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dgs-info, Ausgabe 111, Januar 2019

Liebe Leserinnen und Leser,

die DGS wünscht ihnen ein gesundes und erfolgreiches neues Jahr. Wir wünschen ihnen weiterhin ein erfüllendes Engagement auf dem fordernden aber auch befriedigenden Feld der Suchtmedizin. Die DGS wird auch weiterhin alle in diesem Bereich Tätigen nach Kräften unterstützen. Die Herausforderungen bleiben auch 2019 bestehen, Suchtmedizin bleibt trotz ihrer hohen gesamtgesellschaftlichen Bedeutung weiter ein Stiefkind im Medizinbetrieb. Die demographische Entwicklung macht auch vor den Suchtmedizinern*innen nicht halt, es bleibt schwierig, jüngere Kollegen*innen für dieses faszinierende medizinische Fachgebiet zu begeistern. Dies bedingt eine zunehmend angespannte Versorgungssituation besonders in ländlichen Gebieten. Eine wesentliche Aufgabe für die Zukunft wird daher sein, die Rahmenbedingungen für die Suchtmedizin zu verbessern, die Substitutionstherapie als hocheffektive Behandlungsform der Opiatabhängigkeit in das Denken des wissenschaftlichen Medizinbetriebes und der Öffentlichkeit sowie in die Aus- und Weiterbildung junger Ärzte*innen zu verankern.

Diese Themen werden auch weiterhin im Focus der Debatten stehen und auf unseren Kongressen vertieft werden. Deshalb am besten jetzt schon vormerken – die Kongresse mit Beteiligung der DGS:

20. Interdisziplinärer Kongress für Suchtmedizin

04.07. bis 06.07.2019 in München

Fachintegrierendes Forum für Suchttherapie, Suchtfolgekrankheiten und Akutversorgung Suchtkranker.

24. Suchttherapietage in Hamburg
11. – 14. Juni 2019
Schwerpunkt: Suchttherapie und -prävention: Alles nur noch „online“?

Und natürlich – wie immer – der

28. Kongress der Deutschen Gesellschaft für Suchtmedizin
vom 01.11. bis 03.11. in Berlin

Durch die Novellierung des BtmG´s ist 2018 ein wichtiger Schritt getan worden, der substituierenden Ärztinnen und Ärzten die lange vermisste Rechtssicherheit gibt, es bleibt aber weiter reichlich zu tun – besonders die unbefriedigende Abbildung der Suchtmedizin im EBM ist hier zu nennen. Dies bezieht sich einerseits auf die Vergütung der Substitution, die gerade im Hinblick auf die jetzt möglichen längeren take-home Zeiten und durch die anstehende Zulassung von Buprenorphin Depot-Injektionen nicht mehr adäquat und zeitgemäß ist. Andererseits ist Suchtmedizin viel mehr als Substitution, alle diese Leistungen, die von uns regelmäßig erbracht werden, finden keine Abbildung im EBM:

  • Therapie (incl. Gesprächsleistungen) von Opiatabhängigen mit Opiatantagonisten (z. B. Naltrexon),
  • Screening auf alkoholbezogene Störungen durch standardisierte Testverfahren (Audit, Audit C, Cage) ggf. einschließlich einer ärztlichen Kurzintervention,
  • Therapie alkoholbezogener Störungen mit Anti-craving Substanzen oder Disulfiram oder Ambulanter medikamentengestützter Alkoholentzug,
  • Tabakentwöhnung, ggf. mit Einsatz von Nikotinersatz oder Anti-craving Substanzen,
  • Ambulante Interventionen bei Stimulantienabusus und/oder NPS,
  • Interventionen bei cannabisbezogenen Störungen.

Zu diesen und anderen Fragestellungen steht die DGS in Gesprächen mit der Kassenärztlichen Bundesvereinigung, unsere Anliegen werden „grundsätzlich wohlwollend“ betrachtet, schnelle Ergebnisse sind aber eher nicht zu erwarten. Zu den Versorgungsengpässen bei der Substitutionstherapie wird derzeit – angeregt durch die DGS – eine Datenerhebung und Analyse über das Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland durchgeführt, hieraus könnte eine deutlich verbreiterte Diskussionsgrundlage für die weiteren Gespräche mit der KBV und ggf. der Gesundheitspolitik resultieren.

Zu diesem Problemkreis ein Text von Hans-Günter Meyer Thompson auf unserem Kongress vom November 2018 in Berlin:

Das neue Substitutionsrecht – was hat es in der Praxis bewirkt und kann die medikamentengestützte Behandlung Opioidabhängiger in den kommenden Jahren gesichert werden? (17 Thesen + 1 Frage)

Bitte den Text aus dem Anhang auf die homepage verlinken

Der GBA hat mittlerweile die Richtlinien zur substitutionsgestützten Behandlung an das novellierte BtmG angepasst:

Richtlinie Methoden vertragsärztliche Versorgung: Änderung der Anlage I Nummer 2 – Substitutionsgestützte Behandlung Opiatabhängiger

https://www.g-ba.de/informationen/beschluesse/3472/

Als wissenschaftliche Fachgesellschaft ist die Leitlinienarbeit ein wichtiges Anliegen der DGS, die wissenschaftliche Fundierung der Suchtmedizin ist essentiell für eine Aufwertung und bessere Akzeptanz unseres Fachgebietes. An folgenden Projekten werden wir z. T. in Kooperation mit dem Dachverband Sucht zukünftig arbeiten:

  • DGS-Leitlinien Substitution einschl. Heroin
  • Sedativa, Hypnotika: Medikamentenbezogene Störung,
  • Internet, Spielen

Jetzt einige interessante Meldungen aus den Bereichen der Suchtmedizin:

Suchtberatung für Jugendliche per App

blu:prevent, die Suchtpräventionsarbeit des Blauen Kreuzes in Deutschland, bietet seit August 2018 ein neues Tool zur Online-Beratung für Jugendliche über einen Chat in der blu:app an. https://bluprevent.de/.

https://www.blaues-kreuz.de/de/blaues-kreuz/neuigkeiten-und-presse/pressemitteilungen/pressemitteilung/news/suchtberatung-fuer-jugendliche-per-app/

Die Krisenhilfe Bochum legt eine starke Bilanz vor:

Rückblick, Einblick, Überblick – der Jahresbericht 2016/17 der Krisenhilfe Bochum

http://www.krisenhilfe-bochum.de/wp-content/uploads/2018/08/KHB_Jahresbericht_2016_17_digital.pdf

Liebe Kolleginnen und Kollegen, bitte beteiligen sie sich an dieser Studie, sie ist wichtig:

Befragung zur Anwendbarkeit der S3-Leitlinie Screening, Diagnose und Behandlung alkoholbezogener Störungen

http://www.impela.de/

https://www.limesurvey.uni-hamburg.de/index.php/775995?lang=de

Hier der Verweis auf zwei weitere wichtige Leitlinien:

S3 Leitlinie ADHS:

https://www.awmf.org/uploads/tx_szleitlinien/028-045l_S3_ADHS_2018-06.pdf

S3-Leitlinie Methamphetamin-bezogene Störungen:

https://www.dgppn.de/_Resources/Persistent/42b731d6180ceeaceae551fc8ae2a1b54eea591a/S3-LL-Methamphetamin_lang.pdf

Trauer um Prof. Dr. Robert Newman

Die DGS trauert um Robert Newman. Newman war einer der bedeutenden und charismatischen Menschen in der Etablierung der Substitutionsbehandlung in den USA und auch und besonders in Deutschland, wo er sich große Verdienste um die Einführung der Substitutionstherapie erworben hat. Oft verlacht, beschimpft und unsachlich kritisiert von Abstinenzpredigern, hat sich seine Fachkompetenz, sein Engagement, sein kompromissloser Einsatz für dieses von ihm für richtig und wichtig befundenes Therapieprinzip letztlich durchgesetzt. Seine Verdienste und sein ansteckender Impetus für die Sache der Substitutionsbehandlung und der niedrigschwelligen Hilfen für Drogenabhängige werden bleiben und sind Antrieb für die nachrückende Generation von Suchtmedizinern*innen weltweit.

