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CORK Bibliography: Route of Administration

47 citations. January 2009 to present

Prepared: January 2009

Agrawal A; Lynskey MT. Tobacco and cannabis co-occurrence: Does route of administration matter? Drug and Alcohol Dependence 99(1-3): 240-247, 2009. (68 refs.)

Background: Qualitative research suggests that a shared route of administration (i.e. via inhalation) for the common forms of both tobacco (i.e. cigarettes) and cannabis (i.e. joints) may contribute to their co-occurring use. Methods: We used data on 43,093 U.S. adults who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether cannabis use and abuse/dependence were associated with smoked (cigarettes, cigars, pipes) versus smokeless (snuff, chewed tobacco) forms of tobacco use, even after controlling for socio-demographic, psychiatric and substance-related covariates. Results: Tobacco smoking was associated with a 3.3-4.5 times increased risk for cannabis use and abuse/dependence respectively. After covariate adjustment, importantly for nicotine dependence, smoking tobacco (but not smokeless tobacco) was still significantly associated with both cannabis use (multinomial odds-ratio (MOR) 1.99) and cannabis dependence (MOR 1.55). In contrast, use of smokeless tobacco was not significantly correlated with elevated rates of cannabis use (MOR 0.96) or abuse/dependence (MOR 1.04). Conclusions: Route of administration may play an important role in the observed association between tobacco and cannabis use. This may represent a physiological adaptation of the aero-respiratory system and/or index social and cultural influences surrounding the use of smoked versus smokeless forms of tobacco.

Baumevieille M; Daveluy A; Maurain C; Begaud B; Haramburu F. Medicines submitted to narcotics regulations in France, 1992-2007. Fundamental & Clinical Pharmacology 23(3): 345-349, 2009. (10 refs.)

The objective was to study the current narcotics regulations which are the most restrictive regarding prescription and dispensation practice in France, and their evolution over the period 1992-2007. This is an example of regulation in a European member state regarding medicines with a risk of abuse or dependence. Narcotics regulations were studied in the French public health code. Status and indications of medicines concerned were found on the French medicine agency website, and the retrospective part of the study was conducted using the French public statute law website. Seventeen medicines were found. Three were psychotropics and fourteen narcotics. The prescription rules could be different for a given substance according to the route of administration or indication. In 2007, half of the narcotic opioids could be prescribed for 28 days, whereas in 1992, most of them could be prescribed for only 7 days. These results show the adaptation of French narcotics regulations, with the development of medicines indicated in acute or chronic pain treatment or opioid maintenance treatment.

Brugal MT; Pulido J; Toro C; de la Fuente L; Bravo MJ; Ballesta R et al. Injecting, sexual risk behaviors and HIV infection in young cocaine and heroin users in spain. European Addiction Research 15(3): 171-178, 2009. (44 refs.)

Aim: To evaluate differences between young cocaine users and heroin users (HUs) regarding the prevalence of sexual and injection risk behavior, and HIV, HCV and HBV infection. Methods: Two community cohorts were recruited in Madrid, Barcelona and Seville; 720 cocaine users, of whom 586 had never used heroin (CUs), and 991 HUs were interviewed. Dried blood spot samples were tested. Results: CUs were less marginalized socially than HUs. Only 0.9% had ever injected versus 64.3%; none had ever injected with borrowed syringes versus 25%; 2.2% had an injecting steady partner in the last 12 months versus 24.9%; 4.8% had ever traded sex versus 16.0%. However, 31.0 versus 12.7% had unprotected sex with more than two occasional partners in the last 12 months; 45.0 versus 21.9% had sniffed through tubes used by more than 10 persons. Only 32.3% knew their HIV status versus 80.3%; 0.4 versus 18.1% were HIV positive; 0.9 versus 51.9% were HCV positive, and 1.5 versus 17.0% were HBV positive. Conclusions: The intense cocaine epidemic has hitherto had little impact on either HIV, HBV or HCV in Spain. However, surveillance should be intensified given the high percentage of CUs having unprotected sex with occasional partners.

Cabanas JG; Brice JH; Woodward K. An unrecognized presentation of cocaine-associated pneumomediastinum in the prehospital setting. Prehospital Emergency Care 13(3): 384-387, 2009. (18 refs.)

Cocaine abuse is associated with a significant number of emergency medical services (EMS) calls and emergency department visits every year. The medical complications of recreational cocaine use are diverse, involving almost any body organ, and vary greatly according to the substance used and the route by which is taken. Previous reports have associated cocaine abuse with serious pulmonary complications, including barotrauma. The occurrence of barotrauma is directly related to the way cocaine is consumed. The majority may manifest clinically with subcutaneous emphysema, chest pain, and neck pain. We report a case of cocaine-induced pneumomediastinum in the prehospital environment that masqueraded as an allergic reaction. Prehospital providers should be alert for clinical manifestations suggestive of barotrauma in cocaine users.

Caldwell B; Dickson S; Burgess C; Siebers R; Mala S; Parkes A et al. A pilot study of nicotine delivery to smokers from a metered-dose inhaler. Nicotine & Tobacco Research 11(4): 342-347, 2009. (25 refs.)

The present study generated preliminary data on the acceptability and pharmacokinetics of nicotine administered by a simple metered-dose inhaler (MDI). We conducted a nonrandomized, open-label cross-over trial of 10 current smokers. On Day 1, a single cigarette was smoked ad libitum. On Day 2, participants took 10 puffs (20 inhalations) of 50 mu g nicotine/puff through the inhaler, and on Day 3, they took 10 puffs (20 inhalations) of 100 mu g nicotine/puff, each over 5 min. Nicotine pharmacokinetics, changes in heart rate and blood pressure, and the acceptability of the inhalers were measured and recorded. Nicotine administered by an MDI produced a median maximum plasma concentration that was about 50% of that obtained by smoking a cigarette (12.5 vs. 25.9 ng/ml) and took twice the time to reach that concentration, 6 versus 3 min. Self-rated satisfaction and reduced urge to smoke were similar for the MDIs and a cigarette. The results suggest that nicotine can be delivered effectively by the pulmonary route using a standard MDI. The inhaler appears to provide a satisfaction level and reduction in the urge to smoke relatively similar to that provided by smoking a cigarette. These conclusions require verification in a larger controlled study.

Chaouachi K. Hookah (shisha, narghile) smoking and environmental tobacco smoke (ETS). A critical review of the relevant literature and the public health consequences. (review). International Journal of Environmental Research and Public Health 6(2): 798-843, 2009. (138 refs.)

Hookah (narghile, shisha, "water-pipe") smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker's respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.

Conner KR; Ross ME; Baciewicz G; Sworts LM; Meldrum SC. Reliability of the lifetime Inventory of Drug Use Consequences(INDUC) in methadone maintenance patients. Journal of Psychoactive Drugs 41(1): 93-98, 2009. (25 refs.)

One hundred twenty one opiate-dependent individuals in methadone maintenance treatment at an urban university medical center in the U.S. were administered the Inventory of Drug Use Consequences (InDUC), and 68 subjects provided follow-up assessments at two to six weeks. The sample included 61 (50.4%) women; 86 (71.1%) of the subjects reported that they were White, 29 (24.0%) Black, and six (5.0%) other race. The mean age was 41.9 (SD = 9.7) years. Ninety-nine (81.8%) of participants had used opiates intravenously. INDUC total scores and a short form showed high internal consistency (a) and test-retest reliability (ICC) across gender, race, ethnicity, anew and education, supporting their use as global measures of drug use consequences. The interpersonal scale was also reliable across strata whereas the physical and intrapersonal scales were not reliable. The impulse control and social responsibility scales were stable but not internally consistent.

