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The article comments on the paper by B. Pardo and colleagues about the production of methamphetamine in Afghanistan. Topics discussed include the role of ephedra in the expansion of methamphetamine production in the country, the uncertainty of the Taliban's ban on drug production, and the possible increase in the manufacture of methamphetamine or other synthetic substances using synthetic precursors.

Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Dr Leslie E. Keeley was perhaps the world's most famous addiction cure doctor at the turn of the 20th century, but mainstream medicine dismissed him as a quack because he dispensed a secret cure. This paper aims to describe Keeley's now largely forgotten story and to draw attention to the role of contextual issues in the acceptance or rejection of any theory of addiction, particularly the neuroscientific theories of the early 21st century. Methods: This study is a qualitative assessment and contextualization of historical documents. Its main sources are archival and are, for the most part, unknown to historians. The paper also offers intellectual and historical context that is drawn from leading historical and sociological analyses. Results: Keeley's addiction cure was dismissed as quackery because it failed to meet the changing standards of late 19th‐century professional medicine. This begs us to consider contextual issues in any assertion of the viability of addiction therapeutics, in the present as well the past. Conclusions: Keeley's near erasure from the historical record was a consequence of a broader, late 19th‐century medical power struggle that took precedence over the testimony of tens of thousands of satisfied patients who claimed that Keeley's cure worked. Context matters in the assessment of the viability of theories of addiction from the past, but also from the present. Historians and social scientists are well placed to make those assessments. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: To review early case reports and experimental inductions of amphetamine and methamphetamine psychosis, prior to the prohibition of these drugs, to gain a better understanding of the nature and aetiology of methamphetamine psychosis. Methods: Papers considered were historical case reports and case series of psychosis relating to the use and misuse of prescription amphetamine, focusing upon papers by Young & Scoville (1938), Connell (1958), and three subsequent experimental studies published in the early 1970s (Griffith 1972, Angrist & Gershon 1970 and Bell 1973), where psychosis was induced in volunteers using high‐dose amphetamine and methamphetamine. Results: High‐dose methamphetamine and amphetamine can result in a paranoid psychosis which remits rapidly (within days) of discontinuing use. The central feature is paranoia occurring in a clear state of consciousness. This may be accompanied by other psychotic symptoms (e.g. hallucinations). Pre‐existing schizophrenia is not necessary, and the syndrome is not due to sleep deprivation. Conclusions: Research findings from the 1930s to the 1970s suggest that paranoid psychosis should be considered a probable consequence of high‐dose methamphetamine use. Individuals who experience psychotic symptoms for any substantive period after intoxication has ended should be suspected of having a functional non‐organic psychosis, or a latent vulnerability thereto. [ABSTRACT FROM AUTHOR]

Aims Since 2003, the US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA, CSAT) has awarded 32 Screening, Brief Intervention and Referral to Treatment (SBIRT) grants to states, territories and tribal organizations to enhance services for persons with, or at risk for, substance use disorders. The grants supported an expansion of the continuum of care to include screening, brief intervention, brief treatment and referral to treatment in general medical and community settings. This paper describes the SAMHSA SBIRT program in the context of the scientific research that motivated its development, as well as the two cross-site evaluations that are the subject of subsequent papers in this Supplement. Methods A narrative review of research evidence pertaining to SBIRT and of the cross-site evaluation design that made it possible to determine whether the SAMHSA SBIRT grant program achieved its intended aims. The 11 programs within the two cohorts of grant recipients that were the subject of the cross-site evaluations are described in terms of SBIRT service components, performance sites, providers, management structure/activities and patient/client characteristics. Conclusion The US SAMHSA SBIRT program is an effective way to introduce a variety of new services that extend the continuum of care for substance-involved individuals, ranging from early intervention with non-dependent substance users to referral of more serious cases to specialized substance abuse treatment. [ABSTRACT FROM AUTHOR]