Robert Newman, 26.10.1937 – 01.08.2018
Nachrufe aus der New York Times

https://www.nytimes.com/2018/08/08/obituaries/dr-robert-newman-apostle-of-methadone-treatment-dies-at-80.html

Robert Newman

NEWMAN–Robert („Bob“) G., MD, MPH, 80, passed away on August 01, 2018. As CEO of Beth Israel Medical Center for 20 years, he championed the creation of palliative care and hospice programs, as well as a very successful Japanese medical – resident exchange program for which he was awarded the Order of the Rising Sun by his Excellency Sumio Kusaka then Japan Ambassador, Consul – General in New York. He then led the creation of Continuum Health Partners in 1997, from which he retired in 2001. From 2001 until 2013, Robert served as Director of the Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center. For over 40 years, he played a major role in planning and directing some of the largest addiction treatment programs in the world, including the New York City Methadone Maintenance and Ambulatory Detoxification Programs, which in the 1970s served 33,000 patients annually. He was a prolific writer of opeds and and author of „Methadone Treatment in Narcotic Addiction“. Robert is survived by a large, farflung yet close, international family of which he was the central connecting hub, his children, Hana and Seiji, and granddaughters Miko, Emi, and Noa, whom he loved dearly. He is also survived by the love of his life, his wife Seiko, whom he met while stationed as a U.S. Air Force medical officer in Fukuoka, Japan, in 1967, and brothers Tom (wife Maro), Steve (wife Annie) and their children (Jehan Hanna, Jon („Hank“), Suzanne, Tony and Vivi Larkin) and grandchildren, and his cousins Charles Opels, Elizabeth („Dizzy“) Howard OBE, John Feld, and Marion Iacopucci. Robert and Seiko celebrated the 52nd anniversary of their first date this past June and would have celebrated 50 years of marriage this year on his birthday, October 26, 1937.
Robert was born in The Hague, to which his parents had fled in April 1933 upon Hitler’s ascension to power. October 26 was an auspicious day in his life; it was the day he arrived in America, in 1939, from Holland, narrowly escaping the Holocaust that caught his grandparents. His father, Randolph H. Newman, was one of the prosecutors of I.G. Farben on Brig. Gen. Telford Taylor’s staff at the Nuremberg trials. He received his MD degree with honors at University of Rochester Medical School and a Master of Public Health at the University of California, Berkley. In lieu of flowers, please consider making donations to two organizations that meant a great deal to him and on whose boards he had the privilege of serving for many years — the Drug Policy Alliance and the National Advocates for Pregnant Women. He is irreplaceable and will be missed greatly by all members of his loving extended family, the many people he worked with over the decades and those countless others that he cared for and helped. (Published in The New York Times on Aug. 3, 2018)

Nachruf von Prof. Heino Stöver für akzept e.V.

http://www.akzept.org/uploads0517/BobNewman.pdf

Zum Schluß der Würdigung Robert Newmans sei hier noch ein Diskussionsbeitrag des Autors aus dem Jahr 2014 zitiert:

Robert Newman: Effectiveness of methadone treatment for heroin addiction

The British Journal of Psychiatry, Volume 204, Issue 3 March 2014 , p. 241

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/84DCCCBE4DFC0EA8BD9AD4799D3AB751/S0007125000275855a.pdf/effectiveness_of_methadone_treatment_for_heroin_addiction.pdf

Verabschiedet sich die deutsche Ärzteschaft vom Ziel der HCV Elimination bis 2030?

Die WHO hat mit Zustimmung Deutschlands das Ziel vorgegeben, das Hepatitis C Virus bis 2030 zu eliminieren.

http://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_eng.pdf;jsessionid=5B58CCCDF6E9D8F16A1670B79C4F0EE2?sequence=1

Dieses Ziel ist nach übereinstimmender Ansicht aller Experten realistisch, allerdings ist hierzu umfassendes HCV screening erforderlich. In den Leitlinien zur Substitutionstherapie ist die Diagnostik von Begleiterkrankungen der Sucht vorgegeben und damit ein screening auf HCV essentiell. Anders als bei anderen meldepflichtigen Erkrankungen (z. B. bei der Hepatitis B) wird der nach aktuellem ärztlichen Standard erste Test bei Verdacht auf Hepatitis C den Gesamtlaborleistungen zugerechnet, deren Summe darüber entscheidet, ob ein sog. Wirtschaftlichkeitsbonus gewährt wird.

Seit April 2018 ist der Hepatitis-C-Antikörpertest für niedergelassene Ärzte also nicht mehr “kostenneutral“, sondern belastet das Laborbudget, da er von der sog. Befreiungsziffer 32006 nicht mehr abgedeckt wird. Damit droht den Ärzten ein wirtschaftlicher Nachteil, wenn sie die Testungen veranlassen, die nach den Leitlinienindikationen für die Diagnostik der Hepatitis C durchgeführt werden sollten. Diese Paradoxie ist unverständlich, die DGS hat daher einen Aufruf der Deutschen Gesellschaft für Gastroenterologie an die KBV zusammen mit etlichen anderen Fachgesellschaften mit unterzeichnet.

Bitte den Text Schreiben KBV aus dem Anhang auf die homepage verlinken

Gerade Opiatabhängige sind eine Hauptrisikogruppe für die Hepatitis C-Infektion und müssen entsprechend diagnostiziert werden. Mit der jetzigen Regelung besteht ein drohender Verlust des Wirtschaftlichkeitsbonus bei Testung auf Hepatitis C- Antikörper, der gerade für kleinere Praxen problematisch werden kann. Leider hat die KBV die Intervention dieser zahlreichen wichtigen und kompetenten Fachverbände negativ beschieden.

Bitte den Text Antwort KBV verlnken

Dies ist völlig unverständlich, die Kosteneffektivität eines umfassenden HCV screenings ist hinreichend belegt, die DGS wird weitere Interventionen der beteiligten Verbände unterstützen. Hierzu noch eine Studie aus Frankreich:

Deuffic-Burban, S. et al.: Assessing the cost-effectiveness of hepatitis C screening strategies in France, Journal of Hepatology October 2018Volume 69, Issue 4, Pages 785–792

DOI: https://doi.org/10.1016/j.jhep.2018.05.027

https://www.journal-of-hepatology.eu/article/S0168-8278(18)32112-3/pdf

Highlights

  • In France, universal screening is the most effective strategy for HCV.
  • Universal screening is cost-effective at the threshold of 1–3 times GDP per capita.
  • Cost-effectiveness mainly depends on utility values and time to treatment initiation.

