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Cognitive performance amongst recreational users of "ecstasy".

RATIONALE: Previous work has suggested that memory impairments have been associated with the recreational use of "ecstasy". This previous work, however, has not taken into consideration the additional use of cannabis amongst those examined. Cannabis use has also been associated with memory impairment. There is therefore a clear need to explore the impact of both of these illicit substances upon memory ability. OBJECTIVES: To determine whether recreational use of ecstasy impairs memory and attentional ability and to explore the impact of the concomitant use of cannabis upon these cognitive functions. In addition, an exploration of subjective accounts of cognitive ability was undertaken to determine whether objective impairments were perceived by users in everyday functioning. METHODS: Cognitive functioning was examined in three groups of young people: 15 regular users of ecstasy; 15 regular users of cannabis who had never taken ecstasy and 15 control subjects who had never taken any illicit substances. The Weschler Memory Scale (revised) and a computerised reaction time task were administered on a day when the subjects claimed to be drug free. In addition, subjects completed a biographical questionnaire and the Cognitive Failures Questionnaire (CFQ) in order to assess subjective accounts of cognitive slips. RESULTS: Performance was similar across all three groups for measures of visual reaction time, auditory reaction time, complex reaction time, visual memory and attention and concentration. Significant impairment was found on measures of verbal memory in both cannabis users and ecstasy users. A significant impairment in performance was found on measures of delayed memory for the ecstasy users compared to both the cannabis group and the control group. Despite these findings, no differences in subjective ratings of cognitive failures were found between the groups. CONCLUSIONS: The present study provides additional evidence for longterm neuropsychological sequelae associated with the use of ecstasy, particularly with regard to delayed memory ability.

Adult↗

Memory deficits associated with recreational use of "ecstasy" (MDMA).

Evidence from both animal, and human, studies suggests that repeated administration of 3,4-methylenedioxymethamphetamine (MDMA: "ecstasy") produces lasting decreases in serotonergic activity. Serotonin is believed to play a modulatory role in a variety of psychological processes, including learning and memory. There are recent reports that polydrug users, who have used ecstasy recreationally, exhibit selective impairments in memory. However, these studies did not compare ecstasy users with polydrug users who had not taken ecstasy, leaving open the possibility that the memory deficits may be associated with a history of use of other illicit drugs. The present study used the Rivermead Behavioural Memory test to investigate immediate and delayed recall in: 25 polydrug-users who had taken more than 20 tablets of ecstasy (MDMA group), 22 participants (polydrug controls) who had never taken ecstasy, but, otherwise has personal characteristics (e.g. age, gender, education, height, weight), and illicit drug use histories, that were generally not significantly different from those of the MDMA group, and 19 participants who had not used illicit drugs but who also had similar personal characteristics (non-drug controls). Participants in the MDMA group recalled significantly fewer ideas (approximately 75% of the number of ideas recalled by participants in either of the other two groups), in both immediate and delayed recall conditions. The two illicit drug-using groups did differ in their estimated IQ scores and their duration of use of LSD, but only the latter proved to be a statistically significant covariate, and the difference in recall performance between the MDMA and polydrug controls groups remained statistically significant when this variable was treated as a covariate. The present findings provide the first evidence that deficits in memory performance in recreational ecstasy users are primarily associated with past exposure to ecstasy, rather than with the other legal and illicit drugs consumed by these individuals, and are consistent with reduced serotonergic modulation of mnemonic function as a result of long-term neurotoxic effects of MDMA in humans.

Adult↗

Lifetime health risk assessment from exposure of recreational users to polycyclic aromatic hydrocarbons.

