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CORK Bibliography: Crack Cocaine

38 citations. October 2007 to present

Prepared: September 2008

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.

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.

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.

Brewer TH; Zhao W; Metsch LR; Coltes A; Zenilman J. High-risk behaviors in women who use crack: Knowledge of HIV serostatus and risk behavior. Annals of Epidemiology 17(7): 533-539, 2007. (32 refs.)

PURPOSE: To determine whether crack cocaine-using women who are aware of their HIV serostatus have made modifications in risk behaviors, we compared known HIV-positive (HIV+) and HIV-negative (HIV-) users with respect to sexual risk behaviors, prevalence of sexually transmitted infections (STIs) and vaginitis, and correlates of unprotected sex. METHODS: We used a cross-sectional design with street outreach, recruitment, and interviews of sexually active crack cocaine using women. Women received testing for HIV, STIs, and vaginitis. RESULTS: Sixty-one HIV+ and 117 HIV- women were enrolled. HIV+ women were significantly more likely to be African-American. There were no significant differences in drug use, types of sexual partners, number of paying partners, attitudes regarding condoms, or STI diagnoses. HIV+ women were less likely to engage in unprotected sex compared with HIV- women (56% vs. 75%, adjusted odds ratio [AOR], 0.36; 95% confidence interval [CI], 0. 13-0.99). Among HIV+ women, unprotected sex was negatively associated with stronger beliefs regarding the protective value of condoms (AOR, 0.07; 95% CI, 0.01-0.67) and concurrent injection-drug use (AOR, 0.19; 95% CI, 0.04-0-99). CONCLUSIONS: Although the majority of crack using HIV+ crack using women in this sample continued to engage in high-risk sexual activities, they were less likely to do so than HIV- women. Interventions targeting this population are needed.

Brewer TH; Zhao W; Pereyra M; del Rio C; Loughlin A; Anderson-Mahoney P et al. Initiating HIV care: Attitudes and perceptions of HIV positive crack cocaine users. AIDS and Behavior 11(6): 897-904, 2007. (37 refs.)

There is limited data on the initiation and use of HIV care services by HIV-positive crack cocaine users. We analyzed data from a study of 286 recently infected HIV-positive persons recruited from 4 U.S. cities. Participants completed an Audio Computer Assisted Self Interview (A-CASI) regarding HIV care knowledge, attitudes, beliefs and practices related to the initiation of HIV care. In multiple logistic regression analysis, higher scores on an assessment of knowledge, attitudes and beliefs regarding HIV care, and Hispanic race were positively associated with initiating HIV primary care. Crack cocaine use in the past 30 days and male gender were negatively associated with initiating care. Injection drug use was not associated with initiation of care. Targeted interventions for crack cocaine users, including drug treatment, may be required to provide optimal HIV primary care use in this population.

Daniel JC; Huynh TT; Zhou W; Kougias P; El Sayed HF; Huh J et al. Acute aortic dissection associated with use of cocaine. Journal of Vascular Surgery 46(3): 427-433, 2007. (27 refs.)

Purpose: Cocaine use can result in a variety of cardiovascular complications, including myocardial infarction, arterial thrombosis, coronary dissection, and cardiomyopathy. Cocaine-induced aortic dissection is uncommon and has been described largely in case reports. The purpose of this study was to review our experience with aortic dissection associated with cocaine abuse. Methods. A retrospective chart review was performed of all hospital records during a 15-year period in patients diagnosed with aortic dissection. Among the 164 cases of acute aortic dissection, 16 patients (9.8%) had used cocaine or its derivative, crack cocaine, within 24 hours prior to the onset of symptoms. The remaining 148 patients (90.2%) had no history of cocaine usage. Clinical features, management, and outcome in these two groups were compared. Results. In the cocaine group, powder cocaine was inhaled intranasally in I I patients (69%) and crack cocaine was smoked in five cases (31%). The mean duration between cocaine use and the onset of aortic dissection was 12.8 hours (range, 4 to 24 hours). Patients in the cocaine group were younger in age and more likely to have a history of polysubstance abuse than the non-cocaine cohort. In the cocaine group, the incidence of DeBakey dissection type 1, 11, IIIa, and IIIb was 19%, 25%, 38%, and 19%, respectively. In the group without cocaine use, the incidence of DeBakey dissection type 1, 11, IIIa, and IIIb was 18%, 23%, 39%, and 20%, respectively. Surgical intervention for aortic dissection was performed in 50% of the cocaine group and 45% of the non-cocaine group. In patients who underwent surgical repair, greater pulmonary complications occurred in the cocaine group than the non-cocaine group (n = 0.02). No difference was noted in the hospital length of stay or 30-day operative mortality among the two groups. Conclusions. Cocaine-associated aortic dissection occurs in predominantly male patients with illicit drug abuse who were younger than patients with aortic dissection without cocaine use. Greater pulmonary complications can occur in patients with cocaine-related aortic dissection following surgical interventions.

