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CORK Bibliography: Cocaine

159 citations. June 2008 to present

Prepared: September 2008

Ahmadi J; Kampman K; Dackis C; Sparkman T; Pettinati H. Cocaine withdrawal symptoms identify "Type B" cocaine-dependent patients. American Journal on Addictions 17(1): 60-64, 2008. (21 refs.)

Recent studies of substance dependence typologies briefly show that multivariate systems originally developed for identifying subtypes of alcoholics, such as Babor's Type A and B system, may also be valid in abusers of other substances, such as cocaine. Type B patients are characterized by an earlier onset of addiction and more severe symptoms of their addiction, psychopathology, and impulsivity. The Type B classification has also been associated with deficits in serotonergic function. We have found that patients who exhibit more severe cocaine withdrawal symptoms, as measured by scores on the Cocaine Selective Severity Assessment (CSSA), have poor treatment outcome and share many characteristics with "Type B" patients. In this paper, we review baseline characteristics of cocaine-dependent patients from several recently completed outpatient cocaine dependence treatment trials to assess the association of cocaine withdrawal symptom severity and the Type B profile. Identifying subtypes of cocaine-dependent patients may improve our ability to treat cocaine dependence by targeting treatments for specific subtypes of patients. We examined the ability of the CSSA scores to capture Type B characteristics in cocaine dependence by analyzing a series of cocaine medication trials that included 255 cocaine-dependent subjects. High CSSA scores at baseline were associated with a history of violent behavior, a family history of substance abuse, antisocial personality disorder, higher addiction severity, and co-morbid psychiatric diseases. Patients with high CSSA scores are also more likely to meet criteria for Type B (Type II) cocaine dependence. Identifying Type B cocaine-dependent patients may help to develop targeted psychosocial or pharmacological treatments for these difficult-to-treat patients.

Alvarez GG; van der Jagt RHC. "Crack lung and heart" presenting after chemotherapy in a 65-year-old man with non-Hodgkin lymphoma. Current Oncology 15(1): 63-65, 2008. (11 refs.)

Crack cocaine can cause a variety of pulmonary and cardiac, complications. Pulmonary findings in a 65-year-old man with non-Hodgkin lymphoma who presented with shortness of breath not resolving with antibiotics are presented here. The usual manifestation of "crack lung" in an unusual clinical circumstance underlines the importance of a clinical history in such cases. The finding of "crack lung" preceded the diagnosis of probable "crack heart." No other similar published case reports could be identified in the literature.

Amos C; Peters RJ; Williams L; Johnson RJ; Martin Q; Yacoubian GS. The link between recent sexual abuse and drug use among African American male college students: It's not just a female problem in and around campus. Journal of Psychoactive Drugs 40(2): 161-166, 2008. (26 refs.)

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p <= 0.001) and past 30 day (OR = 5.0, p <= 0.001) drug use.

Arias AJ; Gelernter J; Chan G; Weiss RD; Brady KT; Farrer L; Kranzler HR. Correlates of co-occurring ADHD in drug-dependent subjects: Prevalence and features of substance dependence and psychiatric disorders. Addictive Behaviors 33(9): 1199-1207, 2008. (37 refs.)

We examined the prevalence and course of psychiatric and substance dependence (SD) disorders in subjects with SD and attention deficit hyperactivity disorder (ADHD). Method: We interviewed 1761 adults with a lifetime diagnosis of cocaine and/or opioid dependence using the Semi-Structured Assessment for Drug Dependence and Alcoholism. Generalized linear regression with generalized estimating equation analysis was used to examine the associations between a lifetime diagnosis of ADHD and indicators of clinical course, and to identify unique correlates of ADHD. Results: Lifetime ADHD prevalence in the SD sample was 5.22% (vs. 0.85% in a group of individuals without SD). ADHD was associated with an earlier age of first substance use, more SD and psychiatric diagnoses, a greater likelihood of attempted suicide, and more hospitalizations. After controlling for conduct disorder, there were unique effects of ADHD on age of first substance use and number of SD diagnoses. Conclusion: In subjects with cocaine or opioid dependence, ADHD is associated with greater SD and psychiatric comorbidity and a more severe course of illness.

Armenta S; de la Guardia M. Analytical methods to determine cocaine contamination of banknotes from around the world. Trends in Analytic Chemistry (TrAC) 27(4): 344-351, 2008. (28 refs.)

The presence of cocaine in a significant number of UK pounds () pound, Euros (sic) and North American banknotes ($) in general circulation requires appropriate tools to do determinations. This article discusses the-state-of-the-art in the analysis of cocaine on banknotes. We summarize the usual extraction methods of currency samples and compare them, especially with respect to avoiding sample damage. We critically discuss analytical methods, namely gas chromatography (GC) and liquid chromatography (LC), capillary electrophoresis (CE), immunoassay, thermal desorption tandem mass spectrometry (TD-MS2) and ion-mobility spectrometry (IMS). We also review cocaine levels on banknotes around the world and their possible relationship with drug consumption.

Back SE; Brady KT; Waldrop AE; Yeatts SD; Mcrae AL; Spratt E. Early life trauma and sensitivity to current life stressors in individuals with and without cocaine dependence. American Journal of Drug and Alcohol Abuse 34(4): 389-396, 2008. (22 refs.)

This study investigated the link between exposure to early life trauma, sensitivity to current daily stressors, and cocaine dependence. Individuals with (n = 105) or without (n = 53) cocaine dependence completed the Early Trauma Inventory and the Daily Hassles Scale. In comparison to controls, cocaine-dependent individuals reported almost twice as many daily hassles and perceived those hassles more negatively (p < .001). For participants with cocaine dependence, a significant relationship between exposure to early life trauma and negative perception of current daily hassles was observed (p < .01), whereas no such relationship was observed for participants without cocaine dependence. Adverse childhood events may lead to an altered view of the environment that contributes to increased irritability with daily life events among cocaine-dependent individuals.

Baker JE; Jenkins AJ. Screening for cocaine metabolite fails to detect an intoxication. American Journal of Forensic Medicine and Pathology 29(2): 141-144, 2008. (12 refs.)

Testing for the presence of cocaine is common in postmortem and clinical laboratories. Cocaine use may be detected by screening urine specimens for COcocaineC metabolite. In the forensic arena, screening positive results are confirmed by a more specific and sensitive technique, such as gas chromatography-mass spectrometry. This article reports the case of an individual who died of cocaine intoxication but whose immunoassay screen (EMIT) for cocaine metabolite was negative. Gas chromatography-mass spectrometry analysis of the urine detected benzoylecgonine (BE) at a concentration of 75 ng/mL and COC at 55 ng/mL. These concentrations explain the negative screening result since the cutoff concentration of the assay was 300 ng/mL for BE. The reported cross reactivity with cocaine was 25,000 ng/mL. However, heart blood concentrations of cocaine and BE were 18,330 and 8640 ng/mL, respectively. The results from this case provide evidence that an EMIT test alone may fail to detect cocaine use. Individuals utilizing results of drug screening by immunoassay must be aware of the limitations of this testing methodology.

Bennett DS; Bendersky M; Lewis M. Children's cognitive ability from 4 to 9 years old as a function of prenatal cocaine exposure, environmental risk, and maternal verbal intelligence. Developmental Psychology 44(4): 919-928, 2008. (81 refs.)

This study examined the effects of prenatal cocaine exposure, environmental risk, and maternal verbal intelligence on children's cognitive ability. Gender and age were examined as moderators of potential cocaine exposure effects. The Stanford-Binet IV intelligence test was administered to 23 1 children (91 cocaine exposed, 140 unexposed) at ages 4, 6, and 9 years. Neonatal medical risk and other prenatal exposures (alcohol, cigarettes, and marijuana) were also examined for their unique effects on child IQ. Mixed models analysis indicated that prenatal cocaine exposure interacted with gender, as cocaine-exposed boys had lower composite IQ scores. Age at assessment did not moderate this relation, indicating that cocaine-exposed boys had lower IQs across this age period. A stimulating home environment and high maternal verbal IQ also predicted higher composite IQ scores. Cocaine-exposed boys had lower scores on the Abstract[Visual Reasoning subscale, with trends for lower scores on the Short-Term Memory and Verbal Reasoning subscales, as exposure effects were observed across domains. The findings indicate that cocaine exposure continues to place children at risk for mild cognitive deficits into preadolescence. Possible mechanisms for the Exposure X Gender interaction are discussed.

Bertol E; Trignano C; Di Milia MG; Di Padua M; Mari F. Cocaine-related deaths: An enigma still under investigation. Forensic Science International 176(2-3): 121-123, 2008. (14 refs.)

In recent years there has been an increase interest in cocaine-related death reflecting the rising trend in cocaine use in Europe. Nevertheless is still now very difficult to attribute a death to cocaine. We can affirm that cocaine can be responsible for the cause of death only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Isolated blood cocaine levels are not enough to assess lethality, should be always considered and evaluated in relation to concentrations of cocaine and benzoylecgonine concentrations in body tissue compartments, especially in brain and blood. We have reanalyzed all of our cocaine-related case from 1990 to 2005, applying the methodology used by Spielher and Reed over 30 years ago. Our aim was to try to validate this model and verify its applicability and effectiveness after 20 years.

Beuming T; Kniazeff J; Bergmann ML; Shi L; Gracia L; Raniszewska K et al. The binding sites for cocaine and dopamine in the dopamine transporter overlap. Nature Neuroscience 11(7): 780-789, 2008. (47 refs.)

Cocaine is a widely abused substance with psychostimulant effects that are attributed to inhibition of the dopamine transporter (DAT). We present molecular models for DAT binding of cocaine and cocaine analogs constructed from the high-resolution structure of the bacterial transporter homolog LeuT. Our models suggest that the binding site for cocaine and cocaine analogs is deeply buried between transmembrane segments 1, 3, 6 and 8, and overlaps with the binding sites for the substrates dopamine and amphetamine, as well as for benztropine-like DAT inhibitors. We validated our models by detailed mutagenesis and by trapping the radiolabeled cocaine analog [H-3] CFT in the transporter, either by cross-linking engineered cysteines or with an engineered Zn2+-binding site that was situated extracellularly to the predicted common binding pocket. Our data demonstrate the molecular basis for the competitive inhibition of dopamine transport by cocaine.

Bigi MAB; Aslani A; Mehrpour M. Effect of chronic cocaine abuse on the elastic properties of aorta. Echocardiography 25(3): 308-311, 2008. (21 refs.)

Background: Any unfavorable effect of cocaine on aortic elastic properties will contribute to the adverse effects of cocaine on the cardiovascular system. Objectives: The aim of this study was to evaluate the aortic elastic properties in long-term crack cocaine abusers. Methods: Twenty-eight consecutive chronic cocaine abusers and 36 control subjects with similar age, gender, cholesterol, and triglyceride plasma levels, as well as incidence of cigarette smoking, hypertension, and diabetes mellitus were enrolled in the study. Results: The average duration of cocaine abuse was 10 +/- 3.2 years. Diastolic thoracic aortic diameter was increased in cocaine users compared with control subjects (P < 0.05). Aortic strain and distensibility were approximately twofold lower and aortic stiffness index approximately threefold higher in patients compared with control subjects (P < 0.01). The duration of cocaine abuse was related to low aortic strain and distensibility as well as increased aortic stiffness index (R = -0.32, R = -0.38, and R = 0.28, respectively, weighted for age; P < 0.01). When the cocaine abusers were divided into quartiles of duration of cocaine using (first quartile: < 5 years; second quartile: > 5 and < 8 years; third quartile: > 8 and < 11 years; and fourth quartile: > 11 years), progressive increase was found in aortic stiffness index. Conclusion: The present study demonstrates that chronic cocaine abuse clearly produces significant decrease in the elastic properties of aorta. This effect of cocaine is related to the duration of cocaine abuse.

Bodson Q; Denooz R; Serpe P; Charlier C. Gamma-hydroxybutyric acid (GHB) measurement by GC-MS in blood, urine and gastric contents, following an acute intoxication in Belgium. Acta Clinica Belgica 63(3): 200-208, 2008. (65 refs.)

Gamma-hydroxybutyrate (GHB, sodium oxybate) is a compound related to neuromodulator gamma-aminobutyric acid (GABA), emerging as a recreational drug of abuse and as a rape drug. GHB-related emergencies have dramatically increased in the 1990s, but a decrease is observed since 2000. We describe the case of an acute GHB intoxication in a 28-year-old male who fell unconscious after ingestion of a mouthful of an unknown beverage, and required medical support for 2 days. A cocaine abuse was also detected by preliminary toxicological screening, but the clinical presentation was not typical of cocaine intoxication. A simple liquid-liquid extraction was used for quantitation of GHB, followed by disityl-derivatization and analysis in selective ion monitoring (SIM) mode by gas chromatography-mass spectrometry (GC-MS), using GHB-d6 as internal standard. High concentrations of GHB were detected in urine (3020 mg/L) and gastric contents (71487 mg/L) at admission. After a 6-hours delay, GHB was still present in urine at 2324 mg/L and in blood at 43 mg/L. The clinical symptoms of cocaine intoxication were diminished by GHB consumption, and the cerebral scan was modified. Attention must thus be paid to acute intoxications with surprising clinical symptoms, and GHB has probably to be added to the preliminary toxicological screening. Data available regarding GHB are briefly reviewed, and our results are compared with previously published reports of non-fatal GHB intoxication.

Borders TF; Booth BM; Han X; Wright P; Leukefeld C; Falck RS et al. Longitudinal changes in methamphetamine and cocaine use in untreated rural stimulant users: Racial differences and the impact of methamphetamine legislation. Addiction 103(5): 800-808, 2008. (53 refs.)

Aims: To examine how race and methamphetamine legislation are associated with changes in cocaine and methamphetamine use among untreated rural stimulant users. Design A longitudinal study of stimulant users identified through respondent-driven sampling. Design: Rural areas of three US states. Participants Participants at baseline were current users of methamphetamine and/or cocaine. Measures Self-reports of methamphetamine, crack cocaine and powder cocaine use were assessed at 6-month intervals over a 2-year period. Generalized estimating equations were performed to account for correlations between the repeated measurements. Findings Compared to whites, African Americans were much more likely to use crack cocaine, equally likely to use powder cocaine and much less likely to use methamphetamine. Both whites and African Americans reduced their consumption of methamphetamine and both forms of cocaine over 2 years. Exposure to laws restricting the purchase of over-the-counter cold medications containing methamphetamine precursors was not associated with methamphetamine use, but associated with a slight rise in powder and crack cocaine use. Conclusions: The study yielded disconcerting as well as promising findings regarding the natural history of stimulant use in rural areas. Of some concern is that methamphetamine precursor laws were correlated with increased cocaine consumption, diminishing their net public health benefits. However, despite its insurgence in rural areas of the United States, very few African Americans have initiated methamphetamine use. Regardless of race, many stimulant users stopped using cocaine and methamphetamine without formal substance abuse treatment over 24 months.

Brecht ML; Huang D; Evans E; Hser YI. Polydrug use and implications for longitudinal research: Ten-year trajectories for heroin, cocaine, and methamphetamine users. Drug and Alcohol Dependence 96(3): 193-201, 2008. (53 refs.)

A typical approach to categorizing substance users for epidemiologic purposes or to identify substance use problems at treatment admission is by indicating the primary substance used and/or for which treatment is sought. But does such singular focus on the primary drug limit the validity of conclusions from longitudinal analysis of drug use patterns over time? This analysis combined data from five longitudinal studies conducted in California and examined 10-year patterns of heroin, cocaine, methamphetamine (meth), marijuana, and alcohol use for primary users of heroin (n = 629), cocaine (n = 694), and meth (n = 474). Results suggest relatively low levels of use of non-primary heroin, cocaine, and meth, but moderate levels of alcohol and marijuana use. Growth models showed declining primary drug levels for heroin and meth users and relatively consistent levels over 10 years for cocaine users, while levels of non-primary drugs remained at consistently low levels or declined in tandem with the primary drug. Results indicate that group descriptions of primary heroin, cocaine, or meth use trajectories over time may present valid information about drug use patterns in general.

Buchanan AS; Latkin CA. Drug use in the social networks of heroin and cocaine users before and after drug cessation. Drug and Alcohol Dependence 96(3): 286-289, 2008. (23 refs.)

The present study examined social control processes in drug cessation among adults. Social control theory posits that the association between drug use and the drug use of a person's social network results from an individual seeking out similar peers. The data included 629 individuals who reported past-year heroin or cocaine use at baseline and had follow-up data in a community study in Baltimore, MD. Negative binomial regression modeling indicated that the reduction in social network drug use was significantly greater for quitters than those who did not quit. Compared to non-quitters at baseline, the incidence rate ratio (IRR) of the number of drug-using network members was 0.86 for quitters at baseline, 0.71 for non-quitters at follow-up, and 0.28 for quitters at follow-up (all p < 0.05). These findings support social control theory in adult drug use cessation. Future research should extend the length of follow-up and assess bidirectional influences.

Callaghan RC; Strike C; Kerr T; Fischer B; Buxton J; Stevens E et al. Increasing prevalence of cocaine as the primary detoxification diagnosis among admissions presenting with current intravenous drug use - A review of detoxification records from northern British Columbia, 1999-2005. Canadian Journal of Public Health 99(3): 178-181, 2008. (27 refs.)

Objectives: This study sought to document the trends in drug use among intravenous drug users (IDUs) in northern British Columbia, and to discuss the public health implications. Method: We conducted a 7-year medical-chart review of all IDU-related admissions (n=2072) to an inpatient alcohol and drug cletoxification centre in Prince George, British Columbia. Primary cletoxification diagnosis was modeled onto year of admission using generalized estimating equations (GEE). Results: Our study demonstrated an increasing prevalence of cocaine as the primary cletoxification diagnosis in IDU-related admissions in northern BC, from 32% of all IDU admissions in 1999 to 64% in 2001, and then a relatively steady elevated rate of approximately 60% between 2001-2005. Conclusions: Given that needle exchange programs and other harm reduction services for IDUs in British Columbia are not readily available in many northern and rural areas, the risks associated with intravenous cocaine use among northern IDUs represent a serious public health challenge. Tailored harm reduction strategies should take into account the prominence of intravenous cocaine use as an HIV risk factor. In areas without well-established intravenous drug use monitoring programs, such as rural and remote areas, cletoxification treatment records may serve as important sentinels for changing drug use patterns among IDUs.

Campbell G; Degenhardt L. Australian Capital Territory Drug Trends 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 269. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (26 refs.)

This report reports data on the use of illicit drugs in ACT, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, and antidepressants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 94 figures and tables.

Carmona CGH; Barros RS; Tobar JR; Canobra VH; Montequin EA. Family functioning of out-of-treatment cocaine base paste and cocaine hydrochloride users. Addictive Behaviors 33(7): 866-879, 2008. (50 refs.)

Knowledge of family structure and behavioral dynamics of out-of-treatment drug users under poverty becomes relevant, because of the role that the family plays in drug use and rehabilitation. Hypotheses: 1. The perception of drug users about their family functioning reveals a dysfunctional organization and communication-connection problems with their families; and 2. the family system of cocaine base paste (CBP) users presents greater dysfunctionality than cocaine hydrochloride (CH) users. Method: Cross-sectional descriptive design of primary users of CH (n=236) and primary users of CBP (n=231) during the last month, out-of-substance abuse treatment during the last 6 months. Instruments: Risk Behavior Questionnaire and How-Is-Your-Family Questionnaire. Results: The total sample presented 72.9% of families with risk functioning; CBP users registered a more deteriorated family structure and communication-connection than CH users. Conclusions: CBP and CH users, who are hidden from health treatment services, do indeed present a high degree of family dysfunction; and the CBP group, compared to the CH group, presented various indicators of greater risk in their family dysfunction.

Casale JF; Boudreau DK; Jones LM. Tropane ethyl esters in illicit cocaine: Isolation, detection, and determination of new manufacturing by-products from the clandestine purification of crude cocaine base with ethanol. Journal of Forensic Sciences 53(3): 661-667, 2008. (10 refs.)

Seven ethyl homologues of known tropane esters have recently been detected as impurities in the gas chromatographic signature profiles of authentic Peruvian illicit cocaine base and hydrochloride exhibits. Peruvian cocaine base processors are now known to use ethanol for the purification of crude cocaine base. This process is referred to as the "base lavada" or "washed base" process and is a recent substitute method for the potassium permanganate oxidation purification methodology. Seven ethyl ester homologues were formed in illicit cocaine from the transesterification of known tropane methyl esters or possibly ethyl esterification of their respective tropane C-2 carboxylic acids in the presence of ethanol. Exhibits containing these compounds were subjected to gas chromatographic-mass spectrometric analyses to determine their identity and were subsequently synthesized to verify their structures. Quantitative determinations were obtained from ion-pair chromatography isolation followed by gas chromatography with flame ionization detection. Specifically, hexanoylecgonine ethyl ester, cocaethylene, cis-cinnamoylecgonine ethyl ester, trans-cinnamoylecgonine ethyl ester, 3',4',5'-trimethoxybenzoylecgonine ethyl ester, cis-3',4',5'-trimethoxycinnamoylecgonine ethyl ester, and trans-3',4',5'-trimethoxycinnamoylecgonine ethyl ester were detected and characterized. When present, these compounds were detected at levels ranging from 8.6 x 10(-4) to 9.3 x 10(-1)% relative to cocaine.

Chao C; Jacobson LP; Tashkin D; Martinez-Maza O; Roth MD; Margolick JB et al. Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men. Drug and Alcohol Dependence 94(1/3): 165-171, 2008. (38 refs.)

The effects of recreational drugs on CD4 and CD8 T cells in humans are not well understood. We conducted a longitudinal analysis of men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study (MACS) to define associations between self-reported use of marijuana, cocaine, poppers and amphetamines, and CD4 and CD8 T cell parameters in both HIV-uninfected and HIV-infected MSM. For the HIV-infected MSM, we used clinical and laboratory data collected semiannually before 1996 to avoid potential effects of antiretroviral treatment. A regression model that allowed random intercepts and slopes as well as autoregressive covariance structure for within subject errors was used. Potential confounders adjusted for included length of follow-up, demographics, tobacco smoking, alcohol use, risky sexual behaviors, history of sexually transmitted infections, and antiviral therapy. We found no clinically meaningful associations between use of marijuana, cocaine, poppers, or amphetamines and CD4 and CD8 T cell counts, percentages, or rates of change in either HIV-uninfected or -infected men. The regression coefficients were of minimum magnitude despite some reaching statistical significance. No threshold effect was detected for frequent (at least weekly) or continuous substance use in the previous year. These results indicate that use of these substances does not adversely affect the numbers and percentages of circulating CD4 or CD8 T cells in either HIV-uninfected or -infected MSM.

