Wastewater-based monitoring of illicit drugs in Cyprus by UPLC-MS/MS: The impact of the COVID-19 pandemic.

The outbreak and spread of COVID-19 impacted through various ways the lives of millions of humans globally. In this work, wastewater-based epidemiology (WBE) was applied to investigate the effect of the actions taken by the Republic of Cyprus to confine COVID-19 on the use of illicit stimulant drugs. Daily influent samples were collected from the six main wastewater treatment plants (WWTPs) of the country i) before lockdown (3-9 April 2019), ii) during lockdown (21-27 April 2020), iii) during the post-lockdown period (14-20 July 2020), and, iv) during each season of the following year (20-26 April 2021, 19-25 July 2021, 11-17 October 2021, 25 December 2021-2 January 2022), and analyzed for amphetamine, methamphetamine, MDMA and cocaine. In most areas, amphetamine and methamphetamine use was not affected during the confinement period, but as availability of the substances decreased with time, a drop in their use was observed when most restriction measures were eased (up to 9- and 22-fold decrease, respectively). The limitations on social interactions and events during the quarantine period seem to have led to the reduction of MDMA and cocaine and driven a sharp decrease of their use in most areas studied (up to 11 and 6 times lower, respectively). However, the re-opening of activities led to a pronounced consumption increase, reaching maximum daily values of 800 and 2691 mg/1000 inhabitants/day, respectively. In 2021, drug use was re-established to lower levels. The examination of weekly patterns during this year revealed higher weekend use of methamphetamine, MDMA and cocaine. Our results suggest that both the implementation and the easing of COVID-19 related measures affected the availability and the use of drugs. This study also provides the first insight on the consumption of illicit drugs in the Republic of Cyprus during pre-, post- and pandemic times and demonstrates the importance of WBE.

Amphetamine and Methamphetamine Trafficking in Thailand and Suppression Measures in the COVID-19 Context

During the pandemic, Thai authorities reported large quantities of drug trafficking from Thailand to various countries by evading detection mechanisms of drug enforcement officers. This research aimed to identify the patterns of amphetamine and methamphetamine trafficking witnessed during the COVID-19 pandemic in Thailand and provide suggestions as to how Thailand can enhance its suppression of such activities. The research was produced through the conduct of 30 in-depth interviews with key informants, who comprised of narcotics officials, policy-makers, senior directors of the Thai Narcotics Control Board, scholars, experts and individuals having direct experience of drug addicts and former prisoners. The sample was selected through purposive sampling and snowballing technique with the aim to understand the novel and adaptive methods being used by cross-border drug traffickers to evade detection. The results revealed that the drug traffickers took advantage of the temporary respite from scrutiny given by the Thai Government and its various agencies to cope up with the COVID-19 pandemic. In addition, the new normal emerging out of the pandemic was seen to have expanded the drug trafficking networks and operation in Thailand. The study's recommendations include establishing a central repository of intelligence, increasing legal capability through new regulations, developing professional skills of law enforcement entities, developing a greater knowledge about trafficking structures and trafficking operations, and consolidating postal and communication and public transportation services to detect the drug trafficking more efficiently. © 2021. International Journal of Criminal Justice Sciences. Under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). All Rights Reserved.

Opioid-Induced Leukoencephalopathies: A Report of Two Cases

Acute toxic leukoencephalopathy (ATL) and delayed post-hypoxic leukoencephalopathy (DPHL) are two possible adverse entities related to opioid intoxication (OI), each having a distinct clinical course. While ATL shows a monophasic course with gradual neurological deterioration, DPHL has a distinct biphasic course. We report a case of ATL along with a case of DPHL happening in young male patients with OI, including their clinical courses as well as imaging characteristics with comparable time intervals. Initially, both leukoencephalopathies typically show magnetic resonance imaging findings with confluent and symmetric white matter (WM) abnormalities in the periventricular regions on T2 and fluid-attenuated inversion recovery images along with restricted diffusion on diffusion-weighted imaging. The DPHL patient however also presented with WM cystic substance loss in the deterioration phase, several weeks after hospital admission, which was previously described in a case of DPHL. Interestingly, similar WM changes have recently been observed in virus-associated necrotizing disseminated acute leukoencephalopathy in patients with coronavirus disease 2019 which may suggest a common pathophysiological mechanism. Knowing the distinct imaging features of ATL and DPHL along with their typical clinical courses can provide a faster and more reliable differentiation between these two entities.

