Furosemide is included in the World Anti-Doping Agency’s (WADA) list of prohibited substances because it can be used by athletes to mask the presence of performance-enhancing drugs in urine and/or excrete water for rapid weight loss. But how effective is furosemide in masking prohibited substances in urine? Based on the pharmacology and the available literature, we conclude that the masking effect of furosemide is limited. Furosemide is a doping agent that is mainly relevant for sports with weight categories. Conflict of interest and financial support: none declared.
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As in many other countries worldwide, the coronavirus pandemic prompted the implementation of an “intelligent lockdown” in the spring of 2020 in the Netherlands, including the closure of nightlife venues and cancellation of festivals. Such restrictions and social distancing could particularly affect people who use alcohol or other drugs in recreational settings and give rise to new challenges and additional needs in the field of addiction prevention and care. To monitor changes in substance use and provide services with practical directions for tailored prevention, an anonymous web survey was set up, targeting a convenience sample aged 16 years or older through various social media and other online channels. Between May and October 2020, a total of 6,070 participants completed the survey, mainly adolescents and young adults (16–24 years old). These data were used to explore and describe changing patterns in substance use. Overall results showed declined current use compared to “pre-corona,” but mask underlying variation in changing patterns, including discontinued (tobacco 10.4%, alcohol 11.3%, cannabis 16.3%, other drugs 30.4%), decreased (tobacco 23.0%, alcohol 29.1%, cannabis 17.4%, other drugs 20.7%), unchanged (tobacco 30.3%, alcohol 21.2%, cannabis 22.3%, other drugs 17.3%), increased (tobacco 29.6%, alcohol 32.1%, cannabis 32.9%, other drugs 25.3%), and (re)commenced use (tobacco 6.7%, alcohol 6.3%, cannabis 11.1%, other drugs 6.2%). Especially the use of drugs like ecstasy and nitrous oxide was discontinued or decreased due to the lack of social occasions for use. Increased use was associated with coping motives for all substance types. As measures combatting the coronavirus may need to be practiced for some time to come, possibly leading to prolonged changes in substance use with lingering “post-corona” consequences, timely and ongoing monitoring of changing patterns of substance use is vital for informing prevention services within this field.
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Aims: Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. Methods: A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. Results: In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. Conclusions: This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
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The last decades have seen an increase in the use of illicit recreational drugs. In this article we take a detailed look at the current state of normalisation of the three most popular illicit recreational drugs among Dutch university students in the Netherlands (MDMA/Ecstasy, cocaine and amphetamine) by zooming in on five established aspects of normalisation and expanding on one of those aspects: social accomodation, by adding a behavioural subcomponent (setting of use). For this purpose, we used quantitative data, obtained from four studies (2016, 2017, 2019 and 2020) among Dutch university students in a prototypical university city in the Netherlands (Groningen). Results show that three aspects of normalisation are clearly observable. The drugs are perceived as highly accessible, the last year prevalence of use is high, and experimenting, especially with MDMA/Ecstasy, is common. Accurate knowledge of the drugs and acceptance of occasional use, account in some measure for social accommodation. However, as students do not talk openly about their drug use with everyone in their environment, one cannot speak of cultural accommodation. Thus, although clear signs of normalisation of illicit recreational drugs, especially MDMA/Ecstasy, are observable among Dutch university students, there is no full-scale normalisation of these drugs.
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Introduction: Hardly any research exists on the relationship between substance use and sexual behaviors in patients with a substance use disorder. This study aimed to examine this relation by looking into perceived positive effects on sexual behavior, perceived negative effects and risky sexual behavior due to substance use in patient groups of users of alcohol, stimulants, sedatives and Gamma hydroxybutyrate (GHB). In addition, the current study aimed to address the question whether sexual behavior (e.g. number of sexual partners, sexualactivity) differs between these patient groups.Method: A total of 180 patients with a substance use disorder (i.e. alcohol, amphetamine, cannabis, cocaine, GHB and opiates) participated. A self-report questionnaire was administered with questions on substance use,sexual behaviors (e.g. sexual activity, masturbation, use of pornography) and statements about the perceived changes in sexual functioning and behavior under influence of the primary substance of abuse.Results: All four groups reported changes in sexual thoughts, feelings and behavior due to the use of their primary substance. More than half of the patients reported enhancements in sexual domains (i.e. sexual pleasure,sexual arousal, sexual behavior), but also decrements or risky behaviors and about a quarter stated that their sexual thoughts, feelings and behaviors were often associated with the use of their primary substance of abuse.Patients with a GHB use disorder reported the strongest relation between drug use and sexual behavior. Users of HB not only reported more enhancement in several sexual domains, but also less decline in sexual domains compared to the other patient groups and more risky behavior or more sexual activity than some of the other groups of patients.Conclusions: The results underline the importance of addressing the relationship between substance use and sexual behavior in treatment programs, as patients may be hesitant to stop their use of substances when they experience many positive effects in their sexual behavior. Future research directions are suggested.