Ch'ng CW; Fitzgerald M; Gerostamoulos J; Cameron P; Bui D; Drummer OH et al. Drug use in motor vehicle drivers presenting to an Australian, adult major trauma centre. Emergency Medicine of Australasia 19(4): 359-365, 2007. (25 refs.)

Objectives: To determine the drug use in injured Victorian drivers involved in motor vehicle collisions and subsequently transported to a major adult trauma centre in Victoria. Methods: A blood sample was obtained from patients who had been taken to The Alfred Emergency & Trauma Centre (Prahran, Vic., Australia) following a motor vehicle collision. This was performed at the same time and under the same law as compulsory blood screening in Victoria (Section 56 of the Road Safety Act). Four hundred and thirty-six specimens were analysed. Blood stored in vacutainer tubes containing preservative were screened for drugs using enzyme-linked immunosorbent assay and gas chromatography-mass spectometry analysis. Medically administered drugs were excluded from the results. Results: Four hundred and thirty-six specimens were analysed. Metabolites of cannabis were the most commonly found drug (46.7%), the active form of cannabis (Delta 9-tetrahydrocannabinol) was found in 33 specimens (7.6%). The next most prevalent drugs were benzodiazepines (15.6%), opiates (11%), amphetamines (4.1%) and methadone (3%). Cocaine was detected in 1.4% of cases. Of the motor vehicle collisions 66% involved males and females of 15-44 years old and Delta 9-tetrahydrocannabinol was almost exclusively found in this age group. In motor vehicle collisions involving older drivers there was an increasing use of benzodiazepines. In women > 65 years old 30% were positive for benzodiazepines. Conclusions: Drug usage found in this group of injured drivers was disturbingly high. The introduction of further initiatives to decrease the prevalence of drug use in motor vehicle drivers is required.

Clatts MC; Giang LM; Goldsamt LA; Yi H. Male sex work and HIV risk among young heroin users in Hanoi, Vietnam. Sexual Health 4(4): 261-267, 2007. (25 refs.)

The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.

Cohen M; Nabili V; Chhetri DK. Palatal perforation from cocaine abuse. (editorial). Ear, Nose & Throat Journal 87(5): 262-262, 2008. (4 refs.)

Cole JC; Goudie AJ; Field M; Loverseed AC; Charlton S; Sumnall HR. The effects of perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases. Drug and Alcohol Dependence 94(1/3): 183-190, 2008. (32 refs.)

Previous research has indicated that non-dependent polydrug users are willing to pay more money to buy good quality drugs as their income increased. This study sought to examine whether altering the perceived quality of controlled drugs would affect drug purchases if the monetary price remained fixed. A random sample of 80 polydrug users were recruited. All participants were administered an anonymous questionnaire consisting of the Drug Abuse Screening Test for Adolescents (DAST-A), the Severity of Dependence Scale for cannabis (SDS), the,Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression Scale (HADS), and questions about their drug use. Participants then completed a simulation of controlled drug purchases where the price of alcohol, amphetamine, cannabis, cocaine, and ecstasy remained the same but their perceived quality changed (i.e. unit price increased as the perceived quality decreased). The demand for alcohol was quality inelastic and alcohol quality had no effects on the purchase of any other controlled drug. Demand for cannabis was quality elastic and alcohol substituted for cannabis as its unit price increased. Demand for cocaine was quality elastic and alcohol, cannabis, and ecstasy substituted for cocaine as its unit price increased. Demand for ecstasy was quality elastic and alcohol and cocaine both substituted for ecstasy as its unit price increased. These results suggest that perceived quality influences the demand for controlled drugs and that monitoring the perceived quality of controlled drugs may provide a warning of potential public health problems in the near future.

Colzato LS; Hommel B. Cannabis, cocaine, and visuomotor integration: Evidence for a role of dopamine D1 receptors in binding perception and action. Neuropsychologia 46(5): 1570-1575, 2008. (31 refs.)

The primate cortex represents and produces events in a distributed way, which calls for a mechanism that integrates their features into coherent structures. Visuomotor integration seems to be driven by dopaminergic (DA) pathways but which subsystems are involved is currently unknown. The present study compared the impact of the recreational use of two drugs on visuomotor integration: cannabis, which primarily targets dopaminergic D1 receptors, and cocaine, which mainly targets D2 receptors. Our findings show that cannabis but not cocaine use affects the strength of the binding between task-relevant stimulus features and the accompanying response. In contrast, cocaine but not cannabis use eliminates the inhibition of return. The observed pattern suggests that visuomotor integration is driven by DA/D1, but not DA/D2 receptor systems.

Comer SD; Ashworth JB; Foltin RW; Johanson CE; Zacny JP; Walsh SL. The role of human drug self-administration procedures in the development of medications. Drug and Alcohol Dependence 96(1-2): 1-15, 2008. (116 refs.)

The purpose of this review is to illustrate the utility and value of employing human self-administration procedures in medication development, including abuse liability assessments of novel medications and evaluation of potential pharmacotherapies for substance use disorders. Traditionally, human abuse liability testing has relied primarily on subjective reports describing drug action by use of questionnaires; similarly, drug interactions between putative treatment agents and the drugs of abuse have relied on these measures. Subjective reports are highly valued because they provide qualitative and quantitative information about the characteristics of central and peripheral pharmacodynamic effects as well as safety and tolerability. However, self-administration procedures directly examine the behavior of interest-that is, drug taking. The present paper (1) reviews the most commonly used human self-administration procedures, (2) discusses the concordance of subjective reports and self-administration within the context of medications development for substance use disorders, focusing primarily on illustrative examples from development efforts with opioid and cocaine dependence, and (3) explores the utility of applying self-administration procedures to assess the abuse liability of novel compounds, including "abuse-deterrent" formulations (ADFs). The review will focus on opioid and cocaine dependence because a rich database from both clinical laboratory and clinical trial research exists for these two drug classes. The data reviewed suggest that drug-induced changes in self-administration and subjective effects are not always concordant. Therefore, assessment of self-administration in combination with subjective effects provides a more comprehensive picture that may have improved predictive validity for translating to the clinical setting.

Cox S; Posner SF; Kourtis AP; Jamieson DJ. Hospitalizations with amphetamine abuse among pregnant women. Obstetrics and Gynecology 111(2 (Part 1)): 341-347, 2008. (30 refs.)

OBJECTIVE: To examine trends in pregnancy hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. METHODS: Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse hospitalizations were compared with cocaine-abuse hospitalizations and non-substance-abuse hospitalizations. A chi(2) analysis was used to compare hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. RESULTS: From 1998 to 2004, the hospitalization ratio for cocaine abuse decreased 44%, whereas the hospitalization ratio for amphetamine abuse doubled. Pregnancy hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non-substance-abuse hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non-substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. CONCLUSION: As pregnancy hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population.

Crits-Christoph P; Gibbons MBC; Gallop R; Ring-Kurtz S; Barber JP; Worley M et al. Supportive-expressive psychodynamic therapy for cocaine dependence: A closer look. Psychoanalytic Psychology 25(3): 483-498, 2008. (41 refs.)

Using data from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, this article focuses on the outcomes of patients who received supportive-expressive (SE) psychodynamically oriented psychotherapy (plus group drug counseling; GDC). Short-term SE for cocaine dependent individuals, while not the most efficacious treatment examined in the study (individual drug counseling [IDC] plus GDC was), produced large improvements in cocaine use. In addition, there was evidence that SE was superior to IDC on change in family/social problems at the 12-month follow-up assessment, particularly for those patients with relatively more severe difficulties in this domain at baseline. For patients who achieved abstinence early in treatment, SE produced comparable drug use outcomes to IDC, with mean drug use scores numerically lower for SE at all of the follow-up assessments (9, 12, 15, and 18 months). SE patients who achieved initial abstinence decreased cocaine use from a mean 10.1 day per month at baseline to a mean of 1.3 days at 12 months.

Crouch DJ; Walsh JM; Cangianelli L; Quintela O. Laboratory evaluation and field application of roadside oral fluid collectors and drug testing devices. Therapeutic Drug Monitoring 30(2): 188-195, 2008. (16 refs.)

This study was a part of a collaborative U.S./E.U. international research effort (Roadside Testing Assessment, ROSITA 111) to assess illegal drug use among motor vehicle operators suspected of driving while under the influence of drugs and to evaluate the effectiveness of point-of-collection oral fluid drug detection technologies. A goal of the study was to assess commercial oral fluid drug testing devices for potential use in law enforcement. Ten devices were evaluated in the laboratory for their ability to meet manufacturers' claimed (and proposed) cutoff concentrations for the detection of amphetamine(s), cocaine/metabolite, opiates, cannabinoids, and benzodiazepines (2 devices). The field study portion of the research was conducted in major cities in the United States and Western Europe by teams of scientists working in collaboration with the local police. In Salt Lake City, Utah, the Drugwipe, Securetec, Ottobrunn, Germany (Securetec) oral fluids drug testing device was also evaluated in the field by testing suspected drug-impaired drivers. During the initial phase of the field study, 40 subjects were recruited. Drugwipe results were compared with laboratory-based immunoassay and mass spectrometry results and demonstrated that calculated sensitivities were between 75% and 100% depending on drug class. Specificities varied from 36% for cannabinoids to over 95% for opiates. During the second phase of the field study, 267 subjects were recruited. The Drugwipe sensitivities were 36.4%, 35.9%, 42.9%, and 7.7%, respectively, for amphetamine(s), cocaine, opiates, and cannabinoids. The Drugwipe specificifies were 99.2%, 97.4%, 99.6%, and 99.6%, respectively, for amphetamine(s), cocaine, opiates, and cannabinoids. Drugwipe failed to meet the study criteria for acceptable device performance, required performance sensitivities, and specificifies 90% or greater.

Cunningham R; Walton MA; Tripathi SP; Outman R; Murray R; Booth BM. Tracking inner city substance users from the emergency department: How many contacts does it take? Academic Emergency Medicine 15(2): 136-143, 2008. (34 refs.)

Background: Longitudinal studies of substance users report difficulty in locating and completing 12-month interviews, which may compromise study validity. Objectives: This study examined rates and predictors of contact difficulty and in-person follow-up completion among patients presenting with cocaine-related chest pain to an inner-city emergency department (ED). The authors hypothesize that less staff effort in contacting patients and lower follow-up rates would bias subsequent substance use analysis by missing those with heavier substance misuse. Methods: A total of 219 patients aged 19 to 60 years (65% males; 78% African American) with cocaine-related chest pain were interviewed in the ED and then in person at 3, 6, and 12 months. Demographics, substance use measures, and amount/type of research staff contacts (telephone, letters, home visits, and locating patient during return ED visits) were recorded. Poisson and negative binomial regression analyses were conducted to predict quantity of patient contacts for the 12-month follow-up. Results: Interview completion rates at 3, 6, and 12 months were 78, 82, and 80%, respectively. Average contact attempts to obtain each interview were 10 at 3 months (range 3-44), 8 at 6 months (1-31), and 8 at 12 months (1-49); 13% of patients required a home visit to complete the 12-month interview. Participants requiring more contact attempts by staff were younger and reported more frequent binge drinking at baseline (p < 0.05), but were less likely to meet criteria for substance abuse or dependence (p < 0.5), or to report prior mental health treatment (p < 0.05). Comparisons of parallel regressions predicting contact difficulty based on the entire sample, the low-effort group, and the difficult-to-reach group showed variation in findings. Conclusions: This study demonstrates that substantial staff effort is required to achieve adequate retention over 12 months of patients with substance misuse. Without these extensive efforts at follow-up, longitudinal analyses may be biased.

Czoty PW; Gage D; Nader SH; Reboussin BA; Bounds M; Nader MA. PET imaging of dopamine D2 receptor and transporter availability during acquisition of cocaine self-administration in rhesus monkeys. Journal of Addiction Medicine 1(1): 33-39, 2007. (30 refs.)

Previous studies have demonstrated that cocaine use alters availability of brain dopamine D2 receptors (D2R) and transporters (DAT). The present study examined the effects of low doses of cocaine on this neuroadaptation. Using positron emission tomography (PET), D2R and DAT availability in the caudate nucleus (Cd), putamen (Pt), anterior cingulate cortex (ACC), and amygdala (AMY) were assessed before and after monkeys acquired cocaine self-administration. Twelve rhesus monkeys were trained to self-administer intravenous cocaine (0.03 mg/kg per injection) under conditions that resulted in low drug intakes. PET scans using radiotracers targeting D2R ([18F]fluoroclebopride, FCP) or DAT ([18F]-(+)-N-(4-fluorobenzyl)-2[beta]-propanoyl-3[beta]-(4-chlorophenyl)tropane, FCT) were performed when monkeys were cocaine naive and after 9 weeks of self-administration. Before self-administration, D2R availability was significantly higher only in left vs. right Cd, whereas DAT availability was higher in left vs. right Cd, Pt, and ACC. Nonetheless, after cocaine exposure, left-right differences in D2R were apparent in 3 of 4 regions, but only in the ACC for DAT availability. Self-administration of this dose of cocaine did not significantly affect DAT availability in any region and only decreased D2R availability in the ACC. These results demonstrate lateralization of D2R and DAT availability in brain areas that mediate cocaine self-administration, even under conditions in which cocaine does not affect overall receptor availability.

Dattilo PB; Nordin C; Hailpern SM. Beta-blockers following cocaine use: A reappraisal - Reply. (letter). Annals of Emergency Medicine 52(1): 89-90, 2008. (0 refs.)

Dave D. Illicit drug use among arrestees, prices and policy. Journal of Urban Economics 63(2): 694-714, 2008. (29 refs.)

Prior studies, by relying on nationally representative surveys, have overlooked the important fact that use of addictive substances is not uniformly distributed; subgroups of hardcore users account for most of the drug consumption. This study employs the Arrestee Drug Abuse Monitoring system to analyze the demand for cocaine and heroin by urban arrestees, employing objective indicators of use based on urinalysis. The data are repeated city cross sections, and panel data methodology is employed to account for endogeneity. Cocaine and heroin prices have a negative effect on the probability of use even among this group of heavy users. Results indicate that subjective, self-reported measures of participation are likely to be under-reported, which may impart bias to estimates of the price elasticity. The own-price cocaine participation elasticity is about -0.15, and the own-price heroin participation elasticity is about -0.10 for arrestees. This contemporaneous elasticity understates the full effect, and the long-run price elasticity is about twice the magnitude. The magnitude of the price response is substantially smaller relative to the estimates in the prior literature, and calculations suggest that further enforcement and interdiction-driven increases in drug prices may not be cost-effective.

Davey-Rothwell MA; Kuramoto SJ; Latkin CA. Social networks, norms, and 12-step group participation. American Journal of Drug and Alcohol Abuse 34(2): 185-193, 2008. (22 refs.)

In a sample of active drug users, we assessed the associations between frequency of attending a 12-step program, perceived social norms, and social network structure. Participants who reported that most or all of their drug partners attended 12-step groups were over ten times more likely to be frequent attenders compared to individuals who did not go to Narcotics Anonymous (NA). While social network structure of number of cocaine and heroin users and number of members in treatment was associated with frequent attendance, there was no association among individuals who infrequently went to a 12-step program. Individuals who are trying to control their drug use should be encouraged to affiliate with others in recovery or attending a 12-step program.

de Graaff B; Bruno R. Tasmanian Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 273. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (70 refs.)

This report reports data on the use of illicit drugs in Tasmania, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 135 figures and tables.

de Kloet ER; de Jong IEM; Oitzi MS. Neuropharmacology of glucocorticoids: Focus on emotion, cognition and cocaine. (review). European Journal of Pharmacology 585(2/3): 473-482, 2008. (103 refs.)

Hormone pharmacology has been quite interesting in The Netherlands the past century and this contribution is dedicated to the glucocorticoid hormones underlying adaptation to stress. The story starts in 1936 with Tadeus Reichstein and Ernst Laqueur who discovered corticosterone at the time Hans Selye formulated the stress concept. Today highly sophisticated technologies help to unravel the action mechanism of the glucocorticoids from gene to behaviour. In today's concept glucocorticoids coordinate in concert with other stress mediators the initial stress reactions with the management of later adaptations. Glucocorticoids modulate early life programming of stress reactivity and are a significant factor in brain plasticity underlying adaptation, the aging process and vulnerability to disease. Here we focus on the role of glucocorticoids in emotions, cognitive performance and behavioural sensitisation to cocaine.

de Wit M; Gennings C; Zilberberg M; Burnham EL; Moss M; Balster RL. Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients. Addiction 103(9): 1500-1508, 2008. (37 refs.)

Aims: Alcohol use disorders increase the need for mechanical ventilation (MV) in critically ill medical, surgical and trauma patients. Studies examining other drug use disorders (DUD) in trauma patients have not demonstrated heightened rates of intensive care unit (ICU) complications. Patients with asthma and concurrent cocaine or heroin use disorders have an increased need for MV. The objective of this study is to determine if the presence of DUD and drug withdrawal syndromes are associated with increased need for MV in medical patients. Design: Analysis of a national database. Setting: The Nationwide Inpatient Sample, the largest all-payer in-patient database was utilized for the years 2002-2004. Participants Adult patients with one of the six common diagnoses associated with medical ICU admission were included. Intervention None. Measurements Univariate analysis and multivariate logistic regression were performed to determine if DUD and drug withdrawal were associated independently with the use of MV. Findings: A total 1,218,875 patients fulfilled one of the six diagnoses; 22,827 (1.9%) had DUD, and 102,841 (8.4%) underwent MV. Independent of the medical diagnosis, DUD was associated with an increased risk for requiring MV by univariate analysis (relative risk = 1.50, P < 0.0001). By multivariate analyses, sedative and cocaine use disorders remained associated with increased need for MV. Independent of medical diagnosis and substance, drug withdrawal was associated with increased odds of MV by both univariate and multivariate analysis (odds ratio = 2.94, P < 0.0001). Conclusions: DUD are associated with increased need for MV in medical patients. This study demonstrates the importance of screening all medical patients for DUD.

Denton JS; Donoghue ER; McReynolds J; Kalelkar MB. An epidemic of illicit fentanyl deaths in Cook County, Illinois: September 2005 through April 2007. Journal of Forensic Sciences 53(2): 452-454, 2008. (14 refs.)

Between September 2005 and April 2007, 350 fentanyl intoxication deaths were investigated and certified by the Cook County Medical Examiners Office. Investigations revealed that the majority of these fatalities were by intravenous injection of a white powder followed by a rapid collapse. The fentanyl was clandestinely produced in a lab in Toluca, Mexico and sold by the Mickey Cobra street gang. The term "Drop Dead" was coined for this "tainted heroin." Postmortem samples were screened by ELISA and confirmed by standard GC-MS methods. Fentanyl fatalities peaked at 47 per month in May and June 2006. Fifty-two percent were single fentanyl intoxications, with the remainder accompanied by either cocaine, morphine from heroin, or alcohol. This epidemic stressed the limited resources of the toxicology laboratory and autopsy service of the Medical Examiners Office. The clandestine lab was terminated, distributing gang members and leaders arrested, and the epidemic ceased in April 2007.

Dolan SL; Martin RA; RohsenoW DJ. Self-efficacy for cocaine abstinence: Pretreatment correlates and relationship to outcomes. Addictive Behaviors 33(5): 675-688, 2008. (62 refs.)

Little research has been conducted on the relationship of self-efficacy at treatment entry to individual differences or to treatment outcome for patients with cocaine dependence. Those relationships were examined in 163 cocaine-dependent patients in a residential treatment program using two measures of self-efficacy administered in the first week of treatment: beliefs about success in quitting in general and confidence about not using in 11 cocaine-specific high-risk situations. The most robust correlates of self-efficacy were greater desire to stop using and lower urge to use in high-risk situations. Age, depressive symptoms, cognitive functioning, recent substance use, and past success with quitting also correlated with self-efficacy. Both measures of self-efficacy predicted quantity and frequency of cocaine use and abstinence at 3 but not 6 months after treatment after controlling pretreatment cocaine use. Results suggest that treatments should target self-efficacy in cocaine-dependent patients.

Draus PJ; Carlson RG. Change in the scenery: An ethnographic exploration of crack cocaine use in rural Ohio. Journal of Ethnicity in Substance Abuse 6(1): 81-107, 2007

Though still largely perceived as an "inner city" drug, crack cocaine has become increasingly available in many areas of the United States. However, little research has been conducted on the phenomenon of crack cocaine use outside of urban areas. This paper draws on qualitative interviews with 50 recent and former crack-cocaine users to explore patterns of use and distribution in three counties in rural Ohio. The findings show that variable patterns of crack use previously documented among urban crack users are evident in rural areas as well, though these are modified by the context of the rural small town. It is postulated that local social networks are the primary means by which these patterns are both transmitted and translated. Implications of these exploratory findings and possible directions for future research are discussed.

Ersche KD; Roiser JP; Robbins TW; Sahakian BJ. Chronic cocaine but not chronic amphetamine use is associated with perseverative responding in humans. Psychopharmacology 197(3): 421-431, 2008. (66 refs.)

Rationale: Chronic drug use has been associated with increased impulsivity and maladaptive behaviour, but the underlying mechanisms of this impairment remain unclear. We investigated the ability to adapt behaviour according to changes in reward contingencies, using a probabilistic reversal-learning task, in chronic drug users and controls. Materials and methods: Five groups were compared: chronic amphetamine users (n = 30); chronic cocaine users (n = 27); chronic opiate users (n = 42); former drug users of psychostimulants and opiates (n = 26); and healthy non-drug-taking control volunteers (n = 25). Participants had to make a forced choice between two alternative stimuli on each trial to acquire a stimulus-reward association on the basis of degraded feedback and subsequently to reverse their responses when the reward contingencies changed. Results Chronic cocaine users demonstrated little behavioural change in response to the change in reward contingencies, as reflected by perseverative responding to the previously rewarded stimulus. Perseverative responding was observed in cocaine users regardless of whether they completed the reversal stage successfully. Task performance in chronic users of amphetamines and opiates, as well as in former drug users, was not measurably impaired. Conclusion: Our findings provide convincing evidence for response perseveration in cocaine users during probabilistic reversal-learning. Pharmacological differences between amphetamine and cocaine, in particular their respective effects on the 5-HT system, may account for the divergent task performance between the two psychostimulant user groups. The inability to reverse responses according to changes in reinforcement contingencies may underlie the maladaptive behaviour patterns observed in chronic cocaine users but not in chronic users of amphetamines or opiates.

