Multi-drug cocktails: Impurities in commonly used illicit drugs seized by police in Queensland, Australia

A 26-year-old Caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which showed vascular and glomerular changes consistent with thrombotic microangiopathic injury and advanced glomerulosclerosis. He was treated with antihypertensives and required haemodialysis. He admitted using ‘crystal meth’ regularly for many years, which is likely responsible for his renal failure. We present the case to illustrate methamphetamine-induced renal disease leading to end-stage renal disease and to bring awareness among practising clinicians, ancillary healthcare workers and public health professionals of this often undervalued cause of renal failure, which can be prevented.

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“…Some of the impurities reported in the literature include N -isopropyl benzylamine, cocaine, phenethylamine and acetic acid 20 21…”

Section: Discussionmentioning

confidence: 99%

Methamphetamine (N-methylamphetamine)-induced renal disease: underevaluated cause of end-stage renal disease (ESRD)

et al. 2019

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“…using non‐injecting routes of administration, reducing the quantity of use, identifying signs of psychosis, sleep hygiene) to reduce risks of both acute intoxication and heavy use [8]. Cocaine in Australia is typically heavily adulterated [15,26]. These harm reduction strategies will become even more critical if higher‐purity cocaine emerges as part of Australian drug markets, noting that trends in European countries are being driven mostly by higher‐purity cocaine [20].…”

Section: Discussionmentioning

confidence: 99%

Trends in cocaine use, markets and harms in Australia, 2003–2019

Man

Chrzanowska

Price

et al. 2021

Drug and Alcohol Review

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Introduction This paper aims to describe cocaine use, markets and harms in Australia from 2003 to 2019. Methods Outcome indicators comprised prevalence of use from triennial household surveys; patterns of use from annual surveys of sentinel samples who use stimulants; and cocaine‐related seizures, arrests, hospitalisations, deaths and treatment episodes. Bayesian autoregressive time‐series analyses were conducted to estimate trend over time: Model 1, no change; Model 2, constant rate of change; and Model 3, change over time differing in rate after one change point. Results Past‐year population prevalence of use increased over time. The percentage reporting recent use in sentinel samples increased by 6.1% (95% credible interval [CrI95%] 1.2%,16.9%; Model 3) per year from around 2017 (48%) until the end of the series (2019: 67%). There was a constant annual increase in number of seizures (count ratio: 1.1, CrI95% 1.1,1.2) and arrests (1.2, CrI95% 1.1,1.2), and percentage reporting cocaine as easy to obtain in the sentinel samples (percent increase 1.2%, CrI95% 0.5%,1.8%; Model 2). Cocaine‐related hospitalisation rate increased from 5.1 to 15.6 per 100 000 people from around 2011–2012 to 2017–2018: an annual increase of 1.3 per 100 000 people (CrI95% 0.8,1.8; Model 3). While the death rate was low (0.23 cocaine‐related deaths per 100 000 people in 2018; Model 2), treatment episodes increased from 3.2 to 5.9 per 100 000 people from around 2016–2017 to 2017–2018: an annual increase of 2.9 per 100 000 people (CrI95% 1.6,3.7; Model 3). Discussion and Conclusions Cocaine use, availability and harm have increased, concentrated in recent years, and accompanied by increased treatment engagement.

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“…In one study of people who used a drug checking service, those who acquired drugs onsite were more than twice as likely to have been mis-sold them comparatively to those who acquired offsite [9]. This increases risk of harm, particularly if miss-selling leads to mixing of stimulants of unknown identity, or if drugs adulterants such as paramethoxymethamphetamine, which can potentiate MDMA-related toxicity [36,37]. Purchasing inside the venue may result from not wanting to carry desired drug dosage or any drugs into the venue as a response to police presence.…”

Section: Logistic Regression Analyses Of Higher-risk Drug-related Behavioursmentioning

confidence: 99%

Correlates of higher‐risk drug‐related behaviours at music festivals in New South Wales, Australia

Healey

Siefried

Harrod³

et al. 2021

Drug and Alcohol Review

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Introduction. There are few contemporary data on illicit drug use at music festivals. We describe drug use patterns and prevalence of specific higher-risk drug-related behaviours, and their associations with festivalgoer characteristics. Methods. We approached attendees at six major music festivals in New South Wales, Australia, from November 2019 to March 2020. Participants self-completed an anonymous survey on prior and intended drug use and associated higher-risk behaviours; double dropping; higher-volume ethanol alongside drug use; higher quantity 3,4-methylenedioxymethamphetamine (MDMA); mixing stimulants; and preloading. Logistic regression and UpSet analyses were performed to identify festivalgoer characteristics and the intersection of high-risk behaviours, respectively. Results. Of 1229 participants, 372 (30.3%) used or planned to use drugs at the festival. In multivariable analyses, men and those purchasing drugs both inside and outside the venue had greater odds of engaging in higher-risk behaviours. Of those using MDMA, 47.9% reported double dropping. People using drugs for the first time had 3.3 (95% confidence interval 1.2-8.7) greater odds of higher-volume ethanol alongside drug use. People reporting that police/police dog presence influenced their decision to take drugs had 2.2 (95% confidence interval 1.4-3.6) greater odds of preloading. In UpSet analysis, preloading was the most common intersection (17% of those using drugs). Discussions and Conclusions. Engagement in the five higher-risk drug behaviours was common, particularly amongst males and those using drugs for the first time, while police/police dog presence appeared to influence higher-risk behaviours amongst festival attendees. This information can be used to inform harm reduction advice, public health and law enforcement strategies.

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Multi-drug cocktails: Impurities in commonly used illicit drugs seized by police in Queensland, Australia

Cited by 34 publications

References 112 publications

Methamphetamine (N-methylamphetamine)-induced renal disease: underevaluated cause of end-stage renal disease (ESRD)

Methamphetamine (N-methylamphetamine)-induced renal disease: underevaluated cause of end-stage renal disease (ESRD)

Trends in cocaine use, markets and harms in Australia, 2003–2019

Correlates of higher‐risk drug‐related behaviours at music festivals in New South Wales, Australia

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