Response consistency in young adolescents’ drug use self-reports: a recanting rate analysis.

Aims: To assess the reliability of drug use reports by young respondents, this study examined the extent of recanting previous drug use reports within an ongoing longitudinal survey of adolescent drug use. Here, recanting was defined as a positive report of life-time drug use that was subsequently denied 1 year later. The covariates of recanting were also studied. Design: An ongoing longitudinal survey of young adolescents (Belfast Youth Development Study) in Northern Ireland. Setting: Pencil and paper questionnaires were administered to pupils within participating schools. Measurements: Measures analysed included (a) recanting rates across 13 substances, (b) educational characteristics, (c) offending behaviour and (d) socioeconomic status. Findings: High levels of drug use recanting were identified, ranging from 7% of past alcohol use to 87% of past magic mushroom use. Recanting increased with the social stigma of the substance used. Denying past alcohol use was associated with being male, attending a catholic school, having positive attitudes towards school, having negative education expectations and not reporting any offending behaviour. Recanting alcohol intoxication was associated with being male and not reporting serious offending behaviour. Cannabis recanting was associated with having negative education expectations, receiving drugs education and not reporting serious offending behaviour. Conclusions: The high levels of recanting uncovered cast doubts on the reliability of drug use reports from young adolescents. Failure to address this response error may lead to biased prevalence estimates, particularly within school surveys and drug education evaluation trials.

Validation of an analytical method for nitrous oxide (N2O) laughing gas by headspace gas chromatography coupled to mass spectrometry (HS-GC-MS): Forensic application to a lethal intoxication.

Drug abuse is a widespread problem affecting both teenagers and adults. Nitrous oxide is becoming increasingly popular as an inhalation drug, causing harmful neurological and hematological effects. Some gas chromatography-mass spectrometry (GC-MS) methods for nitrous oxide measurement have been previously described. The main drawbacks of these methods include a lack of sensitivity for forensic applications; including an inability to quantitatively determine the concentration of gas present. The following study provides a validated method using HS-GC-MS which incorporates hydrogen sulfide as a suitable internal standard allowing the quantification of nitrous oxide. Upon analysis, sample and internal standard have similar retention times and are eluted quickly from the molecular sieve 5Å PLOT capillary column and the Porabond Q column therefore providing rapid data collection whilst preserving well defined peaks. After validation, the method has been applied to a real case of N2O intoxication indicating concentrations in a mono-intoxication.

Sustained low-efficiency dialysis with filtration (SLEDD-f) in the management of acute sodium valproate intoxication

Hemodialysis is only infrequently used in drug overdosage situations. The efficacy of hemodialysis to remove the drug depends upon the pharmacokinetics and pharmacodynamics of the drug. At normal therapeutic concentrations, valproic acid is predominantly protein bound and therefore removal by hemodialysis is limited. In an overdose situation, protein binding is rapidly saturated and therefore the substantially larger quantities of the free drug can rapidly cause toxicity. Slow low-efficient daily diafiltration (SLEDD) has not previously been utilized in a drug overdose situation. We report the effective use of SLEDD to remove high toxic concentrations of valproic acid in an overdose situation. Slow low-efficient daily diafiltration also prevented the rebound phenomenon that can occur as the excess drug is released from its protein-bound stores. Hybrid dialysis therapies deserve further evaluation in the management of other poisonings where extra-corporeal therapy is indicated.

It blasted me into space : intoxication and an ethics of pleasure

O'Malley and Valverde point out that in the 21st century, pleasure is a warrantable motive for drug and alcohol use only when it is attached to the idea of moderation. This presents a problem for those researchers who wish to theorise about those individuals who use drugs deliberately to induce intoxication. This paper uses unconventional means to come to an understanding of intoxication, it uses the stories of interviewed former heroin addicts, published autobiographies, biographies and even some fictional accounts to come to an understanding of the. difficulties of dealing with intoxication and the drug-using subject, it also uses the accounts that Michel Foucault gave about his own use of drugs and its relationship to an ethics of pleasure and resistance. The article uses theories of risk and edgework to understand the underlying meanings of intoxication to many drug users.

