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Men who have sex with men (MSM) make up nearly half of all people living with HIV in the United States. The prevalence of the epidemic in this population makes it vitally important to understand the transmission of the infection and to develop methods to prevent its spread. The current study uses longitudinal diary methods to examine relationships between substance use and unprotected anal intercourse in a sample of 158 HIV-positive, mostly ethnic minority MSM. Results indicate that both general substance use and use of specific drugs (i.e., inhalants, cocaine, crack, and club drugs) have a substantial impact on the sexual risk behavior of this population.

Background Volatile substance (thinner) addiction can cause serious cardiac events, such as malignant ventricular arrhythmias, acute coronary syndromes, sudden death syndrome, and dilated cardiomyopathy, as reported in many case studies. We aimed to find echocardiographic and electrocardiographic parameters that could foresee these adverse outcomes in clinical settings. Methods We enrolled 32 healthy young adult patients with at least 1 year of thinner addiction and no cardiac symptoms. We also recruited a control group of 30 healthy individuals without any medical problems. Both groups received standard echocardiography and ECG tests. We analyzed the following echocardiographic parameters: LVEDd (left ventricular end‐diastolic diameter), LVESd (left ventricular end‐systolic diameter), mitral valve EF slope, E/A ratio, and aortic and pulmonary valve VTI (velocity time integral). We also measured the corrected (QTc), uncorrected QT intervals, and widest P‐wave values in the ECG. We used the SPSS 13 software for statistical analysis. Results The echocardiographic findings did not differ significantly between the groups. However, the ECG results showed that the thinner addicts had higher values of corrected (QTc), uncorrected QT intervals, and widest P‐wave values than the control group, according to Mann–Whitney U and Student's T test. Conclusion Corrected QT (QTc) and P‐wave duration are increased in individuals with a thinner addiction. These findings may suggest a higher risk of sudden cardiac death, atrial, and ventricular dysrhythmias in the future.

Volatile substance misuse is among the most prevalent and toxic forms of psychoactive drug use, and often results in highly deleterious social, psychological and medical consequences. The prevalence of this pernicious form of substance misuse owes in part to the fact that volatile substances of misuse are ubiquitous in the natural environment. Commonly misused commercial products include glue, shoe polish, nail polish remover, butane lighter fluid, gasoline and computer duster spray. National samples of volatile substance misusers tend to exhibit high rates of psychiatric problems and antisocial behaviour. In addition, cognitive impairments and affective dysregulation are often observed among these individuals. Volatile substances exert their complex neuropharmacological effects on dopaminergic, glutamatergic, GABAergic and serotoninergic receptor systems, as well as on cell membranes and ion channels. Concomitantly, pharmacotherapies for volatile substance abuse might profitably target a number of mechanisms, including reward circuitry in the brain, symptoms of craving and withdrawal, neuropsychiatric and emotional impairments that promote volatile substance abuse, and cognitive enhancement to rectify deficits in executive function. This review details the modes of use, subjective effects, epidemiology, adverse consequences, neuropsychopharmacology and drug treatment of volatile substance misuse, and discusses the potential role of novel forms of pharmacological intervention for this oft-overlooked public health threat of epidemic proportions.

The abuse of volatile solvents such as toluene is a significant public health concern, predominantly affecting adolescents. To date, inhalant abuse research has primarily focused on the central nervous system; however, inhalants also exert effects on other organ systems and processes, including metabolic function and energy balance. Adolescent inhalant abuse is characterized by a negative energy balance phenotype, with the peak period of abuse overlapping with the adolescent growth spurt. There are multiple components within the central and peripheral regulation of energy balance that may be affected by adolescent inhalant abuse, such as impaired metabolic signaling, decreased food intake, altered dietary preferences, disrupted glucose tolerance and insulin release, reduced adiposity and skeletal density, and adrenal hypertrophy. These effects may persist into abstinence and adulthood, and the long‐term consequences of inhalant‐induced metabolic dysfunction are currently unknown. The signs and symptoms resulting from chronic adolescent inhalant abuse may result in a propensity for the development of adult‐onset metabolic disorders such as type 2 diabetes, however, further research investigating the long‐term effects of inhalant abuse upon energy balance and metabolism are needed. This review addresses several aspects of the short‐ and long‐term effects of inhalant abuse relating to energy and metabolic processes, including energy balance, intake and expenditure; dietary preferences and glycemic control; and the dysfunction of metabolic homeostasis through altered adipose tissue, bone, and hypothalamic‐pituitary‐adrenal axis function.

PurposeTo determine the prevalence of inhalant use in Russian adolescents and to investigate associated psychosocial problems from a gender perspective.MethodsData on inhalant use and comorbid psychopathology were collected by means of self-reports from 2892 (42.4% boys) sixth to tenth grade students in public schools in Arkhangelsk, Russia. Multivariate analysis of covariance was used to assess differences in the levels of internalizing and externalizing problems in boys and girls, who were non-users and users of inhalants.ResultsThe prevalence of inhalant use was 6.1% among boys and 3.4% among girls. Compared with non-users, inhalant users scored significantly higher on internalizing and externalizing problems, functional impairment and lower on academic motivation, with psychopathology increasing with age. While there were no gender differences for internalizing problems, increased levels of externalizing problems in inhalant users were gender-specific (significantly higher in boys).ConclusionsInhalant use is related to significantly higher levels of comorbid psychopathology in Russian adolescents. Comprehensive, evidence-based prevention and intervention policies are needed to address inhalant use and its harmful effects.

