Psychosocial characteristics of the general population who habitually use hypnotics: Results from a national survey on drug use among the Japanese.

Aim: The aim of this study was to examine the characteristics of habitual hypnotic users in Japan. Methods: This nationwide, cross-sectional survey used self-administered questionnaires. Data were collected from four national surveys conducted every 2 years between 2015 and 2021. The participants were Japanese individuals who had taken prescription hypnotics in the past year or had never taken them. We divided 13,396 participants into three groups to compare the social background and status of taking medication and controlled drugs, drinking, and smoking among the three groups: people who use hypnotics habitually daily (habitual hypnotic users [HUs]), people who use them only occasionally (occasional hypnotic users [OUs]), and people who do not use them (hypnotic non-users [NUs]). We compared the perception of using hypnotics between the HU and OU groups. Results: HUs were more likely to be older, unemployed, and to habitually use anxiolytics and analgesics than NUs. The main reasons for taking anxiolytics in HUs were alleviating insomnia and reducing anxiety, whereas the main reason for taking analgesics was improving joint pain. Additionally, the HU group had a higher proportion of habitual smokers than the OU group. There was no difference in drinking status or taking of controlled drugs among the three groups. HUs were more likely to use hypnotics and to have concerns about their side-effects than OUs. Conclusion: HUs were more likely to be unemployed, habitually use anxiolytics and analgesics, smoke heavily, and take hypnotic drugs with concerns regarding side-effects. These results may help encourage the appropriate use of hypnotics.

Rapid screening and identification of targeted and non-targeted illegal added drugs in functional foods by MRSIT-HRMS based on NIST screening database.

The last few decades have witnessed the increasing consumption of functional foods, leading to the expansion of the worldwide market. However, the illegal addition drugs in functional foods remains incessant despite repeated prohibition, making it a key focus of strict crackdowns by regulatory authorities. Effective analytical tools and procedures are desperately needed to rapidly screen and identify illegally added drugs in a large number of samples, given the growing amount and diversity of these substances in functional foods. The MRSIT-HRMS (Multiple Sample Rapid Introduction combined with High Resolution Mass Spectrometry) without chromatographic separation, after direct sampling, utilizes NIST software (National Institute of Standards and Technology) matching with a home-built library to target identification and non-targeted screen of illegal additives. When applied to 50 batches of suspicious samples, the targeted method detected illegal added drugs in 41 batches of samples, while the non-targeted method screened a new phosphodiesterase-5 (PDE-5) inhibitor type structural derivative. The positive results obtained by the targeted method were consistent with LC-MS/MS (QQQ). The novel MRSIT-HRMS with a limit of quantification (LOD) of 1 µg/mL achieved 100 % correct identification for all 50 batches of actual samples, demonstrating its potential as a highly promising and powerful tool for fast screening of illegally added drugs in functional food, especially when compared to traditional LC-MS/MS methods. This is essential for ensuring drug safety and public health.

The use of nitrous oxide whippets as a recreational drug: Hidden health risks.

Whipped cream canisters, also known as nitrous oxide whippets, are traditionally used in the culinary arts to prepare food foams. In recent years, however, these gas canisters have been cracked open and inhaled to produce a "legal" high. Users of these whippets have reported the presence of an oily residue containing metallic particles. This contamination was investigated using liquid chromatography-, gas chromatography- and inductively coupled plasma-mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). The particulate matter was also analyzed by scanning transmission electron microscopy (STEM) combined with energy-dispersive X-ray spectroscopy (EDX). The presence of cyclohexyl isothiocyanate was confirmed at a maximum concentration of 67 µg per whippet. ICP-MS and ICP-OES analysis revealed the presence of mainly iron and zinc, but also, traces of aluminum, chromium, cobalt, nickel, and lead were found. STEM-EDX analysis confirmed the presence of nano-sized particles containing iron and zinc. When simulating inhalation, using the multiple path particle dosimetry model, it was confirmed that these nano-sized particles can reach the deeper parts of the lungs. Most users assume that inhaling a food-grade nitrous oxide whippet for a "legal" high poses no risks. However, this research shows that users are exposed to cyclohexyl isothiocyanate, a substance classified as a respiratory sensitizer. The presence of zinc in the particulate matter could potentially be linked to lung lesions.

Societal costs of illegal drug use in Sweden.