Patron offending and intoxication in night time entertainment districts (POINTED) : a study protocol

Risky alcohol consumption is the subject of considerable community concern in Australia and internationally, particularly the risky drinking practices of young people consuming alcohol in the night-time economy. This study will determine some of the factors and correlates associated with alcohol-related risk-taking, offending and harm in and around licensed venues and night-time entertainment precincts across five Australian cities (three metropolitan and two regional). The primary aim of the study is to measure levels of pre-drinking, drinking in venues, intoxication, illicit drug use and potentially harmful drinking practices (such as mixing with energy drinks) of patrons in entertainment areas, and relating this to offending, risky behaviour and harms experienced. The study will also investigate the effects of license type, trading hours, duration of drinking episodes and geographical location on intoxication, offending, risk-taking and experience of harm. Data collection involves patron interviews (incorporating breathalysing and drug testing) with 7500 people attending licensed venues. Intensive venue observations (n=112) will also be undertaken in a range of venues, including pubs, bars and nightclubs. The information gathered through this study will inform prevention and enforcement approaches of policy makers, police and venue staff.

'Wide-awake drunkenness'? Investigating the association between alcohol intoxication and stimulant use in the night-time economy

Aims: We tested whether patrons of the night-time economy who had co-consumed energy drinks or illicit stimulants with alcohol had higher blood alcohol concentration (BAC) levels than patrons who had consumed only alcohol. Design: Street intercept surveys (n=4227) were undertaken between 9 p.m. and 5 a.m. over a period of 7 months. Setting: Interviews were undertaken with patrons walking through entertainment precincts, queuing to enter venues or exiting venues in five Australian cities. Participants: The response rate was 92.1%; more than half the study sample was male (60.2%) and the median age was 23 years (range 18-72). Measurements: Data were collected on demographics, length of drinking session, venue types visited, types and quantity of alcohol consumed and other substance use. A BAC reading was recorded and a subsample of participants was tested for other drug use. Findings: Compared with the total sample (0.068%), illicit stimulant consumers (0.080%; P=0.004) and energy drink consumers (0.074%; P<0.001) had a significantly higher median BAC reading, and were more likely to engage in pre-drinking (65.6, 82.1 and 77.6%, respectively, P<0.001) and longer drinking sessions (4, 5 and 4.5 hours, respectively, P<0.001). However, stimulant use was not associated independently with higher BAC in the final multivariable model (illicit stimulants P=0.198; energy drinks P=0.112). Interaction analyses showed that stimulant users had a higher BAC in the initial stages of the drinking session, but not after 4-6 hours. Conclusions: While stimulant use does not predict BAC in and of itself, stimulants users are more likely to engage in prolonged sessions of heavy alcohol consumption and a range of risk-taking behaviours on a night out, which may explain higher levels of BAC among stimulants users, at least in the initial stages of the drinking session.

Correlates and motives of pre-drinking with intoxication and harm around licensed venues in two cities

INTRODUCTION AND AIMS: The study investigates the prevalence of pre-drinking culture in the night-time economy (NTE) and its impact upon intoxication and alcohol-related harm and violence experienced by patrons. DESIGN AND METHODS: Cross-sectional surveys were conducted in and around licensed venues in Newcastle (NSW) and Geelong (Victoria) during peak trading hours (typically 9pm-1am). Participants completed a five minute structured interview which targeted: demographics, past and planned movements on the survey night, safety/experience of harm, and patron intoxication. 3949 people agreed to be interviewed, a response rate of 90.7%. Around half (54.9%) of interviewees were male and mean age was 24.4 years (SD = 5.8). RESULTS: 66.8% of participants reported pre-drinking prior to attending licensed venues. On a 1-10 scale measuring self-rated intoxication, pre-drinkers scored significantly higher compared to non pre-drinkers (P < 0.001). Compared to non-pre-drinkers, patrons who had consumed 6-10 standard pre-drinks were 1.5 times more likely to be involved in a violent incident in the past 12 months (OR = 1.50, 95%CI 1.03-2.19, P = 0.037) increasing to 1.8 times more likely for patrons who had 11-15 drinks (OR = 1.80, 95%CI 1.04-3.11 P = .036). Pre-drinking was also associated with both self-rated and observer-rated intoxication, as well as increased probability of illicit drug use. Amongst pre-drinkers, price was the most commonly reported motive for pre-drinking (51.8%). DISCUSSION AND CONCLUSIONS: 'Pre-drinking' was normal behaviour in the current sample and contributes significantly to the burden of harm and intoxication in the NTE. Price disparity between packaged vs. venue liquor is a key motivator for pre-drinking.

