heroin and Cocaine-Related-Disorders

This project offers new epidemiological estimates for DSM-IV cocaine dependence among sub-groups of newly incident cocaine users in the United States (US), including estimated attack rates for 21 dependence-related cocaine side effect problems and experiences occurring <12 months after onset.. In 2002-2016, US National Surveys on Drug Use and Health (NSDUH) sampled, recruited, and assessed cocaine experiences of non-institutionalized civilians. Unweighted estimates for year-pairs (2002-3,…,2015-16) are from 3488 cocaine powder-only initiates and 275 powder-then-crack initiates (all evaluated <12 months after onset). Analysis-weighted attack rate estimates are incidence proportions with 95% confidence intervals (CI), summarized via meta-analysis.. Evaluated <12 months after onset, meta-analysis summaries show 5% of powder-only initiates developed cocaine dependence (95% CI = 4%, 6%) versus 22% of powder-then-crack initiates (95% CI = 17%, 29%). For several cocaine side effect problems and experiences (e.g., 'loss of control' indicators) there is a statistically robust crack-associated excess risk.. Three interpretations of observed crack-associated excess risk are especially cogent and deserving of continued inquiry: (1) Powder-then-crack initiates start with heightened dependence risk susceptibilities (i.e., pre-dating onset); (2) Powder-using initiates become cocaine dependent and then start using crack; (3) The cocaine delivery variant of 'crack-smoking' is more toxic than powder insufflation. For powder-then-crack initiates, the cocaine dependence risk (22%) is modestly lower but statistically undifferentiable from a recently estimated risk of heroin dependence <12 months after heroin onset (30%). Clinicians can use these side effect estimates in an evidence-based diagnostic workup when patients disclose new onsets of cocaine use.

Topics: Adult; Cocaine; Cocaine-Related Disorders; Female; Health Surveys; Heroin; Heroin Dependence; Humans; Incidence; Male; Middle Aged; Powders; Syndrome; Time Factors; United States

Chronic drug exposure is hypothesized to recruit negative reinforcement processes that increase the magnitude and alter the mechanisms of drug reinforcement. Candidate substrates of negative reinforcement include increased signaling via stress-related neurotransmitters such as corticotropin releasing factor (CRF, acting at CRF receptors) or dynorphin (acting at kappa opioid receptors) and/or decreased signaling via reward-related neurotransmitters such as dopamine. Determinants of drug reinforcement can be examined with choice procedures, in which subjects choose between a drug of interest (e.g. heroin or cocaine) and a non-drug alternative reinforcer (e.g. food). This review summarizes evidence collected from studies of drug choice in rhesus monkeys to address the negative reinforcement hypothesis. In monkeys choosing between heroin and food, chronic heroin exposure and subsequent withdrawal produces a robust increase in heroin choice. This withdrawal-associated increase in heroin choice is blocked by morphine and by other mu opioid agonists used to treat opioid use disorder (methadone, buprenorphine); however, withdrawal-associated increases in heroin choice are not reliably blocked by antagonists of CRF or kappa opioid receptors or by an indirect dopamine agonist. In monkeys choosing between cocaine and food, chronic cocaine exposure and withdrawal fail to increase cocaine choice or alter sensitivity of cocaine choice to treatment with candidate therapeutics including an indirect dopamine agonist and a kappa opioid receptor antagonist. These results support a role for negative reinforcement in self-administration of heroin but not cocaine. The constellation of neurobiological changes that constitutes the negative reinforcing stimulus in opioid-dependent rhesus monkeys remains to be determined.

Topics: Animals; Choice Behavior; Cocaine; Cocaine-Related Disorders; Disease Models, Animal; Food; Heroin; Heroin Dependence; Humans; Macaca mulatta; Narcotic Antagonists; Opioid-Related Disorders; Reinforcement, Psychology; Substance Withdrawal Syndrome

High-risk drug consumption is a matter of great concern for public health actors in industrialised countries. The latest trends show a market tendency towards diversification and increasing demand for high-purity synthetic drugs. While most consumers seek medical help after cannabis use, it is high-risk drugs like cocaine, heroin and amphetamines that account for most of the 1000 drug-related deaths that occur in Germany every year.. This article presents the most prominent in vivo cerebral metabolic information in cocaine, heroin and methamphetamine users provided by MRI spectroscopy and PET imaging.. We reviewed the literature reporting neuroimaging studies of in vivo metabolic data for methamphetamine, cocaine and heroin consumption published up to March 2017. The search was conducted using PubMed and a combination of the following key words: methamphetamine, cocaine, heroin, MR spectroscopy, PET.. MRI and PET are indispensable tools in gauging brain metabolic response to illegal drug abuse. Future breakthroughs in this field will most likely come from the investigation of novel neurotransmitter systems in PET and imaging phosphorus and carbon metabolites in MRI.

Topics: Brain; Cocaine; Cocaine-Related Disorders; Germany; Heroin; Humans; Methamphetamine

A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana.. A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed.. Due to the relatively small number of studies, we included all studies and cases.. For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms.. Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

Topics: Administration, Inhalation; Asthma; Cannabis; Cocaine-Related Disorders; Crack Cocaine; Heroin; Heroin Dependence; Humans; Marijuana Abuse; Marijuana Smoking; Respiratory Function Tests; Respiratory Sounds; Retrospective Studies; Substance-Related Disorders

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Topics: Buprenorphine; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms of pharmacotherapies, cocaine use is extraordinarily difficult to disrupt either in the laboratory or in the clinic. A range of medications has been shown to significantly decrease cocaine's subjective effects and craving without decreasing either cocaine self-administration or cocaine abuse by patients. These negative data combined with recent positive findings with modafinil suggest that self-administration procedures are an important intermediary step between pre-clinical and clinical studies. In terms of cannabis, a recent study suggests that medications that improve sleep and mood during cannabis withdrawal decrease the resumption of marijuana self-administration in abstinent volunteers. Clinical data on patients seeking treatment for their marijuana use are needed to validate these laboratory findings. Finally, in contrast to cannabis or cocaine dependence, there are three efficacious Food and Drug Administration-approved medications to treat opioid dependence, all of which decrease both heroin self-administration and subjective effects in the human laboratory. In summary, self-administration procedures provide meaningful behavioral data in a small number of individuals. These studies contribute to our understanding of the variables maintaining cocaine, marijuana and heroin intake, and are important in guiding the development of more effective drug treatment programs.

Topics: Cannabinoids; Cocaine; Cocaine-Related Disorders; Heroin; Heroin Dependence; Humans; Illicit Drugs; Marijuana Abuse; Models, Psychological; Self Administration; Social Environment; Treatment Outcome

The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment. The pharmacological reasons for cocaine use in opioid-dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co-use. We reviewed anecdotal evidence suggesting that cocaine is co-used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. 'speedball') does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid-dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self-administering laboratory animals to uncover the neurobiological correlates of specific patterns of co-use.

Topics: Central Nervous System; Cocaine; Cocaine-Related Disorders; Dopamine Uptake Inhibitors; Heroin; Heroin Dependence; Humans; Narcotics

The objective of this article is to review data from studies that used a reinstatement model in rats to elucidate the neural mechanisms underlying relapse to heroin and cocaine seeking induced by exposure to the self-administered drug (drug priming), conditioned drug cues, and stressors. These factors were reported to contribute to relapse to drug use in humans following prolonged abstinence periods. In the reinstatement model, the ability of acute exposure to drug or nondrug stimuli to reinstate drug seeking is determined following training for drug self-administration and subsequent extinction of the drug-reinforced behavior. We will review studies in which pharmacological agents were injected systemically or intracranially to block (or mimic) reinstatement by drug priming, drug cues, and stressors. We also will review studies in which brain lesions, in vivo microdialysis and electrochemistry, and gene expression methods were used to map brain sites involved in relapse to drug seeking. Subsequently, we will discuss theoretical issues related to the processes underlying relapse to drugs and address methodological issues in studies on reinstatement of drug seeking. Finally, the implications of the findings from the studies reviewed for addiction theories and treatment will be discussed. The main conclusion of this review is that the neuronal mechanisms involved in relapse to heroin and cocaine seeking induced by drug priming, drug cues, and stressors are to a large degree dissociable. The data reviewed also suggest that the neuronal events mediating drug-induced reinstatement are to some degree dissociable from those mediating drug reinforcement.

Topics: Animals; Behavior, Animal; Cocaine; Cocaine-Related Disorders; Cues; Extinction, Psychological; Heroin; Heroin Dependence; Rats; Recurrence; Self Administration; Stress, Psychological

THREE CATEGORIES OF COMPLICATIONS: Heroine and cocaine are the main drugs used by injecting drug-users (IDU) in France. There are three categories of complications associated with intravenous drug abuse: effects related to drug toxicity, effects associated with the administration route, and effects associated with social implications of drug-dependence. OTHER HEALTH PROBLEMS: The impact of HIV infection among IDU, particularly in southern Europe, has led to renewed interest in the other health problems raised by this population. A review of recent literature shows that cocaine toxicity is better understood than heroine toxicity. In addition, intravenous drug abuse can lead to a whole series of disease states related to trauma or infection.

Topics: Cocaine; Cocaine-Related Disorders; Heroin; Heroin Dependence; Humans; Risk Factors; Substance Abuse, Intravenous

This article includes a summary and critique of methodological limitations of the peer-reviewed studies of developmental outcome during the first 2 years in children prenatally exposed to the most commonly used drugs of abuse: tobacco, alcohol, marijuana, heroin/methadone, and cocaine. Reported effects vary by specific drug or drug combinations and amount and timing of exposure; however, few thresholds have been established. Drug effects also appear to be exacerbated in children with multiple risks, including poverty, and nonoptimal caregiving environments. Although prenatal exposure to any one drug cannot reliably predict the outcome of an individual child, it may be a marker for an array of variables that can impact development. Appropriate intervention strategies require future research that determines which factors place exposed children at risk and which are protective for optimal development.

Topics: Alcoholism; Child Abuse; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Ethanol; Female; Heroin; Heroin Dependence; Humans; Infant; Infant, Newborn; Marijuana Abuse; Methadone; Nicotine; Poverty; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors; Smoking; Substance-Related Disorders

Topics: Cocaine-Related Disorders; Cohort Studies; Heroin; Humans; Narcotics; Opioid-Related Disorders; Outcome and Process Assessment, Health Care; Social Adjustment; Substance Abuse, Intravenous; Switzerland; Treatment Outcome

For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit.. The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants' familiarity with the song.. Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design.. Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving.. Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.

Topics: Adult; Alcoholism; Central Nervous System Depressants; Cocaine; Cocaine-Related Disorders; Craving; Dopamine Uptake Inhibitors; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Music Therapy; Narcotics; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders; Treatment Outcome; Young Adult

To determine the efficacy of contingency management (CM), targeting cocaine use, as an add-on intervention for heroin dependent patients in supervised heroin-assisted treatment (HAT) with frequent cocaine use.. Multi-center, open-label, parallel group, randomized controlled trial.. Twelve specialized addiction treatment centers for HAT in The Netherlands; April 2006-January 2011.. 214 chronic, treatment-refractory heroin dependent patients in HAT, with frequent cocaine use.. Routine, daily supervised diacetylmorphine treatment, co-prescribed with oral methadone (HAT), with and without 6 months contingency management for cocaine use as an add-on intervention; HAT+CM and HAT-only, respectively.. Primary outcome was the longest, uninterrupted duration of cocaine abstinence, based upon laboratory urinalysis. Secondary outcome measures included other cocaine-related measures, treatment retention in HAT, and multi-domain health-related treatment response.. In an intention-to-treat analysis, HAT+CM was more effective than HAT-only in promoting longer, uninterrupted duration of cocaine abstinence (3.7 weeks versus 1.6 weeks; negative binomial regression: Exp(B)=2.34, 95%-CI: 1.70-3.23; p<0.001). This result remained significant in sensitivity analyses and was supported by all secondary, cocaine-related outcome measures. Treatment retention in HAT was high (91.6%) with no difference between the groups. The improvement in multi-domain health-related treatment response during the trial was numerically higher in HAT+CM (from 37.4% to 53.1%; +15.7%) than in HAT-only (from 44.5% to 46.5%; +2.0%), but this difference was statistically not significant.. Contingency management is an effective add-on intervention to promote longer, uninterrupted periods of cocaine abstinence in chronic, treatment-refractory heroin dependent patients in heroin-assisted treatment with frequent cocaine use. The trial has been registered in The Netherlands National Trial Register under clinical trial registration number NTR4728.

Topics: Adult; Analgesics, Opioid; Cocaine; Cocaine-Related Disorders; Dopamine Uptake Inhibitors; Drug Therapy, Combination; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Netherlands; Time Factors; Treatment Outcome

The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes.. Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM.. Three supervised injectable opiate clinics in England.. Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support.. wider drug use, crime, health and social functioning at 6 months.. At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013).. Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

Topics: Administration, Oral; Adult; Alcohol Drinking; Analgesics, Opioid; Cocaine-Related Disorders; Comorbidity; Crime; Employment; England; Female; Health Status; Heroin; Heroin Dependence; Housing; Humans; Illicit Drugs; Injections, Intravenous; Interpersonal Relations; Linear Models; Male; Methadone; Needle-Exchange Programs; Opiate Substitution Treatment; Substance Abuse, Intravenous; Treatment Outcome

Cocaine dependence has proved difficult to treat, whether it occurs alone or in combination with opiate dependence. No intervention has been demonstrated to be uniquely effective. Patients might benefit most from combined pharmacotherapeutic and psychotherapeutic interventions. The present study sought to evaluate the feasibility, tolerability, and efficacy of methylphenidate (MP) and cognitive-behavioral group therapy (CBGT) for cocaine dependence in diacetylmorphine-maintained patients. Sixty-two cocaine-dependent diacetylmorphine-maintained patients participated in a dual-site, double-blind, placebo-controlled pilot trial with 4 treatment conditions. The participants were randomly assigned to receive MP or a placebo each combined with either CBGT or treatment as usual for 12 weeks. Methylphenidate 30 mg and a placebo in identical capsules were administered onsite twice daily under supervision in a fixed-dose regimen without titration. Manual-guided CBGT consisted of 12 weekly sessions. Participation in the CBGT sessions was voluntary. Primary outcome measures were retention in pharmacologic treatment, cocaine-free urine samples, self-reported cocaine use, and adverse effects. Urine screens were performed thrice weekly. Seventy-one percent of the participants completed the study protocol. Methylphenidate was well tolerated with similar retention rates compared with the placebo. No serious adverse effects occurred. No difference in cocaine-free urine screens was found across the 4 treatment groups. Self-reported cocaine use was reduced in all 4 study groups. Methylphenidate and CBGT did not provide an advantage over a placebo or treatment as usual in reducing cocaine use. There were no signs of additive benefits of MP and CBGT. Because of the small sample size, the results are preliminary.