BACKGROUND: Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. METHODS: A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. RESULTS: The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. CONCLUSION: Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.

Bombé, an undetermined substance that caused an outbreak of illicit drug use in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Illegal drugs are becoming a public health problem in African cities. In 2021, Bombé, a new drug of unknown composition, caused an outbreak of neuro-psychiatric symptoms in Kinshasa. Bombé was rumored to be based on ground catalytic exhausts stolen from cars. METHODS: The chemical composition of six samples of Bombé obtained from different neighborhoods in Kinshasa was determined by triple quad liquid chromatography-mass spectrometry/mass spectrometry with confirmation by quadrupole time-of-flight mass spectrometry. Metals were determined by inductively coupled plasma-mass spectrometry, and polycyclic aromatic hydrocarbons were measured by gas chromatography-mass spectrometry. RESULTS: Analysis of the Bombé samples revealed that it contained heroin (2-12% of the total area under the curve of the samples) and opioid derivatives, plus paracetamol (33-72%), caffeine (17-26%), and also benzodiazepines (5/6 samples) and cyproheptadine (2/6 samples). The concentrations of neurotoxic metals were unremarkable. The median (range) concentrations of manganese and lead were 9.4 µg/g (range 3-334 µg/g) and 0.36 µg/g (range 0.1-3.12 µg/g ), respectively. All polycyclic aromatic hydrocarbons were below the level of detection (<0.10 µg/g). CONCLUSION: Thanks to international collaboration, Bombé was documented to be a heroin-based drug and its alleged origin from catalytic exhausts was not substantiated. The local human expertise and technical capacity for undertaking toxicological analyses should be increased in Africa.

Utilizing Different Diffusion Mechanisms for Thin Film Fluorescence-Based Detection and Discrimination of Illicit Drug Vapors.

Film-based fluorescence sensors have been demonstrated to be powerful tools for real-time detection of trace chemical vapors. While explosive vapor detection via fluorescence quenching has been widely explored, fluorescence-based real-time detection and identification of illicit drug vapors remains a challenge. Here, we report two perylene diimide-based sensing materials, P1 and P2, incorporating 2,2-dihexyloctanyl chains and 4-[tris(4-{tert-butyl}phenyl)methyl]phenyl moieties at the imide positions, respectively. Quartz crystal microbalance with in situ photoluminescence measurements showed that N-methylphenethylamine, a simulant of methamphetamine (MA), diffused into films of P1 and P2 via Fickian and case-II mechanisms, respectively. The difference in the analyte diffusion mechanism led to P2 showing significantly faster luminescence quenching but slower luminescence recovery compared to P1. Finally, the different diffusion mechanisms were used as the basis for developing a simple sensor array based on P1 and P2 that could selectively detect free-base illicit drugs (MA, cocaine, and tetrahydrocannabinol) from potential interferants (organic amines, alcohol, and cosmetics) within 40 s.

Using the Severity of Dependence Scale to examine cannabis consumers with impaired control in Canada.

Background: The 2018 Cannabis Act legalizing the production, sale, and use of cannabis for non-medical purposes renewed interest in the importance of ongoing and more detailed monitoring of cannabis consumption and consequences. Some cannabis users will experience impaired control over their use of cannabis, putting them at risk for cannabis use disorder (CUD, sometimes called addiction) and other harms. Including the Severity of Dependence Scale (SDS) in the annual Canadian Community Health Survey (CCHS) would allow for monitoring of one of the more harmful consequences of cannabis use in the post-legalization period. Data and methods: Data from the nationally representative 2019-2020 CCHS were used to examine cannabis consumers with and without impaired control. Respondents who used cannabis in the past year were categorized according to their SDS scores: those with impaired control (SDS ≥ 4) versus those without impaired control (SDS < 4). Cross-tabulations were used to examine the sociodemographic, mental health, health behaviour and cannabis exposure characteristics of those with impaired control. Multivariable logistic regression models assessed associations between these characteristics and the risk of impaired control. The prevalence of self-reported cannabis-related problems experienced by consumers-with and without impaired control-is also presented. Results: In 2019-2020, 4.7% of past-year cannabis consumers scored ≥ 4 on the SDS and were considered to have impaired control. Multivariable logistic regression suggested that the odds of having impaired control remained higher for people who were male, were aged 18 to 24 years, were single or never married, were from lower-income households, were diagnosed with an anxiety or a mood disorder, started consuming cannabis at age ≤ 15, and consumed at least monthly. Interpretation: A better understanding of the characteristics of cannabis consumers experiencing impaired control (a correlate of future CUD or addiction) could help with the development of more effective education, prevention and treatment strategies.

