Background and aims
Lysergic acid diethylamide (LSD) and psilocybin are used as recreational drugs, and there is renewed interest in their clinical use. The current study aimed to (1) determine the ...circumstances of death and case characteristics of LSD‐ and psilocybin‐related death in Australia, 2000–23; and (2) determine the toxicological profile and major autopsy findings of these cases.
Methods
This was a retrospective exploratory study of all cases of LSD‐ and psilocybin‐related death in Australia, 2000–23, retrieved from the National Coronial Information System.
Results
A total of 43 cases were identified: 33 LSD and 10 psilocybin. The median ages were 24 years interquartile range (IQR) = 13, range = 16–53 (LSD) and 26 years (IQR = 18.5, range = 20–58) (psilocybin), and fewer than five cases were female. The most common circumstance of death among both groups was traumatic accident (LSD 36.4%, psilocybin 40.0%). There were 12 cases of self‐harm, all of which involved LSD, all by physical means. In a fifth, death was attributed to multiple drug toxicity (LSD 18.2%, psilocybin 20.0%). In one case, death was attributed solely to LSD toxicity, while in a further two cases death was attributed to a cardiovascular event following LSD consumption (one LSD only, one multiple drug toxicity). In four psilocybin cases, the cause of death was undetermined. The most common clinical presentation was severe agitation (LSD 27.3%, psilocybin 20.0%). Median blood concentrations were LSD 0.8 μg/l (IQR = 1.7, range = 0.1–3), psilocin 20 μg/l (IQR = 53.5, range = 6–83). LSD was the only drug present in 25.0% of LSD cases and psilocybin in 20.0% of psilocybin cases. Pre‐existing organ pathology was uncommon.
Conclusions
Lysergic acid diethylamide (LSD)‐ and psilocybin‐related death in Australia from 2000 to 2023 was primarily due to traumatic injury, whether through accident or self‐harm. Cases of acute toxic reactions that were attributed solely to LSD were rare.
Background
The increasingly popular practice among adolescents and young adults of consuming alcohol mixed with energy drinks (AmED) has raised concern regarding potential increases in maladaptive ...drinking practices, negative psychological and physiological intoxication side effects, and risky behavioral outcomes. Comparison of user types has revealed that AmED users report engaging in more risk‐taking behavior relative to alcohol users. However, the comparative likelihood of risk‐taking according to session type (i.e., AmED vs. alcohol session) remains relatively unknown. Thus, this study was designed with the aim of establishing the subjective physiological, psychological, and behavioral risk‐taking outcomes of AmED consumption relative to alcohol consumption for AmED users drawn from the community.
Methods
Between May and June 2011, 403 Australians aged 18 to 35 who had consumed AmED and alcohol only in the preceding 6 months completed a 10‐ to 30‐minute online survey about their use of these substances.
Results
Despite participants consuming a significantly greater quantity of alcohol in AmED sessions compared to alcohol sessions, the odds of participants experiencing disinhibition and engaging in 26 risk behaviors were significantly lower during AmED sessions relative to alcohol sessions. Similarly, the odds of experiencing several physiological (i.e., speech and walking difficulties, nausea, and slurred speech) and psychological (i.e., confusion, exhaustion, sadness) sedation outcomes were less during AmED sessions compared to alcohol sessions. However, the odds of enduring physiological (i.e., heart palpitations, sleep difficulties, agitation, tremors, jolt and crash episodes, and increased speech speed) and psychological (i.e., irritability and tension) outcomes potentially related to overstimulation were significantly greater during AmED sessions than alcohol sessions.
Conclusions
Co‐ingestion may provide a double‐edged effect. The increased stimulation from energy drinks (EDs) may negate some intoxication‐related sedation side effects by increasing alertness. However, it could also lead to negative physiological side effects associated with overstimulation. Notwithstanding any stimulatory effects of EDs, risk and negative effects of excessive alcohol consumption were present in both session types. However, the odds of engaging in risk‐taking were less during AmED sessions relative to alcohol sessions. Objective measurement of behavioral risk‐taking via laboratory‐based measures could confirm the causal relationship between AmED and risk‐taking.
A major alcohol-related harm is structural pathology affecting the brain. The study aimed to: 1. Determine the frequency and nature of neuropathology amongst cases of death due to acute alcohol ...toxicity; 2. Compare diagnoses of brain atrophy with pathology in other organs; 3. Determine the demographic, clinical and organ pathology correlates of brain atrophy.
