Addiction最新文献

{"title":"The rise of novel, semi-synthetic 7-hydroxymitragnine products","authors":"Kirsten E. Smith, Edward W. Boyer, Oliver Grundmann, Christopher R. McCurdy, Abhisheak Sharma","doi":"10.1111/add.16728","DOIUrl":"10.1111/add.16728","url":null,"abstract":"<p>Products containing the psychoactive botanical, <i>Mitragyna speciosa</i>, have transformed from simple leaf powders into an array of products, falling under the broad umbrella of ‘kratom’. [<span>1, 2</span>] Whole-leaf products contain consistent concentrations of kratom’s major alkaloid, mitragynine, and its metabolite 7-hydroxymitragynine; even among extracts, alkaloid concentrations often remain within self-adopted industry norms, with 7-hydroxymitragynine between 1 and 2% of the total content, or below the lower limit of quantification [<span>3-5</span>]. A highly selective partial mu opioid receptor (MOR) agonist, 7-hydroxymitragynine has binding affinity 14–22 times greater than morphine [<span>6</span>]. Although mitragynine has lower abuse potential and relative safety compared to drugs of abuse, 7-hydroxymitragynine dose-dependently substitutes for morphine [<span>7-11</span>].</p><p>However, some manufacturers have begun marketing novel semi-synthetic products with varying routes of administration (e.g. sublingual tablets, nasal sprays) containing 14–25 mg 7-hydroxymitragynine per labeled dose, often with brand names alluding to narcotics. These newly marketed products may contain up to 98% 7-hydroxymitragynine, together with other kratom alkaloids. Concerningly, some product formulations circumvent first-pass metabolism, increasing bioavailability.</p><p>To date, 7-hydroxymitragynine product marketing fails to distinguish itself from kratom. Kratom-naïve consumers purchasing 7-hydroxymitragynine products may erroneously believe that they are relatively safe ‘natural’ products similar or identical to kratom products that have been used in the United States for at least two decades. Consumers of these novel products are unwittingly exposing themselves to high-dose, MOR-binding formulations that have never undergone human or animal testing. Apart from toxicity risks from acute exposure, chronic 7-hydroxymitragynine product use could result in opioid-like physical dependence and possibly addiction. Scale and severity may be distinct from kratom leaf-based and extract products, which have not produced widespread severe addiction, but rather mild–moderate physical dependence [<span>12-14</span>].</p><p>As forensic laboratories use mitragynine as a surrogate marker for kratom use, 7-hydroxymitragynine-related fatalities would incorrectly implicate kratom, as the presence of mitragynine in these products arises from incomplete conversion of mitragynine into 7-hydroxymitragynine [<span>15</span>]. Currently, 7-hydroxymitragynine products contain trace amounts of mitragynine and ‘new’ chemicals yet to be identified. The safety of these unknown chemicals, and of 7-hydroxymitragynine at high doses, has not been evaluated in living subjects. Accordingly, they pose an eminent public health concern until they have been identified and proven to be safe.</p><p>The policy implications of semi-synthetic 7-hydroxymitraynine products are unknown, but ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 2","pages":"387-388"},"PeriodicalIF":5.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of medication for opioid use disorder and their impact on HIV testing among people who inject drugs in India: A longitudinal assessment of clinic-based data.","authors":"Allison M McFall, Lakshmi Ganapathi, Mihili P Gunaratne, Aylur K Srikrishnan, Conjeevaram K Vasudevan, Santhanam Anand, Sunil S Solomon, Shruti H Mehta, Gregory M Lucas","doi":"10.1111/add.16713","DOIUrl":"10.1111/add.16713","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to identify longitudinal trajectories of medication for opioid use disorder (MOUD) use throughout 1 year following MOUD initiation and to examine the association of trajectory membership with HIV testing among people who inject drugs in India.</p><p><strong>Design, setting and participants: </strong>The study comprised group-based trajectory modeling using longitudinal clinic-based MOUD use data, set in seven Indian cities with integrated care centers (ICC) delivering MOUD, predominantly buprenorphine, in 2018-2019. A total of 1562 people who inject drugs who initiated MOUD for the first time at an ICC between 1 January 2018 and 31 December 2018 were included in this study. Median age was 26 years, 98% were male and 22% were living with HIV.