Background: Illicitly manufactured fentanyl and its analogues are appearing in countries throughout the world, often disguised as heroin or counterfeit prescription pills, with resulting high overdose mortality. Possible explanations for this phenomenon include reduced costs and risks to heroin suppliers, heroin shortages, user preferences for a strong, fast‐acting opioid and the emergence of Dark Web cryptomarkets. This paper addresses these potential causes and asks three questions: (1) can users identify fentanyl; (2) do users desire fentanyl; and (3) if users want fentanyl, can they express this demand in a way that influences the supply? Argument/analysis: Existing evidence, while limited, suggests that some users can identify fentanyl, although not reliably, and some desire it, but because fentanyl is frequently marketed deceptively as other drugs, users lack information and choice to express demand effectively. Even when aware of fentanyl's presence, drug users may lack fentanyl‐free alternatives. Cryptomarkets, while difficult to quantify, appear to offer buyers greater information and competition than offline markets. However, access barriers and patterns of fentanyl‐related health consequences make cryptomarkets unlikely sources of user influence on the fentanyl supply. Market condition data indicate heroin supply shocks and shortages prior to the introduction of fentanyl in the United States and parts of Europe, but the much lower production cost of fentanyl compared with heroin may be a more significant factor Conclusion: Current evidence points to a supply‐led addition of fentanyl to the drug market in response to heroin supply shocks and shortages, changing prescription opioid availability and/or reduced costs and risks to suppliers. Current drug users in affected regions of the United States, Canada and Europe appear largely to lack both concrete knowledge of fentanyl's presence in the drugs they buy and access to fentanyl‐free alternatives. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To review systematically the published literature on extended‐release naltrexone (XR‐NTX, Vivitrol®), marketed as a once‐per‐month injection product to treat opioid use disorder. We addressed the following questions: (1) how successful is induction on XR‐NTX; (2) what are adherence rates to XR‐NTX; and (3) does XR‐NTX decrease opioid use? Factors associated with these outcomes as well as overdose rates were examined. Methods: We searched PubMed and used Google Scholar for forward citation searches of peer‐reviewed papers from January 2006 to June 2017. Studies that included individuals seeking treatment for opioid use disorder who were offered XR‐NTX were included. Results: We identified and included 34 studies. Pooled estimates showed that XR‐NTX induction success was lower in studies that included individuals that required opioid detoxification [62.6%, 95% confidence interval (CI) = 54.5–70.0%] compared with studies that included individuals already detoxified from opioids (85.0%, 95% CI = 78.0–90.1%); 44.2% (95% CI = 33.1–55.9%) of individuals took all scheduled injections of XR‐NTX, which were usually six or fewer. Adherence was higher in prospective investigational studies (i.e. studies conducted in a research context according to a study protocol) compared to retrospective studies of medical records taken from routine care (6‐month rates: 46.7%, 95% CI = 34.5–59.2% versus 10.5%, 95% CI = 4.6–22.4%, respectively). Compared with referral to treatment, XR‐NTX reduced opioid use in adults under criminal justice supervision and when administered to inmates before release. XR‐NTX reduced opioid use compared with placebo in Russian adults, but this effect was confounded by differential retention between study groups. XR‐NTX showed similar efficacy to buprenorphine when randomization occurred after detoxification, but was inferior to buprenorphine when randomization occurred prior to detoxification. Conclusions: Many individuals intending to start extended‐release naltrexone (XR‐NTX) do not and most who do start XR‐NTX discontinue treatment prematurely, two factors that limit its clinical utility significantly. XR‐NTX appears to decrease opioid use but there are few experimental demonstrations of this effect. [ABSTRACT FROM AUTHOR]

Background This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. Methods The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. Conclusions There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system [ABSTRACT FROM AUTHOR]

Background and aims Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. Design Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. Setting Publicly funded drug treatment facilities in California, USA (2006-10). Participants A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. Measurements Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. Findings Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). Conclusions In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment. [ABSTRACT FROM AUTHOR]

Aims This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). Methods Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. Findings SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. Conclusions The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This paper reviews the world anthropology of drugs and alcohol use literature, identifying key issues addressed by anthropologists, methods and theoretical models in use, trends in focus over time and future directions. Methods Papers and books that comprise the literature were identified through computer search using the keywords: ethnography of drug use (and variants, e.g. drug ethnography, qualitative approaches in drug research), ethnography of drinking, anthropology and drug use, and anthropology and drinking. Search engines included Google Scholar, EBSCOHost, AnthroSource and PubMed. Identified sources were read and integrated into the review. Results and Conclusions The literature search identified a rich and growing literature on the anthropology of drinking and drug use. The research and published literature on the anthropology of drug use has grown and diversified since the 1970s, found acceptance in the wider multi-disciplinary domain of alcohol and drug studies and developed beyond the socio-cultural model to include life-style, critical medical anthropology and experiential explanatory models. Anthropological research has helped to shape the field of addiction science, e.g. ethnographic studies show that the lived worlds and self-identities of drug users have cultural order and socially constructed purpose and meaning, and experiential research shows that some addictions or aspects of addictions can be affirmative, creative and sustainable, at least at the individual level. The human immunodeficiency virus/acquired immune deficiency syndrome pandemic has significantly increased anthropological research on drug-related issues world-wide. [ABSTRACT FROM AUTHOR]

