Adolescent ecstasy use and depression: cause and effect, or two outcomes of home environment?

Background: This study assessed the association between adolescent ecstasy use and depressive symptoms in adolescence. Methods: The Belfast Youth Development Study surveyed a cohort annually from age 11 to 16 years. Gender, Strengths and Difficulties Questionnaire emotional subscale, living arrangements, parental affluence, parent and peer attachment, tobacco, alcohol, cannabis and ecstasy use were investigated as predictors of Short Mood and Feelings Questionnaire (SMFQ) outcome. Results: Of 5371 respondents, 301 (5.6%) had an SMFQ > 15, and 1620 (30.2) had missing data for SMFQ. Around 8% of the cohort had used ecstasy by the end of follow-up. Of the non-drug users, ∼2% showed symptoms of depression, compared with 6% of those who had used alcohol, 6% of cannabis users, 6% of ecstasy users and 7% of frequent ecstasy users. Without adjustment, ecstasy users showed around a 4-fold increased odds of depressive symptoms compared with non-drug users [odds ratio (OR) = 0.26; 95% confidence interval (CI) = 0.10, 0.68]. Further adjustment for living arrangements, peer and parental attachment attenuated the association to under a 3-fold increase (OR = 0.37; 95% CI = 0.15, 0.94). There were no differences by frequency of use. Conclusions: Ecstasy use during adolescence may be associated with poorer mental health; however, this association can be explained by the confounding social influence of family dynamics. These findings could be used to aid effective evidence-based drug policies, which concentrate criminal justice and public health resources on reducing harm.

Expression et localisation du système endocannabinoïde dans la rétine du singe

Les effets de la marijuana, un médicament utilisé par l’homme depuis des millénaires, sur le système visuel sont peu connus. Une meilleure connaissance de la distribution du système endocannabinoïde (eCB) de la rétine pourrait expliquer comment cette drogue affecte la vision. Cette étude vise à caractériser la distribution du récepteur cannabinoïde CB1 (CB1R) et de l’enzyme de dégradation FAAH (“fatty acid amide hydrolase”) des ligands du CB1R dans la rétine du singe Vert (Chlorocebus sabaeus). De plus, elle vise à déterminer quelles sous-populations cellulaires de la rétine expriment ces composantes. La plupart des études à ce jour ont été conduites surtout sur les rongeurs et peu de travaux ont été réalisés chez le singe. Notre étude vient donc combler cette carence. Par le biais de méthodes immunohistochimiques, nous avons investigué la localisation du CB1R et de l’enzyme FAAH à différentes excentricités rétiniennes, de la fovéa centralis vers la périphérie. Nos résultats, en accord avec notre hypothèse de travail, démontrent que CB1R et FAAH sont exprimés à travers toute la rétine mais avec, cependant, des différences notoires. Au niveau de la couche des photorécepteurs, CB1R est exprimé préférentiellement dans les cônes et ce patron d’expression suit la distribution des photorécepteurs centre-périphérie. De plus, CB1R se retrouve surtout dans les pédicules des cônes de la couche plexiforme externe. CB1R et FAAH sont abondants dans les cellules bipolaires tant au centre qu’en périphérie. Le soma et l’axone des cellules ganglionnaires expriment aussi CB1R et FAAH. Ces données suggèrent que le système eCB est présent à travers toute la rétine du primate et pourrait expliquer les perturbations visuelles entrainées par la marijuana, telles la photosensibilité et la vision des couleurs.

Hair analysis for Delta9-tetrahydrocannabinolic acid A--new insights into the mechanism of drug incorporation of cannabinoids into hair

Differentiation between external contamination and incorporation of drugs or their metabolites from inside the body via blood, sweat or sebum is a general issue in hair analysis and of high concern when interpreting analytical results. In hair analysis for cannabinoids the most common target is Delta9-tetrahydrocannabinol (THC), sometimes cannabidiol (CBD) and cannabinol (CBN) are determined additionally. After repeated external contamination by cannabis smoke these analytes are known to be found in hair even after performing multiple washing steps. A widely accepted strategy to unequivocally prove active cannabis consumption is the analysis of hair extracts for the oxidative metabolite 11-nor-9-carboxy-THC (THC-COOH). Although the acidic nature of this metabolite suggests a lower rate of incorporation into the hair matrix compared to THC, it is not fully understood up to now why hair concentrations of THC-COOH are generally found to be much lower (mostly <10 pg/mg) than the corresponding THC concentrations. Delta9-Tetrahydrocannabinolic acid A (THCA A) is the preliminary end product of the THC biosynthesis in the cannabis plant. Unlike THC it is non-psychoactive and can be regarded as a 'precursor' of THC being largely decarboxylated when heated or smoked. The presented work shows for the first time that THCA A is not only detectable in blood and urine of cannabis consumers but also in THC positive hair samples. A pilot experiment performed within this study showed that after oral intake of THCA A on a regular basis no relevant incorporation into hair occurred. It can be concluded that THCA A in hair almost exclusively derives from external contamination e.g. by side stream smoke. Elevated temperatures during the analytical procedure, particularly under alkaline conditions, can lead to decarboxylation of THCA A and accordingly increase THC concentrations in hair. Additionally, it has to be kept in mind that in hair samples tested positive for THCA A at least a part of the 'non-artefact' THC probably derives from external contamination as well, because in condensate of cannabis smoke both THC and THCA A are present in relevant amounts. External contamination by side stream smoke could therefore explain the great differences in THC and THC-COOH hair concentrations commonly found in cannabis users.