Cooper ZD; Haney M. Comparison of subjective, pharmacokinetic, and physiological effects of marijuana smoked as joints and blunts. Drug and Alcohol Dependence 103(3): 107-113, 2009. (26 refs.)

Recent increases in marijuana Smoking among the Young adult Population have been accompanied by the popularization of smoking marijuana as blunts instead of as joints. Blunts consist of marijuana wrapped in tobacco leaves, whereas joints consist of marijuana wrapped in cigarette paper. To date, the effects of marijuana smoked as joints and blunts have not been systematically compared. The Current within-subject, randomized, double-blind, placebo-controlled study sought to directly compare the Subjective. physiological, and pharmacokinetic effects of marijuana smoked by these two methods. Marijuana blunt smokers (12 women and 12 men) were recruited and participated in a 6-session Outpatient study. Participants were blindfolded and smoked three puffs from either a blunt or a joint containing marijuana with varying Delta(9)-tetrahydrocannabinol (THC) concentrations (0.0, 1.8, and 3.6%). Subjective, physiological (heart rate, blood pressure, and carbon monoxide levels) and pharmacokinetic effects (plasma THC concentration) were monitored before and at specified time points for 3 h after smoking. Joints produced greater increases in plasma THC and subjective ratings of marijuana intoxication, strength, and quality compared to blunts, and these effects were more pronounced in women compared to men. However, blunts produced equivalent increases in heart rate and higher carbon monoxide levels than joints, despite producing lower levels of plasma THC. These findings demonstrate that smoking marijuana in a tobacco leaf may increase the risks of marijuana use by enhancing carbon monoxide exposure and increasing heart rate compared to joints.

Corsi K; Kwiatkowski C; Booth R. Predictors of methamphetamine injection in out-of-treatment IDUs. Substance Use & Misuse 17(1): 24-34, 2009. (82 refs.)

From 2004-2006, 439 injection drug users were recruited in Denver, Colorado, to participate in a study of drug use and HCV risk. Over two-thirds were male, more than half were white and 28% were methamphetamine injectors. The Risk Behavior Assessment, which assesses demographics, drug use, and HIV risk behaviors, was used. Variables were assessed for association with methamphetamine injections. A logistic regression model was build using forward stepwise method to determine independent associations between variables of interest and MA injection. The study's limitations are noted, and implications are described. Injectors were found to report more risk behaviors, such as needle sharing, have unprotected sex, and multiple sex partners. They also were more likely to be white, younger, have more education, and more likely to report their sexual orientation as gay, lesbian, or bisexual.

Darke S; Mills KL; Ross J; Williamson A; Havard A; Teesson M. The ageing heroin user: Career length, clinical profile and outcomes across 36 months. Drug and Alcohol Review 28(3): 243-249, 2009. (31 refs.)

Introduction and Aims. The study examined the relationships between length of career (LOC), clinical presentation and outcomes across 36 months among a cohort of 615 heroin users. Design and Methods. Longitudinal cohort study. Results. At baseline, each additional year of heroin use was associated with increased likelihood of: being male, exposure to treatment, having been imprisoned, daily injecting, lifetime and recent polydrug use, having overdosed, poorer physical health and reduced likelihood of heroin smoking. In contrast, LOC was not related to frequency of heroin use, current polydrug use, recent heroin overdose, recent imprisonment, recent criminality or psychopathology. There were also no associations between LOC and outcomes across 36 months in terms of treatment, drug use, crime, severe psychiatric disability or major depression. Longer LOC was associated across 36 months, however, with daily injecting, poorer physical health, severe physical disability and poorer mental health. Discussion and Conclusions. The data point to the maintenance of heroin-related harms well into the third decade of use.

Dar-Odeh NS; Abu-Hammad OA. Narghile smoking and its adverse health consequences: a literature review. (review). British Dental Journal 206(11): 571-573, 2009. (51 refs.)

Oral squamous cell carcinoma (OSCC) is a world health problem with approximately 50% of patients having a 5-year survival rate. A change in the demographics of the disease is now being recognised, particularly in Europe, where it is increasingly being seen in young males. While a variety of risk factors are important in OSCC, it is tobacco that plays a central part in the pathogenesis of the disease. Narghile is an old form of tobacco use but in the past decade, there has been a resurgence in this form of smoking. The practice is particularly common in young males and females from the Middle East but with the advent of immigration and globalisation, its use is becoming more widespread. It is now not uncommon to see narghile smoking in western countries such as the UK and USA. Studies describing the oral effects of narghile are unfortunately scarce. While adverse effects such as periodontal bone loss and dry socket have been described, its association with OSCC cannot be excluded. Variation in the type of narghile, the type of tobacco and the presence of co-factors such as cigarette smoking may all influence clinical outcome. In the present study, the practice of narghile smoking is reviewed in terms of its effect on health, particularly oral health. The association of narghile smoking and adverse effects on the orofacial region will be outlined, namely, periodontal disease, potentially malignant lesions and oral cancer.

Donny EC; Jones M. Prolonged exposure to denicotinized cigarettes with or without transdermal nicotine. Drug and Alcohol Dependence 104(1-2): 23-33, 2009. (52 refs.)

Sensorimotor smoking stimuli are important determinants of cigarette use. The present study aimed to determine whether denicotinized cigarettes lose their reinforcing and/or subjective effects over a 9-day outpatient period when they are smoked with or without concurrent transdermal nicotine. After a preferred brand baseline, 68 participants were randomized into one of four conditions based on the dose (mg) of transdermal nicotine and the type of cigarettes (dose/cigarette): 0/nicotine, 0/denicotinized, 7/denicotinized, and 21/denicotinized. Under placebo patch conditions, participants smoked a similar number of nicotine and denicotinized cigarettes and no group differences emerged over repeated testing. The total volume of smoke inhaled was lower in the denicotinized group, although this decrease dissipated over time. Denicotinized cigarettes were rated as having low positive and high negative subjective effects. Compared to placebo, transdermal nicotine decreased the number of denicotinized cigarette smoked, produced a lasting decrease in the total volume of denicotinized cigarette smoke inhaled, but had little effect on the subjective effects of denicotinized cigarettes. Transdermal nicotine attenuated withdrawal during initial smoking abstinence; however, once participants were allowed to smoke withdrawal symptoms were relatively low regardless of patch condition. The persistent use of denicotinized cigarettes may result from the presence of nicotine withdrawal and/or the degree to which smoking becomes somewhat independent of the outcome of the behavior (i.e., habit learning). Additional studies would be useful to determine what factors drive continued use of denicotinized cigarettes, whether their use subsides as withdrawal dissipates, and whether they address motives for smoking distinct from current pharmacotherapy.

Dwyer R; Topp L; Maher L; Power R; Hellard M; Walsh N et al. Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users. Drug and Alcohol Dependence 100(1-2): 9-16, 2009. (39 refs.)

