People smoke more when they have filters and low-tar cigarettes.And there is some evidence that improved HIV treatments are associated with increases in risky sexual behavior.How might safety testing have such effects? Conceivably, users who were worried about drug quality in the illicit market may become less worried if they learn through safety testing that drugs are generally pure in the local market. For better or worse, the purity rates presented above suggest little cause for this concern. A somewhat different concern is that the very presence of a safety testing organization, like DanceSafe, might make people feel more comfortable about using MDMA. One survey has examined this possibility.Seven hundred and nineteen students at McDaniel College in Maryland were asked whether they had ever used Ecstasy, and “whether the presence of [DanceSafe] would affect their decision to try [Ecstasy] for the first time or use it.”Among the 75% who had never used, 69% said they would not use under any condition, while 19% said they might be more likely to use under such conditions, and 12% said that if they did decide to use they would not be influenced by the presence of DanceSafe.Students that had previously used Ecstasy were equally divided between those who thought they might be influenced and those who did not.But there are also reasons to think that safety testing, with its historically dire purity statistics, might scare off some drug users. At the very least, some fraction of participants who submit samples that turn out “dirty” presumably quit using, scale back their use,cannabis grow set up or at least delay their use while seeking better samples. And to the extent that other potential users see these statistics, the deterrent effect might be much broader than the limited participation rates indicate. Do current and potential users consider health risks—and the risk of being ripped off—when they consider drug use? The health risks of illicit drugs have long been a major focus of prevention campaigns, and various studies show that current users worry about these risks.
One such study reported that users and nonusers of MDMA frequently relied on the Internet for information about MDMA.Users were more likely to seek information from non-government sites than from government sites , and the nongovernmental sources were perceived to be more accurate than the governmental sources. This Article makes no claim that health fears matter more than legal fears. It is surprisingly difficult to find surveys comparing the relative importance of fear of legal risk and fear of health risk. The Monitoring the Future survey conflates the two dimensions by asking “How much do you think people risk harming themselves , if they [try marijuana].”In the vast literature on drug prevention and on the application of attitudinal theories—reasoned action, planned behavior, and the health belief model—to drug use, there is almost no research directly reporting perceived fear or risk of arrest or other legal sanctions.On the other hand, the smaller “perceptual deterrence” literature assesses perceived legal risk , but does not examine health concerns.An Australian survey by Professors Don Weatherburn and Craig Jones found that those not using cannabis were more likely to cite “worried about your health” than “[c]annabis is illegal” , “[y]ou are afraid you will be caught by the police” , or “[y]ou have drug testing in your workplace” as a reason for not using.And the aforementioned McDaniel College survey, which suggested that people might be influenced by DanceSafe, found that both users and nonusers worried more about the purity of Ecstasy than about legal sanctions.But a broader harm reduction benefit occurs through the testing messages posted by safety testing organizations. These messages can be quite specific. For example, DanceSafe and EcstasyData.org post photographs of contaminated or adulterated “brands” of MDMA, together with the date and geographic region of the purchase.
I have already reviewed evidence that a sizeable fraction of MDMA users say they read such information on the web, that they view the information as credible, and that their health and safety matter to them.So it is possible that for every anonymous sample provider who is helped, there are many more potential users who are also helped. But again, I am not aware of direct evidence of the harms averted by safety testing. As with use testing, there may be other, less direct consequences, some of which may be undesirable. There may be a substitution from one type of drug to another; for example, users may come to distrust MDMA and seek out other substances. Some of those substances are arguably more benign ; others may be more unhealthy. In theory, widespread safety testing could improve the quality of illicit drugs in the marketplace. This provides a stark illustration of the tension between harm reduction and use reduction, because better drug quality should increase demand. But it is difficult to make firm predictions here. In an ordinary market, sellers should charge more for higher quality goods, and buyers should be willing to pay more. In the long run, sellers of low-quality goods can expect to lose customers to sellers offering higher quality goods at the same price. But illicit drugs are not an ordinary market. Professors Jonathan Caulkins and Rema Padman found that prices rose with purity for white and brown heroin and powder cocaine, but surprisingly, they were unable to detect an effect of purity on the prices of crack, methamphetamine, or black tar heroin.To help explain this puzzle, Professors Peter Reuter and Jonathan Caulkins detail a number of distinctive features of illicit drug markets, including the multistage distribution networks connecting producers and consumers, uncertainty about quality, turnover of buyers and sellers, and a limited ability to signal quality through consistent branding.Many of these features produce the kind of informational problems discussed in Professor George Akerlof’s classic paper on “the market for lemons.”A lemons market occurs when there is an informational asymmetry such that sellers know more than buyers about a good’s quality. This asymmetry increases the supply of low-quality goods, and can even collapse the market if potential buyers refuse to make new purchases. One major difference from the classic lemons model is the higher likelihood of repeat buyer-seller transactions; in drug markets, the retail seller also has imperfect knowledge of and control over quality.From a use-reduction standpoint,outdoor cannabis grow the highly variable quality of drugs probably reduces the demand for illicit drugs. But from a harm-reduction standpoint, this feature of illicit markets is quite troubling. First, it creates a high risk of overdose and illness, because adulterants have a toxic effect and also because customers have difficulty calibrating their dosage. Second, it encourages disputes between sellers and buyers, and given the illicit nature of their transactions, these disputes cannot be taken to legal authorities and thus frequently result in violence.