How Substance Use Treatment Services in Iran Survived Despite a Dual Catastrophic Situation

The prevalence of opium, residual opium juice (shireh), crystal methamphetamine, hashish, and heroin use in Iran is 150, 660, 590, 470, and 350 per 100 000 population, respectively.1 Substance use disorder is ranked as one ofthe top four health burdens in Iran.2 Addressing this health crisis has required the legalization of a variety of treatments and harm reduction services, the domestic production of opioid medications, available and low-cost opioid medications, available opium tincture with its short induction period, using seized opium to produce opium tincture, online self-help groups, and coordination among government agencies, the private health care sector, and nongovernmental organizations. HARM REDUCTION SERVICES IN IRAN The largest number of patients are served in private outpatient clinics that offer opioid agonist treatment, although abstinence-based residential centers and therapeutic communities are available in the private sector and the government runs compulsory residential centers.6 In 2018, an estimated 60 000 persons were under methadone maintenance treatment (MMT) while in prison, about 720 000 community residents were receiving MMT, approximately 120 000 were receiving buprenorphine, and about 93 000 were receiving opium tinctures from 1 of 196 government-run outpatient clinics or one of 7029 private outpatient clinics.6 Harm reduction services and facilities such as drop-in centers and outreach programs provide needle and syringe programs, low-threshold methadone treatment, condom promotion, and safer sex education. [...]clinics were authorized to provide larger take-home supplies of methadone, buprenorphine, and opium tincture for their stable patients.8 Although patients did not experience any shortage of opioid maintenance medications, there were fewer psychological services available because of COVID-19 prevention policies and the lack of online services. Methadone is also much less expensive than buprenorphine, and there are seven times more methadone patients than buprenorphine patients in Iran.10 Moreover, local opium tincture manufacture uses seized opium,11 which reduces production costs.12 * Reducing the need for harm reduction: Because of the availability of opioid maintenance medications, in past years the number of PWID decreased and the impact of this is seen in the reduced prevalence of HIV among PWID in Iran.13 This phenomenon has reduced the costs of harm reduction services because fewer harm reduction facilities are needed.

(±)-2-(2-Fluoro-[1,1′-biphenyl]-4-yl)-N-(1-phenylpropan-2-yl)propanamide

2-(2-fluoro-[1,1′-biphenyl]-4-yl)-N-(1-phenylpropan-2-yl)propanamide was synthesized by a reaction between amphetamine and flurbiprofen in high yields. The newly obtained hybrid molecule was fully analyzed and characterized via 1H, 13C, UV, IR, HPLC, and mass spectral data.

Rapid On-Site Detection of Illicit Drugs in Smuggled Samples with a Portable Electrochemical Device

The smuggling of illicit drugs urges the development of new tools for rapid on-site identification in cargos. Current methods rely on presumptive color tests and portable spectroscopic techniques. However, these methods sometimes exhibit inaccurate results due to commonly used cutting agents, the colorful nature of the sample or because the drugs are smuggled in common goods. Interestingly, electrochemical sensors can deal with these specific problems. Herein, an electrochemical device is presented that uses affordable screen-printed electrodes for the electrochemical profiling of several illicit drugs by square-wave voltammetry (SWV). The identification of the illicit compound is based on the oxidation potential of the analyte. Hence, a library of electrochemical profiles is built upon the analysis of illicit drugs and common cutting agents. This library allows the design of a tailor-made script that enables the identification of each drug through a user-friendly interface (laptop or mobile phone). Importantly, the electrochemical test is compared by analyzing 48 confiscated samples with other portable devices based on Raman and FTIR spectroscopy as well as a laboratory standard method (i.e., gas chromatography–mass spectrometry). Overall, the electrochemical results, obtained through the analysis of different samples from confiscated cargos at an end-user site, present a promising alternative to current methods, offering low-cost and rapid testing in the field.

