Patterns of Drug Use and Abuse in the Brazilian Rave Culture

描述(由申请人提供)： 这份精心设计、经过修改的申请建议特拉华大学的Inciardi博士和Surratt博士以及南里奥格兰德联邦大学的Pechansky博士建立合作伙伴关系。他们将一起探索巴西南部新兴的俱乐部毒品流行。这个话题很有趣，这些数据将有助于理解巴西正在出现的俱乐部毒品和狂欢问题。研究小组强大，方法健全，他们对上次审查中表达的所有关切作出了充分反应。该小组认为，该项目将受益于标准访谈中关于烟草使用的一些基线问题，他们对与俱乐部毒品现场有关的艾滋病毒/艾滋病传播风险缺乏关注表示关切。该提案称，他们将在俱乐部活动中分发“减少伤害”的宣传品，这是积极的。然而，制定对这一人群文化上合适和有效的干预措施的计划还没有完全制定出来。然而，这些都不是主要的弱点，审查委员会认为该提案很突出。 描述(申请人提供)：自20世纪70年代以来，出现并扩张了所谓的“俱乐部毒品”和“俱乐部文化”。俱乐部毒品(或称为“狂欢毒品”、“舞蹈毒品”和“派对毒品”)是一个模糊的术语，指的是各种各样的物质，但在美国，最受欢迎的俱乐部毒品是MDMA(摇头丸)、GHB、氯胺酮、LSD、甲基苯丙胺，以及一些处方药，如右旋苯丙胺和哌醋甲酯。最近，大众媒体和科学媒体的报道开始表明，在巴西许多地区，摇头丸的使用正在显著增加。虽然摇头丸早在1994年就被引入巴西，但据大多数人的说法，直到2000-2001年，摇头丸的使用都是局部的和零星的。目前，摇头丸的使用已经蔓延到巴西的大多数主要城市，主要发生在狂欢派对和夜总会。巴西发表的几项关于这一主题的研究表明，摇头丸使用者往往是多药滥用者，非法药物和处方药滥用的比率比非摇头丸使用者高得多。由于绝大多数俱乐部吸毒者年龄较小，而且他们在典型的吸毒狂欢中倾向于混合多种药物，因此俱乐部吸毒者往往是一个高度脆弱的群体。然而，关于俱乐部吸毒总体上对健康和社会影响的科学研究很少发表，巴西也没有进行过任何研究。在这一背景下，拟议研究的总体目标是发展当地研究人员的能力，通过合作研究过程解决这一新出现的健康问题。拟议研究的具体目标是：1)在巴西阿雷格里港招募200名年龄在18-39岁之间的未接受治疗的俱乐部吸毒者，并在基线上评估他们酒精和药物滥用开始和发展的生活史(数量、频率和类型的变化)，以及当前酒精、俱乐部、处方和其他药物使用的程度；2)在6个月和12个月时，评估受访者酒精和俱乐部、处方和其他药物使用的开始、进展和程度的变化；3)在基线、6个月和12个月时，调查药物滥用的数量、频率、类型和持续时间对这一人群的健康和社会后果的性质和程度的影响，包括：性冒险和胁迫；药物相互作用和过量；慢性药物使用；日常活动障碍；身体问题；精神健康问题；和法律问题；以及4)检查性别对药物使用的发生、发展和程度以及健康和社会后果的性质和程度的影响。数据分析将使用各种统计技术来描述人口、俱乐部、处方和其他药物使用的流行病学，以及相关健康后果的性质和流行程度。这项研究将在巴西阿雷格里港南里奥格兰德州联邦大学与Flavio Pechansky博士合作进行，作为NIH#R01DA019048(Inciardi，PI)补助金的延伸。拟议的探索性项目是在更好地了解巴西南部新出现的俱乐部毒品流行的进程中迈出的重要第一步。迈阿密的初步研究表明，俱乐部吸毒者面临着需要干预的身心健康后果的高风险，特别是那些同时滥用处方药的人，而且似乎滥用处方药在巴西也是一个紧急问题。拟议的工作将开始在巴西范围内确定俱乐部和处方药滥用后果的性质和程度--最终可以根据这些信息制定适当的干预措施、保健服务和预防政策。作为第一步，收集的数据将用于编制葡萄牙语培训材料，供当地治疗提供者和卫生从业者使用。

DESCRIPTION (provided by applicant): This well-crafted, revised application proposes a partnership between Drs. Inciardi and Surratt from the University of Delaware and Dr. Pechansky from the Federal University of Rio Grande do Sul. Together, they would explore the emerging club drug epidemic in the Southern part of Brazil. The topic is interesting and the data will be useful to understand the emerging problem of club drugs and raves in Brazil. The research team is strong, the methodology is sound and they have responded adequately to all of the concerns expressed in the previous review. The panel thought that the project would benefit from some baseline questions about tobacco use in the standard interview and they were concerned by the lack of attention to HIV/AIDS transmission risks connected with the club drug scene. The proposal states that they will distribute "harm reduction" literature at club events and that is positive. However, plans are not fully laid out for developing an intervention that is culturally appropriate and effective for this population. Nevertheless, these were not major weaknesses and the review committee thought that the proposal was outstanding. DESCRIPTION (provided by applicant): Since the 1970s there has been the emergence and expansion of the so-called "club drugs" and "club culture." Club drugs (alternatively called "rave drugs," "dance drugs" and "party drugs") is a vague term that refers to a wide variety of substances, yet in the U.S. the most popular of the club drugs have been MDMA (ecstasy), GHB, ketamine, LSD, methamphetamine, and a few prescription drugs, such as dextroamphetamine and methylphenidate. Recently, reports in both popular and scientific media have begun to indicate that ecstasy use is increasing markedly in many