Ketamine Injection and HIV Risk Among High Risk Youth

描述（由申请人提供）：俗称“特殊K”，“维生素K”或简称“K”，氯胺酮是苯环利定（PCP）的一种。氯胺酮在急诊和兽医中作为麻醉剂使用多年，最近在非临床环境中作为几种被归类为“俱乐部毒品”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，大多数关于氯胺酮的信息都来自于对“俱乐部毒品”环境和人群的研究，尤其是男同性恋者场所。这些数据大多是假设氯胺酮的非注射方式，并且已经评估了艾滋病毒风险与性传播风险增加的关系。然而，我们的R03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，特别是在不同的高危青年亚人群中。此外，试点数据还表明，以前未被认识到的注射使用是一种给药方式。虽然氯胺酮注射实践尚未得到系统描述，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源性病原体传播的风险，特别是HIV-1、HBV和HCV。根据我们在以前的治疗外人群研究中成功应用的比较研究设计，我们提出在三个城市-纽约市，新奥尔良和洛杉矶的高危青年中进行氯胺酮注射的描述性流行病学研究。我们将采用人种学观察的方法，对制备和注射氯胺酮的行为进行系统的描述。根据我们之前对注射实践的建模工作，我们将确定氯胺酮注射可能加剧或减弱病毒传播风险的离散特征，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可变性。最后，我们将在纽约市招募一组最近开始注射氯胺酮的高风险青年，并描述与使用注射作为给药模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.