Retrospective study of 500 cases of death attributed to acute alcohol toxicity in Australia, 2011–2022. Data on clinical characteristics, toxicology, neuropathology and other organ pathology were retrieved from police reports, autopsies, toxicology and coronial findings.
Mean age was 49.5 years, 69.4 % were male, with alcohol use problems documented in 70.2 %. Brain atrophy was diagnosed in 60 cases (12.0 %), most commonly in the cerebellum (32 cases, 6.4 %). Atrophy at other sites was present in 37 (7.4 %). The presence of brain atrophy was lower than other major pathologies: cardiomegaly (32.6 %, p<.001), nephro/arteriosclerosis (30.2 %, p<.001), and chronic obstructive pulmonary disease (21.8 %, p<.001) but not hepatic cirrhosis (11.9 % p=1.0). Those diagnosed with atrophy were older (53.4v 49.0 years, p<.001), more likely to have documented alcohol problems (85.0v 68.2 %, Odds ratio: OR 2.53) and seizure history (10.0v 3.0 %, OR 2.92), to have cardiomegaly (43.3v 31.0 %, OR 1.90, COPD (48.3v 18.2 %, 3.57) and nephro/arteriosclerosis (50.0 v 27.4 %, OR 2.27).
Despite the majority of cases having a history of alcohol problems, the level of neuropathology amongst cases of death due to acute alcohol toxicity was comparatively low.
•National profile of neuropathology of alcohol poising deaths.•Brain atrophy was diagnosed in 12.0 %.•The level of brain atrophy was lower than in other major organs.•Those with atrophy were older and more likely to have disease in other organs.•Despite long-standing heavy alcohol use, neuropathology was comparatively low.
Various behavioral impulsivity measures have been developed, yet there has been no recent synthesis and evaluation of available tools. Key to consider is the context for assessment, and whether they ...can be delivered outside of the laboratory. The aim of this review was to identify and appraise behavioral impulsivity measures, with a secondary objective of identifying measures suitable for real-world delivery (independent of researcher administration).
PsycINFO, Embase, Medline and PsycTESTS databases were searched for articles published from 1997 using a behavioral impulsivity measure suitable for adults (PROSPERO: CRD42017057784). Measures assessing response disinhibition, impulsive response initiation, and/or impulsive decision-making were identified, delivery method assessed, and searches undertaken for psychometric properties of tasks.
Twenty four behavioral impulsivity measures were identified; evidence of adequate reliability and validity was reported for only eight measures. Only six measures did not require computer facilities. Two measures were suitable for pen-and-paper delivery, the Monetary Choice Questionnaire and Probabilistic Discounting Task, both of which index impulsive decision-making.
Further validation of impulsivity measures is necessary to assist researchers in choosing an appropriate measure for their research setting. Development of behavioral impulsivity measures which can be delivered outside of the laboratory context is a key priority.
•The review identified and appraised twenty four behavioral impulsivity measures.•Only eight measures had evidence of adequate validity and test-retest reliability.•A majority of measures were designed and optimized for use in laboratory settings.•Two pen-and-paper measures were identified as suitable for use in field research.
Background
While several researchers have proposed a causal relationship between alcohol mixed with energy drink (AmED) consumption and subsequent alcohol intake, there is a dearth of research ...exploring the potential mechanisms underpinning this association.
Methods
Marczinski and colleagues (in press) report the results of a double‐blind, placebo‐controlled, between‐groups study assessing whether an initial AmED dose primes an increased motivation to drink relative to alcohol alone. Participants (n = 80) received either alcohol (0.91 ml/kg vodka), energy drink (ED; 1.82 ml/kg Red Bull®), AmED, or a placebo beverage and then self‐reported their motivation to drink via the Desire‐for‐Drug scale.
Results
Subjective ratings of “desire more alcohol” were significantly higher than predrink in the placebo, alcohol, and AmED conditions, with this effect apparent at more time points in the AmED condition. While it was concluded that EDs may increase alcohol priming, between‐condition analyses revealed that ratings did not differ significantly in AmED and alcohol conditions, with moderate magnitude treatment effects at most, and ratings of desire generally closer to 0 (absence of desire) than 100 (very much desire).