Over 35 million people worldwide live with human immunodeficiency virus , and 1.2 million of these people live in the United States. Since the development of combination antire-troviral therapy , HIV-associated mortality has decreased in the United States, such that the lifespan of people living with HIV with reliable access to cART is comparable to those without HIV. Despite these advances in the medical management of HIV disease, the central nervous system remains vulnerable. In fact, HIV targets the CNS within days after infection leading to neurological, behavioral, and cognitive complications. Even in the current cART era, mild neurocognitive deficits are observed in about 45% of PLWH, particularly in the domains of executive function, learning, and memory. Neuroimaging studies suggest that functional and structural abnormalities in subcortical regions underlie these cognitive deficits. Neurocognitive impairment among PLWH is clinically meaningful because it is known to adversely affect daily functioning, conferring an increased risk of poor medication management , impaired driving ability , problems in employment , and early mortality. As the HIV+ population ages, understanding and addressing HIV-associated comorbidities that impact cognitive performance and everyday functioning is critical to overall healthcare for PLWH. Multiple adverse experiences such as childhood trauma, sexual abuse, physical violence, unemployment, and poverty are highly prevalent among PLWH and have known CNS consequences. For example, estimates of sexual and/or physical abuse in PLWH range from 30% to over 50% Whereas the physiological response to acute stress is typically adaptive, chronically-elevated stress exposure can disturb brain development and function, and increase risk of psychiatric disease. Chronic exposure to stress and stress hormones, glucocorticoids, can hinder immune mechanisms and amplify inflammation in the CNS and, furthermore, exacerbate injury-induced neuronal death. Chronic stress in healthy adults is linked to structural and functional alterations in the hippocampus and prefrontal cortex , and poorer memory recall ability. Due to the overlap in the inflammatory and immune mechanisms shown to be affected by stress and HIV, traumatic and stressful experiences may contribute to or compound the likelihood of CNS injury via this pathway in PLWH. Thus, PLWH with a history of trauma and adversity may be at increased risk for neurocognitive impairment and decreased functional capacity. Among men living with HIV, a previous study found that stressful life events were related to worse executive functioning, attention, and processing speed. In women living with HIV, high levels of self-reported stress were associated with verbal memory deficits, as well as prefrontal cortex structural and functional deficits. Conversely, high stress was not associated with verbal memory performance inwomen without HIV, suggesting that stress may be particularly deleterious to cognitive function in the context of HIV. Another recent study found that PLWH with higher levels of social adversity showed reduced volumes of subcortical structures and worse learning/memory performance, and these findings did not extend to the HIV- group. Stress, emotional reactivity, and avoidant coping behaviors are related to important daily functioning behaviors such as medication nonadherence among PLWH. Although multiple studies have examined the effects of stress on cognitive function within cohorts of PLWH or individuals without HIV, few have directly compared the effects between serostatus groups while examining the combined effects of multiple traumatic and stressful experiences, or included standardized measures of daily functional abilities. In the present study, we investigated whether a composite measure of multiple adverse experiences including trauma, economic hardship, and stress exerts a negative impact on cognitive and everyday function in a cohort of adults living with and without HIV. We hypothesized that PLWH would experience more trauma, economic hardship, and stress than their HIV- counterparts. Furthermore, we hypothesized that elevated TES would relate to worse cognitive function and everyday function in both serostatus groups, but the magnitude of the association would be greater for PLWH compared to their HIV- counterparts, after controlling for established predictors of cognitive and functional status.Participants were 122 PLWH and 95 adults without HIV from the Multi Dimensional Successful Aging among Adults living with HIV study conducted at the University of California San Diego. This study utilized cross-sectional data from the first study visit. The UCSD Institutional Review Board approved this study, and all participants provided written, informed consent. Exclusion criteria were minimal in order to enroll a representative cohort of PLWH and HIV- adults, and included: diagnosis of a psychotic disorder or mood disorder with psychotic features; presence of a significant neurological condition known to impact cognitive functioning ; positive urine toxicology on the day of testing. An HIV/HCV finger stick point of care test was used to test all participants for HIV infection. Of the participants who reported they were HIV- at screening, none tested positive for HIV. Study visits consisted of detailed neuromedical, psychosocial, and cognitive assessments, and specimen collection. Our TES composite variable was derived to capture three components of adversity: traumatic events , economic hardship: food insecurity and low socioeconomic status , and perceived stress. Traumatic events were assessed by the self-report Women’s Health Initiative Life Events Scale, which assesses traumatic events over the past year. For our trauma variable, we included the following five items from this scale: death of a spouse or partner, major problems with money, a major accident, disaster, mugging, unwanted sexual experience, or robbery, physical abuse by a family member or close friend, or verbal abuse by a family member or close friend, for which the participant rated the event as moderately or very upsetting. In the overall cohort, the number of traumatic life events ranged from zero to five.