Buchert, R., Thomasius, R., Nebeling, B., Petersen, K., Obrocki, J., Jenicke, L., et al. (2003). Long-Term Effects of “Ecstasy” : Use on Serotonin Transporters of the Brain Investigated by PET. Journal of nuclear medicine, 44(3), 375–384.
Abstract: Alterations of the serotonergic system due to ecstasy consumption have been extensively documented in recent literature. However, reversibility of these neurotoxic effects still remains unclear. To address this question, PET was performed using the serotonin transporter (SERT) ligand 11C-(+)-McN5652 in a total of 117 subjects subdivided into 4 groups: actual ecstasy users (n = 30), former ecstasy users (n = 29), drug-naive control subjects (n = 29), and subjects with abuse of psychoactive agents other than ecstasy (n = 29). Methods: About 500 MBq 11C-(+)-McN5652 were injected intravenously. Thirty-five scans were acquired according to a dynamic scan protocol of 90 min using a full-ring whole-body PET system. Transaxial slices were reconstructed using an iterative method. Individual brains were transformed to a template defined earlier. Distribution volume ratios (DVRs) were derived by application of a reference tissue approach for reversible binding. Gray matter of the cerebellum served as reference. SERT-rich brain regions—mesencephalon, putamen, caudate, and thalamus—were selected for the evaluation of SERT availability using volumes of interest predefined in the template. Results: Compared with drug-naive control subjects, the DVR in actual ecstasy users was significantly reduced in the mesencephalon (P = 0.004) and the thalamus (P = 0.044). The DVR in former ecstasy users was very close to the DVR in drug-naive control subjects in all brain regions. The DVR in polydrug users was slightly higher than that in the drug-naive control subjects in all SERT-rich regions (not statistically significant). Conclusion: Our findings further support the hypothesis of ecstasy-induced protracted alterations of the SERT. In addition, they might indicate reversibility of the availability of SERT as measured by PET. However, this does not imply full reversibility of the neurotoxic effects.
Keywords: addiction; AOD dependence; chemical addiction; ecstasy
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Strathdee, S. A., & Vlahov, D. (2001). The effectiveness of needle exchange programs : A review of the science and policy. AIDSScience, 1(6; 13.12.2001).
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various. (1992). Needlestick injury (Letters to the Editor). The Lancet, 340(07.11.1992), 1166–1167.
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Nixon, A. D., Law, R., Officer, J. A., Cleland, J. F., & Goldwater, P. N. (1986). Methods and devices : simple device to prevent accidental needle-prick injuries. The Lancet, (19.04.1986), 888–889.
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Guydish, J., Bucardo, J., Young, M., Woods, W., Grinstead, O., & Clark, W. (1993). Evaluating needle exchange : are there negative effects? Aids, 7(6), 871–876.
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Welton, A., Adelberger, K., Patterson, K., & Gilbert, D. (2004). Optimal placement of syringe-exchange programs : abstract. Journal of urban health : bulletin of the New York Academy of Medicine, 81(2), 1.
Abstract: Syringe-exchange programs (SEPs) will likely play a major role in slowing the spread of acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs), but the success of any single SEP will depend to a large extent on where it is located. We show how the optimal position for a new SEP can be chosen given accurate knowledge of where IDUs live and how far they are willing to travel to an SEP. This information is not normally available, and one of our major points is that SEPs will necessarily be placed in suboptimal locations and will serve fewer IDUs than they otherwise might until it becomes available. Our method for choosing the best SEP placement is illustrated with Manhattan as an idealized example.
Keywords: harm reduction
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Stöver, H., & Nelles, J. (2003). Ten years of experience with needle and syringe exchange programmes in European prisons : review. International journal of drug policy, 14(1), 437–444.
Abstract: Results of needle and syringe exchange programmes (SEPs) in prisons based on 10 years experience in Switzerland, Germany, Spain and Moldova are presented. SEPs have been introduced in 46 European prisons, predominantly as pilot projects. Forty-three of these projects were still operating at the time of writing. In 11 prisons, SEPs were evaluated to assess feasibility and efficacy. Results did not support fears that commonly arise in the start-up of implementation of SEPs. Syringe distribution was not followed by an increase in drug use or injection drug use. Syringes were not misused, and disposal of used syringes was uncomplicated. Sharing of syringes among drug users reduced. Based on these experiences, it can be concluded that in these settings harm reduction measures, including syringe exchange, were not only feasible but efficient. Despite these positive results, syringe exchange in prison is far from general acceptance. However, a governmental decree released in Spain in 2001 that all prisons in the country are required to provide drug users with sterile injection equipment may lead to a breakthrough of this harm reduction measure in the future. The discrepancy concerning the success of SEPs in prisons on the one hand and its low acceptance on the other hand is striking. Suggestions for the installation of SEPs in prison are given to assist a more objective discussion.
Keywords: harm reduction
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Stark, K., Leicht, A., & Müller, R. (1994). Characteristics of users of syringe vending machines in Berlin. Sozial- und Präventivmedizin = Social and preventive medicine, 39(4; 07/1994), 209–216.