Background: The prevalences and correlates of non-viral injecting-related injuries and diseases (IRIDs) in Australian injecting drug users (IDUs) remain unknown. Methods: A cross-sectional survey of IDUs was conducted in six sites across Australia's eastern states to investigate IRID experience among Australian IDU. Correlates of IRIDs were explored using logistic and negative binomial regression analyses. Results: 393 IDUs were recruited. Lifetime experience of non-serious IRIDs was common (e.g., 'dirty hit' 68%): potentially serious and serious IRIDs were less commonly experienced (e.g., abscess 16%; gangrene <1%). Factors independently associated with potentially serious or serious IRIDs in the previous 12 months were: injecting in sites other than arms (Adjusted Odds Ratio 3.0, 95% confidence interval 1.7-5.4), injecting non-powder drug forms (5.0, 2.2-11.2), unstable accommodation (2.0, 1.1-3.5), being aged 25 years or older (4.3, 1.7-10.6) and not always washing hands before injection (9.3, 2.1-41.8). Factors independently associated with multiple IRIDs in the preceding 12 months were using three or more injecting sites (Adjusted Incidence Rate Ratio 1.5, 95% CI 1.1-2.0), injecting in sites other than arms (1.7, 1.3-2.2), using: non-powder drug forms(1.9, 1.4-2.5), injecting daily or more often (1.7,1.3-2.2), current pharmacotherapy experience (1.5, 1.1-1.9), and not always washing hands before injecting (1.9, 1.2-2.9). Discussion: Some IRIDs are widespread among Australian IDUs. Observed associations, particularly the protective effect of handwashing, have useful public health implications.

Etter JF. Dependence on the nicotine gum in former smokers. Addictive Behaviors 34(3): 246-251, 2009. (42 refs.)

We conducted an Internet survey in 2004-2007 in 526 daily users of the nicotine gum, to assess use of. and dependence on the nicotine gum in former smokers. We used modified versions of the Nicotine Dependence Syndrome Scale (NDSS-G), the Cigarette Dependence Scale (CDS-G) and the Fagerstrom Test (FFND-G). After 30 days, 155 participants (29%) indicated their gum use. Higher dependence on the gum predicted a lower chance of stopping using it at follow-up (odds ratio=0.36 for each standard deviation unit on CDS-G, p=0.001). More long-term (>3 months) than short-term (<=3 months) users of the gum agreed with: 1 use the nicotine gum because I am addicted to it" (83% vs. 7%. p<.001), and fewer long-term users reported that they used the gum to avoid relapsing to smoking (42% vs. 92%, p<.001). Long-term users had higher ratings of dependence on the gum than short-term users, as assessed with NDSS-Gum, CDS-Gum and FrND-Gum (all p<.001). Most long-term users reported symptoms of dependence on the nicotine gum. Lower levels of dependence on the gum predicted cessation of gum use. However, long term use of the nicotine gum has no known serious adverse consequence, and may be beneficial if it prevents late relapse.

Farahmand S; Maibach HI. Transdermal drug pharmacokinetics in man: Interindividual variability and partial prediction. (review). International Journal of Pharmaceutics 367(1-2): 1-15, 2009. (82 refs.)

A database of human dermatopharmacokinetic parameters of 12 transdermal patches is established. The effect of system design, application site, and metabolism on pharmacokinetic data is discussed, and interindividual variability of data and its possible sources evaluated. Using multiple regression analysis, two equations based on drugs physicochemical characteristics are suggested for partial prediction of peak plasma concentration (C-max) after patch application. Patch application presumably decreases variance as rub-off, wash and exfoliation steps are diminished. The results showed that interindividual variation, in terms of coefficient of variation (CV) Of C-max, is inversely correlated with drugs molecular weight and lipophilicity in the range of 200 < MW < 400 and 1.6 < logK(oct) < 4.3. Multiple regression analysis of C-max against physichochemical parameters demonstrated the prominent contribution of hydrogen bonding acceptability of the molecules on their maximal plasma concentration after patch administration. The findings suggest that the serum concentration profile for transdermal therapeutic systems (TTS) is a net result of the system performance, drug absorption and elimination. Thus, the variability in serum concentration is a function of variability of each process involved. This should be noted in explanation of effect of molecular features of drugs on their plasma concentration profile.

Gupta PK; Krishnan PR; Sudhakar PJ. Hippocampal involvement due to heroin inhalation-"Chasing the Dragon". Clinical Neurology and Neurosurgery 111(3): 278-281, 2009. (25 refs.)

Toxic leukoencephalopathy occurs as a result of exposure to wide variety of agents. Inhalation of heroin or its vapours produces a distinct syndrome with characteristic findings on MR imaging. We report a case of heroin vapour abuse (chasing the dragon) who presented with altered sensorium. MRI of the brain showed symmetrical T2 hyperintensities over the cerebellum and hippocampi. The patient gradually improved and made good recovery but developed spasticity of all the limbs due to delayed involvement of bilateral basal ganglia. This is the first report of bilateral hippocampal involvement in a patient abusing heroin vapour.

Hall W; Gartner C. Supping with the Devil? The role of law in promoting tobacco harm reduction using low nitrosamine smokeless tobacco products. Public Health 123(3): 287-291, 2009. (52 refs.)

In Sweden, male cigarette smoking has declined as snus, a smokeless tobacco product which is low ill Carcinogenic nitrosamines, has gained popularity among male tobacco users. Epidemiological modelling based on the Swedish experience indicates that there would be major public health gains if a substantial number of current smokers in other countries could also be persuaded to switch to this product. This form of 'tobacco harm reduction' is very controversial in the public health community for many reasons. These include: Objections in principle to the use of less harmful but still addictive nicotine products: uncertainties about the long-term effects of these products on health; doubts about the likely interest in and uptake of these products among existing smokers: concerns that increasing the availability of these products will increase the number of new tobacco users and eventually the number of smokers in the population; and anxiety about how the tobacco industry may use these products to undermine current tobacco control policies. This paper concludes with suggestions for a graduated series of policies that may allow exploration of the public health costs and benefits of encouraging smokers to switch to snus.

Harocopos A; Goldsamt LA; Kobrak P; Jost JJ; Clatts MC. New injectors and the social context of injection initiation. International Journal of Drug Policy 20(4): 317-323, 2009. (46 refs.)

Background: Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity. Method: In-depth interviews (n = 54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users. Results: Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study's participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group. Conclusion: Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate.

Higgs P; Dwyer R; Duong D; Thach ML; Hellard M; Power R et al. Heroin-gel capsule cocktails and groin injecting practices among ethnic Vietnamese in Melbourne, Australia. International Journal of Drug Policy 20(4): 340-346, 2009. (38 refs.)

Background: Evidence of harms associated with temazepam gel capsule injecting among injecting drug users in Australia led to its withdrawal from manufacture in Australia. Subsequently, diphenhydramine gel capsule injecting was identified among a subset of ethnic Vietnamese injecting drug users. Methods: Observational fieldwork around an active street-based illicit drug marketplace together with targeted purposive sampling enabled 66 ethnic Vietnamese injecting drug users to be recruited for in-depth interview. Results: Data revealed that the injection of gel capsules increases exposure to non-viral infections. Analysis of participant interviews show how participants have established their own ways of reducing these harms including thinning the drug solution by jacking regularly during injection. Controversially, femoral vein administration of diphenhydramine-heroin cocktails was also seen as a harm reduction strategy by participants. Discussion: Health education campaigns to address the potentially negative consequences of gel capsule groin injection will not be successful unless health workers and policy makers work with drug users and incorporate local understandings and meanings of risk in health promotion activities.

