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Legal drug addiction does the most harm

A new study has compiled the best, most up-to-date evidence on addictive disorders globally. It shows that almost 5% of the world's adult population (240m people) have an alcohol use disorder and more than 20% (1bn people) smoke tobacco. Getting good data on other drugs such as heroin and cannabis is much more difficult but for comparison the number of people injecting drugs is estimated at around 15m worldwide.

The Global Statistics on Addictive Behaviours: 2014 Status Report goes further in showing that the harm to society from legal drugs is many times the harm from illicit drugs. For example, alcohol use is estimated to result in loss of 257 disability adjusted life year per 100,000 of population compared with just 83 for illicit drugs.

There are huge regional differences in use of addictive drugs. The heaviest drinkers are in Eastern Europe where 13.6 litres of alcohol is consumed per head of population each year, followed by Northern Europe at 11.5 litres. Central, Southern and Western Asia have the lowest consumption at 2.1l.

Eastern Europe also has the most smokers at 30.0% of adults, closely followed by Oceania at 29.5% and Western Europe at 28.5%. This compares with Africa at 14%. North and Central America with the Caribbean have the highest rates of injecting drug use at 0.8%, which is more than twice the rate in Northern Europe at 0.3%.

The authors of the report note that there are important limitations to the data, more so for illicit than legal drugs, but believe that putting all this information in one place will make it easier for governments and international agencies to develop policies to combat this scourge.

The report's lead author, Dr Linda Gowing, associate professor at the University of Adelaide in South Australia, said: "Bringing all this data together has been very challenging but having this global snapshot in one accessible resource should prove invaluable for policymakers and researchers".

Robert West, professor University College London, an author of the report and editor-in-chief of the journal Addiction, which commissioned the report, said: "The most striking thing to emerge is how much more damage is done to society by legal drugs than illegal ones. It is a stark reminder of how the need to create shareholder value can work against global health and wellbeing."

 

A study has found that individual differences in brain structure could help to determine the risk for future drug addiction. It found that occasional users who subsequently increased their drug use compared with those who did not, showed brain structural differences when they started using drugs.

Researchers, led by Dr Benjamin Becker, scanned the brain structure of 66 participants to provide the first likely evidence showing volumes of fronto-striato-limbic regions of the brain have an effect on increased drug use. In order for early intervention of addiction to be possible, the study has deemed it essential to identify the biomarkers which may make a person more vulnerable to drug addiction, due to these particular areas of the brain affecting decision making and impulsivity.

In the studies the scientists scanned occasional users of amphetamine-type stimulant (ATS), such as amphetamine and ecstasy (MDMA). Participants were monitored after 12 and 24 months to assess their level of drug use after both periods of time. Those whose ATS use subsequently increased had smaller volumes in front-striato-limbic regions. Becker said, "prospective longitudinal studies in occasional users are of great importance to determine biological vulnerability markers, which can help to identify individuals at greatest risk of developing an addiction."

He went on to conclude that "these findings indicate that individual differences in fronto-stiato-limbic regions implicated in impulsivity and decision making could render individuals vulnerable for the transition from occasional to escalating stimulant use."

Occasional users in both studies, who increased stimulant use during the subsequent 24 months displayed smaller regional grey matter volumes compared to those who with stable or decreased use.

 

More than half of patients who report "weekend-only" drug use end up expanding their drug use to weekdays, too – suggesting that primary care clinicians should monitor patients who acknowledge "recreational" drug use, says a new study by Boston University public health and medicine researchers.

The study led by Judith Bernstein, professor of community health sciences at the BU School of Public Health (BUSPH), recommends that clinicians use "caution in accepting recreational drug use as reassuring," and that they conduct "continued episodic monitoring" of patients who report weekend-only drug use.

The study followed 483 patients at Boston Medical Centre who reported using drugs in the previous month and who completed a follow-up visit six months later. Of those who reported weekend-only use initially, only 19.2% retained that pattern six months later, while 54% were using drugs on other days of the week. Drugs most commonly used included marijuana, cocaine and opioids. "These findings suggest the importance of periodic monitoring of 'recreational' drug use," the study says. "A single-question standardised screen can be used to elicit necessary information."

Bernstein said the findings indicate that weekend-only use "frequently progresses into daily use, and warrants continued monitoring" by clinicians. "The real message of this paper is a monitoring message," she said. Primary care providers "are in a position to support positive behavioural change, as well as to address increases in drug-use intensity as an integral part of their role."

The study notes that weekend-only users had lower odds of increasing drug-use frequency and severity than people whose drug use was not limited to weekends. Also, the study participants were inner-city residents with recent drug use, meaning the findings might not be generalisable to the population as a whole, the authors noted. Illegal drug use among primary care patients is estimated at 5% to 8%, but often goes undetected. Any drug use, even occasional, may have an impact on disease processes and the effectiveness of prescribed medication, the authors said.

