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Journal of Substance Use and Addiction... Aug 2023Patient satisfaction is key to the success of methadone maintenance treatment (MMT), and yet how MMT satisfaction is affected by the increasingly common use of crystal...
BACKGROUND
Patient satisfaction is key to the success of methadone maintenance treatment (MMT), and yet how MMT satisfaction is affected by the increasingly common use of crystal methamphetamine among people receiving opioid treatment remains poorly understood. We aimed to assess the association between crystal methamphetamine use and MMT dissatisfaction.
METHODS
We employed generalized estimating equations to examine the relationship between crystal methamphetamine use and MMT dissatisfaction among patients receiving MMT within two prospective cohorts in Vancouver, Canada, between December 2016 and March 2020.
RESULTS
Of the 836 participants receiving MMT, the median age was 47 years, and 55.3 % self-identified as male at baseline. In a multivariable model, those reporting more than weekly crystal methamphetamine use were more likely to report MMT dissatisfaction (Odds ratio: 1.40, 95 % confidence interval: 1.05-1.86) compared to those reporting less than monthly crystal methamphetamine use.
CONCLUSIONS
Among our sample of people receiving MMT, we noted a positive association of frequent crystal methamphetamine use with MMT dissatisfaction. Our study suggests a need for novel strategies to better understand and address frequent methamphetamine use among those receiving MMT, particularly given recent shifts in substance use patterns involving the rising co-use of methamphetamines and opioids.
Topics: Humans; Male; Middle Aged; Methadone; Prospective Studies; Methamphetamine; Opiate Substitution Treatment; Canada; Analgesics, Opioid
PubMed: 36804867
DOI: 10.1016/j.josat.2023.208956 -
Journal of Psychoactive Drugs 2022Co-use of non-medical opioids (NMO) and methamphetamine is increasing. So too is the use of the psychoactive botanical "kratom," including among people with NMO and...
Co-use of non-medical opioids (NMO) and methamphetamine is increasing. So too is the use of the psychoactive botanical "kratom," including among people with NMO and methamphetamine use histories. We assessed characteristics associated with respondent groups who reported lifetime methamphetamine and/or kratom use within a nationally representative US sample using 2019 National Survey on Drug Use and Health data from respondents reporting lifetime NMO use (diverted prescription opioids, heroin). Weighted prevalence estimates for demographic, mental health, and substance use outcomes were determined. Logistic regression examined associations between group membership and outcomes. Among this sample of respondents with lifetime NMO use, 67.6% (95% CI = 65.6-69.4%) reported only NMO use; 4.6% (3.9-5.4%) reported NMO+Kratom; 24.7% (22.7-26.7%) reported NMO+Methamphetamine; and 3.2% (2.5-3.9%) reported NMO+Methamphetamine+Kratom. Compared to those in the NMO-only group, the NMO+Kratom group was more likely to report past-year serious mental illness (SMI; = 2.27), suicidality (= 1.89), and past-month psychological distress (= 1.88). The NMO+Methamphetamine+Kratom group was more likely to report past-year SMI (= 2.65), past-month psychological distress (= 2.06), and unmet mental health needs (= 2.03); increased odds for drug injection, opioid withdrawal, and perceived treatment need also emerged. Risk factors were observed for all groups but were greatest among those reporting use of all three substances.
Topics: Humans; Analgesics, Opioid; Methamphetamine; Mitragyna; Suicidal Ideation; Psychological Distress; Mental Disorders; United States
PubMed: 34842079
DOI: 10.1080/02791072.2021.2006374 -
Neuroscience and Biobehavioral Reviews Mar 2020The synthetic cathinones are derived from the naturally occurring drug cathinone found in the khat plant (Catha edulis) and have chemical structures and neurochemical... (Review)
Review
The synthetic cathinones are derived from the naturally occurring drug cathinone found in the khat plant (Catha edulis) and have chemical structures and neurochemical consequences similar to other psychostimulants. This class of new psychoactive substances (NPS) also has potential for use and abuse coupled with a range of possible adverse effects including neurotoxicity and lethality. This review provides a general background of the synthetic cathinones in terms of the motivation for and patterns and demographics of their use as well as the behavioral and physiological effects that led to their spread as abused substances and consequent regulatory control. This background is followed by a review focusing on their rewarding and aversive effects as assessed in various pre-clinical animal models and the contribution of these effects to their self-administration (implicating their use and abuse potential). The review closes with an overview of the consequences of synthetic cathinone use and abuse in terms of their potential to produce neurotoxicity and lethality. These characterizations are discussed in the context of other classical psychostimulants.
