Category: Substance Use

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Substantially Higher Risk of Heart Attack in Cannabis Users

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Marijuana is now legal in many places, but is it safe? Two new studies add to mounting evidence that people who use cannabis are more likely to suffer a heart attack than people who do not use the drug, even among younger and otherwise healthy adults. The findings are from a retrospective study of over 4.6 million people published in JACC Advances and a meta-analysis of 12 previously published studies being presented at the American College of Cardiology’s Annual Scientific Session.

Marijuana use has risen in the United States, especially in states where it is legal to buy, sell and use the drug recreationally. In the retrospective study, researchers found that cannabis users younger than age 50 were over six times as likely to suffer a heart attack compared to non-users. The meta-analysis, which is the largest pooled study to date examining heart attacks and cannabis use, showed a 50% increased risk among those who used the drug.

“Asking about cannabis use should be part of clinicians’ workup to understand patients’ overall cardiovascular risk, similar to asking about smoking cigarettes,” said Ibrahim Kamel, MD, clinical instructor at the Boston University Chobanian & Avedisian School of Medicine and internal medicine resident at St. Elizabeth Medical Center in Boston and the study’s lead author. “At a policy level, a fair warning should be made so that the people who are consuming cannabis know that there are risks.”

Kamel and his team conducted the retrospective study using data from TriNetX, a global health research network that provides access to electronic medical records. Their findings indicate that over an average follow-up of over three years, cannabis users had more than a sixfold increased risk of heart attack, fourfold increased risk of ischaemic stroke, twofold increased risk of heart failure and threefold increased risk of cardiovascular death, heart attack or stroke. All study participants were younger than age 50 and free of significant cardiovascular comorbidities at baseline, with blood pressure and low-density lipoprotein (LDL) cholesterol levels within a healthy range and no diabetes, tobacco use or prior coronary artery disease.

For the meta-analysis, the researchers pooled data from 12 previously published research studies that collectively included over 75 million people. The studies were rated as being of moderate to good quality in terms of methodology. Of the 12 studies, 10 were conducted in the United States, one in Canada and one in India. Some of the studies did not include information about participants’ ages, but the average age was 41 years among those that did, suggesting that the pooled sample reflected a relatively young population.

Taken individually, seven of the studies found a significant positive association between cannabis use and heart attack incidence, while four showed no significant difference and one showed a slightly negative association. When the researchers pooled the data from all studies and analysed it together, they found a significant positive association, with active cannabis users being 1.5 times as likely to suffer a heart attack compared with those who aren’t current users.

Cannabis use and heart attack incidence was assessed in a similar manner across the different studies. However, due to inconsistencies in the data available from each study, researchers were unable to account for several potential confounding factors including the duration and amount of cannabis use or the use of tobacco or other drugs. 

“We should have some caution in interpreting the findings in that cannabis consumption is usually associated with other substances such as cocaine or other illicit drugs that are not accounted for,” Kamel said. “Patients should be forthcoming with their doctors and remember that we are their number one advocate and having the full story matters.”

While the mechanisms through which marijuana or its components may impact the cardiovascular system are not fully understood, the researchers hypothesize that it can affect heart rhythm regulation, heighten oxygen demand in the heart muscle and contribute to endothelial dysfunction, which makes it harder for the blood vessels to relax and expand, and can interrupt blood flow. One of the studies included in the meta-analysis found that the risk of heart attack peaked about one hour after marijuana consumption.

Since both studies were limited by their retrospective nature and the meta-analysis was limited by the challenges inherent in pooling data from multiple studies, researchers said that additional prospective studies would help to confirm the findings and determine which groups may face the highest risk. 

A previous study presented at the American College of Cardiology’s Annual Scientific Session in 2023 found that daily marijuana use was associated with an increased risk of developing coronary artery disease. 

The retrospective analysis will simultaneously publish in JACC Advances.

Source: American College of Cardiology

Categories : Neurology Substance UseTags :

Scientists Discover that GLP-1 is Involved in Cocaine Addiction

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Cocaine use disorder casts a long shadow, trapping individuals in a cycle of dependence and leaving limited options for effective treatment. A new study in Science Advances delves deep into the brain, offering crucial insights into the underlying mechanisms of this complex disorder. By understanding how this intricate circuitry functions, scientists can pave the way for the development of more effective therapies, offering new hope to those struggling with this debilitating disorder.