Fasano A; Barra A; Nicosia P; Rinaldi F; Bria P; Bentivoglio AR et al. Cocaine addiction: From habits to stereotypical-repetitive behaviors and punding. Drug and Alcohol Dependence 96(1-2): 178-182, 2008. (14 refs.)

"Punding" is a stereotypical motor behavior characterized by an intense fascination with repetitive handling and examining of objects. Since its first description in amphetamine and cocaine addicts, data on punding has only derived from studies performed in patients with Parkinson's disease (PD). Punding is classifiable as the most severe form of Repetitive Reward-Seeking Behaviours (RRSB) syndromes. The aim of this study was to investigate the occurrence and phenomelogy of RRSB acutely induced by cocaine in order to determine the prevalence, severity and distinctive features discriminating "punders" from "non-punders". A consecutive sample of 50 cocaine addicts received a clinical psychiatric interview. RRSB diagnosis and severity were assessed using a modified version of a previous published questionnaire designed to identify punding in patients with PD. In the present series, 38% of the cocaine addicts met the proposed diagnostic criteria for a RRSB and 8% were considered punders. Subjects with vs. without RRSB did not differ in terms of sex ratio, age, education, occupation, predisposing habits, duration of cocaine use, hours of sleep, comorbid psychiatric disorders, and concomitant use of other drugs. These results and the observation that in the majority of cases RRSB started soon after first drug intake, strongly suggest that an underlying unknown predisposition led to the development of these behaviors. In conclusion, RRSB and punding is much more common than has been described previously and the resultant social disability is often overlooked.

Featherston J; Lenton S. Western Australia Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 268. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (22 refs.)

This annual survey reports data on the use of illicit drugs in Western Australia. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs. For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 77 figures and tables.

Foroud T; Wetherill LF; Kramer J; Tischfield JA; Nurnberger JI; Schuckit MA et al. The tachykinin receptor 3 is associated with alcohol and cocaine dependence. Alcoholism: Clinical and Experimental Research 32(6): 1023-1030, 2008. (40 refs.)

Background: A broad region on chromosome 4q was previously linked to the phenotype of alcohol dependence in the Collaborative Study on the Genetics of Alcoholism sample. A strong positional candidate gene was identified within this region: tachykinin receptor 3 gene (TACR3), which encodes tachykinin receptor 3 (NK3R), the receptor for the tachykinin 3 (neurokinin B) peptide. Pharmacological studies have provided evidence that the administration of NK3R agonists attenuates the intake of alcohol and NK3R can also mediate the acute and chronic behavioral effects of cocaine. Methods: Thirty SNPs were genotyped throughout TACR3. Family based association analysis was performed in 219 European American families to detect an association with alcohol dependence. Subsequent analyses were performed to evaluate the evidence of association with other definitions of alcohol dependence as well as cocaine dependence. Results: Seven of the 9 SNPs in the 3' region of TACR3 provided significant evidence of association with alcohol dependence (p <= 0.05). Further analyses suggest that the evidence of association is strongest among those subjects with more severe alcohol dependence (defined by ICD-10) and those with co-morbid cocaine dependence. Haplotype analyses further strengthen the evidence of association in the 3' region of the gene. Conclusions: These results indicate that sequence variations in TACR3 contribute to the variation in more severe alcohol dependent individuals and those who are also cocaine dependent.

Franken IHA; Dietvorst RC; Hesselmans M; Franzek EJ; de Wetering BJMV; Van Strien JW. Cocaine craving is associated with electrophysiological brain responses to cocaine-related stimuli. Addiction Biology 13(3-4): 386-392, 2008. (28 refs.)

Several studies show that substance dependence disorders are characterized by an enhanced processing of substance-related stimuli. The present study was designed to examine the association between craving levels and selective processing of drug cues in cocaine-dependent patients using event-related brain potentials (ERPs). In abstinent cocaine-dependent patients and a healthy control group, we studied the late positive potential (LPP) amplitudes elicited by neutral and cocaine-related stimuli. The results show that cocaine-dependent patients have an enhanced electrophysiological response in the late LPP time window to cocaine-related stimuli as compared to controls, suggesting an enhanced processing of these stimuli. Most importantly, a robust association was observed between cocaine craving and LPP amplitude. High craving levels were associated with larger LPP amplitudes at central electrode sites in the right hemisphere. These findings are in line with theories linking motivational aspects and appetitive stimulus processing. Furthermore, it is demonstrated that ERPs are a useful index to assess motivational properties of stimuli in cocaine-dependent patients. These findings suggest that electrophysiological measures may have clinical relevance in substance use disorders.

Fung SCA; Chan YC; Lau FL. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. (letter). Annals of Emergency Medicine 52(1): 88-89, 2008. (1 refs.)

Gaither K. Cocaine abuse in pregnancy: An evolution from panacea to pandemonium. (editorial). Southern Medical Journal 101(8): 783-784, 2008. (5 refs.)

Gerra G; Bertacca S; Zaimovic A; Pirani M; Branchi B; Ferri M. Relationship of personality traits and drug of choice by cocaine addicts and heroin addicts. Substance Use & Misuse 43(3/4): 317-330, 2008. (25 refs.)

The link between specific personality profiles and a single psychotropic drug of choice is still unclear and only partially explored. The present study compares three groups of male subjects: 85 patients manifesting heroin dependence (age: 30.07 +/- 2.78), 60 patients manifesting cocaine dependence (age: 31.96 +/- 3.1), and 50 healthy subjects from a random population sample (age: 33.25 +/- 1.45). The patients included in the study showed a long-lasting history of dependence on heroin or cocaine, respectively, 5.2 +/- 2.5 years, 4.6 +/- 2.9 years, and were stabilized in treatment, and abstinent, at least 4 weeks at the time of the diagnostic assessment. Heroin addicts (52.90%) were on methadone maintenance treatment. Cocaine addicts (11.60%) were treated with selective serotonin reuptake inhibitors. Personality traits were measured by the Minnesota Multiphasic Personality Inventory (MMPI-2) and Cloninger's Three-dimensional Personality Questionnaire (TPQ). Character and quantification of aggressiveness were measured by the Buss-Durkee Hostility Inventory (BDHI). Heroin-dependent patients (group A) scored significantly higher on hysteria, masculine-feminine and social introversion subscales of the MMPI, and significantly lower on the harm avoidance (HA) subscale of the TPQ than cocaine addicts. In contrast, scores on the MMPI for hypochondria, psychopathic deviance, and paranoia dimensions were more elevated in cocaine addicts than in heroin-dependent patients. Cocaine addicts scored higher than heroin addicts on the "direct" aggressiveness subscale and on the BDHI total score. Cocaine addicts did not differ from healthy controls on harm avoidance (behavioral control). Although cocaine addicts showed more consistent psychopathic deviance and overt aggressiveness than heroin addicts, higher harm avoidance (behavioral control), hypochondria (or worry about their health), and social extroversion may reduce their proneness to overt antisocial behavior and allow relatively higher levels of social integration. The study's limitations are noted.

Gerra G; Leonardi C; Cortese E; Zaimovic A; Dell'Agnello G; Manfredini M et al. Adrenocorticotropic hormone and cortisol plasma levels directly correlate with childhood neglect and depression measures in addicted patients. Addiction Biology 13(1): 95-104, 2008. (53 refs.)

Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been reported to be involved in vulnerability to alcohol and drug dependence in humans, possibly underlying both addictive behaviour and depression susceptibility. The aim of the present study was to investigate the possible interactions between childhood adverse experiences, depressive symptoms and HPA axis function in addicted patients, in comparison with healthy control. Eighty-two abstinent heroin or cocaine dependent patients and 44 normal controls, matched for age and sex, completed the symptoms Check List-90 (SCL-90), measuring depressive symptoms, and the Childhood Experience of Care and Abuse Questionnaire. Blood samples were collected to determine adrenocorticotropic hormone (ACTH) and cortisol basal plasma levels at 8:00 and 8:30 a.m. Addicted individuals showed significantly higher neglect and depression scores and ACTH-cortisol plasma levels respect to control subjects. Depression scores at SCL-90 in addicted patients positively correlated with plasma ACTH and cortisol values. In turn, plasma ACTH levels were directly associated with childhood neglect measures, reaching statistical significance with 'mother-neglect' scores. Plasma cortisol levels were related to 'father antipathy' among cocaine addicts. These findings suggest the possibility that childhood experience of neglect and poor parent-child attachment may have a persistent effect on HPA axis function as an adult, partially contributing, together with genetic factors and other environmental conditions, to both depressive traits and substance abuse neurobiological vulnerability.

Ghitza UE; Epstein DH; Preston KL. Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Addictive Behaviors 33(4): 593-604, 2008. (39 refs.)

Intravenous drug use is a major vector of HIV transmission. We assessed whether contingency management (CM), in which participants cam reinforcers for drug abstinence, reduces HIV risk behaviors in methadone-maintained opiate- and cocaine-using outpatients. Participants (n = 116) were randomly assigned to prize-based CM or to receipt of prize draws noncontingently on a schedule yoked to the CM group. Both groups received methadone and individual counseling throughout treatment. The HIV-Risk Taking Behaviour Scale was administered in written questionnaire form at 2-week intervals (HRBS; [Darke, S., Hall, W, Heather, N., Ward, J., & Wodak, A. (1991). The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users. AIDS, 5, 181-185]). A mediation analysis was conducted to determine whether abstinence from opiates and cocaine mediated the effect of CM on HRBS scores. Changes in HRBS scores over time differed significantly by treatment (F(9,334)=2.4,p<0.05), with HRBS scores decreasing over time in the CM group to a greater extent than in the noncontingent control group. Participants in the CM group had significantly lower rates of simultaneous cocaine/opiate-positive urine specimens than those in the noncontingent control group during CM treatment (F(1,1 1 1)=6.8, p=0.01). The relationship between treatment condition and HRBS scores was mediated by abstinence. CM targeted toward cocaine and heroin use produces significant reductions in injection-related drug-taking behaviors associated with heightened risk for getting or transmitting HIV.

Glintborg B; Olsen L; Poulsen H; Linnet K; Dalhoff K. Reliability of self-reported use of amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates among acutely hospitalized elderly medical patients. Clinical Toxicology 46(3): 239-242, 2008. (21 refs.)

Background. Undisclosed use of illicit drugs and prescription controlled substances is frequent in some settings. The aim of the present study was to estimate the reliability of self-reported use of amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates among acutely hospitalized medical patients. Methods. Patients admitted to an acute medical department were interviewed about their drug use. Patients provided blood and urine samples for drug analysis. Results of a toxicology screen were compared to self-reported drug use. Toxicology screens positive for drugs not reported during the interview were only considered truly positive after verification by a substance specific analysis. Results. Five hundred patients were included. The median age was 72 years and 298 (60%) were female. In total, 103 patients (21%) reported use of opiates and 65 patients (13%) used benzodiazepines. Only 8 patients reported use of illicit drugs (cannabinoids, 2%). Toxicology analyses were performed in a randomly selected sub-sample of 100 patients. Among 27 patients (27%), the analyses indicated use of one or more drugs, mainly benzodiazepines (15 patients), morphine (12 patients) or cannabinoids (5 patients). Another 6 patients had screenings unexpectedly positive for opiates, but the verification analysis indicated use of codeine-containing drugs. The overall sensitivity of self-reports in detecting drug use was 66%. The negative predictive value of a patient not reporting use of a drug was over 90% for all 7 drug-types screened. Conclusion. Among 100 randomly selected mainly elderly medical patients, undeclared use of illicit drugs was rare. However, some patients underreported use of benzodiazepines and cannabinoids.

Gottfredson DC; Kearley BW; Bushway SD. Substance use, drug treatment, and crime: An examination of intra-individual variation in a drug court population. Journal of Drug Issues 38(2): 601-630, 2008. (64 refs.)

This study examines the association between substance use and crime by modeling change within subjects over an 11 month period in a sample of 157 chronic drug-using offenders. For this sample, increased substance use-cocaine or heroin use as well as alcohol use-was significantly related to increases in self-reports of income generating but not violent crime. The study also demonstrates a significant effect of drug treatment in the last month on income generating crime, but not on violent crime and that the effect of drug treatment on income generating crime is mediated by reductions in drug use. This work refines prior work by showing that drug use effects vary by crime type and by providing further evidence that drug treatment reduces cocaine and heroin use, which leads to a reduction in property crime. It is the first study to examine variability over time in all three components (drug treatment, drug use, and crime) while adequately controlling for individual level propensity variables.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Guindalini C; Laranjeira R; Collier D; Messas G; Vallada H; Breen G. Dopamine-beta hydroxylase polymorphism and cocaine addiction. Behavioral and Brain Functions 4(e-article 1), 2008. (25 refs.)

Cocaine addiction involves a number of medical, psychological and social problems. Understanding the genetic aetiology of this disorder will be essential for design of effective treatments. Dopamine-beta hydroxylase (DbH) catalyzes the conversion of dopamine to norepinephrine and could, therefore, have an influence on both cocaine action and the basal sensitivity of neurotransmitter systems to cocaine. Recently, the - 1021C> T polymorphism have been found to strongly correlated with individual variation in plasma DbH activity. To test the influence of this polymorphism on the susceptibility of cocaine addiction, we decided to genotype it in a sample of 689 cocaine addicts and 832 healthy individuals. Genotypic and allelic analyses did not show any evidence of association with cocaine addiction, even after correcting for the effect of population stratification and other possible confounders. Our results do not support a major role of the - 1021C> T polymorphism or the gene itself in the development of cocaine addiction but further examination of other variants within this gene will be necessary to completely rule out an effect.

Halkitis PN; Palamar JJ. Multivariate modeling of club drug use initiation among gay and bisexual men. Substance Use & Misuse 43(7): 871-879, 2008. (23 refs.)

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a yearlong longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs - cocaine, GHB, ketamine, ecstasy, and methamphetamine - using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.

Hanley MJ; Kenna GA. Quetiapine: Treatment for substance abuse and drug of abuse. American Journal of Health-System Pharmacy 65(7): 611-618, 2008. (59 refs.)

Purpose. The use of quetiapine as a drug to treat various substance use disorders as well as a drug of abuse is examined. Summary. Quetiapine's effectiveness in treating schizophrenia and bipolar disorder is well-known; however, growing evidence has indicated that it may be useful in the treatment of various substance use disorders. Small-scale studies have been conducted to investigate the potential benefit of quetiapine in patients dependent on alcohol, cocaine, and amphetamines. The results of these two studies provide some evidence that quetiapine may benefit patients diagnosed with a mental illness who are also dependent on cocaine, amphetamines, or both, though more rigorous studies are needed. An unforeseen use of antipsychotics, specifically quetiapine, as drugs of abuse has emerged. Since antipsychotics are not classified as controlled substances, the majority of clinicians may not consider the diversion of antipsychotics for recreational purposes, but evidence of this is increasing, particularly in incarcerated individuals. Intravenous quetiapine abuse was first reported in the literature in 2005. Although most cases of quetiapine abuse have been reported in the correctional setting, inappropriate quetiapine use within the community has been documented. Thus far, all of the documented cases have involved patients with a prior history of substance abuse. Clinicians must be cognizant of the potential for quetiapine as a treatment for substance use disorders and as a drug of abuse. Conclusion. Quetiapine is a promising treatment for substance use disorders alone or combined with other psychiatric diagnoses, such as bipolar disorder and schizophrenia. Quetiapine abuse has also been documented, particularly in the correctional setting.

Hanson T; Alessi SM; Petry NM. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Addiction 103(7): 1187-1197, 2008. (46 refs.)

Aim Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment. Design Data were analyzed from a subset of participants in a combined data set of three published randomized controlled trials of CM treatments. Setting A community-based methadone maintenance clinic. Participants One-hundred and sixty-five cocaine-abusing methadone maintenance patients. Intervention Participants received either standard methadone treatment or standard methadone treatment with CM for 3 months. Measurements The HIV Risk Behavior Scale (HRBS) was administered prior to randomization to a study condition and 3 months after the study treatments ended. The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment. Findings Relative to those assigned to standard care, participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors. CM participants also achieved longer durations of consecutive cocaine and opioid abstinence during treatment. Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores. Conclusions These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients.

Hart CL; Haney M; Vosburg SK; Rubin E; Foltin RW. Smoked cocaine self-administration is decreased by modafinil. Neuropsychopharmacology 33(4): 761-768, 2008. (37 refs.)

Modafinil has been reported to reduce cocaine use in a clinical sample of infrequent users (2 days/week), but the effects of modafinil on cocaine self-administration in the laboratory have not been studied. The present study investigated the effects of modafinil maintenance on cocaine self-administration by frequent users (4 days/week) under controlled laboratory conditions. During this 48-day double-blind, crossover design study, the effects of modafinil maintenance (0, 200, and 400 mg/day) on response to smoked cocaine (0, 12, 25, and 50 mg) were examined in nontreatment-seeking cocaine-dependent individuals (n = 8). Cocaine significantly increased self-administration, subjective-effect ratings, and cardiovascular measures; modafinil at both doses (200 and 400 mg/day) markedly attenuated these effects. These findings agree with data from previous human laboratory and clinical investigations of modafinil as a potential cocaine abuse treatment medication. Thus, our data support the potential of modafinil as a pharmacotherapy for cocaine dependence.

Hayaki J; Anderson BJ; Stein MD. Drug use expectancies among nonabstinent community cocaine users. Drug and Alcohol Dependence 94(1/3): 109-115, 2008. (36 refs.)

Previous research has shown that one's expectations about the effects of using a particular substance (i.e., substance use expectancies) are associated with the quantity and frequency of actual use. An extensive literature supports the importance of expectancies in predicting alcohol use, but less is known about the association between expectancies and use of other substances. The purpose of the present investigation was to examine the association between cocaine expectancies and frequency of use in a heterogeneous community sample of drug users. Participants were 157 self-identified primary cocaine users recruited from the community as part of a hepatitis prevention study. Participants completed a structured interview that assessed demographic variables, current and past drug use, and drug expectancies. Results from multivariate logistic regression analyses indicated that frequency of cocaine use was positively associated with higher expectation that drug use would increase social and physical pleasure (OR= 1.67, p < 0.05) and inversely associated with higher expectation that drug use would increase cognitive and physical impairment (OR = 0.59, p < 0.01). These findings suggest that drug use expectancies are an important correlate of cocaine use behavior in nontreatment-seeking community users.

Heffner JL; Blom TJ; Camerota E; Sansone LE; Bodie L; Smith J et al. Interrelated effects of substance use diagnosis, race, and smoking severity on abstinence initiation in dually dependent male smokers: Results of a retrospective chart review. Journal of Addiction Medicine 1(4): 191-197, 2007. (19 refs.)

Purpose: Study goals were 2-fold: 1) to examine differences in demographic and clinical characteristics of smokers who fell into 3 diagnostic groups: alcohol abuse/dependence only (ALC), cocaine abuse/dependence only (COC), and mixed alcohol and cocaine abuse/dependence (ALC + COC); and 2) to determine the degree to which diagnostic grouping predicted short-term abstinence from smoking. Methods: Retrospective chart reviews were conducted by using the treatment records of male veterans (N = 175) who participated in a voluntary smoking cessation program during their stay in residential substance dependence treatment. Results: The ALC group smoked more heavily, had higher levels of nicotine dependence, and reported more emotional problems than the other 2 groups. Short-term abstinence rates were high across the 3 groups (38%, 58%, and 57% for the ALC, COC, and ALC + COC groups, respectively). Lighter smoking at treatment entry, non-white race, and a diagnosis of cocaine abuse/dependence (with or without alcohol abuse/dependence) predicted short-term abstinence in the program. Conclusions: Substance misusers motivated to quit smoking can initiate smoking abstinence at relatively high rates with the aid of combined pharmacotherapy and intensive group counseling. White subjects who smoke more heavily and have a diagnosis of alcohol abuse/dependence only have lower success rates for abstinence initiation.

Hickman TA. The Secret Leprosy of Modern Days: Narcotic Addiction and Cultural Crisis in the United States, 1870-1920. Amherst MA: University of Massachusetts Press, 2007

This book re-examines the notions of addiction in the nineteenth and early twentieth centuries. The case is made that the construct of addiction is as much cultural as it is medical/scientific. It demonstrates how the fears and anxieties about addiction were related to other preoccupations and fears about a changing world. It speaks to the notions of class, race and gender, and how the view of "addict as patient" evolved into the view of "addict as criminal," the latter marked by the passage of the Harrison Narcotics Act of 1914, a view which has prevailed through the rest of the century.

Hill V; Cairns T; Schaffer M. Hair analysis for cocaine: Factors in laboratory contamination studies and their relevance to proficiency sample preparation and hair testing practices. Forensic Science International 176(1): 23-33, 2008. (17 refs.)

Hair samples were contaminated by rubbing with cocaine (COC) followed by sweat application, multiple shampoo treatments and storage. The samples were then washed with isopropanol for 15 min, followed by sequential aqueous washes totaling 3.5 h. The amount of drug in the last wash was used to calculate a wash criterion to determine whether samples were positive due to use or contamination. Analyses of cocaine and metabolites were done by LC/MS/MS. These procedures were applied to samples produced by a U.S. government-sponsored cooperative study, in which this laboratory participated, and to samples in a parallel in-house study. All contaminated samples in both studies were correctly identified as contaminated by cutoff, benzoylecgonine (BE) presence, BE ratio, and/or the wash criterion. A method for determining hair porosity was applied to samples in both studies, and porosity characteristics of hair are discussed as they relate to experimental and real-world contamination of hair, preparation of proficiency survey samples, and analysis of unknown hair samples.

Hser YI; Huang D; Brecht ML; Li LB; Evans E. Contrasting trajectories of heroin, cocaine, and methamphetamine use. Journal of Addictive Diseases 27(3): 13-21, 2008. (29 refs.)