Hsu WY; Chiu NY; Liao YC. Rhabdomyolysis and brain ischemic stroke in a heroin-dependent male under methadone maintenance therapy. Acta Psychiatrica Scandinavica 120(1): 76-79, 2009. (25 refs.)

Objective: There are several complications associated with heroin abuse, some of which are life-threatening. Methadone may aggravate this problem. Method: A clinical case description. Results: A 33-year-old man presented with rhabdomyolysis and cerebral ischemic stroke after intravenous heroin. He had used heroin since age 20, and had used 150 mg methadone daily for 6 months. He was found unconsciousness at home and was sent to our hospital. In the ER, his opiate level was 4497 ng/ml. In the ICU, we found rhabdomyolysis, acute renal failure and acute respiratory failure. After transfer to an internal ward, we noted aphasia and weakness of his left limbs. After MRI, we found cerebral ischemic infarction. Conclusion: Those using methadone and heroin simultaneously may increase risk of rhabdomyolysis and ischemic stroke. Patients under methadone maintenance therapy should be warned regarding these serious adverse events. Hypotheses of heroin-related rhabdomyolysis and stroke in heroin abusers are discussed.

Kaluski DN; Mazengia GD; Shimony T; Goldsmith R; Berry EM. Prevalence and determinants of physical activity and lifestyle in relation to obesity among schoolchildren in Israel. Public Health Nutrition 12(6): 774-782, 2009. (40 refs.)

Objective: To describe the relationships between physical activity, lifestyle determinants and obesity in adolescent Israeli schoolchildren. Design and setting: Cross-sectional survey. Subjects: The MABAT Youth Survey was a nationally representative, school-based study of youth in grades 7 to 12 (ages 11-19 years). Methods: Self-administered questionnaires assessed health behaviours and anthropometric indices were measured. Logistic regression analysis was used to examine the associations between obesity, physical activity, socio-economic status and other lifestyle habits. One-way ANOVA was used to determine me-an physical activity levels (MET values) by BMI categories. Results: The Prevalence of overweight was 13-15% and of obesity 4-9% depending on gender and ethnicity, and was higher among the non-Jewish sectors. Thirty-six per cent and 57% of Jewish girls and boys, and 40% and 58% of non-Jewish girls and boys, respectively, were optimally active. Boys from low socio-economic schools and those who slept for less than 6 h at night were less active. Girls from middle school were found to be 53% more optimally physically active among Jews, and 89% more among non-Jews, compared with girls from high school (P = 0.001); girls with less educated parents were also less physically active. No clear relationship was found between the level of obesity and physical activity. Conclusions: Physical inactivity was strongly related to gender, age, social status, sleeping habits, hookah smoking, and parental educational status. Education and intervention programmes should focus on these risk factors.

Lloyd-Smith E; Wood E; Zhang R; Tyndall MW; Montaner JS; Kerr T. Determinants of cutaneous injection-related infection care at a supervised injecting facility. Annals of Epidemiology 19(6): 404-409, 2009. (34 refs.)

PURPOSE: To evaluate the factors associated with receiving cutaneous injection, related infection (CIRI) care among a representative cohort of supervised injecting facility (SIF) users. METHODS: Data were collected biannually as part of a prospective cohort, the Scientific Evaluation of Supervised Injection study. Kaplan-Meier methods and Cox proportional hazards regression with recurrent events were used to examine incidence and factors associated with CIRI care, respectively. RESULTS: One thousand eighty individuals were recruited between December 1, 2003 and January 31, 2008. The incidence density of participants receiving CIRI care was 22.0 per 100 person-years (95% confidence interval [Cl]: 19.6-24.6). In the adjusted Cox proportional hazard model, female sex (adjusted hazard ratio [AHR] = 1.87 [95% Cl: 1.32-2.64]), unstable housing (AHR = 1.39 [95% Cl: 1.02-1.88]), and daily heroin injection (AHR = 1.52 [95% Cl: 1.13-2.04]) were independently associated with receiving CIRI care at the SIF CONCLUSIONS: These results describe who is more likely to receive CIRI care, which is of use to those engaged with policy and practice of treatment regimens involving this population.

Lloyd-Smith E; Wood E; Li K; Montaner JSG; Kerr T. Incidence and determinants of initiation into cocaine injection and correlates of frequent cocaine injectors. Drug and Alcohol Dependence 99(1-3): 176-182, 2009. (37 refs.)

Purpose: To investigate the incidence and correlates of cocaine injection initiation and the impacts of daily cocaine injection among a cohort of injection drug users. Methods: Among 1603 participants, from May 1996 to December 2005, risk factors for initiation of cocaine injection among baseline heroin users were determined by Cox proportional hazards regression and correlates of daily cocaine injection by generalized estimating equations. Findings: Of the 238 individuals who had never injected cocaine, 200 (84%) had at least one follow-up visit and 121 (61%) consequently initiated into cocaine injection, yielding an incidence density of initiation into cocaine injection of 21.9% (95% confidence interval (121): 17.9-25.8) per 100 person-years. In a multivariate model, Downtown Eastside (DTES) residence (adjusted hazard ratio (AHR)=2.46, 95% Cl:1.68-3.60) incarceration (AHR = 1,507 95% Cl: 1.01-2.24), requiring help injecting (AHR = 1.57, 95% CI: 0.99-2.49), and binge drug use (AHR = 1.82, 95% Cl: 1.22-2.73) remained associated with initiation into cocaine injection. DTES residence (adjusted odds ratio (AOR) = 1.99, 95% Cl: 1.62-2.46), unstable housing (AOR = 1.28, 95% Cl: 1.04-1.53), incarceration (AOR = 1.29, 95% CI: 1.04-1.60), sex trade involvement (AOR = 1.46, 95% Cl: 1.15-1.85), requiring help injecting (AOR = 2.11, 95% Cl: 1.73-2.58)), borrowing syringes (AOR = 1.81, 95% Cl: 1.35-2.43) and binge drug use (AOR = 2.16, 95% Cl: 1.81-2.58) were independently associated with daily cocaine injection. Conclusions: The baseline prevalence and subsequent incidence of initiation into cocaine injection was high. Daily cocaine injection was independently associated with a number of health and social harms, including elevated HIV risk behavior.

Luquero FJ; Vallejo F; de La Fuente L; Toro C; Brugal MT; Bravo MJ; Soriano V et al. The role of injection versus socioeconomic factors in hepatitis A virus infection among young heroin users: Implications for vaccination policies. Vaccine 27(20): 2674-2679, 2009

The aim of this study was to determine whether heroin users have a higher prevalence of HAV infection than the general population in Spain, and whether injection is an independent risk factor. A cross-sectional cohort study was conducted between April 2001 and December 2003 in Spain that included 953 current heroin users aged 18-30 years. Dried blood spot samples were tested for HAV by ELISA. The prevalence of HAV infection (35.5%) was higher than in the general population of the same age. The logistic regression analysis did not show association between HAV infection and injection. HAV infection was associated with low educational level (OR = 4.8; 95% CI = 2.1-10.9) and other low-income variables. Injection is not an independent risk factor for HAV infection; rather, the principal determinants are socioeconomic factors. Consequently, HAV vaccination should be recommended not only in IDUs but also in non-IDUs depending on their socioeconomic characteristics.