Background & Aims
In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.

Methods
A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800).

Results
Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40–80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18–80 is associated with the highest costs, it is more effective than targeting all people aged 40–80, and cost-effective at both thresholds (€31,100/QALY).

Conclusions
In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented.

Lay summary
In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.

Gegen Stigmatisierung und Diskriminierung – viel zu tun bleibt auch bei HIV und Aids:

MILES TO GO, CLOSING GAPS, BREAKING BARRIERS, RIGHTING INJUSTICES

http://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf

Das GLOBAL AIDS UPDATE 2018

Diskriminierung bleibt bei Sucht und bei HIV/Aids ein wesentliches Thema:

https://hiv-diskriminierung.de/
http://www.antistigma.de/

The Impact of Stigma and Discrimination on Key Populations and Their Families
Eine lesenswerte Broschüre von
NSWP Global Network of Sex Work Projects
INPUD, International Network of People who Use Drugs
MPact, Global Action for Gay Men’s Health and Rights

http://fileserver.idpc.net/library/cg_stigma_discrimination_inpud_mpact_nswp.pdf

Der Reitox Bericht 2018 ist erschienen:
Berichte des Nationalen REITOX-Knotenpunkts an die EBDD

https://www.bzga.de/infomaterialien/fachpublikationen/berichte-des-nationalen-reitox-knotenpunkts-an-die-ebdd/

Ein Modellprojekt „Geistige Behinderung und problematischer Substanzkonsum“ ist angelaufen.

http://www.aktionberatung.de/

Der newsletter der Bundesarbeitsgemeinschaft Kinder und Jugendschutz mit einigen, die auch unsere Gesellschaft betreffen:
Jugendschutz-Newsletter Nr. 15 vom 12.12.2018

http://www.bag-jugendschutz.de/nwsltmpl/57

Cannabis und Führerschein?

Eine Publikation der Europäischen Beobachtungsstelle für Drogen und Drogensucht:
(EMCDDA) und des Canadian Centre on Substance Use and Addiction:

Cannabis und Führen eines Kraftfahrzeugs

Da es bei Cannabiskonsum und der Politik zu diesem Thema international laufend neue Entwicklungen gibt, ist die Teilnahme am Straßenverkehr unter Cannabiseinwirkung zu einer immer wichtigeren politischen Frage geworden. Die vorliegende Broschüre soll denen, die von politischen Entwicklungen im Zusammenhang mit Cannabis betroffen sind, einen kurzen Überblick über den aktuellen Wissensstand und die neuesten Entwicklungen bezüglich der Teilnahme am Straßenverkehr vermitteln.

http://www.emcdda.europa.eu/system/files/publications/8805/20181120_TD0418132DEN_PDF.pdf

Hier noch mal eine Publikation der EMCDDA zu Medizinalcannabis:

Medical use of cannabis and cannabinoids

http://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf

Eine Publikation von Indro e.V.:
Auslandsreisen unter Substitutionsbehandlung mit Methadon oder Buprenorphin

https://indro-online.de/wp-content/uploads/2018/12/gauss2018.pdf

Die DHS teilt mit:
Jeder fünfte Suchtkranke abstinent durch Selbsthilfegruppe
Statistik 2017 der fünf Sucht- Selbsthilfe – und Abstinenzverbände erschienen

http://www.dhs.de/fileadmin/user_upload/pdf/Arbeitsfeld_Selbsthilfe/Erhebung_der_5_SSHV_2017.pdf

Drogentod und Harm Reduction:

5 Ways You Can Help End the Overdose Crisis

http://www.drugpolicy.org/EndOverdose?ms=2D7_1808EndOverdoseResourcePage&utm_campaign=fy19newsletter&cid=70141000000TXbOAAW&utm_content=2D7_1808EndOverdoseResourcePage&spMailingID=35456658&spUserID=NTY4MDIyNjI5NDg0S0&spJobID=1340344445&spReportId=MTM0MDM0NDQ0NQS2

THE GLOBAL STATE OF HARM REDUCTION 2018

Eine Publikation von HARM REDUCTION INTERNATIONAL, www.hri.globa

http://fileserver.idpc.net/library/global-state-harm-reduction-2018.pdf

Hat sich harm reduction überwiegend auf Opiatkonsumenten bezogen, so ist diese Broschüre um so wichtiger, in völlig dunklen Feld des Stimulatienkonsums:

HARM REDUCTION FOR PEOPLE WHO USE STIMULANTS

https://mailinglijst.nl/klanten/12707/2018_Mainline__Harm_Reduction_for_People_Who_Use_Stimulants__Full_Report.pdf?v=20180911172200

Die EMCDDA teilt mit:

EUROPA ERHÄLT ROBUSTERES VERFAHREN FÜR DEN UMGANG MIT NEUEN PSYCHOAKTIVEN SUBSTANZEN

Neue Gesetzgebung für schnellere Reaktion auf neue Drogen ab heute gültig

http://www.emcdda.europa.eu/system/files/attachments/10082/News_releaseEN_NewRegulation2018app_NPS_DE_FINAL_webQUOTE1.pdf

E-Zigaretten – eigentlich auch zum harm reduction gedacht….

Die Suchtmaschine
Neuartige E-Zigaretten erobern Amerikas Schulhöfe und machen Hunderttausende Jugendliche nikotinsüchtig. Die US-Gesundheitsbehörde spricht von einer Epidemie. Nun expandiert Marktführer Juul nach Deutschland.

http://www.spiegel.de/wirtschaft/e-zigaretten-juul-aus-den-usa-expandiert-nach-deutschland-a-1239161.html

Zwei lesenswerte Publikationen der EMCDDA:

Trendspotter manual; A handbook for the rapid assessment of emerging drug-related trends

http://www.emcdda.europa.eu/system/files/publications/10233/2018-trendspotter-manual.pdf

Recent changes in Europe’s cocaine market: results from an EMCDDA trendspotter study

http://www.emcdda.europa.eu/system/files/publications/10225/2018-cocaine-trendspotter-rapid-communication.pdf
http://www.emcdda.europa.eu/system/files/publications/10225/2018-cocaine-trendspotter-rapid-communication.pdf

Plädoyers für ein Umdenken in der Drogenpolitik

https://derstandard.at/2000083510953/Plaedoyer-fuer-ein-Umdenken-in-der-Drogenpolitik

Von Javier Solana, Javier Solana (76) ist Mitglied der Global Commission on Drug Policy und ehemaliger Generalsekretär für Außen- und Sicherheitspolitik (GASP) der Europäischen Union sowie ehemaliger Nato-Generalsekretär.

https://idpc.net/profile/global-commission-on-drug-policy

A Pivotal Decade for the Movement to End the “War on Drugs”
December 14, 2018   Diego Garcia-Sayan

https://www.opensocietyfoundations.org/voices/pivotal-decade-movement-end-war-drugs

TAKING STOCK: A DECADE OF DRUG POLICY
A CIVIL SOCIETY SHADOW REPORT
von International Drug Policy Consortium

http://fileserver.idpc.net/library/Shadow_Report_FINAL_ENGLISH.pdf

Eine Mitteilung von Europol und der EMCDDA:

Fentanyle: Verringerung des Risikos einer berufsbedingten Exposition des Strafverfolgungspersonals:

https://www.aelrd.de/index.php/downloads/…/13-medizin?…111…europol…fentanyle

Dark web dealers voluntarily ban deadly fentanyl

Suppliers, fearing police crackdown, decide opioid is too high-risk to trade

https://www.theguardian.com/society/2018/dec/01/dark-web-dealers-voluntary-ban-deadly-fentanyl?CMP=share_btn_tw

Internationales:

An international indigenous network for drug law reform was launched yesterday at the international indigenous conference, Healing Our Spirit Worldwide – The Eighth Gathering, in Sydney, Australia.

https://www.drugfoundation.org.nz/news-media-and-events/international-indigenous-drug-policy-network-launched/

Afghanistan: Afghanistan Opium Survey 2018 Cultivation and Production

https://www.unodc.org/documents/crop-monitoring/Afghanistan/Afghanistan_opium_survey_2018.pdf

Griechenland: Greece Health Ministry Plans Drug Consumption Rooms

https://www.talkingdrugs.org/greece-health-ministry-plans-drug-consumption-rooms

Grossbritannien: The UK Needs to Take a Racial Justice Approach to Drug Policy
In the US, drug policy is seen as a racial justice issue. We should view it through the same lens.

https://www.vice.com/en_uk/article/neg8m8/the-uk-needs-to-take-a-racial-justice-approach-to-drug-policy

Indien: The systematic abuse of India’s female opiate users
Women who use drugs are at increased risk from HIV and violence, but as they don’t explicitly feature in official national data, their needs largely go unmet.

http://www.aidsalliance.org/stories/1211-the-systematic-abuse-of-indias-female-opiate-users

Lesotho: Marijuana, mountains and money: How Lesotho is cashing in
Lesotho is aiming to make money from the booming medicinal marijuana industry, but the BBC’s Vumani Mkhize says the southern African nation already has an unheralded illicit trade in the drug for recreational use.

https://www.bbc.com/news/world-africa-46288374

Mexiko: Marijuana in Mexico: how to legalise it effectively, fairly and safely

https://theconversation.com/marijuana-in-mexico-how-to-legalise-it-effectively-fairly-and-safely-107856

Neuseeland: He Ara Oranga, Report of the Government Inquiry into Mental Health and Addiction.
The purpose of this Inquiry is to:….recommend specific changes to improve New Zealand’s approach to mental health, with a particular focus on equity of access, community confidence in the mental health system and better outcomes, particularly for Māori and other groups with disproportionately poorer outcomes.

https://mentalhealth.inquiry.govt.nz/assets/Summary-reports/He-Ara-Oranga.pdf

Norwegen: Toward a more humane drug policy
Norway has put human rights and civil society on the agenda during its Presidency of the Council of Europe’s cooperation on drug policies.

https://idpc.net/alerts/2018/12/toward-a-more-humane-drug-policy?utm_source=IDPC+Monthly+Alert+%28English%29&utm_campaign=bca8e26889-IDPC+December+Alert+2018&utm_medium=email&utm_term=0_801bc38237-bca8e26889-151913411

Russland: Russia’s Harm Reductionists Are Once Again Under Attack

https://filtermag.org/2018/11/26/russias-harm-reductionists-are-once-again-under-attack/

Saudi Arabien: Saudi Arabia Begins 2019 with Three Executions for Drug Offences

https://www.talkingdrugs.org/saudi-arabia-begins-2019-with-three-executions-for-drug-offences

Thailand: Thailand Legislators Overwhelmingly Endorse Medical Cannabis Legalisation
Thailand’s parliament has almost unanimously accepted the first reading of a bill to legalise medical cannabis, but there is growing fear that foreign companies will monopolise any new marijuana industry.

https://www.talkingdrugs.org/thailand-legislators-overwhelmingly-endorse-medical-cannabis-legalisation

Wissenschaftliche Literatur:

Wie immer – das epidemiologische Bulletin des RKI:

https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2019/Ausgaben/02_19.pdf?__blob=publicationFile

Hughes, B., et al.: Inconsistencies in the assumptions linking punitive sanctions and use of cannabis and new psychoactive substances in Europe
Addiction, 113, 2155 – 2157, 2018

https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.14372

Barry, T. et al.: Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision

Br J Gen Pract. 2017 Apr; 67(657): e267–e273.
Published online 2017 Feb 28. doi: 10.3399/bjgp17X689857 PMCID: PMC5565826
PMID: 28246098

Ledberg A.: Mortality related to methadone maintenance treatment in Stockholm, Sweden, during 2006-2013.
J Subst Abuse Treat. 2017 Mar;74:35-41. doi: 10.1016/j.jsat.2016.12.005. Epub 2016 Dec 24.

https://www.ncbi.nlm.nih.gov/pubmed/28132698

Abstract

BACKGROUND:
Methadone maintenance treatment (MMT) of opiate addiction was introduced in Sweden 50years ago. The first Swedish programs were modeled after the original Dole and Nyswander program, with strict criteria for admittance into treatment, and have been shown to have positive effects on social and health variables, including mortality. During the last 11years, there have been a number of changes in the regulations controlling MMT-programs in Sweden, and the criteria for admittance are now much less strict compared to previous ones. This study aims to characterize the current MMT-programs with respect to mortality and to compare the results to those obtained in earlier periods.

METHODS:
Persons entering into treatment in Stockholm county, between 2006 and 2011, were followed until September 2013 or until death occurred. Death rates for periods in treatment and out of treatment were determined and compared to rates for the general population. Proportional hazards models with treatment status as time-varying covariate were fitted to the data. A competing risk analysis was made to investigate the effects of MMT on drug-related mortality as compared to mortality from other causes. Mortality data for earlier periods were retrieved from the literature.

RESULTS:
A total of 441 persons entered MMT during the time period. Of these 67 died during follow-up, the death rate being almost twenty times higher than in the general population. Not being in treatment was associated with a significantly increased hazard of dying (hazard ratio: 2.1, 95% confidence interval: 1.3-3.4). The hazard ratio was mainly increased for drug-related deaths (hazard ratio: 4.4 (2.1-9.2)).

CONCLUSIONS:
Mortality rates among persons who entered MMT-programs in Stockholm during 2006-2011 were not increased compared to persons in treatment twenty years ago. The mortality was significantly increased during periods off treatment. Changes in regulations that minimizes the time off treatment are therefore likely to reduce the mortality rates among clients of MMT-programs.

Doctor JN et al.: Opioid prescribing decreases after learning of a patient’s fatal overdose.
Science. 2018 Aug 10;361(6402):588-590. doi: 10.1126/science.aat4595.

https://www.ncbi.nlm.nih.gov/pubmed/30093595

Abstract
Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients‘ deaths and a safe prescribing injunction from their county’s medical examiner, whereas physicians in the control group did not. Milligram morphine equivalents in prescriptions filled by patients of letter recipients versus controls decreased by 9.7% (95% confidence interval: 6.2 to 13.2%; P < 0.001) over 3 months after intervention. We also observed both fewer opioid initiates and fewer high-dose opioid prescriptions by letter recipients.