Profiles of drug users in Switzerland and effects of early-onset intensive use of alcohol, tobacco and cannabis on other illicit drug use.

QUESTIONS UNDER STUDY / PRINCIPLES: The main aim of this study was to investigate profiles of drug users, with a particular focus on illicit drugs other than cannabis, and to explore the effect of early-onset intensive use (drunkenness, daily smoking, high on cannabis) on profiles of illicit drug use. METHODS: Baseline data from a representative sample of 5,831 young Swiss men in the ongoing Cohort Study on Substance Use Risk Factors were used. Substance use (alcohol, tobacco, cannabis and 15 types of other illicit drug) and age of onset of intensive use were assessed. The Item Response Theory (IRT) and prevalence rates at different ages of onset were used to reveal different profiles of illicit drug use. RESULTS: In addition to cannabis, there were two profiles of other illicit drug use: (a) "softer" drug users (uppers, hallucinogens and inhaled drugs), among which ecstasy had the highest discriminatory potential (IRT slope = 4.68, standard error (SE) = 0.48; p <0.001); and (b) "harder" drug users (heroin, ketamine, gamma-hydroxybutyrate/gamma-hydroxylactone, research chemicals, crystal meth and spice), among which ketamine had the highest discriminatory potential (slope = 4.05; SE = 0.63; p <0.001). Onset of intensive use at the age of 12 years or younger also discriminated between these two profiles. CONCLUSION: Both the IRT model and the effect of onset of intensive use enabled two groups of illicit drugs to be identified. In particular, very early onset (at 12 years or younger) intensive use of any substance was a marker for later use of the second group of drugs.

Cannabis use correlates of syringe sharing among injection drug users

Ce manuscrit est une pré-publication d'un article paru dans The American Journal on Addictions 2010; 19(3): 231-237 url: http://onlinelibrary.wiley.com/doi/10.1111/ajad.2010.19.issue-3/issuetoc

Changes in cannabis use among psychotic clients without specialised substance use treatment

The need to address substance use among people with psychosis has been well established. However, treatment studies targeting substance use in this population have reported mixed results. Substance users with psychosis in no or minimal treatment control groups achieve similar reductions in substance use compared to those in more active substance use treatment, suggesting a role for natural recovery from substance use. This meta-analysis aims to quantify the amount of natural recovery from substance use within control groups of treatment studies containing samples of psychotic substance users, with a particular focus on changes in cannabis use. A systematic search was conducted to identify substance use treatment studies. Meta-analyses were performed to quantify reductions in the frequency of substance use in the past 30 days. Significant but modest reductions (mean reduction of 0.3–0.4 SD across the time points) in the frequency of substance use were found at 6 to 24 months follow up. The current study is the first to quantify changes in substance use in samples enrolled in no treatment or minimal treatment control conditions. These findings highlight the potential role of natural recovery from substance use among individuals with psychosis, although they do not rule out effects of regression to the mean. Additionally, the results provide a baseline from which to estimate likely changes or needed effects sizes in intervention studies. Future research is required to identify the processes underpinning these changes, in order to identify strategies that may better support self-management of substance use in people with psychosis.

During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption but continue to smoke tobacco and cannabis

While recreational drug use in UK women is prevalent, to date there is little prospective data on patterns of drug use in recreational drug-using women immediately before and during pregnancy. A total of 121 participants from a wide range of backgrounds were recruited to take part in the longitudinal Development and Infancy Study (DAISY) study of prenatal drug use and outcomes. Eighty-six of the women were interviewed prospectively while pregnant and/or soon after their infant was born. Participants reported on use immediately before and during pregnancy and on use over their lifetime. Levels of lifetime drug use of the women recruited were high, with women reporting having used at least four different illegal drugs over their lifetime. Most users of cocaine, 3,4-methylenedioxy-N-methylamphetamine (MDMA) and other stimulants stopped using these by the second trimester and levels of use were low. However, in pregnancy, 64% of the sample continued to use alcohol, 46% tobacco and 48% cannabis. While the level of alcohol use reduced substantially, average tobacco and cannabis levels tended to be sustained at pre-pregnancy levels even into the third trimester (50 cigarettes and/or 11 joints per week). In sum, while the use of ‘party drugs’ and alcohol seems to reduce, levels of tobacco and cannabis use are likely to be sustained throughout pregnancy. The data provide polydrug profiles that can form the basis for the development of more realistic animal models.