Mayhan WG; Arrick DM; Sharpe GM; Sun H. Nitric oxide synthase-dependent responses of the basilar artery during acute infusion of nicotine. Nicotine & Tobacco Research 11(3): 270-277, 2009. (70 refs.)

Our goals were to determine whether acute exposure to nicotine alters nitric oxide synthase (NOS)-dependent responses of the basilar artery and to identify a potential role for activation of NAD(P)H oxidase in nicotine-induced impairment in NOS-dependent responses of the basilar artery. We measured in vivo diameter of the basilar artery in response to NOS-dependent (acetylcholine) and NOS-independent (nitroglycerin) agonists before and during an acute infusion of nicotine (2 mu g/kg/min intravenously for 30 min followed by a maintenance dose of 0.35 mu g/kg/min). In addition, we measured superoxide anion production (lucigenin chemiluminescence) by the basilar artery in response to nicotine in the absence or presence of apocynin. We found that NOS-dependent, but not NOS-independent, vasodilation was impaired during infusion of nicotine. In addition, treatment of the basilar artery with apocynin (100 mu M, 30 min prior to infusion of nicotine) prevented nicotine-induced impairment in NOS-dependent vasodilation. Further, the production of superoxide anion was increased in the basilar artery by nicotine, and this increase could be inhibited by apocynin. Our findings suggest that acute exposure to nicotine impairs NOS-dependent dilation of the basilar artery by a mechanism that appears to be related to the release of superoxide anion. A possible source of superoxide may be via the activation of NAD(P)H oxidase.

Maziak W; Rastam S; Ibrahim I; Ward KD; Shihadeh A; Eissenberg T. CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers. Nicotine & Tobacco Research 11(7): 806-811, 2009. (32 refs.)

Waterpipe tobacco smoking is increasing in popularity though the toxicant exposure and effects associated with this tobacco use method are not well understood. Sixty-one waterpipe tobacco smokers (56 males; mean age +/- SD, 30.9 +/- 9.5 years; mean number of weekly waterpipe smoking episodes, 7.8 +/- 5.7; mean duration of waterpipe smoking 8.5 +/- 6.1 years) abstained from smoking for at least 24 hr and then smoked tobacco from a waterpipe ad libitum in a laboratory. Before and after smoking, expired-air carbon monoxide (CO) and subjective effects were assessed; puff topography was measured during smoking. The mean waterpipe use episode duration was 33.1 +/- 13.1 min. Expired-air CO increased significantly from a mean of 4.0 +/- 1.7 before to 35.5 +/- 32.7 after smoking. On average, participants took 169 +/- 100 puffs, with a mean puff volume of 511 +/- 333 ml. Urge to smoke, restlessness, craving, and other tobacco abstinence symptoms were reduced significantly after smoking, while ratings of dizzy, lightheaded, and other direct effects of nicotine increased. Expired-air CO and puff topography data indicate that, relative to a single cigarette, a single waterpipe tobacco smoking episode is associated with greater smoke exposure. Abstinent waterpipe tobacco smokers report symptoms similar to those reported by abstinent cigarette smokers, and these symptoms are reduced by subsequent waterpipe tobacco smoking. Taken together, these data are consistent with the notion that waterpipe tobacco smoking is likely associated with the risk of tobacco/nicotine dependence.

McDonald D. The evaluation of a trial of syringe vending machines in Canberra, Australia. International Journal of Drug Policy 20(4): 336-339, 2009. (25 refs.)

Background: Syringe vending machines (SVMs) have been trialled in Canberra, Australian Capital Territory, Australia, as an intervention aiming to increase the availability of sterile injecting equipment for use by IDUs. This study evaluated the 12-month trial. Methods: A utilisation-focused evaluation model, with both formative and summative components, was employed. Four SVMs were installed, each dispensing packs containing four 1 mL syringes and associated injecting paraphernalia. The trial participants were the clients of the SVMs and other key informants. The core measurements used were the number of syringes dispensed in Canberra by SVMs and other outlets, SVM clients' demographics and experiences of and attitudes towards SVMs, perceived impacts of SVMs on needle sharing, unsafe disposal of used syringes in the vicinity of SVMs, and community and stakeholder attitudes. Results: The trial was implemented successfully, with no adverse consequences identified. The SVMs appear to be serving both the usual clients of the other outlets for sterile injecting equipment (community pharmacies and the Needle Syringe Program outlets) and others who are reluctant to use such outlets or find them inconvenient. The out-of-business-hours provision of syringes through the SVMs was particularly welcomed by both SVM clients and other stakeholders. The continuing operation of the initial four SVMs is widely supported, and additional machines are requested by clients and others. Conclusions: Owing to the success of the trial in terms of feasibility and outcomes for both IDUs and for the broader community, it is desirable that providing sterile injecting equipment through SVMs continues and be expanded as an integral component of harm reduction strategies.

Noonan D; Kulbok PA. New tobacco trends: Waterpipe (hookah) smoking and implications for healthcare providers. Journal of the American Academy of Nurse Practitioners 21(5): 258-260, 2009. (22 refs.)

Purpose: To inform healthcare providers about waterpipe smoking, a new trend in tobacco Use that is gaining popularity among adolescents and young, adults. Data sources: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note On Waterpipe Smoking, and pertinent publications available in the literature. Conclusions: Waterpipe smoking is a new trend in tobacco Use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction. Implications for practice: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long-lasting problem of nicotine addiction.

Novotny TE; Lum K; Smith E; Wang V; Barnes R. Cigarettes butts and the case for an environmental policy on hazardous cigarette waste. International Journal of Environmental Research and Public Health 6(5): 1691-1705, 2009. (45 refs.)

Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell, safe cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has correspondingly reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt waste, including developing biodegradable filters, increasing fines and penalties for littering butts, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be attractive in coastal regions where beaches accumulate butt waste and where smoking indoors is increasingly prohibited. Additional research is needed on the various policy options, including behavioral research on the impact of banning the sale of filtered cigarettes altogether.

Perkins KA; Grottenthaler A; Ciccocioppo MM; Conklin CA; Sayette MA; Wilson AS. Mood, nicotine, and dose expectancy effects on acute responses to nicotine spray. Nicotine & Tobacco Research 11(5): 540-546, 2009. (30 refs.)

Introduction: We recently showed effects of nicotine dose and nicotine expectancy on some responses to cigarette smoking, with generally no influence of induced mood on these effects. The present study extended this line of research to Nicotrol nasal spray, to determine whether formulation (spray vs. smoking) alters responses. Methods: Smokers abstained overnight before each of two virtually identical sessions, involving negative or positive mood induction. They were randomized to one of five groups, four comprising the 2 x 2 balanced placebo design, varying actual and expected dose of nicotine in the nasal spray, and the fifth group a no-spray control. Dependent measures included self-reported affect, craving, withdrawal, and spray ratings of "liking" and "how much nicotine." Analyses were limited to those whose nicotine expectancies were manipulated successfully (N = 48). Results: The following results matched those from our smoking study: expecting nicotine increased liking; expected, but not actual, nicotine dose increased dose perception; neither actual nor expected nicotine dose had much influence on affect or withdrawal; and mood had no influence on these effects. However, both actual and expected nicotine dose decreased craving in response to spray, contrary to our prior study with smoking. Discussion: Formulation made little difference in some effects of nicotine and expectancies, but other effects differed by formulation. Some of these findings, particularly for craving reduction, may have implications for enhancing the acute therapeutic effects of nasal spray and, perhaps, other medications in smokers trying to maintain abstinence after quitting.