</p><p><strong>Measurements: </strong>Daily directly observed MOUD visits were biometrically verified and entered into an electronic database. A dichotomous variable for MOUD use each day throughout 1 year following initiation was created for the trajectory models. Client socio-demographics, HIV status and testing at the ICC and dose were extracted from the clinical database.</p><p><strong>Findings: </strong>We found five MOUD trajectory groups: (1) early dropout (41%), (2) late dropout (18%), (3) delayed dropout (10%), (4) intermittent use (12%) and (5) persistent use (19%). Differences between the dropout groups were characterized by the rate of decline in MOUD use over time. The late dropout group had an 18% higher rate of HIV testing [adjusted rate ratio (aRR) = 1.18, 95% confidence interval (CI) = 1.10-1.27] and those with persistent MOUD use had a 91% higher rate of testing (aRR = 1.91, 95% CI = 1.77-2.05) compared with the early dropout group.</p><p><strong>Conclusions: </strong>Nearly 70% of clients initiating medication for opioid use disorder (MOUD) at integrated care centers (ICCs) in India stop MOUD use within 1 year, with trajectories characterized by the rate of decline in engagement. Clients with better MOUD adherence appear to return more frequently for HIV testing at the ICCs, underscoring the value of integrated care models.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Serre et al. : Demonstrating the next era of addiction science","authors":"Bryant M. Stone,&nbsp;Johannes Thrul","doi":"10.1111/add.16720","DOIUrl":"10.1111/add.16720","url":null,"abstract":"<p>Persistent challenges to accurately conceptualizing and effectively treating substance use disorders (SUDs) and behavioral addictions have motivated researchers to adopt increasingly sophisticated methodologies. Among these methods, Ecological Momentary Assessments (EMA) [<span>1-4</span>]—real-time data collected in individuals’ daily lives—combined with cutting-edge network analyses, such as multi-level vector autoregression models and group iterative multiple model estimation (GIMME) [<span>5-7</span>], offer much potential to improve our understanding of substance use and other addictive behaviors. Serre <i>et al</i>.’s [1] recent study exemplifies how these methods may reshape addiction research by capturing and modeling the dynamic, moment-to-moment fluctuations in key variables (e.g., craving and self-efficacy), producing rich and highly precise information on potential treatment targets. Combining EMA as a data collection design choice with network analyses as an analytical choice, this study highlights the value of conceptualizing addictions as a personalized, fluid process requiring individualized medicine—paving the way for the next frontier of addiction research and treatments. We note two key reasons why this study’s design and analytical choice articulate this combination’s potential and impact [<span>8</span>].</p><p><b>Bryant M. Stone:</b> Conceptualization (equal); writing—original draft (lead); writing-review &amp; editing (equal). <b>Johannes Thrul:</b> Conceptualization (equal); writing-review &amp; editing (equal).</p><p>All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 1","pages":"59-60"},"PeriodicalIF":5.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental alcohol use and the level of child protection response in Australia (2012–21)","authors":"Koen Smit,&nbsp;Jade Rintala,&nbsp;Benjamin Riordan,&nbsp;Kylie Lee,&nbsp;Anne-Marie Laslett","doi":"10.1111/add.16677","DOIUrl":"10.1111/add.16677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To measure the association of harmful alcohol use by parents and primary caregivers with the level of child protection response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting and participants</h3>\u0000 \u0000 <p>This study was a multivariable logistic regression analysis using data drawn from the Victorian child protection database (2012–21) in Victoria, Australia. Focusing upon the most recent case per child, we analysed whether harmful parental alcohol use was probably associated with children‘s progression throughout the child protection system (from investigation phase, to substantiation, through to protective intervention, protection application and protection orders), while adjusting for socio-demographic variables. The participants comprised 352 800 children [48.5% female, 50.0% male, 1.6% other/unknown; mean age = 8.1 (0–18 years)] with one or more reports (mean = 1.4) in the child protection system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Child protection workers reported on two risk factor variables indicating parental alcohol use during an intake risk assessment: ‘alcohol abuse‘ and ‘alcohol use compromises child‘s safety‘.