Topics: Adult; Analgesics, Opioid; Central Nervous System Stimulants; Chi-Square Distribution; Cocaine-Related Disorders; Cognitive Behavioral Therapy; Combined Modality Therapy; Double-Blind Method; Feasibility Studies; Female; Heroin; Heroin Dependence; Humans; Kaplan-Meier Estimate; Male; Methylphenidate; Opiate Substitution Treatment; Pilot Projects; Substance Abuse Detection; Switzerland; Time Factors; Treatment Outcome; Urinalysis

Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence.. In an open-label, phase 3, randomized, controlled trial in Canada, we compared injectable diacetylmorphine with oral methadone maintenance therapy in patients with opioid dependence that was refractory to treatment. Long-term users of injectable heroin who had not benefited from at least two previous attempts at treatment for addiction (including at least one methadone treatment) were randomly assigned to receive methadone (111 patients) or diacetylmorphine (115 patients). The primary outcomes, assessed at 12 months, were retention in addiction treatment or drug-free status and a reduction in illicit-drug use or other illegal activity according to the European Addiction Severity Index.. The primary outcomes were determined in 95.2% of the participants. On the basis of an intention-to-treat analysis, the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group (rate ratio for retention, 1.62; 95% confidence interval [CI], 1.35 to 1.95; P<0.001). The reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group (rate ratio, 1.40; 95% CI, 1.11 to 1.77; P=0.004). The most common serious adverse events associated with diacetylmorphine injections were overdoses (in 10 patients) and seizures (in 6 patients).. Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available. (ClinicalTrials.gov number, NCT00175357.)

Topics: Administration, Oral; Adult; Cocaine-Related Disorders; Double-Blind Method; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Hydromorphone; Illicit Drugs; Injections; Male; Methadone; Substance Abuse Detection; Substance Abuse, Intravenous

Although commonly assessed with unidimensional scales, craving has been suggested to be multifaceted and to have a complex relationship with drug use and relapse. This study assessed the consistency and predictive validity of unidimensional and multidimensional craving scales. At the beginning of a 12-week outpatient treatment trial, opiate users (n = 101) and cocaine users (n = 72) completed unidimensional visual analog scales (VASs) assessing "want," "need," and "craving" and multidimensional 14- and 45-item versions of the Cocaine Craving Questionnaire (CCQ) or Heroin Craving Questionnaire (HCQ). Spearman correlations between the VASs and the first-order factors from the 45-item CCQ/HCQ were .20-.40, suggesting that the two types of assessment were not redundant. Treatment dropout and in-treatment drug use were more frequently predicted by scores on the 14- or 45-item CCQ than by VAS ratings. Results suggest that the CCQ/HCQ and the 14-item CCQ provide information that unidimensional VASs do not.

Topics: Adult; Ambulatory Care; Cocaine; Cocaine-Related Disorders; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Motivation; Pain Measurement; Patient Dropouts; Personality Inventory; Psychometrics; Recurrence; Reproducibility of Results; Self Efficacy; Statistics as Topic; Substance Abuse Detection; Substance Withdrawal Syndrome; Surveys and Questionnaires; Treatment Refusal

This study tested whether opiate dependence, tobacco smoking, or their combination accompanied impaired performance on the gambling task (GT), which tests decision-making. GT previously detected impairments in patients with lesions of the ventromedial prefrontal cortex and in substance abusers. Four groups were matched on demographic characteristics and intelligence: methadone-maintained smokers (n = 9) and nonsmokers (n = 9), and control (i.e., not opiate-dependent) smokers (n = 9) and nonsmokers (n = 10). The Wisconsin Card Sorting Task (WCST) was administered to test whether differences in GT performance reflected generalized deficits in prefrontal cortical function. While there were no significant group differences on the WCST, groups differed significantly on GT performance (F(3,31) = 2.95, P = 0.048), controlling for depressive symptom ratings and childhood attention deficit hyperactivity disorder. Methadone-maintained smokers (but not nonsmokers) performed more poorly than either of the two control groups (P = 0.007 versus smokers; P = 0.024 versus nonsmokers). In a planned analysis of methadone-maintained subjects, smokers scored more poorly on GT than nonsmokers (F(1,18) = 5.64, P = 0.032) and had more treatment failures (67% heroin use during the last 30 days versus 20%). The findings suggest that among opiate-dependent individuals, tobacco smoking may be a marker for a more severe form of substance abuse disorder, reflecting impaired decision-making, as modeled by GT.

Topics: Adult; Cocaine; Cocaine-Related Disorders; Comorbidity; Decision Making; Female; Gambling; Heroin; Heroin Dependence; Humans; Los Angeles; Male; Middle Aged; Neuropsychological Tests; Prefrontal Cortex; Prospective Studies; Psychometrics; Reference Values; Smoking; Substance Abuse Treatment Centers

This study tested the effectiveness of fluoxetine as a treatment for depression in a population of methadone-maintained opioid addicts. Methadone-maintained opioid addicts (44) with depression received fluoxetine or placebo in addition to their methadone, in a double-blind randomized trial, for 12 weeks. Depressive symptoms decreased significantly overall with no significant differences between the groups treated with fluoxetine versus placebo. In addition, drug use outcomes, including cocaine and heroin self-reported use and urine toxicology were measured. There was a significant decrease in heroin use in treatment, but no medication effect. Cocaine use, was unchanged from pre-treatment to endpoint. In separately analyzing data for the subsample of subjects with the most severe depression, there was a significant decrease in depression during treatment and a significant decrease in self-reported cocaine use, but no medication effect on either depressive symptoms or on cocaine use. This study suggests that fluoxetine is not an effective agent in treating depression or cocaine use in this population.

Topics: Adult; Antidepressive Agents, Second-Generation; Behavior, Addictive; Cocaine; Cocaine-Related Disorders; Depression; Depressive Disorder; Double-Blind Method; Female; Fluoxetine; Heroin; Humans; Male; Methadone; Narcotics; Opioid-Related Disorders; Substance Abuse Detection; Treatment Outcome

Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups.. This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis.. We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group.. Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.

Topics: Amphetamine; Analgesics, Opioid; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Cross-Sectional Studies; Heroin; Humans; Methylphenidate; N-Methyl-3,4-methylenedioxyamphetamine; Substance-Related Disorders; Treatment Outcome

Persistent transcriptional events in ventral tegmental area (VTA) and other reward relevant brain regions contribute to enduring behavioral adaptations that characterize substance use disorder. Recent data from our laboratory indicate that aberrant accumulation of the newly discovered histone post-translational modification (PTM), H3 dopaminylation at glutamine 5 (H3Q5dop), contributes significantly to cocaine-seeking behavior following prolonged periods of abstinence. It remained unclear, however, whether this modification is important for relapse vulnerability in the context of other drugs of abuse, such as opioids. Here, we showed that H3Q5dop plays a critical role in heroin-mediated transcriptional plasticity in midbrain regions, particularly the VTA. In rats undergoing abstinence from heroin self-administration (SA), we found acute and persistent accumulation of H3Q5dop in VTA. Attenuation of H3Q5dop during abstinence induced persistent changes in gene expression programs associated with neuronal signaling and dopaminergic function in heroin abstinence and led to reduced heroin-seeking behavior. Interestingly, the observed changes in molecular pathways after heroin SA showed significant yet reversed overlap with the same genes altered in cocaine SA. These findings establish an essential role for H3Q5dop, and its downstream transcriptional consequences, in heroin-induced functional plasticity in VTA.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Heroin; Histones; Male; Rats; Self Administration; Ventral Tegmental Area

The nature and predictors of insensitivity to aversive consequences of heroin + cocaine polysubstance use are not well characterized.. Translational methods incorporating a tightly controlled animal model of drug self-administration and measures of inhibitory control and avoidance behavior might be helpful for clarifying this issue.. The key approach for distinguishing potential contributions of pre-existing inhibitory control deficits vs. drug use history in meditating insensitivity to aversive consequences was comparison of two rat strains: Wistar (WIS/Crl), an outbred strain, and the spontaneously hypertensive rat (SHR/NCrl), an inbred strain shown previously to exhibit heightened cocaine and heroin self-administration and poor inhibitory control relative to WIS/Crl.. In separate tasks, SHR/NCrl displayed greater impulsive action and compulsive-like behavior than WIS/Crl prior to drug exposure. Under two different schedules of drug delivery, SHR/NCrl self-administered more cocaine than WIS/Crl, but self-administered a similar amount of heroin + cocaine as WIS/Crl. When half the session cycles were punished by random foot shock, SHR/NCrl initially were less sensitive to punishment than WIS/Crl when self-administering cocaine, but were similarly insensitive to punishment when self-administering heroin + cocaine. Based on correlation analyses, only trait impulsivity predicted avoidance capacity in rats self-administering cocaine and receiving yoked-saline. In contrast, only amount of drug use predicted avoidance capacity in rats self-administering heroin + cocaine. Additionally, baseline drug seeking and taking predicted punishment insensitivity in rats self-administering cocaine or heroin + cocaine.. Based on the findings revealed in this animal model, human laboratory research concerning the nature and predictors of insensitivity to aversive consequences in heroin and cocaine polysubstance vs. monosubstance users is warranted.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Heroin; Humans; Rats; Rats, Inbred SHR; Rats, Wistar; Self Administration

Persons with dual severe opioid and cocaine use disorders are at risk of considerable morbidity, and the bidirectional relationship of escalation of mu-opioid agonists and cocaine use is not well understood. The aim of this study was to examine the bidirectional relationship between escalation of heroin and cocaine use in volunteers dually diagnosed with opioid and cocaine dependence (OD + CD). Volunteers from New York with OD + CD (total

Topics: Adolescent; Analgesics, Opioid; Cocaine; Cocaine-Related Disorders; Female; Heroin; Heroin Dependence; Humans; Infant; Male; Opioid-Related Disorders

Cocaine use is prevalent among people receiving injectable opioid agonist treatment. Investigations of cocaine use in this population have been descriptive and the potential heterogeneity existing in patterns of use have not been characterized. As such, among patients receiving injectable opioid agonist treatment, this study aimed to: 1) quantify intra- and inter-individual variation in cocaine use over 24-months and; 2) determine how predictors of interest explained this variation.. Participants were patients receiving injectable opioid agonist treatment for opioid use disorder. Study visits were completed at baseline prior to receiving treatment, and 3,6,9,12,18, and 24 months after baseline. A multi-level regression approach to growth curve modeling was employed to estimate and explain intra- (within-person) and inter-individual (between-person) variation in cocaine use.. Significant intra and inter-individual variation in cocaine use was identified over 24-months. Treatment engagement was on average associated with reductions in the prior month number of days of cocaine use (range: 0-30)(Estimate (standard error): -0.05(0.02), p = 0.003). On average, men reported less cocaine use compared to women (Estimate (standard error): -5.91(1.57), p=<0.001), and participants reporting ever regularly using cocaine at baseline reported more cocaine use over 24-months compared to participants reporting never regularly using cocaine (Estimate (standard error): 4.72 (1.91), p = 0.013).. Significant reductions in cocaine use were observed and significant heterogeneity in patterns of cocaine use was identified. These heterogeneous cocaine use profiles suggest that an individualized approach to care will be critical in responding to patients' cocaine use in injectable opioid agonist treatment.

Topics: Adult; Analgesics, Opioid; Cocaine; Cocaine-Related Disorders; Female; Heroin; Humans; Hydromorphone; Male; Middle Aged; Opioid-Related Disorders

Cocaine and heroin cause impairment of neural plasticity in the brain including striatum. This study aimed to identify genes differentially expressed in the striatum of cynomolgus monkeys in response to cocaine and heroin. After chronic administration of cocaine and heroin in the monkeys, we performed large-scale transcriptome profiling in the striatum using RNA-Seq technology and analysed functional annotation. We found that 547 and 1238 transcripts were more than 1.5-fold up- or down-regulated in cocaine- and heroin-treated groups, respectively, compared to the control group, and 3432 transcripts exhibited differential expression between cocaine- and heroin-treated groups. Functional annotation analysis indicated that genes associated with nervous system development (NAGLU, MOBP and TTL7) and stress granule disassembly (KIF5B and KLC1) were differentially expressed in the cocaine-treated group compared to the control group, whereas gene associated with neuron apoptotic process (ERBB3) was differentially expressed in the heroin-treated group. In addition, IPA network analysis indicated that genes (TRAF6 and TRAF3IP2) associated with inflammation were increased by the chronic administration of cocaine and heroin. These results provide insight into the correlated molecular mechanisms as well as the upregulation and down-regulation of genes in the striatum after chronic exposure to cocaine and heroin.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Corpus Striatum; Disease Models, Animal; Female; Gene Expression Regulation; Heroin; Heroin Dependence; Humans; Kinesins; Macaca fascicularis; Neuronal Plasticity; RNA-Seq; Self Administration; Transcriptome

Comorbid use of heroin and cocaine is highly prevalent among drug users and can greatly increase addiction risk. Nonetheless, little is known regarding how a multi-drug history impacts motivation and cue responsivity to individual drugs.. We used behavioral-economic procedures to examine motivation to maintain drug consumption and tests of drug-seeking to drug-associated cues to assess sensitivity to heroin and cocaine-associated cues in rats that had a self-administration history of heroin, cocaine, or both drugs.. Unexpectedly, we found that groups with a polydrug history of heroin and cocaine did not have higher levels of motivation or cue-induced reinstatement of drug-seeking for either cocaine or heroin compared to single drug groups. Nonetheless, we did find drug-specific differences in both economic price and cue sensitivity. Specifically, demand elasticity was lower for cocaine compared to heroin in animals with a single drug history, but not with polydrug groups. In addition, cocaine demand was predictive of the degree of cue-induced reinstatement of drug-seeking for cocaine following extinction, whereas heroin demand was predictive of the degree of reactivity to a heroin-associated cue. Furthermore, although cue reactivity following the initial self-administration phase did not differ across cues and drug history, reactivity to both heroin and cocaine cues was greater during subsequent heroin use compared to cocaine use, and this enhanced reactivity to heroin cues persisted during forced abstinence.. These results indicate that there is a greater motivation to maintain cocaine consumption, but higher sensitivity to drug-associated cues with a history of heroin use, suggesting that cocaine and heroin may drive continued drug use through different behavioral processes.