Perry CL; Stigler MH; Arora M; Reddy KS. Preventing tobacco use among young people in India: Project MYTRI. American Journal of Public Health 99(5): 889-906, 2009. (27 refs.)

Objectives. We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India. Methods. Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored, cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco. Results. Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future. Conclusions. School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India.

Primack BA; Walsh M; Bryce C; Eissenberg T. Water-pipe tobacco smoking among middle and high school students in Arizona. Pediatrics 123(2): E282-E288, 2009. (31 refs.)

BACKGROUND. Using a water pipe to smoke tobacco is increasing in prevalence among US college students, and it may also be common among younger adolescents. The purpose of this study of Arizona middle and high school students was to examine the prevalence of water-pipe tobacco smoking, compare water-pipe tobacco smoking with other forms of tobacco use, and determine associations between sociodemographic variables and water-pipe tobacco smoking in this population. METHODS. We added items assessing water-pipe tobacco smoking to Arizona's 2005 Youth Tobacco Survey and used them to estimate statewide water-pipe tobacco smoking prevalence among various demographic groups by using survey weights. We also used multiple logistic regression to determine which demographic characteristics had independent relationships with each of 2 outcomes: ever use of water pipe to smoke tobacco and water-pipe tobacco smoking in the previous 30 days. RESULTS. Median age of the sample was 14. Accounting for survey weights, among middle school students, 2.1% had ever smoked water-pipe tobacco and 1.4% had done so within the previous 30 days. Among those in high school, 10.3% had ever smoked from a water pipe and 5.4% had done so in the previous 30 days, making water-pipe tobacco smoking more common than use of smokeless tobacco, pipes, bidis, and kreteks (clove cigarettes). In multivariate analyses that controlled for covariates, ever smoking of water-pipe tobacco was associated with older age, Asian race, white race, charter school attendance, and lack of plans to attend college. CONCLUSIONS. Among Arizona youth, water pipe is the third most common source of tobacco after cigarettes and cigars. Increased national surveillance and additional research will be important for addressing this threat to public health.

Ramchandani VA; Plawecki M; Li TK; O'Connor S. Intravenous ethanol infusions can mimic the time course of breath alcohol concentrations following oral alcohol administration in healthy volunteers. Alcoholism: Clinical and Experimental Research 33(5): 938-944, 2009. (27 refs.)

Our previous studies have used intravenous (IV) clamping methods to demonstrate that family history positive (FHP) subjects exhibit a greater initial response to alcohol than family history negative (FHN) subjects. These results differ from other studies of family history of alcoholism (FHA) influences, most of which have used an oral alcohol challenge, suggesting that the route of administration may influence both the response to alcohol and FHA-related differences in response. To examine this possibility, one approach would be to directly compare responses following oral and IV alcohol administration in the same subjects. There is, however, a 3- to 4-fold variance, between- and within-subjects, in the breath alcohol concentrations (BrACs) following oral alcohol administration. Thus, our objective was to characterize the between-subject variability in the time course of BrACs following oral alcohol administration in healthy volunteers and to develop an IV infusion method to mimic the BrAC-time course attained following oral alcohol in the same subject. This was a 2-session study in young adult, healthy, nondependent drinkers. In the first session, subjects ingested an oral dose of alcohol, based on total body water, to achieve a target peak BrAC of 80 mg%. In the second session, subjects received an IV infusion of ethanol designed to achieve the same BrAC time course as that achieved in the first session. The individualized infusion-rate profile was precomputed using a physiologically-based pharmacokinetic (PBPK) model for alcohol with model parameters adjusted to the individual's physiology. The peak BrACs (C-max), times of peak BrAC (T-max), and the areas under the BrAC vs. time curve (AUC) were compared between sessions to assess how closely the BrAC exposure during the IV infusion session mimicked the exposure following oral alcohol. The time course of BrACs following oral alcohol administration showed a high degree of between-subject variability. Mean C-max, T-max, and AUC did not differ by gender, indicating that calculation of oral doses based on total body water results in comparable BrAC-time courses, on average, for females and males. The IV infusion driven BrAC-time profiles demonstrated good fidelity to the BrAC-time curves resulting from oral alcohol: the mean %difference in C-max and AUC were both 11%, while the mean %difference for T-max was 27%. This degree of variability is less than half that seen across individuals following oral alcohol administration, which was substantial [coefficient of variation (%CV) ranging from 22 to 52%]. Despite the use of standardized doses and controlled experimental conditions, there was substantial between-subject variability in the BrAC time course following oral administration of alcohol. The PBPK-model-based infusion method can mimic the BrACs attained with oral alcohol for individual subjects. This method provides a platform to evaluate effects attributable to the route of administration on the response to alcohol, as well as the influence of determinants such as family history of alcoholism on the alcohol response.

Ray CS. The hookah: The Indian waterpipe. Current Science 96(10): 1319-1323, 2009. (30 refs.)

The hookah, a waterpipe, originated in India and became popular for smoking tobacco. It spread elsewhere and acquired other names like nargile, shisha, goza and hubble-bubble, before its popularity declined in India. A resurgence of hookah smoking is occurring in India and around the world, and is being promoted as safer than cigarette smoking. This article debunks this myth, by showing that hookah smoke contains more tar and carbon monoxide than cigarette smoke, promotes nicotine addiction and exposure to second-hand smoke, and causes gum disease, tuberculosis, chronic lung diseases, lung cancer, cardiovascular disease and low birth weight.

Ray CS; Gupta PC. Bidis and smokeless tobacco. Current Science 96(10): 1324-1334, 2009. (63 refs.)

Bidis and smokeless tobacco are the cheapest, least taxed and most commonly used tobacco products in India. They are highly addictive and high in carcinogens. They cause a broad spectrum of diseases; yet awareness about their ill-effects is low. Smokeless tobacco products containing arecanut, e. g. gutka and mawa, are especially addictive and carcinogenic. The high incidences of oral and lung cancers in India are mainly due to bidis and smokeless tobacco. Bidis bear no health warnings, and smokeless products, only warnings in English in small print. The public favours tobacco control policies and the Government tries to impose them, but the industry delays such implementation. This article highlights the widespread use of bidis and smokeless tobacco in India, reviews their harmful effects, documents public support for tobacco control policies, and provides scientific evidence for the implementation of these policies.

Rodu B; Cole P. Informing consumers about the relative health risks of different nicotine delivery products. Journal of Oral Pathology and Medicine 38(7): 545-550, 2009. (26 refs.)

Background: Compared with smoking, there is much less information about smokeless tobacco (ST) use in the United States. The purpose of this study is to characterize and compare ST use among American men in 2000 and 2005. Methods: We used US National Health Interview Surveys from 2000 and 2005 to estimate the prevalence of ST use, describe the demographic and socioeconomic profile of ST users and evaluate ST use according to product type and with respect to smoking. Results: The prevalence of ST use among American men was 4.4% in 2000 and 4.3% in 2005. Almost all ST users were white, about half were 25-44 years old and 80% lived in the South or Midwest, commonly in small metropolitan and rural areas. Educational and income levels of ST users were lower than those of never users of tobacco. One-third of ST users also smoked; cigarette consumption was lower among dual users than among exclusive smokers. In 2005, 1.3 million current ST users were former smokers but 3.2 million smokers were former ST users. ST users were evenly distributed between snuff (43%) and chewing tobacco (44%) in 2000 and 13% used both products. By 2005 snuff use was clearly dominant. Conclusions: The prevalence of ST use among men is low but stable; dual use of cigarettes and ST is common, and snuff has become the dominant ST product.