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of the 95 592 child cases investigated between 2012 and 2021, 50 476 were substantiated. Probable parental alcohol use was reported as a risk factor in 5.1% of children investigated and substantiated in 9.1% of children. The odds of progressing to investigation [odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.59, 1.69, <i>P</i> &lt; 0.001], substantiation (OR = 2.02, 95% CI = 1.91, 2.13, <i>P</i> &lt; 0.001), protective intervention (OR = 1.40, 95% CI = 1.23, 1.59, <i>P</i> &lt; 0.001), protection application (OR = 1.16, 95% CI = 1.08, 1.25, <i>P</i> &lt; 0.001) and protection order (OR = 1.17, 95% CI = 1.02, 1.34, <i>P</i> = 0.028) were statistically significantly higher for children experiencing probable parental harmful alcohol use. However, the associations for protection application and protection order were not statistically significant after accounting for variables related to family accommodation, income and composition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Victoria, Australia, in cases where child protection workers document parental alcohol use, those children are more likely to progress through the Victorian child protection system than children whose parents have no documented alcohol use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 2","pages":"347-357"},"PeriodicalIF":5.2,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of pharmacotherapy for attention-deficit/hyperactivity disorder and prescription stimulant misuse: A national study of US college students.","authors":"Alynna G Summit, Madison C Moseley, Natasha Chaku, Kit K Elam, Wura Jacobs, Alyssa M Lederer, Ellen L Vaughan, Patrick D Quinn","doi":"10.1111/add.16716","DOIUrl":"https://doi.org/10.1111/add.16716","url":null,"abstract":"<p><strong>Background and aims: </strong>Increasing rates of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy may simultaneously benefit patients and increase the availability of stimulants for misuse. We measured the association between university-level prevalence of ADHD medication treatment and prevalence of prescription stimulant misuse (PSM) among college students.</p><p><strong>Design, setting and participants: </strong>This was an observational study using cross-sectional data from the American College Health Association-National College Health Assessment III. Data included 395 participating universities between Fall 2019 and Fall 2022. Our sample included 224 469 undergraduates aged 18-25 years (65.2% cisgender female; 58.7% White).</p><p><strong>Measurements: </strong>Students self-reported any life-time clinical ADHD diagnosis, past-year ADHD medication treatment and past-3-month PSM. We defined university-level ADHD medication prevalence as the proportion of included students endorsing past-year ADHD medication treatment. Secondary outcomes included life-time PSM and moderate- to high-risk alcohol and cannabis use. We also measured university-level depression medication prevalence as a negative control exposure.</p><p><strong>Findings: </strong>Among the included students, 9.6% reported a life-time clinical ADHD diagnosis, 5.1% reported past-year medication treatment and 2.4% reported past-3-month PSM. The prevalence of ADHD medication treatment varied among universities [mean = 5.3%, standard deviation (SD) = 2.8%]. In adjusted models, prevalence of PSM was 7% relatively greater for every 1% increase in university-level medication prevalence [adjusted prevalence ratio (aPR) = 1.07; 95% confidence interval (CI) = 1.04-1.09]. Further, individuals with non-medication-treated ADHD were 40% more likely to report PSM than those without ADHD (aPR = 1.40; 95% CI = 1.25-1.56). There was no statistically significant difference in PSM among individuals with ADHD who did or did not receive medication (aPR = 0.90; 95% CI = 0.78-1.04). Results for secondary outcomes and the negative control partially supported the specificity of the findings.