Topics: Alkaloids; Animals; Central Nervous System Stimulants; Humans; Methamphetamine; Psychotropic Drugs; Self Administration; Substance-Related Disorders
PubMed: 31101438
DOI: 10.1016/j.neubiorev.2018.07.015 -
International Journal of Environmental... Sep 2020The experience of craving via exposure to drug-related cues often leads to relapse in drug users. This study consolidated existing empirical evidences of cue reactivity... (Review)
Review
The experience of craving via exposure to drug-related cues often leads to relapse in drug users. This study consolidated existing empirical evidences of cue reactivity to methamphetamine to provide an overview of current literature and to inform the directions for future research. The best practice methodological framework for conducting scoping review by Arkey and O'Malley was adopted. Studies that have used a cue paradigm or reported on cue reactivity in persons with a history of methamphetamine use were included. Databases such as Medline, EMBASE, PsycINFO and CINAHL were searched using key terms, in addition to citation check and hand search. The search resulted in a total of 32 original research articles published between 2006 to 2020. Three main themes with regard to cue reactivity were identified and synthesized: (1) effects of cue exposure, (2) individual factors associated with cue reactivity, and (3) strategies that modulate craving or reactivity to cues. Exposure to methamphetamine-associated cues elicits significant craving and other autonomic reactivity. Evidence suggests that drug cue reactivity is strongly associated with indices of drug use and other individual-specific factors. Future studies should focus on high quality studies to support evidence-based interventions for reducing cue reactivity and to examine cue reactivity as an outcome measure.
Topics: Craving; Cues; Humans; Methamphetamine; Recurrence; Substance-Related Disorders
PubMed: 32906716
DOI: 10.3390/ijerph17186504 -
Journal of Pharmaceutical and... Jul 2018Clandestine chemists have demonstrated an ability to convert commercially available pseudoephedrine formulations to methamphetamine. Some of these formulations have... (Comparative Study)
Comparative Study
Clandestine chemists have demonstrated an ability to convert commercially available pseudoephedrine formulations to methamphetamine. Some of these formulations have properties that manufacturers claim limit or block the extraction of pseudoephedrine and its direct conversion to methamphetamine. In this study, 3 commercially available pseudoephedrine formulations were evaluated for ease of extraction and conversion to methamphetamine using a common chemistry technique called the one-pot method that is frequently employed by clandestine chemists. Two marketed pseudoephedrine formulations with claimed tamper-resistant properties - Zephrex-D and Nexafed - were compared to Sunmark, a comparator formulation of pseudoephedrine without tamper-resistant properties. Particle size reduction was conducted using 8 readily available tools; solubility was assessed using 2 common aqueous solutions and various reaction conditions (e.g., temperature, stirring); extractability was evaluated using 8 common organic solvents. The one-pot (single vessel) method commonly used in clandestine processes was employed; chemicals and equipment were purchased locally on the open market. Quantities and addition times of the chemicals used to carry out the procedure and the duration of the reaction were varied to determine the effect on methamphetamine yield. The procedure was appropriately scaled and conducted in a controlled environment to reduce risk and maximize yields. Pseudoephedrine and methamphetamine were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Standard quantitative procedures were used to determine the quantities of pseudoephedrine and methamphetamine recovered and produced, respectively. Particle size reduction resulted in some loss of material of each pseudoephedrine formulation; Zephrex-D tablets were broken down to a coarse material; Nexafed and Sunmark tablets were reduced to a fine powder. The solubility rates of intact and ground tablets varied by product; Zephrex-D was most resistant to solubilizing while Nexafed and Sunmark were comparable and dissolved completely, demonstrating no solubility-resistant properties. Conditions of the one-pot method were modified throughout the studies to increase methamphetamine yield. Using optimal parameters identified in these studies and allowing the reaction to proceed for 90 min, average percent conversions were similar for the 3 formulations: 43.3% for Zephrex-D, 46.4% for Nexafed, and 48.6% for Sunmark. The greatest conversion occurred with a 150 min reaction time and resulted in 44.8%-48.4% conversion of Zephrex-D, 54.1%-66.4% conversion of Nexafed, and 58.6%-71.8% conversion of Sunmark. This series of methodological evaluations demonstrated that clandestine chemists can readily produce similar yields of methamphetamine using pseudoephedrine products with and without claimed tamper-resistant technology.