Aims Regression to the mean (RTM) refers to the tendency for a group of cases that differ from the population mean to move (regress) towards the mean, on average, when re-assessed, if scores at the two points are less than perfectly correlated. This paper considers factors that affect the magnitude of RTM and how RTM may impact findings from primary studies and reviews of substance use disorder (SUD) treatment. Design and methods The paper is guided largely by A Primer on Regression Artifacts by Campbell and Kenny. It reviews potential RTM effects in three areas of SUD treatment research. One is the extent to which within-group improvement in comparative treatment trials, including ‘placebo effects’, is a function of RTM. The second is the vulnerability of treatment evaluations employing non-equivalent control group designs to RTM and biased estimates of treatment effects when matching, or statistical equating is used to adjust for pre-existing group differences. The final issue is the impact of RTM in syntheses of research findings on SUD treatments. In particular, the tendency for later studies of a particular intervention to have smaller treatment effect sizes relative to earlier studies is considered as an RTM phenomenon. Findings RTM is a pervasive, but often unrecognized phenomenon that can bias findings in SUD treatment studies and in systematic reviews of that research. Conclusion SUD treatment researchers should be aware of RTM, take any available steps to reduce it, and try to diagnose whether it is still affecting research findings. [ABSTRACT FROM AUTHOR]

An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders.A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence.The paper places the topic in the context of adherence difficulties among patients with a variety of chronic medical and psychiatric illnesses. Difficulties measuring adherence are discussed, and strategies to improve medication adherence are reviewed. These include specific interventions that prescribing clinicians can implement in their individual meetings with patients; the use of external reinforcers, such as positive and negative contingencies, and involvement of family members or significant others; and specific prescribing and dosing practices that may improve adherence.As the use of pharmacotherapy for substance-dependent patients increases, rigorous and innovative approaches to encourage medication adherence should be sought. [ABSTRACT FROM AUTHOR]

This paper traces the modern history of alcohol and drug policy research through a series of four monographs that were written collaboratively by international groups of career scientists. The books promoted the view, supported by a considerable amount of evidence, that alcohol and drug problems can be reduced, if not prevented, through organized policy action by governments and public health organizations. The books used a problem-focused integrative approach to align research more effectively with public policy. A common thread that runs throughout the monographs is the influence of Professor Griffith Edwards. [ABSTRACT FROM AUTHOR]

Aims This paper aims to identify possible system-level factors contributing to the marked differences in the levels of non-medical prescription opioid use ( NMPOU) and prescription opioid ( PO)-related harms in North America (i.e. the United States and Canada) compared to other global regions. Methods Scientific literature and information related to relevant areas of health systems, policy and practice were reviewed and integrated. Results We identified several but different factors contributing to the observed differences. First, North American health-care systems consume substantially more Pos-even when compared to other high-income countries-than any other global region, with dispensing levels associated strongly with levels of NMPOU and PO-related harms. Secondly, North American health-care systems, compared to other systems, appear to have lesser regulatory access restrictions for, and rely more upon, community-based dispensing mechanisms of POs, facilitating higher dissemination level and availability (e.g. through diversion) of POs implicated in NMPOU and harms. Thirdly, we note that the generally high levels of psychotrophic drug use, dynamics of medical-professional culture (including patient expectations for 'effective treatment'), as well as the more pronounced 'for-profit' orientation of key elements of health care (including pharmaceutical advertising), may have boosted the PO-related problems observed in North America. Conclusions Differences in the organization of health systems, prescription practices, dispensing and medical cultures and patient expectations appear to contribute to the observed inter-regional differences in non-medical prescription opioid use and prescription opioid-related harms, although consistent evidence and causal analyses are limited. Further comparative examination of these and other potential drivers is needed, and also for evidence-based intervention and policy development. [ABSTRACT FROM AUTHOR]

Aims Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. Methods A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. Results Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio ( OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval ( CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. Conclusions There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies. [ABSTRACT FROM AUTHOR]