</p><p><strong>Conclusions: </strong>Among university students in the United States, there appears to be a positive association between attending universities with a greater prevalence of attention deficit/hyperactivity disorder (ADHD) medication treatment and risk of prescription stimulant misuse (PSM). This study provides further support for the possibility that ADHD medication treatment prevalence is a risk factor for PSM.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-based drug repurposing with electronic health record clinical corroboration: A case for ketamine as a potential treatment for amphetamine-type stimulant use disorder.","authors":"Zhenxiang Gao, T John Winhusen, Maria P Gorenflo, Ian Dorney, Udi E Ghitza, David C Kaelber, Rong Xu","doi":"10.1111/add.16715","DOIUrl":"https://doi.org/10.1111/add.16715","url":null,"abstract":"<p><strong>Background and aims: </strong>Amphetamine-type stimulants are the second-most used illicit drugs globally, yet there are no US Food and Drug Administration (FDA)-approved treatments for amphetamine-type stimulant use disorders (ATSUD). The aim of this study was to utilize a drug discovery framework that integrates artificial intelligence (AI)-based drug prediction, clinical corroboration and mechanism of action analysis to identify FDA-approved drugs that can be repurposed for treating ATSUD.</p><p><strong>Design and setting: </strong>An AI-based knowledge graph model was first utilized to prioritize FDA-approved drugs in their potential efficacy for treating ATSUD. Among the top 10 ranked candidate drugs, ketamine represented a novel candidate with few studies examining its effects on ATSUD. We therefore conducted a retrospective cohort study to assess the association between ketamine and ATSUD remission using US electronic health record (EHR) data. Finally, we analyzed the potential mechanisms of action of ketamine in the context of ATSUD.</p><p><strong>Participants and measurements: </strong>ATSUD patients who received anesthesia (n = 3663) or were diagnosed with depression (n = 4328) between January 2019 and June 2022. The outcome measure was the diagnosis of ATSUD remission within one year of the drug prescription.</p><p><strong>Findings: </strong>Ketamine for anesthesia in ATSUD patients was associated with greater ATSUD remission compared with other anesthetics: hazard ratio (HR) = 1.58, 95% confidence interval (CI) = 1.15-2.17. Similar results were found for ATSUD patients with depression when comparing ketamine with antidepressants and bupropion/mirtazapine with HRs of 1.51 (95% CI = 1.14-2.01) and 1.68 (95% CI = 1.18-2.38), respectively. Functional analyses demonstrated that ketamine targets several ATSUD-associated pathways including neuroactive ligand-receptor interaction and amphetamine addiction.</p><p><strong>Conclusions: </strong>There appears to be an association between clinician-prescribed ketamine and higher remission rates in patients with amphetamine-type stimulant use disorders.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety and depression among a community-recruited cohort of people who use methamphetamine: A longitudinal analysis.","authors":"Zoe Duncan, Rebecca Kippen, Keith Sutton, Bernadette Ward, Kasun Rathnayake, Brendan Quinn, Paul Dietze","doi":"10.1111/add.16714","DOIUrl":"https://doi.org/10.1111/add.16714","url":null,"abstract":"<p><strong>Aims: </strong>This study (1) estimated changes in anxiety and depression throughout 3 years in a community-recruited cohort who use methamphetamine and (2) modelled whether these changes were associated with patterns of methamphetamine use or other time-varying or fixed covariates.</p><p><strong>Design, setting and participants: </strong>We used a longitudinal analysis using data derived from surveys conducted between August 2016 and March 2020, set in metropolitan and rural locations in Victoria, Australia. Participants comprised a total of 849 adults with regular methamphetamine use history at baseline, recruited for the prospective VMAX study via snowball and respondent-driven sampling.</p><p><strong>Measurements: </strong>Anxiety and depression symptoms were measured using the Generalized Anxiety Disorder (GAD)-7 and the Patient Health Questionnaire (PHQ)-9 instruments. Frequency of methamphetamine use was measured by self-reported number of days per week participants used any form of methamphetamine in the past month.