Topics: Animals; Behavior, Addictive; Behavior, Animal; Cocaine; Cocaine-Related Disorders; Conditioning, Psychological; Cues; Drug-Seeking Behavior; Economics, Behavioral; Heroin; Male; Motivation; Rats; Rats, Sprague-Dawley; Self Administration

Nationally, it was estimated that 11.4 million people misused opioids in 2017 with more than 47,000 opioid-related deaths. Although medication-assisted treatment (MAT) has been effective in enhancing treatment retention and decreasing frequency of opioid use, relapse rates for opioids and other substances remain high, emphasizing the importance of investigating novel interventions to augment MAT. One potential treatment approach is repetitive transcranial magnetic stimulation (rTMS)-a noninvasive, electrophysiological method of neuromodulation. Recently published studies of rTMS in individuals with alcohol, nicotine, and cocaine use disorder have suggested that this treatment shows promise in reducing cravings and substance use. The literature specific to rTMS and opioid use disorder (OUD) is limited to a single published study in heroin users, which showed that a single session of rTMS to the left dorsolateral prefrontal cortex (DLPFC) reduced cue-induced craving, with a further reduction following 5 consecutive days of rTMS. The following case report involved a 25-year-old Caucasian male diagnosed with OUD and cocaine use disorder. This subject continued to demonstrate ongoing substance use despite participating in comprehensive MAT with buprenorphine/naloxone in combination with psychosocial interventions. He was administered 7 separate sessions of rTMS targeting the left DLPFC. Substance-related cues were presented prior to, during, and following these rTMS administration sessions and the subject rated his substance cravings via a 100-point Visual Analog Scale. When compared with his cue-induced craving ratings, there was a mean reduction in craving for heroin and cocaine by ∼60% to 82% following the 7 administration sessions. Although this is a single case, further investigation of rTMS as an augmentation strategy for OUD and polysubstance use is warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Topics: Adult; Cocaine; Cocaine-Related Disorders; Craving; Cues; Heroin; Heroin Dependence; Humans; Male; Prefrontal Cortex; Substance-Related Disorders; Transcranial Magnetic Stimulation

As a novel first-in-class potent analgesic acting as an agonist of multiple opioid receptors, cebranopadol showed high efficacy and good tolerability in a broad range of preclinical models and clinical trials related to pain. In the present study, to evaluate the efficacy and safety of cebranopadol as a potential treatment of cocaine dependence, we tested the effects of cebranopadol with single and repeated doses (25, 50, 75, or 100 μg/kg, oral gavage) using rat models of cocaine fixed-ratio (FR) self-administration (SA), cocaine progressive-ratio (PR) SA, and sucrose pellet SA. In single-dosing treatment paradigm, cebranopadol significantly and dose-dependently reduced cocaine SA under FR and PR schedules and suppressed food intake under FR schedule without causing apparent side effects. In repeated-dosing treatment scheme, i.e. daily administration of 25, 50, 75, or 100 μg/kg cebranopadol for a week, the similar reduction in cocaine intake was detected, while non-negligible complications/side effects were observed at repeated high doses (75 and 100 μg/kg). The observed side effects were similar to the common toxic signs elicited by heroin at high doses, although cebranopadol did not fully substitute heroin's discriminative stimulant effects in our drug discriminative tests. These results demonstrated that the most appropriate oral dose of cebranopadol to balance the efficacy and safety is 50 μg/kg. Collectively, although cebranopadol may serve as a new treatment for cocaine dependence, more consideration, cautiousness, and a clear optimal dose window to dissociate its therapeutic effects from opioid side effects/complications in male and female subjects will be necessary to increase its practical clinical utility.

Topics: Analgesics, Opioid; Animals; Cocaine-Related Disorders; Conditioning, Operant; Dose-Response Relationship, Drug; Heroin; Indoles; Male; Rats; Rats, Sprague-Dawley; Reinforcement Schedule; Self Administration; Spiro Compounds

Relapse into drug use is a major problem faced by recovering addicts. In humans, an intensification of the desire for the drug induced by environmental cues-incubation of drug craving-has been observed. In rodents, this phenomenon has been modeled by studying drug seeking under extinction after different times of drug withdrawal (or using a natural reinforcer). Although much progress has been made, an integrated approach simultaneously studying different drug classes and natural reward and examining different brain regions is lacking. Lewis rats were used to study the effects of cocaine, heroin, and sucrose seeking incubation on six key brain regions: the nucleus accumbens shell/core, central/basolateral amygdala, and dorsomedial/ventromedial prefrontal cortex. We analyzed PSD95 and gephyrin protein levels, gene expression of glutamatergic, GABAergic and endocannabinoid elements, and amino acid transmitter levels. The relationships between the areas studied were examined by Structural Equation Modelling. Pathways from medial prefrontal cortex and basolateral complex of the amygdala to central nucleus of the amygdala, but not to the nucleus accumbens, were identified as common elements involved in the incubation phenomenon for different substances. These results suggest a key role for the central nucleus of amygdala and its cortical and amygdalar afferences in the incubation phenomenon, and we suggest that by virtue of its regulatory effects on glutamatergic and GABAergic dynamics within amygdalar circuits, the endocannabinoid system might be a potential target to develop medications that are effective in the context of relapse.

Topics: Analgesics, Opioid; Animals; Behavior, Animal; Central Amygdaloid Nucleus; Cocaine; Cocaine-Related Disorders; Disease Models, Animal; Dopamine Uptake Inhibitors; Heroin; Male; Opioid-Related Disorders; Rats; Rats, Inbred Lew; Reinforcement, Psychology; Self Administration; Sucrose

Animal studies suggest that exposure to either of the two widely used drugs of abuse, heroin or cocaine, causes depletion of the antioxidant, reduced glutathione, a hallmark of oxidative stress, in the brain. However, the relevance of the animal findings to the human is uncertain and clinical trials with the antioxidant GSH precursor n-acetylcysteine have produced mixed results in cocaine dependence.. Our major objective was to compare glutathione levels, determined by an HPLC-coulometric procedure, in autopsied brain of chronic heroin (n = 11) and cocaine users (n = 9), who were positive for the drugs in the brain, to those of matched controls (n = 16). Six brain regions were examined, including caudate, hippocampus, thalamus and frontal, temporal and insular cortices.. In contrast to experimental animal findings, we found no statistically significant difference between mean levels of reduced or oxidized glutathione in the drug user vs. control groups. Moreover, no correlation was found between levels of drugs in the brain and those of glutathione.. Acknowledging the many generic limitations of an autopsied human brain study and the preliminary nature of the findings, our data nevertheless suggest that any oxidative stress caused by heroin or cocaine in chronic users of the drugs might not be sufficient to cause substantial loss of stores of glutathione in the human brain, at least during early withdrawal. These findings, requiring replication, might also have some relevance to future clinical trials employing glutathione supplement therapy as an anti-oxidative strategy in chronic users of the two abused drugs.

Topics: Adult; Antioxidants; Autopsy; Brain; Cocaine; Cocaine-Related Disorders; Female; Glutathione; Heroin; Heroin Dependence; Humans; Male; Oxidative Stress

Since 2000, heroin use patterns have shifted within the United States. How this change may relate to polydrug use among local heroin users is unknown. Although polydrug use has been studied, user perceptions of drug use in terms of health risks, arrest risk, availability, cost, liking, and dependence have not been considered.. Data are presented from a brief, face-to-face survey conducted in 2016 of 200 non-in-treatment heroin users from Cleveland, OH. We assessed the use of and attitudes on alcohol, marijuana, methamphetamine, heroin, crack cocaine, powder cocaine, and prescription drugs. We estimated polydrug (concurrent past month) use with cluster analysis and latent profiles. Regression analysis estimated the strength of relationships between attitudes and frequency of use.. We identified five clusters: Cluster 1 used heroin concomitantly with alcohol and occasionally crack; Cluster 2 used heroin and crack cocaine daily; Cluster 3 used heroin daily and almost exclusively; Cluster 4 used heroin and marijuana daily; and Cluster 5 were part-time drug users. Drug use frequency was associated with liking and being anxious when drugs could not be obtained. High perceived availability of heroin and cocaine and low cost facilitated polydrug use.. Understanding polydrug use clusters among heroin users is important for addressing the larger opioid epidemic. Users' perceptions of a drug's availability and cost appeared to facilitate polydrug use and justify more detailed future research on drug access.

Topics: Adult; Alcoholism; Amphetamine-Related Disorders; Analgesics, Opioid; Cocaine-Related Disorders; Crack Cocaine; Drug Users; Female; Heroin; Heroin Dependence; Humans; Male; Marijuana Abuse; Middle Aged; Ohio; Self Report; Substance-Related Disorders

Cannabidiol is a non-psychoactive compound that is the second most abundant component of cannabis. It has been shown to have a potential therapeutic value for a wide range of disorders, including anxiety, psychosis, and depression. Recently, it was suggested that cannabidiol might be a potential treatment for heroin craving and relapse. Here we investigated the effects of an acute treatment with cannabidiol on cocaine self-administration and cue-induced cocaine seeking in rats. Rats were trained to press a lever to self-administer cocaine (0.5 mg/kg/infusion), first under a fixed interval 20 s (FI-20 s) and then under a progressive ratio (PR) schedule of reinforcement. Cocaine self-administration under a PR schedule of reinforcement was not attenuated by cannabidiol injections (5.0 mg/kg and 10.0 mg/kg; i.p.) when tested 30 min and 24 h after treatment. Cannabidiol treatment (5.0 mg/kg or 10.0 mg/kg) also did not attenuate cue-induced cocaine seeking in rats after a withdrawal period of 14 days. In contrast, treatment with cannabidiol (10.0 mg/kg; i.p.) resulted in a statistically significant anxiolytic effect in the elevated plus-maze. Our findings suggest that, under the conditions described here, an acute cannabidiol treatment has a minimal effect on a rat model of cocaine intake and relapse.

Topics: Animals; Behavior, Addictive; Behavior, Animal; Cannabidiol; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Cues; Heroin; Male; Rats; Rats, Long-Evans; Reinforcement, Psychology; Self Administration

Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City.. Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years.. Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIV infection increased from 37% to 43%, (P < 0.001); the percentage with HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk.. There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.

Topics: Adolescent; Adult; Cocaine; Cocaine-Related Disorders; Coinfection; Drug Users; Female; Heroin; Heroin Dependence; Herpes Simplex; Herpesvirus 2, Human; Heterosexuality; HIV Infections; Humans; Male; Middle Aged; New York City; Prevalence; Substance Abuse, Intravenous; Young Adult

Polysubstance use is associated with alterations in different components of executive functioning such as working memory and response inhibition. Nevertheless, less attention has been given to executive planning skills, which are required to benefit of low structured interventions. This study examines the association between severity of use of cocaine, heroin, alcohol, fluid and crystallized intelligence and planning tasks varying on degree of structure.. Data were collected from 60 polysubstance users and 30 healthy controls. Cognitive assessment consisted of three planning tasks with different structure levels: Stockings of Cambridge, Zoo Map test, and Multiple Errands Test.. Polysubstance users had significant planning deficits across the three tasks compared to healthy controls. Hierarchical regression models showed that severity of drug use and fluid and crystallized intelligence significantly explained performance in all the planning tasks. However, these associations were higher for low-structured real world tasks. These low-structured tasks also showed a unique association with crystallized but not fluid intelligence.. Drug abuse is negatively associated with planning abilities, and intelligence is positively associated with planning performance in real-world tasks.

Topics: Case-Control Studies; Cocaine; Cocaine-Related Disorders; Ethanol; Executive Function; Heroin; Humans; Intelligence; Psychological Tests; Substance-Related Disorders

Multiple layers of dealers connect international drug traffickers to users. The fundamental activity of these dealers is buying from higher-level dealers and re-selling in smaller quantities at the next lower market level. Each instance of this can be viewed as completing a drug dealing "cycle". This paper introduces an approach for combining isolated accounts of such cycles into a coherent model of the structure, span, and profitability of the various layers of the domestic supply chain for illegal drugs. The approach is illustrated by synthesizing data from interviews with 116 incarcerated dealers to elucidate the structure and operation of distribution networks for cocaine and heroin in Italy and Slovenia. Inmates' descriptions of cycles in the Italian cocaine market suggest fairly orderly networks, with reasonably well-defined market levels. The Italian heroin market appears to have more "level-jumpers" who skip a market level by making a larger number of sales per cycle, with each sale being of a considerably smaller weight. Slovenian data are sparser, but broadly consistent. Incorporating prices allows calculation of how much of the revenue from retail sales is retained by dealers at each market level. In the Italian cocaine market, both retail sellers and the international supply chain outside of Italy each appear to receive about 30-40% of what users spend, with the remaining 30% going to higher-level dealers operating in Italy (roughly 10% to those at the multi-kilo level and 20% to lower level wholesale dealers). Factoring in cycle frequencies permits rough estimation of the number of organizations at each market level per billion euros in retail sales, and of annual net revenues for organizations at each level. These analyses provide an approach to gaining insight into the structure and operation of the supply chain for illegal drugs. They also illustrate the value of two new graphical tools for describing illicit drug supply chains and hint at possible biases in how respondents describe their drug dealing activities.

Topics: Cocaine; Cocaine-Related Disorders; Commerce; Drug and Narcotic Control; Drug Costs; Drug Trafficking; Efficiency, Organizational; Heroin; Heroin Dependence; Humans; Italy; Models, Economic; Models, Organizational; Policy Making; Slovenia

Between late 2010 and mid 2011 there was a significant heroin shortage in the United Kingdom (UK), resulting in a rapid drop in street heroin purity and increase in price. The most well documented event of this kind is the 2000-2001 Australian heroin shortage, with little published research addressing the UK context. In this paper we draw on qualitative data to explore the impact of, and responses to, the 2010/2011 shortage among London-based heroin users.. Data collection comprised longitudinal life history and narrative interviews with 37 PWID in 2010-2011. The average age of participants was 40, with a 20-year average duration of injecting. Heroin was the drug of choice for the majority of participants (25), with 12 preferring to inject a crack-cocaine and heroin mix. Recruitment took place through London drug and alcohol services and peer networks.. The majority of participants continued to source and inject heroin despite reported decline in purity and increased adulteration. Transitions to poly-drug use during the heroin shortage were also common, increasing vulnerability to overdose and other drug related harms. Participants enacted indigenous harm reduction strategies in attempting to manage changes in drug purity and availability, with variable success.. Epidemiological data gathered during periods of heroin shortage is often drawn on to emphasise the health benefits of reductions in supply. Our findings highlight the importance of understanding the ways in which heroin shortages may increase, as well as reduce, harm. There is a need for enhanced service provision during periods of drug shortage as well as caution in regard to the posited benefits of supply-side drug law enforcement.