parts of Brazil. Although ecstasy was first introduced in Brazil as early as 1994, by most accounts its use remained localized and sporadic until 2000-2001. Currently, ecstasy use has spread to most major cities in Brazil, and occurs primarily in rave and night-club settings. The handful of published studies on this topic in Brazil suggests that ecstasy users are often polydrug abusers, and have significantly higher rates of illicit and prescription drug abuse than do non-ecstasy users. Because of the young age of the vast majority of club drug users and their tendency to mix numerous drugs during their typical drug binges, club drug users tend to be a highly vulnerable population. However, there are few published scientific studies of the health and social consequences of club drug use in general, and none that have been conducted in Brazil. Within this context, the overall goal of the proposed study is to develop the capacity of local investigators to address this emerging health problem through a collaborative research process. The specific aims of the proposed study are to: 1) Recruit a sample of 200 out-of-treatment club drug users ages 18-39 in Porto Alegre, Brazil, and at baseline assess their life histories of alcohol and drug abuse onset and progression (changes in quantity, frequency, and types), and extent of current alcohol, club, prescription, and other drug use; 2) at 6 and 12 months, assess changes in onset, progression, and extent of respondents' alcohol and club, prescription, and other drug use; 3) at baseline, 6 months, and 12 months, investigate the impact of quantity, frequency, types and duration of drug abuse on the nature and extent of health and social consequences within this population, including: sexual risk-taking and coercion; drug interactions and overdose; chronic drug use; impairment of daily activities; physical problems; mental health problems; and legal problems; and 4) examine the impact of gender on onset, progression, and extent of drug use and the nature and extent of health and social consequences. Data analyses will use a variety of statistical techniques to describe the population, the epidemiology of club, prescription and other drug use, and the nature and prevalence of related health consequences. This research will be conducted in Porto Alegre, Brazil, at the Federal University of Rio Grande do Sul in collaboration with Dr. Flavio Pechansky, as an extension of NIH grant #R01DA019048 (Inciardi, PI). The proposed exploratory project represents a significant first step in the process of better understanding the emerging club drug epidemic in the South of Brazil. Preliminary studies in Miami suggest that club drug users are at high risk for both physical and mental health consequences requiring intervention, particularly those who also abuse prescription drugs, and it would appear that the abuse of prescription drugs is an emergent problem in Brazil as well. The proposed work will begin to identify the nature and extent of the consequences of club and prescription drug abuse in the Brazilian context - information from which appropriate interventions, health services, and prevention policies can ultimately be developed. As a first step, the data collected will be used to generate Portuguese language training materials that will be made available to local treatment providers and health practitioners.