In order to assess the lifetime risk of skin cancer for recreational users from dermal exposure to polycyclic aromatic hydrocarbons (PAHs), sediment samples were collected from beach sites along the St. Marys River near Sault Ste. Marie, Ontario, and in Hamilton Harbor and Toronto Harbor, Ontario, and analyzed for PAHs. Dermal exposure and lifetime skin cancer risk were estimated as follows: Concentrations of 11 PAHs with sufficient or limited evidence of carcinogenicity or mutagenicity were converted to benzo(a)pyrene (BaP) equivalents using toxic equivalency factors (TEFs). Lifetime dermal exposure values were derived based on the BaP equivalents in the silt + clay fraction taken as representative of suspended sediment particulates to which recreational users would be exposed. The lifetime health risk of skin cancer associated with such exposures was above the negligible risk level of 1.0 x 10(-6) at offshore Rytac, Lake George Channel, and Bell Point beaches in the St. Marys River; at Pier 4 Park in Hamilton Harbor; and at Humber Bay, Sunnyside Beach, Cherry Beach, and Water Rats Sailing Club in Toronto Harbor. Risk was negligible inshore at the Rytac and Bell Point beaches and at Squirrel Island and Ojibway Trailer Park along St. Marys River, at Lax Beach in Hamilton Harbor; and at Centre Island in Toronto Harbor. Strategies to reduce risk were developed with these communities; a key recommendation was to take a bath or shower within 24 h after a swim because virtually all the PAHs on the skin would be removed.

Animals↗

Environmental Management of Human Waste Disposal for Recreational Boating Activities

/ A methodology to estimate the number of pump-out facilities and dump stations required to service human waste disposal for recreational power boating activities in Pennsylvania during the 1994 boating season is described. Study results suggest that a total of 39 additional pump-out stations and 13 dump stations may be required on seven major waterbodies: The Three Rivers Area, Lake Erie/Presque Isle Bay, Raystown Lake, the Susquehanna River, the Delaware River, Lake Wallenpaupack, and the Kinzua Reservoir. Suggestions for improving the methodology are provided. KEY WORDS: Human waste; Recreation; Power boating; Waste facilities; Waste disposal; Pennsylvania

Journal Article↗

Water recreation-related spinal injuries: risk factors in natural bodies of water.

Spinal cord injuries are a major public health problem, and costs to society may total $6.2 billion per year. Using a case-control design, we investigated risk factors for spinal injury in male Wisconsin residents who sustained their injuries during water recreational activity. Compared with the controls, the people who sustained spinal injury were more likely to have entered the water from a pier or dock; to have dived into water; and to have used alcohol. Injury prevention programs for water recreation enthusiasts should address the topics of the hazards of combining alcohol with these activities, how to enter natural bodies of water safely, and safe water levels for diving.

Adolescent↗

Employment and recreation patterns in patients treated by percutaneous transluminal coronary angioplasty: a multicenter study.

Employment and recreational patterns were analyzed in 279 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for treatment of symptomatic coronary artery disease. PTCA was successful in 180 patients (65%). When it was unsuccessful, coronary artery bypass graft surgery was usually performed (80%). Return-to-work rates were high irrespective of the outcome of PTCA. Of patients employed full-time or part-time before treatment, 98.5% of those who had successful PTCA alone and 97% of those whose PTCA was unsuccessful but who underwent uncomplicated coronary artery bypass surgery maintained or improved their work status. In a subgroup of men who had been employed in occupations requiring physical labor, 85% of the men whose PTCA was successful returned to work, compared with 68% of those whose PTCA was unsuccessful. The interval from attempted PTCA to return to work was significantly shorter in the successfully treated group; in patients with successful PTCA, the median time to return to work was 14 days, compared with 60 days in patients in whom PTCA was unsuccessful (p less than 0.001). During follow-up, patients with successful PTCA had less angina and were more active in recreational activities than patients who required alternative treatments.

Angioplasty, Balloon↗

Mutagenic lifestyles? A review of evidence of associations between germ-cell mutations in humans and smoking, alcohol consumption and use of 'recreational' drugs.

In humans, associations between germ-cell mutations and hypothetical aetiological factors can be investigated by (1) examining the relationship between the factor of interest and conditions known to be of genetic aetiology; (2) examining the relationship between conditions of unknown aetiology and route of exposure, especially paternal preconceptional exposure. As regards smoking, alcohol and 'recreational' drugs, the first approach has been applied in studies of retinoblastoma, Wilms' tumour and chromosomal anomalies. Only Down's syndrome has received intensive investigation, in relation to maternal smoking during pregnancy; the relative risks would be compatible with there being no association in all recognized conceptuses. The second approach has been applied in studies of sperm quality, miscarriage, congenital anomalies and childhood cancer. The available studies do not show a consistent relationship between smoking and sperm quality; there are few data on the effects of the other exposures. There are a substantial number of studies of childhood cancer and smoking by the father; the majority do not indicate any relationship. Some studies of childhood cancer suggest a positive association with use of 'recreational' drugs by the parents, but it has not been possible to clarify which route of exposure, or the specific type of drug which may be involved. Use of molecular techniques to detect individual genetic changes should enable progress to be made in elucidating the origin of mutation. In the meantime, public health actions are justified on the basis of the known non-genetic effects of these agents.

