This case report describes the development of withdrawal from phenibut, a gamma-aminobutyric acid-receptor type B agonist. Although phenibut is not an FDA-approved medication, it is available through online retailers as a nootropic supplement. There are reports of dependence in patients that misuse phenibut. We report a case in which a patient experienced withdrawal symptoms from phenibut and was successfully treated with a baclofen taper. This case report highlights the development of phenibut use disorder with coingestion of alcohol and potential management for phenibut withdrawal. We believe clinicians must be aware of how phenibut dependence may present and how to manage the withdrawal syndrome.

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Fuelled by the opioid crisis, the incidence of hepatitis C virus (HCV) infection in people who use drugs is rising. 1 In national surveillance data, the highest incidence of acute HCV infection is in individuals aged 20-29. 2 This incidence is driven by initiation of injection drug use in this age group: 20% of individuals become HCV-infected within two years of starting to inject drugs, and half within five years. 3 People who use drugs but do not report a history of injection are also at higher risk for hepatitis C than the general population, possibly due to sexual risk or because of unreported injection drug use. 4,5 Several jurisdictions, including New York City, have seen a new peak of HCV prevalence in this younger age group. 6,7 If HCV elimination efforts are to be effective, engaging and treating

Background: There is a dearth of literature concerning the sexual behaviors of women who inject drugs. The existing literature emphasizes the violence, trauma, and social disadvantage experienced by these women and obscures any sense of agency or sexual pleasure. This omission imperils our ability to develop effective interventions for women, ignores the true context of their sexual and injection practices, and presumes women to be free of agency and thus at the will of external social, environmental, and economic factors. This qualitative study strives to extend the boundaries of conventional risk-focused research to understand the complex and multidimensional sexual practices of women who inject drugs Methods: Purposive sampling was used to select women who inject drugs from a syringe exchange program in NYC. The PI and trained study staff conducted interviews with twenty-six women. The interview transcripts were thematically coded in Atlas.ti with a grounded theory approach to understand the concerns, actions, and practices to further explain patterns.Results: Four themes emerged with respect to women's descriptions of their sexual and injection experiences: (a) linguistic parallels of sexual and injection experiences, (b) substituting sex with injection drug use, (c) pleasure, and d) injection drug use as intimacy. Our findings indicated that there was much positive discourse about sexual experiences and injection drug practices, with some women describing injecting as a substitute for negative sexual experiences, and others noting that injection drug use served as a foundation for intimacy and eroticism in a relationship. Conclusions:In contrast to the literature, women who inject drugs demonstrated power and agency and discussed pleasurable sexual experiences. Ultimately, interventions should recognize Correspondence to: Caroline Katzman. Author Contributions Ellen Tuchman has made substantial contributions to conception and design, acquisition of data, coding, and co-author. She has given final approval of the version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Caroline Katzman's contributions were coding, interpretation of the data, drafting and revising the manuscript critically for important intellectual content.