At the heart of this discovery lies the role of glucagon-like peptide-1 (GLP-1), a hormone known for its involvement in regulating food intake and blood sugar. The study reveals that chronic cocaine use is associated with reduced GLP-1 levels, effects that suggest that increasing central GLP-1 signalling could reduce cocaine seeking.

Further investigation pinpointed a specific brain circuit: GLP-1-producing neurons in the nucleus tractus solitarius (NTS) that project to the ventral tegmental area (VTA), a key brain region involved in reward and motivation. By manipulating this circuit, researchers were able to significantly reduce cocaine-seeking behavior in animal models.

The study also sheds light on the specific cells involved. GLP-1 receptors were found to be primarily located on GABA neurons within the VTA. GABA, an inhibitory neurotransmitter, plays a crucial role in regulating brain activity. Importantly, activating these GLP-1 receptors increases the activity of GABA neurons, which in turn reduces the activity of dopamine neurons, a key neurotransmitter involved in reward and addiction.

“This research provides exciting new insights into the brain mechanisms underlying cocaine seeking,” said Schmidt, the Killebrew-Censits Chair of Undergraduate Education and a Professor of Neuroscience and Pharmacology in the Department of Biobehavioral Health Sciences. “By understanding how GLP-1 signaling influences brain activity in this context, we can potentially develop new GLP-1-based treatments to treat cocaine use disorder.”

This research opens a new chapter in the fight against cocaine use disorder. The findings offer a promising avenue for developing innovative therapies that target this critical brain circuit, potentially offering a lifeline to individuals struggling to break free from the grip of this devastating disorder.

Source: University of Pennsylvania School of Nursing

Categories : Pain Management Substance UseTags :

Co-prescribed Stimulants and Opioids Linked to Higher Opioid Doses

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Photo from Pixabay CCO

The combination of prescribed central nervous system stimulants, such as drugs that relieve ADHD symptoms, with prescribed opioid medications is associated with a pattern of escalating opioid intake, a new study has found. 

The analysis of health insurance claims data from almost 3 million US patients investigated prescribed stimulants’ impact on prescription opioid use over 10 years, looking for origins of the so-called “twin epidemic” of combining the two classes of drugs, which can increase the risk for overdose deaths. 

“Combining the two drugs is associated with an increase in overdose deaths. This is something we know. But we didn’t know whether stimulant use has a causal role in high use of opioids, so we conducted a big data analysis of how these two patterns interacted over a long period of time,” said senior study author Ping Zhang, associate professor of computer science and engineering and biomedical informatics at The Ohio State University.

“What we found is that if someone is taking a stimulant and an opioid at the same time, they’re generally taking a high dose of the opioid,” he said. “And if the patient in this study population takes the stimulant before beginning opioid use, they are more likely to have higher doses of subsequent opioids.” 

The study was published in The Lancet Regional Health – Americas.     

The research team obtained data on 22 million patients with 96 million opioid prescriptions from a large US health insurance database. Researchers established a cohort for this study of 2.9 million patients with an average age of 44 who had at least two independent opioid prescriptions between 2012 and 2021. 

Because these prescriptions included a range of oral formulas – codeine, hydrocodone, methadone, oxycodone, morphine and others – researchers standardised every prescription to morphine milligram equivalents (MME) and calculated each patient’s monthly intake of opioids.

First author Seungyeon Lee, a PhD student in Zhang’s lab, used statistical modelling and classified patients into five baseline groups of opioid dosage trajectory over the 10-year study period: very low-dose, low-dose decreasing, low-dose increasing, moderate-dose increasing and high-dose sustained use. 

“Some patients had stable low-dose opioid use, while others had increasing or high dose patterns over time,” Lee said. 

Of the total cohort, 160 243 patients (5.5%) also were prescribed stimulants. The addition of a monthly calculated cumulative number of stimulant prescriptions to the model and statistical analysis showed a shift in the trajectory groups. Characteristics that could serve as risk factors for increasing opioid use also emerged in the data, Lee said. 

Moderate-dose increasing and high-dose groups had an overall higher average MME and a higher proportion of patients with diagnoses of depression, anxiety and attention-deficit/hyperactivity disorder compared to other groups. The low-dose increasing group also had a higher proportion of patients with ADHD compared to the low-dose decreasing group. 