Daniulaityte R; Carlson RG; Kenne DR. Methamphetamine use in Dayton, Ohio: Preliminary findings from the Ohio Substance Abuse Monitoring Network. Journal of Psychoactive Drugs 39(3): 211-221, 2007. (58 refs.)

Since the 1990s, methamphetamine manufacturing and use have been spreading into midwestern and southern United States. However, most research on methamphetamine use has been conducted in the western United States. This exploratory study is based on qualitative interviews with 26 people recruited in Dayton, Ohio, for the Ohio Substance Abuse Monitoring Network, a statewide epidemiological surveillance system. Participants ranged in age from 21 to 57 years. The majority were White and male. The participants reported increases in methamphetamine availability and identified powder-type locally manufactured methamphetamine as the most commonly seen form of the drug. The participants reported extensive drug use histories, and were introduced to methamphetamine in the context of their involvement with pharmaceutical stimulants, crack, powder cocaine, and/or club drug scene. A large proportion of the participants continued to use crack or powder cocaine in addition to methamphetamine. Many primary methamphetamine users felt they were able to moderate methamphetamine use and fulfill their daily responsibilities related to work and family life. Ranking results and consensus analysis revealed that participants shared high agreement about drug-related risks, and perceived methamphetamine as a serious drug, although not as risky as heroin, crack or OxyContin (R). Implications for treatment and prevention are discussed.

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.

Falck RS; Wang JC; Carlson RG. Crack cocaine trajectories among users in a midwestern American city. Addiction 102(9): 1421-1431, 2007. (62 refs.)

Aims: Although crack cocaine first appeared in cities in the United States in the mid-1980s, little is known about its use over long periods of time. This study identified crack cocaine user groups on the basis of long-term trajectories. Design: Following a natural history approach, data were collected periodically from 1996 to 2005. Group-based modeling assessed the probability of a crack smoker becoming abstinent during the observation period. Settings: A targeted sampling plan guided the recruitment of a community sample of crack cocaine users in Dayton, Ohio. Participants: Crack smokers (n = 430) 18 years or older whose urine tested positive for cocaine metabolites at the baseline interview. Measurements Interviewer-administered and audio computer self-administered, structured questionnaires were used to collect data on a range of variables, including frequency of crack use. Abstinence was defined as not having used crack for at least 6 consecutive months during the study. Findings: Three trajectory-based groups were identified: (1) No Change, characterized by a very low probability of abstinence; (2) Some Change, characterized by a low to moderate probability of abstinence; and (3) Dramatic Change, characterized by a high probability of abstinence. African Americans and men were significantly less likely to become abstinent. For the majority of the people (63.6%), crack use was uninterrupted by extended periods of abstinence during the study. Conclusion: Crack cocaine use that persists for a decade or longer may well be the norm for a large proportion of people who have experience with the drug.

Ginsburg HJ; Raffeld P; Alanis KL; Boyce AS. Comparing attitudes about legal sanctions and teratogenic effects for cocaine, alcohol, tobacco and caffeine: A randomized, independent samples design. Substance Abuse Treatment, Prevention, and Policy 1: article 4, 2006. (30 refs.)