Schiller EY.: Opioid, Overdose.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018-.2018 Oct 27.

https://www.ncbi.nlm.nih.gov/pubmed/29262202

Tupper, K.W., et al.: Initial results of a drug checking pilot program to detect fentanyl adulteration in a Canadian setting
Drug and Alcohol Dependence Volume 190, 1 September 2018, Pages 242-245

https://www.sciencedirect.com/science/article/pii/S0376871618303818?via%3Dihub

Abstract

Background
Opioid overdose deaths in North America have been rising largely as a result of fentanyl adulteration in the illegal drug supply. Drug checking is an established harm reduction intervention in some European settings but has not been broadly implemented or evaluated in North America. We are evaluating a pilot program offering drug checking for people who use street drugs in Vancouver, British Columbia.

Methods
Drug checking services were implemented at two locations in Vancouver between November 2017 and April 2018 using a Fourier transform infrared (FTIR) spectrometer and fentanyl immunoassay strips. We report on the findings generated by this technological combination during the study period.

Results
During the study period, a total of 1714 samples were tested. Of 907 samples expected to be heroin, only 160 (17.6%) contained the expected substance, and 822 (90.6%) tested positive for fentanyl. Of 256 samples expected to be speed or crystal meth, 225 (87.9%) contained amphetamine or methamphetamine, and 15 (5.9%) tested positive for fentanyl. The FTIR also found unexpected and potentially dangerous substances and adulterants other than fentanyl.

Conclusions
This pilot program has demonstrated the feasibility of drug checking for identifying individual drug samples containing unexpected or hazardous substances, including fentanyl. By identifying the range of adulterants and diluents and giving an estimate of their prevalence in different drug types, it has also provided information about the composition of the illicit drug supply in an urban North American setting.

Shahid A.: Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies
Innov Clin Neurosci. 2017 Jul-Aug; 14(7-8): 8–19. PMID: 29616150

Abstract

Opiate misuse is a chronic relapsing disease that has become an epidemic in the United States. Methadone is the mainstay of treatment for opiate addiction and has been researched widely. Recently, new avenues of treatment have been researched and developed. The objective of this review is to study methadone in comparison to other pharmacological options available or being considered for opiate addiction treatment through a methodical search and review of evidence provided by recent clinical trials conducted in this regard. There is a paucity of high quality randomized controlled trials focusing on the comparison between buprenorphine and methadone for treatment of opiate use disorder. Buprenorphine should be researched more for patient retention and satisfaction, as well as for its prospect for better outcomes in neonatal abstinence syndrome to generate more decisive recommendations. Current data suggest monitoring of liver enzymes with the use of buprenorphine/naloxone for better liver outcomes. In light of the analyzed data, the authors conclude that methadone should still be considered the preferred treatment mode in comparison to slow-release oral morphine and heroin.

Peles E. et al.: Is a History of Sexual Abuse Related to Poor Sleep Among Former Opioid-Addicted Women With and Without Methadone Maintenance Treatment?

Subst Use Misuse. 2017 Sep 19;52(11):1478-1485. doi: 10.1080/10826084.2017.1289224. Epub 2017 May 4 https://www.ncbi.nlm.nih.gov/pubmed/28471281

Abstract

To study whether poor sleep that is known to characterize methadone maintenance treatment (MMT) patients may be related to their past sexual abuse and/or their treatment modality, we compared perceived sleep indices (Pittsburgh Sleep Quality Index (PSQI); Epworth Sleepiness Scale (ESS)) and depression (21-HAM-D) between women with and without sexual abuse history (Childhood Trauma Questionnaire) in MMT and in a non-MMT („opioid medication-free“) in-patient rehabilitation center (MABAT). Twenty-six sexually abused women in MMT had the worst sleep quality scores (PSQI) (10.4 ± 4.2), followed by 15 sexually abused non-MMT women (7.9 ± 4.8), with the lowest score among 13 MMT non-sexually abused women (6.3 ± 4.8, p = 0.03). ESS score and cognitive state scores (Mini Mental State Exam) were similar. Depression (21-HAM-D) score was similar between the two sexually abused (MABAT and MMT) groups (15.3 ± 7.0 and 15.0 ± 6.3, respectively), but was significantly higher than the nonabused MMT group (10.5 ± 6.3, p = 0.03). Logistic regression model for being poor sleeper (PSQI >5), found depression OR = 1.2 (95% CI: 1.1-1.4, p = 0.001), and poor cognitive state (MMSE) OR = 0.6 (95% CI: 0.3-0.9, p = 0.03) to characterize poor sleep. We conclude that poor sleepers were depressed and this characterized sexually abused women in both the MMT and non-MMT groups.

Jetzt noch einige aktuelle Publikationen zu Metamphetaminkonsum und dessen Komplikationen:

Lam, L. et al.: Efficacy and safety of naltrexone for amfetamine and methamfetamine use disorder: a systematic review of randomized controlled trials
Clinical Toxicology, DOI: 10.1080/15563650.2018.1529317

https://www.tandfonline.com/doi/full/10.1080/15563650.2018.1529317

Abstract

Introduction: Amfetamine and methamfetamine abuse remains a prevalent health problem, increasing the burden on healthcare. Naltrexone, a µ-opioid receptor antagonist, has been suggested as a promising treatment for amfetamine and methamfetamine use disorder.

Objective: To review the current evidence for the efficacy and safety of naltrexone as a pharmacological treatment for amfetamine and methamfetamine use disorder. The primary outcome was defined as abstinence or reduction of use. Secondary outcomes were, attenuated “positive” subjective effects (e.g., “feel good,” “craving,” etc.) of amfetamine or methamfetamine after naltrexone treatment, adverse events and physiological changes (e.g., blood pressure, heart rate).

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature search was conducted on 2 April 2017, and updated on 31 March 2018. Records were retrieved from databases including PubMed, EMBASE Classic plus EMBASE 1980 via Ovid, and the databases were searched using keywords and/or headings: (naltrexone AND amfetamine AND dependence) OR (naltrexone AND amfetamine AND craving) OR (vivitrol AND amfetamine) OR (revia AND amfetamine) OR (naltrexone AND amfetamine) OR (naltrexone AND methamfetamine dependence) OR (naltrexone AND methamfetamine AND craving) OR (vivitrol AND methamfetamine) OR (revia AND methamfetamine) OR (naltrexone AND ice) OR (naltrexone AND crystal meth) OR (naltrexone AND methamfetamine). Studies investigating the effects of naltrexone on amfetamine or methamfetamine use were eligible for inclusion. All studies were rated as low risk of bias using the Cochrane tool for risk of bias.

Results: Among 591 identified studies, there were four randomized controlled trials. Two studies investigated the effects of naltrexone on amfetamine use disorder and two on methamfetamine use. Compared to placebo, the abstinence rate was increased significantly (p < 0.05) by naltrexone in one of two amfetamine studies, whereas there was no statistical difference in the only study reporting methamfetamine use. In one out of two amfetamine studies, naltrexone significantly attenuated either craving levels or subjective effects (e.g., “want more,” “like effect”) relative to placebo (p < 0.05). Additionally, only in one of two methamfetamine studies did naltrexone produce a significant reduction (p < 0.05) in craving levels or attenuated subjective effects. Both amfetamine and methamfetamine studies showed good tolerability of naltrexone, with few adverse events seen.

Conclusions: There is presently insufficient evidence to support the use of naltrexone in amfetamine and metamfetamine use disorders. There is a compelling need for high-quality studies to further evaluate the potential use of naltrexone.