Drug use in Australian nightlife settings: estimation of prevalence and validity of self-report

AIMS: This study aimed to 1) estimate the prevalence of illicit drug use in night-time entertainment districts across five major cities in Australia; and 2) validate self-reported drug use using biochemical marker oral swabs. DESIGN: Street intercept surveys and oral drug swabs conducted over a seven-month period during 2011-2012. SETTING: The night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia, between the hours of 10 pm and 5 am. PARTICIPANTS: 7,340 individuals agreed to participate in the survey (a 93% response rate). More than half (62%) of the sample was male, with a median age of 22 years (range 18-73). MEASUREMENTS: Patrons were approached in thoroughfares, and while entering and leaving licensed venues. Data collected included demographics and current session alcohol and other substance use. Drug swabs (n = 401) were performed with a sub-sample of participants. FINDINGS: Approximately 9% (95% CI, 7% to 12%) of participants self-reported consumption of illicit or non-prescribed pharmaceutical drugs prior to interview; of those, 81% identified psychostimulants as the drug used. One in five drug swabs returned a positive result, with psychostimulants the most commonly detected drugs (15%; 95% CI, 12%-19%). Kappa statistics indicate agreement between self-report of any illicit drug and a positive drug swab is in the slight range (κ = 0.12 (95% CI, .05 to .20) p = .000). CONCLUSIONS: Self-report findings suggest drug use in the nightlife in Australia is common, though still very much a minority past-time. Drug swabs indicate a higher prevalence of use (20%) than self-report (9%), which suggests that self-reported drug use may not be reliable in this context. This article is protected by copyright. All rights reserved.

Sober assessment of the link between substance abuse and crime-eliminating drug and alcohol use from the sentencing calculus

The relevance of drug and alcohol involvement to sentencing law and practice is one of the most perplexing and unsettled areas of sentencing law and practice.1 It is also one of the most important issues in the criminal justice system. Most crimes are committed by offenders who are substance involved, and nearly half of all crimes that are committed are done so by offenders who are intoxicated at the time of the offense. Substance involved individuals are grossly over-represented in the criminal courts. Addiction and intoxication impair sound judgment, and hence, it intuitively appears that intoxicated offenders are less culpable for their crimes. Moreover, there is often a sense that addiction and intoxication causes aberrant behavior and that curing the substance involvement will lead to more prudent (law-abiding) conduct.

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Article

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Article

Fatal methadone intoxication in an infant listed as a homicide.

Voluntary methadone administration for the purpose of sedation eventually resulting in the infant's death is extremely infrequent, though it has been observed. In this report, we describe an autopsy case pertaining to a 32-month-old infant who was repeatedly exposed to methadone by his parents. Autopsy revealed a coarctation of the aorta with a focal stenosis located at the junction of the distal aortic arch and the descending aorta. Left ventricular hypertrophy was also observed. Both these findings were considered to not have played a role in the child's death. Methadone was detected in the femoral blood (0.633 mg/l), urine (5.25 mg/l), bile (2.64 mg/l), and gastric contents (1.08 mg). A segmental hair analysis showed the presence of methadone and morphine in both the proximal and distal portion of the lock. Methadone was also detected in nail samples. A segmental hair analysis performed on the younger brother of the deceased revealed the presence of methadone and morphine in both the proximal and distal segments, as well as the presence of 6-monoacetylmorphine exclusively in the distal portion. Though the parents denied any involvement in methadone administration or exposure for the purpose of sedation, the manner of death was listed as homicide. The case emphasizes the usefulness of hair analysis to identify threatening situations for the children of drug-dependent parents and possibly support measures by the authorities to recognize and intervene in these potentially fatal situations.