Browsing by Subject "Methamphetamine"
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Item Open Access Bupropion and Naltrexone in Methamphetamine Use Disorder.(The New England journal of medicine, 2021-01) Trivedi, Madhukar H; Walker, Robrina; Ling, Walter; Dela Cruz, Adriane; Sharma, Gaurav; Carmody, Thomas; Ghitza, Udi E; Wahle, Aimee; Kim, Mora; Shores-Wilson, Kathy; Sparenborg, Steven; Coffin, Phillip; Schmitz, Joy; Wiest, Katharina; Bart, Gavin; Sonne, Susan C; Wakhlu, Sidarth; Rush, A John; Nunes, Edward V; Shoptaw, StevenBackground
The use of naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied.Methods
We conducted this multisite, double-blind, two-stage, placebo-controlled trial with the use of a sequential parallel comparison design to evaluate the efficacy and safety of extended-release injectable naltrexone (380 mg every 3 weeks) plus oral extended-release bupropion (450 mg per day) in adults with moderate or severe methamphetamine use disorder. In the first stage of the trial, participants were randomly assigned in a 0.26:0.74 ratio to receive naltrexone-bupropion or matching injectable and oral placebo for 6 weeks. Those in the placebo group who did not have a response in stage 1 underwent rerandomization in stage 2 and were assigned in a 1:1 ratio to receive naltrexone-bupropion or placebo for an additional 6 weeks. Urine samples were obtained from participants twice weekly. The primary outcome was a response, defined as at least three methamphetamine-negative urine samples out of four samples obtained at the end of stage 1 or stage 2, and the weighted average of the responses in the two stages is reported. The treatment effect was defined as the between-group difference in the overall weighted responses.Results
A total of 403 participants were enrolled in stage 1, and 225 in stage 2. In the first stage, 18 of 109 participants (16.5%) in the naltrexone-bupropion group and 10 of 294 (3.4%) in the placebo group had a response. In the second stage, 13 of 114 (11.4%) in the naltrexone-bupropion group and 2 of 111 (1.8%) in the placebo group had a response. The weighted average response across the two stages was 13.6% with naltrexone-bupropion and 2.5% with placebo, for an overall treatment effect of 11.1 percentage points (Wald z-test statistic, 4.53; P<0.001). Adverse events with naltrexone-bupropion included gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia. Serious adverse events occurred in 8 of 223 participants (3.6%) who received naltrexone-bupropion during the trial.Conclusions
Among adults with methamphetamine use disorder, the response over a period of 12 weeks among participants who received extended-release injectable naltrexone plus oral extended-release bupropion was low but was higher than that among participants who received placebo. (Funded by the National Institute on Drug Abuse and others; ADAPT-2 ClinicalTrials.gov number, NCT03078075.).Item Open Access Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths.(Drug and alcohol dependence, 2006-09) Wu, Li-Tzy; Schlenger, William E; Galvin, Deborah MThe magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N=19,084).Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs.Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence.Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.Item Open Access Descriptors and Correlates of Sex Trading Amongst Active Methamphetamine Users in Cape Town, South Africa(2015) Lion, Ryan RidenourIntroduction: South Africa has witnessed a tremendous rise in methamphetamine consumption since the year 2000. Sex trading is a phenomenon that has been observed in active drug users, globally and within South Africa, and has been associated with risks for HIV infection and violence. This paper is a secondary analysis examining sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Respondent driven sampling was used to recruit 360 active methamphetamine users in a peri-urban township in Cape Town. A structured clinical interview and computerized survey were used to assess history of sex trading, demographics, drug use, sexual risk behaviors, history of violence, and mental health. Logistic regression models were used to examine predictors of sex trading, separately for men and women. Results: In a total sample of 201 men and 159 women, 40% of men and 33% of women endorsed trading sex for tik or money in the past 3 months. Those who traded sex were more likely to meet the criteria for ICD-10 amphetamine dependence among both men (OR=4.59, 95% CI=1.31-16.13) and women (OR=8.00, 95% CI: 1.02-62.59). Men who were concurrent heroin users were also more likely to exchange sex (OR=2.58, 95% CI: 1.06-6.28). Sexual risk behaviors were significantly associated with sex trading. Notably, unprotected sex with a casual partner was correlated with sex trading in men (OR=3.57, 95% CI:1.66-7.69) and women (OR=3.68, 95% CI:1.63-8.29). Among women, those who experienced childhood sexual trauma (OR=3.79, 95% CI: 1.89-7.59) and had the symptoms of post-traumatic stress disorder (OR=2.95, 95% CI: 1.45-5.99) were also more likely to trade sex. Discussion: This study offers insight into the interventions needed for this high-risk population in a LMIC (low and/or middle income countries) context. The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. The risky sexual practices illustrate how targeted interventions geared toward safe sex practices may help this population. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior. In a context of high rates of trauma and violence, women need interventions that are attuned to their particular vulnerabilities and offer empowerment through counseling.
