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CORK Bibliography: Cocaine



159 citations. March 2012 to present

Prepared: September 2012



Afshar M; Knapp CM; Sarid-Segal O; Devine E; Colaneri LS; Tozier L et al. The efficacy of mirtazapine in the treatment of cocaine dependence with comorbid depression. American Journal of Drug and Alcohol Abuse 38(2): 181-186, 2012. (25 refs.)

Background: Prior findings concerning the use of mirtazapine in the treatment of a variety of substance use disorders and its antagonistic actions at the serotonin 5-HT2A receptor suggest that this drug may have efficacy in the treatment of cocaine dependence in the presence of a depressive disorder. Methods: Depressed cocaine-dependent subjects received either mirtazapine (target dose 45 mg daily) or placebo for 12 weeks. Urine concentrations of benzoylecgonine and self-report were used to assess cocaine consumption. Depression and sleep quality were evaluated using the Hamilton Depression Rating Scale (HAM-D) and the Pittsburgh Sleep Quality Index, respectively. Results: Cocaine consumption during the treatment period did not differ significantly between the mirtazapine (n = 11) and placebo (n = 13) groups in this study. In week 4 sleep latency was significantly lower in the active medication than in the placebo group. Positive effects of mirtazapine treatment on early insomnia were suggested by an item analysis of the HAM-D. Conclusions and Scientific Significance: The results of this study suggest that mirtazapine is superior to placebo in improving sleep in patients with comorbid depression and cocaine dependence, but is not more effective than placebo in reducing cocaine use.

Copyright 2012, Informa HealthCare


Agius R; Nadulski T; Kahl HG; Dufaux B. Significantly increased detection rate of drugs of abuse in urine following the introduction of new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 32-37, 2012. (24 refs.)

In this paper we present the first assessment of the new German driving licence re-granting medical and psychological assessment (MPA) guidelines by comparing over 3500 urine samples tested under the old MPA cut-offs to over 5000 samples tested under the new MPA cut-offs. Since the enzyme multiplied immunoassay technique (EMIT) technology used previously was not sensitive enough to screen for drugs at such low concentrations, as suggested by the new MPA guidelines, enzyme-linked immunosorbent assay (ELISA) screening kits were used to screen for the drugs of abuse at the new MPA cut-offs. The above comparison revealed significantly increased detection rates of drug use or exposure during the rehabilitation period as follows: 1.61, 2.33, 3.33, and 7 times higher for 11-nor-delta-9-tetrahydrocannabinol- 9-carboxylic acid (THC-COOH), morphine, benzoylecgonine and amphetamine respectively. The present MPA guidelines seem to be more effective to detect non-abstinence from drugs of abuse and hence to detecting drivers who do not yet fulfil the MPA requirements to regain their revoked driving licence.

Copyright 2012, Elsevier Science


Agius R; Nadulski T; Moore C. Validation of LUCIO (R)-Direct-ELISA kits for the detection of drugs of abuse in urine: Application to the new German driving licence re-granting guidelines. Forensic Science International 215(1-3): 38-45, 2012. (21 refs.)

LUCIO (R)-Direct-enzyme linked immunosorbent assay (ELISA) tests were validated for the screening of drugs of abuse cannabis, opiates, amphetamines and cocaine in urine for the new German medical and psychological assessment (MPA) guidelines with subsequent gas chromatographic-mass spectrometric (GC-MS) confirmation. The screening cut-offs corresponding to 10 ng/mL 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), 50 ng/mL amphetamine, 25 ng/mL morphine and codeine and 30 ng/mL benzoylecgonine were chosen at the point where the number of false negatives was lower than 1%. Due to their accuracy, ease of use and rapid analysis, these ELISA tests are very promising for cases where a large proportion of the tests are expected to be negative such as for abstinence monitoring as part of the driving licence re-granting process.

Copyright 2012, Elsevier Science


Andrade LF; Alessi SM; Petry NM. The impact of contingency management on quality of life among cocaine abusers with and without alcohol dependence. American Journal on Addictions 21(1): 47-54, 2012. (50 refs.)

The use of quality of life (QOL) measures in substance abuse treatment research is important because it may lead to a broader understanding of patients health status and effects of interventions. Despite the high rates of comorbid cocaine and alcohol use disorders, little is known about the QOL of this population, and even less about the impact of an efficacious behavioral treatment, contingency management (CM), on QOL. In this study, data from three clinical trials were retrospectively analyzed to examine QOL in outpatient cocaine abusers with and without alcohol dependence (AD) and the impact of CM on QOL over time as a function of AD status. Patients were randomized to standard care (n = 115) or standard care plus CM (n = 278) for 12 weeks. QOL was assessed at baseline and Months 1, 3, 6, and 9. At treatment initiation, AD patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of AD status. These data suggest that CM produces benefits that go beyond substance abuse outcomes, and they support the use of QOL indexes to capture information related to treatment outcomes.

Copyright 2012, American Academy of Addiction Psychiatry


Attema-de Jonge ME; Peeters SYG; Franssen EJF. Performance of three point-of-care urinalysis test devices for drugs of abuse and therapeutic drugs applied in the emergency department. Journal of Emergency Medicine 42(6): 682-691, 2012. (30 refs.)

Background: Point-of-care tests for toxicological screening of patients for drugs of abuse and therapeutic drugs may be helpful in the emergency department (ED) to assist in a rapid diagnosis. Objectives: In this prospective study, the performance of TesTcard9 (R) (Varian; Middelburg, Netherlands), Syva Rapid Test d.a.u. 10 (R) (Dade Behring; Leusden, Netherlands), and Triage TOX Drug Screen (R) (Biosite; Bunnik, Netherlands), when applied on-site in the ED by physicians and nurses, was evaluated. Methods: Patients in the ED were included in the study when a physician thought the patient could benefit from a toxicological screen. Urine samples were screened utilizing the three point-of-care tests. All three tests simultaneously determined the presence of amphetamines, methamphetamine, opiates, methadone (except for TesTcard9), cocaine, cannabis, barbiturates, benzodiazepines, tricyclic antidepressants, and phencyclidine. The same urine specimen was analyzed in the pharmacy department using Syva EMIT II immunoassay and chromatographic confirmation. The results were compared for agreement. Results: During the 6-month study period, 80 urine samples were screened. In total, 62 (78%) specimens were found positive for at least one drug. Amphetamines (n = 16), cocaine (n = 27), cannabis (n = 25), benzodiazepines (n = 25), and opiates (n = 8) were the most frequently found. The sensitivity and specificity of all three devices were higher than 93% for these compounds, with the exception of the sensitivity for cannabis with the TesTcard9 (88%) and the sensitivity for benzodiazepines with the Syva RapidTest d.a.u. 10 (88%) and TesTeard9 (80%). Conclusion: In the ED setting, the Triage TOX Drug Screen performed better than the other point-of-care tests, probably due to its more objective reading system and its adequate quality controls.

Copyright 2012, Elsevier Science


Ayres TC; Treadwell J. Bars, drugs and football thugs: Alcohol, cocaine use and violence in the night time economy among English football firms. Criminology & Criminal Justice 12(1): 83, 2012. (65 refs.)

This article draws on ethnographic fieldwork, the aim of which was to explore the functionality of cocaine (used in conjunction with alcohol and on its own) in the subcultural milieu of the English football firm. The study was originally concerned with the use of violence associated with cocaine use among football fans on match days but, like much ethnography, the research evolved beyond its original remit to include the extension of football firm violence within the night time economy (NTE). The study is unique in giving a voice to this group of individuals and permitting them to be active interpreters of their own world. It included 20 interviews with members of football firms who habitually took part in violent exchanges and found that concurrent use of cocaine and alcohol fulfilled three main functions: the facilitation of extreme violence; the acquisition of 'time out'; and the construction of a (hyper-)masculine identity. These functions were not confined to the subcultural context of the football firm, but had also become an integral component of their mainstream leisure pursuits within the NTE. The findings from this explorative study also contribute answers to the under researched question of whether those 'who are violent in the NTE are also violent in other contexts' (Finney, 2004: 5).

Copyright 2012, Sage Publications


Banerjee SC; Greene K. Role of transportation in the persuasion process: Cognitive and affective responses to antidrug narratives. Journal of Health Communication 17(5): 564-581, 2012. (52 refs.)

This study examined transportation effects of first-and third-person narratives as well as the role of transportation in the persuasion process. In particular, the authors evaluated the role of transportation in affecting cognitive and affective responses. Last, they addressed the relation between (a) cognitive and affective responses and (b) antidrug expectancies. Participants were 500 undergraduate students at a large northern university in the United Kingdom who were randomly assigned to 1 of 2 conditions: first-or third-person narratives on cocaine use. The results demonstrated that there was no difference between first-and third-person narratives in terms of transportation. However, overall, greater transportation was associated with more favorable cognitive responses, and more favorable cognitive response was associated with stronger anticocaine expectancies. In terms of affective responses, results indicated the mediating role of sadness and contentment in the association between transportation and anticocaine expectancies. In particular, increased transportation was associated with greater sadness and lower contentment. Lower sadness and contentment were associated with stronger anticocaine expectancies. Important theoretical and empirical implications are discussed.

Copyright 2012, Taylor & Francis


Baumgartner MR; Guglielmello R; Fanger M; Kraemer T. Analysis of drugs of abuse in hair: Evaluation of the immunochemical method VMA-T vs. LC-MS/MS or GC-MS. Forensic Science International 215(1-3): 56-59, 2012. (20 refs.)

Hair analysis is an elaborate and time-consuming multi-step process. The immunometric test VMA-T from Comedical has been evaluated as screening assay for hair analysis. From routine work, authentic samples were selected that were positive for opiates, cocaine, MDMA-type drugs, amphetamines, methadone or THC. These hair samples were investigated by LC-MS or GC-MS and the VMA-T procedure, respectively. Using the cut-off values recommended by the Society of Hair Testing, the VMA-T method discriminates with good sensitivity between negative and positive hair samples and is an expedient screening method for drugs in keratinized matrices such as hair. In order to save time and resources, the residue of the VMA-T extraction solution can be reused for confirmation analysis by LC-MS except for cocaine.

Copyright 2012, Elsevier Science


Beaulieu S; Saury S; Sareen J; Tremblay J; Schutz CG; McIntyre RS et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force recommendations for the management of patients with mood disorders and comorbid substance use disorders. (review). Annals of Clinical Psychiatry 24(1): 38-55, 2012. (128 refs.)

Background: Mood disorders, especially bipolar disorder (BD), frequently are associated with substance use disorders (SUDs). There are well-designed trials for the treatment of SUDs in the absence of a comorbid condition. However, one cannot generalize these study results to individuals with comorbid mood disorders, because therapeutic efficacy and/or safety and tolerability profiles may differ with the presence of the comorbid disorder. Therefore, a review of the available evidence is needed to provide guidance to clinicians facing the challenges of treating patients with comorbid mood disorders and SUDs. Methods: We reviewed the literature published between January 1966 and November 2010 by using the following search strategies on PubMed. Search terms were bipolar disorder or depressive disorder, major (to exclude depression, postpartum; dysthymic disorder; cyclothymic disorder; and seasonal affective disorder) cross-referenced with alcohol or drug or substance and abuse or dependence or disorder. When possible, a level of evidence was determined for each treatment using the framework of previous Canadian Network for Mood and Anxiety Treatments recommendations. The lack of evidence-based literature limited the authors' ability to generate treatment recommendations that were strictly evidence based, and as such, recommendations were often based on the authors' opinion. Results: Even though a large number of treatments were investigated for alcohol use disorder (AUD), none have been sufficiently studied to justify the attribution of level 1 evidence in comorbid AUD with major depressive disorder (MDD) or BD. The available data allows us to generate first-choice recommendations for AUD comorbid with MDD and only third-choice recommendations for cocaine, heroin, and opiate SUD comorbid with MOD. No recommendations were possible for cannabis, amphetamines, methamphetamines, or polysubstance SUD comorbid with MDD. First-choice recommendations were possible for alcohol, cannabis, and cocaine SUD comorbid with BD and only second-choice recommendations for heroin, amphetamine, methamphetamine, and polysubstance SUD comorbid with BD. No recommendations were possible for opiate SUD comorbid with BD. Finally, psychotherapies certainly are considered an essential component of the overall treatment of SUDs comorbid with mood disorders. However, further well-designed studies are needed in order to properly assess their potential role in specific SUDs comorbid with a mood disorder. Conclusions: Although certain treatments show promise in the management of mood disorders comorbid with SUDs, additional well-designed studies are needed to properly assess their potential role in specific SUDs comorbid with a mood disorder.

Copyright 2012, Quadrant Health Com


Beck J; Jang TB. Short answer question case series: Management of cocaine-associated chest pain. (editorial). Emergency Medicine Journal 29(4): 344-345, 2012. (9 refs.)


Bennett ME; Brown CH; Peer J; Li L; Bellack AS. Patterns and predictors of changes in substance use in individuals with schizophrenia and affective disorders. Journal of Dual Diagnosis 8(1): 2-12, 2012. (52 refs.)

Objective: This study examined patterns and predictors of changes in substance use over 1 year in individuals with schizophrenia and affective disorders. We examined patterns of cocaine use over time, baseline predictors of continued cocaine use over 1 year, and predictors of transitions into and out of drug use and treatment. Methods: We recruited 240 individuals with schizophrenia and affective disorders who met DSM-IV criteria for current cocaine dependence or cocaine dependence in early full or sustained full remission and assessed them five times over 12 months. Results: There was no change over time in either the proportion of the sample with at least 1 day of cocaine use in the past month or in the average number of days of cocaine use among those who reported any use. Baseline variables assessing actual substance use were found to predict a decreased likelihood of cocaine use. Several such variables-including self-reported use of cocaine, positive urinalysis results for marijuana, and positive urinalysis results for cocaine-were predictive of transitions into and out of outpatient substance abuse treatment. Readiness to change variables such as self-efficacy and temptation to use drugs showed different predictive patterns for the schizophrenia and affective disorder groups. Conclusions: These findings illustrate how drug use may show a cyclical pattern for those with serious mental illness, in which more severe use-characterized by greater frequency of use and associated problems-is followed by decreased use over time.

Copyright 2012, Taylor & Francis


Bernhardt M. Blue atrophy of the skin from cocaine injections. (editorial). Archives of Dermatology 148(1): 16, 2012. (3 refs.)

This column considers articles published a century earlier. The title of this editorial refers to an article in The Journal of Cutaneous Disease 30(1): 1-4, 1912. [The orgininal article with its references to blue skins is not reprinted here.] This editorial column provides breief factoids about cocaine. There is a description of Freud's use of cocaine; the first cocaine cartel, the predecessors of today's major international pharmaceutical companies; and also the use of cocaine in manufacturing coca-cola. It is asserted that one-third of the world's coca production � in a decocainized form � is used as a flavouring agent.

Copyright 2012, Project Cork


Bernstein E; Ashong D; Heeren T; Winter M; Bliss C; Madico G. The impact of a brief motivational intervention on unprotected sex and sex while high among drug-positive emergency department patients who receive STI/HIV VC/T and drug treatment referral as standard of care. AIDS & Behavior 16(5): 1203-1216, 2012. (33 refs.)

This randomized, controlled trial, conducted among out-of-treatment heroin/cocaine users at an emergency department visit, tests the impact on sexual risk of adding brief motivational intervention (B-MI) to point-of-service testing, counseling and drug treatment referral. 1,030 enrollees aged 18-54 received either voluntary counseling/testing (VC/T) with drug treatment referral, or VC/T, referral, and B-MI, delivered by an outreach worker. We measured number and proportion of non-protected sex acts (last 30 days) at 6 and 12 months ( = 802). At baseline, 70% of past-30-days sex acts were non-protected; 35% of sex acts occurred while high; 64% of sexual acts involved main, 24% casual and 12% transactional sex partners; 1.7% tested positive for an STI, and 8.8% for HIV. At six or 12 month follow-up, 20 enrollees tested positive for Chlamydia and/or Gonorrhea, and 6 enrollees HIV sero-converted. Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence.

Copyright 2012, Springer Publishing


Blanc PD; Chin C; Lynch KL. Multifocal inflammatory leukoencephalopathy associated with cocaine abuse: Is levamisole responsible? (letter). Clinical Toxicology 50(6): 534-535, 2012. (7 refs.)


Borders TF; Booth BM. Stimulant use trajectories and the longitudinal risk of heavy drinking: Findings from a rural population-based study. Addictive Behaviors 37(3): 269-272, 2012. (16 refs.)

The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking. The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use. Participants (n = 710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days. Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a "fast low" trajectory of crack use, those with "steady high" and "declining" trajectories had more heavy drinking days. Compared to those with a "fast low" trajectory of powder cocaine use, those with a "steady moderate" trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days. In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.

Copyright 2012, Elsevier Science


Branson CE; Clemmey P; Harrell P; Subramaniam G; Fishman M. Polysubstance use and heroin relapse among adolescents following residential treatment. Journal of Child & Adolescent Substance Abuse 21(3): 204-221, 2012. (35 refs.)

This study examined post-treatment patterns of polysubstance use and heroin relapse in a sample of 43 adolescents (ages 14-20) entering short-term residential treatment for primary heroin use. At 12-month follow-up, youths that achieved heroin abstinence (N = 19) were significantly less likely than youths that relapsed to heroin (N = 24) to endorse polysubstance use and cannabis, cocaine, or benzodiazepine use. Furthermore, heroin-abstinent youths significantly reduced their cannabis and cocaine use across the study period while youths that relapsed made initial reductions before returning to their pretreatment levels of use for these drugs. Clinical implications for heroin-using youths and areas for future research are discussed.

Copyright 2012, Taylor & Francis


Burillo-Putze G; Becker LT; Rodriguez MG; Torres JS; Nogue S. Liquid cocaine body packers. Clinical Toxicology 50(6): 522-524, 2012. (8 refs.)

Introduction. Internal transport of cocaine in liquid form by body packers has been reported by the media, but there are no scientific publications on the clinical aspects of this practice. Case reports. We describe two cases of body packers bearing 36 and 4 packs containing liquid cocaine in the colon and rectum, respectively. Abdominal X-ray in both cases showed radiological characteristics that differed from those commonly found in body packers transporting solid-state cocaine, heroin, or cannabis (packs with lower radiological density, diffuse borders, elongated and resembling feces). Both patients were asymptomatic and were discharged from the emergency department 6 hours after admission. Discussion. Expulsion time after laxative administration was shorter compared to "solid" drug body packers. The diagnostic sensitivity of different imaging techniques remains to be established for internally concealed liquid drugs. There have been press reports of internal pack rupture resulting in death, so caution is required. The lower radiographic density of liquid cocaine condom packs and their adaptability to intestinal anatomy make them difficult to detect using plain abdominal radiography. Physicians should be aware of the possibility of false negative radiological findings in these cases.

Copyright 2012, Informa Healthcare


Caiata-Zufferey M. From danger to risk: Categorising and valuing recreational heroin and cocaine use. Health Risk & Society 14(5, special issue): 427-443, 2012. (44 refs.)

This article examines how former drug addicts who now feel that they can safely use heroin and cocaine recreationally distinguish between problematic and non-problematic drug-taking. This is a crucial question in current Western societies. After having been linked for most of the twentieth century to deviance and illness, the concept of drug use has recently undergone a process of extension and dilution. The threshold between 'dangerous' and 'safe' has become nebulous and susceptible to categorical revision. In consequence, there is some scope for individuals to define what is problematic or recreational. In this sense, illicit drug use has ceased to be a social scourge, and instead has become a personal risk. To explore the process of categorising recreational heroin/cocaine use, in-depth interviews were conducted in Switzerland with nine former drug addicts, now self-defined recreational users, using a grounded theory approach. Results showed that participants make sense of recreational drug-taking by stressing its positive meaning and pointing out its disciplined modalities of use. This process of making sense is a narrative, social and contingent construction in that it is supported by a discourse, built up in interactions with the social system, and is time-and space-dependent. Because of these features, we called this process of making sense 'legitimation'. The results are discussed in relation to the conjoint socio-cognitive work of homogenisation/differentiation and valorisation that are central to risk categorisation, and this process is considered in relation to the legitimation of otherwise socially stigmatised behaviours.

Copyright 2012, Taylor & Francis


Calcaterra S; Blatchford P; Friedmann PD; Binswanger IA. Psychostimulant-related deaths among former inmates. Journal of Addiction Medicine 6(2): 97-105, 2012. (65 refs.)

Objectives: Psychostimulants are highly addictive and their use is increasing. Little is known about psychostimulant-related deaths. This study identified characteristics, risk factors, and contributing substances reported upon death among former prison inmates who died from a psychostimulant-related death. Methods: This retrospective cohort study of released inmates from 1999 to 2003 (N = 30,237) linked data from the Washington State Department of Corrections with the National Death Index. We examined characteristics of individuals who died with psychostimulants listed among their causes of death. These were categorized into 3 groups: (1) noncocaine psychostimulants, (2) cocaine only, and (3) all psychostimulants. Cox proportional hazards regression determined risk factors for death in each group, and the risk of death in the first 2 weeks after release from prison Results: Of the 443 inmates who died, 25 (6%) had noncocaine psychostimulants listed among their causes of death. Six of these 25 deaths had both noncocaine psychostimulants and cocaine listed among their causes-of-death. Most of the former inmates who died with noncocaine psychostimulants were male (n = 21, 84%) and non-Hispanic white (88%, n = 22). Cocaine only was listed among the causes-of-death for 49 former inmates; mostwere male (n = 35, 71%) and non-Hispanicwhite (n = 27, 55%). Longer length of incarceration was associated with a reduced risk of death from any psychostimulant use (hazard ratio = 0.76, confidence interval = 0.63-0.920 for each additional year of incarceration) and from use of noncocaine psychostimulants (hazard ratio = 0.42, 95% CI = 0.22-0.80). Risk death was highest during the first 2 weeks postrelease for cocaine only-related deaths (incidence mortality ratio = 1224.0, confidence interval = 583-1865). Conclusions: Former prisoners have a significant risk of death from psychostimulants, especially within the first 2 weeks postrelease.

Copyright 2012, Lippincott, Williams & Wilkins


Caldwell KB; Graham OZ; Arnold JJ. Agranulocytosis from levamisole-adulterated cocaine. Journal of the American Board of Family Medicine 25(4): 528-530, 2012. (11 refs.)

Introduction: Afebrile neutropenia with an absolute neutrophil count (ANC) of zero in a nonimmunocompromised individual is unusual. Outlined is a case of agranulocytosis likely due to levamisole laced cocaine. Given recent publications in the news media and medical journals, this is a pertinent issue for primary care providers. Case: A 57-year-old female presented with painful bowel movements and difficulty eating. Physical examination revealed two exquisitely tender ulcerated lesions on her lower lip and anus. Laboratory data revealed an ANC of 0 and urine drug screen positive for cocaine. She was prophylaxed with acyclovir, diflucan, and ciprofloxacin, and was started on granulocyte colony stimulating factor for four days. Her ANC normalized, but the cause of her severe neutropenia remained unclear. Discussion: Levamisole is a veterinary antihelminthic used for treatment of rheumatoid arthritis and colorectal cancer in humans. 88% of regional cocaine samples are testing positive for levamisole, which is thought to potentiate cocaine's effects but can also cause agranulocytosis. Conclusions: Our patient did not fit the clinical picture for malignancy, viral infection, or bone marrow pathology. Given the high rate of levamisole adulterated cocaine and an otherwise negative work-up, this is the most likely explanation for her agranulocytosis.

Copyright 2012, American Board of Family Medicine


Carpenter KM; Martinez D; Vadhan NP; Barnes-Holmes D; Nunes EV. Measures of attentional bias and relational responding are associated with behavioral treatment outcome for cocaine dependence. American Journal of Drug and Alcohol Abuse 38(2): 146-154, 2012. (27 refs.)

Background: Psychosocial interventions for substance dependence have demonstrated efficacy. However, the mechanisms by which specific intervention strategies exert their effect have not been clearly identified. Objective: This study investigated the prospective relationships between two psychological processes, an attentional bias toward cocaine stimuli and beliefs about the consequences of cocaine use, and treatment outcome. Method: Twenty-five cocaine-dependent participants enrolled in a 6-month outpatient treatment program that included voucher incentives for abstinence. All participants were asked to complete two implicit assessment procedures, a Drug Stroop protocol and an Implicit Relational Assessment Procedure (IRAP), as well as explicit measures of cocaine craving and the consequences of cocaine use, prior to beginning treatment. Pearson's correlation coefficients tested the prospective relationships between treatment outcome and the implicit and explicit assessments. Results: Stronger implicit beliefs about the positive effects of cocaine use prior to treatment were associated with poorer treatment outcome when an escalating voucher-incentive program was in place. Further, an attentional bias for cocaine-related stimuli was associated with better treatment outcome when an escalating voucher-incentive program was removed. No association between cocaine use beliefs and treatment outcome was found when beliefs were measured with self-report instruments. Conclusions and scientific significance: These findings highlight the potential utility of performance-based measures for delineating the psychological mechanisms associated with variation in response to treatment for drug dependence.

