Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

Abstract

The recent, and rapid, emergence of injection of the short-acting stimulant mephedrone (4-methylmethcathione) has resulted in concerns about increased infection risks among people who inject drugs (PWID). Data from the bio-behavioural surveillance of PWID in the United Kingdom were analysed to examine the impact of mephedrone injection on infections among PWID. During the year preceding the survey, 8.0% of PWID (163/2,047) had injected mephedrone. In multivariable analyses, those injecting mephedrone were younger, less likely to have injected opiates, and more likely to have injected cocaine or amphetamines, used needle/syringe programmes or sexual health clinics, been recruited in Wales and Northern Ireland or shared needles/syringes. There were no differences in sexual risks. Those injecting mephedrone more often had hepatitis C antibodies (adjusted odds ratio (AOR) = 1.51; 95% confidence interval (CI): 1.08–2.12), human immunodeficiency virus (AOR = 5.43; 95% CI: 1.90–15.5) and overdosed (AOR = 1.70; 95% CI: 1.12–2.57). There were no differences in the frequency of injecting site infections or prevalence of hepatitis B. The elevated levels of risk and infections are a concern considering its recent emergence. Mephedrone injection may currently be focused among higher-risk or more vulnerable groups. Targeted responses are needed to prevent an increase in harm.

Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sectional analysis

“…NPS use by people who inject drugs (PWID) is associated with high frequencies of injecting episodes and sharing of equipment (Karila et al, 2015) thus placing users at considerable risk of physical health harms including blood-borne viruses (BBV) (Tarján et al, 2015). Recent examples include an outbreak of HIV infection among NPS injectors in Dublin (Ireland) associated with frequency of injecting and homelessness (Giese et al, 2015), increases in BBV incidence among NPS injectors in Hungary associated with frequency of injecting, homelessness and low coverage of Injecting Equipment Provision (IEP) sites (Tarján et al, 2015;Rácz et al, 2016), and increased risk of { PAGE \* MERGEFORMAT } needle/syringe sharing and BBV infection among NPS injectors in England and Wales (Hope et al, 2016).…”

Stability of mephedrone and five of its phase I metabolites in human whole blood

“…Mephedrone was detected in 1.0% ( n = 34) of the death cases analyzed by the Toxicology Unit at Imperial College London in 2014 and this number increased to 1.5% ( n = 22) in 2015 . There is also evidence describing an increasing problem with people injecting mephedrone which leads to higher rates of hepatitis C, HIV, and acute toxicity …”

“…4 There is also evidence describing an increasing problem with people injecting mephedrone which leads to higher rates of hepatitis C, HIV, and acute toxicity. 5 Studies investigating the metabolism of mephedrone have been performed in vitro 6,7 and in vivo, both in animal (rat) models 8 and in humans. 9 The main phase I metabolic pathways include N-demethylation of the secondary amine to yield nor-mephedrone (NOR), reduction of the ketone moiety to the hydroxyl group to produce dihydro-mephedrone (DHM), and oxidation of the tolyl moiety, leading to the formation of hydroxytolyl-mephedrone (HYDROXY) and 4-carboxy-mephedrone (4-CARBOXY).…”

New psychoactive substances: driving greater complexity into the drug problem

“…A similar problem exists for the fentanils. Changes in the patterns of drug injection are also being driven by new substances [15][16][17][18][19]; the fallout from this includes HIV, hepatitis C, as well as bacterial infections which have sometimes manifested as outbreaks.…”