Caution Is Necessary When Estimating Treatment Need for Opioid Use Disorder Using National Surveys

Heroin use in particular is thought to be severely underestimated by NSDUH largely because heroin use is a rare and particularly stigmatized behavior concentrated in hard-to-reach populations, whereas NSDUH aims to assess drug use trends in the general population.6 NSDUH also does not include certain populations in its sampling frame that may be more likely to experience OUD, including unstably housed individuals not living in shelters and incarcerated individuals.6,7 In addition, as noted by Saini et al., NSDUH does not ask questions about illicitly manufactured fentanyl use- intentional use or unintentional use via exposure as an adulterant or contaminant in substances such as cocaine and methamphetamine.8 The exclusion of fentanyl, its analogs, and other new synthetic opioids (e.g., U-47700) from NSDUH is particularly troubling given the shifting overdose epidemic, with rapidly increasing fentanyl-involved fatal overdoses and declining nonprescription opioid- and heroin-involved fatal overdoses.8,9 The absence of measures of fentanyl and novel opioids might affect prevalence estimates of opioid use and OUD in the general population. [...]prevalence estimates of past-year opioid (mis)use may be underestimated in NSDUH, potentially biasing population estimates of OUD and associated treatment needs. Physicians in outpatient nonspecialty settings were authorized to prescribe buprenorphine after receipt of training and a waiver issued by the Substance Abuse and Mental Health Services Administration with limits on the types of providers eligible to prescribe buprenorphine and the number of patients at a time to whom a provider could prescribe buprenorphine.10 Some of these strictures have been loosened to prevent coronavirus disease 2019 transmission (e.g., buprenorphine initiation via telehealth for new patients, 28-day medication supplies for established patients), but implementation of these policies across municipalities has been inconsistent.11 Understanding the prevalence of individual structural barriers to treatment access could have important implications for policy planning and expanded delivery of OUD treatment services. ACKNOWLEDGMENTS Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers R01DA044207, R01DA045872, and K01DA049900.

Substance abuse and neurotransmission.

The number of people who suffer from a substance abuse disorder has continued to rise over the last decade; particularly, the number of drug-related overdose deaths has sharply increased during the COVID-19 pandemic. Converging lines of clinical observations, supported by imaging and neuropsychological performance testing, have demonstrated that substance abuse-induced dysregulation of neurotransmissions in the brain is critical for development and expression of the addictive properties of abused substances. Recent scientific advances have allowed for better understanding of the neurobiological processes that mediates drugs of abuse and addiction. This chapter presents the past classic concepts and the recent advances in our knowledge about how cocaine, amphetamines, opioids, alcohol, and nicotine alter multiple neurotransmitter systems, which contribute to the behaviors associated with each drug. Additionally, we discuss the interactive effects of HIV-1 or COVID-19 and substance abuse on neurotransmission and neurobiological pathways. Finally, we introduce therapeutic strategies for development of pharmacotherapies for substance abuse disorders.

Drug and alcohol positivity of traumatically injured patients related to COVID-19 stay-at-home orders.

Background: COVID-19 related stay-at-home (SAH) orders created many economic and social stressors, possibly increasing the risk of drug/alcohol abuse in the community and trauma population.Objectives: Describe changes in alcohol/drug use in traumatically injured patients after SAH orders in California and evaluate demographic or injury pattern changes in alcohol or drug-positive patients.Methods: A retrospective analysis of 11 trauma centers in Southern California (1/1/2020-6/30/2020) was performed. Blood alcohol concentration, urine toxicology results, demographics, and injury characteristics were collected. Patients were grouped based on injury date - before SAH (PRE-SAH), immediately after SAH (POST-SAH), and a historical comparison (3/19/2019-6/30/2019) (CONTROL) - and compared in separate analyses. Groups were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.Results: 20,448 trauma patients (13,634 male, 6,814 female) were identified across three time-periods. The POST-SAH group had higher rates of any drug (26.2% vs. 21.6% and 24.7%, OR = 1.26 and 1.08, p < .001 and p = .035), amphetamine (10.4% vs. 7.5% and 9.3%, OR = 1.43 and 1.14, p < .001 and p = .023), tetrahydrocannabinol (THC) (13.8% vs. 11.0% and 11.4%, OR = 1.30 and 1.25, p < .001 and p < .001), and 3,4-methylenedioxy methamphetamine (MDMA) (0.8% vs. 0.4% and 0.2%, OR = 2.02 and 4.97, p = .003 and p < .001) positivity compared to PRE-SAH and CONTROL groups. Alcohol concentration and positivity were similar between groups (p > .05).Conclusion: This Southern California multicenter study demonstrated increased amphetamine, MDMA, and THC positivity in trauma patients after SAH, but no difference in alcohol positivity or blood concentration. Drug prevention strategies should continue to be adapted within and outside of hospitals during a pandemic.