Ketamine Injection and HIV Risk Among High Risk Youth

描述(申请人提供)：氯胺酮通常被称为“特殊K”、“维生素K”或简称“K”，是苯环利定(PCP)的缩合物。多年来，氯胺酮一直被用作急救和兽医的麻醉剂，最近在非临床环境中出现，成为被归类为“俱乐部药物”的几种合成物质之一。与其他所谓的“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对“俱乐部毒品”环境和人群的研究，特别是MSM场所。这些数据中的大部分都推定了非注射给药氯胺酮的方式，并评估了与性传播风险增加有关的艾滋病毒风险。然而，我们R03研究的初步数据表明，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，以前未被认识到的注射作为一种给药模式的使用。虽然尚未系统地描述氯胺酮注射做法，但初步数据表明，使用了一系列药物制剂和注射技术，可能会增加血液传播病原体，特别是艾滋病毒-1、乙肝病毒和丙型肝炎病毒的风险。按照我们在以前对非治疗人群的研究中成功应用的比较研究设计，我们提出了一项关于在纽约、新奥尔良和洛杉矶三个城市的高危青年中注射氯胺酮的描述性流行病学研究。我们将使用人种学观察的方法，对用于准备和注射氯胺酮的行为实践进行系统的描述。根据我们之前在模拟注射实践中所做的工作，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降低病毒传播的风险，包括这些实践中可能与不同形式的氯胺酮和不同的氯胺酮获取模式相关的变异性。最后，我们将在纽约市招募一群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想不到的医学后果。

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.