retention exceeded 95% at two-month follow-up. At follow-up, participants reported significantly fewer sexual partners, fewer episodes of unprotected anal sex, and greater condom use with their main partner; participants also reported significantly less methamphetamine use, any illicit drug use, and number of illicit drugs used. These findings indicate that couple-based HIV/STI intervention is feasible and promising for at-risk black MSM couples.

Copyright 2011, Springer Publishing

Wu LT; Ling W; Burchett B; Blazer DG; Yang CM; Pan JJ et al. Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network. Drug and Alcohol Dependence 118(2-3): 186-193, 2011. (51 refs.)

Background: This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures. Methods: The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures. Results: A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined especially amphetamine and sedative abuse/dependence from the remaining 90% who had SUDs other than amphetamine and sedative abuse/dependence (entropy = 0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors. Conclusions: A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.

Copyright 2011, Elsevier Science

Yi R; Carter AE; Landes RD. Restricted psychological horizon in active methamphetamine users: Future, past, probability, and social discounting. Behavioural Pharmacology 23(4): 358-366, 2012. (87 refs.)

Methamphetamine users (MAU) exhibit an exaggerated bias for immediate rewards that reflects a restricted time horizon, where outcomes in the future are excessively discounted. An accumulating literature indicates that time in the future shares features with other dimensions of psychological distances including time in the past, probability, and social distance, suggesting that bias for immediacy may be reducible to a more general restriction of psychological horizon. The purpose of the present study was to explore generalized restricted psychological horizon in active MAU by assessing future, past, probability, and social discounting. Compared with nonusing controls, MAU preferred psychologically proximal outcomes, resulting in higher rates for all types of discounting, which supports the conceptualization that MAU insufficiently integrate outcomes of psychological distance (i.e. in the future, the past, probabilistic, for others) into the valuation of current behavioral alternatives. The present results are suggestive of a more fundamental process of problematic decision-making associated with methamphetamine use, indicating the necessity of more comprehensive approaches to address the generalized limitations of restricted psychological horizon.

Copyright 2012, Lippincott, Williams & Wilkins

Yoon JH; Gintzy R; Dodrill CL. Behavioral interventions. IN: Kosten TR; Newton TF; De La Garza R; Halle CN, eds. Cocaine and Methamphetamine Dependence: Advances in Treatment. Washington DC: American Psychiatric Association, 2011. pp. 105-142

This chapter reviews treatment approaches to stimulant use problems. Contingency management and cognitive behavioral therapy are discussed in detail, including how these are used to initiate abstinence as well as prevent relapse. In the discussion of cognitive-behavioral therapy, emphasis is placed on assessing the client's historical and current triggers for drug use, along with the skills for the management of cravings, developing refusal skills, and decision-making strategies. Also considered in the discussion is the use of computerized delivery, which can be useful in settings in less populated areas or those with a scarcity of professional staff.

Copyright 2011, American Psychiatric Association

Zabaneh R; Smith LM; LaGasse LL; Derauf C; Newman E; Shah R et al. The effects of prenatal methamphetamine exposure on childhood growth patterns from birth to 3 years of age. American Journal of Perinatology 29(3): 203-210, 2012. (39 refs.)

We examined the effects of prenatal methamphetamine (MA) exposure on growth parameters from birth to age 3 years. The 412 subjects included (n = 204 exposed) were enrolled at birth in the Infant Development, Environment and Lifestyle study, a longitudinal study assessing the effects of prenatal MA exposure on childhood outcomes. Individual models were used to examine the effects of prenatal MA exposure on weight, head circumference, height, and weight-for-length growth trajectories. After adjusting for covariates, height trajectory was lower in the exposed versus the comparison children (p = 0.021) over the first 3 years of life. Both groups increased height on average by 2.27 cm per month by age 3 years. In term subjects, MA exposure was also associated with a lower height trajectory (p = 0.034), with both the exposed and comparison groups gaining 2.25 cm per month by age 3 years. There was no difference in weight, head circumference, or weight-for-length growth trajectories between the comparison and the exposed groups. Children exposed prenatally to MA have a modest decrease in height growth trajectory during the first 3 years of life with no observed difference in weight, head circumference, or weight-for-length trajectories.

Copyright 2012, Thieme Medical Publishing

Zorick T; Sugar CA; Hellemann G; Shoptaw S; London ED. Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. Drug and Alcohol Dependence 118(2-3): 500-503, 2011. (34 refs.)

Background: Depression is common among individuals with methamphetamine (MA) use disorders. As agents that enhance serotonergic function are frequently used to treat depression, one might predict that they would be useful medications for MA dependence. However, clinical trials of serotonergic agents for MA addiction have been unsuccessful. Objective: To identify factors that distinguish MA-dependent research participants who increased MA self-administration while receiving treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline from other groups of participants. Method: Using a dataset from a 12-week randomized, placebo-controlled trial of sertraline (100 mg daily) for MA addiction, we identified participants who had completed at least 8 weeks of the trial (n = 61 sertraline, n = 68 placebo). We compared the proportions of MA-positive urine tests for weeks 8-12 of the trial for these subjects to their pre-randomization baseline, and identified those subjects who increased MA use during treatment. Using classification trees, we then assessed all data collected during the study to identify factors associated with increasing MA use during treatment with sertraline, compared to placebo. Results: More subjects in the sertraline condition increased MA use during treatment (n = 13) than in the placebo condition (n = 5: p = 0.03). Classification trees identified multiple factors from both pre-treatment and in-treatment data that were associated with increased MA use during treatment. Only elevated in-treatment craving for MA specifically characterized subjects in the sertraline group who increased their MA use. Conclusions: Some MA-abusing individuals treated with SSRIs have sustained craving with an increased propensity to relapse during treatment despite psychosocial treatment interventions.

Copyright 2011, Elsevier Science