Topics: Adult; Cocaine-Related Disorders; Crack Cocaine; Data Collection; Drug Contamination; Drug Overdose; Female; Harm Reduction; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Substance Abuse, Intravenous; United Kingdom; Young Adult

Topics: Cardiomyopathy, Dilated; Cocaine; Cocaine-Related Disorders; Female; Heroin; Humans; Middle Aged; Treatment Outcome; Ultrasonography

Drug abuse is associated with epigenetic changes, such as histone modifications and DNA methylation. The purpose of the present study was to examine the effect of chronic cocaine and heroin administration on global DNA methylation in brain and liver. Male, 8 week old, C57BL/6J mice received heroin in a chronic 'intermittent' escalating dose paradigm, or cocaine in a chronic escalating dose 'binge' paradigm, which mimic the human pattern of opioid or cocaine abuse respectively. Following sacrifice, livers and brains were removed and DNA was extracted from them. The extracted DNA was hydrolyzed and 2'-deoxycytidine and 5-methyl-2'-deoxycytidine were determined by HPLC-UV. The % 5-methyl-2'-deoxycytidine content of DNA was significantly higher in the brain compared to the liver. There were no differences between the control animals and the cocaine or heroin treated animals in neither of the tissues examined, which is surprising since cocaine administration induced gross morphological changes in the liver. Moreover, there was no difference in the % 5-methyl-2'-deoxycytidine content of DNA between the cocaine and the heroin treated animals. The global DNA methylation status in the brain and liver of mice chronically treated with cocaine or heroin remains unaffected, but this finding cannot exclude the existence of anatomical region or gene-specific methylation differences. This is the first time that global DNA methylation in the liver and whole brain has been studied following chronic cocaine or heroin treatment.

Topics: Animals; Biomarkers; Brain; Chromatography, High Pressure Liquid; Cocaine; Cocaine-Related Disorders; Deoxycytidine; Disease Models, Animal; DNA Methylation; Heroin; Heroin Dependence; Liver; Male; Mice; Mice, Inbred C57BL; Spectrophotometry, Ultraviolet; Time Factors

Most animal research on drug relapse involves the reinstatement model where abstinence is a result of drug removal (extinction). However, abstinence in humans often results from the aversive consequences that accompany drug seeking (conflict situation). This study was aimed at using a conflict-based animal model of abstinence/relapse in rats self-administering heroin or cocaine.. Rats were trained to self-administer heroin (0.05 mg kg(-1) injection(-1)) or cocaine (0.5 mg kg(-1) injection(-1)) with each injection paired with a light cue. After stable responding was demonstrated, the floor near the levers was electrified, creating a barrier, in order to model the negative consequences of continued drug seeking. Shock intensities were increased over sessions until no responses occurred for three consecutive sessions. During a relapse test, where shock was maintained,the capacity of noncontingent drug cue presentations to induce active lever pressing was assessed.. Ten of ten heroin animals and three of eight cocaine animals exposed to noncontingent cue presentations resumed responding. During the relapse test, for both drug groups, active lever pressing was significantly higher than during abstinence but only in the heroin group was it significantly higher than inactive lever pressing.. The implementation of negative consequences for drug seeking can result in its cessation just as they might in human addicts. Similarly, exposure to drug cues can lead to resumption of drug seeking. This model may be useful for studying the mechanisms underlying abstinence and relapse and for developing strategies to prevent relapse.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Conflict, Psychological; Cues; Disease Models, Animal; Electroshock; Extinction, Psychological; Heroin; Heroin Dependence; Male; Rats; Rats, Long-Evans; Recurrence; Self Administration

To characterize the demographic, clinical, and epidemiologic features of levamisole-associated neutropenia in cocaine or heroin users.. State health departments were recruited for participation when the Centers for Disease Control and Prevention (CDC) was notified of potential cases by a clinician, a health department official, or a poison center between October 15, 2009, and May 31, 2010. A case was defined as a person with an absolute neutrophil count less than 1,000 cells/μL (or a WBC count <2,000 cells/μL) and a self-reported history or laboratory confirmation of cocaine or heroin use. Health department officials abstracted data from medical charts, attempted a patient interview, and submitted data to CDC for descriptive analysis.. Of the 46 potential cases reported from 6 states, half met eligibility criteria and had medical chart abstractions completed (n=23; 50%). Of these, close to half of the patients were interviewed (n=10; 43%). The average age was 44.4 years; just over half were men (n=12; 52%). The majority of patients presented to emergency departments (n=19; 83%). More than half presented with infectious illnesses (n=12; 52%), and nearly half reported active skin lesions (n=10; 44%). The majority of interview respondents used cocaine greater than 2 to 3 times a week (n=9; 90%), used cocaine more than 2 years (n=6; 60%), and preferred crack cocaine (n=6; 60%). All were unaware of exposure to levamisole through cocaine and of levamisole's inherent toxicity (n=10; 100%).. Physicians should suspect levamisole exposure in patients using illicit drugs, cocaine in particular, who present with unexplained neutropenia. Most patients reported chronic cocaine use and were unaware of levamisole exposure. Cocaine use is more prevalent among men; however, our results identified a higher-than-expected proportion of female users with neutropenia, suggesting women may be at higher risk. Emergency physicians and practitioners are uniquely positioned to recognize these patients early during their hospital course, elucidate a history of cocaine or other drug exposure, and optimize the likelihood of confirming exposure by arranging for appropriate drug testing.

Topics: Adult; Cocaine; Cocaine-Related Disorders; Drug Contamination; Female; Heroin; Heroin Dependence; Humans; Interviews as Topic; Levamisole; Male; Middle Aged; Neutropenia; Population Surveillance; United States

HIV infection and illicit drug use are each associated with diminished cognitive performance. This study examined the separate and interactive effects of HIV and recent illicit drug use on verbal memory, processing speed, and executive function in the multicenter Women's Interagency HIV Study.. Participants included 952 HIV-infected and 443 HIV-uninfected women (mean age = 42.8, 64% African-American). Outcome measures included the Hopkins Verbal Learning Test-Revised and the Stroop test. Three drug use groups were compared: recent illicit drug users (cocaine or heroin use in past 6 months, n = 140), former users (lifetime cocaine or heroin use but not in past 6 months, n = 651), and nonusers (no lifetime use of cocaine or heroin, n = 604).. The typical pattern of recent drug use was daily or weekly smoking of crack cocaine. HIV infection and recent illicit drug use were each associated with worse verbal learning and memory (P < 0.05). Importantly, there was an interaction between HIV serostatus and recent illicit drug use such that recent illicit drug use (compared with nonuse) negatively impacted verbal learning and memory only in HIV-infected women (P < 0.01). There was no interaction between HIV serostatus and illicit drug use on processing speed or executive function on the Stroop test.. The interaction between HIV serostatus and recent illicit drug use on verbal learning and memory suggests a potential synergistic neurotoxicity that may affect the neural circuitry underlying performance on these tasks.

Topics: Adult; Aged; Black or African American; Cocaine-Related Disorders; Cognition; Crack Cocaine; Executive Function; Female; Heroin; Heroin Dependence; HIV Infections; Humans; Illicit Drugs; Memory; Middle Aged; Sex Factors; Verbal Learning; Young Adult

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

Topics: Cocaine; Cocaine-Related Disorders; Codeine; Heroin; Heroin Dependence; Humans; Methadone; Morphine; Morphine Derivatives; Narcotics; Opiate Substitution Treatment; Saliva; Self Report; Substance Abuse Detection

Animal models of drug dependence have described both reductions in brain reward processes and potentiation of stress-like (or anti-reward) mechanisms, including a recruitment of corticotropin-releasing factor (CRF) signaling. Accordingly, chronic exposure to opiates often leads to the development of mechanical hypersensitivity. We measured paw withdrawal thresholds (PWTs) in male Wistar rats allowed limited (short access group: ShA) or extended (long access group: LgA) access to heroin or cocaine self-administration, or in rats made dependent on ethanol via ethanol vapor exposure (ethanol-dependent group). In heroin self-administering animals, after transition to LgA conditions, thresholds were reduced to around 50% of levels observed at baseline, and were also significantly lower than thresholds measured in animals remaining on the ShA schedule. In contrast, thresholds in animals self-administering cocaine under either ShA (1 h) or LgA (6 h) conditions were unaltered. Similar to heroin LgA rats, ethanol-dependent rats also developed mechanical hypersensitivity after eight weeks of ethanol vapor exposure compared to non-dependent animals. Systemic administration of the CRF1R antagonist MPZP significantly alleviated the hypersensitivity observed in rats dependent on heroin or ethanol. The emergence of mechanical hypersensitivity with heroin and ethanol dependence may thus represent one critical drug-associated negative emotional state driving dependence on these substances. These results also suggest a recruitment of CRF-regulated nociceptive pathways associated with escalation of intake and dependence. A greater understanding of relationships between chronic drug exposure and pain-related states may provide insight into mechanisms underlying the transition to drug addiction, as well as reveal new treatment opportunities. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Topics: Alcoholism; Animals; Cocaine; Cocaine-Related Disorders; Heroin; Heroin Dependence; Hyperalgesia; Male; Pain Perception; Pain Threshold; Physical Stimulation; Pyrimidines; Rats; Rats, Wistar; Receptors, Corticotropin-Releasing Hormone; Reward; Self Administration

Important part of the studies on drug use deals with drug use transitions because of their public health consequences. Narrating of drug use change states the active decision making in the centre of the process with adding mental states of the participants to the change process. The transitional narratives can be embedded in the social context of "risk environment".. In the micro-segregation of the Middle-Jozsefvaros (8th district, Budapest) the Blue Point Foundation runs a needle-exchange service in its "Contact Programme". Here the number of registered clients was 2066 in 2010. The study participants were recruited from the clients of this needle-exchange service (from December 2010 to February 2011). The criterion of entering the study sample was injecting mephedrone in the past 30 days. 17 participants were interviewed. The life story interviews had been coded thematically; it had been done until new codes did not carry new meanings.. Study participants speak about rapid tolerance and more intensive use of mephedrone after changing their usual drug. This use is more risky because of more frequent injecting. The effect of mephedrone was described like 3,4- Methylenedioxymethamphetamine (MDMA) and cocaine. In the interviews the usual pattern was narrating the positive effects of mephedrone and after this text the narrating of the negative effects. The "risk narrative" and the "enjoyment narrative" were presented separately in the interviews.. Not the expansion of the drug market, but the drug change was observed: earlier drugs to mephedrone or parallel use of mephedrone with earlier drugs (amphetamine and heroin). The purity and availability of heroin and the increase availability of mephedrone may take a role in this process. The absent of drug market expansion was explained by the closeness of the micro-segregation. Results raise attention of the public health consequences of drug change and the proper training of professionals for this change.

Topics: Adolescent; Adult; Amphetamine; Cocaine; Cocaine-Related Disorders; Designer Drugs; Dopamine Uptake Inhibitors; Drug Users; Female; Heroin; Humans; Hungary; Illicit Drugs; Interview, Psychological; Male; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Narration; Needle-Exchange Programs; Risk-Taking; Substance Abuse, Intravenous; Young Adult

Drug use and relapse involve learned associations between drug-associated environmental cues and drug effects. Extinction procedures in the clinic can suppress conditioned responses to drug cues, but the extinguished responses typically reemerge after exposure to the drug itself (reinstatement), the drug-associated environment (renewal), or the passage of time (spontaneous recovery). We describe a memory retrieval-extinction procedure that decreases conditioned drug effects and drug seeking in rat models of relapse, and drug craving in abstinent heroin addicts. In rats, daily retrieval of drug-associated memories 10 minutes or 1 hour but not 6 hours before extinction sessions attenuated drug-induced reinstatement, spontaneous recovery, and renewal of conditioned drug effects and drug seeking. In heroin addicts, retrieval of drug-associated memories 10 minutes before extinction sessions attenuated cue-induced heroin craving 1, 30, and 180 days later. The memory retrieval-extinction procedure is a promising nonpharmacological method for decreasing drug craving and relapse during abstinence.

Topics: Amygdala; Animals; Behavior, Addictive; Cocaine; Cocaine-Related Disorders; Conditioning, Classical; Conditioning, Operant; Cues; Extinction, Psychological; Heroin; Heroin Dependence; Humans; Male; Memory; Mental Recall; Models, Animal; Prefrontal Cortex; Protein Kinase C; Rats; Rats, Sprague-Dawley; Recurrence; Self Administration; Time Factors

Exposure to intermittent episodes of social defeat stress can increase drug seeking and leads to intense drug taking in rats.. This study investigated the consequences of repeated, intermittent social defeat stress on patterns of drug self-administration in rats with access to heroin, cocaine, or a heroin-cocaine combination ("speedball").. Male Long-Evans rats were either handled (controls) or subjected to 25-min social defeat stress episodes on days 1, 4, 7, and 10 during confrontations with an aggressive resident. Ten days following the last defeat, rats were assessed for locomotor cross-sensitization in response to heroin or cocaine. Animals were then prepared with intrajugular catheters for drug self-administration. Separate groups of controls and defeated rats were examined for self-administration of heroin (experiment 1), a heroin-cocaine combination (experiment 2), or cocaine (experiment 3). Drug self-administration patterns were evaluated using fixed or progressive ratio schedules of reinforcement during limited access sessions or a 24-h unlimited access binge.. Rats with a history of intermittent social defeat stress showed sensitized locomotor behavior when challenged with heroin or cocaine relative to controls. During the 24-h binge session, defeated rats escalated cocaine-taking behavior (ca. 110 mg/kg vs. 66 mg/kg in controls), persisted in self-administering cocaine or the heroin-cocaine mixture for more hours, and showed a tendency for increased heroin-cocaine intake, but no effects on heroin taking.. A history of social defeat stress seems to preferentially promote escalated intake of cocaine but not heroin, unless a heroin-cocaine combination is available.

Topics: Animals; Behavior, Addictive; Cocaine; Cocaine-Related Disorders; Dominance-Subordination; Drug Synergism; Heroin; Heroin Dependence; Male; Motor Activity; Rats; Rats, Long-Evans; Reinforcement Schedule; Reinforcement, Psychology; Self Administration; Stress, Psychological

Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy.