Schürer,S., et al.: Clinical Characteristics, Histopathological Features, and Clinical Outcome of Methamphetamine-Associated Cardiomyopathy
JACC: HEART FAILURE VOL. 5, NO. 6, 2017

https://ac.els-cdn.com/S2213177917301658/1-s2.0-S2213177917301658-main.pdf?_tid=49ad196c-8e0d-4150-be99-668cff9d6e5d&acdnat=1547055642_4525632b7187fe369dc9cb7369224240

ABSTRACT

OBJECTIVES
This study aimed to assess characteristics including endomyocardial biopsy and outcome of patients with methamphetamine (MA)-associated cardiomyopathy in a series of patients treated in Germany.

BACKGROUND
MA abuse is an increasing problem worldwide.

METHODS
The cases of 30 consecutive MA-abusing patients with a left ventricular (LV) ejection fraction of < 40% and endomyocardial biopsy performed at initial diagnosis were analyzed. Baseline characteristics were collected retrospectively, whereas follow-up was prospective. The primary endpoint was a composite of death, nonfatal stroke, and rehospitalization for heart failure.

RESULTS
Patients were 30.3 1.9 years of age, predominantly male (93.3%), and highly symptomatic; 83.3% had New York Heart Association functional class III or IV dyspnea. Echocardiography revealed marked LV dilatation (mean LV end-diastolic diameter 67.17.4 mm) and impaired LV ejection fraction (mean 19 6%). One-third of the patients had intraventricular thrombi. Endomyocardial biopsy revealed markers of in flammation and fibrosis; the fibrosis correlated with the duration of MA abuse. At follow-up, discontinuation of MA abuse together with medical therapy partially improved cardiac function (LV ejection fraction, 19 6 vs. 43 13; p < 0.001) and symptoms (p ¼ 0.056), whereas patients with continued abuse did not show any improvement. The improvement in cardiac function was independently associated with the extent of fibrosis. The primary endpoint occurred more often in patients with continued MA abuse (57.1% vs. 17.4%; p ¼ 0.037).

CONCLUSIONS
MA-associated cardiomyopathy is characterized by severe heart failure and depressed cardiac function. The extent of myocardial fibrosis seems to predict the recoverability of LV function. Cessation of MA abuse is associated with improvement in cardiac function and symptoms, whereas continued MA abuse leads to ongoing heart failure and worse outcome.

Anu Gupta, et al.: N-methylamphetamine (“Crystal Meth”)−Associated Acute Renal Cortical Necrosis
Kidney Int Rep. 2018 Nov; 3(6): 1473–1476. Published online 2018 Jul 7. doi: 10.1016/j.ekir.2018.07.003 PMCID: PMC6224663 PMID: 30450474

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224663/

Zou, X.: Methamphetamine consumption and life-threatening abdominal complications: A case report
Medicine. 97(18):e0647, MAY 2018, DOI: 10.1097/MD.0000000000010647

PMID: 29718879, https://insights.ovid.com/pubmed?pmid=29718879

Abstract

Rationale: Methamphetamine (METH) abuse is increasing rapidly all over the world and becoming a significant public health concern in China. However, abdominal complications secondary to METH abuse are usually overlooked. We describe an unusual case of gangrenous cholecystitis and small intestinal ischemia due to METH abuse.

Patient concerns: In this report, a 44-year-old male patient with abdominal pain and hematochezia has a history of crystal meth abuse.

Diagnosis: The patient was diagnosed as septic shock, paralytic ileus, gangrenous cholecystitis, and small intestinal ischemia due to METH abuse based on computed tomography (CT) scan, endoscopy examination, laparotomy, and pathology.

Interventions: Antishock treatment, broad-spectrum antibiotics, and exploratory laparotomy were given.

Outcomes: The patient survived. Six months later, he tolerated oral intake and stopped using crystal METH.

Lessons: Visceral ischemia should be considered if an adult patient with a history of METH abuse is accompanied by abdominal pain and hematochezia.

McKelvie, M.A., et al.: Paralytic Ileus Secondary to Methamphetamine Abuse: A Rare Case
Case Reports in Surgery Volume 2017, Article ID 9762803, 3 pages

https://www.hindawi.com/journals/cris/2017/9762803/

Abstract: Methamphetamine hydrochloride, colloquially referred to as “crystal meth,” is a potent psychoactive amphetamine derivate. Methamphetamine produces stimulant effects in the user including increased energy and alertness as well as inducing intense euphoric symptoms and suppressing appetite through its dopaminergic, serotonergic, and adrenergic actions. Use of methamphetamine can adversely affect cardiovascular, neurological, and gastrointestinal physiology leading to significant morbidity. We present a rare case of paralytic ileus secondary to methamphetamine abuse which has only once before been described in the literature.

Pabst, A., et al.: Meth Mouth—A Growing Epidemic in Dentistry?

Dent J (Basel). 2017 Dec; 5(4): 29. Published online 2017 Oct 30. doi: 10.3390/dj5040029

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806971/

Abstract
In the past two decades, the synthetic style and fashion drug “crystal meth” (“crystal”, “meth”), chemically representing the crystalline form of the methamphetamine hydrochloride, has become more and more popular in the United States, in Eastern Europe, and just recently in Central and Western Europe. “Meth” is cheap, easy to synthesize and to market, and has an extremely high potential for abuse and dependence. As a strong sympathomimetic, “meth” has the potency to switch off hunger, fatigue and, pain while simultaneously increasing physical and mental performance. The most relevant side effects are heart and circulatory complaints, severe psychotic attacks, personality changes, and progressive neurodegeneration. Another effect is “meth mouth”, defined as serious tooth and oral health damage after long-standing “meth” abuse; this condition may become increasingly relevant in dentistry and oral- and maxillofacial surgery. There might be an association between general methamphetamine abuse and the development of osteonecrosis, similar to the medication-related osteonecrosis of the jaws (MRONJ). Several case reports concerning “meth” patients after tooth extractions or oral surgery have presented clinical pictures similar to MRONJ. This overview summarizes the most relevant aspect concerning “crystal meth” abuse and “meth mouth”.

Proebstl L., et al: Cognitive Deficits in Methamphetamine Users: How Strong is The Evidence?
Pharmacopsychiatry. 2018 Nov;51(6):243-250. doi: 10.1055/s-0043-123471. Epub 2018 Jan 15.

https://www.ncbi.nlm.nih.gov/pubmed/29334687

Abstract
Methamphetamine use has spread in many European countries and the United States. The current review provides a summary and critical analysis of research on cognitive deficits associated with methamphetamine, also known as „crystal meth.“ The literature search performed for this review led us to the hypothesis that methamphetamine use is associated with persistent changes in brain metabolism that result in various impairments, such as deficits in memory, attention, and concentration. The dopaminergic system in particular seems to be affected. Some studies indicate that cognitive impairments may improve when users become abstinent, but results of other studies are conflicting. This review discusses these findings and the consequences for the development of a specific addiction treatment for methamphetamine.

Výtisková T, et al.: Heart-attack in pregnancy
Ceska Gynekol. Summer 2016;81(4):283-285

https://www.ncbi.nlm.nih.gov/pubmed/27882750

Abstract

OBJECTIVE: To describe heart-attack on crystal meth addicted pregnant woman.

DESIGN: Case report.

CONCLUSION: Acute heart-attack during pregnancy means unexpected obstetric complication. The consequences could be fatal for the mother and the fetus. Although good delivery management and treatment could reduce morbidity and mortality to a minimum.