Copyright 2012, Informa HealthCare


Ching JA; Smith DJ. Levamisole-induced necrosis of skin, soft tissue, and bone: Case report and review of literature. Journal of Burn Care & Research 33(1): E1-E5, 2012. (7 refs.)

This represents the largest case of skin necrosis related to levamisole, a common cocaine contaminant, requiring closure with skin grafts, and is the only case resulting in nasal amputation, central upper lip excision, extremity bone necrosis, and above knee amputation. The case report is followed by a review of the literature. Unique considerations for the full-thickness necrosis induced by levamisole vasculitis are highlighted, including antibody level monitoring, need for multiple excisions, timing of skin grafting, and potential for soft tissue and bone necrosis as well. A 54-year-old man presented to an outside facility with fever, generalized weakness, and agranulocytosis, with a history of cocaine use 3 weeks before. After admission, he developed generalized violaceous lesions and an elevated p-antineutrophilic cytoplasmic antibody and was diagnosed with disseminated vasculitis and agranulocytosis secondary to levamisole-contaminated cocaine exposure. On transfer to the authors' facility, 52% TBSA was involved with violaceous, nonblanching lesions, which progressed to full-thickness necrosis. Local wound care continued until necrotic areas fully demarcated and progressive necrosis stabilized, and skin grafting for closure was not performed until antibody levels normalized. Current treatment of levamisole-induced skin rash or necrosis focuses on discontinuation of levamisole. As demonstrated by this case, extensive necrosis secondary to levamisole-induced vasculitis can be successfully treated with multiple excisions until necrosis stabilizes, and then, split-thickness autografts may be applied. In areas with poor vascular supply or areas with poor functional prognosis, amputation may ultimately be required.

Copyright 2012, Lippincott, Williams & Wilkins


Chu M; Gerostamoulos D; Beyer J; Rodda L; Boorman M; Drummer OH. The incidence of drugs of impairment in oral fluid from random roadside testing. Forensic Science International 215(1-3): 28-31, 2012. (31 refs.)

Oral fluid (OF) has become a popular specimen to test for presence of drugs, particularly in regards to road safety. In Victoria, OF specimens from drivers have been used to test for the presence of methylamphetamine (MA) and Delta(9)-tetrahydrocannabinol (THC) since 2003 and 3, 4-methylenedioxy-N-methylamphetamine (MDMA) since 2006. LC-MS/MS has been used to test the most recent 853 submitted OF specimens from Victoria Police for 31 drugs of abuse including those listed in the Australian Standard AS4760-2006. At least one proscribed drug was detected in 96% of drivers, of which MA was the most common (77%), followed by THC (42%), MDMA (17%) and the combination of all three (3.9%). Opioids were detected in 14% of drivers of which 4.8% were positive for 6-acetylmorphine and 3.3% for methadone. The incidence of the opioids tramadol (1.2%) and oxycodone (1.1%) were relatively low. Cocaine (8.0%) was as commonly detected as benzodiazepines (8.0%), and was almost always found in combination with MA (7.9%). Samples positive to benzodiazepines were largely due to diazepam (3.5%) and alprazolam (3.4%), with only 0.2% of drivers combining the two. Ketamine was also detected in 1.5% of cases. While the incidences of the proscribed drugs itself are concerning, it is clear that many drivers are also using other drugs capable of causing impairment.

Copyright 2012, Elsevier Science


Clark BC; Perkins A; McCullumsmith CB; Islam AM; Sung J; Cropsey KL. What does self-identified drug of choice tell us about individuals under community corrections supervision? Journal of Addiction Medicine 6(1): 57-67, 2012. (26 refs.)

Objectives: The term "drug of choice" (DOC) refers to substance abusers' preferred drug and this information often adds to the clinical picture of the patient because substance users often meet diagnostic criteria for dependence on multiple drugs. Characteristics such as age, race, marital status, and psychiatric illnesses have been shown to differentiate among individuals with different DOC preferences. However, no studies have examined DOC in the context of criminal behavior and other drug dependencies. Methods: The participants (N=15, 475) of a community corrections program, Treatment Alternatives for Safer Communities (TASC), were classified by DOC for the 4 main drugs of abuse (alcohol, marijuana, cocaine, and opioids) and each drug class was compared with the other 3 DOC using binary logistic regression. Results: Alcohol as DOC was associated with being older, white, male, having private health insurance, being medicated for a mental health disorder, and having a criminal history of person offenses. Cocaine as DOC was associated with being older, black, female, attempting suicide, having less than a high school education, living in a shelter or with relatives, being unemployed, being uninsured, being physically and sexually abused, and committing property and court offenses but not person or substance offenses. Marijuana as DOC was associated with being younger, black, male, never being married, and committing substance but not property or court offenses. Opioids as DOC were associated with being white, female, being married, higher education, being unemployed, and being medicated for a mental health disorder. Conclusions: Overall, there were substantial differences between the 4 DOC groups, and the results are commensurate with expectations based on the abuse and dependency literature.

Copyright 2012, Lippinocott, Williams & Wilkins


Clarke TK; Ambrose-Lanci L; Ferraro TN; Berrettini WH; Kampman KM; Dackis CA et al. Genetic association analyses of PDYN polymorphisms with heroin and cocaine addiction. Genes, Brain and Behavior 11(4): 415-423, 2012. (50 refs.)

Genetic factors are believed to account for 30-50% of the risk for cocaine and heroin addiction. Dynorphin peptides, derived from the prodynorphin (PDYN) precursor, bind to opioid receptors, preferentially the kappa-opioid receptor, and may mediate the aversive effects of drugs of abuse. Dynorphin peptides produce place aversion in animals and produce dysphoria in humans. Cocaine and heroin have both been shown to increase expression of PDYN in brain regions relevant for drug reward and use. Polymorphisms in PDYN are therefore hypothesized to increase risk for addiction to drugs of abuse. In this study, 3 polymorphisms in PDYN (rs1022563, rs910080 and rs1997794) were genotyped in opioid-addicted [248 African Americans (AAs) and 1040 European Americans (EAs)], cocaine-addicted (1248 AAs and 336 EAs) and control individuals (674 AAs and 656 EAs). Sex-specific analyses were also performed as a previous study identified PDYN polymorphisms to be more significantly associated with female opioid addicts. We found rs1022563 to be significantly associated with opioid addiction in EAs [P = 0.03, odds ratio (OR) = 1.31; false discovery rate (FDR) corrected q-value]; however, when we performed female-specific association analyses, the OR increased from 1.31 to 1.51. Increased ORs were observed for rs910080 and rs199774 in female opioid addicts also in EAs. No statistically significant associations were observed with cocaine or opioid addiction in AAs. These data show that polymorphisms in PDYN are associated with opioid addiction in EAs and provide further evidence that these risk variants may be more relevant in females.

Copyright 2012, Wiley-Blackwell


Cleary BJ; Eogan M; O'Connell MP; Fahey T; Gallagher PJ; Clarke T et al. Methadone and perinatal outcomes: A prospective cohort study. Addiction 107(8): 1482-1492, 2012. (51 refs.)

Aims: Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose. Design: Prospective cohort study. Setting Two tertiary care maternity hospitals. Participants: A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010. Measurements: Information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included pre-term birth (<37 weeks' gestation), small-for-gestational-age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalization. Findings: Of the 114 liveborn infants 11 (9.6%) were born pre-term, 49 (42.9%) were small-for-gestational-age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%) were treated medically for NAS. Neonates exposed to methadone-only had a shorter hospitalization than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, P = 0.03). Neonates exposed to methadone doses =80 mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3 mg, P = 0.03). The incidence and duration of NAS did not differ between the two dosage groups. Conclusions: The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization.

Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs


Comiskey CM; O'Sullivan K; Milnes J; Milnes Jennie. Regional drug user services in times of scarce financial resources: using a rapid assessment response approach to evaluate, plan, and prioritize essential services. Substance Use & Misuse 47(3): 254-264, 2012. (21 refs.)

The objective was to assess need, evaluate projects, and devise a roadmap for future provision given budget cuts. The analysis of 30 substance misuse services in towns and rural areas of Ireland was conducted in 2010. Analysis revealed that 24,315 (95% CI 12,928-40,629) individuals were using illegal drugs in 2006, 893 individuals were using opiates, opiate and cocaine use was increasing as was drug use amongst females. Evaluations demonstrated that not all services were meeting emerging needs, services lacked administrative support, and funding needed to be redirected. The RAR approach was useful for policy decisions and budget cuts in times of economic restraint.

Copyright 2012, Informa Healthcare


Cone EJ. Oral fluid results compared to self reports of recent cocaine and heroin use by methadone maintenance patients. Forensic Science International 215(1-3): 88-91, 2012. (24 refs.)

Introduction: Although self reports of illicit drug use may not be reliable, this information is frequently collected and relied upon by national drug surveys and by counselors in drug treatment programs. The addition of oral fluid testing to these programs would provide objective information on recent drug use. Aim: The goal of this study was to compare oral fluid tests for cocaine, benzoylecgonine, 6-acetylmorphine, morphine, codeine and 6-acetylcodeine to self reports of recent cocaine and heroin use by patients in an outpatient methadone treatment program. Methods: Patients (n = 400) provided an oral fluid specimen and completed a short questionnaire on illicit drug use over the last seven days. Oral fluid was collected with the Intercept (R) Oral Fluid Collection device. Oral fluid was analyzed by a validated assay using liquid chromatography coupled with tandem mass spectrometry. The presence of an analyte was confirmed if all identification criteria were met and its concentration (ng/ mL) was >= LOQ (cocaine, 0.4; benzoylecgonine, 0.4; morphine, 2; codeine, 2; 6-acetylmorphine, 0.4; and 6-acetylcodeine, 1). Results: Analyses of oral fluid specimens collected from the 400 methadone maintained patients revealed that a majority (95%) of subjects who admitted to recent cocaine use were confirmed positive, whereas slightly more than 50% were confirmed positive who admitted to heroin over the last seven days. For those patients who denied recent cocaine and heroin use, approximately 30% were positive for cocaine and 14% were positive for heroin. Conclusion: Oral fluid testing provides an objective means of verifying recent drug use and for assessment of patients in treatment for substance use disorders.

Copyright 2012, Elsevier Science


Connolly CG; Foxe JJ; Nierenberg J; Shpaner M; Garavan H. The neurobiology of cognitive control in successful cocaine abstinence. Drug and Alcohol Dependence 121(1-2): 45-53, 2012. (90 refs.)

Introduction: Extensive evidence demonstrates that current cocaine abusers show hypoactivity in anterior cingulate and dorsolateral prefrontal cortex and respond poorly relative to drug-naive controls on tests of executive function. Relatively little is known about the cognitive sequelae of long-term abstinence in cocaine addicts. Methods: Here, we use a GO-NOGO task in which successful performance necessitated withholding a prepotent response to assay cognitive control in short- and long-term abstinent cocaine users (1-5 weeks and 40-102 weeks, respectively). Results: We report significantly greater activity in prefrontal, cingulate, cerebellar and inferior frontal gyrii in abstinent cocaine users for both successful response inhibitions and errors of commission. Moreover, this relative hyperactivity was present in both abstinent groups, which, in the presence of comparable behavioral performance, suggests a functional compensation. Conclusions: Differences between the short- and long-abstinence groups in the patterns of functional recruitment suggest different cognitive control demands at different stages in abstinence. Short-term abstinence showed increased inhibition-related dorsolateral and inferior frontal activity indicative of the need for increased inhibitory control while long-term abstinence showed increased error-related ACC activity indicative of heightened behavioral monitoring. The results suggest that the integrity of prefrontal systems that underlie cognitive control functions may be an important characteristic of successful long-term abstinence.

Copyright 2012, Elsevier Science


Degenhardt L; Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379(9810): 55-70, 2012. (143 refs.)

This paper summarises data for the prevalence, correlates, and probable adverse health consequences of problem use of amphetamines, cannabis, cocaine, and opioids. We discuss findings from systematic reviews of the prevalence of illicit drug use and dependence, remission from dependence, and mortality in illicit drug users, and evidence for acute and chronic effects of illicit drug use. We outline the regional and global distribution of use and estimated health burden from illicit drugs. These distributions are likely to be underestimates because they have not included all adverse outcomes of drug use and exclude those of cannabis-the mostly widely used illicit drug. In high-income countries, illicit drug use contributes less to the burden of disease than does tobacco but a substantial proportion of that due to alcohol. The major adverse health effects of cannabis use are dependence and probably psychotic disorders and other mental disorders. The health-related harms of cannabis use differ from those of amphetamine, cocaine, and opioid use, in that cannabis contributes little to mortality. Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally. This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas.

Copyright 2012, Lancet Ltd.


Devoto P; Flore G; Saba P; Cadeddu R; Gessa GL. Disulfiram stimulates dopamine release from noradrenergic terminals and potentiates cocaine-induced dopamine release in the prefrontal cortex. Psychopharmacology 219(4): 1153-1164, 2012. (70 refs.)

Rationale: Disulfiram efficacy in treatment of cocaine addiction is attributed to the inhibition of dopamine-beta-hydroxylase and reduction in brain noradrenaline (NA)/dopamine (DA) ratio. Objectives: Using microdialysis, we investigated if disulfiram causes DA release from noradrenergic terminals and modifies cocaine-induced DA release. Results: Disulfiram reduced extracellular NA in the medial prefrontal (mPF) cortex, occipital cortex, accumbens and caudate nuclei, while it markedly increased DA not only in mPF but also in the occipital cortex, despite its scanty dopaminergic afferences, and modestly increased DA in the accumbens and caudate nuclei, despite their dense dopaminergic innervation. Disulfiram-induced DA accumulation was reversed in both cortices by tetrodotoxin infusion and by systemic administration of the alpha(2)-adrenoceptor agonist clonidine, but was not modified by the alpha(2)-adrenoceptor antagonist RS 79948 or the D-2-like agonist quinpirole. Disulfiram prevented cocaine-induced NA release in the mPF cortex and nucleus accumbens, potentiated cocaine-induced DA release in the mPF cortex but failed to modify cocaine effect in the nucleus accumbens. DA release induced by disulfiram-cocaine combination in the mPF cortex was prevented by clonidine but not by quinpirole. Conclusions: We suggested that disulfiram, by removing NA-mediated inhibitory control on noradrenergic terminals, causes an unrestrained cocaine-induced DA release from those terminals in the mPF cortex. In the accumbens and caudate nuclei, "allogenic" DA concentration might be clouded by DA originated from dopaminergic terminals. The possible role of "allogenic" DA in disulfiram ability to prevent stress-induced reinstatement of cocaine seeking is discussed.

Copyright 2012, Springer


Drummer OH; Kourtis I; Beyer J; Tayler P; Boorman M; Gerostamoulos D. The prevalence of drugs in injured drivers. Forensic Science International 215(1-3): 14-17, 2012. (24 refs.)

In mid 2009 Victoria introduced compulsory drug testing of blood taken from all injured drivers taken to hospital. Delta(9)-Tetrahydrocannabinol (THC), methylamphetamine (MA) and 3, 4-methylenedioxy-methylamphetamine (MDMA) are prohibited and if drivers are positive to any amount an automatic penalty is enforced. Laboratory screens were conducted on preserved blood using ELISA testing for cannabis metabolite and methylamphetamines and a fully validated LC-MS/MS method for 105 drugs including THC, amphetamines, opioids, benzodiazepines, antidepressants and antipsychotics and a number of other psychoactive substances using a minimum of two transitions per drug. Conventional GC-testing for ethanol was used to screen and quantify the presence of alcohol. 1714 drivers were tested and showed alcohol in 29% (>= 0.01 g/100 mL) and drugs in 35%. The positive rate for the three drugs prohibited by legislation was 12.5%. The prevalence of THC, MA and MDMA was 9.8%, 3.1%, and 0.8%, respectively. The range of THC concentrations in blood was 2-42 ng/mL (median 7) of which 70% had a concentration of 10 ng/mL or higher. The range of concentrations for MA and MDMA was 0.02-0.4 and 0.03-0.3 mg/L (median for both drugs was 0.05 mg/L). Drugs of any type were detected in 35% of cases. The other drugs were largely prescribed drugs such as the antidepressants (9.3%) and benzodiazepines (8.9%). Neither 6-acetylmorphine nor cocaine (or benzoylecgonine) was detected in these cases.

Copyright 2012, Elsevier Science


Egan DJ; Pare JR. Clinical pathologic conference: A 65-year-old male with left-sided chest pain. A case of an unexpected occupational hazard. Academic Emergency Medicine 19(2): e1-e6, 2012. (36 refs.)

The authors present a case of a 65-year-old male who presented four times to the emergency department (ED) with left-sided chest pain. On the first three visits, the patient was admitted with a different diagnosis related to his chest pain. On the final visit, an abnormality on an imaging study performed in the ED led to the ultimate diagnostic test revealing the cause of the patient's symptoms. The patient's clinical presentation and ultimate clinical course are summarized, and a discussion of the differential diagnoses of his condition is presented.

Copyright 2012, Wiley-Blackwell


Eichen DM; Conner BT; Daly BP; Fauber RL. Weight perception, substance use, and disordered eating behaviors: Comparing normal weight and overweight high-school students. Journal of Youth and Adolescence 41(1, special issue): 1-13, 2012. (70 refs.)

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

Copyright 2012, Springer


Eke N; Luty J. Significant clinical differences between two populations of opioid-addicted mothers from an inner-city and a provincial clinic. Journal of Substance Use 17(2): 176-182, 2012. (24 refs.)

Aims: This study aimed to explore parity and parenting in opioid-dependent women in community-based inner-city and urban drug treatment services. Method: Female opioid addicts from two drug and alcohol services were interviewed using an adapted version of the Maudsley Addiction Profile (MAP) and the HIV Risk-Taking Behaviour Scale (HRBS). Results: Forty female opioid addicts took part. The inner-city participants were three times more likely to be dependent on cocaine (71% vs. 28%; p < 0.05) than those from the provincial unit. Children from the provincial service were significantly more likely to be living with a family member (70% vs. 35%; p < 0.05). Conclusion: There were clinically relevant differences between the two populations regarding substance use behaviour and parenting. This has significant relevance to the generalizability of research from specialized, inner-city research centres to more typical services.

Copyright 2012, Informa Healthcare


Elkashef A; Kahn R; Yu E; Iturriaga E; Li SH; Anderson A et al. Topiramate for the treatment of methamphetamine addiction: A multi-center placebo-controlled trial. Addiction 107(7): 1297-1306, 2012. (20 refs.)

Aims: Topiramate has shown efficacy at facilitating abstinence from alcohol and cocaine abuse. This double-blind, placebo-controlled out-patient trial tested topiramate for treating methamphetamine addiction. Design: Participants (n = 140) were randomized to receive topiramate or placebo (13 weeks) in escalating doses from 50 mg/day to the target maintenance of 200 mg/day in weeks 612 (tapered in week 13). Medication was combined with weekly brief behavioral compliance enhancement treatment. Setting: The trial was conducted at eight medical centers in the United States. Participants: One hundred and forty methamphetamine-dependent adults took part in the trial. Measurements The primary outcome was abstinence from methamphetamine during weeks 612. Secondary outcomes included use reduction versus baseline, as well as psychosocial variables. Findings: In the intent-to-treat analysis, topiramate did not increase abstinence from methamphetamine during weeks 612. For secondary outcomes, topiramate reduced weekly median urine methamphetamine levels and observer-rated severity of dependence scores significantly. Subjects with negative urine before randomization (n = 26) had significantly greater abstinence on topiramate versus placebo during study weeks 612. Topiramate was safe and well tolerated. Conclusions: Topiramate does not appear to promote abstinence in methamphetamine users but can reduce the amount taken and reduce relapse rates in those who are already abstinent.

Copyright 2012, Wiley-Blackwell


Elliott A; Mahmood T; Smalligan RD. Cocaine bugs: A case report of cocaine-induced delusions of parasitosis. American Journal on Addictions 21(2): 180-181, 2012. (4 refs.)

This is a case report of a 48-year-old woman admitted to the hospital for shortness of breath, and was found to have COPD, hypertension, and cocaine-induced cardiomyopathy. When discussing discharge plans, she asked the physician when he was going to do about the bugs, which she said have been crawling on her and biting her for two years. There was evidence of a pruritic rash, from scratching. Delusions of parasitosis, while not common, is associated with chronic cocaine use, and is known as "cocaine bugs." There is a brief description of problems which can arise from self-treatment, e.g. such as use of pesticides on themselves. Beyond cessation of substance use which evokes this, drug therapies are discussed. Given that the individual is wholly convinced the bugs are real, there is a reluctance to accept a psychiatric referral.

Copyright 2012, American Academy of Addiction Psychiatry


Epstein DH; Preston KL. TGI Monday? Drug-dependent outpatients report lower stress and more happiness at work than elsewhere. American Journal on Addictions 21(3): 189-198, 2012. (34 refs.)

In the general population, experience-sampling studies show that work is the aspect of daily life most associated with momentary unhappiness and a desire to be elsewhere. We assessed whether this holds true for urban outpatients in treatment for heroin and cocaine dependence. In a 25-week natural-history study, 79 employed methadone-maintained misusers of heroin and cocaine carried electronic diaries on which mood and behavior were assessed up to five times per day. Being at work was associated with lower stress, greater happiness, and lower drug craving. Work accounted for 14% of the variance in stress, 30% of the variance in happiness, and 50% of the variance in cocaine craving. Participants with skilled jobs reported more positive and less negative mood states (and lower cocaine craving) at all times compared to participants with semi/unskilled jobs, although the latter reported greater mood improvement at work. In all participants, mood improvements occurred specifically in the presence of coworkers (not other companions). Our seemingly unusual findings might be specific to substance-disorder patients (for whom work may be a respite from drug-using companions), but might also hold for other urban dwellers of similar socioeconomic backgrounds (for whom work may be a respite from environmental stressors).

Copyright 2012, Wiley-Blackwell


Fabbian F; Pala M; De Giorgi A; Tiseo R; Molino C; Menegatti AM et al. Left kidney: An unusual site of cocaine-related renal infarction. A case report. European Review for Medical and Pharmacological Sciences 16(supplement 1): 30-33, 2012. (28 refs.)

Acute renal infarction is a well known, although relatively unfrequent, cause of flank pain resistant to administration of spasmolytic and nonsteroidal anti-inflammatory drugs. We present an original case of a 41-year old man, complaining of acute severe left flank pain, resistant to common analgesic therapy, who was diagnosed of segmental renal infarction of a branch of left renal artery. Pathophysiology of renal damage in cocaine users is multifactorial, and it has been postulated that the right kidney was more prone to ischaemia. Left kidney represents an extremely unusual site of cocaine-related renal infarction.

Copyright 2012, Verduci Publsihing


Fahmy V; Hatch SL; Hotopf M; Stewart R. Prevalences of illicit drug use in people aged 50 years and over from two surveys. Age and Ageing 41(4): 553-556, 2012. (15 refs.)

Objectives: to quantify illicit drug use in people aged 50 years and over in England and inner London and to compare this between 50 and 64 and 65+ age groups. Methods: primary analyses used data from the 2007 Adult Psychiatric Morbidity Survey (APMS) and the 2008-10 South East London Community Health (SELCoH) Survey. Secondary analyses included additional data on 50-64 year olds from the 1993, 2000 and 2007 APMS, and on 65-74 year olds from the 2000 and 2007 APMS. Results: cannabis was the drug most commonly used in all samples. Prevalences of use within the last 12 months in 50-64 and 65+ age groups were 1.8 and 0.4%, respectively, in England and 9.0 and 1.1%, respectively, in inner London. Prevalences of use at any time previously were 11.4, 1.7, 42.8 and 9.4%, respectively. Lifetime cannabis, amphetamine, cocaine and LSD use in 50-64 year olds had increased approximately tenfold in England from 1993. Lifetime and 12-month trends in tranquilisers were relatively stable. Conclusions: use of some illicit drugs, particularly cannabis, has increased rapidly in mid- and late-life.

Copyright 2012, Oxford University Press


Farmer RW; Malhotra PS; Mays MP; Egger ME; Smith JW; Jortani SA et al. Necrotizing peripheral vasculitis/vasculopathy following the use of cocaine laced with levamisole. Journal of Burn Care & Research 33(1): E6-E11, 2012. (20 refs.)

The objective of this study was to describe a novel presentation of peripheral vasculitis associated with levamisole-adulterated cocaine. Cocaine abuse is widespread in the United States with 5.3 million people using cocaine in 2008. Over the past decade, drug enforcement officials have noticed the presence of levamisole in confiscated cocaine samples as an adulterant. Known side effects of cocaine-related levamisole ingestion have included agranulocytosis and a cutaneous acral purpura that is histopathologically characterized by a mixture of inflammation (vasculitis) and occlusion (vasculopathy). A 54-year-old man who nasally ingested cocaine laced with levamisole developed widespread necrotic/purpuric skin lesions on approximately 20% of his body with an acral accentuation. These lesions were complicated by multiple areas of sloughing and necrosis. He was initially treated with topical silver sulfadiazine dressing changes but progressed to require debridement and split-thickness skin grafting. Peripheral vasculitis/vasculopathy with severe necrosis resembling Coumadin necrosis is a relatively recently recognized sequelae from levamisole-adulterated cocaine use.