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Drug consumption estimates are of relevance because of public health effects as well as associated criminal activities. Wastewater analysis of drug residues enables the estimation of drug consumption and drug markets. Short-term and long-term trends of cocaine, MDMA (ecstasy), amphetamine (speed) and methamphetamine (crystal meth), were studied for the city of Amsterdam. MDMA (+41%) and cocaine (+26%) showed significantly higher weekend vs. week consumption, while no differences were observed for the other drugs. The consumption of MDMA, cocaine, amphetamine and methamphetamine significantly increased between 2011 and 2019. Weekly trends emerging from wastewater analyses were supported by qualitative and quantitative data from a recreational drug use monitoring scheme. However, information collected in panel interviews within nightlife networks and surveys among visitors of pubs, clubs and festivals only partially reflected the long term increase in consumption as registered from wastewater analysis. Furthermore, methamphetamine use was not well presented in survey data, panel studies and test service samples, but could be monitored trough wastewater analysis. This illustrates that wastewater analysis can function as an early warning if use and user groups are small or difficult to reach trough other forms of research. All in all, this study illustrates that wastewater-based epidemiology is complementary to research among user groups, and vice versa. These different types of information enable to connect observed trends in total drug consumption to behaviour of users and the social context in which the use takes place as well as validate qualitative signals about (increased) consumption of psychoactive substances. Such a multi angular approach to map the illicit drug situation on local or regional scale can provide valuable information for public health.
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Already for some decades lateral flow assays (LFAs) are ‘common use’ devices in our daily life. Also, for forensic use LFAs are developed, such as for the analysis of illicit drugs and DNA, but also for the detection of explosives and body fluid identification. Despite their advantages, including ease-of-use, LFAs are not yet frequently applied at a crime scene. This review describes (academic) developments of LFAs for forensic applications, focusing on biological and chemical applications, whereby the main advantages and disadvantages of LFAs for the different forensic applications are summarized. Additionally, a critical review is provided, discussing why LFAs are not frequently applied within the forensic field and highlighting the steps that are needed to bring LFAs to the forensic market.
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from the repository of Utrecht University: "OBJECTIVES: Antipsychotic drugs are frequently prescribed to elderly patients, but they are associated with serious adverse effects. The objective of the current study was to investigate the association between use of antipsychotics by elderly women and the risk of urinary tract infections (UTIs). COHORT STUDY SETTING: Dispensing data were obtained from the PHARMO Database Network for the period 1998-2008. PARTICIPANTS: Ambulatory Dutch women (≥65 years) with current and past use of antipsychotics. MEASUREMENTS: Incidence rates of UTIs, as defined by use of nitrofurantoin, was calculated within and outside the period of exposure to antipsychotic drugs. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate crude and adjusted hazard ratios (HRs). RESULTS: During the study period, 18,541 women with a first prescription of an antipsychotic were identified. Current use of antipsychotics was associated with an increased risk of UTI compared to past use: HR, adjusted for age and history of UTIs, 1.33, 95% CI 1.27-1.39. A strong temporal relationship was found: the risk of being treated for a UTI was higher in the first week after the start of the treatment (adjusted HR 3.03, 95% CI 2.63-3.50) and decreased after 3 months (adjusted HR 1.22, 95% CI 1.17-1.28). Cumulative exposure was not associated with an increased risk of UTIs. There was no difference in effect between conventional and atypical antipsychotics. CONCLUSION: Our results show an increased risk of uncomplicated UTIs during antipsychotic use in older female patients, especially in the first week of treatment."
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