Dinger, J. et al.: Steigender Konsum von Crystal Meth in Sachsen und dessen Risiken für Mutter und Kind – Erfahrungen an einem Perinatalzentrum Level I aus pädiatrischer Sicht
Z Geburtshilfe Neonatol 2017; 221(02): 73-80
DOI: 10.1055/s-0043-102953

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0043-102953

Zusammenfassung
Die Anzahl bekannter Erstkonsumenten von Methamphetamin ist in Sachsen in den zurückliegenden Jahren sprunghaft angestiegen. Unter ihnen finden sich gehäuft auch junge Frauen im gebärfähigen Alter. Eine Unterstützung mit dem Ziel, die Auswirkungen des Drogenmissbrauches auf das Kind zu minimieren, sollte rechtzeitig, spätestens während der Schwangerschaft, besser noch davor beginnen. Zur Entwicklung entsprechender Angebote sind genauere Kenntnisse hinsichtlich der persönlichen Bedingungen der Frauen sowie der Besonderheiten der kindlichen Entwicklung nach fetaler Drogenexposition erforderlich. Hierzu wurden ausgewählte Daten von allen 129 Frauen sowie ihren neugeborenen Kindern analysiert, die von 2007 bis 2015 unmittelbar postnatal stationär an einem Perinatalzentrum Level 1 wegen des mütterlichen Drogenkonsums aufgenommen wurden. Etwa zwei Drittel der Frauen waren zum Zeitpunkt der Entbindung zwischen 20 und 30 Jahren alt und nur 48% nahmen die erste Vorsorgeuntersuchung bis zur vollendeten 12. Schwangerschaftswoche wahr. Bei den Kindern fielen pathologische Befunde u. a. an Herz, Urogenitalsystem und ZNS sowie eine heterogene klinische Entzugssymptomatik auf. Die vorgestellten Daten sollen die im Bereich der Geburtshilfe und Kindermedizin Tätigen sensibilisieren, um rechtzeitig adäquate Hilfen anbieten zu können. Ein Modell einer im Klinikverbund (Frauenklinik, Kinderklinik, Klinik für Psychiatrie) organisierten zeitgleichen Entzugs-Komplexbehandlung von Mutter und Kind – „Dresdner Versorgungspfad Crystal“ – wird vorgestellt.

Hassanian-Moghaddam, H. et al.: Stimulant Toxicity in Children: A Retrospective Study on 147 Patients
Pediatric Critical Care Medicine. 16(8):e290–e296, OCT 2015 DOI: 10.1097/PCC.0000000000000506, PMID: 26203623 Issn Print: 1529-7535

https://insights.ovid.com/pubmed?pmid=26203623

Abstract

Objective: To evaluate the signs/symptoms of different stimulant toxicities in children to determine differences among them.

Design: Observational, retrospective, single-center case-series.

Setting: The only referral hospital for pediatric poisoned patients in Tehran, Iran, covering 12.5 million permanent and 6.5 million temporary residents.

Patients: All children between 2007 and 2012 were evaluated. Their clinical findings, laboratory tests, electrocardiogram, and outcome were evaluated.

Interventions: None.

Measurements and Main Results: A total of 147 patients were enrolled (115, 24, three, and five with methamphetamine, methylphenidate, ecstasy, and unknown stimulant toxicities, respectively). Median (interquartile range) age of the methamphetamine- intoxicated children (16 mo [22–42 mo]) was significantly less than those with methylphenidate toxicity (66 mo [33–105 mo]). Almost 79% of the patients had ingested the stimulant, whereas 9% had passively been exposed to the methamphetamine smoke. The frequency of stimulant toxicity had significantly increased during the 5-year period of the study. Restlessness, mydriasis, stereotypic movements, and talkativeness were the most common signs and symptoms. Whereas bruxism only seen in 66.7% (95% CI, 21–94%) of ecstasy users, the prevalence of restlessness, sweating, and tremor was also more in this group of children. On the other hand, mydriasis and stereotypic movements were more common in crystal-meth patients by 76.5% (95% CI, 68–83%) and 53% (95% CI, 44–62%), respectively. A comparison between different routes of crystal-meth intoxication showed that flushing was more common in those who had passively/actively smoked/inhaled methamphetamine (odds ratio, 6.3 [95% CI, 1.5–26]). Palpitation was more seen in methylphenidate toxicity by 12.5% (95% CI, 4–31%). Restlessness was more detected in toddlers, whereas talkativeness and ataxia were more common in older children. Nineteen children (21%) had prolonged QTc according to normal values in different ages. None of them died.

Conclusions: More studies are warranted to evaluate the frequency and outcome of this poisoning in children. Educational preventive programs are also recommended.

Von Crystal Meth zu Chemsex – kein allzu weiter Weg:

Knoops, L. et al: TINA AND SLAMMING, MSM, CRYSTAL METH AND INTRAVENOUS DRUG USE IN A SEXUAL SETTING

http://mainline-eng.blogbird.nl/uploads/mainline-eng/Tina_And_Slamming_ENG_compressed2.pdf

Bakker I. et al.: Towards a continuum of care concerning chemsex issues.
Sex Health. 2018 Apr;15(2):173-175. doi: 10.1071/SH17139.

https://www.publish.csiro.au/SH/SH17139

Abstract
In response to the apparent rise in chemsex in the Netherlands Mainline Foundation interviewed 27 MSM about their crystal meth use and/or experience with injecting in a sexual context. These men were interviewed about their motivation for methamphetamine use, their sexual risk-taking behaviour, methods and context of their drug use, and their information- and care needs. In 2015 this resulted in the status report Tina and Slamming: MSM, Crystal Meth Use and Intravenous Drug Use in a Sexual Context. Following the publication of this report Mainline foundation has been offering harm-reduction intervention for MSM and promoting the development of a continuum of care by building networks, training professionals and investing in advocacy. In our view, a continuum of care means the availability of a sufficient level of qualitative and effective preventive interventions, harm reduction services and treatment facilities that are connected, can track and intervene in the ‘lifecycle’ of individual drug use, and are easily accessible by the target group. This case study describes the various interventions of Mainline foundation, that make up their continuum of care approach concerning chemsex issues.

Schmidt A.J., et al: European MSM Internet Survey 2017 Response, Demographics, Chemsex, PrEP

http://sigmaresearch.org.uk/files/AIDS2018_EMIS2017_Schmidt+Weatherburn_MOSA4704.pdf

Schmidt AJ, et al.: Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS).

Int J Drug Policy. 2016 Dec;38:4-12. doi: 10.1016/j.drugpo.2016.09.007. Epub 2016 Oct 25.

https://www.ncbi.nlm.nih.gov/pubmed/27788450

Abstract

BACKGROUND:
Anecdotal evidence suggests that men who have sex with men (MSM) are increasingly combining sex and illicit drugs (an activity referred to as ‚chemsex‘), in particular GHB/GBL, ketamine, crystal meth, or mephedrone (here called 4-chems). Use of such drugs has been associated with mental health and sexual health harms. We aim to compare patterns of illicit drug use among MSM in 44 European urban centres.

METHODS:
In 2010, EMIS recruited 174,209 men from 38 countries to an anonymous online questionnaire in 25 languages. As harm reduction services for drugs and sex are organised at a local level, we chose to compare cities rather than countries. We defined 44 cities based on region/postal code and settlement size. For multivariable regression analyses, three comparison groups of MSM not living in these cities were applied: MSM living in Germany, the UK, and elsewhere in Europe.

