MATERIALS AND METHODS: In this case-control study, we examined 294 patients over the age of 18 who were using synthetic cathinones and opioids. All patients underwent electrocardiography and transthoracic echocardiography.

RESULTS: Our study involved 183 patients using synthetic cathinones and 111 patients reporting opioid use. The average age of the patients was 32.4 ± 8.5 years. In patients using synthetic cathinones, electrocardiography showed a lengthening in the average duration of the ventricular QRS complex (70.5 ± 13.3 ms vs. 69.6 ± 11.7 ms), T wave (154.1 ± 27.5 ms vs. 140.4 ± 24.1 ms), and QT interval (338.2 ± 28.5 ms vs. 334.8 ± 33.5 ms), as well as a shortening of the P wave (79.1 ± 12.2 ms vs. 82.6 ± 14.4 ms) and PQ interval (146.4 ± 19.6 ms vs. 148.3 ± 20.1 ms). Echocardiography confirmed left ventricular hypertrophy in 10.9% of the synthetic cathinones group and 17.1% of the opioid group. Transmitral left ventricular diastolic dysfunction was diagnosed in 23.5% of patients in both groups. Additionally, 31.1% of patients using synthetic cathinones and 44.1% of those using opioids had a reduced ejection fraction on echocardiography.

METHOD: A literature survey of published kratom studies among humans was conducted. Forty published studies relevant to the objective were reviewed.

RESULTS: Apart from the differences in the sources of supply, patterns of use and social acceptability of kratom within these two regions, the most interesting finding is its evolution to a recreational drug in both settings and the severity of the adverse effects of kratom use reported in the West. While several cases of toxicity and death have emerged in the West, such reports have been non-existent in South East Asia where kratom has had a longer history of use. We highlight the possible reasons for this as discussed in the literature. More importantly, it should be borne in mind that the individual clinical case-reports emerging from the West that link kratom use to adverse reactions or fatalities frequently pertained to kratom used together with other substances. Therefore, there is a danger of these reports being used to strengthen the case for legal sanction against kratom. This would be unfortunate since the experiences from South East Asia suggest considerable potential for therapeutic use among people who use drugs.

DESIGN: We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 to 2017.

METHODS: We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving at least 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three-factor structure, employed in the current analyses, were factor 1 (basic needs); factor 2 (housing-related variables) and factor 3 (economic resources).

RESULTS: Recent incarceration [β-coefficient (β) = -0.176, 95% confidence interval (95% CI): -0.288 to -0.063], unmet health needs [β = -0.110, 95% CI: -0.178 to -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336 to -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586 to -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, or for each factor individually.

METHODS: A cross-sectional study involving members of the Malaysian public was carried out using the convenience sampling method. Descriptive statistics were used to summarise the socio-demographic characteristics of the respondents. Associations between knowledge items/scores and other items were assessed using Spearman's rank correlations and Cramer's V. Regression analyses were carried out to determine whether the socio-demographic characteristics of the respondents influenced knowledge and practice relating to unregistered medications.