Current literature has shown that heroin addiction is characterized by long periods of regular use persisting over the life course, whereas the course of stimulant use is less understood. The current study examined long-term trajectories of drug use for primary heroin, cocaine (crack/powder cocaine), and methamphetamine (meth) users. The analyses used data from five studies that collected longitudinal information using the Natural History Instrument, including 629 primary heroin users, 694 cocaine users, and 474 meth users. Drug use trajectories over the 10 years since initiation demonstrated the persistence of use over time for all three drugs, with heroin use at the highest level (13 to 18 days per month), cocaine at the lowest level (8 to I I days), and meth in between (approximately 12 days per month). Application of growth mixture models revealed five distinctive groups: Consistently High Use (n = 545), Increasing Use (n = 260), Decreasing Use (n = 254), Moderate Use (n = 638), and Low Use (n = 100). Heroin users were disproportionately overrepresented in the Consistently High Use group and underrepresented in the Low Use group; cocaine and meth users were mostly in the Moderate Use group. Users in the High Use group also had earlier onsets of drug use and crime, longer incarceration durations, and were the least employed. Clinical/service policy and practice need to recognize and adapt to the specific patterns and needs of users of different drugs while being mindful of the stage drug users are at in their life course.

Hyman SM; Paliwal P; Chaplin TM; Mazure CM; Rounsaville BJ; Sinha R. Severity of childhood trauma is predictive of cocaine relapse outcomes in women but not men. Drug and Alcohol Dependence 92(1/3): 208-216, 2008. (61 refs.)

We prospectively examined the gender-specific effects of childhood trauma on cocaine relapse outcomes in an inpatient sample of treatment engaged cocaine dependent adults. Cocaine dependent men (n = 70) and women (n = 54) participating in inpatient treatment for cocaine dependence were assessed on severity of childhood trauma and followed for 90 days after discharge from treatment. Greater severity of childhood emotional abuse was associated with an increased risk of relapse in women. Severity of emotional abuse, sexual abuse, and overall childhood trauma was associated with the number of days cocaine was used during follow-up in women, as was the association of severity of physical abuse and overall childhood trauma with the average amount of cocaine used per occasion. No associations between childhood trauma and cocaine relapse outcomes were found in men. These findings demonstrate that childhood trauma increases the likelihood of cocaine relapse and drug use escalation after initial relapse in women but not in men. Comprehensive assessments of childhood trauma and specialized treatments that address trauma-related pathophysiology could be of benefit in improving cocaine treatment outcomes in women.

Jofre-Bonet M; Petry NM. Trading apples for oranges? Results of an experiment on the effects of heroin and cocaine price changes on addicts' polydrug use. Journal of Economic Behavior & Organization 66(2): 281-311, 2008. (56 refs.)

This paper studies polydrug use patterns in Heroin and Cocaine addicts from experiments measuring drug elasticities during changes in Heroin and Cocaine prices. Heroin addicts' demand for Heroin is inelastic; Cocaine, Marijuana, and Alcohol are complements, and Valium and Cigarettes are substitutes for Heroin. Heroin addicts' demand for Cocaine is inelastic; Marijuana and Valium are substitutes, and Alcohol is a complement. Cocaine addicts' demand for Cocaine is elastic; complements are Heroin and Alcohol, and substitutes are Marijuana and Valium. Cocaine addicts' demand for Heroin is inelastic; Alcohol is a complement while Cocaine, Marijuana and Valium are substitutes.

Jones AW; Holmgren A; Kugelberg FC. Concentrations of cocaine and its major metabolite benzoylecgonine in blood samples from apprehended drivers in Sweden. Forensic Science International 177(2-3): 133-139, 2008. (28 refs.)

Cocaine and its major metabolite benzoylecgonine (BZE) were determined in blood samples from people arrested in Sweden for driving under the influence of drugs (DUID) over a 5-year period (2000-2004). Venous blood or urine if available, was subjected to a broad toxicological screening analysis for cannabis, cocaine metabolite, amphetamines, opiates and the major benzodiazepines. Verification and quantitative analysis of cocaine and BZE in blood was done by gas chromatography-mass spectrometry (GC-MS) at limits of quantitation (LOQ) of 0.02 mg/L for both substances. Over the study period 26,567 blood samples were analyzed and cocaine and/or BZE were verified in 795 cases (3%). The motorists using cocaine were predominantly men (>96%) with an average age of 28.3 +/- 7.1 years ( standard deviation, S.D.). The concentration of cocaine was below LOQ in 574 cases although BZE was determined at mean, median and highest concentrations of 0.19 mg/L, 0.12 mg/L and 1.3 mg/L, respectively. In 221 cases, cocaine and BZE were together in the blood samples at mean and (median) concentrations of 0.076 mg/L (0.05 mg/L) and 0.859 mg/L (0.70 mg/L), respectively. The concentrations of BZE were always higher than the parent drug; mean BZE/cocaine ratio 14.2 (median 10.9) range 1-55. Cocaine and BZE were the only psychoactive substances reported in N = 61 cases at mean (median) and highest concentrations of 0.095 (0.07) and 0.5 mg/L for cocaine and 1.01 (0.70) and 3.1 mg/L for BZE. Typical signs of drug influence noted by the arresting police officers included bloodshot and glossy eyes, agitation, difficulty in sitting still and incoherent speech.

Jumma O; Koulaouzidis A; Ferguson IT. Cocaine-induced spinal cord infarction. (editorial). Postgraduate Medical Journal 84(993): 391-391, 2008. (5 refs.)

Kable JA; Coles CD; Lynch ME; Platzman K. Physiological responses to social and cognitive challenges in 8-year olds with a history of prenatal cocaine exposure. Developmental Psychobiology 50(3): 251-265, 2008. (76 refs.)

Cocaine-exposed infants have been found to have altered arousal responses but little is known about such responses in later childhood. Physiological responses to stressors were used to assess the arousal modulation of school-aged, cocaine-exposed children (n = 73) and two contrast groups, socioeconomically-matched controls (n = 58) and children with behavioral disturbance (n = 35). The behaviorally disturbed group had the highest heart rate across conditions but demonstrated a pattern of hyporesponsiveness to the stressors. They had the smallest decrement in skin conductance response at baseline and the least recovery of skin conductance response following exposure to stressors. Cocaine-exposed children demonstrated greater acceleratory responses to the stressors as indexed by their skin conductance level and were intermediate between the socioeconomically-matched controls and children with behavioral disturbance in recovery of skin conductance response following stressors. Altered arousal responses associated with prenatal cocaine exposure persisted into middle childhood but were different from those found in behaviorally disturbed children.

Kanneganti P; Nelson RA; Boyd SJ; Ziegelstein RC; Gorelick DA. Exercise stress testing in recently abstinent chronic cocaine abusers. American Journal of Drug and Alcohol Abuse 34(4): 489-498, 2008. (19 refs.)

We compared treadmill exercise stress testing (EST) in 28 medically screened, chronic cocaine users with the cardiovascular effects of an IV cocaine challenge (25 mg or 50 mg). All subjects had a clinically normal EST and echocardiography (except 2 subjects had septal wall hypokinesis). The EST produced significantly greater increases in heart rate and rate-pressure product than did the cocaine challenges. These findings suggest that EST may not provide additional diagnostic information in medically screened cocaine users. EST may cause more cardiac work (indicated by heart rate and blood pressure) than intravenous cocaine (at the doses in this study).

Kaufman MJ; Streeter CC; Barros TL; Sarid-Segal O; Afshar M; Tian H et al. Reduced plasma nitric oxide end products in cocaine-dependent men. Journal of Addiction Medicine 1(2): 96-103, 2007. (85 refs.)

Chronic cocaine abusers experience brain and peripheral vascular dysfunction, the severity of which tends to be greater in men than women. The mechanisms underlying these effects of cocaine are unknown. Because nitric oxide (NO) abnormalities play key roles in development of vascular dysfunction in several disorders, we determined whether vascular nitric oxide end product (NOx) levels, which can serve as markers of systemic vascular NO production, are reduced in cocaine-dependent (CD) subjects. Plasma samples from 24 CD men, 12 CD women, and matched comparison subjects (19 men, 14 women) were analyzed with a Sievers 280i nitric oxide chemiluminescence detection analysis system. NOx levels in comparison in women and men were 24.9 +/- 6.6 and 23.3 +/- 5.7 [mu]mol/L, and in CD women and men were 22.5 +/- 8.4 and 13.0 +/- 9.6 [mu]mol/L, respectively. ANCOVA analysis, adjusted for lifetime smoking, indicated group (P < 0.0005) and sex (P = 0.04) effects, both of which survived posthoc Scheffe tests. Reduced NOx levels in CD men drove the group difference. These data suggest that chronic cocaine abuse is associated with reduced NOx levels in men, although the finding also may be attributable to factors indirectly related to cocaine abuse, including cohort differences in other drug use or lifestyle factors. These findings warrant additional studies to more directly characterize vascular NO turnover in cocaine abusers and to establish whether NO abnormalities contribute to cocaine-associated vascular dysfunction and to sex differences in cocaine's effects.

Kelley BJ; Yeager KR; Pepper TH; Bornstein RA; Beversdorf DQ. The effect of propranolol on cognitive flexibility and memory in acute cocaine withdrawal. Neurocase 13(5-6): 320-327, 2007. (46 refs.)

Upregulated noradrenergic activity occurs early in cocaine withdrawal. Our previous work revealed impaired cognitive flexibility in acute cocaine withdrawal, a cognitive domain that appears to be modulated by noradrenergic activity. Therefore, we wished to determine the effect of beta-adrenergic antagonists on cognitive performance in acute cocaine withdrawal. Eleven subjects acutely withdrawing from cocaine were tested in this pilot study on tasks of cognitive flexibility as well as word fluency, attention, verbal memory, and spatial memory, off and on propranolol in a double-blinded manner. Propranolol significantly benefited certain aspects of cognitive flexibility in acute cocaine withdrawal, and improved some measures of verbal fluency and verbal recall. Cocaine withdrawal treatment is characterized by high failure rates. Further research is needed to determine the role this finding of a reversible cognitive impairment in cocaine withdrawal has in treatment.

Kennedy A; Wood AE; Saxon AJ; Malte C; Harvey M; Jurik J et al. Quetiapine for the treatment of cocaine dependence - An open-label trial. Journal of Clinical Psychopharmacology 28(2): 221-224, 2008. (23 refs.)

The monaminergic properties of second generation antipsychotics are prompting research on their use to treat cocaine dependence, with inconclusive results to date. In preliminary reports, the atypical antipsychotic quetiapine has shown promise for the treatment of substance abuse disorders. The primary objective of the current study was to assess the efficacy of quetiapine in reducing cocaine cravings and use in nonpsychotic subjects with cocaine dependence over 6 weeks of open-label treatment. Twenty-two cocaine-dependent, nonpsychotic men were initiated to open-label treatment with quetiapine (300-600 mg/d). The primary outcome measure was weekly self-report of cocaine cravings as assessed with the Brief Substance Craving Scale. Cocaine use was captured with a self-report Timeline Follow-back calendar, administered every 2 weeks. Side effect monitoring was conducted weekly, and movement disorders were assessed every 2 weeks. Intent-to-treat regression analyses (n = 22) indicated that the Brief Substance Craving Scale total score decreased significantly overtime (P < 0.001). Self-reports also suggested decreased cocaine use. There was no treatment-related increase in movement disorders, and most side effects were mild. However, all subjects did experience sedation, and several subjects dropped out because of it. What is more, weight increased significantly over time (P < 0.001). Open-label quetiapine treatment reduced cravings and improved some aspects of cocaine dependence in nonpsychotic individuals. Additional research is needed to confirm the current findings and to further delineate the role quetiapine may play in the treatment of cocaine use disorders.

Kerr T; Small W; Johnston C; Li K; Montaner JSG; Wood E. Characteristics of injection drug users who participate in drug dealing: Implications for drug policy. Journal of Psychoactive Drugs 40(2): 147-152, 2008. (27 refs.)

So-called "balanced" drug policy couples enforcement initiatives targeting drug dealers with health-focused interventions serving addicted individuals. There are few evaluations of this approach, and little is known about how these two populations may overlap. We evaluated factors associated with drug dealing among injection drug users (IDUs) in Vancouver, Canada, and examined self-reported drug-dealing roles and reasons for dealing. Among 412 IDUs seen from March through December 2005, 68 (17%) had dealt drugs during the previous six months. Variables independently associated with drug dealing included: recent incarceration (adjusted odds ratio [AOR] = 2.9; 95%CI: 1.4 - 6.0); frequent heroin injection (AOR = 2.5; 95%CI: 1.4 - 4.6); frequent cocaine injection (AOR = 2.0; 95%CI: 1.1 - 3.8); and recent overdose (AOR = 2.7; 95 %CI: 1.0 - 7.3). The most common drug-dealing roles were direct selling (82%), middling (35%), and steering (19%), while the most common reasons for dealing included obtaining drugs (49%) and money (36%). Drug dealing among IDUs was predicted by several markers of higher intensity addiction, and drug-dealing IDUs tended to occupy the most dangerous positions in the drug-dealing hierarchy. These findings suggest that elements of "balanced" drug policies may undermine each other and indicate the need for alternative interventions.

Khazaal Y; Chatton A; Cochand S; Zullino D. Quality of web-based information on cocaine addiction. Patient Education and Counseling 72(2): 336-341, 2008. (30 refs.)

Objective: To evaluate the quality of web-based information on cocaine use and addiction and to investigate potential content quality indicators. Methods: Three keywords: cocaine, cocaine addiction and cocaine dependence were entered into two popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality. "Health on the Net" (HON) quality label, and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. Results: Of the 120 websites identified, 61 were included. Most were commercial sites. The results of the study indicate low scores on each of the measures including content quality. A global score (the sum of accountability, interactivity, content quality and aesthetic criteria) appeared as a good content quality indicator. Conclusions: While cocaine education websites for patients are widespread, their global quality is poor. There is a need for better evidence-based information about cocaine use and addiction on the web. Practice implications: The poor and variable quality of web-based information and its possible impact on physician-patient relationship argue for a serious provider for patient talk about the health information found on Internet. Internet sites could improve their content using the global score as a quality indicator.

Kinner SSA; Lloyd B. Queensland Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 272. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (14 refs.)

This report reports data on the use of illicit drugs in Queensland, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 127 figures and tables.

Klys M; Rojek S; Kowalski P; Rzepecka-Wozniak E. Death of a female addict due to heroin and cocaine overdoses: A case report with multiparameter evaluation. Forensic Toxicology 26(1): 36-40, 2008. (20 refs.)

This study undertook a multiparameter evaluation of the death of a 21-year-old woman known to be an abuser of heroin and cocaine. The toxicological analysis of multiple postmortem specimens such as blood and hair was carried out using liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The blood specimens of the deceased showed the presence of opium components such as morphine and its glucuronides together with cocaine and benzoylecgonine. The detected xenobiotic levels probably explained the cause of her death resulting from combined action of unintentional illicit drug overdose. By analysis of four 2-cm long hair segments, a heroin-cocaine addiction for at least 8 months antemortem was able to be documented; the presence of 6-monoacetylmorphine (6-MAM), cocaine, and benzoylecgonine was demonstrated. The histopathological findings of lesions of the internal organs of the deceased were consistent with long heroin and cocaine abuse. The use of multiple parameters, such as blood and hair segments as matrices and drug metabolites such as 6-MAM, morphine, glucuronides, and benzoylecgonine as target compounds, gave a well-defined outline of her death.

Koren G; Hutson J; Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: Implications for maternal and child health. Clinical Pharmacology and Therapeutics 83(4): 631-634, 2008. (31 refs.)

Despite extensive evidence of fetal and neonatal risk, a large number of pregnant women are involved in excessive alcohol and drug abuse, such as with cocaine, methamphetamine, opioids, and cannabinoids.

Kosten TA; Zhang XY. Sex differences in non-reinforced responding for cocaine. American Journal of Drug and Alcohol Abuse 34(4): 473-488, 2008. (46 refs.)

Prior studies report no sex differences in cocaine consumption during maintenance of self-administration. We find female rats show poorer lever discrimination during acquisition of self-administration. Now, we test whether female rats show greater non-reinforced or ineffective responding (presses during infusion and time-out periods as well as inactive lever presses) than male rats during maintenance of cocaine self-administration (.0625-1.0 mg/kg/infusion) in Experiment 1. Persistence of responding during extinction when saline-replaced cocaine was also examined. Whether response differences reflect sex differences in movements under a non-drug condition was tested in Experiment 2. Because cocaine may affect lever press rates differentially between sexes, we examined the effects of cocaine (.3-30 mg/kg; IP) on responding for food in Experiment 3. Cocaine consumption does not differ between female and male rats. However, females respond more during infusion and time-out periods and during extinction than males. There is no sex difference in movements and high cocaine doses decrease responding for food more in female vs. male rats. That females engage in more ineffective responding may represent heightened "craving" and cannot be explained by increased movements or cocaine-stimulated increases in lever pressing. In contrast, responding for cocaine in males appears driven by drug delivery.

Kranzler HR; Wilcox M; Weiss RD; Brady K; Hesselbrock V; Rounsaville B. The validity of cocaine dependence subtypes. Addictive Behaviors 33(1): 41-53, 2008. (41 refs.)

Cocaine dependence (CD) is a multifactorial disorder, variable in its manifestations, and heritable. We examined the concurrent validity of homogeneous subgroups of CD as phenotypes for genetic analysis. We applied data reduction methods and an empirical cluster-analytic approach to measures of cocaine use, cocaine-related effects, and cocaine treatment history in 1393 subjects, from 660 small nuclear families. Four of the six clusters that were derived yielded heritability estimates in excess of 0.3. Linkage analysis showed genome-wide significant results for two of the clusters. Here we examine the concurrent validity of the six clusters using a variety of demographic and substance-related measures. In addition to being differentiated by a variety of cocaine-related measures, the clusters differed significantly on measures that were independent of those used to generate the clusters, i.e., demographic features and prevalence rates of co-morbid substance use and psychiatric disorders. These findings support the validity of the methods used to derive homogeneous subgroups of CD subjects and the resulting CD subtypes. Independent replication of these findings would provide further validation of this approach.

Ledgerwood DM; Goldberger BA; Risk NK; Lewis CE; Price RK. Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men. Addictive Behaviors 33(9): 1131-1139, 2008. (32 refs.)

Discrepancies between biological assays and self-report of illicit drug use could undermine epidemiological research findings. Two objectives of the present study are to examine the degree of agreement between self-reported illicit drug use and hair analysis in a community sample of middle-aged men, and to identify factors that may predict discrepancies between self-report and hair testing. Male participants followed since 1972 were interviewed about substance use, and hair samples were analyzed for marijuana, cocaine, opiates, phencyclidine (PCP) and methamphetamine using radioimmunoassay and gas chromatography-mass spectrometry (CC-MS) techniques. Self-report and hair testing generally met good, but not excellent, agreement. Apparent underreporting of recent cocaine use was associated with inpatient hospitalization for the participant's most recent quit attempt, younger age, identifying as African American or other, and not having a diagnosis of antisocial personality disorder. The overestimate of marijuana use relative to hair test was associated with frequent use since 1972 and providing an inadequate hair sample. Additional research is needed to identify factors that differentially affect the validity of both hair drug testing and self-report.

Lehrmann E; Afanador ZR; Deep-Soboslay A; Gallegos G; Darwin WD; Lowe RH et al. Postmortem diagnosis and toxicological validation of illicit substance use. Addiction Biology 13(1): 105-117, 2008. (35 refs.)

The present study examines the diagnostic challenges of identifying ante-mortem illicit substance use in human postmortem cases. Substance use, assessed by clinical case history reviews, structured next-of-kin interviews, by general toxicology of blood, urine and/or brain, and by scalp hair testing, identified 33 cocaine, 29 cannabis, 10 phencyclidine and nine opioid cases. Case history identified 42% cocaine, 76% cannabis, 10% phencyclidine and 33% opioid cases. Next-of-kin interviews identified almost twice as many cocaine and cannabis cases as Medical Examiner (ME) case histories, and were crucial in establishing a detailed lifetime substance use history. Toxicology identified 91% cocaine, 68% cannabis, 80% phencyclidine and 100% opioid cases, with hair testing increasing detection for all drug classes. A cocaine or cannabis use history was corroborated by general toxicology with 50% and 32% sensitivity, respectively, and with 82% and 64% sensitivity by hair testing. Hair testing corroborated a positive general toxicology for cocaine and cannabis with 91% and 100% sensitivity, respectively. Case history corroborated hair toxicology with 38% sensitivity for cocaine and 79% sensitivity for cannabis, suggesting that both case history and general toxicology underestimated cocaine use. Identifying ante-mortem substance use in human postmortem cases are key considerations in case diagnosis and for characterization of disorder-specific changes in neurobiology. The sensitivity and specificity of substance use assessments increased when ME case history was supplemented with structured next-of-kin interviews to establish a detailed lifetime substance use history, while comprehensive toxicology, and hair testing in particular, increased detection of recent illicit substance use.

Leigh BC; Ames SL; Stacy AW. Alcohol drugs and condom use among drug offenders: An event-based analysis. Drug and Alcohol Dependence 93(1/2): 38-42, 2008. (41 refs.)

Background: Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. Goal: This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. Design: Participants in court-ordered drug diversion programs (n = 536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. Results: In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. Conclusions: In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.

Leonard L; DeRubeis E; Pelude L; Medd E; Birkett N; Seto J. "I inject less as I have easier access to pipes" - Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking resources are distributed. International Journal of Drug Policy 19(3): 255-264, 2008. (35 refs.)

Among injection drug users (IDUs) in Ottawa, the capital of Canada, prevalence rates of HIV (20.6 percent) and hepatitis C HCV (75.8 percent) are among the highest in Canada. Recent research evidence suggests the potential for HCV and HIV transmission through the multiperson use of crack-smoking implements. On the basis of this scientific evidence, in April 2005, Ottawa's needle exchange programme (NEP) commenced distributing glass stems, rubber mouthpieces, brass screens, chopsticks, lip balm and chewing gum to reduce the harms associated with smoking crack. This study aims to evaluate the impact of this initiative on a variety of HCV- and HIV-related risk practices. Active, street-recruited IDUs who also smoked crack consented to personal interviews and provided saliva samples for HCV and HIV testing at four time points: 6-months pre-implementation (N= 112), 1-month (N= 114), 6-months (N= 157) and 12-months (N = 167) post-implementation. Descriptive and univariate analyses were completed. Following implementation of the initiative, a significant decrease in injecting was observed. Pre-implementation, 96 percent of IDUs reported injecting in the month prior to the interview compared with 84 percent in the 1 month, and 78 percent in the 6- and 12-month post-implementation interviews (p <.01). Conversely, approximately one-quarter of participants at both the 6- and 12-month post-implementation evaluation points reported that they were smoking crack more frequently since the availability of clean equipment-25 and 29 percent, respectively. In addition to a shift to a less harmful method of drug ingestion, HCV- and HIV-related risks associated with this method were reduced. Among crack-smoking IDUs sharing pipes, the proportion sharing "every time" declined from:37 percent in the 6-month pre-implementation stage, to 31 percent in the 1-month, 12 percent in the 6-month and 13 percent in the 12-month post-implementation stages (p <.01). Since distributing safer crack-smoking materials by a NEP contributes to transition to safer methods of drug ingestion and significantly reduces disease-related risk practices, other NEPs should adopt this practice.