Abortion, Spontaneous↗

Relative abuse liability of lorazepam and diazepam: an evaluation in 'recreational' drug users.

The subjective, psychomotor and cognitive effects of oral doses of lorazepam (0, 1.5, 3 and 6 mg) and diazepam (0, 10, 20 and 40 mg) were studied under double-blind conditions in 14 volunteers with histories of 'recreational' benzodiazepine use/abuse. For each subject, drug was administered over 4 test days in a 2 (drug) by 4 (dose level) mixed design. Drug was the between-groups factor while dose was the within-subjects factor. Test days were separated by at least 1 week. The results showed that subjective ratings of drug 'liking' and the psychomotor and cognitive effects of lorazepam were generally similar to those of diazepam over the range of doses studied. Lorazepam, however, tended to produce effects of longer duration than diazepam. Since previous studies have shown that diazepam has a relatively high abuse liability among the benzodiazepines, the present findings suggest that lorazepam shares this property with diazepam is subjects with a history of 'recreational' drug use/abuse.

Adult↗

Ongoing high-risk sexual behaviors in relation recreational drug use in sexual encounters. Analysis of 5 years of data from the Toronto Sexual Contact Study.

The current study investigated the association between the use of recreational drugs at the time of sexual activity and high-risk sexual behavior in a Toronto cohort of 249 homosexual and bisexual men over a 5-year period commencing in 1984 to 1985 and concluding in 1989 to 1990. The main analysis was based on a total of 2536 visits. Univariate and multivariate Liang-Zeger regression models were used to relate the log of the sexual activity score (SARS) to the independent variables over the 20 follow-up visits while controlling for intercorrelations between variables from the same respondent. We found that there was a significant decline, over time, in the sexual activities that pose a higher risk of infection with human immunodeficiency virus. Recreational drugs still appear to be playing an important role in the continuation of higher-risk sexual activities. The use of poppers in conjunction with sex is a strong predictor of high-risk activity, as is use of alcohol and marijuana in conjunction with sex. Also, simultaneously strongly associated with higher-risk score is the Centers for Disease Control classification II. More emphasis needs to be placed on educating the population about the potential risks of combining reactional drugs with sexual activity.

Acquired Immunodeficiency Syndrome↗

Profiling the subjective, psychomotor, and physiological effects of a hydrocodone/acetaminophen product in recreational drug users.

BACKGROUND: Hydrocodone (HYD) is a mu opioid agonist. Hydrocodone/acetaminophen HYD/ACET compounds are both widely prescribed and abused prescription painkillers in the United States. In the present study, we profiled the subjective, psychomotor, and physiological effects of the compound. It was of particular interest to determine if HYD/ACET had abuse liability-related subjective effects in a population of recreational drug users. METHODS: Eighteen volunteers participated in a crossover, randomized, double-blind study in which they received, all p.o., placebo; 5 mg HYD/500 mg ACET; 10mg HYD/500 mg ACET; 20 mg HYD/1000 mg ACET; 40 mg morphine (MOR) sulfate; and 1000 mg ACET. Measures were assessed before and for 300 min after drug administration. RESULTS: HYD/ACET produced effects that were dose-related, and the highest dose produced a similar magnitude of effect to that of MOR. There were some abuse liability-related subjective effects produced by 20 mg HYD/ACET and MOR, but there were also unpleasant effects. Some unpleasant subjective effects were experienced only by females. Overall liking and "take again" ratings assessed 24 h post-session were not significant, but several subjects had elevated liking and "take again" ratings at this time in one or more of the HYD/ACET conditions and/or in the MOR condition. Both 20 mg HYD/1000 mg ACET and MOR impaired psychomotor performance. HYD/ACET and MOR produced miosis. CONCLUSIONS: HYD/ACET produced some abuse liability-related subjective effects in recreational drug users, which is consistent with the widespread non-medical use and abuse of this product.