Abuse of inhalants containing the volatile solvent toluene is a significant public health issue, especially for adolescent and Indigenous communities. Adolescent inhalant abuse can lead to chronic health issues and may initiate a trajectory towards further drug use. Identification of at‐risk individuals is difficult and diagnostic tools are limited primarily to measurement of serum toluene. Our objective was to identify the effects of adolescent inhalant abuse on subsequent drug use and growth parameters, and to test the predictive power of growth parameters as a diagnostic measure for inhalant abuse. We retrospectively analysed drug use and growth data from 118 Indigenous males; 86 chronically sniffed petrol as adolescents. Petrol sniffing was the earliest drug used (mean 13 years) and increased the likelihood and earlier use of other drugs. Petrol sniffing significantly impaired height and weight and was associated with meeting ‘failure to thrive’ criteria; growth diagnostically out‐performed serum toluene. Adolescent inhalant abuse increases the risk for subsequent and earlier drug use. It also impairs growth such that individuals meet ‘failure to thrive’ criteria, representing an improved diagnostic model for inhalant abuse. Improved diagnosis of adolescent inhalant abuse may lead to earlier detection and enhanced health outcomes.

Background “Legal highs” are novel psychoactive substances that have evaded statutory control. Synthetic cannabinoid compounds with adamantane moieties have recently been identified, which have high potency at target receptors and are undetectable on conventional toxicology testing. However, little is known about any harmful effects, and their potential to cause serious ill health. We describe a case of myocardial infarction following the use of this class of drug. Case presentation We report the case of a 39-year-old man admitted after an out-of-hospital cardiac arrest, in whom ECG and elevated cardiac enzymes confirmed ST-elevation myocardial infarction. Normal coronary perfusion was restored after thrombectomy and coronary artery stenting. In the hours preceding his admission, the patient is known to have consumed the legal high product “Black Mamba”. Subsequent urine testing confirmed the presence of an adamantyl-group synthetic cannabinoid, whilst cannabis, cocaine, amphetamines and other drugs of abuse were not detected. Conclusion The use of legal highs is being increasingly recognised, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. Synthetic cannabinoids, rarely identified on toxicological testing, can be linked to serious adverse cardiovascular events. This case highlights the importance of testing for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.

A 19-year-old man presented with a 1-month history of progressive 4-limb numbness and gait imbalance. Physical examination revealed mild general muscular weakness, areflexia, and wide-based, ataxic, steppage gait. Sensory tests showed diminished superficial sensation below the level of the cervical-thoracic junction and a glove-and-stocking pattern of sensory loss at the 4 extremities. An initial magnetic resonance imaging examination of the cervical spine revealed an increased bilateral signal from the posterior and anterior columns on T2-weighted images. Nerve conduction velocity and electromyographic tests revealed polyneuropathy. On further inquiry, the patient admitted to chronic recreational use of nitrous oxide. The final diagnosis was nitrous oxide–induced neurotoxicity. The patient was treated for 5 days with injections of 1000 μg/day vitamin B12, followed by an additional 2-month treatment at a dose of 1000 μg/week. The numbness resolved after the first week, but there remained a mild sensory ataxic gait. The patient recovered fully after 2 months of treatment and nitrous oxide abstinence. We recommend an investigation of the patient's history of nitrous oxide exposure in cases where an individual presents to the emergency department or outpatient department with acute numbness characterized by megaloblastic red blood cells and symmetric neurologic deficits.

Sergeant Jack McKay has pulled small children out of groups of adults and youths sniffing gas from plastic bags in houses in the community. \"The youngest one was six,\" says McKay, who had worked in Pikangikum for more than 25 years as one of about five Aboriginal police officers serving the community. \"That's way too young - way too young.\" \"Most of the kids don't feel wanted - they don't feel loved,\" says Macfad- den, who now lives in Dryden, Ont. \"There isn't sufficient food for them. You have an intergenerational impact, in which the parents or the grandpar- ents are still drinking.\" Despite a preponderance of reports that concur Pikangikum needs more addiction and mental health supports, [Charlie Strang] doesn't know why Pikangikum isn't getting the resources it urgently needs. He believes the rest of Canada \"probably\" knows about the tragedies the community lives with every day - tragedies etched in stark reality on the graves many families tend in their front yards. \"They probably care - they probably just don't know how to get involved or to show their support.\"

•Three cases of butane sniffing death were reported.•Concentrations of n-butane metabolites in blood and tissues were determined.•n-Butane metabolites were detected only in cases with a history of chronic misuse.•n-Butane metabolite detection could be useful to understand the case history. Butane is an addictive volatile substance like toluene. We report three forensic autopsy cases of sudden death that occurred while sniffing n-butane and isobutane from portable gas cartridges. n-Butane and isobutane were detected in all three cases. In cases 1–3, n-butane concentrations in heart blood were 54.3, 25.5, and 30.7μg/mL, respectively. These concentrations were considered fatal according to the previous reports. In addition, n-butane metabolites (2-butanol and 2-butanone) were detected in cases 1 and 3 but not in case 2. Blood levels of 2-butanol and 2-butanone were 6.5 and 1.8μg/mL, respectively, in case 1, and 6.3 and 5.6μg/mL, respectively, in case 3. According to the police investigation, the decedent in case 1 had misused butane gas for more than 6 months in the period leading up to death. The decedent in case 3 also had a history of chronic misuse of butane gas. There was no history of chronic misuse of butane gas by the decedent in case 2. It was suspected that he attempted suicide via inhalation of butane gas using a plastic bag, leading to a rapid death. The presence or absence of n-butane metabolites might reflect the way of butane inhalation, such as the frequency and duration. Although additional experimental and case studies are necessary to establish the forensic applications of n-butane metabolite detection, it may be a useful method to understand the decedents’ pattern of butane sniffing before death.