Aims This paper reviews the published literature regarding outcomes following maternal treatment with buprenorphine in five areas: maternal efficacy, fetal effects, neonatal effects, effects on breast milk and longer-term developmental effects. Methods Within each outcome area, findings are summarized first for the three randomized clinical trials and then for the 44 non-randomized studies (i.e. prospective studies, case reports and series and retrospective chart reviews), only 28 of which involve independent samples. Results Results indicate that maternal treatment with buprenorphine has comparable efficacy to methadone, although difficulties may exist with current buprenorphine induction methods. The available fetal data suggest buprenorphine results in less physiological suppression of fetal heart rate and movements than methadone. Regarding neonatal effects, perhaps the single definitive conclusion is that prenatal buprenorphine treatment results in a clinically significant less severe neonatal abstinence syndrome ( NAS) than treatment with methadone. The limited research suggests that, like methadone, buprenorphine is compatible with breastfeeding. Data available thus far suggest that there are no deleterious effects of in utero buprenorphine exposure on infant development. Conclusions While buprenorphine produces a less severe neonatal abstinence syndrome than methadone, both methadone and buprenorphine are important parts of a complete comprehensive treatment approach for opioid-dependent pregnant women. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This paper queries the notion that young people overestimate peer substance use, asking whether there is robust evidence that such misperceptions are widespread and whether the phenomenon may have been exaggerated in the research literature. Method An examination of the research literature was conducted, focusing mainly on studies published since 2000. Some analyses of relevant data on cannabis use from a Norwegian youth survey were also undertaken. Results The research in question is characterized by many weaknesses, including low response rates and widespread use of convenience samples, as well as the presence of contextual factors and the use of assessment tools that may have created a bias in favour of 'demonstrating' that youth overestimate peer drinking or drug use. Moreover, in some cases, the apparent tendency to hold such misbeliefs may reflect the reality. Further, although most studies conclude that the modal tendency is to overestimate, high levels of underestimation of peer substance use have been reported. There is also suggestive evidence that many youth may have no pre-existing beliefs when responding to items on the issue. Results from the Norwegian youth survey added to this picture. Conclusion Young people's tendency to overestimate peer drinking and drug use has been exaggerated, while the uncertainty surrounding the evidence in question has been understated. [ABSTRACT FROM AUTHOR]

ABSTRACT The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. The unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population. [ABSTRACT FROM AUTHOR]

Aim To provide a clinician's perspective on the problem of diversion of prescribed pharmaceuticals. Methods The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986–2006, Australia 1996–2008 and the United States and France from the mid-1990s. Results Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long-term opioid prescribing. All long-term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements—including dilution of methadone take-aways, supervision of administration for high-risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines. Conclusion Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels. [ABSTRACT FROM AUTHOR]

Aims The current study examined developmental changes in substance use behaviors (SUBS) based upon sexual orientation. The analyses also attempted to address a number of methodological limitations in the extant longitudinal literature (i.e. distinct operationalizations of sexual orientation, timing of sexual orientation assessment with respect to reports of SUBs, non-linear growth). Participants Data were drawn from a longitudinal study of incoming first-time college students at a large public university ( n = 3720). Design After a paper-and-pencil assessment just prior to matriculation, participants completed a web-based survey every fall and spring for 4 years (sub-sample n = 2854). Findings Latent growth models revealed that sexual minorities demonstrated significant heterogeneity with regard to substance use trajectories. Initial levels and trajectories of the frequency of substance use for sexual minority individuals were distinct, generally, from their exclusively heterosexual peers. Methodologically, the timing of the assessment of sexual orientation influenced the results, and modeling non-linear components indicated that sexual minorities are at risk for exponential increases in their frequency of certain SUBs over time (i.e. drunkenness; cannabis use). Conclusions Sexual minority and majority individuals exhibited differences in SUBs during emerging adulthood, especially when using self-identification to define sexual orientation. Individuals who endorsed a sexual minority self-identification at the onset of emerging adulthood, as opposed to 4 years later, evidenced exponential increases in rates of drunkenness and cannabis use. These results support that the timing of assessment is important and that some trajectories of sexual minority SUBs are non-linear during this developmental period. [ABSTRACT FROM AUTHOR]

Aims Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. Methods Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. Results LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. Conclusions The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown. [ABSTRACT FROM AUTHOR]