Levin KH; Herning RI; Better WE; Epstein DH; Cadet J-L; Gorelick DA. EEG absolute power during extended cocaine abstinence. Journal of Addiction Medicine 1(3): 139-144, 2007. (35 refs.)

We examined the effects of cocaine withdrawal on EEG during 3 months of abstinence. Twenty physically healthy cocaine users (80% men, 80% African American, mean (SD) age, 34.8 (4.1) years, 9 (5.4) years of cocaine use, minimal recent use of other drugs) were subject to 1 to 3 EEG recordings during 3 months of monitored abstinence on a closed clinical research ward. Three-minute eyes closed EEG recordings used 8 or 16 leads located at standard International 10/20 scalp sites. First EEG was recorded 16.8 (13.6) days after last cocaine use. Beta1 absolute power in the left temporal region and delta power in the mid right hemisphere (temporal region) increased significantly over time. Eight subjects tested during the first 2 weeks of abstinence showed trends toward decreased absolute power in all bands except beta1 in the left frontal region, and toward decreased absolute delta power in the mid right hemisphere, compared with 8 nondrug-using controls. These results are not totally consistent with some previous studies, which may be the result of differences in subject characteristics and EEG recording procedures. The findings suggest that chronic cocaine use is associated with EEG changes that may reflect persisting brain electrophysiological abnormalities during cocaine abstinence.

Lim KO; Wozniak JR; Mueller BA; Franc DT; Specker SM; Rodriguez CP et al. Brain macrostructural and microstructural abnormalities in cocaine dependence. Drug and Alcohol Dependence 92(1/3): 164-172, 2008. (42 refs.)

Rationale: Two previous studies have utilized diffusion tensor imaging (DTI) to examine microstructural integrity in cocaine abuse and found 41 evidence of brain abnormalities in white matter. Objective: Using anatomical magnetic resonance imaging (MRI), DTI, and clinical evaluation, the macrostructural and microstructural correlates of cocaine abuse were investigated. Methods: Twenty-one men and women (mean age 42.5 and mean 18.9 years of cocaine use) and 21 age/gender-matched controls were included. Fractional anisotropy (FA) was measured in frontal white matter ROIs. Gray and white matter volumes in superior and inferior frontal regions were compared. Results: DTI data revealed that cocaine users had lower FA than controls, specifically in inferior frontal white matter. FA differences were not seen in other areas. Significant volumetric differences were not seen, but both gray and white matter inferior frontal volumes trended toward smaller in the cocaine group. The data suggested that duration of use was associated with decreased gray and white matter volumes. FA and gray matter volume were correlated in cocaine users. Conclusions: Both macrostructural and microstructural abnormalities were seen in a group of cocaine abusers. Length of cocaine use was associated with severity of the brain abnormalities. Future studies of white matter tissue integrity are warranted including examination of the relationship between DTI measures and traditional volumetric measures.

Lynch WJ; Kalayasiri R; Sughondhabirom A; Pittman B; Coric V; Morgan PT et al. Subjective responses and cardiovascular effects of self-administered cocaine in cocaine-abusing men and women. Addiction Biology 13(3-4): 403-410, 2008. (18 refs.)

This study aimed to examine sex differences in cocaine self-administration and cocaine-induced subjective and cardiovascular measures. The research was based on secondary analysis of data collected in our human laboratory in which subjects self-administered cocaine infusions (8, 16 and 32 mg/70 kg) over a 2-hour period under a fixed ratio 1, 5 minute time out schedule in three test sessions. Subjects were 10 women and 21 men with a history of either cocaine abuse or dependence who were not currently seeking treatment. Women and men self-administered similar amounts of cocaine. None of the subjective effects measures showed a significant main effect of sex during the cocaine self-administration session. Significant interactions were observed for subjective ratings of 'high' (sex x time) and 'stimulated' (sex x time x dose), with women reporting lower ratings over time/doses than men. Relative to men, cocaine produced dose- and time-dependent increases in feelings of hunger (i.e., reduced appetite suppression) in women. Systolic and diastolic blood pressures showed different patterns of change in men and women, with women showing less robust cocaine-induced increases than men. Taken together, these findings suggest that women and men may differ in their subjective and cardiovascular responses to self-administered cocaine. Further research that prospectively controls for hormonal influences upon these measures is needed.

Mac Nally AC. A functionalist approach to the definition of "cocaine base" in 841. University of Chicago Law Review 74(2): 711-744, 2007. (18 refs.)

Responding to the rise of crack cocaine in the early 1980s, Congress passed the Anti-Drug Abuse Act of 1986 (ADAA). The ADAA amended 21 USC Sec 841 of the criminal code by creating a system of mandatory minimum sentences for the possession of different substances. There is no definition of "cocaine base" or "cocaine" in the statute. A circuit split has developed over how to define cocaine base. This article analyzes the circuit split and advocates the adoption of a functional, or smokeable, definition of "cocaine base." The article proceeds by providing a general background to the relevant issues in Part I. Part II sets forth the arguments for and against each of the potential solutions the lower courts have raised. Finally, Part III suggests a new justification for the functionalist approach, focusing first on the text of Sec 841, which is analyzed in light of the rule of lenity, and then on the purposes behind its amendment.

Mahoney JJ; Kalechstein AD; De la Garza R; Newton TF. Presence and persistence of psychotic symptoms in cocaine- versus methamphetamine-dependent participants. American Journal on Addictions 17(2): 83-98, 2008. (20 refs.)

The primary objective of this study was to compare and contrast psychotic symptoms reported by cocaine- and methamphetamine-dependent individuals. Participants included 27 cocaine -dependent and 25 methamphetamine-dependent males, as well as 15 cocoine-dependent and 18 methamphetamine-dependent females. After screening, participants were excluded if they met criteria for any Axis I diagnosis other than nicotine dependence, or methamphetamine or cocaine dependence (ie, participants had to use either methamphetamine or cocaine but were excluded if they met dependence criteria for both). The participants were administered the, newly developed Psychotic Symptom Assessment Scale (PSAS), which assesses psychotic symptoms. A high proportion of both cocaine- and methamphetamine-dependent men and women reported delusions of paranoia and auditory hallucinations. However, during the abstinent and intoxicated conditions, methamphetamine-dependent men and women were more likely than cocaine-dependent men and women to report psychotic symptoms. Future studies will compare psychotic symptoms reported by non-dependent recreational stimulant users to stimulant-dependent individuals.

Maremmani I; Pacini M; Perugi G; Deltito J; Akiskal H. Cocaine abuse and the bipolar spectrum in 1090 heroin addicts: Clinical observations and a proposed pathophysiologic model. Journal of Affective Disorders 106(1-2): 55-61, 2008. (41 refs.)

Background: Several studies indicate a specific relationship between bipolar disorder and stimulant use and abuse. It has generally been assumed that cocaine use represents self-enhancement or attempts to optimize one's level of hypomania, cyclothymia or hyperthyrnia. This topic required further examination among heroin abusers because cocaine abuse is commonly comorbid with heroin abuse. Methods: Cocaine abuse by bipolar subjects was investigated in a group of 1090 treatment-seeking heroin addicts enrolled between 1994 and 2005. We collected data with 1) the Drug Addiction History Rating Scale; and 2) the Semi-structured Interview for Depression, which inquires systematically among others, about hypomania, cyclothymia, hyperthymia and depressive temperament. Subjects were aged 29 6 years, and predominantly male (76.2%). Results: Univariate and multivariate analyses provided correlations in favour of a link between current cocaine abuse and double diagnosis, with special relevance to the bipolar spectrum, as well as psychotic disorders (p<0.0001). Limitation: The modality of access to cocaine in different communities and the difficulty to distinguish cocaine use from abuse by the rating scale administered may have limited the interpretation of results. Conclusions: If cocaine abuse precedes that of heroin or is concomitant, heroin may hypothetically serve as a "mood balancer" which transiently dampens subthreshold excitatory states and mood swings. Our data further suggest the need for a more complex model linking cocaine and bipolarity: subthreshold bipolarity, including hyperthymic and cyclothymic temperaments, seems to predispose to heroin addiction, but craving for the suppressed hypomania in turn could lead to cocaine abuse, which eventually unmasks a frank bipolar disorder - in some cases leading to mixed state, severe mania, as well as psychosis beyond mania. Prospective observations would shed further insight on this complex interface of major clinical and public health importance.

Mariani PJ. Beta-blockers following cocaine use: A reappraisal. (letter). Annals of Emergency Medicine 52(1): 89-89, 2008. (4 refs.)

Mariani JJ; Horey J; Bisaga A; Aharonovich E; Raby W; Cheng WY et al. Antisocial behavioral syndromes in cocaine and cannabis dependence. American Journal of Drug and Alcohol Abuse 34(4): 405-414, 2008. (30 refs.)

Antisocial personality disorder (ASPD) is highly associated with substance use disorders (SUD). In addition to the full ASPD syndrome, which requires both childhood conduct disorder and the adult features, other antisocial behavioral syndromes, including conduct disorder (CD) alone without the adult syndrome, and the adult antisocial behavioral syndrome without childhood CD (AABS) are also frequently diagnosed in patients with SUD. The aim of this study was to compare the rates of these various ASPD syndromes between cocaine- and cannabis-dependent individuals seeking treatment. A structured interview for ASPD excluding symptoms that occurred solely in the context of substance use was conducted in 241 outpatients (cocaine dependence, n = 111; cannabis dependence, n = 130). Overall, the proportion of substance-dependent individuals in this study with AABS was significantly larger than the proportion with ASPD (30.9% vs. 17.3%). A diagnosis of CD-only, where CD did not progress to ASPD, was uncommon. No significant differences in the prevalence of antisocial behavioral syndrome diagnoses were found between cocaine-and cannabis-dependent patients. Antisocial behavioral syndrome diagnosis did not influence treatment retention. Antisocial behavioral syndromes are commonly diagnosed in patients with SUD and future research should evaluate prognostic implications of AABS compared to ASPD in a variety of clinical treatment settings.

Marsden J; Farrell M; Bradbury C; Dale-Perera A; Eastwood B; Roxburgh M et al. Development of the treatment outcomes profile. Addiction 103(9): 1450-1460, 2008. (58 refs.)

Aim To develop the Treatment Outcomes Profile (TOP), a new instrument for monitoring substance misuse treatment. Design Prospective cohort, psychometric evaluation with 7-day retest and 1-month follow-up to assess inter-rater reliability, concurrent, discriminant and construct validity, and change sensitivity. Participants A sample of 1021 service users, aged 16-62 years. Recruitment from 63 treatment agencies in England, collectively providing opioid substitution treatment, psychosocial interventions, in-patient detoxification and residential rehabilitation. Measurements Thirty-eight frequency, rating scale and period prevalence measures, with 28-day recall, across substance use, health, crime and social functioning domains, administered as personal interview by 163 treatment keyworkers. Findings: Twenty outcome measures met inter-rater reliability criteria: days used alcohol, opioids, crack cocaine, cocaine powder, amphetamines, cannabis and one other named substance; days injected and period prevalence of direct or indirect needle/syringe sharing; subjective rating of physical and psychological health; days committed shop theft and drug selling, period prevalence of vehicle, property, fraud/forgery and assault/violence offences; rating of quality of life; days worked and attended for education/training; and period prevalence of acute housing problems and risk of eviction. Intraclass correlation coefficients for scale measures and Cohen's kappa for dichotomous measures reached or exceeded 0.75 and 0.61, respectively. There were satisfactory validity assessments and change sensitivity of scale items judged by effect size and smallest detectable difference. The TOP clinical tool contains an additional 10 items for individual treatment planning and review. Conclusions The TOP is a reliable and valid 20-item instrument for treatment outcomes monitoring.

McCord J; Jneid H; Hollander JE; de Lemos JA; Cercek B; Hsue P et al. Management of cocaine-associated chest pain and myocardial infarction - A scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. (review). Circulation 117(14): 1897-1907, 2008. (111 refs.)

Cocaine is the second most commonly used illicit drug in the United States, with marijuana use more frequently. Cocaine is also the illicit drug that leads to the most ED visits. In 2005, there were 448,481 cocaine-related visits to EDs in the United States. Chest discomfort has been reported in 40% of patients who present to the ED after cocaine use. The Drug Abuse Warning Network (DAWN) reported that in the last 6 months of 2004, there were 126,000 cocaine-related ED visits in the United States, or 40% of all ED visits related to substance abuse (illicit or otherwise). The most frequent age group for these visits was 35 to 44 years of age; this group accounted for 37% of all cocaine-related ED encounters. Cocaine-related ED visits increased by 47% from 1999 to 2002. Thus, the number of ED encounters with patients with cocaine-associated chest pain will likely be increasing. This article provides guidelines for management of cocaine-associated chest pain and myocardial infarction . It reviews the epidemiology of cocaine use, pathophysiology, incidence of myocardial infarction, clinical presentation, timing between cocaine use and MI, patient characteristics, complications and prognosis, diagnostic strategie, myocartdiao perfusion imaging, therapeutic strategies, ST-segment-elevation MI, and discharge management and secondary prevention.

Meade CS; Graff FS; Griffin ML; Weiss RD. HIV risk behavior among patients with co-occurring bipolar and substance use disorders: Associations with mania and drug abuse. Drug and Alcohol Dependence 92(1/3): 296-300, 2008. (40 refs.)

Background: Bipolar and substance use disorders frequently co-occur, and both are associated with impulsivity, impaired judgment, and risk-taking. Objectives: This study aimed to: (1) describe the rates of HIV sexual and drug risk behaviors among patients with co-occurring bipolar and substance use disorders, (2) test whether acute mania, psychiatric severity, and drug severity independently predict HIV risk, and (3) examine the relationship between specific substance dependencies and sexual risk behaviors. Method: Participants (N = 101) were assessed for psychiatric diagnoses, substance abuse, and HIV risk behavior using structured clinical interviews and self-report questionnaires. Results: The majority (75%) were sexually active in the past 6 months and reported high rates of sexual risk behaviors, including unprotected intercourse (69%), multiple partners (39%), sex with prostitutes (24%, men only), and sex trading (10%). In a multivariate linear regression model, recent manic episode, lower psychiatric severity, and greater drug severity were independent predictors of total HIV risk. Cocaine dependence was associated with increased risk of sex trading. Conclusions: Results underscore the importance of HIV prevention for this population.

Milby JB; Schumacher JE; Vuchinich RE; Freedman MJ; Kertesz S; Wallace D. Toward cost-effective initial care for substance-abusing homeless. Journal of Substance Abuse Treatment 34(2): 180-191, 2008. (40 refs.)

In a randomized controlled trial, behavioral day treatment, including contingency management (CM+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM+ also received cognitive-behavioral therapy, therapeutic goal management, and other intervention components. Results revealed that CM, treatment attendance and abstinence were not significantly different from CM during 24 weeks of treatment. After treatment and contingencies ended, however, CM+ showed more abstinence than CM, indicating a delayed effect of treatment from 6 to 18 months. CM+ had more consecutive weeks abstinent across 52 weeks, but not during active treatment. We conclude that CM alone may be viable as initial care for cocaine-dependent homeless persons. That CM+ yields more durable abstinence indicates that it may be appropriate as stepped-up care for clients not responding to CM (Clinical Trials.gov, no. NCT00368524).

Minnes S; Singer LT; Kirchner HL; Satayathum S; Short EJ; Min M et al. The association of prenatal cocaine use and childhood trauma with psychological symptoms over 6 years. Archives of Women's Mental Health 11(3): 181-192, 2008. (55 refs.)

The use of cocaine and other drugs during pregnancy may have serious public health consequences. The objective of this study was to determine if the use of cocaine prenatally identifies women for ongoing risk of psychological symptoms. Four hundred and two women (207 cocaine using [C], 195 non-cocaine using [NC]) were assessed for rates of clinically elevated psychological symptoms shortly after childbirth, 6.5 months and 1, 2, 4 and 6 years after using the Brief Symptom Inventory (BSI). Generalized estimating equation modeling (GEE) was used to compare psychological symptom severity, controlling for confounding factors including early childhood trauma. Results indicated that women identified as having used cocaine during pregnancy had clinically elevated psychological distress (OR = 1.76, 95%CI = 1.15-2.71, p = 0.01), psychoticism (OR = 1.97, 95%CI = 1.41-2.76, p = 0.001), interpersonal sensitivity (OR = 2.34; 95%CI = 1.65-3.34; p < 0.0001) and phobic anxiety (OR = 1.86; 95%CI = 1.24-2.79) across all assessments compared to NC women. Childhood emotional abuse was also independently associated with psychological distress. Women who use cocaine during pregnancy should be recognized as at very high risk of ongoing clinically elevated psychological symptoms and should receive early and regular assessments and intervention for mental health and substance use problems.

Mionel O. The drug geopolitics in South America. Metalurgia International 13(6): 71-75, 2008. (7 refs.)

This article wants to present some doubts concerning the drugs geo-politic in South America. The most interesting examples are Colombia, Peru and Bolivia; Colombia is the country with the largest illicit coca growing area and cocaine production in the word, in Peru grow the most solids coca fields and Bolivia is very important for the seizure of illicit laboratories.

Mistral W; Wilkinson S; Mastache C; Midgley S; Law F. Efficacy of naltrexone treatment with combined crack and opiate users: A descriptive study of a new treatment service in Bristol, UK. Drugs: Education, Prevention and Policy 15(1): 107-119, 2008. (34 refs.)

Naltrexone has been shown to be clinically effective in treating opioid dependence, although there are reports that it may be unsafe in treatment of unselected cases. Although there are no generally accepted pharmacological treatments for crack cocaine addiction alone, there is evidence that naltrexone can be useful in cases of concurrent cocaine and heroin use. In 2005 Bristol Specialist Drug Service initiated a naltrexone treatment programme targeted at pre-release offenders using both crack cocaine and heroin. Of 172 referrals, only 51 (30%) were inducted into treatment, and only 16% of these were retained at 3 months, and 4% at 9 months. There was evidence to support induction in prison, as 90% of those who were inducted there continued treatment on release. An integrated approach between criminal justice and community services is of primary importance in getting users into treatment. Interviews highlighted that the environment outside of prison can trigger relapse, and that community clinics need to separate clients on an abstinence programme from those who continue to use. Of clients interviewed, 52% reported that they use heroin to mitigate severe come down from crack, and it is suggested that naltrexone may be of use for these specialized combined users.

Moon C. Northern Territory Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 271. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (50 refs.)

This report reports data on the use of illicit drugs in New South Wales (NSW), derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 123 figures and tables.

Morgan PT; Pace-Schott EF; Sahul ZH; Coric V; Stickgold R; Malison RT. Sleep architecture, cocaine and visual learning. Addiction 103(8): 1344-1352, 2008. (38 refs.)

Background: Disturbances in sleep associated with chronic cocaine use may underlie abstinence-related cognitive dysfunction. We hypothesized that sleep-related cognitive function would be impaired in chronic cocaine users, and that this impairment would be associated with abstinence-related changes in sleep architecture. Methods: Twelve chronic cocaine users completed a 23-day in-patient study that included randomized, placebo-controlled, cocaine self-administration sessions. We report polysomnographic measurement of rapid eye-movement (REM) sleep and slow-wave activity, and performance on a visual texture discrimination task. Findings: Progressive abstinence from cocaine was associated with characteristic changes in REM sleep. REM sleep was shortest on nights following cocaine use and rebounded in the first week of abstinence before diminishing with progressive abstinence, following a pattern opposite that of slow-wave activity. Overnight visual learning was observed over the first night following 3 consecutive days of laboratory cocaine use; however, learningwas not observed at 3 days or 17 days of abstinence. Across all points of abstinence, early-night slow-wave activity was associated strongly with non-deterioration of visual performance overnight. Furthermore, overnight enhancement of visual performance was predicted by the co-occurrence of sufficient early-night slow-wave activity and late night REM sleep, similar to results from studies in healthy subjects. Conclusions: These results suggest that abstinence-associated sleep-dependent learning deficits are related to characteristic changes in sleep architecture, and promote the idea that treatments directed at sleep ('somno-tropic' treatments) could be helpful in offsetting physiological consequences of cocaine abstinence.

Munafo M; Albery IP, eds. Cognition and Addiction. Oxford: Oxford University Press, 2006

This book, with 10 chapters and 23 contributors, is directed to clinicians and assembles key research on cognitive mechanisms from the field of experimental psychology. It focuses upon the application of these constructs to specific addictive behaviors. Specific drugs examined included alcohol, nicotine, cocaine and opiates. Following an introductory chapter, establishing the theoretical perspectives and approaches, individual chapters deal with implicit cognition and associative memory; attentional biases; application of automatic network theory as a explanation for loss of control; and the neurocircuitry of attentional processes.

Nidecker M; DiClemente CC; Bennett ME; Bellack AS. Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness. Addictive Behaviors 33(8): 1021-1030, 2008. (53 refs.)

People with severe mental illness (SMI) have high rates of substance use disorders. The Transtheoretical Model (TTM) is a framework for understanding behavior change. There are five leading measures associated with the TTM - University of Rhode Island Change Assessment, Processes of Change Scale, Decisional Balance Scale, Abstinence Self-Efficacy Scale, and Temptation to Use Drugs Scale. While these measures have been found to be reliable and valid in primary substance abusers, it is unknown if these measures are relevant in people with co-occurring SMI and substance use disorders (SUD). We evaluated the psychometric properties of these measures in a sample (n = 240) of people with co-occurring disorders. Participants met DSM-IV criteria for schizophrenia/schizoaffective disorder or non-psychotic affective disorder, and current cocaine dependence or cocaine dependence in remission. All subscales showed good reliability and validity in the total sample. Analyses within diagnostic groups showed good reliability and validity in most groups, with some falling off in the affective disorders and remitted cocaine dependence groups. Overall, findings support the use of these measures in people with co-occurring disorders.

Niveau G; Ritter C. Route of administration of illicit drugs among remand prison entrants. European Addiction Research 14(2): 92-98, 2008. (30 refs.)