Copyright 2012, Lippincott, Williams & Wilkins


Fiedler KK; Kim N; Kondo DG; Renshaw PF. Cocaine use in the past year is associated with altitude of residence. Journal of Addiction Medicine 6(2): 166-171, 2012. (86 refs.)

Objectives: Recently, increased rates of suicide in US counties at higher altitudes have been noted. Because of the documented association between cocaine use and suicide, we hypothesized that there would be a correlation between incidence of cocaine use and altitude of residence. Methods: Cocaine use data were obtained from the Substate Substance Abuse Estimates from the 1999-2001 National Surveys on Drug Use and Health. Data related to the percentages of people 12 years or older who used cocaine in the past year. Average elevation for US counties was calculated using the Shuttle Radar Topography Mission elevation data set, and subject region elevation was calculated by averaging the weighted elevations of each region's relevant counties. The correlation between elevation of a substate region and incidence of cocaine use in that region was calculated using Pearson correlation coefficients. Results: A significant correlation exists between mean altitude of a substate region and incidence of cocaine use in that region (r = 0.34; P < 0.0001). Regression analysis controlling for age, sex, race, education level, income, unemployment, and population density was performed. Altitude remained a significant factor (P = 0.007), whereas male sex (P = 0.008) and possessing less than a college education (P < 0.0001) were also significant predictors of self-reported cocaine use in the past year. It is important to note that cocaine use was assessed in isolation of other drugs of abuse, an additional confounding variable. Conclusions: This study demonstrates a significant correlation between altitude of substate region of residence and incidence of cocaine use. It is possible that stress response due to hypoxia is responsible; however, this requires further investigation. However, because other substance use was not assessed, specificity of this association is unknown. In addition, this correlation may help explain the increased rate of suicide in areas of higher elevation.

Copyright 2012, Lippincott, Williams & Wilkins


Fort E; Massardier-Pilonchery A; Facy F; Bergeret A. Prevalence of drug use in French seamen. Addictive Behaviors 37(3): 335-338, 2012. (22 refs.)

The main objective of the present study is to determine the prevalence of lifetime use and use in the past 30 days of narcotics in French seamen and to assess factors correlated with positive urine test in seamen as a whole. A stratified survey conducted in 19 French ports collected 1, 928 self-administered questionnaires on cigarette, alcohol and narcotics consumption. Seafarers were randomly selected and interviewed during their annual seafaring aptitude consultation. Only the 1847 male respondents were included in analysis. Nearly half of the seamen had tried cannabis at some point in their life, and 16% were users in the past 30 days. Lifetime use of certain other illegal drugs (cocaine, heroin, hallucinogenic mushrooms, poppers and ecstasy) was non-negligible, but cocaine and heroin were the only ones showing exceptional prevalence of consumption over the previous 30 days. Lifetime use of drugs was non-negligible among seamen. Prevalence of recent cannabis use was elevated. Recent consumption as indicated by positive urine test correlated with age group, family situation, occupational category, geographical area, young age of first alcohol consumption and experimentation with other drugs.

Copyright 2012, Elsevier Science


Fox HC; D'Sa C; Kimmerling A; Siedlarz KM; Tuit KL; Stowe R et al. Immune system inflammation in cocaine dependent individuals: implications for medications development. Human Psychopharmacology: Clinical and Experimental 27(2): 156-166, 2012. (100 refs.)

Objectives: Cocaine dependence is a chronic stress state. Furthermore, both stress and substance abuse have robust and reciprocal effects on immune system cytokines, which are known to be powerful modulators of mood. We therefore examine basal and provoked changes in peripheral cytokines in cocaine dependent individuals to better understand their role in the negative reinforcing effects of cocaine. Methods Twenty-eight (16 F/12 M) treatment-seeking cocaine dependent individuals and 27 (14 F/13 M) social drinkers were exposed to three 5-min guided imagery conditions (stress, drug cue, relaxing) presented randomly across consecutive days. Measures of salivary cortisol, tumor necrosis factor alpha (TNF alpha), interleukin-10 (IL-10), and interleukin-1 receptor antagonist (IL-1ra) were collected at baseline and various post-imagery time-points. Results: Cocaine abusers demonstrated decreased basal IL-10 compared with social drinkers. They also showed significant elevations in pro-inflammatory TNFa when exposed to stress compared with when they were exposed to relaxing imagery. This was not observed in the social drinkers. Conversely, social drinkers demonstrated increases in the anti-inflammatory markers, IL-10 and IL-1ra, following exposure to cue, which were not seen in the dependent individuals. Conclusions: Cocaine dependent individuals demonstrate an elevated inflammatory state both at baseline and following exposure to the stress imagery condition. Cytokines may reflect potentially novel biomarkers in addicted populations for treatment development.

Copyright 2012, Wiley-Blackwell


Fox HC; Seo D; Tuit K; Hansen J; Kimmerling A; Morgan PT et al. Guanfacine effects on stress, drug craving and prefrontal activation in cocaine dependent individuals: Preliminary findings. Journal of Psychopharmacology 26(7): 958-972, 2012. (127 refs.)

Cocaine dependence is associated with increased stress and drug cue-induced craving and physiological arousal but decreased prefrontal activity to emotional and cognitive challenge. As these changes are associated with relapse risk, we investigated the effects of alpha 2 receptor agonist guanfacine on these processes. Twenty-nine early abstinent treatment-seeking cocaine dependent individuals were randomly assigned to either daily placebo or guanfacine (up to 3 mg) for four weeks. In a laboratory experiment, all patients were exposed to three 10-min guided imagery conditions (stress/stress, drug cue/drug cue, stress/drug cue), one per day, consecutively in a random, counterbalanced order. Subjective craving, anxiety and arousal as well as cardiovascular output were assessed repeatedly. Brain response to stress, drug cue and relaxing imagery was also assessed during a functional magnetic resonance (fMRI) imaging session. In the current study, guanfacine was found to be safe and well-tolerated. Lower basal heart rate and blood pressure was observed in the guanfacine versus placebo group. Guanfacine lowered stress and cue-induced nicotine craving and cue-induced cocaine craving, anxiety and arousal. The guanfacine group also showed increased medial and lateral prefrontal activity following stress and drug cue exposure compared with placebo. Data suggest further exploration of guanfacine is warranted in terms of its potential for reducing stress-induced and cue-induced drug craving and arousal.

Copyright 2012, Sage Publications


Friend K; Milone MC; Perrone J. Hyponatremia associated with levamisole-adulterated cocaine use in emergency department patients. Annals of Emergency Medicine 60(1): 94-96, 2012. (6 refs.)

An increasing percentage of US cocaine has been adulterated with levamisole, an immunomodulator associated with agranulocytosis. We describe 3 emergency department patients with hyponatremia and cocaine use. [NB. Hyponatremia is low levels of sodium in the blood.] Despite extensive evaluation, the cause of the hyponatremia was not elucidated but resolved during hospitalization. Because hyponatremia has not previously been associated with cocaine, we sought to uncover a plausible explanation that might be contributing to this new finding. Levamisole was detected in all 3 patients. Although we are unable to confirm causality, we propose that levamisole-adulterated cocaine may have contributed to the hyponatremia described in these patients.

Copyright 2012, Elsevier Science


Galicia M; Nogue S; Casanas X; Iglesias ML; Puiguriguer J; Supervia A et al. Multicenter assessment of the revisit risk for a further drug-related problem in the emergency department in cocaine users (MARRIED-cocaine study). Clinical Toxicology 50(3): 176-182, 2012. (30 refs.)

Introduction and objectives. Emergency departments (EDs) in Spanish hospitals daily attend a large number of patients for adverse reactions or clinical complications resulting from cocaine use. After discharge, some of these patients revisit the ED for the same reason within a year. The objective of the present study was to quantify the rate of such revisits and identify the factors associated with them. Method. We performed a retrospective, multicenter study with cohort follow-up and without a control group, conducted in the EDs of six Spanish hospitals during 12 months (January-December 2009). We included all ED patients attended for cocaine-related symptoms who reported recent cocaine use and those with cocaine-positive urine analysis by immunoassay without declared consumption. Twelve independent variables assessed for each hospital ED were collected: sex, age, place of consumption, month, day, and time of consumption, mode of arrival at the ED, discharge diagnosis, psychiatric assessment on the ED episode, concomitant drugs, destination on discharge, and history of previous ED visits related with drug use and alcohol use. The dependent variable was a subsequent visit to the ED associated with drug use, identified using the computerized hospital admissions system. Results. The study included 807 patients, of whom 6.7% revisited the ED within 30 days, 11.9% within 3 months and 18.9% within 1 year. The variables significantly associated with ED revisits were: presence of clinical manifestations directly related to cocaine (p < 0.05), ED attendance on a working day (p < 0.05), history of ED visits related with the consumption of alcohol (p < 0.001) or drugs (p < 0.001), and the need for urgent consultation with a psychiatrist (p < 0.001), although only the last four were independent predictors in multivariate analysis. We derived a score based on these variables to predict risk of revisits (MARRIED-score, ranging from 0 to 400 points), which had a reasonably good predictive value for revisit (area under ROC of 0.75; 95% CI 0.71-0.79).

Copyright 2012, Informa Healthcare


Gardini S; Venneri A. Reduced grey matter in the posterior insula as a structural vulnerability or diathesis to addiction. Brain Research Bulletin 87(2-3): 205-211, 2012. (45 refs.)

A number of neuroimaging studies have shown that drug addiction is associated with morphological differences in several brain areas, including orbito-frontal and limbic structures. Most of these studies have investigated patients with addiction to cocaine. The neurobiological mechanisms which play a role in drug addiction are not fully understood, however, and the causal factors remain under investigation. The present study investigated morphological differences between patients with history of cocaine (N=14) and heroin (N=24) abuse and healthy matched controls (N=24). A 3D T1W MRI scan was acquired for all participants and the grey matter images of each patient group compared with those of controls. A direct comparison of the two addiction groups was also carried out. When compared with controls cocaine dependent patients had lower grey matter values in the left middle occipital gyrus, right putamen and insula, whereas heroin abusers had lower grey matter values in the right insula. The direct comparison between the two addiction groups showed that cocaine abusers had less grey matter in the right posterior cingulate, medio-temporal and cerebellar regions, whereas heroin abusers showed less grey matter in parietal regions on both sides, including postcentral gyrus and inferior parietal lobule. Reduced right posterior insular cortex was commonly found in both cocaine and heroin dependent patients. This morphological difference might represent a structural marker of addiction, which is independent of the discrete regional effects of each psychotropic substance of abuse, and might constitute a possible neurobiological vulnerability or diathesis to addiction. Equally, the discrete structural differences emerging from the direct comparison of cocaine and heroin abusers might reflect the effects of differential drug binding in the brain and/or express a form of neurobiological vulnerability which might explain individual drug choice.

Copyright 2012, Elsevier Science


Gilbert L; El-Bassel N; Chang MW; Wu EW; Roy L. Substance use and partner violence among urban women seeking emergency care. Psychology of Addictive Behaviors 26(2): 226-235, 2012. (58 refs.)

Growing evidence suggests intimate partner violence (IPV) and substance misuse are co-occurring problems that disproportionately affect low income urban women seeking care in emergency departments (EDs) and represent leading causes of injuries that result in ED visits. This paper examines temporal bidirectional associations between different types of drug and alcohol use and different types of IPV in a longitudinal study of a representative sample of 241 low-income urban women receiving emergency care from an ED in the Bronx, New York. After adjusting and matching for sociodemographics and potentially confounding multilevel risk and protective covariates, women who reported using heroin in the prior 6 months at Wave 1 were twice as likely as nonheroin-using women to indicate any physical, injurious, or sexual IPV at subsequent waves and were 2.7 times more likely to indicate experiencing an injury from IPV at subsequent waves. Crack or cocaine use in the past 6 months at Wave 1 was associated with an increased likelihood of injurious IPV and severe verbal abuse at subsequent waves. Findings also suggested that sexual IPV was significantly associated with subsequent use of crack or cocaine. The multiple bidirectional associations found linking these problems underscore the need for conducting routine screening for IPV and substance misuse among women in low-income urban EDs, and for improving linkages to services that will ultimately reduce the risk of morbidity, disability, and mortality related to these co-occurring problems.

Copyright 2012, American Psychological Association


Gilchrist G; Langohr K; Fonseca F; Muga R; Torrens M. Factors associated with discharge against medical advice from an alcohol and drug inpatient detoxification unit in Barcelona between 1993 and 2006. Heroin Addiction and Related Clinical Problems 14(1): 35-43, 2012. (31 refs.)

Records from 1,228 consecutively admitted patients (74.5% male) to an inpatient detoxification unit in Barcelona between 1993 and 2006 were examined to determine factors associated with discharge against medical advice (AMA). 21.5% of admissions were discharged AMA. In multiple logistic regression and compared with patients who were medically discharged, those discharged AMA were younger, more likely to be dependent on heroin, other opiates, cocaine or psychostimulants, or to be experiencing reduction or elimination methadone maintenance therapy [reference category: alcohol]. The provision of assistance to clinicians in identifying the patients who are most at risk of leaving inpatient detoxification AMA will enhance their ability to motivate such patients to stay in treatment.

Copyright 2012, Pacini Editore


Giraldo EA; Taqi MA; Vaidean GD. A case-control study of stroke risk factors and outcomes in African American stroke patients with and without crack-cocaine abuse. Neurocritical Care 16(2): 273-279, 2012. (23 refs.)

Background: Stroke in crack-cocaine abusers is increasingly recognized. We aimed to identify significant differences in stroke risk factors, characteristics, and outcomes between hospitalized stroke patients with and without crack-cocaine abuse. Methods: This was a retrospective study that compared stroke patients with crack-cocaine abuse (cases) to stroke patients without crack-cocaine (controls). Results: We identified 93 crack-cocaine cases and 93 controls admitted between January 2004 and May 2006 to one teaching hospital. There were significant differences between crack-cocaine cases and controls in age (48.7 years vs. 55 years) (P = 0.0001), male gender (65.6% vs. 40.9%) (odds ratios, OR = 1.64, 95% CI 1.22-2.21), arterial hypertension (61.1% vs. 83.9%) (OR = 0.30, 95% CI 0.15-0.60), hypercholesterolemia (18.7% vs. 68.5%) (OR = 0.10, 95% CI 0.05-0.21), diabetes (20.9% vs. 41.9%) (OR = 0.36, 95% CI 0.19-0.70), cigarette smoking (70.6% vs. 29%) (OR = 5.86, 95% CI 3.07-11.20), ischemic stroke (61.3% vs. 79.6%) (OR = 0.40, 95% CI 0.21-0.78), and intracerebral hemorrhage (33.3% vs. 17.2%) (OR = 3.03, 95% CI 1.53-6.00). Also, there were significant differences in National Institutes of Health Stroke Scale scores (3.3 vs. 7) (P < 0.0001), and MRS scores (1.8 vs. 2.5) (P = 0.0022) at hospital discharge. Using univariable and multivariable logistic regression, we found that crack-cocaine abusers had 2.28 higher odds of having a favorable functional outcome (MRS score <= 2) at hospital discharge, after adjusting for stroke risk factors and characteristics. Conclusions: Our study suggests that crack-cocaine abusers with stroke had fewer traditional risk factors, and more favorable functional outcome as compared to non-crack-cocaine abusers.

Copyright 2012, Humana Press


Gjini K; Ziemann U; Napier TC; Boutros N. Dysbalance of cortical inhibition and excitation in abstinent cocaine-dependent patients. Journal of Psychiatric Research 46(2): 248-255, 2012. (55 refs.)

The effects of chronic cocaine dependence on cortical inhibitory/excitatory processes are not well characterized. Employing transcranial magnetic stimulation measures of motor cortical excitability, we have previously reported an elevation of motor threshold (MT) suggesting reduced excitability and an increased long-interval intracortical facilitation (LICF) suggesting increased excitability. In the current study, we used an expanded battery of TMS cortical excitability measures to further examine motor cortex excitability in a larger sample of well-characterized and closely monitored for drug use, abstinent cocaine-dependent subjects (N = 52) and healthy controls (N = 42). Furthermore, coil-to-cortex distance was assessed in a subsample of both groups. We verified that long-interval intracortical facilitation (LICF), possibly representing glutamatergic cortical neurotransmission, was significantly increased in cocaine-dependent patients. Significantly longer cortical silent periods (CSP) and elevated MT were also observed while there was no significant abnormality in long-interval intracortical inhibition (LICI). Increased LICF and CSP duration suggest increased cortical excitability and increased inhibition, respectively, of different neurotransmitter systems in cocaine-dependent patients. Increased MT might reflect an adaptation to those effects of cocaine abuse that enhance cortical excitability. Overall, the data point to the complex nature of chronic cocaine dependence on the balance of cortical inhibitory/excitatory mechanisms.

Copyright 2012, Elsevier Science


Goerig M; Bacon D; van Zundert A. Carl Koller, cocaine, and local anesthesia: Some less known and forgotten facts. Regional Anesthesia and Pain Medicine 37(3): 318-324, 2012. (49 refs.)

Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a controversial priority discussion emerged. There is little information about this "dark side" of Koller's discovery and only sparse data about the personalities involved in this controversy. In addition, Carl Koller's decision to leave Vienna is also surrounded in secrecy. The story surrounding the revelation of the local anesthetic effect of cocaine and the personalities involved is fascinating and relatively unknown.

Copyright 2012, Lippincott, Williams & Wilkins


Gootenberg P. Cocaine's long march north, 1900-2010. Latin American Politics and Society 54(1): 159-180, 2012. (34 refs.)

This essay charts the entanglements and blowback effects of U.S. policy toward Latin American drug exports over the last century as the backdrop to today's cascading drug violence in northern Mexico. The history of cocaine reveals a series of major geopolitical shifts (closely related to U.S. interdictionist drug war policies) that bring drug commodity chains, illicit trafficking centers, and conflicts, over the long run, closer to the United States. It analyzes shifts from initial legal cocaine and small-time postwar smuggling of the central Andes to the concentrating 1970s - 1990s cartel epicenter in northern Andean Colombia, to the 1990s political shift north to Mexican transhipment and organizational leadership. Violence around cocaine has intensified at every step, and the present conflict portends another shift in the chain.

Copyright 2012, Wiley-Blackwell


Grau-Lopez L; Roncero C; Navarro MC; Casas M. Psychosis induced by the interaction between disulfiram and methylphenidate may be dose dependent. Substance Abuse 33(2): 186-188, 2012. (8 refs.)

There are few studies describing psychiatric symptoms occurring when methylphenidate and disulfiram are used together. The authors report a case of disulfiram and methylphenidate interaction in which psychotic symptoms could be dose dependent. The patient, diagnosed of alcohol and cocaine dependence and attention deficit hyperactivity disorder (ADHD), started treatment with methylphenidate increasing doses and disulfiram 250 mg/day over 4 weeks. During the first 2 weeks at doses of 36 mg/day of methylphenidate and maintaining disulfiram, side effects were not observed. However, by increasing to 54 mg/day, psychotic symptoms were detected. The authors reported that the effects are dose dependent. This is the first report about dose-dependent side effects in substance use disorder with ADHD.

Copyright 2012, Taylor & Francis


Graziotti AL; Hammond J; Messinger DS; Bann CM; Miller-Loncar C; Twomey JE et al. Maintaining participation and momentum in longitudinal research involving high-risk families. Journal of Nursing Scholarship 44(2): 120-126, 2012. (16 refs.)

Purpose: The purpose of the current study was to identify and describe strategies available to optimize retention of a high-risk research cohort and assist in the recovery of study participants following participant dropout. Design and Methods: The Maternal Lifestyle Study (MLS), which investigated the effects of prenatal substance exposure (cocaine or opiates) on child outcome, is a prospective longitudinal follow-up study that extended from birth through 15 years of age. Retention strategies to maximize participation and factors that might negatively impact compliance were examined over the course of five follow-up phases. Findings: At the conclusion of the 15-year visits, MLS had successfully maintained compliance at 76%. Retention rates did not differ by exposure group. Conclusions: Maintaining ongoing participation of enrolled study subjects is a critical element of any successful longitudinal study. Strategies that can be used to reengage and maintain participants in longitudinal research include persistence, flexibility with scheduling, home visits, long-distance trips, increased incentives, and development of a computerized tracking system. Establishing rapport with families and ensuring confidentiality contributed to overall participant retention. The use of multiple tracking techniques is essential. Clinical Relevance: Researchers are challenged to maintain participants in longitudinal studies to ensure the integrity of their research.

Copyright 2012, Wiley-Blackwell


Gryczynski J; Kinlock TW; Kelly SM; O'Grady KE; Gordon MS; Schwartz RP. Opioid agonist maintenance for probationers: Patient-level predictors of treatment retention, drug use, and crime. Substance Abuse 33(1, special issue): 30-39, 2012. (35 refs.)

This study examined outcomes and their predictors among 181 probationers enrolling in opioid agonist maintenance with methadone or levo-alpha-acetylmethadol (LAAM). Participants were interviewed at treatment entry and 2-, 6-, and 12-month follow-ups. Treatment retention and frequency of heroin use, cocaine use, and income-generating criminal activity were examined using survival and longitudinal analyses. Participants reported marked reductions in drug use and crime relative to treatment entry. A number of patient characteristics associated with various outcomes were identified. The findings support engaging probationers in treatment and highlight patient factors that might influence outcomes.

Copyright 2012, Taylor & Francis


Gunasekera RS; Brown AB; Costas EH. Tales from the grave: Opposing autopsy reports from a body exhumed. Journal of Forensic and Legal Medicine 19(5): 297-301, 2012. (14 refs.)

We report an autopsy case of a 42-year-old woman who, when discovered, had been dead in her apartment for approximately 1 week under circumstances involving treachery, assault and possible drug overdose. This case is unique as it involved two autopsies of the deceased by two different medical examiners who reached opposing conclusions. The first autopsy was performed about 10 days after death. The second autopsy was performed after an exhumation approximately 2 years after burial. Evidence collected at the crime scene included blood samples from which DNA was extracted and analysed, fingerprints and clothing containing dried body fluids. The conclusion of the first autopsy was accidental death due to cocaine toxicity; the conclusion of the second autopsy was death due to homicide given the totality of evidence. Suspects 1 and 2 were linked to the death of the victim by physical evidence and suspect 3 was linked by testimony. Suspect 1 received life in prison, and suspects 2 and 3 received 45 and 20 years in prison, respectively. This case indicates that cocaine toxicity is difficult to determine in putrefied tissue and that exhumations can be important in collecting forensic information. It further reveals that the combined findings of medical examiners, even though contradictory, are useful in determining the circumstances leading to death in criminal justice. Thus, this report demonstrates that such criminal circumstances require comparative forensic review and, in such cases, scientific conclusions can be difficult.

Copyright 2012, Elsevier Science


Haile CN; Mahoney JJ; Newton TF; De La Garza R. Pharmacotherapeutics directed at deficiencies associated with cocaine dependence: Focus on dopamine, norepinephrine and glutamate. (review). Pharmacology & Therapeutics 134(2): 260-277, 2012. (378 refs.)

Much effort has been devoted to research focused on pharmacotherapies for cocaine dependence yet there are no FDA-approved medications for this brain disease. Preclinical models have been essential to defining the central and peripheral effects produced by cocaine. Recent evidence suggests that cocaine exerts its reinforcing effects by acting on multiple neurotransmitter systems within mesocorticolimibic circuitry. Imaging studies in cocaine-dependent individuals have identified deficiencies in dopaminergic signaling primarily localized to corticolimbic areas. In addition to dysregulated striatal dopamine, norepinephrine and glutamate are also altered in cocaine dependence. In this review, we present these brain abnormalities as therapeutic targets for the treatment of cocaine dependence. We then survey promising medications that exert their therapeutic effects by presumably ameliorating these brain deficiencies. Correcting neurochemical deficits in cocaine-dependent individuals improves memory and impulse control, and reduces drug craving that may decrease cocaine use. We hypothesize that using medications aimed at reversing known neurochemical imbalances is likely to be more productive than current approaches. This view is also consistent with treatment paradigms used in neuropsychiatry and general medicine.

Copyright 2012, Elsevier Science


Haltigan JD; Lambert BL; Seifer R; Ekas NV; Bauer CR; Messinger DS. Security of attachment and quality of mother-toddler social interaction in a high-risk sample. Infant Behavior & Development 35(1): 83-93, 2012. (70 refs.)

The quality of children's social interactions and their attachment security with a primary caregiver are two widely studied indices of socioemotional functioning in early childhood. Although both Bowlby and Ainsworth suggested that the parent-child interactions underlying the development of attachment security could be distinguished from other aspects of parent-child interaction (e.g., play), relatively little empirical research has examined this proposition. The aim of the current study was to explore this issue by examining concurrent relations between toddler's attachment security in the Strange Situation Procedure and quality of mother-child social interaction in a high-risk sample of toddlers characterized by prenatal cocaine exposure and low levels of maternal education. Analyses of variance suggested limited relations between attachment security and quality of social interaction. Further research examining the interrelations among various components of the parent-child relationship is needed.