Item Open Access Effectiveness of Respondent Driven Sampling in Engaging Methamphetamine Users in HIV Prevention Research in Cape Town, South Africa(2014) Kimani, Stephen MburuSouth Africa has a substantial HIV epidemic as well as a rising methamphetamine use problem, particularly in Cape Town. Respondent driven sampling (RDS) may be a useful tool for engaging vulnerable and hard-to-reach populations in HIV research, although its effectiveness has not yet been examined among South African methamphetamine users. The aim of the current study was to describe the effectiveness of RDS as a method for engaging methamphetamine users in Cape Town into a HIV behavioral research study. RDS procedures were used to screen 374 potential participants from a peri-urban township in Cape Town. Measures of homophily, equilibrium and RDS-1 estimators were computed for key demographic and social variables.
Beginning with 8 seeds, 345 methamphetamine users were enrolled over a 6 month period, with a coupon return rate of 67%. The sample included 197 men and 148 women who were ethnically diverse (73% Coloured, 27% Black African) and had a mean age of 28.8 years (SD=7.2). Social networks were adequate (mean network size >5) and mainly comprised of close social ties. Equilibrium on race was reached after 11 waves of recruitment, and after ≤3 waves for all other variables of interest. There was little to moderate preference for either in- or out-group recruiting in all subgroups.
Results suggest that RDS is an effective method for engaging methamphetamine users into HIV prevention research in South Africa. RDS may be a useful strategy for seeking high risk methamphetamine users for HIV testing and linkage to HIV care in this and other low resource settings. We also discuss future directions for RDS studies.
Item Open Access Infrequent illicit methadone use among stimulant-using patients in methadone maintenance treatment programs: a national drug abuse treatment clinical trials network study.(The American journal on addictions, 2008-07) Wu, Li-Tzy; Blazer, Dan G; Stitzer, Maxine L; Patkar, Ashwin A; Blaine, Jack DWe sought to determine the prevalence, patterns, and correlates of past-month illicit methadone use and history of regular illicit use among stimulant-using methadone maintenance treatment patients. We obtained self-reported information on illicit methadone use from 383 participants recruited from six community-based methadone maintenance programs. Overall, 1.6% of participants reported illicit use in the past month, and 4.7% reported a history of regular use. Younger age and history of outpatient psychological treatment were associated with increased odds of past-month illicit use. Illicit methadone use among patients in maintenance programs is infrequent; however, a number of factors may increase risk of illicit use.Item Open Access Misuse of methamphetamine and prescription stimulants among youths and young adults in the community.(Drug and alcohol dependence, 2007-07) Wu, Li-Tzy; Pilowsky, Daniel J; Schlenger, William E; Galvin, Deborah MGender differences in the prevalence and characteristics of misuse of methamphetamine (meth) and prescription stimulants were examined in a representative US sample of youths and young adults aged 16-25 (N=24,409).Stimulant misusers were categorized into three mutually exclusive subgroups: meth users only, meth and prescription stimulant users, and prescription stimulant users only (e.g., Benzedrine, Ritalin, or Dexedrine). Multinominal logistic regression analyses identified the characteristics associated with misuse of meth and prescription stimulants.About 1 in 10 youths reported any misuse of stimulants in their lifetime. Prescription stimulant misuse occurred earlier and was more frequent than meth misuse. About 47% of meth misusers also reported prescription stimulant misuse. Among misusers of meth and prescription stimulants, males were more likely than females to misuse methylphenidate (82% versus 65%) but were less likely to misuse diet pills or amphetamines (37% versus 49%). Multinominal logistic regression analyses indicated that all subgroups of lifetime stimulant misuse were associated with past year substance abuse. The characteristics of meth misusers differed slightly from prescription