Adult↗

Profiling the subjective, psychomotor, and physiological effects of tramadol in recreational drug users.

Tramadol is a mu opioid agonist that also inhibits the reuptake of norepinephrine and serotonin. Because non-medical use of prescription opioids, including tramadol, has increased in the U.S. over the last several years, we sought to profile its subjective, psychomotor, and physiological effects in recreational drug users. Twenty-two subjects received placebo, 50 or 100 mg tramadol, morphine, or 2 mg lorazepam in a randomized, crossover, double-blind design. The last 12 subjects in the study received 25 mg morphine, a dose that is putatively equianalgesic to 100 mg tramadol. In these subjects, morphine induced miosis and several other mu agonist subjective effects; 100 mg tramadol increased "feel drug effect" and drug liking ratings, and decreased pupil size, but the miotic effect was not statistically significant. Lorazepam, but neither tramadol nor morphine, impaired psychomotor performance. When the placebo, tramadol, and lorazepam data from all 22 subjects were analyzed, 100 mg tramadol induced miosis, and several subjective effects were increased significantly, including ratings of drug liking and "want to take again." The present results indicating that a clinically-prescribed dose of oral tramadol has abuse liability-related effects in recreational drug users suggest the need for further abuse liability testing of the oral formulation in opioid abusers.

Adult↗

Rapid screening procedure based on headspace solid-phase microextraction and gas chromatography-mass spectrometry for the detection of many recreational drugs in hair.

An increasing number of synthetic drugs are appearing on the illicit market and on the scene of drug use by youngsters. Official figures are underestimated. In addition, immunochemical tests are blind to many of these drugs and appropriate analytical procedures for routine clinical and epidemiological purposes are lacking. Therefore, the perceived increasing abuse of recreational drugs has not been proved yet. In a previous paper, we proposed a procedure for the preliminary screening of several recreational substances in hair and other biological matrices. Unfortunately, this procedure cannot apply to cocaine. Consequently, we performed a new headspace solid-phase microextraction and gas chromatography-mass spectrometry (HS-SPME-GC-MS) procedure for the simultaneous detection of cocaine, amphetamine (A), methamphetamine (MA), methylen-dioxyamphetamine (MDA), methylen-dioxymethamphetamine (MDMA), methylen-dioxyethamphetamine (MDE), N-methyl-1-(1,3-benzodioxol-5-yl)-2-butanamine (MBDB), ketamine, and methadone in human hair. Hair was washed with water and acetone in an ultrasonic bath. A short acid extraction with 1M hydrochloric acid was needed; the fiber was exposed to a 5 min absorption at 90 degrees C and thermal desorption was performed at 250 degrees C for 3 min. The procedure was simple, rapid, required small quantities of sample and no derivatization. Good linearity was obtained over the 0.1-20.0 ng/mg range for the target compounds. Sensitivity was good enough: limits of detection (LOD) were 0.7 ng/mg of hair for the majority of substances. The intra-day precision ranged between 7 and 20%. This paper deals with the analytical performance of this procedure and its preliminary application to hair samples obtained on a voluntary basis from 183 young people (138 males and 45 females) in the Rome area.

Adolescent↗

Cardiovascular responses during recreational 5-a-side indoor-soccer.

The aims of this study were to examine the cardiovascular response to recreational 5-a-side indoor-soccer (5v5) matches (5v5 study, 5v5S, n=15) and to assess the validity of using heart rate (HR) to estimate oxygen uptake (VO(2)) demands during actual game-play (validity study, VS, n=16) in young subjects (age 16.8+/-1.5 years). Game responses during 5v5S were assessed during 30 min matches using short-range telemetry heart-rate monitors. In VS games (12 min), VO(2) and HR were monitored with a portable gas analyser (K4b(2), COSMED, Rome, Italy). Individual HR-VO(2) relationships were determined from a laboratory treadmill run to exhaustion (VS) and a multistage shuttle running fitness test (5v5S) using K4b(2). Results showed that 5v5 elicits 83.5+/-5.4 and 75.3+/-11.2% of HR(peak) and VO(2peak), respectively. Ninety-one percent of the playing time (30 min) was spent at HR higher than 70% of HR(peak). In VS match, gas analyses revealed that only 71% of HR variance was explained by VO(2) variations. However, playing at approximately 70% of HR(peak) elicited 51.6+/-11.2% of VO(2peak). Group actual versus predicted VO(2) values demonstrated no significant differences (p>0.05), however, large confidence limits were observed (+6.20 and -10.53 mlkg(-1)min(-1)). These results show that HR and VO(2) responses to recreational 5v5 soccer in young athletes are similar to the exercise intensities recommended by ACSM for promoting cardiovascular health and suggest that HR is valid to prescribe and monitor aerobic intermittent exercise. These results also show that HR measures are acceptable for estimating VO(2) during intermittent exercise when assessing large groups, but show that large estimation errors can occur at the individual level.

