About 15 years ago, a diverse group of new recreational psychotropic substances began to emerge, which were marketed for example as "legal highs," "research chemicals," or "designer drugs." These ...substances were later subsumed under the label "Novel Psychoactive Substances" (NPS). Important NPS classes are cathinones, synthetic cannabimimetics, phenethylamines, and herbal drugs. The health care system for psychotropic substance use disorders (SUDs) traditionally focused on a few substances, such as alcohol, heroin, cocaine, amphetamines, or cannabis. Users of illicit substances often engage in polydrug use. However little is known about the prevalence of NPS use within the group of "classical" illicit substance users.
We investigated lifetime and recent use of NPS and other drugs in patients who underwent in-patient detoxification treatment from illicit drugs in Germany.
In a multicenter study with eight participating facilities, patients admitted to treatment underwent a standardized interview at admission, concerning their past and current substance use. The interview comprised classical substances of abuse, NPS, and rarely used substances such as LSD. In addition, participating sites had the opportunity to analyze their patients' routine drug screenings by means of gas chromatography/mass spectrometry (GC/MS), which permitted detection of NPS.
Interviews from 295 patients could be analyzed. Most patients were opiate dependent and multiple substance users. About 32% reported use of synthetic cannabimimetics during lifetime, but usually only a few times. An important reason for their use was that NPS were not detected by drug testing in prisons or drug treatment facilities. Cathinones, herbal drugs or other NPS had rarely been used during lifetime. NPS use during the last 30 days before admission was nearly zero. This was confirmed by urine analysis results. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. In addition, 18% reported of regular unprescribed pregabalin use during lifetime, and 20% had recently used pregabalin.
Patients admitted to drug detoxification treatment showed multiple substance use, but this did not include NPS use. The diversion of legal medications such as pregabalin in this group is a serious concern.
Background:
Over the past 15 years, comparative assessments of psychoactive substance harms to both users and others have been compiled by addiction experts. None of these rankings however have ...included synthetic cannabinoids or non-opioid prescription analgesics (NOAs, e.g., gabapentinoids) despite evidence of increasing recreational use. We present here an updated assessment by German addiction medicine experts, considering changing Western consumption trends–including those of NOAs.
Methods:
In an initial survey, 101 German addiction medicine physicians evaluated both physical and psychosocial harms (in 5 dimensions) of 33 psychoactive substances including opioids and NOAs, to both users and others. In a second survey, 36 addiction medicine physicians estimated the relative weight of each health and social harm dimension to determine the overall harm rank of an individual substance. We compared our ranking with the most recent European assessment from 2014.
Results:
Illicit drugs such as methamphetamine, heroin, cocaine and also alcohol were judged particularly harmful, and new psychoactive drugs (cathinones, synthetic cannabinoids) were ranked among the most harmful substances. Cannabis was ranked in the midrange, on par with benzodiazepines and ketamine—somewhat more favorable compared to the last European survey. Prescribed drugs including opioids (in contrast to the USA, Canada, and Australia) were judged less harmful. NOAs were at the bottom end of the ranking.
Conclusion:
In Germany, alcohol and illicit drugs (including new psychoactive substances) continue to rank among the most harmful addictive substances in contrast to prescribed agents including opioid analgesics and NOAs. Current laws are incongruent with these harm rankings. This study is the first of its kind to include comparative harm rankings of several novel abused substances, both licit/prescribed and illicit.
Introduction
Over the last decade, the use of New/Novel Synthetic Opioids (NSO) has emerged as an increasing problem, and especially so in the USA. However, only little is known about the prevalence ...and history of NSO use in European heroin dependents.
Method
A cross-sectional multicenter study, carried out with the means of both standardized interviews and urine toxicology enhanced screening, in a sample of opioid addicted patients referred for an in-patient detoxification treatment.
Results
Sample size included here
n
= 256 patients; prior to admission, 63.7% were prescribed with an opioid maintenance treatment. Lifetime use of heroin and opioid analgesics was reported by 99.2 and 30.4%, respectively. Lifetime NSO/fentanyl use was reported by 8.7% (
n
= 22); a regular use was reported by 1.6% (
n
= 4), and ingestion over the 30 days prior to admission by 0.8% (
n
= 2). Most typically, patients had started with a regular consumption of heroin, followed by maintenance opioids; opioid analgesics; and by NSO. Self-reported data were corroborated by the toxicology screenings carried out; no evidence was here identified for the presence of heroin being contaminated by fentanyl/derivatives.