stimulants misusers.Multidrug use is common among stimulant misusers. Parents should be informed about the risk of prescription stimulant misuse by their youths.Item Open Access Predictors of police brutality in a group of methamphetamine users in Delft, Cape Town, South Africa(2017) Rice, RebeccaIntroduction: Police brutality is a form of violence that negatively impacts health globally. Illegal drug use increases the likelihood that substance users will meet police globally. Methamphetamine use trends in South Africa have been increasing since the early 2000s. In this paper, secondary data analysis was done to examine predictors of methamphetamine users experiencing police brutality. Methods: Respondent driven sampling was used to recruit a sample of 360 active methamphetamine users in Delft, Cape Town, South Africa. Clinical interviews and computerized interviews were used to capture historical information about demographics, drug use, experiences of police violence, attitudes towards police, gang involvement, and arrest records. Logistic regression models were used to determine predictors of experiences of police brutality by sex. Results: The sample had a total of 202 males and 160 females, experiences of police violence were 53% and 14%, respectively by sex. 94% of participants reported prior arrests. Of those arrests, 48% and 39% were gang and drug related, respectively. Both male and female participants were more likely to experience police violence when reported weapon-related (OR 2.988, 95% CI=1.543-5.787) and drug-related (OR 1.796; 95% CI=1.140-2.829). Discussion: The analysis presented here adds to the current data about predictors of experiencing police violence. Further research should be conducted to determine if these results are generalizable to populations of substance users outside of the Delft township. The creation of policing policies based on research driven interventions need to be drafted and implemented to decrease the negative effects that abuses of police power have on public health.
Item Open Access α4β2 Nicotinic receptor desensitizing compounds can decrease self-administration of cocaine and methamphetamine in rats.(European journal of pharmacology, 2019-02) Levin, Edward D; Rezvani, Amir H; Wells, Corinne; Slade, Susan; Yenugonda, Venkata M; Liu, Yong; Brown, Milton L; Xiao, Yingxian; Kellar, Kenneth JSazetidine-A [6-(5(((S)-azetidine-2-yl)methoxy)pyridine-3-yl)hex-5-yn-1-ol] is a selective α4β2 nicotinic receptor desensitizing agent and partial agonist. Sazetidine-A has been shown in our previous studies to significantly reduce nicotine and alcohol self-administration in rats. The question arises whether sazetidine-A would reduce self-administration of other addictive drugs as well. Nicotinic receptors on the dopaminergic neurons in the ventral tegmental area play an important role in controlling the activity of these neurons and release of dopamine in the nucleus accumbens, which is critical mechanism for reinforcing value of drugs of abuse. Previously, we showed that the nonspecific nicotinic antagonist mecamylamine significantly reduces cocaine self-administration in rats. In this study, we acutely administered systemically sazetidine-A and two other selective α4β2 nicotinic receptor-desensitizing agents, VMY-2-95 and YL-2-203, to young adult female Sprague-Dawley rats and determined their effects on IV self-administration of cocaine and methamphetamine. Cocaine self-administration was significantly reduced by 0.3 mg/kg of sazetidine-A. In another set of rats, sazetidine-A (3 mg/kg) significantly reduced methamphetamine self-administration. VMY-2-95 significantly reduced both cocaine and methamphetamine self-administration with threshold effective doses of 3 and 0.3 mg/kg, respectively. In contrast, YL-2-203 did not significantly reduce cocaine self-administration at the same dose range and actually significantly increased cocaine self-administration at the 1 mg/kg dose. YL-2-203 (3 mg/kg) did significantly decrease methamphetamine self-administration. Sazetidine-A and VMY-2-95 are promising candidates to develop as new treatments to help addicts successfully overcome a variety of addictions including tobacco, alcohol as well as the stimulant drugs cocaine and methamphetamine.