Abstract: Vending machines providing sterile injection equipment are part of the AIDS prevention measures for injecting drug users (IDU) in Berlin. A study was carried out to assess characteristics (history of iv drug use, frequency of use of the machines, contact with counselling units for IDU, attitudes towards the machines, HIV serostatus) in users of syringe vending machines. Of the 313 individuals surveyed 77% reported using the vending machines regularly (more than four times a week). Compared to other studies of IDU in Berlin (e.g. at syringe exchange programmes) the users of the vending machines hat a significantly shorter history of iv drug use. Overall, 72% of the IDU had had contacts at some time with specialised agencies for counselling on drug abuse and AIDS; however, only 33% had such contacts currently. Sixty-five percent of the IDU commented critically on the machines or made suggestions for improvement; 18% had experienced that the machines did not always work well, 14% called for more machines. HIV seroprevalence based on selfreported test results (N=252) was 20%. In multivariate statistical analysis positive HIV serostatus was associated with site of interview, longer history of intravenous drug use, and current contact with counselling agencies. Despite the ready availability of syringes and needles, 25% of the participants reported borrowing injection equipment from other IDU in the previous six months. This proportion was significantly higher in IDU younger than 25 years (39%). In addition to syringe exchange programmes and pharmacies, the syringe vending machines appear to be an important source of sterile injection equipment for IDU in Berlin particularly for those without current contacts to specialised counselling units. Automaten zur Abgabe steriler injektionsbestecke sind in Berlin Teil der AIDS-Präventionsmassnahmen für iv Drogenkonsumenten (IVD). Eine Studie wurde durchgeführt, um Informationen zu bestimmten Charakteristika (Inanspruchnahme der Automaten, Kontakt zu Beratungseinrichtungen für IVD, Kritik/Verbesserungsvorschläge zu den Automaten, HIV-Serostatus) bei den Benutzern der Automaten zu gewinnen Siebenundsiebzig Prozent der 313 Untersuchten benutzten die Automaten regelmässig (mehr als viermal wöchentlich). Im Vergleich zu einer Studie bei IVD in Spritzentauschprogrammen war die Dauer des iv Drogenkonsums bei den Benutzern der Spritzenautomaten signifikant kürzer. Zwar hatten 72% schon einmal Kontakt zu Beratungseinrichtungen für IVD gehabt, zur Zeit der Untersuchung bestanden solche Kontakte jedoch nur bei 33% Von allen Untersuchten äusserten 65% Kritik oder Verbesserungsvorschläge zu den Automaten bei 18% hatten diese nicht immer funktioniert 14% forderten mehr Automaten. Die HIV-infektionsraten bei denjenigen mit bekanntem Testergebnis (N=252) lag bei 20%. In der multivariaten statistischen Analyse waren, Untersuchungsort, längere Dauer des iv Konsums und aktueller Kontakt zu Beratungseinrichtungen signifikant mit einem positiven HIV-Serostatus assoziiert. Trotz der guten Verfügbarkeit von sterilen injektionsbestecken gaben 25% der Befragten an, in den letzten 6 Monaten gebrauchte Spritzbestecke von anderen IVD benutzt zu haben. Dieser Anteil war bei jüngeren IVD (<25 Jahren) mit 39% signifikant erhöht. Die Spritzenautomaten stellen eine wichtige Ergänzung zur Abgabe von sterilen Spritzen und Kanülen in Spritzentauschprogrammen und Apotheken dar, insbesondere für IVD ohne Kontakt zu spezialisierten Beratungseinrichtungen. La mise en place de distributeurs automatiques de seringues stériles pour les toxicomanes fait partie des mesures préventives contre le SIDA à Berlin. Une étude a été réalisée pour déterminer les caractéristiques des usagers de distributeurs automatiques (utilisation des distributeurs, contacts avec les services d’aide aux toxicomanes, avis à propos des distributeurs, status sérologique VIH). Parmi les 313 personnes participant à l’étude, 77% ont déclaré utiliser les distributeurs régulièrement (plus de 4 fois par semaine). 72% des participants avaient en des contacts avec des services specialisés d’aide aux toxicomanes mais seulement 33% utilisaient ces services au moment de l’etude. 65% de personnes examinées ont éxprimé leurs critiques ou suggestions pour l’amélioration des distributeurs: 18% ont signalé que les distributeurs ne fonctionnaient pas toujours, 14% demandaient l’installation d’un plus grand nombre de ceux-ci. La prévalence de l’infection à VIH rapportées par les toxicomanes était de 20% (N=252) Une analyse statistique multivariée montre que la séropositivité au VIH est associée avec de lieu de l’examen, la durée de la consommation de drogue par injection et le contact avec des services d’aide. Malgré la disponibilité de seringues stériles; 25% des personnes ont indiqué avoir utilisé du matériel d’injection usagé au cours des 6 derniers mois. Cette proportion était significativement plus élevée parmi les toxicomanes de moins de 25 ans (39%). Les distributeurs automatiques semblent constituer un complément important au programme d’échange de seringues stériles en particulier pour les toxicomanes qui n’ont pas de contact avec les services d’aide aux toxicomanes.
Keywords: harm reduction
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McConnell, H. (1991). Needle sticks a low risk, Italian scientist suggests. The Journal, August/September, 5.
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Vernick, J. S., Burris, S., & Strathdee, S. A. (2003). Public opinion about syringe exchange programmes in the USA: an analysis of national surveys. International journal of drug policy, 14, 431–435.
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