Copyright 2012, Elsevier Science


Harp KLH; Oser C; Leukefeld C. Social support and crack/cocaine use among incarcerated mothers and nonmothers. Substance Use & Misuse 47(6): 686-694, 2012. (51 refs.)

Limited research shows that correlates of substance use differ for mothers and nonmothers. This study compares mothers and nonmothers by examining the relationship between perceived social support and frequency of crack/cocaine use. Data for the 307 female prisoners in this sample were collected between 2007 and 2008 in four US states during the Criminal Justice-Drug Abuse Treatment Studies' (CJ-DATS) Reducing Risky Relationships for HIV protocol. Ordinary least squares regression models revealed that greater social support was significantly associated with less frequent crack/cocaine use among mothers but not nonmothers. Implications are discussed.

Copyright 2012, Informa HealthCare


Harrell PT; Mancha BE; Petras H; Trenz RC; Latimer WW. Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors. Drug and Alcohol Dependence 122(3): 220-227, 2012. (96 refs.)

Background: Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections. Methods: Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV. Results: Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR = 6.97, 95% CI = 4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR = 2.66, 95% CI = 1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR = 2.50, 95% CI = 1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR = 0.10, 95% CI = 0.06-0.18), but no significant differences were found for HIV. Conclusions: Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.

Copyright 2012, Elsevier Science


Harrell PT; Trenz RC; Scherer M; Pacek LR; Latimer WW. Cigarette smoking, illicit drug use, and routes of administration among heroin and cocaine users. Addictive Behaviors 37(5): 678-681, 2012. (50 refs.)

Cigarette smoking is ubiquitous among illicit drug users. Some have speculated that this may be partially due to similarities in the route of administration. However, research examining the relationship between cigarette smoking and routes of administration of illicit drugs is limited. To address this gap, we investigated sociodemographic and drug use factors associated with cigarette smoking among cocaine and heroin users in the Baltimore. Maryland community (N = 576). Regular and heavy cigarette smokers were more likely to be White, have a history of a prior marriage, and have a lower education level. Regular smoking of marijuana and crack was associated with cigarette smoking, but not heavy cigarette smoking. Injection use was more common among heavy cigarette smokers. In particular, regular cigarette smokers were more likely to have a lifetime history of regularly injecting heroin. Optimal prevention and treatment outcomes can only occur through a comprehensive understanding of the interrelations between different substances of abuse.

Copyright 2012, Elsevier Science


Hartwell KJ; Back SE; McRae-Clark AL; Shaftman SR; Brady KT. Motives for using: A comparison of prescription opioid, marijuana and cocaine dependent individuals. Addictive Behaviors 37(4): 373-378, 2012. (34 refs.)

Identification of the motives for drug use is critical to the development of effective interventions. Furthermore, consideration of the differences in motives for drug use across substance dependent populations may assist in tailoring interventions. To date, few studies have systematically compared motives for substance use across drug classes. The current study examined motives for drug use between non-treatment seeking individuals with current prescription opioid, marijuana, or cocaine dependence. Participants (N=227) completed the Inventory of Drug-Taking Situations (IDTS; Annis, Turner & Sklar,1997), which contains eight subscales assessing motives for drug use. The findings revealed that prescription opioid dependent individuals scored significantly higher than all other groups on the Physical Discomfort, Testing Personal Control and Conflict with Others subscales. Both the prescription opioid and cocaine dependent groups scored significantly higher than the marijuana group on the Urges or a Temptation to Use subscale. In contrast, marijuana dependent individuals scored highest on the Pleasant Emotions and Pleasant Times with Others subscales. The marked differences revealed in motives for drug use could be used in the development and implementation of specific treatment interventions for prescription opioid, marijuana and cocaine dependent individuals.

Copyright 2012, Elsevier Science


Hasin DS; Fenton MC; Beseler C; Park JY; Wall MM. Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients. Drug and Alcohol Dependence 122(1-2): 28-37, 2012. (78 refs.)

Background: A number of changes have been proposed and investigated in the criteria for substance use disorders in DSM-5. However, although clinical utility of DSM-5 is a high priority, relatively little of the empirical evidence supporting the changes was obtained from samples of substance abuse patients. Methods: Proposed changes were examined in 663 patients in treatment for substance use disorders, evaluated by experienced clinicians using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Factor and item response theory analysis was used to investigate the dimensionality and psychometric properties of alcohol, cannabis, cocaine and heroin abuse and dependence criteria, and craving. Results: The seven dependence criteria, three of the abuse criteria (hazardous use; social/interpersonal problems related to use; neglect of roles to use), and craving form a unidimensional latent trait for alcohol, cannabis, cocaine and heroin. Craving did not add significantly to the total information offered by the dependence criteria, but adding the three abuse criteria and craving together did significantly increase total information for the criteria sets associated with alcohol, cannabis and heroin. Conclusion: Among adult patients in treatment for substance disorders, the alcohol, cannabis, cocaine and heroin criteria for dependence, abuse (with the exception of legal problems), and craving measure a single underlying dimension. Results support the proposal to combine abuse and dependence into a single diagnosis in the DSM-5, omitting legal problems. Mixed support was provided for the addition of craving as a new criterion, warranting future studies of this important construct in substance use disorders.

Copyright 2012, Elsevier Science


Henry PK; Umbricht A; Kleykamp BA; Vandrey R; Strain EC; Bigelow GE et al. Comparison of cognitive performance in methadone maintenance patients with and without current cocaine dependence. Drug and Alcohol Dependence 124(1-2): 167-171, 2012. (25 refs.)

Background: There is evidence for psychomotor and cognitive performance impairment in methadone maintenance patients (MMP), as well as in individuals with current cocaine dependence. It is unknown whether MMP with concurrent cocaine dependence perform worse on tests of cognitive function than MMP without cocaine dependence. Methods: Performance was compared between MMP with and without current cocaine dependence (MMP/CD+; N = 53 and MMP/CD-; N = 24) on a standard battery of tasks designed to measure psychomotor performance, attention, episodic and working memory, and executive function. Results: Participant characteristics were mostly similar across groups. However, the MMP/CD+ group had a shorter duration of methadone treatment, and a larger percentage of participants with self-reported 30-day poly-substance abuse and positive urine drug tests on the day of cognitive testing. There were no differences between the groups on measures of balance, psychomotor coordination, divided attention, working memory, most measures of episodic memory, or executive function. Relative to MMP/CD-, MMP/CD+ showed significant impairment on select measures of psychomotor performance/attention (simple reaction time and trail-making test A) and episodic memory (higher false alarm rates on recognition memory). Conclusions: The absence of differences between MMP/CD+ and MMP/CD- on measures of higher order cognitive functions, and the relatively small magnitude between-group differences on other measures suggest that current cocaine dependence, in the absence of cocaine intoxication, is unlikely to be associated with clinically meaningful increases in performance impairment in MMP.

Copyright 2012, Elsevier Science


Hien DA; Morgan-Lopez AA; Campbell ANC; Saavedra LM; Wu E; Cohen L et al. Attendance and substance use outcomes for the Seeking Safety Program: Sometimes less is more. Journal of Consulting and Clinical Psychology 80(1): 29-42, 2012. (50 refs.)

Objective: This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups. Method: Women receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover. Results: Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance. droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels. Conclusions: The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population.

Copyright 2012, American Psychological Association


Hjorthoj CR; Hjorthoj AR; Nordentoft M. Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances : Systematic review and meta-analysis. (review). Addictive Behaviors 37(3): 225-233, 2012. (78 refs.)

Background: Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances. Methods: PubMedicine, PsycINFO, Cochrane CENTRAL and EMBASE were searched in December 2010. 16, 633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB. Results: Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%), for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected. Conclusions: TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.

Copyright 2012, Elsevier Science


Hoffman RS; Larocque A. Response to "Multifocal inflammatory leukoencephalopathy associated with cocaine abuse: Is levamisole responsible?". Clinical Toxicology 50(6): 536-536, 2012. (6 refs.)


Horey JT; Mariani JJ; Cheng WY; Bisaga A; Sullivan M; Nunes E et al. Comparison of substance use milestones in cannabis- and cocaine-dependent patients. Journal of Addictive Diseases 31(1): 60-66, 2012. (27 refs.)

Objectives: To compare the progression of substance use milestones between cocaine- and cannabis-dependent patients. Methods: Using data gathered from two separate clinical studies for treatment of cocaine dependence and cannabis dependence, 130 cannabis-dependent and 112 cocaine-dependent individuals were compared on milestones related to their substance use. Results: In cannabis-vs. cocaine-dependent patients, the mean age of first use, regular use and first treatment contact differed significantly. No statistically significant differences were found between the two groups for other measured milestones. Conclusions: These results differ from most epidemiologic studies that suggest cocaine users progress more rapidly to regular use and treatment contact.

Copyright 2012, Taylor & Francis


Hser YI; Kagihara J; Huang D; Evans E; Messina N. Mortality among substance-using mothers in California: A 10-year prospective study. Addiction 107(1): 215-222, 2012. (60 refs.)

Aims: To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality. Design, setting, participants This is a prospective study of a cohort of 4447 substance using mothers (pregnant or parenting) who were enrolled during 2000-02 in 40 drug abuse treatment programs across California. Methods: All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard (Cox) regression was used to identify risk factors predicting death. Results: At the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% confidence interval: 7.2-9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine or marijuana (relative to methamphetamine) as the primary drug problem, drug injection and greater severity of employment, medical /health and psychiatric problems. Conclusions: Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/ health and psychiatric problems contributed to the elevated mortality.

Copyright 2012, Society for the Study of Addiction


Hughes CE; Chalmers J; Bright DA; Matthew-Simmons F; Sindicich N. Examining supply changes in Australia's cocaine market. Drug and Alcohol Review 31(3): 263-272, 2012. (55 refs.)

Introduction and Aims. Media attention to cocaine use and supply has increased following some of the largest cocaine seizures in Australia's history. Whether there has been an expansion in supply remains unclear. This paper examines the evidence behind assertions of increased supply in Australia and the scale and nature of any apparent increase, using proxy indicators of cocaine importation, distribution and use. Design and Methods. Eight proxies of cocaine importation, distribution and use were adopted, including amount of importation, mode of importation and supply flows to Australia. Each proxy indicator was sourced using publicly available and Australia-wide data, including information on the total weight of border seizures, mode of detection and country of embarkation of individual seizures. Data permitting, trends were examined for up to a 12 year period (1997-1998 to 2009-2010). Results. Since 2006-2007 there was evidence of increased cocaine importation, albeit less than between 1998-1999 and 2001-2002. There were further signs that the 2006-2007 expansion coincided with a diversification of trafficking routes to and through Australia (beyond the traditional site of entry-Sydney) and shifts in the geographic distribution of use. Discussion and Conclusions. The congruity between indicators suggests that there has been a recent expansion in cocaine supply to and distribution within Australia, but that the more notable shift has concerned the nature of supply, with an apparent growth in importation and distribution beyond New SouthWales. The diversification of cocaine supply routes may increase risks of market entrenchment and organised crime throughout Australia.

Copyright 2012, Wiley-Blackwell


Jauffret-Roustide M; Cohen J; Poisot-Martin I; Spire B; Gossop M; Carrieri MP. Distributive sharing among HIV-HCV co-infected injecting drug users: The preventive role of trust in one's physician. AIDS Care 24(2): 232-238, 2012. (40 refs.)

This study, based on data from the MANIF 2000 cohort study, investigates the relationship between the lending of injecting equipment, drug use, and experience with HIV care. The sample comprised 224 HIV-HCV co-infected patients who reported having injected drugs in the previous six months and their 538 visits to clinical services. Longitudinal data were collected for medical status, and self-reported risk behaviors. A logistic regression GEE model was used to identify correlates of distributive sharing. After multiple adjustment, patients who reported trust in physicians were significantly less likely to report lending injection equipment while cocaine users were at increased risk. Promoting dialog between physicians and injecting drug users (IDUs) may play an important role in HIV-HCV positive prevention.

Copyright 2012, Taylor & Francis


Johnson MW. An efficient operant choice procedure for assessing delay discounting in humans: Initial validation in cocaine-dependent and control individuals. Experimental And Clinical Psychopharmacology 20(3): 191-204, 2012. (89 refs.)

Delay discounting is the decline in a consequence's control of behavior as a function of its delay, and may be a fundamental behavioral process in drug dependence. Human delay-discounting studies have usually relied on choices between hypothetical rewards. Some human tasks have assessed delay discounting using operant procedures with consequences provided during the task, as in nonhuman animal studies. However, these tasks have limitations such as long duration, potentially indeterminate data, or confounding the effect of delay with probability. A study in 20 cocaine-dependent volunteers and 20 demographically matched non-cocaine-dependent volunteers was designed to investigate a novel operant delay-discounting task providing monetary reinforcement by coin delivery throughout the task (Quick Discounting Operant Task; QDOT). Participants completed a hypothetical delay-discounting procedure, a potentially real reward delay-discounting procedure, and an existing operant delay-discounting task: the Experiential Discounting Task (EDT). The QDOT resulted in complete data for all participants, showed systematic effects of delay that were well described by a hyperbolic function, had a maximum duration of 17 min, and resulted in relatively little variability in session earnings. QDOT performance was significantly, positively correlated with performance on the EDT but not the other tasks. The QDOT resulted in an effect size between the groups that was similar to most other delay-discounting tasks examined, and showed that the cocaine-dependent participants delay discounted significantly more than the control participants. The QDOT is an efficient operant human delay-discounting task that may be useful in a variety of experimental settings.

Copyright 2012, American Psychological Association


Johnson MW; Bruner NR. The sexual discounting task: HIV risk behavior and the discounting of delayed sexual rewards in cocaine dependence. Drug and Alcohol Dependence 123(1-3): 15-21, 2012. (60 refs.)

Background: Cocaine dependence is associated with high rates of sexual risk behavior and HIV infection. However, little is known about the responsible mechanism(s). Methods: Cocaine-dependent individuals (N = 62) completed a novel Sexual Discounting Task assessing decisions between immediate unprotected sex and delayed sex with a condom across four hypothetical partners: most (and least) likely to have a sexually transmitted infection (STI), and most (and least) sexually desirable; a real rewards money delay-discounting task, and self-reported sexual risk behavior using the HIV Risk-Taking Behavior Scale (HRBS). Results: Sexual Discounting Task results were largely systematic and showed a strong effect of delay in decreasing condom use. Sexual discounting (preference for immediate unprotected sex) was significantly greater when making responses for partners judged least (compared to most) likely to have an STI, and for partners judged most (compared to least) desirable. Differences in sexual discounting were significant after controlling for differences in condom use (with no delay) between conditions. Greater discounting in 3 of the 4 Sexual Discounting Task conditions, but not in the money discounting task, was associated with greater self-reported sexual risk behavior as measured by the HRBS. Conclusions: Results suggest that delay is a critical variable strongly affecting HIV sexual risk behavior, and that the Sexual Discounting Task provides a clinically sensitive measure of this phenomenon that may address a variety of questions about HIV risk in future research. The wealth of behavioral and neurobiological data on delay discounting should be brought to bear on HIV education and prevention.

Copyright 2012, Elsevier Science


Johnson S; MacDonald SF; Cheverie M; Myrick C; Fischer B. Prevalence and trends of non-medical opioid and other drug use histories among federal correctional inmates in methadone maintenance treatment in Canada. Drug and Alcohol Dependence 124(1-2): 172-176, 2012. (24 refs.)

Background: The prevalence of illicit drug use among correctional populations is high, and associated with high levels of drug related morbidity risks and harms. The purpose of this study was to examine temporal and regional patterns of illicit drug use among a sample of Canadian federal correctional inmates participating in correctional methadone maintenance treatment (MMT). Methods: Socio-demographic and drug use data collected from 1272 male federal offenders admitted to Correctional Service Canada's (CSC) MMT program between 2003 and 2008 were examined. Univariate analyses were conducted on inmates' key demographic and correctional characteristics, pre-MMT opioid use and other problematic drug use, and opioid and injecting use while incarcerated. Bivariate associations on drug use measures across regions and over time were computed. Results: Prevalence of heroin use decreased, and prevalence of prescription opioid (PO) use increased over the study period. Significant regional differences existed for PO use, specifically for morphine/hydromorphone and oxycodone use. The majority used opioids and injected while incarcerated, with overall downward trends over time and regional variations. Approximately half the sample indicated a history of lifetime non-opioid problematic drug use, most commonly cocaine (72%) for which substantial regional differences were found. Conclusions: Pre-MMT opioid and other problematic non-opioid drug use in the sample was high. Temporal and regional patterns of drug use observed may reflect developments in the general population, e.g. increasing PO misuse. The observed drug use patterns underscore the need for targeted drug specific prevention/treatment measures in correctional environments beyond existing interventions.

Copyright 2012, Elsevier Science


Joya X; Gomez-Culebras M; Callejon A; Friguls B; Puig C; Ortigosa S et al. Cocaine use during pregnancy assessed by hair analysis in a Canary Islands cohort. BMC Pregnancy and Childbirth 12: article 2, 2012. (39 refs.)

Background: Drug use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. The aim of this study was to estimate the prevalence of illicit drug use among pregnant women by using maternal hair analysis. Methods: A toxicological analysis of hair was used to detect chronic recreational drug use during pregnancy. In 2007, 347 mother-infant dyads were included from the Hospital La Candelaria, Santa Cruz de Tenerife, Canary Islands (Spain). Data on socioeconomic characteristics and on substance misuse during pregnancy were collected using a structured questionnaire. Drugs of abuse: opiates, cocaine, cannabinoids and amphetamines were detected in maternal hair by immunoassay followed by gas chromatography-mass spectrometry for confirmation and quantitation. Results: Hair analysis revealed 2.6% positivity for cocaine and its metabolites. Use of cocaine during pregnancy was associated with unusual behaviour with potentially harmful effects on the baby. Conclusions: The results of the study demonstrate significant cocaine use by pregnant women in Canary Islands. The data should be used for the purpose of preventive health and policy strategies aimed to detect and possibly to avoid in the future prenatal exposure to drugs of abuse.

Copyright 2012, BioMed Central


Kangas BD; Branch MN. Effects of acute and chronic cocaine administration on titrating-delay matching-to-sample performance. Journal of the Experimental Analysis of Behavior 97(2): 151-162, 2012. (42 refs.)

The effects of cocaine were examined under a titrating-delay matching-to-sample procedure. In this procedure, the delay between sample stimulus offset and comparison stimuli onset adjusts as a function of the subject's performance. Specifically, matches increase the delay and mismatches decrease the delay. Titrated delay values served as the primary dependent measure. After establishing stable performance in pigeons, several behaviorally-effective doses of cocaine were administered acutely. Dose-related within-session decreases in titrated delay values were observed. Following acute determinations, the dose of cocaine that produced the most rapid decline without eliminating performance was administered prior to each daily session. Chronic administration resulted in performance trending toward control levels. A redetermination of the dose response function following chronic exposure revealed reduced potency (i.e., tolerance) under cocaine on titrated delay matching-to-sample performance. Supplemental analyses suggest that cocaine may serve as a disruptor of the stimulus conditions in which the performance was established.

Copyright 2012, Society of Experimental Analysis of Behavior


Karch SB; Mari F; Bartolini V; Bertol E. Aminorex poisoning in cocaine abusers. (review). International Journal of Cardiology 158(3): 344-346, 2012. (43 refs.)

Levamisole is found in more than 80% of illicit cocaine seized within United States borders. Percentages are somewhat lower in Europe. In 2009, controlled in vivo studies demonstrated that horses metabolize levamisole to aminorex. Earlier this year our laboratory demonstrated that the same conversion occurs in man. Levamisole itself causes aplastic anemia and numerous reports have begun to appear in the literature, but the conversion of levamisole to aminorex is of much more concern. Aminorex ingestion was responsible for a five-year epidemic (1967-1972) of idiopathic pulmonary hypertension (IPH) confined to Switzerland, Austria, and Germany, the only countries where aminorex had been marketed as an anorectic. The incidence of IPH reverted to normal levels as soon as aminorex was withdrawn. In most cases onset of symptoms in IPH began after six to nine months of aminorex use, with average dosage ranges of 10 to 40 mg per day. The outcome was almost uniformly fatal. The conversion rate of levamisole to aminorex has not been established, but given the high daily intake of cocaine by many abusers, it seems likely that many of them will have ingested enough contaminated cocaine to ultimately cause IPH. Until the disease is well established, the symptoms of IHP are vague, and existing drug registries specifically exclude drug abusers, making it difficult to track these cases. This review is intended to draw attention to what may be a slowly emerging new epidemic.

Copyright 2012, Elsevier Science


Kazanga I; Tameni S; Piccinotti A; Floris I; Zanchetti G; Polettini A. Prevalence of drug abuse among workers: Strengths and pitfalls of the recent Italian Workplace Drug Testing (WDT) legislation. Forensic Science International 215(1-3): 46-50, 2012. (22 refs.)

Background: In 2008 a Workplace Drug Testing (WDT) law became effective in Italy for workers involved in public/private transportation, oil/gas companies, and explosives/fireworks industry with the aim to ensure public safety for the community. Aims: To examine and elaborate WDT data collected on a large group of workers (over 43, 500) during March 2009-February 2010 in order to highlight pros and cons and to draw suggestions for policies in the field. Setting: Northern Italy. Methods: After <= 24 h notification, workers provided a urine sample screened for opiates, methadone, buprenorphine, cocaine, amphetamines, ecstasy, and cannabinoids (THC) by immunoassay. Positives were confirmed by GC-MS. Results: The positive rate was 2.0%, THC being most frequent drug (1.3%; cocaine, 0.4%; opioids, 0.3%). 6.9% of the positive workers tested positive for >= 2 classes (most often THC + cocaine). Gender ratio and mean age were significantly lower in positives (F/M = 0.007; 35.5 +/- 8.3 years) than negatives (0.016 and 40.7 + 9.5, respectively). No decline in rates of positives and an increase of diluted samples over time were observed. The highest rates of positives were detected when sampling was performed just before/after weekend and during morning hours. Possible correlation between job type and drugs used were observed (e.g. more cocaine positives among road vehicle-drivers than among lift truck-drivers). Declared use of medicine/illicit drugs during the preceding week showed that illicit drug use was likely not always detected in urine and that almost 4% workers declared use of medicine drugs possibly affecting performance. Conclusions: This survey enabled to evidence relevant pitfalls of the law and to define strategies to improve the outcomes of WDT policies.

Copyright 2012, Elsevier Science


Kennedy AP; Gross RE; Whitfield N; Drexler KPG; Kilts CD. A controlled trial of the adjunct use of D-cycloserine to facilitate cognitive behavioral therapy outcomes in a cocaine-dependent population. Addictive Behaviors 37(8): 900-907, 2012. (48 refs.)

Cocaine dependence is a chronically relapsing disorder for which its predominant behavioral therapies are associated with only partial efficacy. The goal of this study was to determine if the N-methyl-D-aspartate (NMDA) glutamate receptor partial agonist and cognitive enhancer, D-cycloserine (DCS), could boost the cocaine abstinence and treatment retention goals of cognitive behavioral therapy (CBT). This study employed a placebo-controlled, randomized double-blind trial design of 44 cocaine-dependent men enrolled in a 4-week outpatient Substance Abuse Treatment Program (SATP) at the Atlanta Veteran's Administration Medical Center. Subjects received 50 mg of DCS or placebo prior to four weekly sessions of a condensed version of a manual-based CBT for cocaine dependence. Cocaine abstinence and treatment retention measures represented primary outcome variables. Relative to a 12-step based treatment-as-usual, an under-dosed CBT was associated with significant improvements in drug abstinence and treatment retention at 4-weeks and for maintenance of drug abstinence after four more weeks of follow-up. The robust response to the under-dosed CBT was not enhanced by the adjunct administration of DCS at either the 4- or 8-week endpoints. This controlled clinical trial failed to demonstrate an ability of DCS to boost the relapse prevention or treatment retention goals of CBT.

Copyright 2012, Elsevier Science


Kerr T; Marshall BDL; Milloy MJ; Zhang R; Guillemi S; Montaner JSG et al. Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users. Drug and Alcohol Dependence 124(1-2): 108-112, 2012. (38 refs.)