Conclusions
While the study by Marczinski and colleagues fills an important gap in the literature, direct measurement of AmED priming's effect on subsequent alcohol consumption using a within‐subjects design and appropriate statistical comparison is required to (i) establish the practical implications of these results for AmED consumers and (ii) discount any individual differences in such priming effects.
Aims
To (i) assess the population mortality rates of cocaine‐related deaths in Australia, 2000 to 2021; (ii) determine the circumstances of death and case characteristics; and (iii) determine their ...toxicological profile.
Design
Retrospective study of cocaine‐related deaths in Australia, 2000 to 2021, retrieved from the National Coronial Information System.
Setting
Australia‐wide.
Cases
A total of 884 cases, mean age = 33.8 (SD, 10.0) years and 86.5% (n = 765) male.
Measurements
Information was collected on characteristics, manner of death and toxicology. Only cases in which the presence of blood cocaine and/or metabolites were included.
Findings
Population rates did not significantly increase during 2001–2011 (annual percentage change APC = 1.5; CI, −3.2, 6.5), but from 2012, there was a marked acceleration (APC = 20.0, 95% CI, 15.5, 25.3). Circumstances of death were unintentional drug toxicity (70.7%, n = 625), intentional self‐harm (17.8%, n = 157), traumatic accident (11.5%, n = 102). The proportion of cases constituted by unintentional toxicity declined across the study period (APC = −2.6; CI, −3.1, −2.1). There was a substantial decline in the proportion of cases with a history of injecting drug use (APC = −5.7; CI, −6.5, −4.9) and with a history of substance use problems (APC = −3.2; CI, −3.9, −2.5). Both cocaine (0.100 vs 0.050 mg/L, P < 0.001) and benzoylecgonine (0.590 vs 0.240 mg/L, P < 0.001) concentrations were higher amongst toxicity cases than in cases of death from traumatic injury. Cocaethylene was present in 26.4% (n = 233), levamisole in 18.6% (n = 164) and lignocaine in 11.5% (n = 102). Psychoactive drugs in addition to cocaine were present in 92.9% (n = 821), most commonly opioids (50.5%, n = 446), alcohol (47.1%, n = 416), hypnosedatives (43.2%, n = 382) and psychostimulants (30.3%, n = 268). There was a steady decline in the proportion of opioid positive cases (APC = −5.4; CI, −6.3, −4.5).
Conclusions
There was a large increase in cocaine‐related deaths across Australia from 2000 to 2021. This was accompanied by changes in case profiles, with histories of injecting drug use and substance use problems, as well as recent opioid use, becoming less prominent.
•Vaccine uptake among people who inject drugs was lower than the general population.•Barriers to vaccination were predominantly related to lack of perceived vaccine utility.•Those reporting recent ...opioid agonist therapy were more likely to be vaccinated.
Comorbid chronic health conditions place people who inject drugs (PWID) at risk of severe health outcomes after influenza infection. However, little is known about the uptake, barriers and correlates of influenza vaccination among PWID.
During structured surveys, 872 PWID reported whether they had received an influenza vaccination during the last year (disaggregated as pre- or post-March 2020 to ascertain current season vaccine uptake), and if not, the barriers to vaccination. Logistic regression was used to examine demographic, drug use, health and service engagement correlates of vaccine uptake.
Thirty-nine percent of participants reported past-year influenza vaccination, with one-quarter (24 %) vaccinated in the current season. The main barriers to vaccination were motivation-based, with few citing issues relating to affordability, supply or perceived stigma. Opioid agonist therapy in the past six months was significantly associated with vaccination.
Influenza vaccine uptake was lower among PWID than the Australian general population. Provision of the vaccine at services commonly accessed by PWID may increase uptake.
► We assessed the independent and interactive impact of energy drink ingredients. ► Caffeine’s facilitative effect on reaction time was task-dependent. ► Taurine did not improve performance and ...attenuated caffeine’s positive effects. ► Taurine may not contribute to energy drinks’ performance-enhancing effects.