Chest pain secondary to drug use treated in hospital emergency departments in Spain.

OBJECTIVE: To determine the characteristics of patients with chest pain (CP) associated with recent drug use. METHODS: Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. RESULTS: CP accounted for 8.97% of attendances (males 82.9%, p<0.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, p<0.001), anxiety (42.5%, p<0.001), hypertension (13.6%, p<0.001) and arrhythmias (5.9%, p<0.001). Patients with TD received more treatment (81.9% vs 74.1%; p<0.001), although they were admitted less (7.6%, p=0.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). CONCLUSIONS: In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing.

Assessing the impact of a major electronic music festival on the consumption patterns of illicit and licit psychoactive substances in a Mediterranean city using wastewater analysis.

The consumption patterns of five categories of psychoactive substances (PS), including "conventional" illicit drugs, new psychoactive substances (NPS), therapeutic opioids, alcohol and nicotine, were studied in the city of Split, Croatia, using wastewater-based epidemiology (WBE), with an emphasis on the impact of a large electronic music festival. The study involved the analysis of 57 urinary biomarkers of PS in raw municipal wastewater samples collected in three characteristic periods, including the festival week in the peak-tourist season (July) and reference weeks in the peak-tourist season (August) and the off-tourist season (November). Such a large number of biomarkers allowed the recognition of distinct patterns of PS use associated with the festival, but also revealed some subtle differences between summer and autumn seasons. The festival week was characterized by markedly increased use of illicit stimulants (MDMA: 30-fold increase; cocaine and amphetamine: 1.7-fold increase) and alcohol (1.7-fold increase), while consumption of other common illicit drugs (cannabis and heroin), major therapeutic opioids (morphine, codeine and tramadol) and nicotine remained rather constant. Interestingly, NPS and methamphetamine clearly contributed to the festival PS signature in wastewater, but their prevalence was rather low compared to that of common illicit drugs. Estimates of cocaine and cannabis use were largely consistent with prevalence data from national surveys, whereas differences were found for typical amphetamine-type recreational drugs, particularly MDMA, and for heroin. The WBE data suggest that the largest proportion of morphine came from heroin consumption and that the percentage of heroin users seeking treatment in Split is probably rather low. The prevalence of smoking calculated in this study (30.6 %) was consistent with national survey data for 2015 (27.5-31.5 %), while the average alcohol consumption per capita >15 years (5.2 L) was lower than sales statistics suggest (8.9 L).

Screening strategy for ketamine-based new psychoactive substances using fragmentation characteristics from high resolution mass spectrometry.

Recreational designer drugs called new psychoactive substances (NPS) are emerging and pose enormous risks to public health. Detection of recently discovered or unreported NPS remains a huge challenge by using traditional targeted mass spectrometry methods. Here a novel screening strategy was developed to detect both known and novel analogs of NPS based on fragmentation characteristics from liquid chromatography-high resolution mass spectrometry (LC-HRMS). The HRMS fragmentation pathway of one selected NPS family was investigated to form a database containing predicted drugs as well as their mass characteristics. During the study, an unexpected substituent effect was found to distinguish geometric isomers. Seventy-eight seized samples were analyzed using this strategy, four ketamine-based NPS were detected and three of them were newly marketed. The substituent effect predicted the position of their phenylic substituent, the results were confirmed by NMR.

Exploring the contextual risk factors and characteristics of individuals who died from the acute toxic effects of opioids and other illegal substances: listening to the coroner and medical examiner voice. / Exploration des facteurs de risque contextuels et des caractéristiques des personnes décédées des effets toxiques aigus d'opioïdes et d'autres substances illégales : prise en compte de l'avis des coroners et des médecins légistes.