Rolke HB; Bakke PS; Gallefoss F. Relationships between hand-rolled cigarettes and primary lung cancer: A Norwegian experience. Clinical Respiratory Journal 3(3): 152-160, 2009. (33 refs.)

Introduction: Detailed smoking history of patients developing lung cancer is rarely known, especially not for users of hand-rolled cigarettes. In Norway, smoking hand-rolled tobacco is still popular, accounting for one-third of the total tobacco consume. Methods: A questionnaire-based study revealing detailed information about tobacco consume with consecutive inclusion of all persons developing lung cancer in Southern Norway 2002-2005. Results: In this unselected population with 479 patients with newly diagnosed lung cancer, 95% had a smoking history and 88% of ever-smokers had smoked primarily hand-rolled cigarettes. The hand-rolled cigarette smokers had smoked fewer cigarettes daily (15) and less pack-years of tobacco (34) than fabricated cigarette smokers (20, P < 0.0001 and 42, P = 0.021, respectively). Smoking hand-rolled cigarettes was considerably more frequent than expected from official sales statistics. Hand-rolled cigarette smoking revealed an odds ratio of 13 for developing lung cancer compared with smoking fabricated cigarettes. Conclusion: In this unselected population with newly diagnosed lung cancer, nine out of 10 ever-smokers had smoked primarily hand-rolled cigarettes. Patients smoking hand-rolled cigarettes had a smoking history of fewer daily cigarettes and less pack-years tobacco consumed than fabricated cigarette smokers. In this study, hand-rolled cigarettes are more frequently used than shown in national statistics. Smokers of hand-rolled cigarettes may have a greatly increased risk for lung cancer compared with smokers of fabricated cigarettes.

Roose RJ; Hayashi AS; Cunningham CO. Self-management of injection-related wounds among injecting drug users. Journal of Addictive Diseases 28(1): 74-80, 2009. (22 refs.)

Injection-related wounds are an important complication of injection drug use. This study describes behaviors related to self-management of injection-related wounds and identifies factors associated with behaviors that may increase the potential for harm. We conducted interviews with 101 injecting drug users in Washington, DC. A total of 82 (81.2%) injecting drug users reported ever having an injection-related wound, and of these 93.9% reported self-management of their wounds. The most commonly reported behaviors were cleaning and applying ointment to wounds; however, several participants engaged in behaviors determined to be more potentially harmful, including acquiring antibiotics without prescriptions and manipulating their wounds. In multivariate analysis, injecting drug users who had ever injected amphetamines were more likely to engage in potentially harmful self-management behaviors (adjusted odds ratio = 4.38; 95% confidence interval = 1.15-16.64). Self-management of injection-related wounds is common and certain behaviors may increase the potential for harm. Further research is needed to best focus efforts to improve wound care for injecting drug users.

Schnoll RA; Patterson F; Wileyto EP; Tyndale RF; Benowitz N; Lerman C. Nicotine metabolic rate predicts successful smoking cessation with transdermal nicotine: A validation study. Pharmacology, Biochemistry and Behavior 92(1): 6-11, 2009. (28 refs.)

Transdermal nicotine is widely used for smoking cessation, but only similar to 20% of smokers quit successfully with this medication. Interindividual variability in nicotine metabolism rate may influence treatment response. This study sought to validate, and extend in a larger sample, our previous finding that the ratio of plasma nicotine metabolites 3'-hydroxycotinine (3-HC)/cotinine, a measure of nicotine metabolism rate, predicts response to nicotine patch. A sample of 568 smokers was enrolled in a study that provided counseling and 8-weeks of 21 mg nicotine patch. Pretreatment 3-HC/cotinine ratio was examined as a predictor of 7-day point prevalence abstinence, verified with breath carbon monoxide (CO), 8 weeks after the quit date. Controlling for sex, race, age, and nicotine dependence, smokers in the upper 3 quartiles of 3-HC/cotinine ratio (faster metabolizers) were similar to 50% less likely to be abstinent vs. smokers in the first quartile (slow metabolizers; 28% vs. 42%; OR = .54 [95% CI : .36-.82], p = .003). Among abstainers, plasma nicotine levels (assessed I week after treatment began) decreased linearly across the 3-HC/cotinine ratio (beta = -3.38, t[355] = -3.09, p < .05). These data support the value of the 3-HC/cotinine ratio as a biomarker to predict success with transdermal nicotine for smoking cessation.

Smith A. Effects of caffeine in chewing gum on mood and attention. Human Psychopharmacology: Clinical and Experimental 24(3): 239-247, 2009. (18 refs.)

Rationale Recent research has shown that even small doses (<40mg) of caffeine can improve alertness and increase performance efficiency on attention tasks. Previous studies have given the caffeine in a variety of beverages or in capsules and it was of interest to see whether similar effects could be observed when the caffeine was given in gum. In addition, chewing gum has been shown to have behavioural effects and the present study extended our knowledge of this topic. Objectives To compare the effects of caffeinated gum (40 mg), placebo gum and no gum conditions on mood and attention. Methods A double blind placebo controlled study was conducted with volunteers being randomly assigned to one of the three conditions. Baseline measures of mood and attention were taken prior to chewing and a test session was then conducted. One hundred and eighteen young adults part cipated in the study. Results: Caffeinated gum was associated with a more positive mood and better performance on tasks requiring sustained attention. The caffeine improved the speed of encoding of new information which is consistent with previous findings. Chewing placebo guru was also found to be associated with more positive mood, both shortly after chewing and at the end of the study. Conclusions: The implications of the present study are that chewing caffeinated gum has been shown to improve performance efficiency and mood by its alerting and energising effects. The profile of caffeine effects is what one would predict from the existing caffeine literature and such effects may be extremely beneficial in real-life situations. Prior chewing of placebo gum was associated with a more positive mood and this also confirms previous findings.

Smith MJ; Thirthalli J; Ben Abdallah A; Murray RM; Cottler LB. Prevalence of psychotic symptoms in substance users: A comparison across substances. Comprehesive Psychiatry 50(3): 245-250, 2009. (45 refs.)

Background: psychotic symptoms (delusions and hallucinations) are reported to be increased among persons using illicit substances, but little is known about the comparative frequency with which the symptoms occur with abuse of different substances. To establish this, we interviewed individuals who had wide experience of commonly used drugs. Methods: Four hundred seventy-six intravenous drug users, crack-cocaine users, and heroin snorters recruited via street outreach were interviewed using the Composite International Diagnostic Interview-Substance Abuse Model to assess dependence on a number of substances including amphetamines, cannabis, cocaine, and opioids. As a part of this assessment, we assessed a history of delusions and hallucinations in the context of use of, or withdrawal from, these specific substances. Results: From 27.8% to 79.6%, users of amphetamine, cannabis, cocaine, and opiates met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, dependence for that specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (5.2%-100%), cannabis (12.4%-80.0%), cocaine (6.7%-80.7%), and opiates (6.7%-58.2%). The risk of psychotic symptoms increased for respondents who abused (odds ratio [OR], 12.2) or had mild (OR, 17.1), moderate (OR, 47.0), or severe dependence (OR, 114.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users. Conclusions: Most users dependent on illicit substances experience psychotic symptoms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the substance use disorders for all 4 Substances. These findings emphasize the importance of developing services to target this population as they are at a heightened risk for developing psychotic symptoms.