Topics: Chemical Fractionation; Chromatography, High Pressure Liquid; Feasibility Studies; Illicit Drugs; Methamphetamine; Nasal Decongestants; Particle Size; Pseudoephedrine; Solubility; Solvents; Tablets; Tandem Mass Spectrometry
PubMed: 29684907
DOI: 10.1016/j.jpba.2018.04.016 -
Journal of Clinical Pharmacology Nov 2016This article presents information on the predominant synthetic cathinones used in the Western world, mephedrone and methylenedioxypyrovalerone (MDPV). Synthetic... (Review)
Review
This article presents information on the predominant synthetic cathinones used in the Western world, mephedrone and methylenedioxypyrovalerone (MDPV). Synthetic cathinones are commonly used drugs of abuse in the United States and Europe, with numerous cases of patient harm and death. Patients exhibit many neurological, cardiovascular, and muscular adverse events and frequently require therapy to control psychotic or agitated states and acute kidney injury resulting from myopathy or rhabdomyolysis. There are potential genetic polymorphisms and drug interactions that might accentuate risk, but there are no studies evaluating to what extent this occurs or if it is clinically relevant. Clinicians should be aware of the known pharmacology, pharmacokinetics, and reports of effects to detect potential issues and treat patients presenting with these adverse effects.
Topics: Animals; Benzodioxoles; Humans; Illicit Drugs; Methamphetamine; Psychotic Disorders; Psychotropic Drugs; Pyrrolidines; Substance-Related Disorders; Synthetic Cathinone
PubMed: 27029951
DOI: 10.1002/jcph.742 -
Birth Defects Research. Part C, Embryo... Jun 2016Methamphetamine exposure in utero leads to a variety of higher-order cognitive deficits, such as decreased attention and working, and spatial memory impairments in... (Review)
Review
Methamphetamine exposure in utero leads to a variety of higher-order cognitive deficits, such as decreased attention and working, and spatial memory impairments in exposed children (Piper et al., 2011; Roussotte et al., 2011; Kiblawi et al., 2011). As with other teratogens, the timing of methamphetamine exposure greatly determines its effects on both neuroanatomical and behavioral outcomes. Methamphetamine exposure in rodents during the third trimester human equivalent period of brain development results in distinct and long-lasting route-based and spatial navigation deficits (Williams et al., 2003; Vorhees et al., 2005, 2008, 2009;). Here, we examine the impact of neonatal methamphetamine-induced neurotoxicity on behavioral outcomes, neurotransmission, receptor changes, plasticity proteins, and DNA damage. Birth Defects Research (Part C) 108:131-141, 2016. © 2016 Wiley Periodicals, Inc.