RESULTS:
Data from 55,446 MSM living in 44 urban centres were included. Use of 4-chems (past 4 weeks) was highest in Brighton (16.3%), Manchester (15.5%), London (13.2%), Amsterdam (11.2%), Barcelona (7.9%), Zurich (7.0%) and Berlin (5.3%). It was lowest in Sofia (0.4%). The rank order was largely consistent when controlling for age, HIV diagnosis, and number of sexual partners. City of residence was the strongest demographic predictor of chemsex-drug use.

CONCLUSION:
Use of drugs associated with chemsex among MSM varies substantially across European cities. As city is the strongest predictor of chemsex-drug use, effective harm reduction programmes must include structural as well as individual interventions.

Card, K. et al.: Assessing the longitudinal stability of latent classes of substance use among gay, bisexual, and other men who have sex with men

Drug and Alcohol Dependence Volume 188, 1 July 2018, Pages 348-355,

https://www.sciencedirect.com/science/article/pii/S0376871618302813?via%3Dihub

Abstract

Background
Association between substance use and HIV-risk among gay and bisexual men (GBM) is well documented. However, their substance use patterns are diverse, and it is unknown whether self-reported use patterns are stable over time.

Methods
Sexually-active GBM, aged >16 years, were recruited in Metro Vancouver using respondent-driven sampling and followed across 5 study visits at six-month intervals (n = 449). To identify distinct patterns of substance use and their longitudinal stability, Latent Transition Analysis (LTA) was conducted for drugs reported by at least 30 participants. Intraclass correlation coefficients (ICC) quantified the stability of class assignments.

Results
Six classes characterizing ‘limited drug use’ (i.e., low use of all drugs, except alcohol), ‘conventional drug use’ (i.e., use of alcohol, marijuana, and tobacco), ‘club drug use’ (i.e., use of alcohol, cocaine, and psychedelics), ‘sex drug use’ (i.e., use of alcohol, crystal meth, GHB, poppers, and erectile dysfunction drugs), ‘street drug use’ (i.e., use of alcohol and street opioids) and ‘assorted drug use’ (i.e., use of most drugs) were identified. Across five visits (2.5 years), 26.3% (n = 118/449) of GBM transitioned between classes. The prevalence of limited use trended upwards (Baseline:24.5%, Visit 5:28.3%, p < 0.0001) and assorted use trended downwards (13.4%–9.6%, p = 0.001). All classes had strong longitudinal stability (ICC > 0.97).

Conclusion
The stability of latent substance use patterns highlight the utility of these measures in identifying patterns of substance use among people who use drugs – potentially allowing for better assessment of these groups and interventions related to their health.

Literaturhinweis:

Ratgeber E-Zigarette: Einsteigen, Umsteigen, Aussteigen;Taschenbuch– 2. Oktober 2018

von Heino Stöver (Autor), Daniela Jamin (Autor), Sascha Eisenbeil (Autor)

Immer mehr Menschen nutzen sie, sind erfolgreich von den Tabakzigaretten losgekommen oder rauchen durch sie weniger. Auch Promis wie z.B. Leonardo DiCaprio, Johnny Depp, Kate Moss, Bruno Mars und Udo Lindenberg sieht man immer häufiger mit ihr in der Hand: Die E-Zigarette! Denn wie mittleiweile in der gesamten Gesellschaft angekommen sein dürfte, ist Rauchen die Hauptursache von vielen Erkrankungen und gesundheitlichen Problemen – es lohnt sich damit aufzuhören. Trotz rapider Zunahme von Dampfer_innen bestehen noch immer Unsicherheiten über die Schädlichkeit oder die richtige Nutzung der E-Zigarette. Dieser Ratgeber hat das Ziel, genau diese Unsicherheiten aus dem Weg zu räumen. Er bietet für Lesefaule oder Eilige einen schnellen Überblick über Mythen rund um die E-Zigarette und die ersten Schritte zum Umstieg, bietet aber auch Informationen zum aktuellen Forschungsstand und den Aufbau der E-Zigarette für Interessierte, die tiefer in die Materie einsteigen möchten. Mit dem Fokus auf Schadensminimierung versucht der Ratgeber explizit die Menschen anzusprechen, die sich vom Tabak verabschieden möchten und eine Alternative zu den bisherigen Methoden suchen.

Termine:

Kurs Suchtmedizinische Grundversorgung im Rahmen der Langeooger Fortbildungswochen

LANGEOOGER FORTBILDUNGSWOCHEN 2019

www.aekn.de, 18. Mai –7. Juni 2019

Datum: 02.06. – 07.06.2019 Ort: Langeoog, Kosten: 650,00 €
Kursleiter: Frau Professor Havemann-Reinecke und Herr Dr. Cimander

https://www.aekn.de/fileadmin/media/Downloadcenter/Fortbildung/Langeoog_2019/Flyer-Langeooger-FBW_2019-2-Web.pdf

62nd Session of the Commission on Narcotic Drugs (CND) and Ministerial Segment

14 – 22 March 2019
Vienna, Austria,

http://www.unodc.org/unodc/en/commissions/CND/CND_Meetings-Current-Year.html

SSDP2019: The Global Students for Sensible Drug Policy Conference
3/29-3/31
Crowne Plaza Chicago Ohare Hotel & Conference Center
5440 N River Rd, Rosemont, IL 60018

https://conference.ssdp.org/

The International Liver Congress™ 2019
Annual Meeting – Vienna 10-14 April, 2019

http://www.easl.eu/discover/events/detail/2019/the-international-liver-congress-2019

26th Harm Reduction International Conference

28 April – 1 May 2019 Porto, Portugal

https://idpc.net/events/2019/04/hr19-host-city-announced-as-porto-portugal?utm_source=IDPC+Monthly+Alert+%28English%29&utm_campaign=bca8e26889-IDPC+December+Alert+2018&utm_medium=email&utm_term=0_801bc38237-bca8e26889-151913411

XIV. Kongress der DGGPP 15. bis 17. Mai 2019 in Essen

Gerontopsychiatrie 2019 – mit Kompetenz die Versorgung für die neue Dekade sichern (mit Symposium „Sucht und Alter)

http://kongress.dggpp.de/call.htm

9. Deutsch – Östereichischer AIDS Kongress

Hamburg vom 13.06. – 15.06.2019

https://doeak2019.de/

10th IAS Conference on HIV Science

Mexiko-City vom 21.07. bis 24.07. 2019

https://www.ias2019.org/

29. dagnä–Workshop

6.-7. September 2019 in Köln

https://daignet.de/site-content

8th International Conference on Hepatitis Care in Substance Users

Le Westin, Montréal, Canada
11 – 13 September 2019

http://inhsu2019.com/

Deutscher Suchtkongress 2019

15. September 2019 bis 17. September 2019 in Mainz

http://www.dg-sucht.de/tagungen/kongresse/?L=0

17th European AIDS Conference

Vom 06.11.2019 bis 09.11.2019 in Basel

https://eacs-conference2019.com/

DGPPN Kongress 2019

Kongress Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde
27. November 2019 – 30. November 2019 in Berlin

https://www.dgppn.de/

Mit freundlichen und kollegialen Grüßen
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Verantwortlicher Redakteur: Konrad Isernhagen (Köln). 
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