INTRODUCTION: Substance-related acute toxicity deaths continue to be a serious public health concern in Canada. This study explored coroner and medical examiner (C/ME)perspectives of contextual risk factors and characteristics associated with deaths from acute toxic effects of opioids and other illegal substances in Canada. METHODS: In-depth interviews were conducted with 36 C/MEs in eight provinces and territories between December 2017 and February 2018. Interview audio recordings were transcribed and coded for key themes using thematic analysis. RESULTS: Four themes described the perspectives of C/MEs: (1) Who is experiencing a substance-related acute toxicity death?; (2) Who is present at the time of death?; (3) Why are people experiencing an acute toxicity death?; (4) What are the social contextual factors contributing to deaths? Deaths crossed demographic and socioeconomic groups and included people who used substances on occasion, chronically, or for the first time. Using alone presents risk, while using in the presence of others can also contribute to risk if others are unable or unprepared to respond. People who died from a substance-related acute toxicity often had one or more contextual risk factors: contaminated substances, history of substance use, history of chronic pain and decreased tolerance. Social contextual factors contributing to deaths included diagnosed or undiagnosed mental illness, stigma, lack of support and lack of follow-up from health care. CONCLUSION: Findings revealed contextual factors and characteristics associated with substance-related acute toxicity deaths that contribute to a better understanding of the circumstances surrounding these deaths across Canada and that can inform targeted prevention and intervention efforts.

Automated identification of unknown doping agents in confiscation samples by flow-injection mass spectrometry and mass spectral library searches.

Rapid and accurate identification of unknown compounds within suspicious samples confiscated for sports doping control and law enforcement drug testing is critical, but such analyses are often conducted manually and can be time-consuming. Here, we report a methodology for automated identification of unknown substances in confiscation samples by rapid automatic flow-injection analysis on a liquid chromatography coupled to high-resolution mass spectrometry system and identifying unknown compounds with Compound Discoverer software. The developed methodology was validated by comparing the automated identification results with those obtained from manual syringe-infusion experiments and manual tandem mass spectral library searches. The automated methodology resulted in far higher throughput and remarkably shorter turnaround time for analysis when compared with manual procedures and, in most cases, yielded more compounds. As this is the first such report to the authors' knowledge, this methodology may potentially transform analysis of confiscated samples in sports doping control and law enforcement drug testing.

Illegal drugs and periodontal conditions.

In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.

Social service providers' perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study.

BACKGROUND: People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers' perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. METHODS: We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. RESULTS: Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients' ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. CONCLUSIONS: Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care's ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management.

Policy actor views on structural vulnerability in harm reduction and policymaking for illegal drugs: A qualitative study.

BACKGROUND: Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD. METHODS: The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings. RESULTS: The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. CONCLUSIONS: Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.

Portable Digital Linear Ion Trap Mass Spectrometer Based on Separate-Region Corona Discharge Ionization Source for On-Site Rapid Detection of Illegal Drugs.

As narcotic control has become worse in the past decade and the death toll of drug abuse hits a record high, there is an increasing demand for on-site rapid detection of illegal drugs. This work developed a portable digital linear ion trap mass spectrometer based on separate-region corona discharge ionization source to meet this need. A separate design of discharge and reaction regions was adopted with filter air as both carrier gas for the analyte and protection of the corona discharge needle. The linear ion trap was driven by a digital waveform with a low voltage (±100 V) to cover a mass range of 50-500 Da with a unit resolution at a scan rate of 10,000 Da/s. Eighteen representative drugs were analyzed, demonstrating excellent qualitative analysis capability. Tandem mass spectrometry (MS/MS) was also performed by ion isolation and collision-induced dissociation (CID) with air as a buffer gas. With cocaine as an example, over two orders of magnitude dynamic range and 10 pg of detection limit were achieved. A single analysis time of less than 10 s was obtained by comparing the information of characteristic ions and product ions with the built-in database. Analysis of a real-world sample further validated the feasibility of the instrument, with the results benchmarked by GC-MS. The developed system has powerful analytical capability without using consumables including solvent and inert gas, meeting the requirements of on-site rapid detection applications.

Portable fully automated oral fluid extraction device for illegal drugs.