Topics: Abdomen, Acute; Adult; Cocaine; Cocaine-Related Disorders; Diagnosis, Differential; Heroin; Heroin Dependence; Humans; Laparoscopy; Male; Narcotics; Peptic Ulcer Perforation; Peritonitis; Pylorus; Stomach Ulcer; Vasoconstrictor Agents

To evaluate the effect of methadone maintenance treatment (MMT) on cocaine use and cocaine injection among heroin users.. Generalized estimating equations (GEE) were used to examine the association between MMT enrollment (0, <12, ≥12 months) and changes in frequency of cocaine use or injection in two consecutive follow-up visits among heroin users in the Itinere cohort, and to determine whether these changes were independent of equivalent changes in heroin use or injection. Seven multivariate models were constructed, one for each outcome variable on drug use changes.. Of the 992 participants recruited in 2001-2003, 628 (63.3%) had at least one follow-up visit. Of these, 55.8% were enrolled in MMT at baseline and an additional 23.2% initiated MMT during follow-up. In multivariate GEE, changes significantly and positively associated with MMT enrollment were: less cocaine use [MMT<12 months (OR=1.70, 95% CI=1.17-2.48)] and less cocaine injection [MMT≥12 months (OR=2.98, 95% CI=1.51-5.89)]. Being on MMT≥12 months was negatively associated with more cocaine use (OR=0.62, 95% CI=0.38-0.99) and with more cocaine injection (OR=0.52, 95% CI=0.28-0.98). When equivalent changes in heroin were used as a covariate, the MMT effect on less cocaine use was hardly modified (OR=1.69, 95% CI=1.07-2.65), and the effect on changes in cocaine injection disappeared.. MMT enrollment is a protective factor against both cocaine use and injection among heroin users. The effect of MMT on cocaine injection appears to be mediated by heroin injection, whereas its effect on cocaine use is more direct.

Topics: Cocaine; Cocaine-Related Disorders; Cohort Studies; Female; Heroin; Heroin Dependence; Humans; Injections; Male; Methadone; Narcotics; Opiate Substitution Treatment; Substance Abuse, Intravenous

The success of methadone in treating opiate addiction has suggested that long-acting agonist therapies may be similarly useful for treating cocaine addiction. Here, we examined this hypothesis, using the slow-onset long-acting monoamine reuptake inhibitor 31,345, a trans-aminotetralin analog, in a variety of addiction-related animal models, and compared it with methadone's effects on heroin's actions in the same animal models. Systemic administration of 31,345 produced long-lasting enhancement of electrical brain-stimulation reward (BSR) and extracellular nucleus accumbens (NAc) dopamine (DA). Pretreatment with 31,345 augmented cocaine-enhanced BSR, prolonged cocaine-enhanced NAc DA, and produced a long-term (24-48  h) reduction in cocaine self-administration rate without obvious extinction pattern, suggesting an additive effect of 31,345 with cocaine. In contrast, methadone pretreatment not only dose-dependently inhibited heroin self-administration with an extinction pattern but also dose-dependently inhibited heroin-enhanced BSR and NAc DA, suggesting functional antagonism by methadone of heroin's actions. In addition, 31,345 appears to possess significant abuse liability, as it produces dose-dependent enhancement of BSR and NAc DA, maintains a low rate of self-administration behavior, and dose-dependently reinstates drug-seeking behavior. In contrast, methadone only partially maintains self-administration with an extinction pattern, and fails to induce reinstatement of drug-seeking behavior. These findings suggest that 31,345 is a cocaine-like slow-onset long-acting monoamine transporter inhibitor that may act as an agonist therapy for cocaine addiction. However, its pattern of action appears to be significantly different from that of methadone. Ideal agonist substitutes for cocaine should fully emulate methadone's actions, that is, functionally antagonizing cocaine's action while blocking monoamine transporters to augment synaptic DA.

Topics: Animals; Brain; Cocaine; Cocaine-Related Disorders; Delayed-Action Preparations; Disease Models, Animal; Dopamine; Dose-Response Relationship, Drug; Electric Stimulation; Extinction, Psychological; Heroin; Male; Methadone; Nucleus Accumbens; Plasma Membrane Neurotransmitter Transport Proteins; Rats; Rats, Long-Evans; Self Administration; Tetrahydronaphthalenes

Opiate addiction has been widely documented to have negative impact on pregnancy course and outcome. Unfavorable psychosocial situation of addicted women predispose for poor processing of the physiological and psychological demands of pregnancy. Thus aim of our study was to investigate the psychological mood state of opiate addicts during pregnancy and postpartum in comparison to healthy women. In a case-controlled, prospective, longitudinal study nine pregnant opiate addicts and nine healthy pregnant women matched by age, level of education and gestational age at birth were interviewed in the third trimester of pregnancy and postpartum. Standardized questionnaires and inventories for assessment of the general psychopathology and emotional state, the perceived self-efficacy expectancy, the psychosocial adaptation to pregnancy and the fear of delivery, respectively were applied. Addicted women achieved significantly higher scores in the test assessing general psychopathology and emotional state before delivery compared to abstinent women. Interestingly this difference was unverifiable postpartum. This study reaffirms the presumption of a disadvantageous psychological condition in pregnant opiate addicts in comparison to healthy pregnant women for the first time in a prospective case-control study design.

Topics: Adult; Affect; Anxiety; Case-Control Studies; Cocaine; Cocaine-Related Disorders; Comorbidity; Depression, Postpartum; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Longitudinal Studies; Narcotics; Parturition; Personality Inventory; Pregnancy; Pregnancy Complications; Prospective Studies; Psychometrics; Self Efficacy; Social Support; Young Adult

We have previously reported that cocaine self-administration is facilitated in male rats not residing in the test chambers (Non Resident rats) relative to rats living in the test chambers at all times (Resident rats). Surprisingly, the opposite was found for heroin.. We predicted that, when given access to both cocaine and heroin on alternate days, Non Resident rats would take more cocaine relative to heroin than Resident rats. Heroin (25.0 microg/kg) and cocaine (400 microg/kg), were made alternately available for 14 self-administration sessions, on a fixed ratio (FR) schedule that was progressively increased from FR1 to FR5. Next, some rats underwent a progressive-ratio procedure for heroin and cocaine. The other rats continued to alternate heroin and cocaine self-administration for 12 additional sessions, during which the FR schedule was progressively increased from FR10 to FR100. The second aim of the study was to investigate Fos mRNA expression in Resident and Non Resident rats treated with non-contingent intravenous infusion of "self-administration doses" of heroin (25.0 microg/kg) and cocaine (400 microg/kg).. We found that: (1) drug-taking context differentially modulates intravenous cocaine versus heroin self-administration; (2) very low doses of cocaine and heroin are sufficient to induce Fos mRNA expression in the posterior caudate; (3) drug-administration context differentially modulates cocaine- versus heroin-induced Fos mRNA expression.. Our study indicates that the context of drug taking can play a powerful role in modulating cocaine versus heroin intake in the laboratory rat.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Gene Expression; Genes, fos; Heroin; Heroin Dependence; In Situ Hybridization; Male; Narcotics; Rats; Rats, Sprague-Dawley; Reinforcement Schedule; RNA, Messenger; Self Administration; Substance Abuse, Intravenous

In humans, micro opioid-cocaine combinations (speedballs) have been reported to heighten pleasurable effects and result in greater abuse potential compared to either drug individually. Emerging evidence in animals suggests that the ability of mu opioids to enhance the reinforcing effects of cocaine might be independent of their mu intrinsic efficacy even though mu agonist efficacy appears to be a determinant in the reinforcing effects of micro opioids themselves.. This study examined the relationship between agonist efficacy, self-administration, and the enhancement of cocaine self-administration using the high-efficacy mu agonist etonitazene.. Rhesus monkeys self-administered cocaine, heroin, etonitazene, and opioid-cocaine combinations under a progressive-ratio schedule of intravenous drug injection.. Unlike cocaine and heroin, etonitazene did not maintain consistent self-administration at any dose tested (0.001-1.0 microg/kg/injection). However, combining etonitazene (0.1-1.0 microg/kg/injection) with cocaine (0.01 and 0.03 mg/kg/injection) enhanced cocaine self-administration, and this enhancement was attenuated by naltrexone. These effects are similar to those obtained by combining non-reinforcing doses of heroin and cocaine. Antagonism of etonitazene-cocaine and heroin-cocaine self-administration by naloxonazine was short lasting and was not maintained after 24 h (when naloxonazine's purported micro(1) subtype antagonist effects are thought to predominate).. The results suggest that high micro agonist efficacy does not guarantee consistent drug self-administration and that the ability of mu agonists to enhance cocaine self-administration does not depend exclusively on reinforcing efficacy. Moreover, the results do not support a major role for micro(1) receptor mechanisms in either etonitazene- or heroin-induced enhancement of cocaine self-administration.

Topics: Animals; Benzimidazoles; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Data Interpretation, Statistical; Dose-Response Relationship, Drug; Drug Interactions; Female; Heroin; Injections, Intravenous; Macaca mulatta; Naloxone; Naltrexone; Narcotic Antagonists; Narcotics; Receptors, Opioid, mu; Reinforcement, Psychology; Self Administration; Substance Abuse, Intravenous

HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users.. A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4+ cell count, and viral load were performed every 6 months.. Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to

Topics: Adult; Alcoholism; Antiretroviral Therapy, Highly Active; Cannabis; CD4 Lymphocyte Count; Cocaine-Related Disorders; Cohort Studies; Crack Cocaine; Disease Progression; Female; Heroin; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Substance-Related Disorders; Viral Load

Despite the large volume of public effort devoted to restrain drug supply and the growing attention given to drug demand reduction policies, the use of cocaine and heroin remains steady. Furthermore, retail drug prices have fallen significantly in Europe and the US. This puzzling evidence leads us to develop a model aiming at systematically analysing illicit drug markets.. We model the markets of cocaine and heroin from production to the final retail markets. One novelty of the analysis consists in characterising the retail market as a monopolistic competitive one. Then, upper level dealers have some market power in the retail market. This allows them to charge a markup and to earn extra profits. These extra profits attract newcomers so that profits tend to fall over time.. Theoretical model was used to analyse the effect of supply containment policies on the retail market, the producer market and the export-import business. This introduces the discussion of the impact of demand reduction policies on the high level traffickers' profit. Finally, globalisation enters in the model.. Law enforcement measures increase the risk premia received by the lower and higher level traffickers. Consequently, trafficking intermediation margins tend to increase. However, globalisation has the opposite effect. It lowers intermediation margins and, then, pushes retail prices down, thereby stimulating consumption. In doing so, globalisation offsets the effects of supply containment policies. Finally, we discuss how the effectiveness of supply containment policies can be enhanced by combining them with demand reduction policies.

Topics: Cocaine; Cocaine-Related Disorders; Commerce; Crime; Drug and Narcotic Control; Government Regulation; Heroin; Heroin Dependence; Humans; Illicit Drugs; Internationality; Law Enforcement; Models, Economic; Public Policy; Time Factors

Hearing loss is an infrequently-reported consequence of recreational drug abuse. Although there are sporadic reports of hearing loss from heroin and cocaine ingested separately, there are no reports of hearing loss resulting from the combination of both drugs ingested simultaneously in the form of speedballing.. The purpose of this report is to document a case of bilateral sensorineural hearing loss associated with an episode of speedballing.. Case Report.. The subject of this report was a 40-year-old man with a 20-year history of substance abuse. Data collected included a case history, pure tone audiometry, tympanometry and acoustic reflexes, and transient evoked otoacoustic emissions.. The audiologic evaluation indicated a mild to moderate, relatively flat, bilateral sensorineural hearing loss that was worse in the right ear.. A bilateral sensorineural hearing loss involving both cochlear and neural pathology may be a rare complication of cocaine, heroin, or the combination of the two drugs.

Topics: Acoustic Impedance Tests; Adult; Audiometry, Pure-Tone; Cocaine; Cocaine-Related Disorders; Diagnosis, Differential; Drug Synergism; Hearing Loss, Bilateral; Hearing Loss, Sudden; Heroin; Heroin Dependence; Humans; Male; Otoacoustic Emissions, Spontaneous; Reflex, Acoustic; Retrocochlear Diseases; Tinnitus; Vestibulocochlear Nerve

Interest in oral fluid as an alternative matrix for monitoring drug use is due to its ease-of-collection and non-invasiveness; however, limited data are available on the disposition of drugs into oral fluid. The objective of this research was to provide data on the presence and concentrations of heroin, cocaine and multiple metabolites in oral fluid after illicit opioid and cocaine use. Thrice weekly oral fluid specimens (N=403) from 16 pregnant opiate-dependent women were obtained with the Salivette oral fluid collection device. Evidence of heroin (N=62) and cocaine (N=130) use was detected in oral fluid by LC-APCI-MS/MS. 6-Acetylmorphine (6-AM), heroin and morphine were the major opiates detected, with median concentrations of 5.2, 2.3, and 7.5 microg/L, respectively. Cocaine and benzoylecgonine (BE) had median concentrations of 6.4 and 3.4 microg/L. Application of the Substance Abuse Mental Health Services Administration (SAMHSA) recommended cutoffs for morphine and codeine (40 microg/L), 6-AM (4 microg/L) and cocaine and BE (8 microg/L), yielded 28 opiate- and 50 cocaine-positive specimens. Oral fluid is a promising alternative matrix to monitor opiate and cocaine use in drug testing programs. These data guide interpretation of oral fluid test results and evaluate currently proposed SAMHSA oral fluid testing cutoffs.

Topics: Analgesics, Opioid; Cocaine; Cocaine-Related Disorders; Environmental Monitoring; Female; Heroin; Humans; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Saliva

The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol.. We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use.. Lifetime prevalence for any OD was 30.9% (145/470) in the total sample and 42.3% (85/201) in patients with opioid problems. During the 2-year follow-up, OD was estimated to occur in 16.9% of the total sample and 26.7% of the opioid problem subgroup, with new-onset (incidence) OD estimated at 5.7% and 11.0%, respectively. Factors associated with an increased hazard of OD in both samples included white race, more depressive symptoms, and prior OD regardless of intent. Prior suicidal ideation or attempt was not associated with future OD.. Findings underscore both the high prevalence of non-fatal OD among detoxification patients especially opioid users, and the potency of prior OD as a risk factor for future OD. Depressive symptoms, a modifiable risk factor, may represent a potential intervention target to prevent OD, including some "unintentional" ODs.