Background: Previous studies suggest that active drug use may compromise HIV treatment among HIV-positive injection drug users (IOU). However, little is known about the differential impacts of cocaine injection, heroin injection, and combined cocaine and heroin injection on plasma HIV-1 RNA suppression. Methods: Data were derived from a longstanding open prospective cohort of HIV-positive IOU in Vancouver, Canada. Kaplan-Meier methods and Cox proportional hazards regression were used to examine the impacts of different drug use patterns on rates of plasma HIV-1 RNA suppression. Results: Between May 1996 and April 2008, 267 antiretroviral (ART) naive participants were seen for a median follow-up duration of 50.6 months after initiating ART. The incidence density of HIV-1 RNA suppression was 65.2 (95%CI: 57.0-74.2) per 100 person-years. In Kaplan-Meier analyses, compared to those who abstained from injecting, individuals injecting heroin, cocaine, or combined heroin/cocaine at baseline were significantly less likely to achieve viral suppression (all p < 0.01). However, none of the drug use categories remained associated with a reduced rate of viral suppression when considered as time-updated variables (all p > 0.05). Conclusions: Active injecting at the time of ART initiation was associated with lower plasma HIV-1 RNA suppression rates; however, there was no difference in suppression rates when drug use patterns were examined over time. These findings imply that adherence interventions for active injectors should optimally be applied at the time of ART initiation.

Copyright 2012, Elsevier Science


Kertesz SG; Khodneva Y; Richman J; Tucker JA; Safford MM; Jones B et al. Trajectories of drug use and mortality outcomes among adults followed over 18 years. Journal of General Internal Medicine 27(7): 808-816, 2012. (41 refs.)

For adults in general population community settings, data regarding long-term course and outcomes of illicit drug use are sparse, limiting the formulation of evidence-based recommendations for drug use screening of adults in primary care. To describe trajectories of three illicit drugs (cocaine, opioids, amphetamines) among adults in community settings, and to assess their relation to all-cause mortality. Longitudinal cohort, 1987/88 - 2005/06. Community-based recruitment from four cities (Birmingham, Chicago, Oakland, Minneapolis). Healthy adults, balanced for race (black and white) and gender were assessed for drug use from 1987/88-2005/06, and for mortality through 12/31/2008 (n = 4301) Use of cocaine, amphetamines, and opioids (last 30 days) was queried in the following years: 1987/88, 1990/91, 1992/93, 1995/96, 2000/01, 2005/06. Survey-based assessment of demographics and psychosocial characteristics. Mortality over 18 years. Trajectory analysis identified four groups: Nonusers (n = 3691, 85.8%), Early Occasional Users (n = 340, 7.9%), Persistent Occasional Users (n = 160, 3.7%), and Early Frequent/Later Occasional Users (n = 110, 2.6%). Trajectories conformed to expected patterns regarding demographics, other substance use, family background and education. Adjusting for demographics, baseline health status, health behaviors (alcohol, tobacco), and psychosocial characteristics, Early Frequent/Later Occasional Users had greater all-cause mortality (Hazard Ratio, HR = 4.94, 95% CI = 1.58-15.51, p = 0.006). Study is restricted to three common drugs, and trajectory analyses represent statistical approximations rather than identifiable "types". Causal inferences are tentative. Four trajectories describe illicit drug use from young adulthood to middle age. Two trajectories, representing over one third of adult users, continued use into middle age. These persons were more likely to continue harmful risk behaviors such as smoking, and more likely to die.

Copyright 2012, Springer


Kessler FHP; Terra MB; Faller S; Stolf AR; Peuker AC; Benzano D et al. Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. American Journal on Addictions 21(4): 370-380, 2012. (60 refs.)

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 +/- 8.1 and 32.9 +/- 8.8 vs. 42.4 +/- 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Copyright 2012, Wiley-Blackwell


Kinner SA; Milloy MJ; Wood E; Qi JZ; Zhang R; Kerr T. Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users. Addictive Behaviors 37(6): 691-696, 2012. (55 refs.)

Background: Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration. Methods: Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months. Results: One third of participants (n = 829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently. Conclusions: Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.

Copyright 2012, Elsevier Science


Kreiner ER. Whose applicable guideline range is it anyway? Examining whether nominal career offenders can receive sentence modifications based on retroactive reductions in the crack cocaine guidelines. Columbia Law Review 112(4): 870-911, 2012. (6 refs.)

The recent reductions in the guideline range for federal crack cocaine offenses have spurred tens of thousands of motions for sentence modifications under 18 U.S.C. 3582(c)(2) by individuals sentenced pursuant to the old, harsher crack cocaine guidelines. This deluge of 3582(c)(2) motions has forced courts to grapple with difficult eligibility questions far many defendants whose sentences were impacted by the old crack cocaine guidelines. These eligibility questions revolve around the requirement that amendments to the United States Sentencing Guidelines ("Guidelines") reduce a defendant's "applicable guideline range" in order to qualify for a retroactive sentence modification. This Note examines a circuit split regarding the eligibility for 3582(c)(2) sentence modifications of "nominal career offenders"-defendants who were subject to the increased penalties of the Guidelines' career offender provision, but received sentences within the crack cocaine guideline range because career offender status significantly overstated the seriousness of their criminal history. After examining this complex circuit split, this Note argues that nominal career offenders are not eligible for 3582(c)(2) sentence modifications because their applicable guideline range is the career of range, not the crack cocaine range.

Copyright 2012, Columbia Journal Transnational Law Association


Lai H; Fishman EK; Gerstenblith G; Brinker JA; Tong WJ; Bhatia S et al. Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users. International Journal of Cardiology 158(2): 211-216, 2012. (51 refs.)

Background: Chronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported. Methods: Between August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54 years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (>= 50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed. Results: Significant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle-high risk Framingham score, respectively. In thosewith low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D<10 ng/mL (p = 0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR = 2.18, 95% CI: 1.07-4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors. Conclusions: The study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.

Copyright 2012, Elsevier Science


Large MM; Smith G; Sara G; Paton MB; Kedzior KK; Nielssen OB. Meta-analysis of self-reported substance use compared with laboratory substance assay in general adult mental health settings. International Journal of Methods in Psychiatric Research 21(2): 134-148, 2012. (56 refs.)

An accurate assessment of substance use is necessary to make a correct psychiatric diagnosis and to provide appropriate treatment. This study uses meta-analysis to establish the strength of the association between self-reported substance use and the results of laboratory substance assay including the testing for specific substances and screening for any substance use in psychiatric hospitals and in community mental health settings. A systematic search for published studies was supplemented by additional data required for meta-analysis provided by several researchers in this field. Using random-effects meta-analysis, we calculated the pooled estimate of the odds ratio of a positive substance assay in patients reporting use or non-use of substances and estimated the sensitivity, specificity, positive predictive value and negative predictive value. Twenty-six studies met the inclusion criteria. Very strong associations were found between self-reported use and positive tests for cannabis [N = 11 studies, odds ratio (OR) = 22.3; 95% confidence interval (CI) = 10.149.1], amphetamines (N = 8, OR = 26.6; 95% CI = 7.988.9), cocaine (N = 8, OR = 39.7; 95% CI = 16.297.2) and opiates (N = 7, OR = 83.5; 95% CI = 26.7260.7). Strong associations were found between self-reported use of any substance and positive substance screening (N = 15, OR = 7.2, 95% CI = 3.614.1) and tests for alcohol use (N = 5, OR = 8.5; 95% CI = 2.528.4). Screening for any substance use had a sensitivity of 61% and a specificity of 66%. Testing for individual substances was specific but lacked sensitivity. Screening has the potential to detect clinically relevant substances that would not be reported by the patient, whereas testing for a specific substance has little advantage over self-report. The sensitivity of the substance assay might be improved by obtaining a sample at the earliest opportunity. Consideration should be given to the increased use of substance screening in general adult mental health settings because it could improve the accuracy of psychiatric diagnosis and increase the likelihood of patients receiving treatment for substance use disorders.

Copyright 2012, Wiley-Blackwell


Lee KC; Ladizinski B; Federman DG. Complications associated with use of levamisole-contaminated cocaine: An emerging public health challenge. (review). Mayo Clinic Proceedings 87(6): 581-586, 2012. (46 refs.)

Levamisole is an immunomodulatory agent that was used to treat various cancers before being withdrawn from the United States market in 2000 because of adverse effects. Levamisole is currently approved as an antihelminthic agent in veterinary medicine, but is also being used illicitly as a cocaine adulterant. Potential complications associated with use of levamisole-laced cocaine include neutropenia, agranulocytosis, arthralgias, retiform purpura, and skin necrosis. Treatment is primarily supportive, and skin lesions typically resolve with cessation of cocaine use. The incidence of hospitalizations related to use of levamisole-contaminated cocaine continues to increase and clinicians should be aware of the more common clinical manifestations.

Copyright 2012, Mayo Foundation for Medical Education and Research


Lendoiro E; Quintela O; de Castro A; Cruz A; Lopez-Rivadulla M; Concheiro M. Target screening and confirmation of 35 licit and illicit drugs and metabolites in hair by LC-MSMS. Forensic Science International 217(1-3): 207-215, 2012. (22 refs.)

A liquid chromatography-tandem mass spectrometry (LC-MSMS) target screening in 50 mg hair was developed and fully validated for 35 analytes (Delta 9-tetrahidrocannabinol (THC), morphine, 6-acetylmorphine, codeine, methadone, fentanyl, amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine, benzoylecgonine, cocaine, lysergic acid diethylamide, ketamine, scopolamine, alprazolam, bromazepam, clonazepam, diazepam, flunitrazepam, 7-aminoflunitrazepam, lorazepam, lormetazepam, nordiazepam, oxazepam, tetrazepam, triazolam, zolpidem, zopiclone, amitriptyline, citalopram, clomipramine, fluoxetine, paroxetine and venlafaxine). Hair decontamination was performed with dichloromethane, and incubation in 2 mL of acetonitrile at 50 degrees C overnight. Extraction procedure was performed in 2 steps, first liquid-liquid extraction, hexane: ethyl acetate (55: 45, v: v) at pH 9, followed by solid-phase extraction (Strata-X cartridges). Chromatographic separation was performed in AtlantisT3 (2.1 mm x 100 mm, 3 mu m) column, acetonitrile and ammonium formate pH 3 as mobile phase, and 32 min total run time. One transition per analyte was monitored in MRM mode. To confirm a positive result, a second injection monitoring 2 transitions was performed. The method was specific (no endogenous interferences, n = 9); LOD was 0.2-50 pg/mg and LOQ 0.5-100 pg/mg; linearity ranged from 0.5-100 to 2000-20,000 pg/mg; imprecision <15%; analytical recovery 85-115%; extraction efficiency 4.1-85.6%; and process efficiency 2.5-207.7%; 27 analytes showed ion suppression (up to -86.2%), 4 ion enhancement (up to 647.1%), and 4 no matrix effect; compounds showed good stability 24-48 h in autosampler. The method was applied to 17 forensic cases. In conclusion, a sensitive and specific target screening of 35 analytes in 50 mg hair, including drugs of abuse (THC, cocaine, opiates, amphetamines) and medicines (benzodiazepines, antidepressants) was developed and validated, achieving lower cut-offs than Society of Hair Testing recommendations.

Copyright 2012, Elsevier Science


Levine TP; Lester B; Lagasse L; Shankaran S; Bada HS; Bauer CR et al. Psychopathology and special education enrollment in children with prenatal cocaine exposure. Journal of Developmental And Behavioral Pediatrics 33(5): 377-386, 2012. (61 refs.)

Objective: This study evaluated how enrollment in special education services in 11-year-old children relates to prenatal cocaine exposure (PCE), psychopathology, and other risk factors. Methods: Participants were 498 children enrolled in The Maternal Lifestyle Study, a prospective, longitudinal, multisite study examining outcomes of children with PCE. Logistic regression was used to examine the effect of PCE and psychopathology on enrollment in an individualized education plan (IEP; a designation specific to children with special education needs), with environmental, maternal, and infant medical variables as covariates. Results: PCE, an interaction of PCE and oppositional defiant disorder, child attention-deficit hyperactivity disorder, parent-reported internalizing behaviors, and teacher-reported externalizing behaviors, predicted enrollment in an IEP. Other statistically significant variables in the model were male gender, low birth weight, being small for gestational age, white race, caregiver change, low socioeconomic status, low child intelligence quotient, caregiver depression, and prenatal marijuana exposure. Conclusions: PCE increased the likelihood of receiving an IEP with adjustment for covariates. Psychopathology also predicted this special education outcome, in combination with and independent of prenatal cocaine exposure.

Copyright 2012, Lippincott, Williams & Wilkins


Li ZH; Liu YF; Li KN; DuanMu HZ; Chang ZQ; Li ZQ et al. Analysis of functional and pathway association of differential co-expressed genes: A case study in drug addiction. Journal of Biomedical Informatics 45(1): 30-36, 2012. (28 refs.)

Drug addiction has been considered as a kind of chronic relapsing brain disease influenced by both genetic and environmental factors. At present, many causative genes and pathways related to diverse kinds of drug addiction have been discovered, while less attention has been paid to common mechanisms shared by different drugs underlying addiction. By applying a co-expression meta-analysis method to mRNA expression profiles of alcohol, cocaine, heroin addicted and normal samples, we identified significant gene co-expression pairs. As co-expression networks of drug group and control group constructed, associated function term pairs and pathway pairs reflected by co-expression pattern changes were discovered by integrating functional and pathway information respectively. The results indicated that respiratory electron transport chain, synaptic transmission, mitochondrial electron transport, signal transduction, locomotory behavior, response to amphetamine, negative regulation of cell migration, glucose regulation of insulin secretion, signaling by NGF, diabetes pathways, integration of energy metabolism, dopamine receptors may play an important role in drug addiction. In addition, the results can provide theory support for studies of addiction mechanisms.

Copyright 2012, Elsevier Science


Lindsey WT; Stewart D; Childress D. Drug interactions between common illicit drugs and prescription therapies. American Journal of Drug and Alcohol Abuse 38(4): 334-343, 2012. (51 refs.)

Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Copyright 2012, Informa Healthcare


Liu SJ; Lane SD; Schmitz JM; Green CE; Cunningham KA; Moeller FG. Increased intra-individual reaction time variability in cocaine-dependent subjects: Role of cocaine-related cues. Addictive Behaviors 37(2): 193-197, 2012. (38 refs.)

Neuroimaging data suggest that impaired performance on response inhibition and information processing tests in cocaine-dependent subjects is related to prefrontal and frontal cortical dysfunction and that dysfunction in these brain areas may underlie some aspects of cocaine addiction. In subjects with attention-deficit hyperactivity disorder and other psychiatric disorders, the Intra-individual Reaction Time Variability (IIRTV) has been associated with frontal cortical dysfunction. In the present study, we evaluated IIRTV parameters in cocaine-dependent subjects vs. controls using a cocaine Stroop task. Fifty control and 123 cocaine-dependent subjects compiled from three studies completed a cocaine Stroop task Standard deviation (SD) and coefficient of variation (CV) for reaction times (RT) were calculated for both trials with neutral and trials with cocaine-related words. The parameters mu, sigma, and tau were calculated using an ex-Gaussian analysis employed to characterize variability in RTs. The ex-Gaussian analysis divides the RTs into normal (mu, sigma) and exponential (tau) components. Using robust regression analysis, cocaine-dependent subjects showed greater SD, CV and Tau on trials with cocaine-related words compared to controls (p<0.05). However, in trials with neutral words, there was no evidence of group differences in any IIRTV parameters (p>0.05). The Wilcoxon matched-pairs signed-rank test showed that for cocaine-dependent subjects, both SD and tau were larger in trials with cocaine-related words than in trials with neutral words (p<0.05). The observation that only cocaine-related words increased IIRTV in cocaine-dependent subjects suggests that cocaine-related stimuli might disrupt information processing sub-served by prefrontal and frontal cortical circuits.

Copyright 2012, Elsevier Science


Lurie Y; Gopher A; Lavon O; Almog S; Sulimani L; Bentur Y. Severe paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) outbreak in Israel. Clinical Toxicology 50(1): 39-43, 2012. (21 refs.)

Context. Paramethoxymethamphetamine (PMMA) is a hallucinogenic synthetic substituted amphetamine that was not included in the Israeli Controlled Substance Act (CSA). Objective. To report a severe PMMA and paramethoxyamphetamine (PMA) outbreak. Patients and methods. The Israeli national forensic toxicology laboratory analyzes the body fluids of unnatural deaths by means of screening immunoassays and chromatographic confirmation and quantification. Samples are referred to this laboratory by the Israeli Forensic Medicine Institute and by hospitals following consultation with the Israel Poison Information Center. The forensic toxicology laboratory began determining PMMA and PMA in February 2007. In all fatal cases with a positive immunoassay screen for amphetamines, a chromatographic analysis of PMA and PMMA was performed. The laboratory and demographic data of consecutive patients in whom PMMA or PMA were detected, were collected during 1 year and subjected to descriptive analysis. Results. Of 108 fatal cases with a positive screen for amphetamines, 32 were confirmed. Twenty-four of the 32 cases tested positive for PMMA and PMA -age 27 +/- 5 years, 79.2% males, post mortem whole blood PMMA and PMA concentrations 0.35 +/- 0.24 and 2.72 +/- 1.67 mcg/mL, respectively. Co-exposures were detected in 17 (70.8%) fatalities; including methylenedioxymethamphetamine, methylenedioxyamphetamine, cocaine, cannabinoids, cathinone derivatives, ephedrine/pseudoephedrine, opiates, and ethanol. In addition, five non-fatal male cases were identified; age 32 +/- 5 years, four had co-exposures to cocaine, cathinone derivatives, and cannabinoids. These findings led to the inclusion of PMMA in the CSA in July 2007, resulting in only three more fatalities in the following year. Discussion. We report an outbreak of PMMA and PMA poisoning resulting in 24 fatalities, and the post mortem whole blood and urine concentrations of these two compounds. PMA was probably the result of PMMA metabolism. Stimulant co-exposures may have contributed to the severity of the poisoning. Conclusion. Forensic laboratory and poison center co-operation is important in identifying a new drug of abuse.

Copyright 2012, Informa Healthcare


Mackowick KM; Heishman SJ; Wehring HJ; Liu F; McMahon RP; Kelly DL. Illicit drug use in heavy smokers with and without schizophrenia. Schizophrenia Research 139(1-3): 194-200, 2012. (75 refs.)

Objective: The prevalence of cigarette smoking among people with schizophrenia is greater than that of the general population. Because smoking and use of other drugs co-vary, we examined illicit drug use in current smokers not trying to quit or reduce their tobacco use. We recruited outpatient participants who had a DSM-IV diagnosis of schizophrenia or schizoaffective disorder (schizophrenia, n=70) and a control group who had no Axis I psychiatric disorders (control, n=97). During a 2-3-hour session, participants completed demographic and research questionnaires, including the Drug Use Survey (DUS). Results: Participants with schizophrenia were older than controls (p<0.001) and smoked more cigarettes per day (p=0.01), but did not differ in degree of nicotine dependence. Ever using a drug was similar between the groups, except that significantly more participants with schizophrenia reported ever using hallucinogens (p<0.001) and inhalants (p=0.001). For alcohol, cocaine, and marijuana, fewer participants with schizophrenia were current users, but more participants with schizophrenia were past users (ps<0.0001). Heavy smokers from the general population continued to use illicit drugs throughout their lives, while schizophrenia participants had the highest period of illicit drug use in their 20s. Conclusions: These data suggest that illicit drug use tends to be high in heavy cigarette smokers, regardless of a schizophrenia diagnosis. However, while illicit drug use is high across the lifespan of heavy smokers in the general population, heavy smokers with schizophrenia use illicit drugs mostly in the first decade of their illness.

Copyright 2012, Elsevier Science


Mansoor E; Morrow CE; Accornero VH; Xue LH; Johnson AL; Anthony JC et al. Longitudinal effects of prenatal cocaine use on mother-child interactions at ages 3 and 5 years. Journal of Developmental and Behavioral Pediatrics 33(1): 32-41, 2012. (29 refs.)

Objective: To assess the effect of maternal prenatal and past-year cocaine use on mother-child interactions across preschool years. Methods: The sample is drawn from the Miami Prenatal Cocaine Study, a longitudinal follow-up of prenatal cocaine exposure (PCE) in a large cohort of African-American infants prospectively enrolled at birth. Analyses are based on the 366 children (168 PCE and 198 non-cocaine-exposed) in the care of their biological mothers and with completed mother-child interaction measures at the 3- and/or 5-year assessments. Videotaped interactions were coded using a modified Egeland Teaching Task scheme. Generalized linear models with a generalized estimating equations approach were used to evaluate the effect of PCE on the overall quality of maternal-child interaction, measured by the Egeland total score at both study visits, and on the individual Egeland subscales at the 5-year visit, while adjusting for other suspected influences on interactions. Results: PCE dyads demonstrated less optimal overall mother-child interactions compared with non-cocaine-exposed dyads. The estimated PCE-associated difference did not shift appreciably with statistical adjustment for child sex, child age at examination, or other birth covariates. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared with children with neither exposure. In subscale analyses, PCE was most strongly associated with greater maternal intrusiveness and boundary dissolution at the 5-year visit. Conclusions: Prenatal and past-year maternal cocaine use seems to be associated with poorer quality in mother-child interaction during early childhood. These dynamics should be considered when examining the association between PCE and child cognitive, behavioral, and academic outcomes.

Copyright 2012, Lippincott, Williams & Wilkins


Mariani JJ; Levin FR. Psychostimulant treatment of cocaine dependence. Psychiatric Clinics of North America 35(2): 425+, 2012. (67 refs.)

Substitution pharmacotherapy is an effective approach for treating opioid and nicotine dependence, and accumulating evidence indicates that stimulant pharmacotherapy for cocaine dependence is a promising strategy. To date, the available evidence is strongest for amphetamine analogs or dopaminergic agents combined with contingency management behavioral interventions as potential psychostimulant treatments for cocaine dependence. Most psychostimulants are controlled substances with inherent risks of misuse and diversion, and their use in patients with active substance use disorders is complex. As stimulant substitution treatment models for cocaine dependence are developed, particular attention to patient risk stratification is needed.

Copyright 2012, Elsevier Science


Marshall BDL; Milloy MJ; Wood E; Galea S; Kerr T. Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada. Annals of Epidemiology 22(3): 198-206, 2012. (64 refs.)

PURPOSE: Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. METHODS: We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and noncocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. RESULTS: During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. CONCLUSIONS: Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.

Copyright 2012, Elsevier Science


Maxwell JC. Drunk versus drugged: How different are the drivers? Drug and Alcohol Dependence 121(1-2): 68-72, 2012. (33 refs.)

Background: Driving under the influence (DUI) of drugs is increasing in the U.S., but little is known about the differences based on their patterns of use and abuse of alcohol and other drugs. Methods: This paper uses a large dataset to study patients admitted to Texas substance abuse treatment programs with one or more past-year DUI arrests. t-Tests are used for comparisons between normally distributed continuous data and chi square for categorical data. Results: First-time DUI offenders not only differ from those reporting more than one past-year DUI, but they differ among themselves in terms of demographics, treatment participation, substance use problems, and mental health disorders. Those with primary problems with methamphetamine, crack cocaine, powder cocaine, other opiates, sedatives, and heroin reported more days of problems and more daily use than those with problems with alcohol, while offenders with primary problems with cannabis were less impaired. Conclusions: The most impaired clients were less likely to be referred to treatment from the justice system, and the differences in drug and alcohol offenders show the need to tailor approaches with education and treatment programs. More attention should be given to the needs of drivers impaired through use of prescription drugs such as the opiates and sedatives, as well as female drivers, and the role of acculturation should be recognized in programs for Hispanic drivers. In addition, specific programs should be targeted to young cannabis abusers and underage offenders. All first-time DUI arrestees should be assessed for their levels of impairment.

Copyright 2012, Elsevier Science


Mbah AK; Alio AP; Fombo DW; Bruder K; Dagne G; Salihu HM. Association between cocaine abuse in pregnancy and placenta-associated syndromes using propensity score matching approach. Early Human Development 88(6): 333-337, 2012. (27 refs.)

Aims: We used propensity scores matching techniques to assess the association between maternal cocaine abuse in pregnancy and the occurrence of placenta-associated syndromes (PAS). Study design: Mothers who abused cocaine (n = 5026) were matched to controls (n = 5026) from a sample of 1,693,197, unexposed mothers in Florida from 1998 to 2007. Cocaine abuse was identified using the ICD-9 principal and secondary diagnosis codes (304.2 for cocaine dependence and 305.6 for cocaine abuse). The outcome of interest, PAS, was identified as any indication in diagnosis field of ICD-9-CM codes for: placental abruption (641.2), oligohydramnios (658.0), placental infarction (656.7, 656.8, 656.9). gestational hypertension (642.3, 642.9), preeclampsia (642.4, 642.5, and 642.7) or eclampsia (642.6). Results: Nearly 6% of mothers in the study sample experienced a condition associated with PAS prior to matching. Women who abused cocaine were 58% more likely to have PAS when compared to women who did not (OR = 1.48, 95% confidence interval: 1.33, 1.66). Women who abused cocaine were at elevated odds for placental abruption, placenta infarction and preeclampsia with the most pronounced odds noted for placental abruption (OR = 2.79, 95% confidence interval: 2.19. 3.55). Conclusions: These findings indicate that cocaine abuse during pregnancy is associated with more placenta-related disorders than previously reported.