Currently used methods for in-field determination of illegal drugs involve various test kits based mainly on the immunoassay technique, where the presence of a compound of interest is assessed by antibody-antigen reaction and manifested by observable color change. Despite being accepted and widely used by police forces to test the presence of illegal drugs in a suspect person, these tests often suffer from unreliable results (high level of false-positive and/or false-negative) due to the cross-reactivity and difficulties with quantification. Therefore, we have developed a portable capillary electrophoresis instrument to determine illegal drugs in oral fluid collected from a suspected person. However, this drug analyzer has still required manual sample preparation. Therefore, this research aimed to develop, test, and validate a fully automated sample pretreatment (purification, extraction, pre-concentration) prototype compatible with the capillary electrophoresis drug of abuse analyzer and suitable for confirmatory analysis by mass spectrometry. The cotton swab from Salivette® oral fluid collector was examined and integrated into the fully automated extractor prototype. The recoveries for the automated extractor were between 18 and 20%, with repeatabilities within 5-11% for 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxy-N-ethylamphetamine (MDEA), cocaine (COC), and cocaethylene (COET). The developed extraction device was easy to use even for unskilled persons, required minimal liquid handling, and was applicable to use in field conditions.

Synthesis of a novel polydopamine and C18 dual-functionalized magnetic core-shell mesoporous nanocomposite for enrichment and analysis of widely abused illegal drugs in urine samples on site and in the laboratory.

In this study, a novel polydopamine and C18 dual-functionalized magnetic core-shell mesoporous silica (Fe3O4@nSiO2@mSiO2@PDA-C18) nanocomposite was designed and synthesized, which was employed as an adsorbent to extract illegal drugs from urine samples by magnetic solid-phase extraction (MSPE) procedures. The as-prepared nanocomposite was fully characterized and combined with ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) to monitor 12 trace illegal drugs and metabolites, including 6-monoacetylmorphine (6-MAM), morphine (MOR), codeine (COD), amphetamine (AMP), methamphetamine (MAMP), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), ketamine (KET), norketamine (NK), cocaine (COC), benzoylecgonine (BZE) and methcathinone (MC). Optimal MSPE procedures were achieved by fully investigating parameters of activation, adsorption, washing and desorption steps. The MSPE-UHPLC-MS/MS method offered high sensitivity with limit of detection (LOD) range of 0.005-0.05 ng mL-1 and good linearity with the concentration of 0.01-1000 ng mL-1. Also, the intra- and inter-day recovery respectively ranged in 90.2-105.0% and 89.8-107.4%, and the intra- and inter-day precision was in the range of 0.5-14.0% and 1.2-10.0%, respectively. By application to real urine samples, the proposed method could not only be equally sensitive for quantifying 12 illegal drugs in urine but also significantly reduce the pretreatment time when comparing with methods based on solid-phase extraction. Furthermore, the designed dual-functionalized adsorbents could also be applied for on-site determination of MAMP in urine coupled with urine test kit, and the detection threshold of MAMP urine test kit remarkably reduced from 1000 ng mL-1 to 50 ng mL-1. Therefore, the present method was a convenient, economic and sensitive approach for determining illegal drugs in urine samples both on site and in the laboratory.

Estimación del coste social del consumo de drogas ilegales en Catalunya / An estimation of the social cost of illicit drug consumption in Catalonia

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.(AU)

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.(AU)

Perceived unmet substance use and mental health care needs of acute care patients who use drugs: A cross-sectional analysis using the Behavioral Model for Vulnerable Populations.

INTRODUCTION: The perceived unmet service needs of acute care-seeking people who use illegal drugs (PWUD) have been poorly documented, despite evidence of frequent hospital utilisation. This study applies the Behavioral Model for Vulnerable Populations to investigate correlates of unmet service needs in this subpopulation. METHODS: Survey data from 285 PWUD at three urban Canadian acute care centres were examined. The survey included the Perceived Need for Care Questionnaire, which measured service seeking and care satisfaction for mental health and substance use concerns across seven types of services, as well as barriers to having care needs met. The Behavioral Model for Vulnerable Populations was applied in hierarchical setwise logistic regression to examine associations between high unmet service need and socio-structural predictors (i.e. predisposing, enabling and need factors). RESULTS: Almost half (46%) of participants reported a high level of unmet service need, despite seeking services during the past year. Participants reporting recent criminal activity, adverse childhood experiences, transitory sleeping, having no community support worker, and meeting screening criteria for depression were more likely to report a high level of unmet service needs. Structural barriers to care (57%) were more commonly reported than motivational barriers (43%). DISCUSSION AND CONCLUSIONS: Acute care-seeking PWUD experience high rates of unmet service needs for their mental health and substance use problems. Strategies that can help overcome structural barriers to care are necessary to help address the service needs of this population.