Background Δ9-Tetrahydrocannabinol (THC) is the major psychoactive constituent of cannabis and its various preparations. Increasing use of cannabis for recreational purposes has created a problem for road-traffic safety. This paper compares age, gender and the concentrations of THC in blood of individuals apprehended for driving under the influence of drugs (DUID) in Sweden, where a zero-tolerance law operates. Measurements Specimens of blood or urine were subjected to a broad screening analysis by enzyme immunoassay methods. THC positives were verified by analysis of blood by gas chromatography-mass spectrometry (GC-MS) with a deuterium-labelled internal standard (d3-THC). All toxicology results were entered into a database (TOXBASE) along with the age and gender of apprehended drivers. Findings Over a 10-year period (1995–2004), between 18% and 30% of all DUID suspects had measurable amounts of THC in their blood (> 0.3 ng/ml) either alone or together with other drugs. The mean age [± standard deviation (SD)] of cannabis users was 33 ± 9.4 years (range 15–66 years), with a strong predominance of men (94%, P < 0.001). The frequency distribution of THC concentrations ( n = 8794) was skewed markedly to the right with mean, median and highest values of 2.1 ng/ml, 1.0 ng/ml and 67 ng/ml, respectively. The THC concentration was less than 1.0 ng/ml in 43% of cases and below 2.0 ng/ml in 61% of cases. The age of offenders was not correlated with the concentration of THC in blood ( r = −0.027, P > 0.05). THC concentrations in blood were higher when this was the only psychoactive substance present ( n = 1276); mean 3.6 ng/ml, median 2.0 ng/ml compared with multi-drug users; mean 1.8 ng/ml, median 1.0 ng/ml ( P < 0.001). In cases with THC as the only drug present the concentration was less than 1.0 ng/ml in 26% and below 2.0 ng/ml in 41% of cases. The high prevalence of men, the average age and the concentrations of THC in blood were similar in users of illicit drugs (non-traffic cases). Conclusions The concentration of THC in blood at the time of driving is probably a great deal higher than at the time of sampling (30–90 minutes later). The notion of enacting science-based concentration limits of THC in blood (e.g. 3–5 ng/ml), as discussed in some quarters, would result in many individuals evading prosecution. Zero-tolerance or limit of quantitation laws are a much more pragmatic way to enforce DUID legislation. [ABSTRACT FROM AUTHOR]

Aims The publication of the Journal of Inebriety (1876–1914) chronicled the rise and fall of the first era of organized addiction medicine in the United States. Methods Findings from historical research, a content analysis of the Journal's 35 volumes and 141 issues and images from the Journal illustrate visually the medical treatment of addiction in the United States in the late 19th and early 20th centuries. Results Under the editorial direction of Dr T. D. Crothers, the Journal of Inebriety published papers and reviews focused primarily on the medical treatment of alcohol and opiate addiction within a growing international network of inebriate homes and asylums. Conclusions The history of the Journal of Inebriety mirrors efforts in America to forge a legitimized field of addiction medicine amid conflicting conceptualizations of the nature of severe alcohol and other drug problems. [ABSTRACT FROM AUTHOR]

Prescribing nicotine replacement therapy (NRT) or bupropion for smoking cessation is of considerable importance to public health but little is known about prescribing practices. This paper examines general practitioners’ (GPs’) prescribing patterns in Britain where these drugs are reimbursed. The results have implications for other health-care systems considering introducing reimbursement.Postal survey conducted in 2002 of a random sample of 1088 GPs in England and Wales, of whom 642 (59%) responded.Number of requests GPs reported having received from patients for NRT and bupropion over the past month, the number of prescriptions they reported issuing and ratings of attitudes to these medications.GPs reported receiving an average of 4.3 requests for NRT and 1.9 for bupropion in the previous month. They reported issuing 3.5 prescriptions for NRT and 1.2 for bupropion. Almost all GPs accepted that NRT (95%) and bupropion (97%) should be reimbursable on National Health Service (NHS) prescription. However, a significant minority of those who received requests for prescriptions did not issue any (8% for NRT and 26% for bupropion). This was related to whether they thought these products should be available on NHS prescription for both NRT and bupropion (OR = 0.66,P < 0.05), which in turn was related to beliefs about whether smokers should have to pay for treatment themselves, the cost-effectiveness of NRT/bupropion and the low priority they would give NRT/bupropion in the drug budget. For bupropion, concern about side-effects independently predicted not prescribing[odds ratio (OR) = 1.46,P < 0.03].In the British health-care system, which has a well-established system for technology assessment and professionally endorsed guidelines, a significant minority of GPs decline all patient requests for stop-smoking medicines. [ABSTRACT FROM AUTHOR]