Background: Establishing more sensible measures to treat cocaine-addicted mothers and their children is essential for improving U.S. drug policy. Favorable post-natal environments have moderated potential deleterious prenatal effects. However, since cocaine is an illicit substance having long been demonized, we hypothesized that attitudes toward prenatal cocaine exposure would be more negative than for licit substances, alcohol, nicotine and caffeine. Further, media portrayals about long-term outcomes were hypothesized to influence viewers' attitudes, measured immediately post-viewing. Reducing popular crack baby stigmas could influence future policy decisions by legislators. In Study 1, 336 participants were randomly assigned to 1 of 4 conditions describing hypothetical legal sanction scenarios for pregnant women using cocaine, alcohol, nicotine or caffeine. Participants rated legal sanctions against pregnant women who used one of these substances and risk potential for developing children. In Study 2, 139 participants were randomly assigned to positive, neutral and negative media conditions. Immediately post-viewing, participants rated prenatal cocaine-exposed or non-exposed teens for their academic performance and risk for problems at age18. Results: Participants in Study 1 imposed significantly greater legal sanctions for cocaine, perceiving prenatal cocaine exposure as more harmful than alcohol, nicotine or caffeine. A one-way ANOVA for independent samples showed significant differences, beyond .0001. Post-hoc Sheffe test illustrated that cocaine was rated differently from other substances. In Study 2, a one-way ANOVA for independent samples was performed on difference scores for the positive, neutral or negative media conditions about prenatal cocaine exposure. Participants in the neutral and negative media conditions estimated significantly lower grade point averages and more problems for the teen with prenatal cocaine exposure than for the non-exposed teen beyond .0001 alpha level. The positive media program closed estimated grade point average differences and risks of later problems to a non-statistically significant margin, p >.05. Conclusion: Ratings for prenatal cocaine were more negative than comparable ratings for alcohol, nicotine or caffeine exposure. Stereotypes can be reduced, showing viewers that positive postnatal environments ameliorate potential teratogenic effects of cocaine. Reducing negative stereotypes for crack babies may be a requisite for substantive changes in current policy.

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.

Kamath S; Bajaj N. Crack dancing in the United Kingdom: Apropos a video case presentation. Movement Disorders 22(8): 1190-1191, 2007. (12 refs.)

We report an adult patient presenting with choreiform movements 4 days after a large intravenous dose of cocaine. These movements were transitory and they normalized a week after admission. We believe this to be the first video case of acute chorea secondary to cocaine -- a phenomenon popularly known as "crack dancing." Cocaine abuse is associated with a wide range of movement disorders, including dystonia and exacerbation of Tourette's syndrome, multifocal tics, opsoclonus-myoclonus, choreiform movements, and stereotyped behavior known as "punding." Transient choreiform movements with a typical duration of 2 to 6 days are recognized by cocaine abusers themselves as crack dancing, but are infrequently reported. We present a video report of a patient with cocaine dependency and choreiform movements that normalized within a week of admission.

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.

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.

Manzoni P; Fischer B; Rehm J. Local drug-crime dynamics in a Canadian multi-site sample of untreated opioid users. Canadian Journal of Criminology and Criminal Justice 49(3): 341-373, 2007. (84 refs.)

This multi-site study analysed self-reported involvement in property crime, drug dealing, and sex work, across five Canadian cities, among a sample of 677 illicit opioid and other drug users outside of treatment. First, we assessed drug-use patterns and the extent of illegal income-generating behaviour for each city. We then analysed factors and city interactions contributing to engagement in the respective criminal activities, including drug-use patterns, socio-economic characteristics, and other illegal activities. With this approach we explored city-specific patterns of crime prediction; thus we identified local drug-crime associations. The study sample was recruited by outreach and snowball methods and was assessed by standardized study protocols. Findings revealed substantial differences among the cities regarding both the extent and frequency of illegal activities. In regard to local differences, multiple logistic regression models revealed that crack use was strongly associated with property crime in Toronto, while cocaine use was strongly related with sex work in Montreal and Quebec City. This evidence points to local dynamics of drug cultures that are related to specific criminal activities. Implications for further research and intervention efforts are discussed.

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.

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.

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. 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

Parry CDH; Pluddemann A; Myers BJ. Cocaine treatment admissions at three sentinel sites in South Africa (1997-2006): Findings and implications for policy, practice and research. Substance Abuse Treatment, Prevention, and Policy 2: article 37, 2007. (24 refs.)

Accurate prevalence data on cocaine use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of problematic cocaine use in South Africa. Methods: Data were collected between January 1997 and December 2006 on admissions for drug abuse treatment through a regular monitoring system involving 56 drug treatment centres and programmes in Cape Town, Gauteng Province (Johannesburg and Pretoria) and the Eastern Cape every six months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance, and information on prior treatment. Results: Treatment indicators point to a significant increase in cocaine related admissions over time in all sites, but with substantial inter-site variation, particularly in recent years. The data indicate high levels of crack cocaine use and high levels of daily usage among patients, most of whom were first time admissions. Patients with cocaine related problems continue to be predominantly male, with a mean age of around 30 years. Substantial changes in the racial profile of patients have occurred over time. Poly drug use is high with cocaine often used with alcohol, cannabis and other drugs. Conclusions: These trends point to the possibility of cocaine use becoming a serious health and social issue in South Africa and demonstrate the utility of continued monitoring of cocaine treatment admissions in the future. They also highlight the need to address cocaine use in national and provincial policy planning and intervention efforts. In terms of treatment, the findings highlight the need to ensure that treatment practitioners are adequately trained to address stimulant problems, poly drug use, and HIV and other risk behaviour related to crack cocaine use. Possible gaps in access to treatment by certain sectors of the population should be addessed as a matter of urgency.