The most common diagnoses linked to co-prescription of stimulants and opioids were depression and ADHD or ADHD and chronic pain. 

“This was an important finding, that many patients with ADHD and depression, also experiencing chronic pain, have an opioid prescription,” said Zhang. “This cohort represents a very realistic health care problem.” 

Even taking those factors into account, the model showed that stimulant use was key to driving up the odds that patients who took both stimulants and opioids would belong to a group of people who increased their doses of opioids. 

“Stimulant use before initiating opioids and stimulant co-prescription with opioids are both positively associated with escalating opioid doses compared to other factors,” Lee said. 

Analysis of geographic and gender data also offered some clues to opioid use patterns in the United States. Patients in the South and West regions had higher total opioid intakes over the 10-year study period compared to the Northeast and North Central regions, with the highest frequency of opioid prescriptions in the South and higher MMEs per prescription in the West. Males also had higher average daily opioid intakes than females. 

The results linking high opioid doses and stimulant use suggest stimulants may be a driving force behind the emergence of the twin epidemic and offer evidence that regulation of stimulant prescribing may be needed for patients already taking prescription opioids, the researchers said. In addition to the increased risk of overdose death, co-using prescription stimulants and opioids can increase the risk for cardiovascular events and mental health problems, previous research has shown. 

Source: Ohio State University

Categories : Substance Use UncategorizedTags :

What is the Drug Captagon and How is it Linked to Syria’s Fallen Assad Regime?

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Photo by James Coleman on Unsplash

Nicole Lee, Curtin University

After the fall of the al-Assad regime in Syria, large stockpiles of the illicit drug captagon have reportedly been uncovered.

The stockpiles, found by Syrian rebels, are believed to be linked to al-Assad military headquarters, implicating the fallen regime in the drug’s manufacture and distribution.

But as we’ll see, captagon was once a pharmaceutical drug, similar to some of the legally available stimulants we still use today for conditions including attention-deficit hyperactivity disorder (ADHD).

Captagon was once a pharmaceutical

Captagon is the original brand name of an old synthetic pharmaceutical stimulant originally made in Germany in the 1960s. It was an alternative to amphetamine and methamphetamine, which were both used as medicines at the time.

The drug has the active ingredient fenethylline and was initially marketed for conditions including ADHD and the sleeping disorder narcolepsy. It had a similar use to some of the legally available stimulants we still use today, such as dexamphetamine.

Captagon has similar effects to amphetamines. It increases dopamine in the brain, leading to feelings of wellbeing, pleasure and euphoria. It also improves focus, concentration and stamina. But it has a lot of unwanted side effects, such as low-level psychosis.

The drug was originally sold mostly in the Middle East and parts of Europe. It was available over the counter (without a prescription) in Europe for a short time before it became prescription-only.

It was approved only briefly in the United States before becoming a controlled substance in the 1980s, but was still legal for the treatment of narcolepsy in many European countries until relatively recently.

According to the International Narcotics Control Board pharmaceutical manufacture of Captagon had stopped by 2009.

The illicit trade took over

The illegally manufactured version is usually referred to as captagon (with a small c). It is sometimes called “chemical courage” because it is thought to be used by soldiers in war-torn areas of the Middle East to help give them focus and energy.

For instance, it’s been reportedly found on the bodies of Hamas soldiers during the conflict with Israel.

Its manufacture is relatively straightforward and inexpensive, making it an obvious target for the black-market drug trade.

Black-market captagon is now nearly exclusively manufactured in Syria and surrounding countries such as Lebanon. It’s mostly used in the Middle East, including recreationally in some Gulf states.

It is one of the most commonly used illicit drugs in Syria.

A recent report suggests captagon generated more than US$7.3 billion in Syria and Lebanon between 2020 and 2022 (about $2.4 billion a year).

What we know about illicit drugs generally is that any seizures or crackdowns on manufacturing or sale have a very limited impact on the drug market because another manufacturer or distributor pops up to meet demand.

So in all likelihood, given the size of the captagon market in the Middle East, these latest drug discoveries and seizures are likely to reduce manufacture only for a short time.

Nicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Neurology Substance UseTags :

Cannabis Disrupts Brain Activity in Young Adults Prone to Psychosis

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Young adults at risk of psychosis show reduced brain connectivity, a deficit that cannabis use appears to worsen, a new study has found. The breakthrough paves the way for psychosis treatments targeting symptoms that current medications miss. In the first-of-its-kind study, McGill University researchers detected a marked decrease in synaptic density in individuals at risk of psychosis, compared to a healthy control group.