Sofuoglu M; Mooney M. Subjective responses to intravenous nicotine: Greater sensitivity in women than in men. Experimental and Clinical Psychopharmacology 17(2): 63-69, 2009. (56 refs.)

Although approximately 45% of smokers in the United States are women, the influence of sex on nicotine dependence remains incompletely understood. Evidence from preclinical and clinical studies has indicated that there are significant sex differences in nicotine's effects. The authors' goal in this report was to determine whether men and women differ in their acute response to intravenous nicotine, which has not been examined in previous studies. Twelve male and 12 female smokers received saline followed by 0.5 mg/70 kg and 1.0 mg/70 kg nicotine intravenously. In response to nicotine, women, as compared with men, had enhanced ratings for drug strength, head rush, and bad effects. Women and men experienced similar suppression of smoking urges by nicotine as assessed by the Brief Questionnaire on Smoking Urges. Nicotine-induced heart rate and systolic and diastolic blood pressure increases were also similar in magnitude in men and women. The findings, consistent with those of several previous studies, support greater sensitivity of female smokers to some but not all of the subjective effects of nicotine. Further studies are warranted to examine the role of this differential nicotine sensitivity to development of nicotine dependence and response to nicotine replacement treatments in men and women.

Somala RK. Rhabdomyolysis and brain ischemic stroke in a heroin-dependent male under methadone maintenance therapy. (Comment). Acta Psychiatrica Scandinavica 120(1): 80-81, 2009. (10 refs.)

Tis is a commentary on an article in this issue, pages 76-79, by WY Hsu et al.

Tavafian SS; Aghamolaei T; Zare S. Water pipe smoking and health-related quality of life: A population-based study. Archives of Iranian Medicine 12(3): 232-237, 2009. (25 refs.)

Background: Water pipe smoking is increasing in Eastern Mediterranean Region. The objective of this study was to investigate any relationship between water pipe smoking and health-related quality of life in the general population of Bandar Abbas, Iran. Methods: Using a multistage sampling method, a random sample of 1675 individuals aged 15 years and over was studied from June through July 2007. All eligible participants were interviewed using the Short Form Health Survey (SF-36) questionnaire and a short questionnaire containing items regarding socio-demographic characteristics and water pipe smoking status. To compare SF-36 scores between water pipe smokers and nonsmokers, t-test was performed. In addition, multiple logistic regression analysis was used to determine the influence of water pipe smoking on SF-36 scores after adjusting for other independent variables. Results: In all, 1675 individuals were studied. The mean age of the respondents was 42.1 (SD=16.5) years. One hundred and seventy-two participants (10.4%) were water pipe smokers. There were statistically significant differences between water pipe smokers and nonsmokers on all scales except for role emotional (P < 0.001). Logistic regression analysis showed that using water pipe was a risk factor for decreasing Physical Component Summary and Mental Component Summary scores [OR (95% Cl): 2.15 (1.56 - 2.96), P < 0.01; and OR (95% Cl): 1.88 (1.36 - 2.60), P < 0.01, respectively]. Conclusion: The study findings indicated that people who smoked water pipe carried a higher risk for poorer health-related quality of life.

Timberlake D. A Comparison of drug use and dependence between blunt smokers and other cannabis users. Substance Use & Misuse 44(3): 401-415, 2009. (34 refs.)

Ethnographic studies have suggested that blunt smokers represent a subculture of cannabis users whose drug use is moderated by social norms. The objective of this study was to compare rates of cannabis dependence/abuse and nicotine dependence between blunt and other cannabis smokers. The sample included adolescents and young adults (n = 4348) who reported some form of past-month cannabis use in the 2004 National Survey on Drug Use and Health. Compared to smokers who never used blunts, blunt smokers had significantly greater odds of being dependent on cannabis and tobacco. Associations with cannabis dependence/abuse remained statistically significant with adjustment for smoking frequency and demographic characteristics. These findings highlight the need for differentiating types of cannabis users in epidemiologic studies. The study's limitations are noted.

Zhu SH; Wang JB; Hartman A; Zhuang Y; Gamst A; Gibson JT et al. Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results? Tobacco Control 18(2): 82-87, 2009. (41 refs.)

Background: Swedish male smokers are more likely than female smokers to switch to smokeless tobacco (snus) and males' smoking cessation rate is higher than that of females. These results have fuelled international debate over promoting smokeless tobacco for harm reduction. This study examines whether similar results emerge in the United States, one of few other western countries where smokeless tobacco has long been widely available. Methods: US data source: national sample in Tobacco Use Supplement to Current Population Survey, 2002, with 1-year follow-up in 2003. Analyses included adult self-respondents in this longitudinal sample (n = 15 056). Population-weighted rates of quitting smoking and switching to smokeless tobacco were computed for the 1-year period. Results: Among US men, few current smokers switched to smokeless tobacco (0.3% in 12 months). Few former smokers turned to smokeless tobacco (1.7%). Switching between cigarettes and smokeless tobacco, infrequent among current tobacco users (< 4%), was more often from smokeless to smoking. Men quit smokeless tobacco at three times the rate of quitting cigarettes (38.8% vs 11.6%, p < 0.001). Overall, US men have no advantage over women in quitting smoking (11.7% vs 12.4%, p = 0.65), even though men are far likelier to use smokeless tobacco. Conclusion: The Swedish results are not replicated in the United States. Both male and female US smokers appear to have higher quit rates for smoking than have their Swedish counterparts, despite greater use of smokeless tobacco in Sweden. Promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programmes may not result in any positive population effect on smoking cessation.

Zule WA; Bobashev G. High dead-space syringes and the risk of HIV and HCV infection among injecting drug users. Drug and Alcohol Dependence 100(3): 204-213, 2009. (63 refs.)

This study examines the association between using and sharing high dead-space syringes (HDSSs)-which retain over 1000 times more blood after rinsing than low dead-space syringes (LDSSs)-and prevalent HIV and hepatitis C virus (HCV) infections among injecting drug users (IDUs). A sample of 851 out-of-treatment IDUs was recruited in Raleigh-Durham, North Carolina, between 2003 and 2005. Participants were tested for HIV and HCV antibodies. Demographic, drug use, and injection practice data were collected via interviews. Data were analyzed using multiple logistic regression analysis. Participants had a mean age of 40 years and 74% are male, 63% are African American, 29% are non-Hispanic white, and 8% are of other race/ethnicity. Overall, 42% of participants had ever used an HDSS and 12% had shared one. HIV prevalence was 5% among IDUs who had never used an HDSS compared with 16% among IDUs who had shared one. The HIV model used a propensity score approach to adjust for differences between IDUs who had used an HDSS and those who had never used one. The HCV models included all potential confounders as covariates. A history of sharing HDSSs was associated with prevalent HIV (odds ratio = 2.50; 95% confidence interval = 1.01, 6.15). Use and sharing of HDSSs were also associated with increased odds of HCV infection. Prospective studies are needed to determine if sharing HDSSs is associated with increased HIV and HCV incidence among IDUs.