Adolescent↗

Risk perception bias, self-reporting of illness, and the validity of reported results in an epidemiologic study of recreational water associated illnesses.

Epidemiologic studies of water associated illness often have to rely on self-reported symptoms of the outcome illness(es) under study. Individual participant's perception of risk, in theory, can affect the validity of self-reported symptoms. The magnitude and effect of possible "risk perception bias" was evaluated as part of a series of randomized trials designed to assess infectious disease transmission via exposure to marine recreational waters with modest sewage contamination. All study subjects were blinded to both their individual indices of exposure and the outcome illnesses under study. Of the five outcome illnesses studied, the effect of "risk perception bias" only effected one: skin ailments. Although analysis of crude rates of skin ailments showed the exposed group (bathers) to be 3.5 times more likely to report skin ailments relative to the non-exposed (non-bathers), when the data was stratified by any perceived health risk of bathing in such waters, this association was shown to be spurious in nature. Bathers having pre-conceived notions of any health risk due to the exposure were 10.63 times more likely to report skin ailments relative to the unexposed (non-bathers) (95% CI 2.36-47.8, P = 0.0002), while bathers without any pre-conceived notion of risk were no more likely to report skin ailments relative to non-bathers (OR = 0.60, 95% CI 0.11-3.24, P = 0.71). Further stratification by exposure grouping showed bathers with pre-conceived notions of excess risk to be 4.78 times more likely to report skin ailments relative to bathers without any notion of excess risk (95% CI 1.04-21.86, P = 0.03), while among non-bathers those with pre-conceived notions of risk were 3.70 times less likely to report skin ailments relative to non-bathers without any pre-conceived notion of risk (95% CI 0.70-19.60, P = 0.10). This study shows that "risk perception bias" can be strong enough to lead to spurious associations in the presence of self-reported symptoms, and should be controlled for in future epidemiologic studies of recreational water associated illnesses and other water associated environmental exposures where the use of self-reported symptoms cannot be avoided.

Bias↗

The application of peptide nucleic acid probes for rapid detection and enumeration of eubacteria, Staphylococcus aureus and Pseudomonas aeruginosa in recreational beaches of S. Florida.

A novel chemiluminescent in situ hybridization technique using peptide nucleic acids (PNA) was adapted for the detection of bacteria in beach sand and recreational waters in South Florida. The simultaneous detection and enumeration of eubacteria and the novel indicators, Staphylococcus aureus and Pseudomonas aeruginosa, was achieved within 6-8 h of processing. Following 5 h of incubation on TSA, soybean peroxidase-labeled peptide nucleic acid probes (Boston Probes, Boston, MA) targeting species-specific 16S rRNA sequences of P. aeruginosa and S. aureus were used to hybridize microcolonies of the target species in-situ. In addition, a universal probe for 16S rRNA sequences was used to target the eubacteria. Probes were detected after a light generating reaction with a chemiluminescent substrate and their presence recorded on Polaroid film. The probes showed limited cross-reactivity with mixed indigenous bacteria extracted from seawater and sand by shaking with phosphate-buffered saline (PBS). Specificity and cross-reactivity was tested on the reference bacterial genera Pseudomonas, Staphylococcus, Vibrio, Shigella, Salmonella, Acinetobacter, Enterobacter, Escherichia and Citrobacter. These tests confirmed that the probes were specific for the microorganisms of interest and were unaffected by high salt levels. The results of the PNA chemiluminescent in situ hybridization were compared with traditional plate count methods (PCM) for total 'freshwater' eubacteria, S. aureus and P. aeruginosa. Counts of eubacteria and S. aureus were comparable with numbers obtained from traditional plate counts but levels of P. aeruginosa were higher with PNA than with PCM. It is possible that PNA is more sensitive than PCM because it can detect microcolonies on the agar surface that never fully develop with the plate count method. We conclude that the in situ hybridization technique used here represents an important potential tool for the rapid monitoring of novel indicator organisms in beaches and recreational waters.