“Not every cannabis user will develop psychosis, but for some, the risks are high. Our research helps clarify why,” said Dr Romina Mizrahi, senior author of the study and professor in McGill’s Department of Psychiatry.

“Cannabis appears to disrupt the brain’s natural process of refining and pruning synapses, which is essential for healthy brain development.”

Hope for new treatments

Using advanced brain scanning technology, the team studied 49 participants aged 16 to 30, including individuals with recent psychotic symptoms and those considered at high risk. The results, published in JAMA Psychiatry, indicate that lower synaptic density is linked to social withdrawal and lack of motivation, symptoms the researchers say are difficult to treat.

“Current medications largely target hallucinations, but they don’t address symptoms that make it difficult to manage social relationships, work, or school,” said first author Belen Blasco, a PhD student at McGill’s Integrated Program in Neuroscience. “By focusing on synaptic density, we may eventually develop therapies that enhance social function and quality of life for those affected.”

While cannabis is a known risk factor for developing psychosis, which can progress to schizophrenia, this is the first time researchers have measured structural changes in the brains of a high-risk population in real time.

The team’s next research phase will explore whether these observed brain changes could predict psychosis development, potentially enabling earlier intervention.

Source: McGill University

Categories : Substance UseTags :

Long Ring Fingers are Associated with a Preference for Alcohol

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People’s finger lengths may hold a vital clue to their drinking habits, a new study suggests. There is evidence that alcohol consumption is influenced by prenatal sex steroids – so experts from Swansea University and colleagues from the Medical University of Lodz decided to use a sample of students for their research into the subject.

Their findings, published in the American Journal of Human Biology, revealed relationships between high alcohol consumption and long 4th  digits (ring fingers) relative to 2nd  digits (index fingers). This showed that high prenatal testosterone relative to oestrogen is linked to high student alcohol consumption.

Professor John Manning said: “Alcohol consumption is a major social and economic problem. Therefore, it is important to understand why alcohol use shows considerable differences across individuals.”

The study used a sample of 258 participants – 169 of them female  –  and it revealed consumption rates varied between the sexes. In comparison to women, men show higher alcohol consumption and higher mortality from alcohol abuse.

He said: “A pattern like this suggests an involvement of sex hormones, such as testosterone and oestrogen. Digit ratio (2D:4D: the relative lengths of the 2nd and 4th fingers) is thought to be an index of early testosterone (long 4th digit) and oestrogen (long 2nd digit).

“It is known that alcohol-dependent patients have very long 4th digits relative to their 2nd digits, suggesting high testosterone relative to oestrogen exposure before birth. As expected, the associations were stronger for men than women.”

Now the researchers hope their conclusions will bring a better understanding of the factors underlying the pattern of alcohol consumption, from abstinence to occasional use to harmful dependence. 

This is the latest paper which has highlighted Professor Manning’s work in the field of digit ratios. Previous research  has examined how digit ratio may provide vital information concerning outcomes after contracting Covid-19, as well as oxygen consumption in footballers.

Source: University of Swansea

Categories : Substance UseTags :

GLP-1 RAs may be Useful Aid for Reducing Alcohol Intake

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New research, led by experts at the University of Nottingham, has found that a certain class of diabetes medication may be effective in reducing alcohol use. The study, which is published in eClinicalMedicine, looked at whether GLP-1 receptor agonists (GLP-1 RAs), could also be used to help people cut down on drinking.

The study was led by Dr Mohsen Subhani, Clinical Assistant Professor of Gastroenterology at the NIHR Nottingham Biomedical Research Centre, in the School of Medicine, at the University of Nottingham. It was funded by the National Institute for Health and Care Research (NIHR) and the NIHR Nottingham Biomedical Research Centre.

In the new study, researchers evaluated existing literature on GLP-1 RAs use and the change in alcohol consumption.

They gathered studies up to August 2024 that examined whether GLP-1 RAs affect alcohol use, alcohol-related health problems, hospital visits, and brain reactions to alcohol cues. The team evaluated six articles, including two randomised control trials made up of 88,190 participants, of these 38,740 (43.9%) of participants received GLP-1RA.