Topics: Adult; Alcoholism; Boston; Cocaine; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Depression; Drug Overdose; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Proportional Hazards Models; Prospective Studies; Risk Factors; Urban Population

In early 2001, Australia experienced a sudden and dramatic reduction in the availability of heroin. Research examining the impact of the reduction on drug-related harms has yielded a conflicting picture. The current study uses data from a prospective cohort study of anti-HCV negative injecting drug users (IDU) (n=368) to examine patterns of injecting drug use, risk behaviours and HCV incidence before and after the reduction. The proportion of participants mainly injecting heroin declined sharply from 74% to 47% after the onset of the reduction and continued throughout 2001. There was marked shift to other drugs, mainly cocaine and amphetamine. Cocaine injectors had the highest risk profile and the highest incidence of HCV (82.6 per 100 person years, 95% CI 52.0-131.0). While HCV seroconversions increased by year, this increase was not statistically significant. We observed a reduction in heroin injection and a concomitant increase in cocaine injection and a significant association between cocaine injection and incident HCV infection during a period of reduced heroin availability. Results suggest that attempts to suppress drug markets by manipulating availability may result in collateral damage in the form of drug-related harms, indicating a need for more sophisticated understandings of the potential trade-offs involved in attempting to suppress the supply of illicit drugs.

Topics: Amphetamine-Related Disorders; Cocaine-Related Disorders; Cohort Studies; Cross-Sectional Studies; Hepatitis C; Heroin; Heroin Dependence; Humans; Incidence; Needle Sharing; New South Wales; Prospective Studies; Risk-Taking; Statistics as Topic; Substance Abuse Detection; Substance Abuse, Intravenous

In the UK, few doctors prescribe diamorphine for the treatment of opiate dependence to a small number of patients. A retrospective case note review of patients receiving diamorphine in 2000 was conducted in the UK to determine how and why these patients came to receive a prescription for diamorphine. Patient eligibility criteria were examined together with doctors' stated reasons for initiating a diamorphine (heroin) prescription. Two hundred and ten sets of patients' case notes were reviewed at 27 of the 42 (64%) drug clinics in England and Wales where diamorphine was prescribed by the doctor. There appeared to be a general consensus among the few doctors who had prescribed diamorphine that it was a treatment of last resort, for those with long histories of heroin use and injecting, and those who had not responded sufficiently well to previous other treatments. However, there was also a small number of patients initiated on diamorphine without ever having previously received opiate treatments and some because they were experiencing problems injecting methadone. This reflects the UK history of the individual doctor's clinical autonomy in deciding when diamorphine is appropriate and the previous lack of nationally agreed patient eligibility criteria.

Topics: Adolescent; Adult; Cocaine-Related Disorders; Crack Cocaine; Drug Administration Routes; Drug Prescriptions; England; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Narcotics; Retreatment; Retrospective Studies; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Treatment Failure; Wales

This study compared the characteristics of intravenous (i.v.) and intranasal (i.n.) heroin users seeking methadone treatment, and their response to treatment.. A total of 319 heroin-dependent adults.. Participants were assigned randomly to receive interim methadone treatment or to a waiting list control on a 3 : 2 basis. Analyses were conducted by dividing participants into two groups based on their route of heroin ingestion: i.v. or i.n.. A methadone clinic in Baltimore City, Maryland.. Interim methadone treatment consisted of providing an adequate and stable dose of methadone, but no psychosocial services, to heroin-dependent adults for up to 120 days while they awaited an opening for comprehensive methadone treatment.. Addiction Severity Index, Texas Christian University AIDS Risk Assessment, a questionnaire on treatment entry and a urine drug test were collected at baseline and at entry into a comprehensive treatment program, or at 120 days after baseline assessment, whichever came first.. At baseline, over 60% of participants were i.n. users and had been for an average of over 12 years; i.v. users, compared to i.n. users, were more likely to have ever used cocaine, to have used cocaine in the past 30 days, to have more medical complications and to report more income generated from criminal behavior. Both i.v. and i.n. users reduced their self-reported days of heroin use, cocaine use and days of criminal activity in response to interim methadone treatment.. Despite differences in baseline characteristics, i.n. and i.v. heroin-dependent individuals did not differ in their response to interim methadone treatment.

Topics: Adult; Cocaine-Related Disorders; Drug Administration Schedule; Female; Heroin; Heroin Dependence; Humans; Male; Maryland; Methadone; Patient Acceptance of Health Care; Social Class; Substance Abuse Treatment Centers; Treatment Outcome

This article investigates behaviours that may be associated HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem. Chain referral sampling and other strategies were combined to acquire a sample of 637 (Users = 546; Sellers = 91) who provided urine specimens that were tested for the presence of drugs and HIV. Nearly a quarter (23.9%) of all respondents were HIV positive. Drug injectors were more than 2.5 times more likely to have HIV infections than other respondents (OR = 2.66; 95% CI 1.66-4.26). Those involved in frauds/cons were almost as likely to be HIV positive (OR = 2.58; 95% CI 1.64-4.06). Those with a marital status of being separated, divorced or widowed were twice as likely to be HIV infected (OR 2.16; 95% CI 1.43-3.25). Respondents currently having multiple partner sex (OR = 1.66; 95% CI 1.1-2.51) or who were female (OR = 1.66; 95% CI 1.12-2.45) were more than 1.5 times more likely to be HIV positive. Thus, controlling for lifetime drug injection and current multiple partner sex, other factors, such as participating in frauds/cons, as well as relationship status and being female, were also associated with HIV infection.

Topics: Adult; Chi-Square Distribution; Cocaine; Cocaine-Related Disorders; Crack Cocaine; Female; Heroin; Heroin Dependence; HIV Infections; Humans; Male; Middle Aged; New York City; Regression Analysis; Risk Factors; Risk-Taking; Sex Factors; Urban Health

The distribution of naloxone to heroin users is a suggested intervention to reduce overdose and death rates. However, the level of willingness of drug users to administer this medication to others is unclear. Drug users recruited from the community between January 2002 and January 2004 completed a structured interview that assessed topics including drug use, overdose history, and attitudes toward using overdose remedies to assist others. Of the 329 drug users, 82% had used heroin and 64.3% reported that they had injected drugs. Nearly two thirds (64.6%) said that they had witnessed a drug overdose and more than one third (34.6%) had experienced an accidental drug overdose. Most participants (88.5%) said that they would be willing to administer a medication to another drug user in the event of an overdose. Participants who had used heroin (p = .024), had injected drugs (p = .022), had witnessed a drug overdose (p = .001), or had a history of one or more accidental drug overdoses (p = .009) were significantly more willing to treat a companion who had overdosed. Drug users were willing to use naloxone in the event of a friend's overdose. Specific drug use and overdose histories were associated with the greatest willingness to administer naloxone.

Topics: Adolescent; Adult; Cocaine; Cocaine-Related Disorders; Drug Overdose; Female; Friends; Helping Behavior; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Male; Naloxone; Narcotic Antagonists; Psychotic Disorders

We examined potential links between cocaine use and street-based sex work in New South Wales (NSW), Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analysed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested that a greater number of primary heroin users were engaging in street-based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.

Topics: Cocaine-Related Disorders; Crack Cocaine; Crime; Drug and Narcotic Control; Heroin; Humans; Illicit Drugs; New South Wales; Sex Work; Substance Abuse, Intravenous; Violence

In early 2001 Australia experienced a sudden reduction in the availability of heroin which had widespread effects on illicit drug markets across the country. The consequences of this event, commonly referred to as the Australian 'heroin shortage', have been extensively studied and there has been considerable debate as to the causes of the shortage and its implications for drug policy. This paper aims to investigate the presence of these epidemic patterns, to quantify the scale over which they occur and to estimate the relative importance of the 'heroin shortage' and any epidemic patterns in the drug markets.. Key indicator data series from the New South Wales illicit drug market were analysed using the statistical methods Principal Component Analysis and SiZer.. The 'heroin shortage' represents the single most important source of variation in this illicit drug market. Furthermore the size of the effect of the heroin shortage is more than three times that evidenced by long-term 'epidemic' patterns.. The 'heroin shortage' was unlikely to have been a simple correction at the end of a long period of reduced heroin availability, and represents a separate non-random shock which strongly affected the markets.

Topics: Amphetamine; Amphetamine-Related Disorders; Cluster Analysis; Cocaine; Cocaine-Related Disorders; Drug and Narcotic Control; Heroin; Heroin Dependence; Humans; Illicit Drugs; Law Enforcement; New South Wales; Normal Distribution; Principal Component Analysis; Time Factors

The concomitant use of cocaine by heroin-dependent subjects, or by patients on methadone maintenance treatment, is a relevant phenomenon that determines the negative consequences on health, social adjustment, and outcome of opioid addiction treatment. Little is known about the patterns of co-use of these two substances and the pathophysiological alterations following this condition. Only a few studies have evaluated the neurochemical effects in subjects carrying this specific pattern of abuse. Similarly, the impact of cocaine abuse on psychiatric and social function in subjects already affected by opioid addiction is still poorly understood and further studies are necessary to investigate this specific area that could profoundly affect methadone maintenance treatment. The aim of this article is to investigate the psychopathological symptoms of heroin-cocaine abuse in a group of heroin addicts applying for treatment. Results show a direct relationship between cocaine abuse and a higher rate of psychiatric disorders, but a negative correlation with the severity of self-rated psychopathology.

Topics: Adult; Cocaine; Cocaine-Related Disorders; Dopamine Uptake Inhibitors; Drug Interactions; Female; Heroin; Heroin Dependence; Humans; Longitudinal Studies; Male; Methadone; Narcotics

A 37-year-old man with a 19-years history of injection drug use (IDU) who had acquired a chronic hepatitis C virus (HCV-) infection 9 years ago, entered the German clinical study on heroine assisted treatment ("Modellprojekt zur heroingestützten Behandlung Opiatabhängiger"). Before study onset he received buprenorphine maintainance treatment, while at the same time engaging in illicit IDU (heroine, cocaine). He lived in a caravan and was on social welfare.. PCR revealed a genotype 2 and an HCV-viral load of 310,000 IU/ml. Liver biopsy showed a moderate chronic active hepatitis and a mild portal fibrosis without signs of liver cirrhosis.. Within the heroine-assisted treatment program the patient injected heroine under medical supervision several times a day and attended the standardized psychosocial program that comprised an intensive education on HCV-infection. Within a period of ten months of physical and social stabilization he managed to stop illicit drug use, found stable housing and started to work. We then initiated treatment of HCV-infection. Subcutaneous pegylated interferon alpha-2a, peroral ribavirin and intravenous heroine were administered as directly observed therapy. Based on the close mashed care of the heroine assisted treatment setting, side effects were well controllable and reversible after the end of antiviral therapy. A sustained response was obtained.. After careful indication, heroine-assisted treatment with particularly intensive medical and psychological care can offer appropriate conditions for a save and successful treatment of hepatitis C as well as for a sustained result.

Topics: Administration, Oral; Adult; Antiviral Agents; Buprenorphine; Cocaine-Related Disorders; Combined Modality Therapy; Comorbidity; Drug Therapy, Combination; Hepatitis C, Chronic; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Injections, Subcutaneous; Interferon alpha-2; Interferon-alpha; Male; Polyethylene Glycols; Recombinant Proteins; Rehabilitation, Vocational; Ribavirin; Social Adjustment; Social Welfare; Substance Abuse, Intravenous

A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide.. Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing.. There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults.. The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Topics: Cocaine-Related Disorders; Crack Cocaine; Crime; Drug and Narcotic Control; Firearms; Heroin; Humans; Illicit Drugs; Interviews as Topic; Law Enforcement; New South Wales; New York City; Public Policy; Substance Abuse, Intravenous; Violence

Toxic leukoencephalopathy has been described with inhalation and intravenous consumption of heroin and cocaine. The clinical picture varies widely but the imaging and histological features are characteristic. Magnetic resonance imaging (MRI) typically reveals diffuse bihemispheric white matter lesions. Histologically there is extensive spongiform degeneration of the cerebral white matter.. To report two cases of fatal toxin associated leukoencephalopathy, along with detailed imaging and neuropathological studies.. MRI revealed diffuse white matter changes. Histologically there was widespread confluent vacuolar degeneration of the deep white matter. In both cases, there was sparing of the brain stem and cerebellar white matter. There was evidence of severe and extensive axonal injury.. This pattern of radiological involvement and histological findings has not previously been reported and may reflect the presence of a yet unidentified impurity.

Topics: Adult; Brain; Brain Stem; Cerebellum; Cerebral Cortex; Cocaine; Cocaine-Related Disorders; Disease Progression; Dominance, Cerebral; Fatal Outcome; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Nerve Degeneration; Nerve Fibers; Neurologic Examination; Neurotoxicity Syndromes

Cocaine-related myocardial infarction is a well-known phenomenon. Concurrent heroin use can mask signs and symptoms of myocardial infarction. We discuss an unusual presentation of myocardial infarction, associated with both cocaine and heroin ("speedball") self-injection, that initially went undiagnosed.