Aims: To describe the self-reported routes of administration of illicit drugs among subjects entering a remand prison and the different drugs used by this population. Methods: A cross-sectional study, with a sample of 770 subjects, was conducted in Geneva ( Switzerland). Participants were assessed with the semi-structured interview from the Council of Europe Pompidou Group multi-city study. Results: 428 (55.6%) subjects admitted to having used illicit drugs during the 3 months prior to entry. Amongst these illicit drug users, 54.7% took several drugs. Injectable drugs ( heroin, cocaine or illicit benzodiazepines) were taken by 75.7% of drug users but the majority (84.1%) declared that they had not injected drugs during the 3 months prior to entering prison. 68 subjects (8.8% of the total sample) declared that they had injected drugs during the 3 months prior to entering prison, either alone or in association with other methods. Conclusion: By extrapolation it is possible to suggest that about 200 intravenous drug users entered the remand prison in Geneva in 1 year. This confirms the need for prison health services to implement a policy of treatment, prevention and education adapted to patterns of drug use in the local context.

Office of Applied Studies, Substance Abuse and Mental Health Administration. Treatment Episode Data Set (TEDS): 1994-2004. National Admissions to Substance Abuse Treatment Services. DASIS Series S-33. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (0 refs.)

This report provides information on the 1.9 million admissions for treatment in 2004, along with trends from 1994. Among the significant findings are that five substances account for 95% of the admissions. Alcohol represents 40%; opiates 18% primarily heroin; marijuana,16%; cocaine, 14%; and stimulants 8%. Information is provided on the age, racial and ethnic groups for each of the substances. There are 107 tables and figures summarizing data.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS) 1995-2005. National Admissions to Substance Abuse Treatment Services. DASIS Series S-37. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (0 refs.)

Following a summary of the major findings, this report is organized into six chapters. Chapter 1 describes the data set from which the report is derived. Chapter 2 sets forth trends in treatment admissions over a 10 year period, the trends in terms of the primary substance of abuse, the co-occurence of alcohol and drug abuse, admissions rates by state and primary substance, demographic characteriesticsd and socioeconomic status. Chapter 3 reviews characteristics of those admitted in terms of types of drugs uses --alcohol only, alcohol with a secondary drug of abuse, heroin, other opiates, smoked and non-smoked cocaine, marijuana, methamphetamine and other stimulants, tranquilizers, sedatives, hallucinogens, PCP, and inhalants. Chapter 4 summarizes state data trends from 1995-2005. Chapter 5 addresses special interests, adolescents, heroin use by route of administration and anticipated drug-substitution therapy, polydrug abuse, and racial and ethic subgroups. The final chapter considers admissions for detoxification. Data is presented in 107 figures and tables.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Male Admissions with Co-occurring Psychiatric and Substance Use Disorders: 2005. (December 13, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (8 refs.)

Among male admissions reporting alcohol, cocaine, marijuana, or stimulants as the primary substance of abuse, those with co-occurring disorders were more likely than those without co-occurring disorders to report daily use of these substances.Sixty-two percent of male admissions with co-occurring disorders reported more than one substance of abuse compared with 52 percent of male admissions without co-occurring disorders. Male admissions with co-occurring disorders were more likely than those without co-occurring disorders to report five or more prior substance abuse treatment episodes (17 vs. 10 percent)

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Cocaine Route of Administration Trends: 1995-2005. (September 13, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (9 refs.)

Inhaling cocaine was the predominant route of cocaine administration for much of the 20th century. In the early 1980s, a potent smokeable form of cocaine known as "crack" was developed. Trends in admissions to substance abuse treatment for cocaine and cocaine route of administration were examined with annual data from SAMHSA's Treatment Episode Data Set (TEDS). In 1995, 63% of primary smoked cocaine (crack) were younger than age 35. By 2005, only 32% of primary crack admissions were in this age group. The proportion of both inhaled and smoked cocaine (crack) admissions who were employed full time decreased between 1995 and 2005. The proportion of primary cocaine admissions who smoked the drug declined from 79 percent in 1995 to 73 percent in 2005. In 1995, 63 percent of primary smoked cocaine admissions were younger than 35; by 2005, only 32 percent of primary smoked cocaine admissions were in this age group. The proportion of both inhaled and smoked cocaine admissions who were employed full time decreased between 1995 and 2005

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-29. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (24 refs.)

SAMHSA's Drug Abuse Warning Network (DAWN) provides national data on emergency department visits involving illicit drugs, alcohol, and nonmedical use of pharmaceuticals. In 2005, general non-Federal hospitals delivered 108 million emergency department visits. An estimated 1,449,154 of these emergency visits were associated with drug misuse or abuse. Cocaine was involved in 448,481 visits; marijuana in 242,200 visits; heroin in 164,572 visits, and stimulants (including amphetamines and methamphetamines) were involved in 138,950 emergency department visits. Alcohol-related visits accounted for 34% of all drug misuse or drug abuse emergency department visits. Alcohol was most frequently combined with cocaine alone (86,482 visits), marijuana alone (33,643 visits), cocaine and marijuana (22,377 visits), and heroin alone (12,797 visits). Opiates/opioid analgesics accounted for 33% of the nonmedical visits and included: Hydrocodone/combinations (51,225 visits), Oxycodone/combinations (42,810 visits), methadone (41,216 visits), and fentanyl/combinations (9,160 visits). Anti-anxiety agents (sedatives and hypnotics) accounted for 34% of the nonmedical visits and included benzodiazepines (172,388 visits). There are 28 figures and tables

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use and Dependence Following Initiation of Alcohol or Illicit Drug Use. (March 27, 2008). Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (6 refs.)

Alcohol and illicit drug dependence were defined in SAMHSA's National Survey on Drug Use and Health using the DSM-IV diagnostic criteria which includes such symptoms as withdrawal, tolerance, unsuccessful attempts to cut down on use, and continued use despite health and emotional problems caused by the substance. The Survey found that 3.2% of the persons aged 12 or older who first used alcohol 13 to 24 months prior to the survey interview were dependent on alcohol in the past 12 months. Of those 12 years or older who first used marijuana 13 to 24 months prior to the survey interview, 5.8% were dependent on marijuana in the past year. Among new users of crack cocaine in the 13 to 24 months prior to the survey interview, 9.2% were dependent on any type of cocaine in the past year. Of the new users of heroin in the 13 to 24 months prior to the survey interview, 13.4% were dependent on heroin in the past year.

Public Domain

Pahwal P; Hyman SM; Sinha R. Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the Cocaine Craving Questionnaire. Drug and Alcohol Dependence 93(3): 252-259, 2008. (42 refs.)

Background The 10-item version of the cocaine craving questionnaire (CCQ-Brief) has not been validated in a mixed-gender sample, and predictive validity of the CCQ-Now and CCQ-Brief in terms of their relationship with cocaine relapse has not been demonstrated. Objective: To further validate the CCQ-Brief in a mixed gender sample and to determine the predictive validity of the CCQ-Now and CCQ-Brief. Method: Seventy-two men and 51 women (Total N = 123) seeking inpatient cocaine dependence treatment were administered assessments upon admission, and a prospective design was employed to assess cocaine relapse outcomes during a 90-day follow-up period after discharge from inpatient treatment. Data were analyzed using Pearson's correlation, Cox proportional hazards regression, and multiple regression. Findings: The CCQ-Brief demonstrated good internal consistency and construct and concurrent validity. Both the CCQ-Now and the CCQ-Brief summary scores predicted time to cocaine relapse. In addition, the anticipation of a positive outcome from cocaine use, and intent and planning to use cocaine subscales of the CCQ-Now also predicted time to cocaine relapse. Conclusions: The CCQ-Brief was found to be a reliable and valid measure in a mixed gender sample, and both the CCQ-Now and CCQ-Brief were predictive of cocaine relapse risk. Craving assessments that go beyond desire and take into account intent and planning to use cocaine and the patient's anticipation of a positive outcome from using cocaine are likely to provide a sensitive index of cocaine relapse susceptibility. However, fear of social and clinical consequences could impact accurate reporting of cocaine craving and intent to use cocaine.

Palmer JM; Indermaur MD; Tebes CC; Spellacy WN. Placenta increta and cocaine abuse in a grand multipara leading to a second trimester rupture of an unscarred uterus: A case report. Southern Medical Journal 101(8): 834-835, 2008. (5 refs.)

A case of a uterine rupture in a grand multiparous patient with an unscarred uterus at 19 weeks' gestation secondary to placenta increta and cocaine abuse is presented. This was a diagnostically difficult case where abnormal implantation of the placenta, grand multiparity, and cocaine abuse were all contributors to the uterine rupture.

Papadodima SA; Athanaselis SA; Stefanidou ME; Dona AA; Papoutsis I; Maravelias CP et al. Driving under the influence in Greece: A 7-year survey (1998-2004). Forensic Science International 174(2-3): 157-160, 2008. (28 refs.)

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the southern part of Greece. The objective of the present study was to identify the prevalence of alcohol and other psychoactive substances among drivers involved in road traffic accidents in Greece during the period 1998-2004. Alcohol was detected in the blood of about 37% of the drivers involved in traffic accident during the years 1998-2000. The detection of alcohol was lower (29%) in the years 2001-2004. Cannabis, benzodiazepines, opiates, and cocaine were found in 4%, 4%, 4% and 1% of the total number of cases, respectively. The above values were compared with those of a previous study concerning the period 1995--1997 and the reasons for the reduction of the number of alcohol-related traffic accidents during the last years are discussed.

Patterson TL; Semple SJ; Staines H; Lozada R; Orozovich P; Bucardo J et al. Prevalence and correlates of HIV infection among female sex workers in 2 Mexico-US border cities. Journal of Infectious Diseases 197(5): 728-732, 2008. (15 refs.)

Background. We examined human immunodeficiency virus (HIV) prevalence and correlates among female sex workers (FSWs) in Tijuana and Ciudad Juarez, 2 large cities on the Mexico-US border. Methods. FSWs aged >= 18 years underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with HIV infection. Results. In 924 FSWs, the prevalence of HIV, gonorrhea, chlamydia, and syphilis titers >= 1:8 was 6%, 6.4%, 13%, and 14.2%, respectively. Factors independently associated with HIV were the injection of cocaine (odds ratio [OR], 2.96); the smoking, snorting, or inhalation of methamphetamine (OR, 3.32); and syphilis titers >= 1:8 (OR, 4.16). Conclusions. Culturally appropriate interventions are needed to identify and treat ulcerative sexually transmitted infections and reduce HIV risks associated with stimulants among FSWs in the Mexico-US border region.

Pavlovic Z; Jakovljevic B. Frequency and risk factors of the use of psychoactive substances among the young. (Serbian). Vojnosanitetski Pregled 65(6): 441-448, 2008. (17 refs.)

Background/Aim. Socio-economic changes that occured in the wake of dismemberment of former Yugoslavia resulted in the appearance of social pathology, one of which was the increase in the use of psychoactive substances. The overwhole epidemiological research in the use of psychoactive substances has not been conducted so far. The aim of this study was to establish the type and form of the use of psychoactive substances considering sex and age, as well as risk factors for the use of psychoactive substances among the children and adolescents. Methods. The research was carried out among 1011 elementary school children (seventh and eighth grades) and secondary school children (all four grades) in the area of Belgrade from October 2003 to January 2004. Out of the total number 457 (45.2%) were elementary school pupils and 554 (54.8%) secondary school pupils. There were 524 (51.8%) boys and 487 (48.2%) girls, aged from 12 to 18 years (the average age being 15.3 years). The method used was the European School Survey Project on Alcohol and Other Drugs Questionaire. Chisquare test, Mann-Whitney, Student's t test and Logistic Regression test were used in statistical processing of the data. Results. Totally 14.2% examinees tried psychoactive substances. The most frequent drug used at the first contact was marijuana (10.8%) at the age of 15 tried by 12.7% examinees, inhalants (4.4%), amphetamines (4.1%), sedatives (3.7%), alcohol combined with marijuana (3.9%), then cocaine (2.8%), heroin (2.3%), alcohol combined with sedatives (2.2%), and ecstasy (1.6%), followed by anabolic steroids, heroin, diethilamid lisergic acid (LSD) and magic mushrooms. It was determined that going out in the evening, smoking and binge form drinking were directly connected with the use of psychoactive substances. Conclusion. Totally 14.2% of the exameneers used psychoactive substances, mostly marijuana, followed by amphetamines and others. New tendencies of use characterized by the increase in the use are of synthetic substances, simultaneous use of more psychoactive substances and younger age. The risk factors are going out in the evening, smoking, binge drinking and use of synthetic substances among peers. Our research indicates the neccessity of primary prevention.

Pehrsson A; Gunnar T; Engblom C; Seppa H; Jama A; Lillsunde P. Roadside oral fluid testing: Comparison of the results of Drugwipe 5 and Drugwipe Benzodiazepines on-site tests with laboratory confirmation results of oral fluid and whole blood. Forensic Science International 175(2-3): 140-148, 2008. (31 refs.)

Drugged drivers pose a serious threat to other people in traffic as well as to themselves. Reliable oral fluid screening devices for on-site screening of drugged drivers would be both a useful and convenient means for traffic control. In this study we evaluated the appropriateness of Drugwipe 5 and Drugwipe Benzodiazepines oral fluid on-site tests for roadside drug screening. Drivers suspected of driving under the influence of drugs were screened with the Drugwipe tests. Oral fluid and whole blood samples were collected from the drivers and tested for amphetamine-type stimulant drugs, cannabis, opiates, cocaine and benzodiazepines by immunological methods, GC and GC-MS. The performance evaluations of the tests were made by comparing the results of the Drugwipe tests with laboratory GC-MS confirmation results of oral fluid or whole blood. In addition to the performance evaluations of the Drugwipe tests based on laboratory results, a questionnaire on the practical aspects of the tests was written for the police officers who performed the tests. The aim of the questionnaire was to obtain user comments on the practicality of the tests as well as the advantages and weak points of the tests. The results of the performance evaluations were: for oral fluid (sensitivity; specificity; accuracy) amphetamines (95.5%; 92.9%; 95.3%), cannabis (52.2%; 91.2%: 85.1%), cocaine (50.0%; 99.3%; 98.6%), opiates (100%; 95.8%; 95.9%), benzodiazepines (74.4%; 84.2%; 79.2%) and for whole blood accordingly, amphetamines (97.7%; 86.7%; 95.9%), cannabis (68.3%; 87.9%; 84.9%), cocaine (50.0%; 98.5%; 97.7%), opiates (87.5%; 96.9%; 96.6%) and benzodiazepines (66.7%; 87.0%; 74.4%). Although the Drugwipe 5 successfully detected amphetamine-type stimulant drugs and the police officers were quite pleased with the current features of the Drugwipe tests, improvements must still be made regarding the detection of cannabis and benzodiazepines.

Pettinati HM; Kampman KM; Lynch KG; Xie H; Dackis C; Rabinowitz AR et al. A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence. Addictive Behaviors 33(5): 651-667, 2008. (64 refs.)

Background: This is a double blind, placebo-controlled trial that evaluated the efficacy of disulfiram, naltrexone and their combination in patients with co-occurring cocaine and alcohol dependence. Methods: 208 patients were randomized to disulfiram (250 mg/day), naltrexone (100 mg/day), the combination, or placebo for 11 weeks. Outcomes were in-trial abstinence from cocaine and/or alcohol. Results: Few safety concerns were reported, although medication adherence was low in a number of patients for both medications, alone or in combination. In the primary analyses (GEE modeling), abstinence from cocaine as measured by cocaine-negative urines and days of self-reported abstinence from cocaine or alcohol did not differ between placebo and any of the medication groups. However, patients taking disulfiram (alone or in combination) were most likely to achieve combined abstinence from cocaine and alcohol. Secondary analyses revealed that patients taking the disulfiram-naltrexone combination were most likely to achieve 3 consecutive weeks of abstinence from cocaine and alcohol. Conclusion: There was an association between disulfiram treatment and abstinence from cocaine and alcohol. More patients taking the disulfiram-naltrexone combination achieved 3 consecutive weeks of abstinence in treatment than placebo-treated patients.

Pettinati HM; Kampman KM; Lynch KG; Suh JJ; Dackis CA; Oslin DW et al. Gender differences with high-dose naltrexone in patients with co-occurring cocaine and alcohol dependence. Journal of Substance Abuse Treatment 34(4): 378-390, 2008. (74 refs.)

This is a randomized, double-blind, placebo-controlled clinical trial that evaluated the efficacy of a higher-than-typical daily dose of naltrexone (150 mg/day), taken for 12 weeks, in 164 patients (n = 116 men and n = 48 women) with co-occurring cocaine and alcohol dependence. Patients were stratified by gender and then randomly assigned to either naltrexone or placebo, and to either cognitive-behavioral therapy or a type of medical management. The two primary outcomes were cocaine use and alcohol use. Significant Gender x Medication interactions were found for cocaine use via urine drug screens (three way, with time) and self-reports (two way) for drug severity (two way) and alcohol use (two way). The type of psychosocial treatment did not affect outcomes. Thus, 150 mg/day naltrexone added to a psychosocial treatment resulted in reductions in cocaine and alcohol use and drug severity in men, compared to higher rates of cocaine and alcohol use and drug severity in women.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Rajab R; Stearns E; Baithun S. Autopsy pathology of cocaine users from the Eastern district of London: A retrospective cohort study. Journal of Clinical Pathology 61(7): 848-850, 2008. (19 refs.)

Aim: To establish the most frequent pathological findings encountered at postmortem examination during the investigation of a fatality with a history of cocaine abuse. Methods: Autopsied deaths investigated by the coroner for the Eastern district of London, between 2004 and 2007, in which the decedent had positive toxicology for cocaine were identified (n = 28). The autopsy records and histology of tissue taken at autopsy were retrieved and reviewed. Pathological findings (gross and microscopic, including cardiac, pulmonary, gastrointestinal, hepatobiliary, renal and neurological) were collated. Results: The main pathological findings at autopsy occurring in this cohort (comprising predominantly men, mean age 31 years), were cardiovascular: left ventricular hypertrophy (46%), multifocal myocardial fibrosis (21%), coronary artery disease (29%), cerebrovascular disease (36%) and pulmonary oedema (71%). Hepatic steatosis (29%) and gastrointestinal haemorrhage (18%), due mostly to gastric erosions/ulceration, were also frequent findings. Conclusions: During a coroner's autopsy of a cocaine user, a thorough cardiac examination combined with cardiac tissue sampling for histology, are valuable investigations, which are most likely to help show pathology relevant to the cause of death.

Rash CJ; Alessi SM; Petry NM. Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments. Experimental and Clinical Psychopharmacology 16(4): 275-281, 2008. (29 refs.)

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM.

Reis AD; Castro LA; Faria R; Laranjeira R. Craving decrease with topiramate in outpatient treatment for cocaine dependence: an open label trial. Revista Brasileira de Psiguiatria 30(2): 132-135, 2008. (14 refs.)

Objective: To evaluate anticraving action and tolerability of topiramate in cocaine user treatment. Method: Male users of inhaled cocaine which met criteria for cocaine dependence (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were selected for outpatient 12-week, open label trial with topiramate; individual dosage ranged between 25-300 mg/day. Main clinical variables were abstinence rate, craving intensity, frequency and duration, adherence, dropouts, side effects and impulsivity measure through Barratt Impulsivity Scale. Patients received assertive strategic counseling for abstinence assistance and medication monitoring evaluation every two weeks. Comparative analysis was made with intention to treat, missing values were replaced (last observation carried forward), and significance level was 5%. Results: Adherence to treatment was 57% (at least three evaluations), 32% dropped out (one evaluation). There were no severe side effects. Negative test average was 25.4% (31.2). Significant reduction in craving intensity and duration was observed in 25% of the sample. No statistical significant reduction in craving frequency was observed in 7.1%. Increase in frequency was observed in 10.7% and 82.1% did not present any variation. No significant statistical variations in Barratt Impulsivity Scale or in the total score were found in the final evaluation when compared to baseline. Conclusion: More randomized placebo-controlled trials with topiramate for cocaine dependants should be performed to evaluate preliminary evidence.

Riddell S; Shanahan M; Degenhardt L; Roxburgh A. A review of the use of US-derived aetiological fractions in an Australian setting for antenatal problems related to cocaine use. (review). Australian and New Zealand Journal of Public Health 32(4): 393-394, 2008. (17 refs.)

Aetiological fractions are often used as an indirect measure of morbidity and mortality related to a specific risk factor. Aetiological fractions previously used in Australia for cocaine-related antenatal haemorrhage and low birth weight newborns have relied on risk ratios calculated from US-based studies. As outlined in this paper, there are several differences in the use and prevalence of cocaine and its associated harms between the two nations. As such, it is recommended that any use of these aetiological fractions with Australian data should occur with caution.

Rinehart CS; Bridges LJ; Sigelman CK. Differences between black and white elementary school children's orientations toward alcohol and cocaine: A three-study comparison. Journal of Ethnicity in Substance Abuse 5(3): 75-102, 2006

To trace the origins of race differences in substance use, this study examined differences between Black and White elementary school children's knowledge of alcohol and cocaine, beliefs about their shortand long-term effects, and attitudes toward and intentions to use them across three independent samples (N = 181, N = 287, N = 234). Black children were more negatively oriented toward alcohol and cocaine than White children from an early age. Most notably, in all samples Black children had less positive attitudes toward adult alcohol use and lower intentions to use alcohol. Black children were also more likely to attribute negative long-term health and social effects to alcohol and cocaine use, but there were few significant race differences in knowledge or in expectancies regarding short-term effects of use. Since race differences in beliefs, exposure to alcohol, and socioeconomic factors could not explain race differences in attitudes toward substance use, other cultural differences must be considered.

Rios-Bedoya CF; Wilcox HC; Piazza M; Anthony JC. Children taking risks: The association with cocaine and other drug use by young adulthood. Addictive Behaviors 33(9): 1154-1161, 2008. (34 refs.)

In this report from a longitudinal study, the main aim was to evaluate the long-term predictive strength of a novel cartoon-based risk-taking trait assessments which might prove to have utility in future research on mechanisms leading toward illegal drug involvement. The study population originated as 2311 first-graders entering 19 elementary schools during two successive school years. The assessments started soon after the children entered primary school. The key response variable was participants' use of cocaine by the time of a young adult assessment. We found that for each standard deviation increase in the risk-taking scale there was a two-fold increase in the risk of becoming a cocaine user by young adulthood (estimated relative risk, RR=1.9; 95% confidence interval, CI = 1.3,23). Independently, onset of cannabis use by young adulthood was also predicted by risk-taking scale values, but use of legal drugs (alcohol and tobacco) was not. These long-span associations provide support for new research on very early risk-taking mechanisms that lead toward illegal drug involvement.

