Rare but relevant: Nitrous oxide and peripheral neurotoxicity, what do we know?

Nitrous oxide (NO), used medically as an anaesthetic, has gained popularity as a recreational drug, with rising prevalence particularly among young adults. While its reinforcing and addictive potential remains debated, NO is proven to be neurotoxic, especially with prolonged, heavy use, which is often unexpected for users. The neurotoxicological mechanism underlying NO-induced neurotoxicity involves inactivation of vitamin B (cobalamin), which disrupts methionine synthesis, essential for maintaining the myelin sheath.

Challenges and support needs among persons with a migration background who use drugs in four European metropolitan cities.

Background: Persons who migrate for economic reasons, along with asylum seekers and refugees, face multiple personal experiences and societal inequalities that increase the risk of mental health problems and substance dependency, compounded by intersectional social and economic vulnerabilities. The precarious situation and limited access to care of persons with a migration background who use drugs (PMWUD) in Europe raises concern. Therefore, this qualitative study explores the challenges and support needs of a sample of PMWUD in vulnerable situations living in Amsterdam, Athens, Berlin and Paris.

Treatment Seeking Nitrous Oxide Users in Addiction Care: A Comparison with Cocaine Users on Clinical and Treatment Characteristics.

Introduction: Over the past decade, frequent use of large quantities of nitrous oxide (N2O) has become more common in the Netherlands. Although N2O poses several negative health consequences for a subgroup of problematic N2O users, there is a lack of knowledge on what characterizes these intensive users. This study therefore aims to provide the demographic and substance use characteristics and experiences during treatment of treatment seeking problematic N2O users and to compare this with a matched group of treatment-seeking problematic cocaine users.

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine-A Systematic Review.

: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. : A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone.

Explaining the high mortality among opioid-cocaine co-users compared to opioid-only users. A systematic review.

Rationale: The opioid crisis in North America has recently seen a fourth wave, which is dominated by drug-related deaths due to the combined use of illicitly manufactured fentanyl [IMF] and stimulants such as cocaine and methamphetamine.

Objectives: A systematic review addressing the question why drug users combine opioids and stimulants and why the combination results in such a high overdose mortality: from specific and dangerous pharmacokinetic or pharmacodynamic interactions or from accidental poisoning?

Results: Motives for the combined use include a more intensive high or rush when used at the same time, and some users have the unfounded and dangerous belief that co-use of stimulants will counteract opioid-induced respiratory depression. Overdose deaths due to combined (intravenous) use of opioids and stimulants are not likely to be caused by specific pharmacokinetic or pharmacodynamic interactions between the two drugs and it is unlikely that the main cause of overdose deaths is due to accidental poisoning.

Combined use of cocaine and alcohol: A violent cocktail? A systematic review.

It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents.

Multi-trial, aggregated, individual participant data mega-analysis of short-term antidepressant versus mood stabilizer monotherapy of bipolar type II major depressive episode.

Background: Few studies have systematically examined the safety and effectiveness of antidepressant versus mood stabilizer monotherapy of bipolar II depression. To date, there are no aggregated or mega-analyses of prospective trials of individual participant-level data (IPD) to inform future treatment guidelines on the relative safety and effectiveness of antidepressant or lithium monotherapy.

Methods: Data from a series of four independent, similarly designed trials of antidepressant or lithium monotherapy (where longitudinal IPD were available) (n = 393) were aggregated into an IPD dataset (i.

Legal Approaches to New Psychoactive Substances: First Empirical Findings.

Background: Generic drug legislation, i.e., simultaneously banning groups of drugs, has been introduced worldwide to counteract the trade and use of emerging "new psychoactive substances" (NPSs) more effectively.

What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study's patient-level data with fidelity to the original research protocol.

Objective: Reanalyse the patient-level data set of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with fidelity to the original research protocol and related publications.

Design: The study was open label and semirandomised examining the effectiveness of up to four optimised and increasingly aggressive, antidepressant therapies in depressed adults. Patients who failed to gain adequate relief from their level 1 trial on the SSRI citalopram could receive up to three additional treatment trials in levels 2-4.

Predictors and motives of polydrug use in opioid users. A narrative review.