Topics: Adult; Cocaine-Related Disorders; Drug Combinations; Heroin; Humans; Male; Myocardial Infarction

In recent years, there has been an increase in cocaine-related deaths at the Department of Legal Medicine and Public Health of Pavia, probably reflecting the rising trend in cocaine use in Western Europe. Deaths from cocaine alone have increased from 6 cases in 1979-1991 (1.5% of drug-of-abuse deaths) to 13 in 1992-2002 (3.2%) and comparing the same periods, heroin-related deaths (HRDs) involving cocaine more than doubled from 8 (1.9%) to 22 (5.4%). In an attempt to investigate the role of cocaine in HRDs, acute narcotic death cases testing positive for cocaine use (blood cocaine or metabolite concentration >0.01 mg/l, COC+) were examined. Only cases from 1997 to 2001 were considered as in this period all data were obtained using the same analytical procedures (free morphine and total morphine by DPC Coat-A-Count radioimmunoassay before and after enzymatic hydrolysis, cocaine and metabolites in blood by SPE, TMS derivatization and gas chromatography-mass spectrometry (GC-MS)). The median, minimum and maximum concentrations of free morphine in blood (FM) and total morphine in blood (TM), urine (UM) and bile (BM) in the COC+ group (n = 9) were compared with those calculated in the group of "pure" HRDs (no other drugs detected in blood, COC-, n = 30). Differences among the medians in the two groups were statistically evaluated using the two-tailed Mann-Whitney U-Test. Statistical analysis was also carried out including in both groups cases with a blood alcohol concentration (BAC) > 20 mg/L (COC+, n = 19; COC-, n = 76). For the COC+ group, median TM was lower (0.32 mg/l versus 0.90 mg/l, P = 0.0214), median FM was lower, but not statistically significant (0.08 mg/l versus 0.28 mg/l, P = 0.1064), FM/TM ratio was similar (0.33 and 0.35), UM was also similar (21.0 mg/l and 18.0 mg/l), and BM was higher (90.0 mg/l versus 49.0 mg/l, P = 0.0268). Similar comparison results were obtained by repeating statistical analyses after including in the two groups cases with positive BAC. The picture observed for HRD cases involving cocaine is very different from what was previously observed for HRD cases involving ethanol [A. Polettini, A. Groppi, M. Montagna, The role of alcohol abuse in the etiology of heroin related deaths: evidence for pharmacokinetic interactions between heroin and alcohol, J. Anal. Toxicol. 23 (1999) 570-576], and updated with more recent data; in the high-ethanol (HE, BAC > 1000 mg/l) group, TM was lower than in the low-ethanol (LE, BAC

Topics: Adolescent; Adult; Bile; Central Nervous System Depressants; Cocaine; Cocaine-Related Disorders; Dopamine Uptake Inhibitors; Drug Interactions; Ethanol; Female; Forensic Medicine; Heroin; Heroin Dependence; Humans; Male; Morphine; Narcotics; Substance Abuse Detection

The use of illicit drugs, specifically heroin and cocaine, complicates trauma patient management and consumes extensive hospital resources. This paper focuses on heroin- and cocaine-related injuries observed by physicians at Detroit Receiving Hospital, a large urban Level I trauma center. The pharmaceutical effects, mode of administration, and the manner in which these drugs affect diagnosis and treatment of injuries are documented and discussed. Specific drug-related complications associated with overdose, soft-tissue infections, bacterial endocarditis (therapy resistant), vascular thromboses, vascular aneurysms, vasoconstriction, stroke, cardiac arrhythmias, muscle ischemia, and solid-organ abscesses are also analyzed. Illicit drug use significantly complicates initial diagnosis and trauma management and is associated with severe adverse pathophysiologic effects. Currently, prevention efforts, such as interventions in trauma centers, should be considered as the most efficient and feasible way to prevent injury recidivism in this patient population. We also conclude that legislative change may be the answer in reducing or preventing the horrendous problems caused by illicit drugs.

Topics: Cocaine; Cocaine-Related Disorders; Disease; Heroin; Heroin Dependence; Humans; Illicit Drugs; Patient Care; Wounds and Injuries

Crack cocaine use is more associated with impulsivity and a propensity to take risks than heroin use, yet no studies have examined this relationship in the absence of acute drug effects. The current study examined impulsivity (using the Delay Discounting Task) and risk-taking propensity (using the Balloon Analogue Risk Task) across independent groups of primary crack cocaine users with minimal heroin use (n = 16) and primary heroin users with minimal crack cocaine use (n = 11) in residential treatment, with all participants drug abstinent during participation. Crack cocaine users evidenced greater levels of impulsivity and risk-taking propensity, with only the difference in impulsivity persisting after controlling for age and gender. These data hold potential theoretical importance in understanding differences between crack cocaine and heroin users, as the findings cannot be attributed solely to acute pharmacological drug effects.

Topics: Age Factors; Analysis of Variance; Behavioral Research; Cocaine-Related Disorders; Crack Cocaine; District of Columbia; Female; Heroin; Heroin Dependence; Humans; Impulsive Behavior; Male; Residential Treatment; Reward; Risk-Taking; Sex Factors; Surveys and Questionnaires; Urban Population

The leading cause of death among heroin users is drug overdose. The present study examined the relationship between history of self-reported drug overdoses and social network characteristics among cocaine and opiate users. Data were from cross-sectional surveys administered from March 2001 through February 2003 as part of follow-up of an experimental network oriented HIV prevention intervention. A total of 838 participants with histories of cocaine and opiate use completed the survey. Several social network variables were found to be significantly associated with drug overdose in the prior 2 years, including larger number of network members who were injection drug users and a larger number of conflictual ties among the network members. Even after controlling for age, gender, frequency of injection drug and alcohol use, and health status, network variables continued to have a strong association with history of recent overdose. These data suggest that large drug networks should be targeted for drug overdose prevention interventions.

Topics: Adult; Alcohol Drinking; Baltimore; Cocaine-Related Disorders; Comorbidity; Conflict, Psychological; Crack Cocaine; Drug Overdose; Female; Health Education; Health Knowledge, Attitudes, Practice; Health Status Indicators; Heroin; Heroin Dependence; HIV Infections; Humans; Male; Multivariate Analysis; Risk Factors; Social Facilitation; Social Support; Substance Abuse, Intravenous; Urban Population

Conditioned environmental stimuli are known to be important determinants of drug seeking. Traditional models of drug seeking under the control of conditioned stimuli have focused on the ability of conditioned reinforcers either to reinstate extinguished responding or to maintain prolonged chains of drug seeking under second-order schedules. These models have consistently suggested that it is the conditioned reinforcing, rather than other, effects of Pavlovian drug stimuli that most profoundly influence drug seeking. However, the impact of drug-associated conditioned reinforcers has not been studied directly and in isolation, not least because the instrumental seeking response is invariably the same as that which was previously reinforced with the drug itself. The purpose of the present study was, therefore, to investigate the conditioned reinforcing properties of drug-paired CSs using an acquisition of a new response procedure in which an animal learns to make a new instrumental response reinforced solely by the CS. It was found that CSs paired with either cocaine, heroin or sucrose supported the rapid acquisition of lever pressing for the CS that persisted over months of repeated, intermittent testing. Furthermore, rats did not acquire the lever press response when the CS was not paired with drug, suggesting that for this stimulus to acquire conditioned reinforcing properties, it must be predictively associated with the drug's effect. Moreover, lever pressing for the CS could not be explained as coincidental to an over-riding Pavlovian approach response to the location of the lever, since animals also acquired discriminated lever pressing when the CS was above the opposite, inactive lever. Extinction decreased responding with conditioned reinforcement, but only when the CS-US association was devalued prior to, and not after, acquisition of the lever press response, providing evidence for the establishment of habitual CS-maintained responding that may explain the persistence of drug-seeking responses in animal models of addiction and relapse.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Dose-Response Relationship, Drug; Extinction, Psychological; Heroin; Heroin Dependence; Injections, Intravenous; Male; Mental Recall; Narcotics; Rats; Self Administration; Substance-Related Disorders; Sucrose

To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA).. Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998).. Inner-city, public hospital ICU.. Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results.. In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups.. At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.

Topics: Adolescent; Adult; Asthma; Case-Control Studies; Chicago; Cocaine-Related Disorders; Cross-Sectional Studies; Diabetic Ketoacidosis; Female; Heroin; Heroin Dependence; Humans; Intensive Care Units; Male; Middle Aged; Patient Admission; Retrospective Studies; Substance Abuse Detection; Urban Population

Accumbal dopamine (DA) is generally accepted to participate in the neural mechanisms underlying drug dependence. Recently the involvement of accumbal DA in drug-seeking behaviour has gained more experimental attention. To study an involvement of accumbal DA in drug-seeking behaviour within and between daily self-administration behaviour, changes in extracellular DA concentration in the nucleus accumbens (NAc) shell were measured during the daily dynamics of intravenous heroin and cocaine self-administration. Groups of drug naive rats were allowed to intravenously self-administer heroin (30 microg/infusion) and cocaine (30 microg/infusion) during five consecutive daily 3 h sessions. Extracellular DA concentrations in the NAc were measured before and after a single 3 h session (acute) and before and after 5 consecutive 3 h sessions (repeated). Following acute and repeated heroin and cocaine self-administration the extracellular DA concentration in the NAc shell was increased by two-fold to three-fold over baseline. These changes in DA concentrations are thought to reflect a direct effect of heroin and cocaine on DA neurotransmission in the NAC shell. Measurement of basal DA concentrations before the self-administration sessions revealed that just before the scheduled 5th self-administration session the (absolute) basal DA levels in the NAc in heroin or cocaine self-administering animals were decreased by approximately halve, as compared to drug-naive animals. It is assumed that just before a scheduled next session the (daily) desire for the drug is high. This decrease in basal DA neurotransmission in the NAc shell may, therefore, reflect an involvement of accumbal DA in drug-seeking behaviour during daily self-administration behaviour. The results demonstrate that initiation of i.v. heroin and cocaine self-administration is linked with changes in extracellular levels of DA in the NAc shell. Moreover, the present data suggest that accumbal DA might be involved in processes underlying the motivational aspects involved in daily drug-seeking behaviour, and that neuroadaptive changes in the mesolimbic DA system due to repeated drug intake lead to an tonic decrease in overall DA activity in the NAc.

Topics: Analgesics, Opioid; Animals; Behavior, Animal; Cocaine; Cocaine-Related Disorders; Dopamine; Dopamine Uptake Inhibitors; Heroin; Heroin Dependence; Male; Microdialysis; Nucleus Accumbens; Rats; Rats, Wistar; Self Administration

To document trends in the price, purity, availability and use of heroin in New South Wales detected by the Illicit Drug Reporting System (IDRS) between 1996 and 2000, and to demonstrate the utility of the IDRS in identifying such trends.. The IDRS compares information derived from interviews with injecting drug users, key informants who work in the illicit drugs field, and key indicator data on illicit drug trends.. New South Wales, Australia.. The price of heroin approximately halved over this period, from a median of A$400 per gram in 1996 to A$220 per gram in 2000. While the price of heroin fell dramatically over the study period, the purity of police seizures of the drug was high across all years, ranging between 62% and 71%. In all years heroin was considered easy to obtain by both heroin users who purchased the drug, and by key informants from the law enforcement and health fields. Concurrent with the large fall in heroin prices, there appeared to have been an increase in the number of heroin users. Between 1997 and 1998 there was a sharp increase in the injecting use of cocaine by heroin users in NSW, a pattern that has persisted.. Regular and formal monitoring of illicit drug trends provides timely data in a systematic way to inform health and law enforcement policies towards current and emerging illicit drug problems.

Topics: Adolescent; Adult; Cocaine-Related Disorders; Cost of Illness; Cross-Sectional Studies; Drug Contamination; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; New South Wales

In our area, inhaling heroin mixed with cocaine vaporized on aluminum foil, known as rebujo, is becoming more and more common.. To define the prevalence and the characteristics of bronchial disease (wheezing, bronchial hyperreactivity [BHR], and asthma) present in subjects inhaling heroin mixed with cocaine vaporized on aluminum foil.. Ninety-one subjects who inhaled the drug mixture were included in the study: 62 subjects were from a drug rehabilitation center (INH-I group), and 29 subjects were among patients admitted to our hospital for a variety of reasons (INH-II group). A questionnaire was completed in both groups, as well as IgE determination and lung function tests (spirometry and methacholine challenge). The control group consisted of 122 individuals who did not inhale the drug mixture, and were chosen randomly from the general population (NO-INH group). All subjects were tobacco smokers.. In the INH-I group, there was a 41.9% prevalence of wheezing over the past 12 months, a 44.4% prevalence of BHR, and a 22.02% prevalence of asthma, defined as wheezing plus BHR. In the NO-INH group, these values were 32.78% (p = 0.22), 15.57% (p < 0.0001), and 8.19% (p < 0.01), respectively. Of the subjects who inhaled the drug mixture and denied having symptoms prior to the use of the drug mixture, 31.4% had wheezing develop after commencing use of the drug, following a mean latency of 4.09 months. Wheezing remitted in only 7.6% after discontinuation of the drug.. (1) There is a real increase in BHR in subjects who inhale heroin mixed with cocaine vaporized on aluminum foil; and (2) this BHR is associated with wheezing that develops after a variable period of latency, once drug inhalation begins, and persists despite discontinuation of the drug.

Topics: Administration, Inhalation; Adult; Bronchial Hyperreactivity; Bronchial Provocation Tests; Cocaine; Cocaine-Related Disorders; Drug Interactions; Female; Heroin; Heroin Dependence; Humans; Male; Methacholine Chloride; Respiratory Sounds; Spain

Providing maintenance treatment for heroin users who also use cocaine presents special problems. Poly-drug use is prevalent among clients in the Swiss Program for the Medical Prescription of Heroin (1994-1996).. A formative evaluation examines whether cocaine use was associated with a higher drop-out rate from treatment, and how cocaine use changed among those who remained in treatment. Frequency of cocaine use before and during treatment was measured by self-report every six months and by urinalysis every two months.. There was no significant difference between the drop-out rates for cocaine users vs. non-users (n = 995). A significant reduction in cocaine use over an 18-month period from 84 to 48% was found for a sample of clients (n = 266). Overall retention in programme was high and also the prevalence of factors associated with cocaine use such as criminality, prostitution, and contact with drug scene decreased.. The results suggest that prescribed heroin maintenance provides a treatment context that may help reduce consumption of other illicit drugs such as cocaine.

Topics: Cocaine-Related Disorders; Cohort Studies; Drug Prescriptions; Heroin; Heroin Dependence; Humans; Long-Term Care; Patient Dropouts; Substance Abuse, Intravenous; Switzerland

Few well-controlled studies have examined psychomotor and cognitive performance in methadone maintenance patients (MMP). In the present study, performance of 18 opioid-dependent MMP was evaluated relative to that of 21 control participants without substance abuse histories. The MMP and control groups were balanced with respect to gender, race, age, years of education, current employment status, current reading level, and estimated IQ score. Recent drug abstinence was verified by urine testing. Participants with a urine screen positive for benzodiazepines or a breathalyzer test positive for alcohol prior to performance testing were excluded. To avoid testing under conditions of acute heroin or cocaine intoxication, but without testing under conditions of acute withdrawal, participants with current use of heroin or cocaine were only required to abstain for 24 h prior to performance testing. MMP exhibited impairment relative to controls in psychomotor speed (digit symbol substitution and trail-making tests), working memory (two-back task), decision making (gambling task), and metamemory (confidence ratings on a recognition memory test); results also suggested possible impairment in inhibitory mechanisms (Stroop color-word paradigm). MMP did not exhibit impairment in time estimation, conceptual flexibility or long-term memory. The wide range of impaired functions is striking, and may have important implications for daily functioning in MMP. Further research is necessary to determine the clinical significance of the impairments in laboratory-based tests for daily performance in the natural environment, as well as to differentiate impairments due to acute methadone dosing, chronic methadone maintenance, chronic poly-drug abuse, and other factors.