Restrepo CS; Carrillo JA; Martinez S; Ojeda P; Rivera AL; Hatta A. Pulmonary complications from cocaine and cocaine-based substances: Imaging manifestations. Radiographics 27(4): 941-U13, 2007. (75 refs.)

Cocaine is the illicit drug whose abuse most often results in cardiopulmonary symptoms and emergency treatment. Habitual smoking of alkaloidal cocaine ("freebase," "crack") has replaced nasal insufflation as the most common method of abuse. Smoking of cocaine exposes the lung directly to the volatilized drug as well as to the other combustion products of the smoked mixture, thereby increasing the risk of adverse pulmonary effects. A wide variety of pulmonary complications including interstitial pneumonitis, fibrosis, pulmonary hypertension, alveolar hemorrhage, asthma exacerbation, barotrauma, thermal airway injury, hilar lymphadenopathies, and bullous emphysema may be associated with the inhalation of crack cocaine or of associated substances such as talc, silica, and lactose. Cocaine abuse represents one of the most serious medical and social problems of our time. Radiologists should be familiar with the various pleuropulmonary complications associated with the abuse of illicit drugs in general and of cocaine in particular to ensure correct diagnosis and appropriate treatment planning in patients with respiratory manifestations associated with such abuse.

Rhodes T; Briggs D; Kimber J; Jones S; Holloway G. Crack-heroin speedball injection and its implications for vein care: Qualitative study. Addiction 102(11): 1782-1790, 2007. (49 refs.)

Background: We report on an exploratory qualitative study investigating drug injectors' narratives of vein damage and groin (femoral vein) injection associated with the injection of crack-heroin speedball. Methods: We undertook 44 in-depth qualitative interviews among injectors of crack-heroin speedball in Bristol and London, England, in 2006. Findings: The data suggest an emerging culture of crack-based speedball injection. Injectors' narratives link speedball injection with shifts towards groin injection articulated as an acceptable risk, and not merely as a last resort in the face of increased vein deterioration associated with speedball. Accounts of vein damage linked to speedball emphasize 'missed hits' related to the local anaesthetic action of crack, the excess use of citric in the preparation of speedball injections and 'flushing' when making a hit. We find that groin injection persists despite an awareness of health risks and medical complications. Conclusions We emphasize an urgent need for reviewing harm reduction in relation to vein care in the context of shifts to crack-based speedball injection, and the use of the femoral vein, among UK injectors. There is an additional need for interventions to promote safer groin and speedball injecting as well as to prevent transitions toward groin and crack injection.

Richardson GA; Goldschmidt L; Larkby C. Effects of prenatal cocaine exposure on growth: A longitudinal analysis. Pediatrics 120(4): e1017-e1027, 2007. (58 refs.)

OBJECTIVE. There has been a limited amount of research on the long-term effects of prenatal cocaine exposure on growth of the infant, and there has been no use of longitudinal growth models. We investigated the effects of prenatal cocaine exposure on offspring growth from 1 through 10 years of age by using a repeated-measures growth-curve model. METHODS. Women were enrolled from a prenatal clinic and interviewed at the end of each trimester of pregnancy about their cocaine, crack, alcohol, marijuana, tobacco, and other drug use. Fifty percent of the women were white, and 50% were black. Follow-up assessments occurred at 1, 3, 7, and 10 years of age. RESULTS. Cross-sectional analyses showed that children exposed to cocaine during the first trimester (n = 99) were smaller on all growth parameters at 7 and 10 years, but not at 1 or 3 years, than the children who were not exposed to cocaine during the first trimester (n = 125). The longitudinal analyses indicated that the growth curves for the 2 groups diverged over time: children who were prenatally exposed to cocaine grew at a slower rate than children who were not exposed. These analyses controlled for other factors associated with child growth. CONCLUSIONS. To our knowledge, this is the first study of the long-term effects of prenatal cocaine exposure to conduct longitudinal growth-curve analyses using 4 time points in childhood. Children who were exposed to cocaine during the first trimester grew at a slower rate than those who were not exposed. These findings indicate that prenatal cocaine exposure has a lasting effect on child development.