 

Research has demonstrated a new, non-invasive test that can detect cocaine use through a simple fingerprint. For the first time, this new fingerprint method can determine whether cocaine has been ingested, rather than just touched.
Led by the University of Surrey, a team of researchers from the Netherlands Forensic Institute, the UK's National Physical Laboratory, King's College London and Sheffield Hallam University, used different types of an analytical chemistry technique known as mass spectrometry to analyse the fingerprints of patients attending drug treatment services. They tested these prints against more commonly used saliva samples to determine whether the two tests correlated. While previous fingerprint tests have employed similar methods, they have only been able to show whether a person had touched cocaine, and not whether they have actually taken the drug.

"When someone has taken cocaine, they excrete traces of benzoylecgonine and methylecgonine as they metabolise the drug, and these chemical indicators are present in fingerprint residue," said lead author Dr Melanie Bailey from the University of Surrey. "For our part of the investigations, we sprayed a beam of solvent onto the fingerprint slide (a technique known as Desorption Electrospray Ionisation, or DESI) to determine if these substances were present. DESI has been used for a number of forensic applications, but no other studies have shown it to demonstrate drug use."

Researchers believe that the applications for this test could be far-reaching. Drug testing is used routinely by probation services, prisons, courts and other law enforcement agencies. However, traditional testing methods have limitations. For example, blood testing requires trained staff and there are privacy concerns about urine testing. Where bodily fluids are tested, there can be biological hazards and often a requirement for particular storage and disposal methods. Often these tests also require analysis off-site.

"The beauty of this method is that, not only is it non-invasive and more hygienic than testing blood or saliva, it can't be faked," added Bailey. "By the very nature of the test, the identity of the subject is captured within the fingerprint ridge detail itself."

It is anticipated that this technology could see the introduction of portable drug tests for law enforcement agencies to use within the next decade. "We are only bound by the size of the current technology. Companies are already working on miniaturised mass spectrometers, and in the future portable fingerprint drugs tests could be deployed. This will help to protect the public and indeed provide a much safer test for drug users," said Bailey.

 

Bloomberg reports, meanwhile, that the online drug trade has been dealt another blow. Evolution, a massive website for buying drugs on the so-called Dark Web, has suddenly disappeared, along with millions of dollars in its users' Bitcoins. The leading store for illicit e-commerce, it seems, was an elaborate scam.

The report says as recently as two years ago, online black markets worked well enough that many thought buying drugs there was on its way to being as safe and easy as dealing in braided necklaces on Etsy. That utopia began to crumble with the seizure of online black market Silk Road in 2013 and the arrest and conviction of Ross Ulbricht as the mastermind behind the site. It's been tumultuous days ever since.

But, the report says, insecurity doesn't seem to be damping demand. Just before Silk Road was shut down, there were about 13,000 listings for drugs on the site, and 18,000 such listings on the Dark Web overall, according to the Digital Citizens Alliance. On the day Evolution vanished, there were 19,900 drug listings on that site alone, and 41,900 in all.

Distrust in marketplaces has caused a number of large dealers to take their customers off the markets and continue selling them drugs directly through their own secret sites, earning loyalty through their continued good names, says Tim Bingham, an independent researcher studying the drug trade. He says three or four major dealers have done this since the Silk Road shutdown, although he adds that they probably also continue to do business on marketplaces like Agora.

[link url="http://www.eurekalert.org/pub_releases/2015-05/w-ast051215.php"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/add.12899/abstract"]Addiction abstract[/link]
[link url="http://www.eurekalert.org/pub_releases/2015-05/oupu-naf051515.php"]Oxford University Press US material[/link]
[link url="http://brain.oxfordjournals.org/content/early/2015/05/09/brain.awv113"]Brain: A Journal of Neurology article summary[/link]
[link url="http://www.bu.edu/sph/2015/05/12/recreational-drug-use-on-weekends-often-morphs-into-daily-use-study-suggests/"]Boston University Medical Centre material[/link]
[link url="http://annfammed.org/content/13/3/257.full"]Annals of Family Medicine abstract[/link]
[link url="http://www.surrey.ac.uk/mediacentre/features/new-test-detects-drug-use-single-fingerprint"]University of Surrey material[/link]
[link url="http://pubs.rsc.org/en/content/articlelanding/2015/an/c5an00112a#!divAbstract"]Analyst abstract[/link]
[link url="http://www.bloomberg.com/news/articles/2015-03-19/can-you-ever-trust-your-online-drug-dealer-again-"]Full Bloomberg report[/link]

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