Copyright 2012, Elsevier Science


Mieczkowski T; Kruger M. The informational yield of paired samples from a large sample: Hair analysis and urinalysis for cocaine and cannabinoids. Journal of Addictions Nursing 23(1): 30-39, 2012. (8 refs.)

In a variety of decision settings when categorical information is the data in hand, the correspondence between an indicator test and a true condition (i.e., an accepted "gold standard") is often assessed by the use of comparison or "truth" tables. The results from such a table can be considered an informational yield and allow a practitioner to assess the utility of the indicator test in various ways, such as specificity and sensitivity, false positive and negative rates, and the positive and negative predictive values. There are many reasons for the use of an indicator test. This article proposes a novel application of an informational measure in determining the utility of hair and urine specimens for clinical decision making. It does this for two commonly abused substances, cocaine and cannabinoids. It suggests that in clinical applications the ability to assess informational yield is an important factor in developing clinical strategies for treatment of addictive disorders.

Copyright 2012, Informa Healthcare


Moeller FG. Sex, stress, and drug cues in addiction. (editorial). American Journal of Psychiatry 169(4): 351-353, 2012. (14 refs.)


Montgomery BEE; Stewart KE; Wright PB; McSweeney J; Booth BM. "We as drug addicts need that program": Insight from rural African American cocaine users on designing a sexual risk reduction intervention for their community. Substance Use & Misuse 47(1): 44-55, 2012. (38 refs.)

This focused ethnographic study examines data collected in 2007 from four gender- and age-specific focus groups (FGs) (N = 31) to inform the development of a sexual risk reduction intervention for African American cocaine users in rural Arkansas. A semi-structured protocol was used to guide audio-recorded FGs. Data were entered into Ethnograph and analyzed using constant comparison and content analysis. Four codes with accompanying factors emerged from the data and revealed recommendations for sexual risk reduction interventions with similar populations. Intervention design implications and challenges, study limitations, and future research are discussed.

Copyright 2012, Informa Healthcare


Moore RA; Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? International Journal of Environmental Research and Public Health 9(1): 192-211, 2012. (48 refs.)

There is an implied assumption that addictions to different substances vary in strength from weak (easier to stop) to strong (harder to stop), though explicit definitions are lacking. Our hypothesis is that the strength of addictions can be measured by cessation rates found with placebo or no treatment controls, and that a weaker addiction would have a higher cessation rate than a stronger addiction. We report an overview of systematic reviews and meta-analyses of cessation trials, using randomised or quasi-randomised trials and reporting objectively-measured abstinence. The outcome for comparison was quit rates-typically the percentage of participants abstinent according to an objective test of abstinence at six months or longer. Twenty-eight cessation reviews (139,000 participants) were found. Most data came from reviews of smoking cessation in over 127,000 participants, and other reviews each covered a few thousand participants. Few reviews used data from studies shorter than three months, and almost all determined abstinence using objective measures. Cessation rates with placebo in randomised trials using objective measures of abstinence and typically over six months duration were 8% for nicotine, 18% for alcohol, 47% for cocaine, and 44% for opioids. Evidence from placebo cessation rates indicates that nicotine is more difficult to give up than alcohol, cocaine, and opioids. Tobacco is also a severe addiction, with a number of major deleterious health effects in a large number of people.

Copyright 2012, MDPI AG


Morris GW; Mason BC; Sprunger RH; Harris HH; White LA; Patterson DA. Levamisole-adulterated cocaine: A case series. Journal of the American Board of Family Medicine 25(4): 531-535, 2012. (16 refs.)

The percentage of cocaine adulterated with levamisole is steadily increasing in the United States. In susceptible persons, this combination of drugs leads to a clinical syndrome that can include leukopenia and cutaneous manifestations. Many patients also demonstrate positive autoimmune markers. Biopsies of skin lesions often reveal a thrombotic pattern, leukocytoclastic vasculitis, or both. We report 2 cases of this clinical phenomenon, one of which was severe enough to require skin grafting. It is important for clinicians be aware of this emerging public health threat.

Copyright 2012, American Board of Family Medicine


Mugele J; Nanagas KA; Tormoehlen LM. Serotonin syndrome associated with MDPV use: A case report. Annals of Emergency Medicine 60(1): 100-102, 2012. (15 refs.)

Serotonin syndrome is associated with use of certain street drugs, including methamphetamine, cocaine, and ecstasy. We describe a case of a woman who developed clinical findings consistent with serotonin syndrome after insufflation of 3,4-methylenedioxypyrovalerone (MDPV), a synthetic amphetamine. MDPV belongs to a group of substances called phenylethylamines, which are beta-ketone analogs of other drugs of abuse, such as amphetamines and 3,4-methylenedioxymethamphetamine. She also received fentanyl initially during her hospitalization, which has also been associated with serotonin syndrome. In addition to benzodiazepines and supportive care, she was treated with cyproheptadine for 8 days, with slow resolution of her symptoms.

Copyright 2012, Elsevier Science


Murthy P; Chand P. Treatment of dual diagnosis disorders. (review). Current Opinion in Psychiatry 25(3): 194-200, 2012. (46 refs.)

Purpose of review: Treatment of dual diagnosis [co-occurrence of a substance use disorder (SUD) in patients with mental illness] poses several challenges for mental health professionals. This article seeks to review the recent advances in dual diagnosis treatment with respect to pharmacotherapy and psychosocial approaches. Recent findings: Atypical antipsychotics are commonly used for comorbid schizophrenia and SUD. Whereas there is no difference between risperidone and olanzapine, clozapine appears to have a distinct advantage in reducing psychotic symptoms as well as substance abuse (including smoking). There is emerging evidence that quetiapine is beneficial in dually diagnosed patients, particularly using alcohol, cocaine and amphetamine. A combination of naltrexone and sertraline was found to be effective in patients with depressive disorder and alcohol dependence. Effectiveness of atomoxetine is yet to be established in patients with comorbid adult attention-deficit/hyperactivity disorder with respect to decrease in substance abuse. Integrated intervention is the choice of treatment for patients with dual diagnosis. Summary: In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.

Copyright 2012, Lippincott, Williams & Wilkins


Musshoff F; Kirschbaum KM; Graumann K; Herzfeld C; Sachs H; Madea B. Evaluation of two immunoassay procedures for drug testing in hair samples. Forensic Science International 215(1-3): 60-63, 2012. (20 refs.)

A preliminary initial enzyme-linked immunosorbent assay (LUCIO (R)-Direct ELISA kit) and a preliminary DRI (R) enzyme immunoassay were evaluated for drug detection in head hair with respect to lowered cutoff values recommended in Germany for the control of abstinence in cases of re-granting of drivers' licences. Following drug classes were included: cannabinoids, opiates, cocaine like substances, amphetamine, methamphetamine (and methylenedioxyamphetamines), methadone, and benzodiazepines. 759 analyses were performed using LUCIO (R)-Direct ELISA kits and 936 analyses using DRI (R) enzyme immunoassay tests. Sample size for each drug group and immunoassay test reached from 74 to 178. The LUCIO (R)-Direct ELISA kit revealed a sensitivity of 91% for amphetamine up to 98% for methadone (methamphetamine 92%, cocaine 94%, opiates 94%, benzodiazepines 96%) and values of specificity of 72% for methadone up to 89% for amphetamine and benzodiazepines. The test was not useful for a preliminary screening for tetrahydrocannabinol (sensitivity of 65%) in consideration of a suggested cutoff of 0.02 ng/mg. The DRI (R) enzyme immunoassay test was only useful for morphine and cocaine testing at low recommended new cutoff values (0.1 ng/mg) revealing sensitivities of 94% and 99%, respectively.

Copyright 2012, Elsevier Science


Narendran R; Lopresti BJ; Martinez D; Mason NS; Nimes M; May MA et al. In vivo evidence for low striatal vesicular monoamine transporter 2 (VMAT2) availability in cocaine abusers. American Journal of Psychiatry 169(1): 55-63, 2012. (39 refs.)

Objective: Positron emission tomography (PET) imaging studies in cocaine abusers have shown that low dopamine release in the striatum following an amphetamine challenge is associated with higher relapse rates. One possible mechanism that might lead to lower amphetamine-induced dopamine release is low availability of dopamine storage vesicles in the presynaptic terminals for release. Consistent with this hypothesis, postmortem studies have shown low levels of vesicular monoamine transporter, type 2 (VMAT2), the membrane protein that regulates the size of the vesicular dopamine pool, in cocaine abusers relative to healthy subjects. To confirm the postmortem findings, the authors used PET and the VMAT2 radioligand [(11)C]-(+)-dihydrotetrabenazine (DTBZ) to assess the in vivo VMAT2 availability in a group of 12 recently abstinent cocaine-dependent subjects and matched healthy comparison subjects. Method: [(11)C]DTBZ nondisplaceable binding potential (BP(ND)) was measured by kinetic analysis using the arterial input function or, if arterial input was unavailable, by the simplified reference tissue method. Results: [(11)C]DTBZ BP(ND) was significantly lower in the cocaine abusers than in the comparison subjects in the limbic striatum (10.0% lower), associative striatum (-13.4%), and sensorimotor striatum (-11.5%). Conclusions: The results of this in vivo PET study confirm previous in vitro reports of low VMAT2 availability in the striatum of cocaine abusers. It also suggests a compensatory down-regulation of the dopamine storage vesicles in response to chronic cocaine abuse and/or a loss of dopaminergic terminals. Further research is necessary to understand the clinical relevance of this observation to relapse and outcome in abstinent cocaine abusers.

Copyright 2012, American Psychiatric Association


Narvaez JCM; Magalhaes PVS; Trindade EK; Vieira DC; Kauer-Sant'Anna M; Gama CS et al. Childhood trauma, impulsivity, and executive functioning in crack cocaine users. Comprehensive Psychiatry 53(3): 238-244, 2012. (61 refs.)

Background: The use of crack cocaine is a major public health concern in Brazil and internationally. Recent data suggest that childhood trauma is associated with worse outcomes among cocaine users. This study had the objective of evaluating the relationship of childhood trauma with executive functioning and impulsivity in outpatients with crack cocaine use disorders. Methods: This is a cross-sectional study of 84 consecutive outpatients with a primary crack cocaine use disorder who sought treatment in Porto Alegre, Brazil. Childhood trauma was evaluated with the Childhood Trauma Questionnaire; executive functioning, with the Wisconsin Card Sorting Test; and impulsivity, with the Barratt Impulsivity Scale. Results: Childhood trauma was strongly associated with executive dysfunction and impulsivity, even when controlled for possible confounders. Conclusions: Childhood trauma may be associated with executive dysfunction and impulsivity in crack cocaine users. The full impact of trauma needs to be further investigated in longitudinal studies.

Copyright 2012, WB Saunders


Nielsen DA; Ho A; Bahl A; Varma P; Kellogg S; Borg L et al. Former heroin addicts with or without a history of cocaine dependence are more impulsive than controls. Drug and Alcohol Dependence 124(1-2): 113-120, 2012. (57 refs.)

Background: Personality traits such as impulsivity and sensation seeking may contribute to the initiation and maintenance of illicit drug use. Since studies have reported higher impulsivity and sensation seeking traits in cocaine dependent subjects, we were interested in determining whether former heroin addicts in methadone pharmacotherapy with comorbid cocaine addiction have greater impulsivity than those without. Methods: Instruments to assess impulsivity (Barratt Impulsiveness Scale version 11) and sensation seeking (Sensation Seeking Scale version V) were administered to former severe heroin addicts meeting Federal criteria for methadone maintenance pharmacotherapy with (n = 71) or without cocaine dependence (n = 31) and to 145 normal healthy (non-methadone-maintained) volunteers. Results: The methadone-maintained without cocaine dependence and the methadone-maintained with cocaine dependence groups, both scored higher than did the normal volunteer group on the Barratt Impulsiveness Scale total score (p < 0.001). On the Barratt Impulsiveness Scale Attentional, Nonplanning, and Motor subscales, the methadone-maintained and methadone-maintained with cocaine dependence groups scored higher than did normal volunteers with no history of drug abuse or dependence (p < 0.001). There was no difference among groups on total score or any subscale of the Sensation Seeking Scale. However, males in all groups overall scored higher than did females on Disinhibition and Thrill and Adventure seeking subscales of the Sensation Seeking Scale version V (p < 0.001). Conclusions: This study demonstrates higher impulsivity in former severe heroin addicts meeting criteria for or currently in stable methadone maintenance pharmacotherapy, irrespective of a positive or negative history of cocaine dependence.

Copyright 2012, Elsevier Science


Nyamathi A; Hudson A; Greengold B; Leake B. Characteristics of homeless youth who use cocaine and methamphetamine. American Journal on Addictions 21(3): 243-249, 2012. (44 refs.)

This cross-sectional hepatitis health promotion study (N = 156) was designed to identify correlates of cocaine and methamphetamine use among young, homeless persons living in Los Angeles County. Structured questionnaires were administered at baseline to assess sociodemographic characteristics, drug history, and social support. Unadjusted analysis showed that older age, having a history of incarceration, injection drug use (IDU), 10 or more sexual partners, and sex for money were associated with both cocaine and methamphetamine use. Logistic regression results showed that injection drug users had over seven times greater odds of using each stimulant compared with nonusers of injection drugs; those reporting at least 10 sexual partners and alcohol use in the past 6 months were more likely to use cocaine than their respective counterparts. African Americans were also less likely than Whites to report cocaine use. Understanding of these relationships can guide interventions targeting the multiple challenges faced by this population.

Copyright 2012, Wiley-Blackwell


Nyamathi A; Marfisee M; Slagle A; Greengold B; Liu YH; Leake B. Correlates of depressive symptoms among homeless young adults. Western Journal of Nursing Research 34(1): 97-117, 2012. (64 refs.)

Adolescent homelessness has received increasing attention because of its fast growth throughout the United States and the poor mental outcomes experienced by homeless young people. This cross-sectional study (N = 156) identified correlates of depressive symptomatology among homeless young adults and investigated how depressive symptoms are influenced by the coping strategies these young adults use. The findings are based on analysis of baseline data collected for a hepatitis vaccination intervention pilot study conducted in partnership with a young adult's drop-in center in Santa Monica, California. Standardized tools assessed drug use history, coping ability, and psychiatric symptomatology. Linear regression modeling was used to identify correlates of depressive symptom severity. Poor perceived physical health, recent crack cocaine use, and recent use of tranquilizers were significantly associated with increased severity of depressive symptoms. Self-destructive escape, nondisclosure/avoidance, passive problem solving, and thoughts of harming self were also associated with increased severity of depressive symptoms.

Copyright 2012, Sage Publications


O'Brien MS; Comment LA; Liang KY; Anthony JC. Does cannabis onset trigger cocaine onset? A case-crossover approach. International Journal of Methods in Psychiatric Research 21(1): 66-75, 2012. (34 refs.)

Psychiatric researchers tend to select the discordant co-twin design when they seek to hold constant genetic influence while estimating exposure-associated disease risk. The epidemiologic case-crossover research design developed for the past two decades represents a viable alternative, not often seen in psychiatric studies. Here, we turn to the epidemiologic case-crossover approach to examine the idea that cannabis onset is a proximal trigger for cocaine use, with the power of subject-as-own-control research used to hold constant antecedent characteristics of the individual drug user, including genetic influence and other traits experienced up to the time of the observed hazard and control intervals. Data are from newly incident cocaine users identified in the 2002-2006 US National Surveys on Drug Use and Health. Among these cocaine users, 48 had both cannabis onset and cocaine onset in the same month-long hazard interval; the expected value is 30 users, based on the control interval we had pre-specified for case-crossover estimation (estimated relative risk, RR=1.6; exact mid-p=0.042). Within the framework of a subject-as-own-control design, the evidence is consistent with the hypothesis that cannabis onset is a proximal trigger for cocaine use, with genetic influences (and many environmental conditions and processes) held constant. Limitations are noted and implications are discussed.

Copyright 2012, Wiley-Blackwell


Oliveto A; Poling J; Mancino MJ; Williams DK; Thostenson J; Pruzinsky R et al. Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms. Addiction 107(1): 131-141, 2012. (97 refs.)

Aims: Whether the selective serotonin re-uptake inhibitor sertraline at 200 mg/day delays relapse in recently abstinent cocaine-dependent individuals. Design: The study involved a 12-week, double-blind, placebo-controlled clinical trial with 2-week residential stay followed by 10-week out-patient participation. Setting: Veterans Affairs residential unit and out-patient treatment research program. Participants: Cocaine-dependent volunteers (n = 86) with depressive symptoms (Hamilton score > 15), but otherwise no major psychiatric or medical disorder or contraindication to sertraline. Measurements: Participants were housed on a drug-free residential unit (weeks 1-2) and randomized to receive sertraline or placebo. Participants then participated on an out-patient basis during weeks 3-12 while continuing to receive study medication. Patients participated in a day substance abuse/ day treatment program during weeks 1-3 and underwent weekly cognitive behavioral therapy during weeks 4-12. The primary outcome measure was thrice-weekly urine results and the secondary measure was Hamilton Depression scores. Findings: Pre-hoc analyses were performed on those who participated beyond week 2. Generally, no group differences in retention or baseline characteristics occurred. Sertraline patients showed a trend towards longer time before their first cocaine-positive urine ('lapse', chi(2) = 3.67, P = 0.056), went significantly longer before having two consecutive urine samples positive for cocaine ('relapse', chi(2) = 4.03, P = 0.04) and showed significantly more days to lapse (26.1 +/- 16.7 versus 13.2 +/- 10.5; Z = 2.89, P = 0.004) and relapse (21.3 +/- 10.8 versus 32.3 +/- 14.9; Z = 2.25, P = 0.02). Depression scores decreased over time (F = 43.43, P < 0.0001), but did not differ between groups (F = 0.09, P = 0.77). Conclusions: Sertraline delays time to relapse relative to placebo in cocaine-dependent patients who initially achieve at least 2 weeks of abstinence.

Copyright 2012, Society for the Study of Addiction


Ortigosa S; Friguls B; Joya X; Martinez S; Marinoso ML; Alameda F et al. Feto-placental morphological effects of prenatal exposure to drugs of abuse. Reproductive Toxicology 34(1): 73-79, 2012. (63 refs.)

The aim of the study was to find morphological changes in the feto-placental unit due to prenatal exposure to drugs of abuse. A blind histomorphometric study was performed using 225 placentas. Based on meconium testing, the fetuses were classified as exposed or unexposed to opiates, cocaine, cannabis or alcohol. To establish prenatal tobacco exposure, cotinine in cord blood was analyzed. At the microscopic level a non statistically significant reduction of placental vascularization was observed in cocaine, opiates and alcohol using mothers. In addition, alcohol-consuming mothers did not present with larger placental vessel diameter than controls. Prenatal use of cocaine and tobacco was associated with a decrease in newborn weight and length. Furthermore, tobacco use was associated with a higher rate of previous abortions. In conclusion, placentas from mothers using tobacco, cocaine, opiates or alcohol during pregnancy present vasculature changes that may explain the adverse perinatal outcomes in their newborns.

Copyright 2012, Elsevier Science


Osborne V; Cottler LB. Subtypes of alcohol dependence and their effect on sexual behavior change. Substance Use & Misuse 47(3): 318-328, 2012. (53 refs.)

This study utilized data from a National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism funded community-based HIV prevention program in the Midwest in 2000. We categorized women who met lifetime criteria for alcohol dependence (using the DIS) and who also had used cocaine (n = 324) into four alcohol typologies based on onset of regular drinking and the length of time to dependence. The Risk Behavior Assessment measured sex behaviors, combined into a risk index, before and after the program. Generalized linear modeling compared decreases over time. Women who began drinking regularly later and became dependent more slowly significantly decreased risky sex behaviors. Tailored prevention protocols may more effectively decrease HIV risk.

Copyright 2012, Informa Healthcare


Parrott AC; Murphy P; Scholey AB. Applied human psychopharmacology: The practical psychobiological consequences of some novel and ancient psychoactive drugs. (editorial). Human Psychopharmacology: Clinical and Experimental 27(2): 103-105, 2012. (37 refs.)

This special applied issue of Human Psychopharmacology is based on two symposia from the 27th International Congress of Applied Psychology (ICAP). This was held at the International Congress Centre, Melbourne, Australia, on July 2010. The first of our two symposia was entitled �Psychoactive drugs, psychobiological health and wellbeing�. Here, the presenters covered the effects of a range of drugs, including cannabis, alcohol, nicotine, cocaine, ginseng and others. The second symposium was entitled �Ecstasy-MDMA: psychological and health related implications�; hence, the articles on Ecstasy/MDMA and related recreational stimulant drugs.

Copyright 2012, Wiley-Blackwell


Phan HM; Yoshizuka K; Murry DJ; Perry PJ. Drug testing in the workplace. (review). Pharmacotherapy 32(7): 649-656, 2012. (20 refs.)

Congress passed the Drug-Free Workplace Act in April 1988, which resulted in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. The intent was to establish a substance-free work environment for all federal workers by requiring that all federal employees pass a urine drug test before employment. These guidelines specifically, and exclusively, focus on testing urine specimens for metabolites of marijuana, cocaine, phencyclidine, opiates (focusing on heroin metabolites), and amphetamines (including Ecstasy). Since then, there have been many scientific, technical, and legal challenges to the validity of urine drug testing. In response, the Substance Abuse and Mental Health Services Administration, a division operating under the executive branch of the United States Department of Health and Human Services, put forth, through many revisions, strict procedural guidelines and specimen validity-testing criteria to manage suspicious or adulterated samples during and after urine collection. This review focuses on the legal ramifications, the procedural process, and the sensitivity and specificity of the two urine drug tests used for workplace drug testing: immunoassay and gas chromatographymass spectrometry. Moreover, we dissect the problematic issue of cross-sensitivity between illicit and prescription drugs, and how this affects the validity of future urine drug testing.

Copyright 2012, Wiley-Blackwell


Plebani JG; Lynch KG; Yu Q; Pettinati HM; O'Brien CP; Kampman KM. Results of an initial clinical trial of varenicline for the treatment of cocaine dependence. Drug and Alcohol Dependence 121(1-2): 163-166, 2012. (22 refs.)

Background: Cocaine use, abuse and dependence remains a pressing public health problem. Based on its mechanism of action, varenicline, an alpha4beta2 partial agonist seemed to be a likely candidate for treating cocaine dependence. Methods: Cocaine dependent participants (n=37) were enrolled in a 9-week double-blind placebo controlled clinical trial. Varenicline was titrated up to a target dose of 1 mg BID during the first week of medication. Results: Varenicline was associated with lower odds of cocaine use than placebo (OR=2.02, p=0.08), as measured by thrice-weekly urinalysis results. Compared to placebo-treated participants, varenicline treated participants had significantly decreased rates of cocaine reward, as measured by the Multiple Choice Procedure (MCP) (p=0.02). Conclusions: Varenicline appears to decrease cocaine use and reward, suggesting that further investigation of varenicline may be warranted.

Copyright 2012, Elsevier Science


Potenza MN; Hong KIA; Lacadie CM; Fulbright RK; Tuit KL; Sinha R. Neural correlates of stress-induced and cue-induced drug craving: Influences of sex and cocaine dependence. American Journal of Psychiatry 169(4): 406-414, 2012. (64 refs.)

Objective: Although stress and drug cue exposure each increase drug craving and contribute to relapse in cocaine dependence, no previous research has directly examined the neural correlates of stress-induced and drug cue-induced craving in cocaine-dependent women and men relative to comparison subjects. Method: Functional MRI was used to assess responses to individualized scripts for stress, drug/alcohol cue and neutral-relaxing-imagery conditions in 30 abstinent cocaine-dependent individuals (16 women, 14 men) and 36 healthy recreational-drinking comparison subjects (18 women, 18 men). Results: Significant three-way interactions between diagnostic group, sex, and script condition were observed in multiple brain regions including the striatum, insula, and anterior and posterior cingulate. Within women, group-by-condition interactions were observed involving these regions and were attributable to relatively increased regional activations in cocaine-dependent women during the stress and, to a lesser extent, neutral-relaxing conditions. Within men, group main effects were observed involving these same regions, with cocaine-dependent men demonstrating relatively increased activation across conditions, with the main contributions from the drug and neutral-relaxing conditions. In men and women, subjective drug-induced craving measures correlated positively with corticostriatal-limbic activations. Conclusions: In cocaine dependence, corticostriatal-limbic hyperactivity appears to be linked to stress cues in women, drug cues in men, and neutral-relaxing conditions in both. These findings suggest that sex should be taken into account in the selection of therapies in the treatment of addiction, particularly those targeting stress reduction.

Copyright 2012, American Psychiatric Association


Proctor SL; Kopak AM; Hoffmann NG. Compatibility of current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders. Addictive Behaviors 37(6): 722-728, 2012. (40 refs.)