Romney MG; Hull MW; Gustafson R; Sandhu J; Champagne S; Wong T et al. Large community outbreak of Streptococcus pneumoniae serotype 5 invasive infection in an impoverished, urban population. Clinical Infectious Diseases 47(6): 768-774, 2008. (42 refs.)

Background. Streptococcus pneumoniae is a common cause of sporadic invasive infections, but outbreaks of invasive pneumococcal disease are infrequent. In August 2006, a sudden increase in the number of patients presenting with invasive pneumococcal disease was noted at St. Paul's Hospital (Vancouver, Canada). Most patients with severe disease resided in an area referred to as the Downtown Eastside, a neighborhood known for its high rates of poverty and illicit drug use. Methods. Prospective, laboratory-based surveillance for invasive pneumococcal disease was initiated, including on-site serotyping of S. pneumoniae isolates. A vaccination campaign using 23-valent polysaccharide pneumococcal vaccine was launched in the Downtown Eastside. Multiple logistic regression was used to examine the association of sociodemographic variables and medical risk factors with S. pneumoniae serotype status. Results. A single S. pneumoniae serotype (serotype 5) was responsible for 78% of invasive pneumococcal disease cases (137 of 175 cases) during the outbreak period of August 2006-July 2007. The outbreak strain, although fully susceptible to penicillin, caused significant morbidity and placed considerable strain on the acute care system within the Vancouver Coastal Health region. Crack cocaine use was found to be the main independent risk factor associated with invasive pneumococcal disease due to S. pneumoniae serotype 5 (odds ratio, 12.4; 95% confidence interval, 2.22-69.5). Conclusions. A targeted vaccination campaign using polysaccharide pneumococcal vaccine appeared to help control this outbreak. In urban centers with high rates of illicit drug use, vaccination strategies for preventing invasive pneumococcal disease may need to be refined to include individuals who use crack cocaine.

Rossi D; Radulich G; Muzzio E; Naveira J; Sosa-Estani S; Rey J et al. Multiple infections and associated risk factors among non-injecting cocaine users in Argentina. Cadernos de Saude Publica 24(5): 965-974, 2008. (26 refs.)

The aim of this study was to estimate the seroprevalence rates of human immunodeficiency virus (HIV), hepatitis B virus (HBV, core antibody), hepatitis C virus (HCV), and syphilis infections and analyze associated risk factors among 504 non-injecting cocaine users (NICU) in Buenos Aires, Argentina. Participants were interviewed in face-to-face sessions through a short structured questionnaire. Using venipuncture, 10 mL of blood was collected. Seroprevalence rates were: HIV (6.3%), HBV (9%), HCV (7.5%), and VDRL (4.2%). The risk of being infected with HIV, HBV, and HCV was significantly associated with having had a sex partner who was either a drug injector or who was known to be HIV positive. HIV and HCV infections were associated with former imprisonment, and HCV was associated with having been tattooed. Because of the rising number of NICU and the multiple infections detected, it is essential to implement prevention strategies focused on this population.

Roxburgh A; Degenhardt L. Hospital stays related to illicit drugs in Australia, 1993-2004. NDARC Technical Report No. 261. Sydney: National Drug and Alcohol Research Centre (Australia), 2006. (45 refs.)

This report examines trends in drug-related hospital separations (including use, dependence, psychosis and withdrawal) in Australia during the period 1993 to 2004. The report presents data on characteristics of those people being treated in hospital for drug-related reasons, details of their hospital stay, analysis of which other drugs co-occur with each drug type, and analysis of the non drug-related treatment received while in hospital in conjunction with drug-related treatment. Opioid-related separations were the most frequent illicit drug-related separations occurring in Australia over the eleven-year period. A substantial proportion (up to 54%) of opioid mentions was accompanied by a broad spectrum of physical health problems, which is indicative of the relatively poor physical health of this group of drug users. Opioid-related separations declined dramatically in 2001/02, the period of the heroin shortage. Despite the dramatic decline in opioid-related separations, they remain the highest across the drug types. Amphetamine-related separations were the next highest in number, and increased over the eleven-year period. Information is provided for other drug classes-- cocaine, marijuana, amphetaminesm, and the numbers treated for withdrawal. Data is presented in 92 tables and figures.

Roxburgh A; Degenhardt L; Copeland J; Larance B. Drug dependence and associated risks among female street-based sex workers in the greater Sydney area, Australia. Substance Use & Misuse 43(8-9): 1202-1217, 2008. (44 refs.)

Background: This study examines drug use and dependence and associated risks among female street-based sex workers. Methods: Cross-sectional data collected from 72 women between April and August 2005 in Sydney, Australia, via face-to-face interviews. Sample: The average age was 34 years. Results: Risk factors associated with developing problematic drug use were prevalent. Child sexual abuse, leaving home before the age of 16, and exposure to multiple traumas was common. Depression and posttraumatic stress disorder were also prevalent. A substantial minority reported cocaine dependence which was associated with engaging in sex and injecting risk behaviors. Conclusions: More targeted interventions for this group are needed. Research on the value of extending existing outreach services to further reduce the harms associated with sex work and drug use is indicated. The study's limitations are noted.

Santora PB; Hutton HE. Longitudinal trends in hospital admissions with co-occurring alcohol/drug diagnoses, 1994-2002. Journal of Substance Abuse Treatment 35(1): 1-12, 2008. (73 refs.)

In this observational study, longitudinal trends (1994-2002) in hospital admissions with co-occurring alcohol/drug abuse and addiction (ADAA; N = 43,073) were examined to determine prevalence and hospital costs by payer group and type of drug used. Four primary drug types were reported: 49% used a combination of two or more drugs, 25% used alcohol only, 11.8% used opioids only, and 6.5% used cocaine only. Costs of admissions increased significantly for those using two or more drugs (119%, from US$12.7 to US$27.8 million), alcohol (120%, from US$9 to US$19.8 million), and opioids (482%, from US$1.7 to US$9.9 million). Medicaid/Medicare represented 70% of the overall number of admissions and also paid 70% of hospital costs. Among Medicaid/Medicare and uninsured admissions, illicit drug use was more common, whereas among private payer admissions, alcohol abuse was more common. Hospital admissions with co-occurring ADAA must be considered when estimating the scope of ADAA and its financial burden.

Schepis TS; Krishnan-Sarin S. Characterizing adolescent prescription misusers: A population-based study. Journal of the American Academy of Child and Adolescent Psychiatry 47(7): 745-754, 2008. (42 refs.)

Objective: To examine the risk factors associated with adolescent (ages 12-17) misuse of opioids, stimulants, tranquilizers, and sedatives using a nationally representative sample. The characteristics associated with symptoms of abuse and/or dependence related to prescription medication misuse among adolescents were also analyzed. Method: These questions were addressed using the 2005 National Survey on Drug Use and Health. Screening and full interview response rates were 91% and 76%, respectively, and data from 18,678 adolescents were used. Regression analyses, using population-based weights, were performed to identify characteristics associated with past year misuse of prescription medications and the presence of past year abuse or dependence symptoms related to misuse. Results: Among adolescents, 8.2% misused a medication and 3.0% endorsed symptoms of a substance use disorder related to prescription medication misuse in the past year. The predictors of misuse from multivariate analyses were poorer academic performance (odds ratio [OR] 2.9, 95% confidence interval [CI] 2.37-3.52), past year major depression (OR 3.1, 95% CI 2.62-3.74), higher risk-taking levels (OR 3.6, 95% CI 3.13-4.20), past year use of alcohol (OR 7.3, 95% CI 6.19-8.59), cigarettes (OR 8.6, 95% CI 7.43-9.91), marijuana (OR 9.9, 95% CI 8.53-11.44), or past year use of cocaine or an inhalant (OR 10.7, 95% CI 8.98-12.72). Past year major depression (OR 1.5, 95% CI 1.03-2.25), past year cocaine or inhalant use (OR 1.7, 95% CI 1.21-2.41), or >= 10 episodes of past year prescription misuse (OR 3.0, 95% CI 2.13-4.17) was associated with having symptoms of abuse of or dependence among adolescent prescription medication misusers. Conclusions: These risk factors could help clinicians identity those at risk for significant problems due to prescription misuse, allowing for prevention or early treatment in this population.

Schifano F; Corkery J. Cocaine/crack cocaine consumption, treatment demand, seizures, related offences, prices, average purity levels and deaths in the UK (1990-2004). Journal of Psychopharmacology 22(1): 71-79, 2008. (59 refs.)

A recent trend of escalating use of cocaine/crack cocaine was observed in the UK. The number of mentions on death certificates; last year use of cocaine; treatment demand, number of drug offenders, seizures, prices and average purity levels were the indicators used for this descriptive and correlational study. Figures ( 1990-2004) were taken from official UK sources. A total of 1022 cocaine/crack cocaine death mentions ( i.e. deaths from any cause where the presence of cocaine/ crack cocaine was also detected) were identified, with cocaine/ crack cocaine being the sole drug mentioned in 36% of cases. The number of cocaine/ crack cocaine death mentions showed a year-on-year increase and correlated positively with the following cocaine ( powder) figures: last year use ( p < 0.001); number of offenders ( p < 0.001) and number of seizures ( p < 0.001), but correlated negatively with price ( p < 0.001). Furthermore, the number of cocaine/ crack cocaine death mentions correlated positively with the number of crack offenders ( p < 0.001) and seizures ( p < 0.001), but correlated negatively with both crack purity ( p < 0.001) and price ( p < 0.05). With conditions of increasing drug availability having been met in the UK, decrease in cocaine prices were associated with higher consumption levels and this, in turn, contributed to the increase in number of cocaine-related fatalities. There are limitations with the information collected, since no distinction is usually made on medical death certificates between cocaine and crack cocaine. The present study being an ecological one, it proved difficult to address the role of confounding variables that may well explain some of the associations observed.

Schlosser AV; Ben Abdallah A; Callahan CL; Bradford S; Cottler LB. Does readiness to change predict reduced crack use in human immunodeficiency virus prevention? Journal of Substance Abuse Treatment 35(1): 28-35, 2008. (34 refs.)

This study examines crack cocaine (crack) use, readiness to change, and gender in a sample of 923 men and women randomized to standard human immunodeficiency virus (HIV) education (standard intervention [SI]) or peer-delivered intervention (enhanced intervention [EI]). Four levels of crack use characterized frequency of use in the past 30 days; readiness was assessed on three levels (precontemplation, contemplation, and preparation/action). Differences between intervention groups on crack use and readiness by gender were examined from baseline to 3-month follow-up. Overall, participants reduced their crack use from baseline, with those in the El showing greater improvement than those in the SI. A small proportion of participants improved readiness; those who improved were more likely to improve their crack use. No significant gender differences were found. These findings suggest that the readiness construct does not fully capture the dynamics of change among out-of-treatment crack users. Further research is needed to fully comprehend the dynamics of change among this group.

Schmidt S; Hugli O; Rizzo E; Lepori D; Gudinchet R; Yersin B et al. Detection of ingested cocaine-filled packets - Diagnostic value of unenhanced CT. European Journal of Radiology 67(1): 133-138, 2008. (24 refs.)

Purpose: Emergency departments are facing nowadays an increasing number of illegal drug-related health problems, associated with medicolegal and/or social consequences. Body stuffers are street cocaine dealers, who either store wrapped packets of drugs in their rectum or hastily swallow them, prompted by fear of police's arrest. These packets can be life threatening in case of leakage. We evaluate the diagnostic value of unenhanced multidetector CT (MDCT) for detection of cocaine-filled packets (CFP) ingested by body stuffers in a phantom model. Materials and methods: Our phantom simulated normal bowel contents in which a varying number of true and false UP were randomly mixed. Both only differ in radiological density. During 18 different reading sessions, four radiologists independently evaluated the presence and number of true and false CFP. Interobserver agreement, sensitivity, specificity, positive and negative predictive value were calculated. Results: Interobserver agreement for detection of any packets, for visualization of true, and false UP was good (kappa=0.63, 0.74 and 0.58, respectively). Sensitivity, specificity, positive and negative predictive value for detection of any packets was 95.6%, 100%, 100% and 62.5%, respectively; for visualization of the true UP 86.5%, 100%, 100% and 77.6%, respectively; and for the false packets 98.1%, 65%, 88.6% and 87.5%, respectively. Conclusion: Unenhanced MDCT without bowel preparation is a fast, reliable and easily reproducible imaging modality for the immediate detection of ingested UP, thus facilitating medicolegal management of body stuffers.

Schockett ER. Risky business: Assessing operative risk in the cocaine-positive patient. (meeting abstract). Journal of General Internal Medicine 23(Supplement 2): 169-169, 2008. (0 refs.)

Severtson SG; Latimer WW. Factors related to correctional facility incarceration among active injection drug users in Baltimore, MD. Drug and Alcohol Dependence 94(1/3): 73-81, 2008. (33 refs.)

Aim: We investigated the moderating effect of impulse control on the association between drug use and incarceration among active injection drug users (IDU). Methods: The study sample consisted of 282 IDUs aged 15-50 years from the Baltimore metropolitan region who reported injection drug use within the past 6 months and indicated that heroin or speedball was their drug of choice. Impulse control was measured using commission error standardized scores from the Test of Variables of Attention (TOVA). Incarceration was obtained using self-reported lifetime history of incarceration in correctional facilities. Results: Findings indicated that impulse control moderated the association between years of injection drug use and incarceration in correctional facilities adjusting for ethnicity, gender, estimated pre-morbid intelligence, and age of first injection use. Specifically, among individuals who were intact in impulse control, four or more years of injection drug use was associated with incarceration (AOR=4.97, 95% Cl: 2.02-12.23). This finding was not observed among individuals with impaired impulse control (AOR = 0.57, 95% CI: 0.10-3.23). Furthermore, impulse control moderated the association between regular cocaine use and incarceration. Among individuals who had a history of cocaine use, individuals with low impulse control but not impaired were more likely to have reported time in a correctional facility (AOR = 6.28, 95% CI: 1.68-23.60). There was no association among individuals with impaired or intact impulse control. Conclusion: Results highlight the importance of considering cognitive measures of impulse control in addressing negative outcomes associated with drug use.

Shannon K; Rusch M; Morgan R; Oleson M; Kerr T; Tyndall MW. HIV and HCV prevalence and gender-specific risk profiles of crack cocaine smokers and dual users of injection drugs. Substance Use & Misuse 43(3/4): 521-534, 2008. (39 refs.)

The present analysis compares HIV and HCV prevalence and associated gender-specific risk patterns of dual users (i.e., crack smokers who inject drugs) and never injectors. Two logistic models, one restricted to female and the other to male crack smokers, were constructed to identify gender-specific risk factors associated with dual use (p 0.05). Of 437 crack smokers, 246 (56%) were dual users while 191 (44%) were never injectors. In a fitted logistic regression model, dual use among female crack smokers was associated with HCV infection (adjusted OR = 4.65, 95% CI: 1.92-9.70), exchanging sex for money, drugs, or shelter while using crack (aOR = 4.47, 95% CI: 1.56-12.80), having a casual partner who injects (aOR = 4.13, 95% CI: 1.05-16.26), having equipment broken or confiscated by police without being arrested (aOR = 3.66, 95% CI: 1.43-9.34), and HIV infection (aOR = 2.07, 95% CI: 1.18-5.96). Among male crack smokers, dual use was associated with HCV infection (aOR = 5.34, 95% CI: 2.10-13.18), exchanging sex for money, drugs, or shelter (aOR = 3.25, 95% CI: 1.59-6.65), crack use history 5 years (aOR = 2.16, 95% CI: 1.29-3.63), and smoking in a group of unknown people (such as crack houses, alleys; aOR = 1.70, 95% CI: 1.10-2.81). These findings highlight the need for evidence-based prevention and harm reduction initiatives that directly targeting crack cocaine smokers, with particular attention given to female dual users of injection drugs.

Simon RW; Pfammatter T; Amann-Vesti BR. Accidental intraarterial cocaine injection. (letter). Journal of Vascular and Interventional Radiology 19(7): 1124-1125, 2008. (3 refs.)

Stoops WW; Blackburn JW; Hudson DA; Hays LR; Rush CR. Safety, tolerability and subject-rated effects of acute intranasal cocaine administration during atomoxetine maintenance. Drug and Alcohol Dependence 92(1/3): 282-285, 2008. (23 refs.)

The results of recent research indicate that agonist replacement may be a viable option in the treatment of cocaine dependence. For example, D-amphetamine and modafinil have shown promise in managing cocaine dependence in preliminary clinical trials. The aim of this study was to determine the physiological and subject-rated effects of acute intranasal cocaine doses during chronic atomoxetine treatment. Atomoxetine was chosen because it produces pharmacological and subject-rated effects similar to those of prototypical stimulants and thus may also be a viable agonist replacement therapy. To this end, seven cocaine-dependent subjects were maintained on doses of atomoxetine (0 mg [lead in], 5, 10, 20 and 0 mg [washout], four times daily) for 3-5 days prior to completing experimental sessions in which ascending doses of intranasal cocaine (4, 20, 40 and 60 mg) were administered. Cocaine produced prototypical cardiovascular and subject-rated effects. Atomoxetine attenuated the systolic pressure increasing effects and enhanced the heart rate increasing effects of cocaine, but was otherwise devoid of effects. These results indicate that cocaine is well tolerated during atomoxetine maintenance. Further research is needed to better determine the effects of atomoxetine and cocaine combinations.

Suh JJ; Ruffins S; Robins CE; Albanese MJ; Khantzian EJ. Self-medication hypothesis: Connecting affective experience and drug choice. Psychoanalytic Psychology 25(3): 518-532, 2008. (67 refs.)

According to E. J. Khantzian's (2003) self-medication hypothesis (SMH), a psychoanalytically informed theory of substance addiction that considers emotional and psychological dimensions, substance addiction functions as a compensatory means to modulate affects and self-soothe from the distressful psychological states. To manage emotional pain, dysphoria, and anxiety, substance abusers use the drug actions, both physiological and psychological effects, to achieve emotional stability. The SMH was retrospectively tested using 6 Minnesota Multiphasic Personality Inventory-2 special scales with 402 non-drug users and drug users to capture the psychological elements relevant to the SMH. Three logistic regression models were formed to predict alcohol, cocaine, and heroin "drug-of-choice" groups. Predicting variables were the Repression, Overcontrolled Hostility, Psychomotor Acceleration, Depression, Posttraumatic Stress Disorder, and Cynicism scales. Repression and, inversely, Depression scales significantly predicted the alcohol group. Psychomotor Acceleration was the only significant predictor of the cocaine group. Cynicism significantly predicted heroin preference. The results are partially consistent with the SMH. Implications of these results for understanding the relationship between affect regulation and addiction and treatment interventions are discussed.

Thomas MJ; Kalivas PW; Shaham Y. Neuroplasticity in the mesolimbic dopamine system and cocaine addiction. (review). British Journal of Pharmacology 154(2): 327-342, 2008. (169 refs.)

The main characteristics of cocaine addiction are compulsive drug use despite adverse consequences and high rates of relapse during periods of abstinence. A current popular hypothesis is that compulsive cocaine use and cocaine relapse is due to drug-induced neuroadaptations in reward-related learning and memory processes, which cause hypersensitivity to cocaine-associated Here, we review results from studies on the effect of cocaine exposure on selected signalling cascades, growth factors and physiological processes previously implicated in neuroplasticity underlying normal learning and memory. These include the extracellular signal-regulated kinase (ERK) signalling pathway, brain-derived neurotrophic factor (BDNF), glutamate transmission, and synaptic plasticity (primarily in the form of long-term potentiation and depression, LTP and LTD). We also discuss the degree to which these cocaine-induced neuroplasticity changes in the mesolimbic dopamine system mediate cocaine psychomotor sensitization and cocaine-seeking behaviours, as assessed in animal models of drug addiction. Finally, we speculate on how these factors may interact to initiate and sustain cocaine psychomotor sensitization and cocaine seeking.

Topik S; Marichal C; Frank Z, eds. From Silver to Cocaine: Latin American Commodity Chains and the Building of the World Economy, 1500-2000. Durham, NC: Duke University Press, 2006. (Chapter refs.)

This edited collection includes 12 essays with 16 contributors. It examines the "commodity chain approach" to history, with each essay focusing on one commodity taken from Latin America over a 500 year period, and the relationship to the expansion of the world economy. The first of these was silver, which became the "money" of the emerging Atlantic economy. Other raw materials to be appropriated from the continent and which became central to the emerging global economy included indigo, cochineal ( a red dye valued by European nobility), tobacco, coffee, sugar, cacao, bananas, fertilizers (guano and nitrates), rubber, henequen, and, most recently cocaine. Each of these raw materials is examined as a "product" which became central to the international economy. Rather than the nation-state being the focus of analysis, the interest is commodities/products, and which bind different nations and areas in diverse ways. In this view, globalization is not a new phenomenon but a long-standing one. Aside from a vehicle for exploring different approaches to history, this volume considers products of interest to those involved in substance abuse: tobacco, coffee, and cocaine.

Tsapas A; Paletas K; Vlachaki E; Bekiari E; Spanos C; Economidis D. Eosinophilic pneumonia associated with heroin inhalation: A case report. Wiener Klinische Wochenschrift 120(5-6): 178-180, 2008. (13 refs.)

Drugs are known to be a cause of pulmonary eosinophilia and several case reports of acute eosinophilic pneumonia associated with the use of cocaine have been reported. The changing pattern of heroin use, with a shift from intravenous use to smoking/inhalation of the substance, may lead to increased prevalence of heroin-induced pulmonary eosinophilia. We report on a case of a patient who had been inhaling heroin for about ten years. He presented with fever, cough, dyspnea and pleuritic chest pain. Chest radiograph showed unilateral pleural effusion with segmental atelectasis. Examination of pleuritic fluid aspirate and bronchoalveolar lavage fluid revealed significant eosinophilia. He was diagnosed with acute eosinophilic pneumonia. Rapid remission was achieved after heroin abstinence and initiation of corticosteroid treatment.

Vadhan NP; Myers CE; Rubin E; Shohamy D; Foltin RW; Gluck MA. Stimulus-response learning in long-term cocaine users: Acquired equivalence and probabilistic category learning. Drug and Alcohol Dependence 93(1/2): 155-162, 2008. (26 refs.)