Our findings show that this type of diabetes medication shows promise in reducing alcohol consumption, potentially by targeting the brain’s reward centre, especially in people with a BMI over 30.”Dr Mohsen Subhani, Clinical Assistant Professor of Gastroenterology at the NIHR Nottingham Biomedical Research Centre, in the School of Medicine

The key findings:

  • In one main study, the medication exenatide did not significantly reduce drinking overall after six months, but people with obesity showed some positive results.
  • Another study found that people taking the drug dulaglutide were 29% more likely to reduce drinking than those on a placebo.
  • Observational studies (non-randomised) showed fewer alcohol-related health problems and lower alcohol use in people taking GLP-1 RAs compared to other treatments.

“Whilst further research is needed, our findings suggest this could be a potential treatment option in the future for excessive alcohol use and subsequently could lead to a reduction in alcohol-related deaths,” adds Dr Subhani.

Source: University of Nottingham

Categories : Substance UseTags :

Objective Study Shows that Cannabinol does in Fact Increase Sleep

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Research by scientists at the University of Sydney has identified cannabinol (CBN), a constituent in the cannabis plant that improves sleep. Their report is the first to use objective measures to show that (CBN), while not intoxicating, does increase sleep in rats. The study, which has been published in the leading journal Neuropsychopharmacology, found that CBN was comparable in efficacy to zolpidem.

“For decades, cannabis folklore has suggested that aged cannabis makes consumers sleepy via the build-up of CBN, however there was no convincing evidence for this,” said lead author Professor Jonathon Arnold, Director of Preclinical Research, at the Lambert Initiative for Cannabinoid Therapeutics and the Sydney Pharmacy School.

“Our study provides the first objective evidence that CBN increases sleep, at least in rats, by modifying the architecture of sleep in a beneficial way.”

CBN is an end-product of the main intoxicating constituent of cannabis, delta9-tetrahydrocannabinol (THC). THC in cannabis is slowly converted to CBN over time, which means older cannabis contains higher levels of this compound. It has been suggested that the consumption of older cannabis is associated with a sleepier cannabis “high”. 

In the United States, highly purified CBN products are being sold as sleep aids, but there has been little high-quality scientific evidence to support this application.

The research team at the Lambert Initiative for Cannabinoid Therapeutics tested the effects of purified CBN on sleep in rats. Using high-tech monitoring, the experiments provided insights into the rats’ sleep patterns including the amount of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. 

NREM is deep sleep that promotes physical recovery and strengthens memories, while REM sleep is associated with dreaming and processing of emotions. 

Professor Arnold said: “CBN was found to increase both NREM and REM sleep, leading to increased total sleep time, with a comparable effect to the known sleep drug zolpidem.”

Non-intoxicating

Unlike its parent molecule THC, CBN did not appear to intoxicate rats. THC intoxicates by activating CB1 cannabinoid receptors, which are present in the brain. The study showed that unlike THC, CBN only weakly activates these receptors. To their surprise, the researchers found that a metabolite of CBN had significant effects on cannabinoid CB1 receptors. 

A metabolite is a chemical produced via the metabolism of a larger molecule in the body.

They also found that the 11-OH CBN metabolite had some impact on sleep architecture, which might contribute to the overall effects of CBN on sleep.

“This provides the first evidence that CBN indeed increases sleep using objective sleep measures. It was a surprise that CBN metabolism in the body can yield a much greater effect on cannabinoid CB1 receptors than the parent molecule CBN, which has much more limited activity,” Professor Arnold said.

“At this stage our results are confined to testing in rats. Further research is needed to see if this translates to humans.”  

Further study

In a parallel study, yet to be published, Professor Iain McGregor, Director of Clinical Research at the Lambert Initiative, initiated a placebo-controlled randomised human clinical trial in insomnia patients. This was led by PhD student Isobel Lavender with leading sleep researcher Dr Camilla Hoyos from the Woolcock Institute of Medical Research. The trial has now been completed with very promising results that were recently announced at the International Cannabinoid Research Society and Sleep DownUnder scientific conferences.

“Our research encourages further basic and clinical research on CBN as a new treatment strategy for sleep disorders, including insomnia. Our clinical study only administered CBN on a single occasion. A trial on a larger scale, that includes repeated dosing, is the logical next step,” Professor McGregor said.