Objectives: The present study examined the compatibility of the current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders (CUD) among state prison inmates, and evaluated the diagnostic utility of the proposed criteria in accounting for DSM-IV "diagnostic orphans" (i.e., individuals who meet one or two of the diagnostic criteria for substance dependence yet fail to report indications of substance abuse). Method: Data were derived from routine clinical assessments of adult male inmates (N=6871) recently admitted to the Minnesota Department of Corrections state prison system from 2000 to 2003. An automated (i.e., computer-prompted) version of the Substance Use Disorder Diagnostic Schedule-IV (SUDDS-IV; Hoffmann & Harrison, 1995) was administered to all inmates as part of routine assessments. DSM-IV and DSM-5 criteria were coded using proposed guidelines. Results: The past 12-month prevalence of DSM-IV CUDs was 12.7% (Abuse, 3.8%, Dependence, 8.9%), while 11.0% met past 12-month DSM-5 criteria for a CUD (Moderate IMCUD], 1.7%; Severe I SCUD], 9.3%). When DSM-5 criteria were applied, 11.8% of the DSM-IV diagnostic orphans received a MCUD diagnosis. The vast majority of those with no diagnosis (99.6%) continued to have no diagnosis, and a similar proportion who met dependence criteria (98.4%) met SCUD criteria of the proposed DSM-5. Most of the variation in diagnostic classifications was accounted for by those with a current abuse diagnosis. Conclusions: The proposed DSM-5 criteria perform similarly to DSM-IV criteria in terms of the observed past 12-month CUD prevalence and diagnostic classifications. The proposed criteria appear to account for diagnostic orphans that may warrant a diagnosis. DSM-IV abuse cases were most affected when DSM-5 criteria were applied. Additional criteria, beyond those included in the proposed DSM-5 changes, concerning use to relieve emotional stress and preoccupation with use were frequently endorsed by those with a proposed DSM-5 diagnosis.

Copyright 2012, Elsevier Science


Quesada O; Gotman N; Howell HB; Funai EF; Rounsaville BJ; Yonkers KA. Prenatal hazardous substance use and adverse birth outcomes. Journal of Maternal-Fetal & Neonatal Medicine 25(8): 1222-1227, 2012. (30 refs.)

Objective: Assess the relative effects of a variety of illicit and licit drugs on risk for adverse birth outcomes. Methods: We used data from two large prospective investigations, and a novel analytic method, recursive partitioning class analysis to identify risk factors associated with preterm birth and delivering a small for gestational age infant. Results: Compared to cocaine and opiate non-users, cocaine users were 3.53 times as likely (95% CI: 1.65-7.56; p = 0.001) and opiate users 2.86 times as likely (95% CI: 1.11-7.36; p = 0.03) to deliver preterm. The odds of delivering a small for gestational age infant for women who smoked more than two cigarettes daily was 3.74, (95% CI: 2.47-5.65; p < 0.0001) compared to women who smoked two or less cigarettes daily and had one previous child. Similarly, less educated, nulliparous women who smoked two or fewer cigarettes daily were 4.12 times as likely (95% CI: 2.04-8.34; p < 0.0001) to have a small for gestational age infant. Conclusions: Among our covariates, prenatal cocaine and opiate use are the predominant risk factors for preterm birth; while tobacco use was the primary risk factor predicting small for gestational age at delivery. Multi-substance use did not substantially increase risk of adverse birth outcomes over these risk factors.

Copyright 2012, Informa Healthcare


Ramakrishnan M; De Melo FA; Kinsey BM; Ladbury JE; Kosten TR; Orson FM. Probing cocaine-antibody interactions in buffer and human serum. PLoS ONE 7(7): article e40518, 2012. (28 refs.)

Background: Despite progress in cocaine immunotherapy, the kinetic and thermodynamic properties of antibodies which bind to cocaine and its metabolites are not well understood. It is also not clear how the interactions between them differ in a complex matrix such as the serum present in the human body. In the present study, we have used microscale thermophoresis (MST), isothermal titration calorimetry (ITC), and surface plasmon resonance (SPR) we have evaluated the affinity properties of a representative mouse monoclonal (mAb08) as well as those of polyclonal antibodies purified from vaccinated mouse and human patient serum. Results: MST analysis of fluorescently tagged mAb08 binding to cocaine reveals an approximately 15 fold decrease in its equilibrium dissociation constant in 20-50% human serum compared with that in saline buffer. A similar trend was also found using enriched polyclonal antibodies purified from vaccinated mice and patient serum, for which we have used fluorescently tagged bovine serum albumin conjugated to succinyl norcocaine (BSA-SNC). This conjugate closely mimics both cocaine and the hapten used to raise these antibodies. The ITC data also revealed that cocaine has a moderate affinity of about 2 mu M to 20% human serum and very little interaction with human serum albumin or nonspecific human IgG at that concentration range. In a SPR inhibition experiment, the binding of mAb08 to immobilized BSA-SNC was inhibited by cocaine and benzoylecgonine in a highly competitive manner, whereas the purified polyclonal antibodies from vaccinated humans and mice, revealed preferential selectivity to pharmacologically active cocaine but not to the inactive metabolite benzoylecgonine. We have also developed a simple binding model to simulate the challenges associated with cocaine immunotherapy using the variable quantitative and kinetic properties of the antibodies. Conclusions: High sensitivity calorimetric determination of antibody binding to cocaine and its metabolites provide valuable information for characterization of their interactions and thermodynamic properties. In addition MST measurements of antibody affinity in the presence of biological fluids will provide a better opportunity to make reliable decisions and facilitate the design of cocaine vaccines and immunization conditions. The methods should be more widely adopted in characterization of antibody complexes.

Copyright 2012, Public Library Science


Reback CJ; Peck JA; Fletcher JB; Nuno M; Dierst-Davies R. Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM. Journal of Psychoactive Drugs 44(2): 166-172, 2012. (36 refs.)

Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p<.05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p <=.05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p<.05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.

Copyright 2012, Haight-Ashbury Publishing


Rhodes SD; McCoy TP; Hergenrather KC; Vissman AT; Wolfson M; Alonzo J et al. Prevalence estimates of health risk behaviors of immigrant Latino men who have sex with men. Journal of Rural Health 28(1): 73-83, 2012. (66 refs.)

Purpose: Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain hidden from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina. Methods: A community-based participatory research (CBPR) partnership used respondent-driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer-administered behavioral assessment. RDS-weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008. Results: A total of 190 Latino MSM was reached; the average age was 25.5 years and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30-day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12-month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3-month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively. Conclusions: Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern United States, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM.

Copyright 2012, Wiley-Blackwell


Rosenberg H; Bonar EE; Pavlick M; Jones LD; Hoffmann E; Murray S et al. Associations between university students' reported reasons for abstinence from illicit substances and type of drug. Journal of College Student Development 53(1): 91-105, 2012. (35 refs.)

We recruited 211 undergraduates to rate the degree to which each of 34 listed reasons for not taking drugs had influenced their abstinence from MDMA/ecstasy, cocaine, marijuana, and hallucinogens. Participants rated reasons such as personal and family medical histories, religion, and physiological consequences of drug use as having little or no impact on abstention from all four substances. Consistent with previous research and developmental theory, concerns about drug-induced impairment and drug use being contrary to one's self-image reportedly inhibited students' consumption of notably different types of illicit substances.

Copyright 2012, Johns Hopkins University Press


Roy E; Arruda N; Vaillancourt E; Boivin JF; Morissette C; Leclerc P et al. Drug use patterns in the presence of crack in downtown Montreal. Drug and Alcohol Review 31(1): 72-80, 2012. (47 refs.)

Introduction and Aims. A study was undertaken to verify reports of an increasing presence of crack in downtown Montreal, and to investigate the influence of crack availability on current drug use patterns among street-based cocaine users. Design and Methods. The study combined both qualitative and quantitative methods. These included long-term intensive participant observation carried out by an ethnographer familiar with the field and a survey. The ethnographic component involved observations and unstructured interviews with 64 street-based cocaine users. Sampling was based on a combination of snowballing and purposeful recruitment methods. For the survey, structured interviews were conducted with a convenience sample of 387 cocaine users attending HIV/HCV prevention programs, downtown Montreal. Results. A gradual shift has occurred in the last 10 years, with the crack street market overtaking the powder cocaine street market. Although the data pointed to an increase in crack smoking, 54.5% of survey participants both smoked and injected cocaine. Drug market forces were major contributing factors to the observed modes of cocaine consumption. While the study focused primarily on cocaine users, it became apparent from the ethnographic fieldwork that prescription opioids (POs) were very present on the streets. According to the survey, 52.7% of participants consumed opioids, essentially POs, with 88% of them injecting these drugs. Discussion and Conclusions. Despite the increased availability of crack, injection is still present among cocaine users due at least in part to the concurrent increasing popularity of POs.

Copyright 2012, Wiley-Blackwell


Saha TD; Compton WM; Chou SP; Smith S; Ruan WJ; Huang B et al. Analyses related to the development of DSM-5 criteria for substance use related disorders 1. Toward amphetamine, cocaine and prescription drug use disorder continua using item response theory. Drug and Alcohol Dependence 122(1-2): 38-46, 2012. (40 refs.)

Background: Prior research has demonstrated the dimensionality of alcohol, nicotine and cannabis use disorders criteria. The purpose of this study was to examine the unidimensionality of DSM-IV cocaine, amphetamine and prescription drug abuse and dependence criteria and to determine the impact of elimination of the legal problems criterion on the information value of the aggregate criteria. Methods: Factor analyses and Item Response Theory (IRT) analyses were used to explore the unidimensionality and psychometric properties of the illicit drug use criteria using a large representative sample of the U.S. population. Results: All illicit drug abuse and dependence criteria formed unidimensional latent traits. For amphetamines, cocaine, sedatives, tranquilizers and opioids, IRT models fit better for models without legal problems criterion than models with legal problems criterion and there were no differences in the information value of the IRT models with and without the legal problems criterion, supporting the elimination of that criterion. Conclusion: Consistent with findings for alcohol, nicotine and cannabis, amphetamine, cocaine, sedative, tranquilizer and opioid abuse and dependence criteria reflect underlying unitary dimensions of severity. The legal problems criterion associated with each of these substance use disorders can be eliminated with no loss in informational value and an advantage of parsimony. Taken together, these findings support the changes to substance use disorder diagnoses recommended by the American Psychiatric Association's DSM-5 Substance and Related Disorders Workgroup.

Copyright 2012, Elsevier Science


Saha TD; Harford T; Goldstein RB; Kerridge BT; Hasin D. Relationship of substance abuse to dependence in the U.S. general population. Journal of Studies on Alcohol and Drugs 73(3): 368-378, 2012. (48 refs.)

Objective: The diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for substance abuse and dependence are commonly used in clinical work and research studies, but whether abuse and dependence represent two different syndromes has been debated. The purpose of this article is to investigate the relationship of substance abuse and dependence for cannabis, cocaine, stimulants and sedatives among lifetime users of these substances in the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey conducted in 2001-2002. Method: The multiple indicators multiple causes (MIMIC) model addresses three sets of relationships: those between (1) diagnostic criteria and latent factors, (2) latent factors and covariates, and (3) criteria and covariates. This approach allows for the detection of and compensation for noninvariance of the measurement of criteria across subgroups. Results: Compared with one-factor models, two-factor models (factors roughly corresponding to abuse and dependence) fit significantly better across all substances, with abuse and dependence factors highly correlated. The MIMIC model indicated that race/ethnicity, age, income, and marital status showed some differential relationships across substance groups, although most covariates showed similar associations to dependence and abuse factors. Noninvariance of criteria measurement by demographic covariates was most pronounced for cannabis abuse and dependence criteria. Conclusions: The general relationship of abuse to dependence was consistent across substances. Results were equivocal on the value of retaining separate factors; therefore, investigating the relationships of specific genetic variants and treatment outcomes to dimensional indicators of abuse, dependence, and measures combining these criteria is warranted. Measurement of cannabis abuse and dependence criteria appears most affected by demographic characteristics.

Copyright 2012, Alcohol Research Documentation


Sanchez-Hervas E; Gomez FJS; Villa RS; Garcia-Fernandez G; Garcia-Rodriguez O; Romaguera FZ. Psychosocial predictors of relapse in cocaine-dependent patients in treatment. Spanish Journal of Psychology 15(2): 748-755, 2012. (49 refs.)

Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment.

Copyright 2012, Universite Complutense Madrid


Santos S; Brugal MT; Barrio G; Castellano Y; Domingo-Salvany A; Espelt A et al. Assessing the effect of patterns of cocaine and alcohol use on the risk of adverse acute cocaine intoxication. Drug and Alcohol Review 31(4): 439-446, 2012. (54 refs.)

Introduction and Aims. Although, in the laboratory, most acute adverse effects of cocaine are dose-dependent and alcohol potentiates some of these effects, there are few observational studies, and scarce awareness that the risk of acute cocaine intoxication (ACI) can increase as the amounts of cocaine and alcohol consumed increase. Our objectives were to assess if the risk of ACI increases with the level cocaine use, both in chronic and binge use; and also to determine whether it increases when a cocaine binge is combined with binge drinking or with regular excessive drinking. Design and Methods. Hypotheses were evaluated using logistic regression and case-crossover analyses in a sample of 720 young regular cocaine users who did not regularly use heroin, recruited at drug scenes in 20042006. All data on ACI, predictor and confounding variables were obtained through a computer-assisted personal interview. Results. The annual prevalence of ACI was 21%. In the last year 10.3% of the participants reported cocaine binges (=0.5 g in 4 h). ACI risk increased considerably in the 4 h following a cocaine binge (odds ratio = 34.6; 95% confidence interval 11.5170.8). Also, it increased with increases in the average level of cocaine used over a long period and when users regularly drank excessively. Finally, the results suggest that the high risk of ACI associated with cocaine binge may increase even more when combined with binge drinking. Discussion and Conclusions. Awareness of the dose-dependent effect of cocaine on ACI risk, as well as the possible synergistic effect of alcohol, ought to be incorporated into preventive and care strategies.

Copyright 2012, Wiley-Blackwell


Schmaal L; Veltman DJ; Nederveen A; van den Brink W; Goudriaan AE. N-Acetylcysteine normalizes glutamate levels in cocaine-dependent patients: A randomized crossover magnetic resonance spectroscopy study. Neuropsychopharmacology 37(9): 2143-2152, 2012. (70 refs.)

Treatment with N-acetylcysteine (NAC) normalizes glutamate (Glu) homeostasis and prevents relapse in drug-dependent animals. However, the effect of NAC on brain Glu levels in substance-dependent humans has not yet been investigated. Proton magnetic resonance spectroscopy (H-1 MRS) was used to investigate Glu changes in the dorsal anterior cingulate cortex (dACC) after a single dose of NAC in cocaine-dependent patients and normal controls. In an open-label, randomized, crossover study, 8 cocaine-dependent patients and 14 healthy controls underwent two scan sessions: one group receiving no compound and the other following a single administration of 2400mg NAC. The Barratt Impulsiveness Scale was administered to examine the relation between dACC Glu levels and impulsivity. In the medication-free condition, Glu levels in the dACC were significantly higher in cocaine-dependent patients compared with healthy controls. After administration of NAC, Glu levels were reduced in the cocaine-dependent group, whereas NAC had no effect in healthy controls. Higher baseline Glu levels were associated with higher impulsivity, and both were predictive of greater NAC-induced Glu reduction. The current findings indicate that NAC can normalize elevated Glu levels in cocaine-dependent patients. These findings may have important implications for treatment, because abnormal Glu levels are related to relapse, and treatment with NAC prevented relapse in animal studies. Furthermore, clinical studies have indicated beneficial effects of NAC in cocaine-dependent patients, and the current study suggests that these beneficial effects might in part be mediated by the ability of NAC to normalize glutamatergic abnormalities.

Copyright 2012, Nature Publishing


Smith PH; Homish GG; Leonard KE; Cornelius JR. Intimate partner violence and specific substance use disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychology of Addictive Behaviors 26(2): 236-245, 2012. (37 refs.)

The association between substance use and intimate partner violence (IPV) is robust. It is less clear how the use of specific substances relates to relationship violence. This study examined IPV perpetration and victimization related to the following specific substance use disorders: alcohol, cannabis, cocaine, and opioid. The poly substance use of alcohol and cocaine, as well as alcohol and marijuana, were also examined. Data were analyzed from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Associations between substance use disorders and IPV were tested using logistic regression models while controlling for important covariates and accounting for the complex survey design. Alcohol use disorders and cocaine use disorders were most strongly associated with IPV perpetration, while cannabis use disorders and opioid use disorders were most strongly associated with IPV victimization. A diagnosis of both an alcohol use disorder and cannabis use disorder decreased the likelihood of IPV perpetration compared to each individual substance use disorder. A diagnosis of both an alcohol use disorder and cocaine use disorder increased likelihood of reporting IPV perpetration compared with alcohol use disorders alone but decreased likelihood of perpetration compared with a cocaine use disorder diagnosis alone. Overall, substance use disorders were consistently related to intimate partner violence after controlling for important covariates. These results provide further evidence for the important link between substance use disorders and IPV and add to our knowledge of which specific substances may be related to relationship violence.

Copyright 2012, American Psychological Association


Solomon TM; Halkitis PN; Moeller RW; Pappas MK. Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men. Addiction Research & Theory 20(1): 21-29, 2012. (54 refs.)

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.

Copyright 2012, Informa Healthcare


Stoduto G; Mann RE; Ialomiteanu A; Wickens CM; Brands B. Examining the link between collision involvement and cocaine use. Drug and Alcohol Dependence 123(1-3): 260-263, 2012. (26 refs.)

Background: Cocaine is one of the more commonly found illicit drugs in injured drivers. In this work, we examine the association between self-reported past year cocaine use and past year collision involvement in a large representative sample of adult drivers in Ontario. Methods: Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older. Five years of data (2002, 2003, 2004, 2006, 2008) were merged for this study (N = 8107) due to survey item availability. Logistic regression analysis was performed to identify the risk of self-reported collision involvement within the past 12 months associated with past year use of cocaine, while controlling for sociodemographic, driving exposure and drinking-driving (as a function of drinking status) factors. Due to listwise deletion, the logistic regression model was based on a reduced sample (N = 7284). Results: The prevalence of self-reported collision involvement within the past year was 18.9% among those who used cocaine in the past year compared to 7.4% of non-users. Logistic regression analysis, controlling for the potential confounding effects of age, gender, income, driving exposure and drinking-driving measures, found the odds of collision involvement in the preceding year among cocaine users was over twice that of non-users (OR = 2.11, 95% CI = 1.06-4.18). Conclusions: This study suggests that cocaine users are significantly more likely to report collision involvement in the past year. Additional work to confirm these observations, and to assess possible causal pathways, is needed.

Copyright 2012, Elsevier Science


Stoops WW; Lile JA; Glaser PEA; Hays LR; Rush CR. Alternative reinforcer response cost impacts cocaine choice in humans. (review). Progress In Neuro-Psychopharmacology & Biological Psychiatry 36(1): 189-193, 2012. (30 refs.)

Cocaine use disorders are an unrelenting public health concern. Behavioral treatments reduce cocaine use by providing non-drug alternative reinforcers. The purpose of this human laboratory experiment was to determine how response cost for non-drug alternative reinforcers influenced cocaine choice. Seven cocaine-using, non-treatment-seeking subjects completed a crossover, double-blind protocol in which they first sampled doses of intranasal cocaine (5, 10, 20 or 30 mg) and completed a battery of subject-rated and physiological measures. Subjects then made eight discrete choices between the sampled dose and an alternative reinforcer (US$025). The response cost to earn a cocaine dose was always a fixed ratio (FR) of 100 responses. The response cost for the alternative reinforcer varied across sessions (FR1, FR10, FR100, FR1000). Dose-related increases were observed for cocaine choice. Subjects made fewer drug choices when the FR requirements for the alternative reinforcers were lower than that for drug relative to when the FR requirements were equal to or higher than that for drug. Intranasal cocaine also produced prototypical stimulant-like subject-rated and physiological effects (e.g., increased ratings of Like Drug; elevated blood pressure). These data demonstrate that making alternative reinforcers easier to earn reduces cocaine self-administration, which has implications for treatment efforts.

Copyright 2012, Elsevier Science


Stoops WW; Lile JA; Glaser PEA; Hays LR; Rush CR. Influence of acute bupropion pre-treatment on the effects of intranasal cocaine. Addiction 107(6): 1140-1147, 2012. (27 refs.)

Aims: The aim of this experiment was to determine the influence of acute bupropion pre-treatment on subject-rated effects and choice of intranasal cocaine versus money. Design: A randomized, within-subject, placebo-controlled, double-blind experiment. Setting: An out-patient research unit. Participants: Eight cocaine-using adults. Measurements: Subjects completed nine experimental sessions in which they were pre-treated with 0, 100 or 200 mg oral immediate release bupropion. Ninety minutes later they sampled an intranasal cocaine dose [4 (placebo), 15 or 45 mg] and made six choices between that dose and an alternative reinforcer (US$0.25), available on independent, concurrent progressive ratio schedules. Subjects also completed a battery of subject-rated, performance and physiological measures following the sample doses of cocaine. Findings: After 0 mg bupropion, the high dose of cocaine (45 mg) was chosen five of six times on average compared to 2.25 of six choices for placebo cocaine (4 mg) (P < 0.05). Active bupropion reduced choice of 45 mg cocaine to 3.13 (100 mg) or 4.00 (200 mg) out of six drug choices on average. Bupropion also consistently enhanced positive subject-rated effects of cocaine (e.g. good effects; willing to take again) while having no effects of its own. Conclusions: The atypical antidepressant, bupropion, acutely appears to reduce preference for intranasal cocaine versus a small amount of money but to increase reported positive experiences of the drug.

Copyright 2012, Wiley-Blackwell


Sucharew H; Khoury JC; Xu YY; Succop P; Yolton K. NICU Network Neurobehavioral Scale (NNNS) profiles predict developmental outcomes in a low-risk sample. Paediatric And Perinatal Epidemiology 26(4): 344-352, 2012. (22 refs.)

Background: Latent profile analysis (LPA) has been used previously to classify neurobehavioral responses of infants prenatally exposed to cocaine and other drugs of abuse. The objective of this study was to define NICU Network Neurobehavioral Scale (NNNS) profile response patterns in a cohort of infants with no known cocaine exposure or other risks for neurobehavior deficits, and determine whether these profiles predict neurobehavioral outcomes in these low-risk infants. Methods: NNNS exams were performed on 355 low-risk infants at approximately 5 weeks after birth. LPA was used to define discrete profiles based on the standard NNNS summary scales. Associations between the infant profiles and neurobehavioral outcomes at one to three years of age were examined. Results: Twelve of the 13 summary scales were used and three discrete NNNS profiles identified: social/easy going infants (44%), hypotonic infants (24%), and high arousal/difficult infants (32%). Statistically significant associations between NNNS profiles and later neurobehavioral outcomes were found for psychomotor development and externalizing behaviors. Hypotonic infants had both lower psychomotor development and lower externalizing scores compared to the other two profiles. Conclusions: Three distinct profiles of the NNNS summary scores were identifiable using LPA among infants with no known cocaine exposure. These profile patterns were associated with early childhood neurobehavioral outcome, similar to findings reported in a study of infants with substantial cocaine exposure, demonstrating the utility of this profiling technique in both exposed and unexposed populations.

Copyright 2012, Wiley-Blackwell


Swift W; Coffey C; Degenhardt L; Carlin JB; Romaniuk H; Patton GC. Cannabis and progression to other substance use in young adults: Findings from a 13-year prospective population-based study. Journal of Epidemiology and Community Health 66(7): e26, 2012. (49 refs.)

Background: Adolescent cannabis use predicts the onset of later illicit drug use. In contrast, little is known about whether cannabis in young adulthood also predicts subsequent progression or cessation of licit or illicit drug use. Methods: 13-year longitudinal cohort study with recruitment in secondary school students in Victoria, Australia. There were six waves of adolescent data collection (mean age 14.9-17.4 years) followed by three in young adulthood (mean age 20.7, 24.1 and 29.0 years). Discrete-time proportional hazards models were used to assess predictive associations between cannabis use frequency (occasional (Copyright 2012, BMJ Publishing Group


Thoumi FE. Illegal drugs, anti-drug policy failure, and the need for institutional reforms in Colombia. Substance Use & Misuse 47(8): 972-1004, 2012. (128 refs.)

This paper is inspired by two anomalies encountered in the study of the illegal drugs industry. First, despite the very high profits of coca/cocaine and poppy/opium/heroin production, most countries that can produce do not. Why, for example, does Colombia face much greater competition in the international coffee, banana, and other legal product markets than in cocaine? And second, though illegal drugs are clearly associated with violence, why is it that illegal drug trafficking organizations have been so much more violent in Colombia and Mexico than in the rest of the world? The answers to these questions cannot be found in factors external to Colombia (and Mexico). They require identifying the societal weaknesses of each country. To do so, the history of the illegal drugs industry is surveyed, a simple model of human behavior that stresses the conflict between formal (legal) and informal (socially accepted) norms as a source of the weaknesses that make societies vulnerable is formulated. The reasons why there is a wide gap between formal and informal norms in Colombia are explored and the effectiveness of anti-drug policies is considered to explain why they fail to achieve their posited goals. The essay ends with reflections and conclusion on the need for institutional change.