Objective: The purpose of this study was to examine stimulus-response (S-R) learning in active cocaine users. Participants and methods: Twenty-two cocaine-dependent participants (20 males and 2 females) and 21 non-drug using control participants (19 males and 2 females) who were similar in age and education were administered two computerized learning tasks. The Acquired Equivalence task initially requires learning of simple antecedent-consequent discriminations, but later requires generalization of this learning when the stimuli are presented in novel recombinations. The Weather Prediction task requires the prediction of a dichotomous outcome based on different stimuli combinations when the stimuli predict the outcome only probabilistically. Results: On the Acquired Equivalence task, cocaine users made significantly more errors than control participants when required to learn new discriminations while maintaining previously learned discriminations, but performed similarly to controls when required to generalize this learning. No group differences were seen on the Weather Prediction task. Conclusions: Cocaine users' learning of stimulus discriminations under conflicting response demands was impaired, but their ability to generalize this learning once they achieved criterion was intact. This performance pattern is consistent with other laboratory studies of long-term cocaine users that demonstrated that established learning interfered with new learning on incremental learning tasks, relative to healthy controls, and may reflect altered dopamine transmission in the basal ganglia of long-term cocaine users.

Veyrie N; Servajean S; Aissat A; Corigliano N; Angelakov C; Bouillot JL. Value of a systematic operative protocol for cocaine body packers. World Journal of Surgery 32(7): 1432-1437, 2008. (24 refs.)

Background: Internal concealment of illicit drugs during international drug traffic represents an important problem in developed countries. These drug traffickers are called "body packers." The aim of this study was to analyze retroprospectively the surgical indications and complications for cocaine body packers and to describe our systematic operative protocol. Methods From January 1997 to December 2005, 1,181 cocaine body packers were admitted to our Medico-Judiciary Emergency Department. All patients had the same medical surveillance protocol. Nineteen patients required surgical procedure to remove drug packets. Results: Thirteen patients had obstruction or intestinal retention (68%). Suspicion of packet rupture or cocaine intoxication occurred in six patients (32%). Zero to three enterotomies were necessary during laparotomy. No deaths occurred. One pouch abscess required relaparotomy and one wound abscess was treated medically. The median hospital stay was 7 days (range: 5-30 days). Conclusions: Few cocaine body packers required a laparotomy. Our systematic operative protocol allowed intestinal clearance and caused acceptable morbidity rate.

Vivancos R; Abubakar I; Hunter PR. Sex, drugs and sexually transmitted infections in British university students. International Journal of STD and AIDS 19(6): 370-377, 2008. (32 refs.)

Understanding predisposing factors for sexually transmitted infections (STIs) in young adults may identify targets for public health interventions. We conducted a cross-sectional web-based survey of university students' sexual attitudes, behaviours and lifestyles and self-reported rates of STI. A total of 827 students responded, 22.4% had two or more sexual partners in the previous year with inconsistent condom use and the lifetime prevalence of STIs was 9.6%. Factors associated with a diagnosis of STI were increasing age and number of sexual partners ever, female gender (adjusted odds ratio [AOR] 2.70, 95% confidence interval [Cl] 1.31, 5.56) and use of crack (AOR 10.45, 95% CI 1.46, 75.16). For female students, these were increasing age and number of partners ever, whereas for male students having sex with other men (bisexual AOR 4.8, 95% CI 1.02, 22.595, homosexual AOR 17.66, 95% CI 3.03,103.04) and use of crack (AOR 32.24, 95% CI 3.33, 312.08). Multiple partners and recreational drug use may predict incidence of STI. Prevention strategies need to aim at reducing risk behaviour across various activities.

Wiesbeck GA; Kuhl HC; Yaldizli O; Wurst FM. Tobacco smoking and depression - Results from the WHO/ISBRA study. Neuropsychobiology 57(1-2): 26-31, 2008. (19 refs.)

Aims: To elucidate the relationship between tobacco smoking and depression, and to estimate the impact of other substance dependencies. Design: Cross-sectional. Participants: A total of 1,849 men and women were interviewed face-to-face using a validated structured questionnaire. According to their tobacco smoking behavior, participants were grouped into never smokers, ex-smokers and current smokers. Measurements: Data were generated through the WHO/ISBRA study, an international multicenter study with a cross-sectional design. A standardized questionnaire was administered face-to-face by trained interviewers. Logistic regression analysis was used to predict depression. Results: There was a significant difference across the 3 smoking groups in the number of subjects who had major depression (DSM-IV) during their lifetime. The highest rate of depressives was found in current smokers (23.7%), the lowest rate in never smokers (6.2%), while the rate of those who had quit smoking (14.6%) was between both. In a logistic regression analysis, alcohol dependence (both current and during lifetime) as well as cocaine dependence were significant predictors of depression. However, the association between smoking and depression still remained statistically significant. Conclusions: This study adds support to the evidence that smoking is linked to depression. It also elucidates the importance of taking into account alcohol and cocaine dependence since they have a significant impact on the relationship between smoking and depression.

Wiley JL; Evans RL; Grainger DB; Nicholson KL. Age-dependent differences in sensitivity and sensitization to cannabinoids and 'club drugs' in male adolescent and adult rats. Addiction Biology 13(3-4): 277-286, 2008. (46 refs.)

Lifelong substance abuse is often initiated during adolescence; yet, most pre-clinical research in this area has been conducted in adult animals. Substantial evidence exists that the brain development that continues throughout adolescence may result in pharmacological responses that differ in a crucial manner from those of adults. The goal of this study was to evaluate age differences in motor activity following acute and repeated administration of drugs that are commonly abused by adolescents, including cocaine, Delta(9)-tetrahydrocannabinol (Delta(9)-THC), and the club drugs, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Adolescent and adult male rats were injected once daily with saline or with a dose of one of the test drugs for two 5-day dosing periods, separated by a 2-day drug holiday during which they remained in their home cages. Following each injection, rats were placed in a locomotor chamber for a 20-minute session. The potencies of cocaine, ketamine and MDMA for producing motor stimulation were less in male adolescents than in male adults. Furthermore, sensitization to the club drug, ketamine, developed after repeated dosing in adults, but not adolescents. In contrast, adolescents were initially more sensitive to the stimulatory effects of low doses of Delta(9)-THC than were adults, although rapid tolerance occurred. These results suggest that adolescents are less sensitive to the acute and repeated stimulant effects of some, but not all, of the drugs that are preferentially abused by this age group. This differential sensitivity may contribute to the different patterns of use that have been noted in adolescent versus adult drug abusers.

Williams MJ; Adinoff B. The role of acetylcholine in cocaine addiction. (review). Neuropsychopharmacology 33(8): 1779-1797, 2008. (249 refs.)

Central nervous system cholinergic neurons arise from several discrete sources, project to multiple brain regions, and exert specific effects on reward, learning, and memory. These processes are critical for the development and persistence of addictive disorders. Although other neurotransmitters, including dopamine, glutamate, and serotonin, have been the primary focus of drug research to date, a growing preclinical literature reveals a critical role of acetylcholine (ACh) in the experience and progression of drug use. This review will present and integrate the findings regarding the role of ACh in drug dependence, with a primary focus on cocaine and the muscarinic ACh system. Mesostriatal ACh appears to mediate reinforcement through its effect on reward, satiation, and aversion, and chronic cocaine administration produces neuroadaptive changes in the striatum. ACh is further involved in the acquisition of conditional associations that underlie cocaine self-administration and context-dependent sensitization, the acquisition of associations in conditioned learning, and drug procurement through its effects on arousal and attention. Long-term cocaine use may induce neuronal alterations in the brain that affect the ACh system and impair executive function, possibly contributing to the disruptions in decision making that characterize this population. These primarily preclinical studies suggest that ACh exerts a myriad of effects on the addictive process and that persistent changes to the ACh system following chronic drug use may exacerbate the risk of relapse during recovery. Ultimately, ACh modulation may be a potential target for pharmacological treatment interventions in cocaine-addicted subjects. However, the complicated neurocircuitry of the cholinergic system, the multiple ACh receptor subtypes, the confluence of excitatory and inhibitory ACh inputs, and the unique properties of the striatal cholinergic interneurons suggest that a precise target of cholinergic manipulation will be required to impact substance use in the clinical population.

Worley M; Gallop R; Gibbons MBC; Ring-Kurtz S; Present J; Weiss RD et al. Additional treatment services in a cocaine treatment study: Level of services obtained and impact on outcome. American Journal on Addictions 17(3): 209-217, 2008. (22 refs.)

The objective of this study was to examine the level of additional treatment services obtained by patients enrolled in the NIDA Cocaine Collaborative Study, a multi-center efficacy trial of four treatments for cocaine dependence, and to determine whether these set-vices impact treatment outcome. Cocaine-dependent patients (N = 487) were recruited at five sites and randomly assigned to six months of one of four psychosocial treatments. Assessments were made at baseline, monthly during treatment, and at follow-ups at 9, 12, 15, and 18 months post-randomization. On average, patients received little or no additional treatment services during active treatment (first six months), but the rate of obtaining most services increased during the follow-up phase (month 7 to 18). In general, the treatment groups did not differ in the rates of obtaining non-protocol services. For all treatment groups, patients with greater psychiatric severity received more medical and psychiatric services during active treatment and follow-up. Use of treatment services was unrelated to drug use outcomes during active treatment. However, during the follow-up period, increased use of psychiatric medication, twelve-step attendance, and twelve-step participation was related to less drug use. The results suggest that during uncontrolled follow-up phases, additional non-protocol services may potentially confound the interpretation of treatment group comparisons in drug use outcomes.

Wright NMJ; Martin M; Goff T; Morgan J; Elworthy R; Ghoneim S. Cocaine and thrombosis: a narrative systematic review of clinical and in-vivo studies. Substance Abuse Treatment, Prevention, and Policy 2(e-article 27), 2007. (50 refs.)

Purpose: To systematically review the literature pertaining to the link between cocaine and either arterial or venous thrombosis. Procedures: Narrative systematic review of Medline, CINAHL, Embase, Psycinfo and Cochrane databases supplemented by hand trawling of relevant journals and reference lists up to April 2007. In-vivo studies and those with clinical endpoints were included in the review. Results: A total of 2458 abstracts led to 186 full-text papers being retrieved. 15 met the criteria for inclusion in the review. The weight of evidence would support cocaine as a pro-thrombotic agent. There is evidence of it activating thrombotic pathways. The effect of cocaine upon clinical endpoints has not been quantified though there is evidence of an association between cocaine and myocardial infarction particularly amongst young adults. Cocaine may also be a causal agent in cerebrovascular accident though studies lacked sufficient power to determine a statistically significant effect. There is a gap in the evidence pertaining to the issue of cocaine and venous thrombosis. Conclusion: Clinicians should consider questioning for cocaine use particularly amongst young adults who present with cardiac symptoms. More epidemiological work is required to quantify the effect of cocaine upon both arterial and venous clotting mechanisms.

Wryobeck JM; Walton MA; Curran GM; Massey LS; Booth BM. Complexities of cocaine users presenting to the emergency department with chest pain: Interactions between depression symptoms, alcohol use, and race. Journal of Addiction Medicine 1(4): 213-221, 2007. (55 refs.)

Chest pain is the most frequent cocaine-related medical event for which patients seek treatment in inner-city emergency departments (EDs). Given that depression increases risk for poor substance use and cardiac outcomes, knowledge of correlates of depressive symptoms among these out-of-treatment cocaine users is crucial to developing interventions for these inner-city populations that frequently present to the ED. A total of 219 individuals presenting to an inner-city ED with chest pain and recent cocaine use were divided into 2 groups based on scoring positive (42%) for moderate-to-severe depression on the Patient Health Questionnaire (PHQ-9). The depression symptoms group reported a significantly greater number of standard drinks per drinking occasion (7.1 versus 4.6) and a greater number of heavy drinking days (9 versus 5). A significant 3-way interaction effect found males and non-white females reporting a greater number of heavy drinking days were more likely to be in the depression symptoms group, whereas white females with a greater number of heavy drinking days were more likely to be in the nondepression symptoms group. Depression is clearly a problem among not-in-treatment cocaine users presenting to an inner-city ED; heavy drinking in concert with cocaine use increases the risk for depression, with important interactions by race and gender.

Wu ZHL; Eschbach K; Grady JJ. Contextual influences on polydrug use among young, low-income women: Effects of neighborhood and personal networks. American Journal on Addictions 17(2): 135-144, 2008. (61 refs.)

This study assessed contextual risks for polydrug use in a triethnic sample (non-Hispanic white, African American, Hispanic) of young women with a low income. For the current analysis, a total of 712 young women aged 18 to 31 years who sought care in state-funded family planning clinics in southeast Texas from December 2001 to May 2003 participated in the survey. The main outcome of the study was the number of illicit drugs (including marijuana, MDMA [ecstasy], crack cocaine, and other hard drugs) used in the last 12 months. Of the 712 subjects, 198 (28%) reported using illicit drugs it? the past 12 months. Neighborhood socioeconomic status was significantly associated with drug use in a bivariate model. The proportion of women living in the most advantaged neighborhoods who reported drug use was more than twice that of women living in the most disadvantaged neighborhoods. However, the significance of neighborhood socioeconomic status was eliminated after controlling for ethnicity or for personal network characteristics in a multivariate ordinal logistic regression model. In contrast, in multivariate models, personal network indicators, such as a larger number of monthly contacts with friends (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.11, 1.56) and a target-number of friends who used illicit drugs (OR = 1.47, 95% CI = 1.33, 1.62) were associated with increased drug use. In addition, not being currently married (vs. being married) (OR = 2.73, 95% CI = 1.44, 5.16) was associated with a larger number of drugs used in the last 12 months. In conclusion, we found that neighborhood socioeconomic status was not directly associated with more drug use when controlling for ethnicity or for personal network characteristics. Personal networks may mediate the relationships between neighborhood and drug use. Strategies to reduce polydrug use should target personal networks where friends use illicit drugs.

Yamaguchi ET; Cardoso MMSC; Torres MLA; de Andrade AG. Drug abuse during pregnancy. (review) [Portuguese]. Revista de Investigacion Clinica 35(Supplement 1): 44-47, 2008. (41 refs.)

Background: Despite the fact that it has being a growing problem worldwide, very few works and papers have been published on drug use during pregnancy. Objectives: To objectively address the most commonly abused drugs (alcohol, cocaine, marijuana, and tobacco) by women of a reproductive age. Methods: A literature review (MEDLINE, LILACS) of the most recent papers on drug abuse by women of reproductive age was carried out. Results: The primary consequences of drug abuse both for the mother and the infant are described. Conclusions: This is a little discussed major public health issue which requires the involvement of a multidisciplinary team. The publication of a greater number of papers on the problem is necessary in order to establish the best strategy for addressing intervention in this population.

Yamamoto RT; Karlsgodt KH; Rott D; Lukas SE; Elman I. Effects of perceived cocaine availability on subjective and objective responses to the drug. Substance Abuse Treatment, Prevention, and Policy 2(e-article 30), 2007. (65 refs.)

Rationale: Several lines of evidence suggest that cocaine expectancy and craving are two related phenomena. The present study assessed this potential link by contrasting reactions to varying degrees of the drug's perceived availability. Method: Non-treatment seeking individuals with cocaine dependence were administered an intravenous bolus of cocaine (0.2 mg/kg) under 100% ('unblinded'; N = 33) and 33% ('blinded'; N = 12) probability conditions for the delivery of drug. Subjective ratings of craving, high, rush and low along with heart rate and blood pressure measurements were collected at baseline and every minute for 20 minutes following the infusions. Results: Compared to the 'blinded' subjects, their 'unblinded' counterparts had similar craving scores on a multidimensional assessment several hours before the infusion, but reported higher craving levels on a more proximal evaluation, immediately prior to the receipt of cocaine. Furthermore, the 'unblinded' subjects displayed a more rapid onset of high and rush cocaine responses along with significantly higher cocaine-induced heart rate elevations. Conclusion: These results support the hypothesis that cocaine expectancy modulates subjective and objective responses to the drug. Provided the important public health policy implications of heavy cocaine use, health policy makers and clinicians alike may favor cocaine craving assessments performed in the settings with access to the drug rather than in more neutral environments as a more meaningful marker of disease staging and assignment to the proper level of care.

Yamamoto RT; Teter CJ; Barros TL; McCarthy E; Mileti C; Juliano T et al. Antiandrogen pretreatment alters cocaine pharmacokinetics in men. Journal of Addiction Medicine 1(4): 198-204, 2007

Among cocaine users, men experience more adverse brain and vascular effects than their female counterparts. This could be caused by testosterone, which may potentiate some of cocaine's effects. We examined whether antiandrogen (flutamide, FL) pretreatment alters cocaine's acute behavioral, physiologic, and pharmacokinetic effects in men with histories of occasional cocaine use. Participants (N = 8) were pretreated with oral FL (250 mg) and placebo on separate study days followed by intravenous (IV) cocaine (0.4 mg/kg). Vital signs, subjective ratings, and blood samples for cocaine and metabolites were obtained at baseline and for 90 minutes after cocaine administration. FL, itself, had no effects on physiologic or subjective responses; however, after cocaine, heart rate recovered faster with FL pretreatment. Flutamide reduced peak plasma cocaine levels (Wilcoxon signed-rank z = 2.1, P < 0.04) and area under the curve (AUC; z = 1.96, P < 0.05). Additionally, FL reduced EME levels (z = 1.96, P < 0.05) and AUC for BE and EME (z = 2.38, P < 0.02 and z = 1.96, P < 0.05, respectively). These results suggest that FL may alter cocaine pharmacokinetics in men. Because cocaine and BE are vasoconstrictive, the data imply that FL might reduce some of cocaine's cardiovascular effects.

Yu Y; Kranzler HR; Panhuysen C; Weiss RD; Poling J; Farrer LA et al. Substance dependence low-density whole genome association study in two distinct American populations. Human Genetics 123(5): 495-506, 2008. (67 refs.)

Cocaine and opioid dependence are common, complex disorders with high heritability that commonly co-occur with other substance dependence disorders. Improved insight into the genetic basis of substance dependence would help elucidate its etiology and could inform its prevention and treatment. To generate new hypotheses about the genetics of substance dependence, we genotyped 5633 tagging single nucleotide polymorphism (SNP) markers in 1699 subjects from 339 African American (AA) families and 334 European American (EA) families ascertained through a sib pair meeting DSM-IV criteria for either cocaine or opioid dependence. The associations between genetic markers and five substance dependence traits (cocaine dependence, opioid dependence, cocaine-induced paranoia, alcohol dependence, and nicotine dependence) were assessed by family based association tests (FBAT). Results were ranked according to several criteria including statistical significance, concordance of results across population samples, and potential biological relevance of the implicated gene. The top-ranked result was an association of SNP rs1133503 in the MANEA gene with cocaine-induced paranoia (CIP). Our study provides an initial substance dependence trait-specific blueprint of associated regions for future candidate gene studies.

Zuccato E; Castiglioni S; Bagnati R; Chiabrando C; Grassi P; Fanelli R. Illicit drugs, a novel group of environmental contaminants. Water Research 42(4-5): 961-968, 2008. (13 refs.)

It is now well established that residues from therapeutic drugs consumed by humans can end up, through the sewage system, in the surface water of populated areas. Given that the global production of major illicit drugs is comparable to that of widely used pharmaceuticals, we tested for the presence of drugs of abuse (cocaine, opioids, amphetamines and cannabis derivatives), some related opioid pharmaceuticals (codeine and methadone) and or their metabolites in Italian and British surface waters. Having identified residues of all major drugs abuse in raw and treated urban wastewater, we now measured their levels in several rivers and lakes by a selective multi-residue assay based on liquid chromatography-tandern mass spectrometry. Recoveries in surface water were generally higher than 80%, with overall variability of the method lower than 10%. LODs were generally lower than 0.2 ng/L, and LOQs were lower than 0.6 ng/L, with few exceptions. Many of the tested substances were found in both rivers and lakes, at concentrations ranging from high pg/L to high ng/L, with loads in rivers in the range of tenths to hundreds of grams per day. our data indicate that residues of drugs of abuse have become widespread surface water contaminants in populated areas. Since most of these residues still have potent pharmacological activities, their presence in the aquatic environment may have potential implications for human health and wildlife.

Zule WA; Morgan-Lopez AA; Lam WKK; Wechsberg WM; Luseno WK; Young SK. Perceived neighborhood safety and depressive symptoms among African American crack users. Substance Use & Misuse 43(3/4): 445-468, 2008. (63 refs.)

This study examined the association between perceived neighborhood safety and depressive symptoms among 443 out-of-treatment African American crack cocaine users interviewed between 2000 and 2002 in North Carolina and tested the regression of depression on perceived neighborhood safety and common predictors of depression. Perceived neighborhood safety was an important predictor of depressive symptoms in models that adjusted for other correlates of depression. The findings are limited by the cross-sectional nature of the data and the complex etiology and course of depression. Additional research is needed to clarify the relationship between perceived neighborhood safety and depression.

Zuo YG; Zhang K; Wu JP; Rego C; Fritz J. An accurate and nondestructive GC method for determination of cocaine on US paper currency. Journal of Separation Science 31(13): 2444-2450, 2008. (20 refs.)

The presence of cocaine on US paper currency has been known for a long time. Banknotes become contaminated during the exchange, storage, and abuse of cocaine. The analysis of cocaine on various denominations of US banknotes in the general circulation can provide law enforcement circles and forensic epidemiologists objective and timely information on epidemiology of illicit drug use and on how to differentiate money contaminated in the general circulation from banknotes used in drug transaction. A simple, nondestructive, and accurate capillary gas chromatographic method has been developed for the determination of cocaine on various denominations of US banknotes in this study. The method comprises a fast ultrasonic extraction using water as a solvent followed by a SPE cleanup process with a C, cartridge and capillary GC separation, identification, and quantification. This nondestructive analytical method has been successfully applied to determine the cocaine contamination in US paper currency of all denominations. Standard calibration curve was linear over the concentration range from the LOQ (2.00 ng/mL) to 100 mu g/mL and the RSD less than 2.0%. Cocaine was detected in 67% of the circulated banknotes collected in Southeastern Massachusetts in amounts ranging from similar to 2 ng to 49.4 mu g per note. On average, $5, 10, 20, and 50 denominations contain higher amounts of cocaine than $1 and 100 denominations of US banknotes.