Polyconsommation d’alcool et de cannabis et comportements à risque chez les étudiants universitaires canadiens : une analyse situationnelle

La polyconsommation d’alcool et de cannabis est rapportée par un grand nombre de jeunes adultes canadiens (Flight, 2007). Les recherches épidémiologiques suggèrent que le statut de polyconsommateur est associé à certains comportements à risque, dont la consommation excessive d’alcool et la conduite d’un véhicule automobile sous l’influence de l’alcool (Jones et al. 2001; Mohler-Kuo, et al. 2003; Shillington & Clapp, 2006). Les études qui soutiennent le risque accru de comportements à risque pour les polyconsommateurs se focalisent sur l’effet des substances. En rupture avec cette approche, ce mémoire présente une étude situationnelle de la polyconsommation en examinant l’effet du statut de polyconsommateur et, pour ceux-ci l’effet de la consommation simultanée d’alcool et de cannabis, en situant l’action dans son contexte de survenu et en examinant la contribution du contexte. La probabilité d’avoir conduit une voiture sous l’influence de l’alcool et d’avoir consommé excessivement de l’alcool sera examinée auprès d’étudiants universitaires. La contribution respective des substances, des situations et de l’expérience de la vie universitaire sera examinée. La méthodologie employée repose sur la construction de modèles de régression logistique multiniveaux, à la fois chez l’ensemble des buveurs (10 747 occasions, nichées dans 4396 buveurs) et dans le sous-échantillon des polyconsommateurs (2311 occasions de consommation d’alcool, nichées dans 880 polyconsommateurs). Les données sont issues de l’Enquête sur les campus canadiens (2004), menée auprès d’un échantillon représentatif de 6282 étudiants issus de 40 universités. Le statut de polyconsommateur est associé à la consommation excessive d’alcool, mais pas à la conduite d’une voiture suite à la consommation. Cependant, la consommation simultanée d’alcool et de cannabis n’est pas associée à un risque plus élevé de consommer excessivement de l’alcool, et est négativement associée à la conduite d’une voiture après la consommation. Plusieurs caractéristiques situationnelles sont associées aux deux comportements à l’étude et diminuent la force d’association entre ces comportements et le statut de polyconsommateur.

Whither RDS? An investigation of respondent driven sampling as a method of recruiting mainstream marijuana users.

Background: An important challenge in conducting social research of specific relevance to harm reduction programs is locating hidden populations of consumers of substances like cannabis who typically report few adverse or unwanted consequences of their use. Much of the deviant, pathologized perception of drug users is historically derived from, and empirically supported, by a research emphasis on gaining ready access to users in drug treatment or in prison populations with higher incidence of problems of dependence and misuse. Because they are less visible, responsible recreational users of illicit drugs have been more difficult to study. Methods: This article investigates Respondent Driven Sampling (RDS) as a method of recruiting experienced marijuana users representative of users in the general population. Based on sampling conducted in a multi-city study (Halifax, Montreal, Toronto, and Vancouver), and compared to samples gathered using other research methods, we assess the strengths and weaknesses of RDS recruitment as a means of gaining access to illicit substance users who experience few harmful consequences of their use. Demographic characteristics of the sample in Toronto are compared with those of users in a recent household survey and a pilot study of Toronto where the latter utilized nonrandom self-selection of respondents. Results: A modified approach to RDS was necessary to attain the target sample size in all four cities (i.e., 40 'users' from each site). The final sample in Toronto was largely similar, however, to marijuana users in a random household survey that was carried out in the same city. Whereas well-educated, married, whites and females in the survey were all somewhat overrepresented, the two samples, overall, were more alike than different with respect to economic status and employment. Furthermore, comparison with a self-selected sample suggests that (even modified) RDS recruitment is a cost-effective way of gathering respondents who are more representative of users in the general population than nonrandom methods of recruitment ordinarily produce. Conclusions: Research on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on 'at-risk' populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation.