Riehman KS; Wechsberg WM; Zule W; Lam WK; Levine B. Gender differences in the impact of social support on crack use among African Americans. Substance Use & Misuse 43(1): 85-104, 2008. (54 refs.)

This article examines the influence of social support on crack use in a sample of 435 African American out-of-treatment crack users recruited through street outreach in Raleigh, North Carolina, between 2000 and 2002. Multivariate regression models indicated that social support was not a strong influence on crack use. For women, no social support variables predicted crack use, whereas for men, having a non-using partner was negatively associated with crack use. Findings indicate that existing social support is not strongly linked to drug use among African Americans, but African American men may be positively influenced by non-using sexual partners. Limitations of the sample and data are discussed. Further research is needed on the influence of social support for African American drug-using populations.

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.

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.

Schumacher JE; Milby JB; Wallace D; Meehan DC; Kertesz S; Vuchinich R; Dunning J; Usdan S. Meta-analysis of day treatment and contingency-management dismantling research: Birmingham homeless cocaine studies (1990-2006). Journal of Consulting and Clinical Psychology 75(5): 823-828, 2007. (15 refs.)

Four successive randomized clinical trials studying contingency management (CM), involving various treatment arms of drug-abstinent housing and work therapy and day treatment (DT) with a behavioral component, were compared on common drug abstinence outcomes at 2 treatment completion points (2 and 6 months). The clinical trials were conducted from 1990 to 2006 in Birmingham, Alabama, with a total of 644 homeless persons with primary crack cocaine addiction. The meta-analysis utilized the weighted least squares approach to integrate data encompassing 9 different treatment arms to assess the effects of CM and DT (neither, DT only, CM only, and CM + DT) on a common estimate of prevalence of drug abstinence. Taken together, the results show much stronger benefits from CM + DT and from CM only than for DT alone. Throughout all of the Birmingham Homeless Cocaine Studies, the CM + DT consistently produced higher abstinence prevalence than did no CM.

Shannon K; Bright V; Gibson K; Tyndall MW; Maka Project Partnership. Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Canadian Journal of Public Health 95(6): 465-469, 2007. (37 refs.)

Background: Women engaged in survival sex work face multiple sexual and drug-related harms that directly enhance their vulnerability to HIV infection. Although research on injection-drug-using women has explored predictors of sex work and HIV infection, little information currently exists on the complex vulnerabilities to HIV transmission faced by survival sex workers in this setting. This analysis aimed to determine HIV prevalence among women engaged in survival sex work, and explore sexual and drug-related vulnerabilities associated with baseline infection. Methods: Descriptive and univariate analysis were used to explore associations with baseline HIV infection. Variables found to be associated with baseline infection at the univariate level (p < 0.05) were entered into a fixed logistic regression model, adjusted for age. Results: Of a total of 198 women, baseline HIV prevalence was 26%. In multivariate logistic regression, baseline HIV infection was associated with early age of sex work initiation (< 18 years) (aOR=1.8, 95% CI: 1.3-2.2), Aboriginal ethnicity (aOR=2.1, 95% CI: 1.4-3.8), daily cocaine injection (aOR=2.2, 95% CI: 1.3-3.5), intensive, daily crack smoking (aOR=2.7, 95% CI: 2.1-3.9), and unprotected sex with an intimate partner (aOR=2.8, 95% CI: 1.9-3.6). Interpretation: Innovative and evidence-based strategies are urgently needed that address the sexual and drug-related vulnerabilities to HIV infection among survival sex workers and in particular, interventions targeting the precursors to early initiation into sex work.

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.

Stephens T; Mcgee W; Braithwaite RL. Age-based correlates of substance misuse among convicted felons in Georgia. American Journal of Drug and Alcohol Abuse 33(6): 885-892, 2007. (26 refs.)

Objective: This study sought to identify variables that independently correlate with age and substance use among a sample of 187 convicted felons in Georgia. Results: Results of regression analysis indicated that younger inmates were 2 times more likely than older inmates to report the occurrence of alcohol use (RR 2.07; 95% CI.37, 11.6) and three times more likely than older inmates to report some history of marijuana use ( RR 3.07; 95% CI 1.52, 6.11). In addition, younger inmates were half as likely or less to report using sedatives ( RR.53, 95% CI.22, 1.29), tranquilizers (RR.49, 95% CI.22, 1.29), crack or cocaine (RR.33, 95% CI.18,.62), heroin (RR.48, 95% CI.16, 1.25), and to having ever received treatment for a drug problem (RR.46, 95% CI.23,.90). Conclusion: In conclusion, age-based factors correlate with participant's history of substance use. Ascertainment of these variables among inmate populations has the potential to improve treatment decisions both during and after incarceration.