Objectives This paper will present the most recent estimates for problematic drug use in European Member States and explore the problems of comparability. Methods Estimates of problematic drug use, derived according to agreed guidelines, were collected from all EU countries and Norway. Methods included multipliers based on treatment, police, mortality or AIDS/HIV data, the capture-recapture method and the multivariate indicator method. Prevalence estimates were transformed into rates per 1000 population aged 15-64 years. Results Target populations varied according to data selection. Estimates for six partially overlapping types of drug use could be identified: 'problem opiate use', 'problem opiate or cocaine use', 'problem amphetamine or opiate use', 'problem drug use', '(current) injecting' and 'life-time injecting'. Rates of injectors ranged from 2.6 in Germany to 4.8 in Luxembourg; rates in Austria, Denmark, Finland, Portugal and the United Kingdom fell within this range. For problem opiate use, a group of high prevalence countries were found with average rates exceeding six cases (Italy, Luxembourg, Spain and the United Kingdom) and a group with lower prevalence with average rates close to three cases (Austria, Germany, Ireland, the Netherlands). Rates obtained for France (problem opiate or cocaine use), Finland and Sweden (problem amphetamine or opiate use) are not directly comparable and fall between these rates. Conclusions Cross-national comparisons should be made with care and estimated target populations may vary greatly between countries. For estimating various forms of problem drug use at national level, a multi-method approach is recommended. [ABSTRACT FROM AUTHOR]

Aims This paper examines ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students, with a particular focus on girls. Design The study uses cross-sectional data from large, ethnically diverse, nationally representative samples of 8th, 10th and 12th grade girls. Setting Data were collected through questionnaires administered in schools. Participants A total of 40416 8th grade girls and 37977 8th grade boys, 35451 10th grade girls and 33188 10th grade boys, and 33588 12th grade girls and 31014 12th grade boys took part in the study. Findings Across ethnic groups, drug use is highest among Native American girls and lowest among black and Asian American girls. Trend data suggest that there have been important changes in girls' drug use over time and that girls' and boys' drug use patterns are converging. Conclusions Drug use is widespread among American adolescent girls. Future research should examine further girls' drug use and seek to identify whether risk and protective factors identified in past research based on predominantly white samples, are also important predictors for drug use among non-white girls. [ABSTRACT FROM AUTHOR]

The article offer news briefs related to medicine and science. The growth of the death rate from liver cirrhosis in Great Britain is most evident in Western Europe. The British system for drugs classification is reviewed and detailed in a consultation paper. A new web site database is formulated to provide researchers with complex research information on cannabis, ecstasy and cocaine. A list of medical conferences is enumerated.

In this article the author discusses his insights on the paper by psychiatrist Doug Sellman on the facts about addiction. He states several facts expressed by Sellman at his paper that he fully agrees including the neuropsychological processes, addiction trends, and treatment alliance relevance. Furthermore, he questions the possibility of creating a list of things known about addiction by Sellman.

The author comments on the paper published by Shaw and others about the association of homicide to alcohol, drugs and psychiatric disorders in this issue of the periodical. She commends the paper for obtaining useful data and suggests ways for its presentation for easier interpretation. According to the author, the study is in line with other results showing that alcohol and drug perpetrators came from marginalized section of society and understanding the circumstances for which alcohol- and drug-related homicides occur by using a situational crime prevention approach may be the key for effective prevention.

The article presents a commentary on a research paper that examined the effect of prescription drug misuse. The article sought to demonstrate that strong universal drug prevention programs would also be effective in preventing uptake of these drugs. The author states that the researchers made a strong case for the increasing amount of prescription drug abuse and its harmful effects. The author states that the basis for the research is flawed and not very useful for selecting successful prevention interventions.

The paper by Blows and colleagues on the effects of marijuana use on car crash injury and death risks provides a good illustration of the value of the case-control design in risk factor research. Although there is often advocacy for prospective or longitudinal studies of risk, the case-control design has a number of clear advantages in studying risk factors involved in rare but severe outcomes. Their findings add to a growing literature that is beginning to explore the extent to which the use of cannabis has adverse consequences on driver behaviors. Their results show that while the habitual use of cannabis is associated with clear increases in the risk of death or injury from car crashes, the association with acute exposure was non-significant. Of course, these findings are subject to the usual methodological caveats relating to the use of self report and possible failure to control confounding. With regard to the analysis of acute effects, there is also a possibility that the association was ‘over-controlled’ as a result of the authors’ controlling factors such as sleepiness and seat belt usage that may have been a consequence of cannabis use. If these factors are not included in the regression adjustment, the results suggest an odds ratio of 3.9 for acute exposure.