</p><p><strong>Findings: </strong>Changes in anxiety and depression symptom scores were associated with change in route of administration from non-injecting to injecting [adjusted coefficient (adj. coeff.) = 1.44, 95% confidence intervals (CI) = 0.39, 2.48, adj. coeff. = 1.49, 95% CI = 0.39, 2.58], change in severity of dependence for methamphetamine (adj. coeff. = 0.29, 95% CI = 0.21, 0.37, adj. coeff. = 0.34, 95% CI = 0.26, 0.42), starting treatment for drugs other than methamphetamine (adj. coeff. = -2.21, 95% CI = -3.70, -0.73, adj. coeff. = -2.09, 95% CI = -3.60, -0.58) and other covariates.</p><p><strong>Conclusions: </strong>Among regular methamphetamine users in Australia, changes in anxiety or depression scores are associated with changes in route of administration, dependence severity and starting treatment for other drugs, but do not appear to be associated with frequency of methamphetamine use.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial”","authors":"","doi":"10.1111/add.16717","DOIUrl":"10.1111/add.16717","url":null,"abstract":"<p>\u0000 <span>De-Loyde, K</span>, <span>Ferrar, J</span>, <span>Pilling, MA</span>, <span>Hollands, GJ</span>, <span>Clarke, N</span>, <span>Matthews, JA</span>, et al. <span>The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial</span>. <i>Addiction</i>. <span>2024</span>; <span>119</span>(<span>6</span>): <span>1071</span>–<span>1079</span>. https://doi.org/10.1111/add.16449</p><p>In the “Results” section, in the second paragraph under “Primary outcome”, there is a typographical error in the confidence intervals for the adjusted sensitivity analysis of the primary outcome. The upper and lower bounds have been inverted.</p><p>The text should read: “The sensitivity analysis, excluding any venue that did not use a like-for-like replacement for draught alcoholic beer (n = 2 venues removed), showed an adjusted mean difference for the primary outcome of -20 L per week (95% CI = -45 to 6)”.</p><p>These same confidence intervals are also incorrect in Table 3, and again should read “-20 (-45 to 6)”.</p><p>We apologize for this error.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 2","pages":"389"},"PeriodicalIF":5.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16717","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on ter Laak et al.: The importance of drug market information and differentiating drug use patterns","authors":"Rory Verhagen,&nbsp;Phong K. Thai","doi":"10.1111/add.16712","DOIUrl":"10.1111/add.16712","url":null,"abstract":"&lt;p&gt;Wastewater analysis has been used to monitor spatial and temporal trends of drug use in communities for more than a decade now [&lt;span&gt;1&lt;/span&gt;], but the data needs to be integrated to inform law enforcement and health policy.&lt;/p&gt;&lt;p&gt;ter Laak &lt;i&gt;et al&lt;/i&gt;.’s study [&lt;span&gt;2&lt;/span&gt;] provides a comprehensive analysis of drug market size and user behavioural differences in relation to urbanity, offering valuable insights for relevant stakeholders. Two key aspects of this study stand out: the critical role of drug market information for the interpretation of market size/prevalence, and the difference of use patterns among the three target drugs, which has the potential to indicate the nature of drug use.&lt;/p&gt;&lt;p&gt;The data presented on drug prices and purity levels are essential for understanding a national drug market and the broad context of drug use. Variations in street drug purity can influence the levels of drugs measured in wastewater. Therefore, it is important to evaluate trends in purity data and adjust, when necessary, particularly when examining temporal and spatial patterns of population drug use, with substantially varying levels of purity [&lt;span&gt;3, 4&lt;/span&gt;]. The study by ter Laak &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;2&lt;/span&gt;] is a good example of how purity data can be used to estimate market size and reduce uncertainties. The consistency in the purity and price of drugs serves as an indicator of the stability of the Dutch drug market. Triangulation of wastewater data with drug prices and purity may provide a better reflection of changes (or the lack thereof) in the drug market because of any intervention including shifts in manufacturing practices or the introduction of adulterants [&lt;span&gt;5-8&lt;/span&gt;] that could lead to change in the mass of target drugs measured in wastewater.