While the performance-enhancing effects of energy drinks are commonly attributed to caffeine, recent research has shown greater facilitation of performance post-consumption than typically expected from caffeine content alone. Consequently, the aim of the present study was to investigate the independent and combined effect of taurine and caffeine on behavioural performance, specifically reaction time. Using a double-blind, placebo-controlled, crossover, within-subjects design, female undergraduates (N=19) completed a visual oddball task and a stimulus degradation task 45min post-ingestion of capsules containing: (i) 80mg caffeine, (ii) 1000mg taurine, (iii) caffeine and taurine combined, and (iv) matched placebo. Participants completed each treatment condition, with sessions separated by a minimum 2-day washout period. Whereas no significant treatment effects were recorded for reaction time in the visual oddball task, facilitative caffeine effects were evident in the stimulus degradation task, with significantly faster reaction time in active relative to placebo caffeine conditions. Furthermore, there was a trend towards faster mean reaction time in the caffeine condition relative to the taurine condition and combined caffeine and taurine condition. Thus, treatment effects were task-dependent, in that independent caffeine administration exerted a positive effect on performance, and co-administration with taurine tended to attenuate the facilitative effects of caffeine in the stimulus degradation task only.
Introduction
We examine how smoking and injecting methamphetamine change over time and correlate with specific health and social outcomes.
Methods
Panel data from a longitudinal cohort dependent on ...methamphetamine (N = 444; 891 months). Random effects regression models examined the relationship between smoking and/or injecting methamphetamine and past month outcomes (substance use, ≥daily injection, needle/syringe sharing, psychological distress, poor mental and physical health, sexual behaviour, psychotic symptoms, violent behaviour and crime). Effects were adjusted for between‐group differences at baseline.
Results
At baseline, 56% of participants only injected methamphetamine in the past month, 18% only smoked and 26% both injected and smoked (concurrent injecting and smoking). Compared to injecting only, concurrent injecting and smoking was associated with more days of methamphetamine use (b = 1.3, P < 0.001; adjusted A b = 1.2, P < 0.001), more frequent injection odds ratio (OR) 1.8, P = 0.013; adjusted OR (AOR) 1.6, P = 0.042, violent behaviour (OR 2.1, P = 0.001; AOR 1.8, P = 0.013 and crime (OR 3.1, P < 0.001; AOR 2.5, P < 0.001). Non‐injecting related outcomes did not differ significantly for only smoking versus only injecting. There was no significant transition from injecting methamphetamine at baseline to non‐injecting methamphetamine use at follow up, or from exclusively smoking methamphetamine at baseline to any methamphetamine injection at follow up.
Discussion and Conclusion
Efforts are needed to address heavier methamphetamine use, more frequent drug injection and elevated violent behaviour and crime among people who concurrently smoke and inject methamphetamine.
Aims
To describe (i) self‐reported changes in drug use and (ii) trends in price, perceived availability, and perceived purity of illicit drugs, among people who regularly use ecstasy/ ...3,4‐methylenedioxymethamphetamine (MDMA) and other illicit stimulants in Australia following COVID‐19 and associated restrictions.
Design
Annual interviews with cross‐sectional sentinel samples conducted face‐to‐face in 2016–19 and via video conferencing or telephone in 2020. Data were collected via an interviewer‐administered structured questionnaire.
Setting
Australian capital cities.
Participants
Australians aged 16 years or older who used ecstasy/MDMA and other illicit stimulants on a monthly or more frequent basis and resided in a capital city, recruited via social media and word‐of‐mouth (n ~ 800 each year).
Measurements
Key outcome measures were self‐reported illicit drug market indicators (price, purity and availability) and, in 2020 only, perceived change in drug use (including alcohol and tobacco) since March 2020 and reasons for this change.
Findings
For most drugs, participants reported either no change or a reduction in their use since COVID‐19 restrictions were introduced. Ecstasy/MDMA was the drug most frequently cited as reduced in use (n = 552, 70% of those reporting recent use), mainly due to reduced opportunities for socialization. While market indicators were largely stable across most drugs, the odds of perceiving MDMA capsules as ‘high’ in purity decreased compared with 2016–19 adjusted odds ratio (aOR) = 0.72, 95% confidence interval (CI) = 0.53–0.99, as did perceiving them as ‘easy’ to obtain (aOR = 0.42, CI = 0.26–0.67). The odds of perceiving cocaine and methamphetamine crystal as ‘easy’ to obtain also decreased (aOR = 0.67, CI = 0.46–0.96 and aOR = 0.12, CI = 0.04–0.41, respectively).
Conclusions
After COVID‐19‐related restrictions were introduced in Australia, use of ecstasy/MDMA, related stimulants and other licit and illicit drugs mainly appeared to remain stable or decrease, primarily due to impediments to socialization.
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