Discussion
NSO and also opioid analgesics did not play a relevant role in the development and the course of opioid/opioid use disorders in German patients referred for an inpatient detoxification treatment.
Karl August von Hardenberg (1750-1822) stand lange Zeit im Schatten seines berühmteren Ministerkollegen, des Freiherrn vom Stein. Allmählich bricht sich die Auffassung Bahn, dass Hardenberg, der ...zwölf Jahre lang mit einer beispiellosen Machtfülle als preußischer Staatskanzler amtierte, den größeren Anteil an den preußischen Reformen zu verantworten hat. Diese Reformen werden in den Beiträgen dieses Buches, die von den jeweils besten Kennern der Materie stammen, erneut bewertet. Vor allem aber geben die Beiträge in ihrer Gesamtheit ein rundes Bild der Persönlichkeit Hardenbergs und seiner langen politischen Laufbahn, nicht nur in Preußen, sondern auch in Hannover, Braunschweig und den fränkischen Nebenlanden der Hohenzollern, ab. Auch bisher vernachlässigte Gebiete, wie Hardenbergs Rolle als Diplomat von europäischer Bedeutung sowie seine erst vor kurzem erschienenen Tagebücher, kommen zur Geltung. Beiträge von David E. Barclay, Walter Demel, Christof Dipper, Philip G. Dwyer, Rudolf Endres, Hans-Werner Hahn, Andrea Hofmeister, Michael Hundt, Silke Lesemann, Georg Moll, Paul Nolte, Brendan Simms, Thomas Stamm-Kuhlmann, Barbara Vogel.
Die Brücke Stamm-Kuhlmann, Thomas
Zeitschrift für Ideengeschichte,
2023, Letnik:
17, Številka:
2
Journal Article
In Glienicke ist Berlin zu Ende. Wenn man über die Brücke gefahren ist, ist man in Potsdam. Im Kalten Krieg konnte man diese Brücke gar nicht passieren, es sei denn, man war ein Spion, der ...ausgetauscht und in sein Friedenslager zurückgeschickt wurde. Über die Brücke führte die Chaussee, die 1788 bis 1794 zwischen den Residenzstädten Berlin und Potsdam angelegt worden ist. Bis heute heißt sie Königstraße, denn hier war der König tatsächlich unterwegs, wenn er, wie so häufig, seinen Wohnsitz von Berlin-Mitte oder Charlottenburg ins Potsdamer Stadtschloss oder nach Sanssouci und wieder zurückverlegte. Auf Berliner Seite endete die Berlin-Potsdamer Chaussee am Potsdamer Tor. Von hier aus war es nicht weit bis zum Dönhoffplatz, Standort des Null-Meilen-Zeigers für die Entfernungsangabe nach Potsdam. Am Dönhoffplatz in der Leipziger Straße 75 stand das Palais des Ministers und späteren Staatskanzlers Karl August von Hardenberg, den König Friedrich Wilhelm III. 1814 in den Fürstenrang erhob.
Alte Hüte. Preußen, Reformen und Moderne Richter, Hedwig; Stamm-Kuhlmann, Thomas
Zeitschrift für Ideengeschichte,
02/2018, Letnik:
12, Številka:
1
Journal Article
Auch Wissenschaft kann sich nicht den Fragen der Mode entziehen. Als neulich auf einer Tagung das Wort «Moderne» fiel, erklärte ein junger Herr (mit Bart, Undercut und dunklem Brillengestell): ...«‹Moderne›» (angewidertes Kräuseln der Gesichtszüge), «nein, das geht nicht mehr.» Keine Frage, ein unschlagbares Argument.
Patients from opioid maintenance treatment (OMT) may taper off from opioids during rehab treatment. It is investigated whether this option improves treatment outcomes in particular for those patients ...who are affected by psychiatric or somatic comorbidity, or by social problems.
Multicenter study with 4 rehab units. Patient characteristics and treatment outcomes were collected retrospectively. There were n = 227 patients who were admitted to treatment while still receiving OMT, and n = 156 who were opioid free.
With regard to regular completion of rehab treatment, an interaction was observed between status at admission and diagnosis of affective, neurotic and anxiety disorders, and between status and previous rehab treatment experience. If admitted in an abstinent status, patients who had never entered rehab, and patients with affective or anxiety disorders showed decreased regular completion rates, while they showed increased completion rates if tapered off during treatment. There was no interaction between initial status and acute life crisis (release from prison, homelessness), somatic diagnoses, or number of stabilizing social factors.
Admission while still receiving opiate maintenance could be helpful for patients with psychiatric comorbidity and for patients who had previously been reluctant to enter rehab treatment.
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