Topics: Animals; Animals, Newborn; Cognition; Female; Humans; Methamphetamine; Neurodevelopmental Disorders; Neurotoxicity Syndromes; Oxidative Stress; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 27297291
DOI: 10.1002/bdrc.21130 -
Oxidative Medicine and Cellular... 2020Methamphetamine is a derivative of amphetamines, a highly addictive central stimulant with multiple systemic toxicity including the brain, heart, liver, lung, and... (Review)
Review
Methamphetamine is a derivative of amphetamines, a highly addictive central stimulant with multiple systemic toxicity including the brain, heart, liver, lung, and spleen. It has adverse effects such as apoptosis and breakdown of the blood-brain barrier. Methamphetamine is a fatal and toxic chemical substance, and its lethal mechanism has been widely studied in recent years. The possible mechanism is that methamphetamine can cause cardiotoxicity and neurotoxicity mainly by inducing oxidative stress so as to generate heat, eliminate people's hunger and thirst, and maintain a state of excitement so that people can continue to exercise. According to many research, there is no doubt that methamphetamine triggers neurotoxicity by inducing reactive oxygen species (ROS) production and redox imbalance. This review summarized the mechanisms of methamphetamine-induced neurotoxicity including apoptosis and blood-brain barrier breakdown through oxidative stress and analyzed several possible antioxidative mechanisms of tert-butylhydroquinone (TBHQ) which is a kind of food additive with antioxidative effects. As a nuclear factor E2-related factor 2 (Nrf2) agonist, TBHQ may inhibit neurotoxicity caused by oxidative stress through the following three mechanisms: the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system, the astrocytes activation, and the glutathione pathway. The mechanism about methamphetamine's toxic effects and its antioxidative therapeutic drugs would become a research hotspot in this field and has very important research significance.
Topics: Antioxidants; Humans; Hydroquinones; Methamphetamine; NF-E2-Related Factor 2; Neurotoxicity Syndromes; Oxidative Stress
PubMed: 33354283
DOI: 10.1155/2020/8874304 -
Journal of the Neurological Sciences Jan 2021Approved food and drug administration (FDA) medications to treat Psychostimulant Use Disorder (PUD) are needed. Both acute and chronic neurological deficits related to... (Review)
Review
BACKGROUND
Approved food and drug administration (FDA) medications to treat Psychostimulant Use Disorder (PUD) are needed. Both acute and chronic neurological deficits related to the neurophysiological effects of these powerfully addictive drugs can cause stroke and alterations in mood and cognition.
OBJECTIVE
This article presents a brief review of the psychiatric and neurobiological sequelae of methamphetamine use disorder, some known neurogenetic associations impacted by psychostimulants, and explores treatment modalities and outcomes.
HYPOTHESIS
The authors propose that gentle D2 receptor stimulation accomplished via some treatment modalities can induce dopamine release, causing alteration of D2-directed mRNA and thus enhanced function of D2 receptors in the human. This proliferation of D2 receptors, in turn, will induce the attenuation of craving behavior, especially in genetically compromised high-risk populations.
DISCUSSION
A better understanding of the involvement of molecular neurogenetic opioid, mesolimbic dopamine, and psychostimulant connections in "wanting" supports this hypothesis. While both scientific and, clinical professionals search for an FDA approved treatment for PUD the induction of dopamine homeostasis, via activation of the brain reward circuitry, offers treatment for underlying neurotransmitter functional deficits, potential prophylaxis, and support for recovery efforts.
CONCLUSION
Dopamine regulation may help people dig out of their hypodopaminergia ditch.
Topics: Analgesics, Opioid; Central Nervous System Stimulants; Dopamine; Humans; Methamphetamine; Reward
PubMed: 33279726
DOI: 10.1016/j.jns.2020.117252 -
Biochemistry and Cell Biology =... Jun 2023Methamphetamine is one of the most commonly used illicit drugs during pregnancy. Most studies investigating the impact of maternal use of methamphetamine on children... (Review)
Review
Methamphetamine is one of the most commonly used illicit drugs during pregnancy. Most studies investigating the impact of maternal use of methamphetamine on children have focused on neurological outcomes. In contrast, cardiovascular outcomes in these children have not been characterized. Recent studies in rodents provide evidence that prenatal exposure to methamphetamine induces changes in cardiac gene expression, changes in the heart's susceptibility to ischemic injury, and changes in vascular function that may increase the risk of developing cardiovascular disorders later in life. Importantly, these changes are sex-dependent. This review summarizes our current understanding of how methamphetamine use during pregnancy impacts the cardiovascular function of adult offspring and highlights gaps in our knowledge of the potential cardiovascular risks associated with prenatal exposure to methamphetamine.
Topics: Pregnancy; Humans; Female; Methamphetamine; Prenatal Exposure Delayed Effects
PubMed: 36763967
DOI: 10.1139/bcb-2022-0349