Development of an integrative cessation program for co-smokers of cigarettes and cannabis: demand analysis, program description, and acceptability

Abstract Background Tobacco and cannabis use are strongly interrelated, but current national and international cessation programs typically focus on one substance, and address the other substance either only marginally or not at all. This study aimed to identify the demand for, and describe the development and content of, the first integrative group cessation program for co-smokers of cigarettes and cannabis. Methods First, a preliminary study using expert interviews, user focus groups with (ex-)smokers, and an online survey was conducted to investigate the demand for, and potential content of, an integrative smoking cessation program (ISCP) for tobacco and cannabis co-smokers. This study revealed that both experts and co-smokers considered an ISCP to be useful but expected only modest levels of readiness for participation.Based on the findings of the preliminary study, an interdisciplinary expert team developed a course concept and a recruitment strategy. The developed group cessation program is based on current treatment techniques (such as motivational interviewing, cognitive behavioural therapy, and self-control training) and structured into six course sessions.The program was evaluated regarding its acceptability among participants and course instructors. Results Both the participants and course instructors evaluated the course positively. Participants and instructors especially appreciated the group discussions and the modules that were aimed at developing personal strategies that could be applied during simultaneous cessation of tobacco and cannabis, such as dealing with craving, withdrawal, and high-risk situations. Conclusions There is a clear demand for a double cessation program for co-users of cigarettes and cannabis, and the first group cessation program tailored for these users has been developed and evaluated for acceptability. In the near future, the feasibility of the program will be evaluated. Trial registration Current Controlled Trials ISRCTN15248397

Alcohol use and risk taking among regular ecstasy users

We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks (binge alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting heavy alcohol users. The study's limitations are noted.

Subtypes of Illicit Drug Users: A Latent Class Analysis of Data From an Australian Twin Sample

This article applies methods of latent class analysis (LCA) to data on lifetime illicit drug use in order to determine whether qualitatively distinct classes of illicit drug users can be identified. Self-report data on lifetime illicit drug use (cannabis, stimulants, hallucinogens, sedatives, inhalants, cocaine, opioids and solvents) collected from a sample of 6265 Australian twins (average age 30 years) were analyzed using LCA. Rates of childhood sexual and physical abuse, lifetime alcohol and tobacco dependence, symptoms of illicit drug abuse/dependence and psychiatric comorbidity were compared across classes using multinomial logistic regression. LCA identified a 5-class model: Class 1 (68.5%) had low risks of the use of all drugs except cannabis; Class 2 (17.8%) had moderate risks of the use of all drugs; Class 3 (6.6%) had high rates of cocaine, other stimulant and hallucinogen use but lower risks for the use of sedatives or opioids. Conversely, Class 4 (3.0%) had relatively low risks of cocaine, other stimulant or hallucinogen use but high rates of sedative and opioid use. Finally, Class 5 (4.2%) had uniformly high probabilities for the use of all drugs. Rates of psychiatric comorbidity were highest in the polydrug class although the sedative/opioid class had elevated rates of depression/suicidal behaviors and exposure to childhood abuse. Aggregation of population-level data may obscure important subgroup differences in patterns of illicit drug use and psychiatric comorbidity. Further exploration of a 'self-medicating' subgroup is needed.

Representações Sociais da Cannabis no Concelho de Góis

A cannabis permanece como a substância ilícita mais consumida no mundo. Defendida por uns e “diabolizada” por outros, constitui uma das substâncias psicoactivas mais polémicas. Alguns autores destacaram já, a importância do estudo das representações sociais das substâncias psicoactivas. No entanto, desconhecem-se investigações que abordem a representação social desta substância num espaço rural. São objectivos deste estudo: 1) conhecer as representações sociais da cannabis no que diz respeito à substância, ao consumidor e ao contexto da utilização, 2) identificar as diferenças existentes entre utilizadores e não utilizadores desta substância da amostra em estudo. Para concretizar estes objectivos, foi realizado um estudo qualitativo que recorreu a uma dupla abordagem etno-metodológica e fenomenológica. Foram realizadas 30 entrevistas a indivíduos residentes nas duas maiores freguesias do concelho de Góis que, depois de transcritas, foram objecto de análise de conteúdo. No espaço rural considerado, a cannabis é maioritariamente representada como uma “droga”, indutora de uma sensação de mal-estar e causadora de dependência. Para os participantes o utilizador é percebido como detentor de características de personalidade negativas, que o induzem ao consumo. Relativamente ao eixo espacial, o espaço rural, e mais especificamente o concelho de Góis é representado como local de consumo e de produção da cannabis herbácea. Há uma distinção clara entre a representação social dos participantes que não utilizam a substância e os que utilizam. O último grupo representa-a como uma “droga leve”, e mostra-se esclarecido sobre as possíveis consequências da sua utilização. Neste grupo é ainda evidente a valorização da cannabis herbácea, em detrimento dos seus derivados. /