Swaminathan S; Schoenbaum EE; Klein RS; Howard AA; Lo YT; Gourevitch MN. Two-step tuberculin skin testing in drug users. Journal of Addictive Diseases 26(2): 71-79, 2007. (37 refs.)

To assess the utility of booster testing and to identify factors associated with a positive booster test, two-step tuberculin testing was performed in drug users recruited from methadone treatment. Participants also received a standardized interview on demographics and testing for HIV and CD4+ lymphocyte count. Of 619 enrollees completing the protocol, 174 (28%) had a positive PPD and 24 of the remaining 445 (5%) had a positive booster test. On multivariate analysis, boosting was associated with older age (adjusted odds ratio [ORadj] 2.38/decade, 95% confidence interval [CI] 1.34-4.22), history of using crack cocaine (ORadj 2.61, 95% CI 1.10-6.18) and a history of working as a home health aide (ORadj 4.23, 95% CI 1.39-12.86). Two-step tuberculin skin testing increased the proportion of participants with latent tuberculosis infection from 22% to 25%. Given the effectiveness of chemoprophylaxis, booster testing should be considered when drug users are screened for tuberculosis infection.

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.

Wechsberg WM; Zule WA; Riehman KS; Luseno WK; Lam WKK. African-American crack abusers and drug treatment initiation: barriers and effects of a pretreatment intervention. Substance Abuse Treatment, Prevention, and Policy 2: article 10, 2007. (44 refs.)

Background: Individual and sociocultural factors may pose significant barriers for drug abusers seeking treatment, particularly for African-American crack cocaine abusers. However, there is evidence that pretreatment interventions may reduce treatment initiation barriers. This study examined the effects of a pretreatment intervention designed to enhance treatment motivation, decrease crack use, and prepare crack abusers for treatment entry. Methods: Using street outreach, 443 African-American crack users were recruited in North Carolina and randomly assigned to either the pretreatment intervention or control group. Results: At 3-month follow-up, both groups significantly reduced their crack use but the intervention group participants were more likely to have initiated treatment. Conclusion: The intervention helped motivate change but structural barriers to treatment remained keeping actual admissions low. Policy makers may be interested in these pretreatment sites as an alternative to treatment for short term outcomes.

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.

Young J; Beech D; Offodile R. Foreign body ingestion and management: "I swallowed a crack pipe". American Surgeon 73(11): 1144-1146, 2007. (10 refs.)

There is a wide variety of objects that find their way into the human gastrointestinal tract, either accidentally or deliberately. In this case a crack pipe was ingested in its entirety. Despite the seemingly rare and random nature that this scenario presents, this patient's care serves to reinforce what should be done to successfully manage a patient with an ingested foreign body, as well as the important issues related to crack cocaine abuse.

Zule WA; Costenbader E; Coomes CM; Meyer WJ; Riehman K; Poehlman J et al. Stimulant use and sexual risk behaviors for HIV in rural North Carolina. Journal of Rural Health 23(Supplement S): 73-78, 2007. (17 refs.)

Context: While literature exists on sexual risks for HIV among rural populations, the specific role, of stimulants in increasing these risks has primarily been studied in the context of a single drug and/or racial group. Purpose: This study explores the use of multiple stimulants and sexual risk behaviors among individuals of different races and sexual identities in rural North Carolina. Methods: In-depth interviews were conducted with 41 individuals in 3 rural North Carolina counties between June 2004 and December 2005. Interviews were audiotaped, transcribed and reviewed for accuracy. Edited interviews were imported into Atlas.ti and askSam for analysis. Findings: Along with marijuana, stimulants-including powder cocaine; crack, and methamphetamine-were the most frequently used illicit drugs in these counties. Powder cocaine use was more closely associated with white participants, crack with African Americans, and both were more commonly used by female participants: Participants reported 3 overlapping behaviors involving stimulant use that may be associated with increased risk of HIV infection: engaging in sex while using drugs, sex trading and group sex. Nearly half of participants reported engaging in group sex activity. Conclusions: HIV risk through injection appears to be low in these rural counties. However, nearly all study participants reported some form of sexual risk behavior that may increase transmission of HIV and other sexually transmitted infections. Further research is warranted focusing on the nexus between substance abuse and risky sexual behaviors.

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.