Copyright 2012, Informa Healthcare


Torche F; Warren JR; Halpern-Manners A; Valenzuela E. Panel conditioning in a longitudinal study of adolescents' substance use: Evidence from an experiment. Social Forces 90(3): 891-918, 2012. (31 refs.)

Panel surveys are widely used in sociology to examine life-course trajectories and to assess causal effects. However, when using panel data researchers usually assume that the act of measuring respondents' attitudes and behaviors has no effect on the attributes being measured or on the accuracy of reports about those attributes. Evidence from cognitive psychology, marketing research, political science and other fields suggests that this assumption may not be warranted. Using a rigorous experimental design, we examine the magnitude of panel conditioning bias - the bias emerging from having answered questions in prior waves of a survey - in a panel study of substance use among adolescents in Chile. We find that adolescents who answered survey questions about alcohol, cigarette, marijuana and cocaine use were considerably less likely than members of a control group to report substance use when re-interviewed one year later. This finding has important implications, and also points to the need for sociologists to be concerned about panel conditioning as an important methodological issue.

Copyright 2012, Oxford University Press


Treweek JB; Janda KD. An antidote for acute cocaine toxicity. Molecular Pharmaceutics 9(4): 969-978, 2012. (37 refs.)

Not only has immunopharmacotherapy grown into a field that addresses the abuse of numerous illicit substances, but also the treatment methodologies within immunopharmacotherapy have expanded from traditional active vaccination to passive immunization with anti-drug monoclonal antibodies, optimized mAb formats, and catalytic drug-degrading antibodies. Many laboratories have focused on transitioning distinct immunopharmacotherapeutics to clinical evaluation, but with respect to the indication of cocaine abuse, only the active vaccine TA-CD, which is modeled after our original cocaine hapten GNC,(1) has been carried through to human clinical trials.(2) The successful application of murine mAb GNC92H2 to the reversal of cocaine overdose in a mouse model prompted investigations of human immunoglobulins with the clinical potential to serve as cocaine antidotes. We now report the therapeutic utility of a superior clone, human mAb GNCgzk (K-d = 0.18 nM), which offers a 10-fold improvement in cocaine binding affinity. The GNCgzk manifold was engineered for rapid cocaine clearance, and administration of the F(ab')(2) and Fab formats even after the appearance of acute behavioral signs of cocaine toxicity granted nearly complete prevention of lethality. Thus, contrary to the immunopharmacotherapeutic treatment of drug self-administration, minimal antibody doses were shown to counteract the lethality of a molar excess of circulating cocaine. Passive vaccination with drug-specific antibodies represents a viable treatment strategy for the human condition of cocaine overdose.

Copyright 2012, American Chemical Society


Tuten M; DeFulio A; Jones HE; Stitzer M. Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification. Addiction 107(5): 973-982, 2012. (31 refs.)

Aims: To conduct a randomized, controlled trial of abstinence-contingent recovery housing delivered with or without intensive day treatment among individuals exiting residential opioid detoxification. Setting: Out-patient drug-free substance abuse treatment program in Baltimore, Maryland. Participants Patients (n = 243) who completed medication-assisted opioid detoxification. Measurements: Primary outcome was drug abstinence (opioid-and cocaine-negative urine and no self-reported opioid or cocaine use in the previous 30 days). Secondary outcomes included abstinence at all time-points (1, 3 and 6 months), days in recovery housing and employment. Findings: Overall rates of drug abstinence were 50% for RH + RBT, 37% for RH and 13% for UC (P < 0.001). At 6 months, RH + RBT participants remained more likely to meet abstinence criteria than UC participants (37% versus 20%, P = 0.016). Length of stay in recovery housing mediated abstinence outcomes andwas longer in RH + RBT (49.5 days) than in RH (32.2 days; P < 0.002). Conclusions: Abstinence-contingent recovery housing improves abstinence in opioid-dependent adults following medication-assisted detoxification. The addition of intensive 'reinforcement-based treatment' behavioural counseling further improves treatment outcomes, in part by promoting longer recovery house stays.

Copyright 2012, Wiley-Blackwell


van Emmerik-van Oortmerssen K; van de Glind G; van den Brink W; Smit F; Crunelle CL; Swets M et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. (review). Drug and Alcohol Dependence 122(1-2): 11-19, 2012. (70 refs.)

Context: Substance use disorders (SUD) are a major public health problem. Attention deficit hyperactivity disorder (ADHD) is a comorbid condition associated with both onset and prognosis of SUD. Prevalence estimates of ADHD in SUD vary significantly. Objective: To obtain a best estimate of the prevalence of ADHD in SUD populations. Data sources: A literature search was conducted using MEDLINE, PsycINFO and EMBASE. Search terms were ADHD, substance-related disorders, addiction, drug abuse, drug dependence, alcohol abuse, alcoholism, co-morbidity, and prevalence. Results were limited to the English language. Study selection: After assessing the quality of the retrieved studies, 29 studies were selected. Studies in which nicotine was the primary drug of abuse were not included. Data extraction: All relevant data were extracted and analysed in a meta-analysis. A series of meta-regression analyses was performed to evaluate the effect of age, primary substance of abuse, setting and assessment procedure on the prevalence of ADHD in a variety of SUD populations. Data synthesis: Overall, 23.1% (Cl: 19.4-27.2%) of all SUD subjects met DSM-criteria for comorbid ADHD. Cocaine dependence was associated with lower ADHD prevalence than alcohol dependence, opioid dependence and other addictions. Studies using the DICA or the SADS-L for the diagnosis of ADHD showed significantly higher co-morbidity rates than studies using the KSADS, DISC, DIS or other assessment instruments. Conclusions: ADHD is present in almost one out of every four patients with SUD. The prevalence estimate is dependent on substance of abuse and assessment instrument.

Copyright 2012, Elsevier Science


Verdejo-Garcia A; Betanzos-Espinosa P; Lozano OM; Vergara-Moragues E; Gonzalez-Saiz F; Fernandez-Calderon F et al. Self-regulation and treatment retention in cocaine dependent individuals: A longitudinal study. Drug and Alcohol Dependence 122(1-2): 142-148, 2012. (52 refs.)

Background: We aimed to explore the association between baseline executive functioning and treatment outcome in Therapeutic Communities (TCs). Methods: We used a longitudinal descriptive design: a baseline neuropsychological assessment was performed within the first 30 days of treatment in TCs. Once participants finished or abandoned treatment, the information about time of stay in treatment was computed for each individual. The study was conducted across six TCs located in the region of Andalusia (Spain): Cartaya, Almonte, Mijas, Los Palacios, La Linea, and Tarifa. Participants were 131 patients with cocaine dependence who initiated and finished treatment in TCs between January 2009 and December 2010 (2 years). Cognitive assessment was composed of general measures of executive functioning: Letter Number Sequencing (working memory) and Similarities (reasoning), and executive tasks sensitive to ventromedial prefrontal cortex dysfunction, including the Delis-Kaplan Stroop test (inhibition/cognitive switching), the Revised-Strategy Application Test (strategy application/multitasking), and the Iowa Gambling Task (decision-making). The outcome measure was retention, defined as time in TC treatment (number of days). Results: Poor executive functioning significantly predicted shorter treatment retention in cocaine dependent individuals on TC residential treatment (14% of explained variance). Reduced performance on the R-SAT, a multitasking test taxing the ability to develop and apply the best strategy to organize multiple sub-routine tasks in order to achieve a long-term goal, was the most powerful predictor of treatment retention. Conclusions: Self-regulation deficits predict the capacity to remain in residential treatment among cocaine dependents.

Copyright 2012, Elsevier Science


Vignali C; Stramesi C; Vecchio M; Groppi A. Hair testing and self-report of cocaine use. Forensic Science International 215(1-3): 77-80, 2012. (14 refs.)

Hair analysis is a useful tool in both clinical and forensic fields: it allows information about drugs of abuse (DOA) consumption to be obtained. However, in spite of analytical results, sometimes patients continue to deny using drugs or, on the contrary, insist on describing themselves as severe drug addicts; indeed there are often considerable difficulties in getting truthful statements about the real amount of drugs used. In this study we have tried to compare cocaine concentration in hair samples with self-reported drug intake. We enrolled 113 subjects (61 Africans, 52 Caucasians) who had been recently sent to jail. They were asked to tell about their use of illicit drugs during the last three months and then submitted to hair analysis. Hair segments (3 cm) were analyzed by GC-MS for amphetamines, cocaine and opiates. Useful data was obtained from 82 subjects, separated into two main groups on account of ethnic origin (African or Caucasian) and divided further into daily, weekly and monthly users. The results showed qualitative results and self-reported consumption to be in good agreement, although the correlation between frequency of consumption and concentration in hair revealed sometimes higher concentrations in contrast with the admission of low consumption. There was a definite separation between occasional and daily use (especially in Caucasian people), while concentrations found where weekly use was reported were more variable. Concentrations of cocaine measured in Africans' hair were much higher than in Caucasians'. Even if this study is exclusively based on self-report, it provides some interesting information in order to differentiate the frequency of consumption, and especially underlines the great importance of ethnic bias on hair analysis.

Copyright 2012, Elsevier Science


Vilke GM; Bozeman WP; Dawes DM; DeMers G; Wilson MR. Excited delirium syndrome (ExDS): Treatment options and considerations. (review). Journal of Forensic and Legal Medicine 19(3): 117-121, 2012. (24 refs.)

The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation. Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, noncompliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment. In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication. Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options.

Copyright 2012, Faculty of Forensic and Legal Medicine


Vindenes V; Lund HME; Andresen W; Gjerde H; Ikdahl SE; Christophersen AS et al. Detection of drugs of abuse in simultaneously collected oral fluid, urine and blood from Norwegian drug drivers. Forensic Science International 219(1-3): no page number, 2012. (42 refs.)

Blood and urine samples are collected when the Norwegian police apprehend a person suspected of driving under the influence of drugs other than alcohol. Impairment is judged from the findings in blood. In our routine samples, urine is analysed if morphine is detected in blood to differentiate between ingestion of heroin, morphine or codeine and also in cases where the amount of blood is too low to perform both screening and quantification analysis. In several cases, the collection of urine might be time consuming and challenging. The aim of this study was to investigate if drugs detected in blood were found in oral fluid and if interpretation of opiate findings in oral fluid is as conclusive as in urine. Blood, urine and oral fluid samples were collected from 100 drivers suspected of drugged driving. Oral fluid and blood were screened using LC-MS/MS methods and urine by immunological methods. Positive findings in blood and urine were confirmed with chromatographic methods. The analytical method for oral fluid included 25 of the most commonly abused drugs in Norway and some metabolites. The analysis showed a good correlation between the findings in urine and oral fluid for amphetamines, cocaine/benzoylecgonine, methadone, opiates, zopiclone and benzodiazepines including the 7-amino-benzodiazepines. Cocaine and the heroin marker 6-monoacetylmorphine (6-MAM) were more frequently detected in oral fluid than in urine. Drug concentrations above the cut-off values were found in both samples of oral fluid and urine in 15 of 22 cases positive for morphine, in 18 of 20 cases positive for codeine and in 19 of 26 cases positive for 6-MAM. The use of cannabis was confirmed by detecting THC in oral fluid and THC-COOH in urine. In 34 of 46 cases the use of cannabis was confirmed both in oral fluid and urine. The use of cannabis was confirmed by a positive finding in only urine in 11 cases and in only oral fluid in one case. All the drug groups detected in blood were also found in oral fluid. Since all relevant drugs detected in blood were possible to find in oral fluid and the interpretation of the opiate findings in oral fluid was more conclusive than in urine, oral fluid might replace urine in driving under the influence cases. The fast and easy sampling is time saving and less intrusive for the drivers.

Copyright 2012, Elsevier Science


Vorspan F; Bellais L; Romo L; Bloch V; Neira R; Lepine JP. The Obsessive-Compulsive Cocaine Scale (OCCS): A pilot study of a new questionnaire for assessing cocaine craving. American Journal on Addictions 21(4): 313-319, 2012. (38 refs.)

This study aimed to develop a scale (Obsessive-Compulsive Cocaine Scale [OCCS]) for measuring cocaine craving based on the Obsessive Compulsive Drinking Scale (OCDS). We tested the scale on 116 French-speaking cocaine users. The scale was reliable (Cronbach's alpha = 0.93). It was significantly correlated with a visual analogue scale of craving (r = 0.641, p < .001) and discriminated between cocaine-dependant subjects (score 36 +/- 11) and abusers (score 17 +/- 9, p < .001). Prospective tests on a sample of 20 subjects showed that the OCCS score changed over 3 weeks of treatment and was significantly correlated with the visual analogue scale of craving (r = 0.492, p = .038). Principal component analysis identified three factors: resistance, intensity, and interference. The OCCS questionnaire could be used to repeatedly assess cocaine craving in prospective studies in cocaine addicts.

Copyright 2012, Wiley-Blackwell


Wehring HJ; Liu F; McMahon RP; Mackowick KM; Love RC; Dixon L et al. Clinical characteristics of heavy and non-heavy smokers with schizophrenia. Schizophrenia Research 138(2-3): 285-289, 2012. (58 refs.)

Up to 50-90% of persons with schizophrenia smoke cigarettes. Limited data and theories suggest persons with schizophrenia may smoke for different reasons than persons without schizophrenia, making smoking cessation interventions particularly challenging in this population. Although health consequences of smoking are widely known, less information is available regarding characteristics of different amounts of smoking exposure in this population. This study was performed to investigate differences between heavy (>= 1 pack per day) and non-heavy (<1 pack per day) smoking in patients with schizophrenia. Data from 745 patients, mean age 41.3 +/- 12.6 years, were drawn from a population of smokers admitted to State of Maryland inpatient mental health facilities (1994-2000). Records were reviewed to obtain demographic information, diagnosis, medication, smoking and substance use. 43% of patients were characterized as heavy smokers. Heavy and non-heavy groups did not differ in age, GAF, weight, or BMI. No differences were found in race, gender or antipsychotic treatments. However, patients smoking >= 1 packs per day were more likely to use other substances such as alcohol (chi(2) = 6.67, df = 1, p = 0.01), cocaine (chi(2) = 6.66, df = 1, p = 0.01), and other substances (chi(2) = 9.95, df = 1, p = 0.003) compared to non-heavy smokers. No differences in cannabis or heroin use were found by smoking category. Controlling for age, race, sex and BMI, heavy smokers had higher total cholesterol (190.7(51.6) mg/dL) compared to non-heavy smokers (178.2 (43.0) mg/dL, p = 0.03), but no differences were found in glucose or blood pressure. Heavy smoking may be a particular health risk in schizophrenia and significant efforts for smoking cessation or reduction are needed.

Copyright 2012, Elsevier Science


Wilmoth DR. Intelligence and past use of recreational drugs. Intelligence 40(1): 15-22, 2012. (44 refs.)

One motivation for trying recreational drugs is the desire for novel experiences. More intelligent people tend to value novelty more highly and may therefore be more likely to have tried recreational drugs. Using data from a national survey, it is shown that intelligence tends to be positively related to the probabilities of having tried alcohol, marijuana, cocaine and several other recreational drugs. Evidence is also presented that those relationships typically disappear or change sign at high levels of intelligence. These patterns persist after accounting for a wide range of personal characteristics.

Copyright 2012, Elseiver Science


Windle M; Windle RC. Early onset problem behaviors and alcohol, tobacco, and other substance use disorders in young adulthood. Drug and Alcohol Dependence 121(1-2): 152-158, 2012. (28 refs.)

Objective: Ten early onset problem behaviors were used to prospectively predict alcohol, tobacco, cannabis, and cocaine disorders in young adulthood (mean age = 28.6 yrs) for a U.S. community sample of 671 participants. Method: Data from a longitudinal study of participants who were recruited from high schools during adolescence and followed into young adulthood were used to evaluate prospective associations. The relationship between early onset problem behaviors, reported when participants were age 16 years, and psychiatric diagnoses assessed in young adulthood was tested. Structural equation models were used to evaluate both generality and specificity hypotheses regarding relationships between early onset problem behaviors and young adult disorders. Results: Findings supported the specificity hypothesis in that "like" early onset problem behaviors significantly predicted "like" young adult outcomes (e.g., early cocaine use predicted cocaine disorders). Furthermore, eliminating such "like" predictors in regression equations resulted in a 36% reduction in the amount of variance accounted for by the equation. The generality hypothesis was also supported in that a larger number of early onset problem behaviors strengthened the prediction of young adult disorders beyond the "like" attribute, and a dose response pattern indicated that additional early onset problem behaviors increased the probable occurrence of a young adult disorder. Conclusions: A comprehensive framework relating early onset problem behaviors to young adult substance disorders will require the integration of both generality and specificity hypotheses, and a developmental orientation focused on the unfolding of mediating and moderating processes. Early screening of multiple, rather than single, early onset problems is also discussed.

Copyright 2012, Elsevier Science


Wolford A; McDonald TS; Eng H; Hansel S; Chen Y; Bauman J et al. Immune-mediated agranulocytosis caused by the cocaine adulterant levamisole: A case for reactive metabolite(s) involvement. Drug Metabolism and Disposition 40(6): 1067-1075, 2012. (60 refs.)

The United States Public Health Service Administration is alerting medical professionals that a substantial percentage of cocaine imported into the United States is adulterated with levamisole, a veterinary pharmaceutical that can cause blood cell disorders such as severe neutropenia and agranulocytosis. Levamisole was previously approved in combination with fluorouracil for the treatment of colon cancer; however, the drug was withdrawn from the U. S. market in 2000 because of the frequent occurrence of agranulocytosis. The detection of autoantibodies such as antithrombin (lupus anticoagulant) and an increased risk of agranulocytosis in patients carrying the human leukocyte antigen B27 genotype suggest that toxicity is immune-mediated. In this perspective, we provide an historical account of the levamisole/cocaine story as it first surfaced in 2008, including a succinct review of levamisole pharmacology, pharmacokinetics, and preclinical/clinical evidence for levamisole-induced agranulocytosis. Based on the available information on levamisole metabolism in humans, we propose that reactive metabolite formation is the rate-limiting step in the etiology of agranulocytosis associated with levamisole, in a manner similar to other drugs (e. g., propylthiouracil, methimazole, captopril, etc.) associated with blood dyscrasias. Finally, considering the toxicity associated with levamisole, we propose that the 2,3,5,6-tetrahydroimidazo[2,1-b]thiazole scaffold found in levamisole be categorized as a new structural alert, which is to be avoided in drug design.

Copyright 2012, American Society of Pharmacology and Experimental Therapeutics


Yang BZ; Han SZ; Kranzler HR; Farrer LA; Elston RC; Gelernter J. Autosomal linkage scan for loci predisposing to comorbid dependence on multiple substances. American Journal of Medical Genetics. Part B-Neuropsychiatric Genetics 159B(4): 361-369, 2012. (72 refs.)

Multiple substance dependence (MSD) trait comorbidity is common, and MSD patients are often severely affected clinically. While shared genetic risks have been documented, so far there has been no published report using the linkage scan approach to survey risk loci for MSD as a phenotype. A total of 1,758 individuals in 739 families [384 African American (AA) and 355 European American (EA) families] ascertained via affected sib-pairs with cocaine or opioid or alcohol dependence were genotyped using an array-based linkage panel of single-nucleotide polymorphism markers. Fuzzy clustering analysis was conducted on individuals with alcohol, cannabis, cocaine, opioid, and nicotine dependence for AAs and EAs separately, and linkage scans were conducted for the output membership coefficients using Merlin-regression. In EAs, we observed an autosome-wide significant linkage signal on chromosome 4 (peak lod = 3.31 at 68.3 cM; empirical autosome-wide P = 0.038), and a suggestive linkage signal on chromosome 21 (peak lod = 2.37 at 19.4 cM). In AAs, four suggestive linkage peaks were observed: two peaks on chromosome 10 (lod = 2.66 at 96.7 cM and lod = 3.02 at 147.6 cM] and the other two on chromosomes 3 (lod = 2.81 at 145.5 cM) and 9 (lod = 1.93 at 146.8 cM). Three particularly promising candidate genes, GABRA4, GABRB1, and CLOCK, are located within or very close to the autosome-wide significant linkage region for EAs on chromosome 4. This is the first linkage evidence supporting existence of genetic loci influencing risk for several comorbid disorders simultaneously in two major US populations.

Copyright 2012, Wiley-Blackwell


Yoo JH; Kitchen I; Bailey A. The endogenous opioid system in cocaine addiction: What lessons have opioid peptide and receptor knockout mice taught us? (review). British Journal of Pharmacology 166(7): 1993-2014, 2012. (204 refs.)

Cocaine addiction has become a major concern in the UK as Britain tops the European league table for cocaine abuse. Despite its devastating health and socio-economic consequences, no effective pharmacotherapy for treating cocaine addiction is available. Identifying neurochemical changes induced by repeated drug exposure is critical not only for understanding the transition from recreational drug use towards compulsive drug abuse but also for the development of novel targets for the treatment of the disease and especially for relapse prevention. This article focuses on the effects of chronic cocaine exposure and withdrawal on each of the endogenous opioid peptides and receptors in rodent models. In addition, we review the studies that utilized opioid peptide or receptor knockout mice in order to identify and/or clarify the role of different components of the opioid system in cocaine-addictive behaviours and in cocaine-induced alterations of brain neurochemistry. The review of these studies indicates a region-specific activation of the mu-opioid receptor system following chronic cocaine exposure, which may contribute towards the rewarding effect of the drug and possibly towards cocaine craving during withdrawal followed by relapse. Cocaine also causes a region-specific activation of the ?-opioid receptor/dynorphin system, which may antagonize the rewarding effect of the drug, and at the same time, contribute to the stress-inducing properties of the drug and the triggering of relapse. These conclusions have important implications for the development of effective pharmacotherapy for the treatment of cocaine addiction and the prevention of relapse.

Copyright 2012, Wiley-Blackwell


Young AM; Havens JR; Leukefeld CG. A comparison of rural and urban nonmedical prescription opioid users' lifetime and recent drug use. American Journal of Drug and Alcohol Abuse 38(3): 220-227, 2012. (31 refs.)

Background: Nonmedical prescription opioid use has emerged as a major public health concern. The growing burden of nonmedical prescription opioid use in America may have unique manifestations and consequences in rural areas, which to a large extent have yet to be explored. Objectives: To describe rural-urban differences among drug users in recent and lifetime use and age of onset of use for alcohol, heroin, OxyContin (R), oxycodone, hydrocodone, barbiturates, benzodiazepines, cocaine, crack, methamphetamine, amphetamine, marijuana, hallucinogens, and inhalants. Methods: A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101) and a major metropolitan area (n = 111) in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric characteristics, and self-reported drug use. Results: Rural drug users had significantly earlier ages of onset for use of oxycodone, hydrocodone, benzodiazepines, cocaine, and crack. In age-, gender-, and race-adjusted logistic regression analyses, rural drug users had significantly higher odds of lifetime and recent use of methadone, OxyContin (R), and oxycodone. Rural drug users also had significantly higher odds of lifetime cocaine and crack use. However, urban participants as expected had significantly higher odds of recent crack use. Conclusions: The findings demonstrate that, in this sample, nonmedical prescription opioid use is dissimilar among rural and urban drug users. Additional research is needed to better understand the individual, social, and structural level factors contributing to the burden of nonmedical opioid use, particularly in rural populations, with the aim of developing tailored substance abuse treatment and prevention.

Copyright 2012, Informa HealthCare


Zimmer BA; Oleson EB; Roberts DCS. The motivation to self-administer is increased after a history of spiking brain levels of cocaine. Neuropsychopharmacology 37(8): 1901-1910, 2012. (65 refs.)

Recent attempts to model the addiction process in rodents have focused on cocaine self-administration procedures that provide extended daily access. Such procedures produce a characteristic loading phase during which blood levels rapidly rise and then are maintained within an elevated range for the duration of the session. The present experiments tested the hypothesis that multiple fast-rising spikes in cocaine levels contribute to the addiction process more robustly than constant, maintained drug levels. Here, we compared the effects of various cocaine self-administration procedures that produced very different patterns of drug intake and drug dynamics on Pmax, a behavioral economic measure of the motivation to self-administer drug. Two groups received intermittent access (IntA) to cocaine during daily 6-h sessions. Access was limited to twelve 5-min trials that alternated with 25-min timeout periods, using either a hold-down procedure or a fixed ratio 1 (FRI). Cocaine levels could not be maintained with this procedure; instead the animals experienced 12 fast-rising spikes in cocaine levels each day. The IntA groups were compared with groups given 6-h FRI long access and 2-h short access sessions and two other control groups. Here, we report that cocaine self-administration procedures resulting in repeatedly spiking drug levels produce more robust increases in Pmax than procedures resulting in maintained high levels of cocaine. These results suggest that rapid spiking of brain-cocaine levels is sufficient to increase the motivation to self-administer cocaine.

Copyright 2012, Nature Publishing