Ketamine Injection and HIV Risk Among High Risk Youth

描述（由申请人提供）：局部称为“特殊K”，“维生素K”或简称“K”，氯胺酮是苯环己哌啶（PCP）的一种。氯胺酮在急诊和兽医中作为麻醉剂使用多年，最近在非临床背景下作为几种被归类为“俱乐部药物”的合成物质之一出现。像其他所谓的“俱乐部毒品”，如MDMA，GHB和甲基苯丙胺一样，关于氯胺酮的大多数可用信息都来自于专注于“俱乐部毒品”环境和人群的研究，特别是MSM场所。大部分数据都假定了氯胺酮的非注射给药方式，并根据性传播风险的增加评估了艾滋病毒风险。然而，我们的R 03研究的试点数据表明，氯胺酮在非MSM人群和场所中普遍存在，特别是在高危青年的不同亚群中。此外，试点数据还表明，以前未认识到使用注射作为一种给药方式。虽然氯胺酮注射做法尚未得到系统描述，但初步数据表明，使用一系列药物制备和注射技术可能会增加血液传播病原体（特别是HIV-1、HBV和HCV）的传播风险。根据我们已经成功地应用在以前的治疗人群的研究中的比较研究设计，我们提出了一个描述性的流行病学研究氯胺酮注射在三个城市的高危青年-纽约市，新奥尔良和洛杉矶。我们将采用人种学观察的方法，对用于制备和注射氯胺酮的行为实践进行系统描述。根据我们先前在建模注射实践方面的工作，我们将确定氯胺酮注射的离散特征，这些特征可能会加剧或减弱病毒传播的风险，包括这些实践中可能与不同形式的氯胺酮和各种氯胺酮获取模式相关的变异性。最后，我们将在纽约招募一组最近开始注射氯胺酮的高危青年，并描述与使用注射作为一种给药方式相关的社会过程和意外医疗后果。

DESCRIPTION (provided by applicant): Parochially known as "Special K," "Vitamin K," or simply "K," ketamine is a conger of phencyclidine (PCP). Used for many years as an anesthetic in emergency and veterinary medicine, ketamine has recently emerged in a non-clinical context as one of several synthetic substances classified as "club drugs." Like other so-called "club drugs," such as MDMA, GHB, and Methamphetamine, most available information about ketamine stems from studies focused on "club drug" environments and populations, notably MSM venues. Much of this data has presumed non-injected modes of administrating ketamine, and HIV risk has been assessed in relation to increased risk for sexual transmission. However, pilot data from our R03 study indicates that ketamine is prevalent among non-MSM populations and venues, notably in diverse sub-populations of high risk youth. Moreover, pilot data also indicate the previously unrecognized use of injection as a mode of administration. While ketamine injection practices have yet to be systematically described, preliminary data indicate the use of an array of drug preparation and injection techniques that may pose increased risk for transmission of blood-borne pathogens, notably HIV-1, HBV, and HCV. Following a comparative research design that we have successfully applied in previous studies of out-of-treatment populations, we propose a descriptive epidemiological study of ketamine injection among high risk youth in three cities - New York City, New Orleans, and Los Angles. We will employ methods of ethnographic observation to develop a systematic description of the behavioral practices used to prepare and inject ketamine. Following our prior work in modeling injection practices, we will identify discrete features of ketamine injection that may exacerbate or attenuate risk for viral transmission, including variability in these practices that may be associated with different forms of ketamine and various of patterns of ketamine acquisition. Finally, we will recruit a cohort of high risk youth in NYC who have recently initiated injection of ketamine and describe the social course and unintended medical consequences associated with the use of injection as a mode of administration.