&lt;/p&gt;&lt;p&gt;ter Laak &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;2&lt;/span&gt;] also evaluate the association of drug use with the level of urbanity. The positive relationship between urbanity and drug loads of benzoylecgonine and 3,4-methyl​enedioxy​methamphetamine (MDMA) was used to extrapolate the drug consumption estimates in all towns in the Netherlands based on their urbanity index.&lt;/p&gt;&lt;p&gt;The variation in drug consumption throughout the week has not been discussed, but could be used to explain the observed relationship between the levels of drug consumption and the urbanity score. Both MDMA and cocaine are party drugs and have large weekday-weekend variation [&lt;span&gt;9&lt;/span&gt;]. Sites that have a high urbanity score are more likely to contain a higher percentage of nightlife venues (pubs and clubs) compared to sites with a lower urbanity score, and therefore, have higher levels of party related drugs. Amphetamine shows no correlation with urbanity (so possibly not a party drug) and is, therefore, more regularly used. By assessing the weekly variation of the data, the authors could differentiate the nature of drug use per catchment (i.e. regular users and those who use drugs recreationally in social or party set","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 1","pages":"126-127"},"PeriodicalIF":5.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16712","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in heroin overdose risk associated with the unregulated drug market: Insights from a supervised injecting facility in Melbourne, Australia","authors":"Nathan C. Stam,&nbsp;John Furler,&nbsp;Sarah Hiley,&nbsp;Jennifer L. Schumann","doi":"10.1111/add.16706","DOIUrl":"10.1111/add.16706","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine the contribution that variation in the unregulated drug market has on the risk of heroin overdose across individuals with different levels of personal overdose risk.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective cohort study of heroin injecting episodes and overdose cases were examined over a 12-month period between 30 June 2022 and 30 June 2023.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The Medically Supervised Injecting Room in Melbourne, Australia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Cases&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;1474 witnessed heroin overdose cases were examined amongst a cohort of 337 individuals who were predominantly male (&lt;i&gt;n&lt;/i&gt; = 276, 81.7%) with a median age of 43.5 years (interquartile range 37.25–49.00 years, range 20–75 years).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Measurements&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The daily overdose rate was used to differentiate &lt;i&gt;High&lt;/i&gt; and &lt;i&gt;Low&lt;/i&gt; daily overdose risk categories. The number of overdose events that an individual experienced during the study period was used to differentiate people into &lt;i&gt;Standard&lt;/i&gt;, &lt;i&gt;Moderate&lt;/i&gt; and &lt;i&gt;High&lt;/i&gt; personal overdose risk categories. Each overdose case was differentiated by the personal overdose risk of the individual who experienced the overdose, as well as the overdose risk of the day that overdose occurred. A stratified overdose risk profile was then derived across the nine different daily overdose risk and personal overdose risk categories.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The rate of overdose approximately doubled on &lt;i&gt;High&lt;/i&gt; overdose risk days compared with &lt;i&gt;Standard&lt;/i&gt; overdose risk days, increasing by a factor of 2.11, 2.41 and 2.03 times for individuals in the &lt;i&gt;Standard&lt;/i&gt;, &lt;i&gt;Moderate&lt;/i&gt; and &lt;i&gt;High&lt;/i&gt; personal overdose risk groups. Conversely, the rate of overdose was also substantially reduced on &lt;i&gt;Low&lt;/i&gt; overdose risk days to a factor of 0.17, 0.28 and 0.20, respectively.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among heroin users in Melbourne, Australia, there is an approximately 10-times difference in the risk of overdose on some days compared with others, which appears to be attributable to the effects of the unregulated drug market and not the effects of variation in personal overdose ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 2","pages":"285-292"},"PeriodicalIF":5.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}