Professor Arnold said: “The team has now commenced a preclinical drug discovery program around CBN, as well as observing whether the pro-sleep effects of CBN can be further amplified by other molecules found in cannabis, or by conventional sleep aids, such as melatonin.”

Source: University of Sydney

Categories : HIV Substance UseTags :

Alarming Rise in HIV among Drug Users as Government Fails to Implement Policy

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Needle programs are officially supported, but the state often obstructs them

Photo by Raghavendra V Konkathi on Unsplash

By Jesse Copelyn

Rates of HIV and Hepatitis C are “extremely high” among people who inject illicit drugs, according to new research by TB HIV Care. The organisation tested over 1200 injecting drug users in Tshwane, eThekwini, Mashishing and Mbombela (formerly Nelspruit).

In Tshwane 72% tested positive for HIV and nearly 90% had antibodies for hepatitis C virus (HCV), which could indicate past or present infection.

HCV is a blood-borne virus which damages the liver. When left undiagnosed it can be fatal, though it’s usually curable if treated.

Less than half of those who tested positive for HIV in Tshwane were aware of their HIV status. As such they would not have been on treatment and could have been spreading the virus without knowing.

Survey SiteHIV Prevalence among people who inject drugsAntibodies for Hepatitis C among people who inject drugsShare of HIV positive people who knew their status
eThekwini49%75%76%
Mashishing45%41%77%
Mbombela30%91%64%
Tshwane72%89%48%
Results of the TB HIV Care survey of four cities.

People who inject drugs (such as heroin) are at a higher risk of contracting HIV and HCV when needles are shared – something which happens because drug users don’t have easy access to new ones.

This has long been a problem in South Africa and appears to be getting worse. Research conducted in eThekwini in 2013 found that 17% of injecting drug users were HIV-positive. According to the new research, a decade later the figure has nearly tripled to 49%.

Professor Harry Hausler, CEO of TB HIV Care and a former technical advisor to the National Department of Health on TB/HIV, believes the main reason for this “massive” uptick in blood-borne diseases among drug users is “the limited access to needle and syringe programs” in the country.

Government ignored its own solution

Research shows overwhelmingly that providing clean needles to drug users reduces the spread of HIV, not only by removing the need to share injecting equipment but often because needle programs offer other services such as health education and condoms.

A large review published in 2017 identified 133 academic studies on needle and syringe programs (commonly known as NSP). The results were “supportive of the effectiveness of NSP in reducing HIV transmission among [people who inject drugs], as well as in reducing HCV infection, although the latter to a lesser extent”.

South Africa’s Drug Master Plan, government’s official policy document for managing illicit drug use, explicitly endorses needle and syringe programs, as does the National Strategic Plan on HIV, TB and STIs.

Yet despite these formal policy commitments, there is virtually no public funding for such interventions.

A person discards used needles in a specialised bin provided by TB HIV Care at a mobile clinic in Wynberg, Cape Town.

One exception is the Pretoria-based Community Oriented Substance Use Program, sponsored by the Tshwane Municipality. It has been left to non-profit groups, such as TB HIV Care, to provide these services. According to Hausler, the organisation currently provides clean needles to nearly 10 000 injecting drug users in Cape Town, Nelson Mandela Bay, eThekwini, Tshwane and Mbombela.

Users access needles from drop-in centres as well as mobile clinics – usually vans that get driven on set days to areas where injecting users congregate. Users discard their old needles in specialised bins provided by TB HIV Care. They will then receive a pack, which includes clean needles, alcohol swabs and sterile water.

Nurses are present at the mobile clinics so users can also get tested for HIV and HCV. They also offer ordinary medical services, such as cleaning and bandaging wounds.

Mobile clinics are also manned by psychosocial and human rights workers, and peer educators (people who were beneficiaries but now work for TB HIV Care) from whom users can get counselling or report abuses.

“We’re not just a needle provision organisation”, says Loraine Moses, who oversees quality standards for the program. “We’re a health services organisation”. Users have to register with peers and get health counselling and education before getting their needles, she says.

Beneficiaries have access to various amenities at TB HIV Care’s drop-in centres, including showers, lounging areas and washing machines.

Needle program as a first step to rehab

In many cases, needle and syringe programs also provide a first point of contact for people who want to stop using drugs.

Anthony (surname withheld), previously a heroin user for 15 years, who now volunteers for TB HIV Care, spoke to GroundUp at a drop-in centre in Cape Town.