Acinetobacter↗

Outcomes associated with participation in a therapeutic recreation camping programme for children from 15 European countries: Data from the 'Barretstown Studies'.

In recent years, specialised camping programmes, based largely on the premise of therapeutic recreation, have emerged as a form of intervention for children with chronic illnesses, and their siblings. Although these programmes are proliferating, little systematic evaluation of their outcomes has been undertaken, particularly within a European context. The aim of this research was to investigate the symptom and psychosocial outcomes of The Barretstown Gang Camp therapeutic recreation programme in Ireland, a programme aimed at European children with chronic illnesses and their siblings, in the short and longer term. Measures assessing children's physical, psychological and social functioning, specifically their self-reported physical symptoms, affect, self-esteem and quality of life, were translated into 12 European languages and administered at 3 time periods: 2 weeks before each child participated in the programme (Time 1), 2 weeks after participation (Time 2) and at 6 months following participation (Time 3). Benefits were noted in their experience of physical symptoms, affect pertaining to physiological hyperarousal and quality of life in the short and longer term. Positive changes were also noted in relation to self-esteem as it pertains to global self-worth and physical attractiveness though these were, for the most part, in the longer term only and were preceded by adverse effects in the short term. While some of these positive changes were global, there were group differences based mostly on children's age, and patient/sibling status and to a lesser extent on their nationality. However, no benefits were evident in many aspects of children's functioning, either at a global or a group level, in the short and longer term. These findings clarify previous research and suggest that camping programmes have an important role to play as a complementary intervention in facilitating adjustment to chronic illness.

Adaptation, Psychological↗

Activation of natural killer cell function in recreational athletes with paraplegia during a wheelchair half-marathon race.

OBJECTIVE: To investigate a part of the immune homeostasis in recreational athletes with spinal cord injury (SCI) during and after a wheelchair half-marathon race. DESIGN: Case-control study in an actual race. SETTING: The half-marathon division of an international wheelchair marathon race in Japan. PARTICIPANTS: Seven male wheelchair racers with SCI between T7 and L1. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Changes in the number and function of natural killer (NK) cells and the endocrine effects, including plasma catecholamines and cortisol in blood samples obtained the day before the race, immediately after it, and 1 day after the race. RESULTS: Both the percentage and absolute number of peripheral NK cells did not change significantly throughout the experiment. Mean NK cell cytotoxic activity +/- standard deviation increased significantly, from 45.5%+/-7.5% to 56.1%+/-5.1% (P<.01) immediately after the race and remained increased until the next day. Plasma adrenaline levels were increased (P<.05) immediately after the race and recovered 1 day later; the plasma concentration of cortisol did not change throughout the experiment. CONCLUSIONS: The wheelchair half-marathon race induced activation of NK cell function in recreational athletes with SCI between T7 and L1.

Adult↗

Recognition and management of complications of new recreational drug use.

Use of illicit drugs in clubs and large dance parties (so-called raves) is a burgeoning cultural trend. Such recreational drug use is associated with several medical complications, both acute and longlasting. Although few, if any, of the drugs currently used in recreational venues are truly new, their patterns and context of use have changed (a great deal in some instances). For some of these substances, this cultural repackaging of the drug experience has resulted in various medical disorders that have previously gone undocumented. This review aims to help treating physicians recognise and manage complications associated with the use of new drugs in clubs, including methylenedioxymethamfetamine, ephedrine, gamma-hydroxybutyrate; gamma-butyrolactone, 1,4-butanediol, flunitrazepam, ketamine, and nitrites. We also alert researchers to specific toxic effects of club-drugs on which more basic information is needed.

Drug Overdose↗