Purpose Of Review: To review the recent literature on predictors and personal motives of polydrug use in opioid users with a focus on combined use of opioids with stimulants, benzodiazepines and gabapentinoids.

Recent Findings: In North America, methamphetamine is now the most prevalent co-drug in opioid users and is responsible for high mortality rates. In Europe, opioids are rather combined with either cocaine, benzodiazepines or gabapentionoids, but recent data are lacking.

Anabolic Androgenic Steroid Use Patterns and Steroid Use Disorders in a Sample of Male Gym Visitors.

Introduction: The use of anabolic androgenic steroids (AAS) and other image- and performance-enhancing drugs is a growing public health concern. AAS use is associated with various physical and mental harms, including cardiovascular risks, cognitive deficiencies, and dependence. The aim of this study was to determine whether patterns of AAS use and other variables are associated with the presence of an AAS use disorder (AASUD).

The effect of alcohol use on smoking cessation: A systematic review.

Only a small minority of all attempts to stop smoking are successful, especially among smokers who are heavy drinkers and those with an alcohol use disorder. The current systematic review focuses on the negative effects of alcohol use, either before or during attempts to quit smoking, on the success rate of these attempt(s) in alcohol-drinking tobacco smokers. We conducted a systematic review of naturalistic and experimental studies, which included at least 40 tobacco smokers with a recorded drinking status (non-drinking, heavy drinking, alcohol use disorder) and a clearly documented change in alcohol consumption.

Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review.

The recreational use of nitrous oxide (NO) has increased over the years. At the same time, more NO intoxications are presented to hospitals. The incidental use of NO is relatively harmless, but heavy, frequent and chronic use comes with considerable health risks.

Effectiveness and safety of monoamine oxidase inhibitor treatment for bipolar depression versus unipolar depression: An exploratory case cohort study.

Objective: Patients with bipolar disorder spend most of their clinical lifetime in the depressive phase of their illness. However, antidepressants are discouraged in the treatment of bipolar depression due to concerns over manic induction and drug ineffectiveness. Some reports suggest that monoamine oxidase inhibitors (MAOIs) may be safe and effective compared to other antidepressants in treating bipolar depression.

Slamsex in The Netherlands among men who have sex with men (MSM): use patterns, motives, and adverse effects.

Background: This paper describes an online survey of men who have sex with men (MSM) and use drugs before or during sex ('chemsex') via injection ('slamming' or 'practising slamsex'). Approximately 15-30% of the MSM population in The Netherlands have practiced chemsex at some point, and 0.5-3.

The Added Value of Pharmacotherapy to Cognitive Behavior Therapy And Vice Versa in the Treatment of Alcohol Use Disorders: A Systematic Review.

Aim: To explore whether combined interventions i.e. psychotherapeutic plus psychosocial interventions are more effective than monotherapies in the treatment of alcohol use disorders.

The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression.

This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies.

Increasing recreational nitrous oxide use: Should we worry? A narrative review.

Background: Since 2000, the prevalence of recreational nitrous oxide (NO) use has increased in the Western world. Although NO is a relatively safe drug, the overall increase in the use of NO has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg NO tanks, allowing high and prolonged dosing, has facilitated this excessive use.

Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders.

Aims: To clarify whether smoking interferes with successful treatment of alcohol use disorder (AUD).

Methods: The current systematic review investigates the potential moderating effect of smoking on behavioural and pharmacological treatment of AUD. In addition, this review summarizes the results of randomized controlled trials investigating the effect of smoking cessation treatments in subjects with AUD on drinking outcomes.

Nitrous oxide-induced reproductive risks: Should recreational nitrous oxide users worry?

Background: Nitrous oxide (NO) is a frequently used anaesthetic. Since the year 2000, recreational use of NO, also known as 'laughing gas', became popular as a recreational drug due to its mild effect. In the 1980s, several reports warned against NO-induced reproductive risks among healthcare personnel, questioning the occupational safety of NO in health care.

The therapeutic potential of psilocybin: a systematic review.

Introduction: Psychedelic drugs were used quite extensively before their prohibition in 1968 which delayed research. However, since the 1990s, studies on the potential therapeutic benefits of psychedelics have rapidly increased.

Areas Covered: This systematic review provides an overview of the clinical effects of psilocybin in the treatment of a variety of mental disorders.