“In the beginning, I started experimenting with friends in school [but] after my mother passed away, I found that there are those properties in [heroin] that calm you and numb pain, so that’s when I started to delve [into the drug] more.”

After ending up on the street and becoming “a slave to that drug”, he increasingly wanted to get sober. Fetching needles from a TB HIV Care site, he began speaking with one of the peers. The person told him about TB HIV Care’s opioid agonist program, which helps users to quit or reduce their heroin intake.

Opioid agonists are drugs which block heroin withdrawal. Methadone is the most widely known. Numerous clinical trials show that initiatives which offer methadone to heroin users over an extended period are more effective than rehab programs that force users to quit cold turkey.

Hausler says that TB HIV Care currently provides methadone to over 1100 people. Along with the medicine, they receive counselling and are assisted with finding shelter, and in some cases to reintegrate with their families.

Anthony says he’s been taking methadone since June last year. The program also helped him link up with a shelter and get an ID document so that he could find work.

“Being a client at TB HIV Care has helped me a lot to reintegrate back into society,” he says. “Being on the street, you lose a lot of yourself”.

A notice board at the TB HIV Care drop-in centre in central Cape Town.

Law enforcement continues to confiscate needles

Local governments have assisted TB HIV Care with some of its services. The City of Cape Town provides the HIV tests for use at mobile clinics, according to Hausler.

And yet, not only has the government failed to directly fund the sterile needle programs but in some cases it appears to work against them.

Research carried out by TB HIV Care shows that users frequently have their injecting equipment confiscated by law enforcement officers.

In Tshwane and eThekwini more than half of all people surveyed said that the authorities had seized or destroyed their needles at least once in the previous six months.

OutcomeMashishingMbombelaeThekwiniTshwane
No57%76%31%36%
Yes, In the last 6 months18%20%64%54%
Yes, but not in the last 6 months25%4%5%10%

Results of survey question: Have you ever had your needles and syringes confiscated or destroyed by a police officer/law enforcement? Source: TB HIV Care

“What’s very frustrating is that there are two arms of government,” says Hausler. “There’s health and then there’s police. And police are confiscating needles and syringes that we’ve been providing to clients – [even though what we’re doing] is a clearly endorsed health intervention.”

Hausler notes that in some cases the organisation has “really good alliances with local police”, but in other cases it is a constant battle.

“There needs to be better mainstreaming of education of officials across all government departments on the … HIV and TB response [plans],” says Hausler. “If people were really sensitised, we would not run up against as many obstacles.”

Asked for comment, Gauteng SAPS spokesperson Lieutenant Colonel Mavela Masondo told GroundUp that “possession of needles is not a criminal offence. Therefore, we cannot arrest a person [for] possession of needles, and neither can we confiscate needles”.

Note: The full report by TB HIV Care, which received assistance from the United States CDC, is not yet publicly available. A 16 page summary of some of the findings can be found here.

Professor Harry Hausler, CEO of TB HIV Care, at his office in Cape Town.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International Licence.

Read the original article.

Categories : Environmental Effects Substance UseTags :

Pharmaceutical and Illicit Drugs Contaminating New York’s Rivers

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Photo by Bill Oxford on Unsplash

In research published in Environmental Toxicology & Chemistry, investigators sampled water from 19 locations across the Hudson and East Rivers in 2021 and 2022 to identify and quantify the prescribed pharmaceuticals and drugs of abuse that are making their way into New York City’s rivers and to determine the source of these pollutants.

Metoprolol and atenolol (blood pressure medications), benzoylecgonine (the main metabolite of cocaine), methamphetamine (a stimulant), and methadone (an opioid) were the most prevalent drugs, present in more than 60% of water samples.

More drugs and higher concentrations were detected in water contaminated by Enterococci (bacteria that live in the intestinal tract) and after rainfall, indicating an impact from sewer overflow. However, the presence of drugs in clean water and during periods of dry weather indicated that wastewater treatment plant discharge may also contribute to the presence of drugs in rivers.

“This study shows how pharmaceuticals and drugs of abuse enter the New York City aquatic environment, highlighting the necessity of improving the current water management system,” said corresponding author Marta Concheiro-Guisan, PharmD, PhD, of the John Jay College of Criminal Justice.

Source: Wiley