Topics: Adult; Cocaine; Cocaine-Related Disorders; Cognition Disorders; Concept Formation; Female; Heroin; Heroin Dependence; Humans; Male; Mental Recall; Methadone; Neuropsychological Tests; Problem Solving; Psychometrics; Psychomotor Performance; Reaction Time; Retention, Psychology; Risk Factors; Substance Abuse Detection; Time Perception

The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts.. In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview.. Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %.. The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

Topics: Adult; Alcoholism; Cocaine-Related Disorders; Comorbidity; Cross-Sectional Studies; Diagnosis, Dual (Psychiatry); Female; Heroin; Heroin Dependence; Humans; Male; Mental Disorders; Opioid-Related Disorders; Psychiatric Status Rating Scales; Rehabilitation Centers; Substance-Related Disorders; Switzerland

The simultaneous intravenous (i.v.) administration of heroin and cocaine, called a "speedball," is often reported clinically, and identification of effective pharmacotherapies is a continuing challenge. We hypothesized that treatment with combinations of a dopamine reuptake inhibitor, indatraline, and a mu partial agonist, buprenorphine, might reduce speedball self-administration by rhesus monkeys more effectively than either drug alone. Speedballs (0.01 mg/kg/inj cocaine + 0.0032 mg/kg/inj heroin) and food (1 g banana pellets) were available in four daily sessions on a second-order schedule of reinforcement [fixed ratio (FR)4; variable ratio (VR)16:S]. Monkeys were treated for 10 days with saline or ascending dose combinations of indatraline (0.001-0.032 mg/kg/day) and buprenorphine (0.00032-0.01 mg/kg/day). Two combinations of indatraline (0.32 and 0.56 mg/kg/day) + buprenorphine (0.10 and 0.18 mg/kg/day) significantly reduced speedball self-administration in comparison to the saline treatment baseline (p <.01-.001), whereas the same doses of each compound alone had no significant effect on speedball-maintained responding. Daily treatment with 0.56 mg/kg/day indatraline + 0.18 mg/kg/day buprenorphine produced a significant downward shift in the speedball dose-effect curve (p <.01) and transient changes in food-maintained responding. These findings suggest that medication mixtures designed to target both the stimulant and opioid component of the speedball combination may be an effective approach to polydrug abuse treatment.

Topics: Animals; Buprenorphine; Cocaine; Cocaine-Related Disorders; Dopamine Uptake Inhibitors; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Drug Interactions; Female; Heroin; Heroin Dependence; Indans; Macaca mulatta; Male; Methylamines; Narcotics; Neurotransmitter Uptake Inhibitors; Self Administration

The authors investigated several features of polydrug use in rats. Heroin and cocaine were self-administered following responses on different levers, with only 1 drug and 1 lever available on alternate days of training. Four doses of each drug (heroin: 25, 50, 100, and 200 microg/kg/infusion; cocaine: 0.25, 0.5, 1, and 2 mg/kg/infusion) were tested, and each rat was exposed to a single dose combination. Rats readily developed drug-specific and dose-related responding. During extinction, rats displayed a significant bias for responding on the cocaine- associated lever. Priming injections of either cocaine (20 mg/kg) or heroin (0.25 mg/kg) reinstated responding that was selective for the lever previously associated with each drug. These results suggest that in this type of polydrug use, drugs have the capacity to activate drug-seeking behavior selectively oriented toward stimuli previously associated with their administration.

Topics: Animals; Cocaine; Cocaine-Related Disorders; Conditioning, Operant; Disease Models, Animal; Dose-Response Relationship, Drug; Extinction, Psychological; Heroin; Heroin Dependence; Infusions, Intravenous; Male; Narcotics; Rats; Rats, Long-Evans; Recurrence; Self Administration

NHSDA and MTF survey data indicate "epidemic"-like growth in hallucinogen use from 1992-1996 and associated increases in cocaine, crack, heroin and amphetamine use. These trends might have resulted from a proliferation of raves and dance clubs in the U.S. as occurred in Europe and elsewhere, although in contrast to evidence regarding European experiences the American epidemic involves primarily teens as opposed to persons in their twenties and involves primarily use of LSD as opposed to MDMA. This analysis highlights the need for further research into the context, significance, and consequences of these recently popular American drug use practices.

Topics: Adolescent; Age Factors; Amphetamine-Related Disorders; Cocaine-Related Disorders; Disease Outbreaks; Female; Hallucinogens; Health Surveys; Heroin; Humans; Lysergic Acid Diethylamide; Male; Models, Theoretical; Substance-Related Disorders; United States

In a series of licit and illicit drug-related deaths, qualitative and quantitative analyses on extracts of adipose tissue and skin were performed by GC/MS. In all cases, the adipose tissue was found to contain drugs at concentrations lower than, approximately equal to, or even greater than the concentrations of the same analytes found in the blood, which may reflect a consequence of long-term chronic exposure, or acute intoxication, or some combination of both. Approximately one cubic inch of skin with adipose tissue was removed from the mid to lower abdominal region adjacent to the midline incision during autopsy. The drugs were recovered from the specimens following incubation and alkaline, acidic, and alkaline chloroform back extraction of one to three grams of tissue. Deuterated analogs of the analytes were added to the matrix at the beginning of the incubation period. Cocaine and free morphine (from heroin) were readily identified in several cases. The presence of these illicit drugs in adipose tissue raises significant forensic questions, especially the use of 'sweat patches' to monitor recent cocaine or heroin use in chronic drug users.

Topics: Adipose Tissue; Cocaine; Cocaine-Related Disorders; Deuterium; Gas Chromatography-Mass Spectrometry; Heroin; Heroin Dependence; Humans; Illicit Drugs; Male; Morphine; Narcotics; Opioid-Related Disorders; Radiopharmaceuticals; Skin; Substance Abuse Detection; Sweat

Reported are the results of a survey to assess the prevalence of illicit drug use among high-school students in Jamaica. A total of 2417 high-school students in 26 schools were covered: 1063 boys and 1354 girls of whom 1317 were grade-10 students (mean age 15.7 years) and 1100 were grade-11 students (mean age 16.8 years). Of the students, 1072 and 1345 were from rural and urban schools, respectively, while 1126 and 1291 were children of parents who were professionals and nonprofessionals, respectively. The following drugs were used by the students: marijuana (10.2%), cocaine (2.2%), heroin (1.5%) and opium (1.2%). Illicit drug use among males, urban students and children of professionals was higher than that among females, rural students and children of nonprofessionals, respectively.

Topics: Adolescent; Cocaine-Related Disorders; Female; Heroin; Humans; Jamaica; Male; Marijuana Abuse; Narcotics; Opioid-Related Disorders; Opium; Prevalence

Hair specimens were collected from 322 subjects and analyzed as part of an experimental study administering household surveys during 1997 to a high-risk community sample of adults from Chicago, Illinois. Toxicologic results were compared with survey responses about recent and lifetime drug use. About 35% of the sample tested positive for cocaine, and 4% tested positive for heroin. Sample prevalence estimates of cocaine use based on toxicologic results were nearly five times the survey-based estimates of past month use and nearly four times the survey-based estimates of past year use. With the hair test results as the standard, cocaine and heroin use were considerably underreported in the survey. Underreporting was more of a problem for cocaine than for heroin. Among those who tested positive, survey disclosure of cocaine use was associated with higher levels of cocaine detected in hair. In general, when recent drug use was reported, it was usually detected in hair. When a drug was detected in hair, use was usually not reported in the survey. When heroin was detected in hair, cocaine was almost always detected as well.

Topics: Adolescent; Adult; Chicago; Cocaine; Cocaine-Related Disorders; Community Health Services; Female; Hair; Heroin; Heroin Dependence; Humans; Male; Prevalence; Reproducibility of Results; Surveys and Questionnaires

The simultaneous i.v. administration of heroin and cocaine, called "speedball," is often reported clinically, and identification of effective pharmacotherapies for polydrug abuse is a continuing challenge. This study compared the effects of treatment using combinations of dopamine and opioid antagonists with each antagonist alone on speedball self-administration by rhesus monkeys. Speedballs (0.01 mg/kg/inj cocaine and 0.0032 mg/kg/inj heroin) and food (1 g banana pellets) were available in four daily sessions on a second-order schedule of reinforcement [FR4 (VR16:S)]. Monkeys were treated for 10 days with saline or ascending 1:10 dose combinations of the dopamine antagonist flupenthixol and the opioid antagonist quadazocine. The combination of flupenthixol (0.018 mg/kg/day) + quadazocine (0.18 mg/kg/day) significantly reduced speedball self-administration in comparison to the saline treatment baseline (p < .05), whereas, the same doses of each antagonist alone had no significant effect on speedball-maintained responding. Treatment with 0.018 mg/kg/day flupenthixol + 0.18 mg/kg/day quadazocine produced a 3-fold rightward shift in the speedball (3:1 cocaine-heroin combination) dose-effect curve. Food-maintained responding was similar during treatment with saline and with flupenthixol + quadazocine combinations. These findings suggest that medication mixtures designed to target both the stimulant and opioid component of the speedball combination, may be an effective approach to polydrug abuse treatment.

Topics: Animals; Azocines; Cocaine; Cocaine-Related Disorders; Dopamine Antagonists; Dose-Response Relationship, Drug; Drug Therapy, Combination; Eating; Female; Flupenthixol; Heroin; Heroin Dependence; Macaca mulatta; Male; Narcotic Antagonists; Narcotics; Self Administration

The present study examined differences in neuropsychological performance among chronic cocaine, alcohol, and polysubstance abusers. A comprehensive neuropsychological battery was completed by 355 incarcerated adult male felons who were classified by DSM-IV criteria into four subgroups: (1) alcohol dependence or abuse (ETOH) (n = 101), (2) cocaine dependence or abuse (COC) (n = 60), (3) polysubstance dependence or abuse (POLY (n = 56), and (4) a group of age and education matched adult male felons with no history of drug abuse (n = 138). Results showed no significant differences in neuropsychological performance between COC and control subjects. However, both the POLY and ETOH groups were found to perform significantly worse on nearly all measures compared to the COC and control groups. Further, analysis of neuropsychological domains showed the POLY group to perform significantly worse compared to the other groups in the areas of short-term memory, long-term memory and visual motor ability. Correlations between neuropsychological performance and length of abstinence from drug use showed the ETOH group to have made the greatest amount of improvement on individual measures and domains. The COC group showed the least amount of improvement, but their performance was not significantly different from controls. Results provide further support for the differential effects of drug use on neuropsychological functioning.

Topics: Adult; Alcohol Drinking; Alcohol-Related Disorders; Amphetamines; Chi-Square Distribution; Cocaine; Cocaine-Related Disorders; Cognition Disorders; Cross-Sectional Studies; Drug Interactions; Forensic Psychiatry; Heroin; Humans; Male; Multivariate Analysis; Neuropsychological Tests; Prisoners; Substance-Related Disorders; Time Factors

Smooth pursuit eye movements were evaluated in 21 healthy volunteers and 126 patients meeting criteria for one of the following DSM-III-R dependence diagnoses: alcohol (n = 10), cocaine (n = 44), heroin (n = 34), or dual alcohol and cocaine (n = 38). A significant reduction in tracking accuracy was found in the heroin and the dually dependent groups relative to controls. Interestingly, the eye movement dysfunction in the drug-dependent groups was no longer detectable when the effects of antisocial personality disorder were statistically removed. The magnitude of the dysfunction also correlated with several antisocial personality-related features, including an increased number of criminal charges and months of incarceration, increased problems associated with drug abuse, and lower intellectual functioning. The relationship demonstrated presently between antisocial personality disorder and eye movement dysfunction may have implications beyond studies of substance dependence.

Topics: Adult; Alcohol-Related Disorders; Antisocial Personality Disorder; Cocaine; Cocaine-Related Disorders; Comorbidity; Diagnosis, Dual (Psychiatry); Ethanol; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Ocular Motility Disorders; Pursuit, Smooth; Reaction Time; Risk Factors

Topics: Adult; Anti-Bacterial Agents; Cocaine-Related Disorders; Combined Modality Therapy; Disease-Free Survival; Edema; Female; Fingers; Heroin; Humans; Range of Motion, Articular; Streptococcal Infections; Substance Abuse, Intravenous; Tenosynovitis

The present study was designed to evaluate the relationship between reinstatement of drug-seeking behaviour following long-term extinction of intravenous (i.v.) drug self-administration (an animal model for craving) and long-term behavioural sensitization. Rats were allowed to self-administer heroin (50 microg/kg per inj., 14 daily sessions), cocaine (500 microg/kg per inj., 10 daily sessions) or saline. Following a 3-week extinction period, reinstatement tests were performed to evaluate priming effects of amphetamine, cocaine and heroin on nonreinforced drug-seeking behaviour. In addition, the occurrence of long-term behavioural sensitization in rats with a history of heroin or cocaine self-administration was determined. Heroin-seeking behaviour was reinstated by heroin (0.25 mg/kg), amphetamine (1.0 mg/kg) and cocaine (10 mg/kg). In addition, animals with a history of heroin self-administration displayed locomotor sensitization to both heroin and amphetamine. Cocaine-seeking behaviour was reinstated by cocaine and amphetamine, but not by heroin. Interestingly, locomotor sensitization to amphetamine, but not heroin, was observed in animals with a history of cocaine self-administration. In other words, the induction of drug-seeking behaviour following a prolonged drug-free period was found to be associated with the expression of long-term behavioural sensitization. These data provide experimental evidence for a role of behavioural sensitization in the incentive motivation underlying drug-seeking behaviour. If drug hyperresponsiveness would indeed be a crucial factor in drug-induced craving in human addicts, pharmacological readjustment of the neuroadaptations underlying drug sensitization may prevent relapse to drug use long after detoxification.

Topics: Animals; Central Nervous System Stimulants; Cocaine; Cocaine-Related Disorders; Extinction, Psychological; Heroin; Heroin Dependence; Injections, Intravenous; Male; Motor Activity; Rats; Rats, Wistar; Self Administration

A new method for the fast screening of cocaine and 6-monoacetylmorphine (6-MAM) in a single hair, using gas chromatography/mass spectrometry (GC/MS), is described. The analyses are conducted in less than 10 min with minimal sample preparation. The novel method combines the ChromatoProbe direct sample introduction device for intrainjector thermal extraction, fast GC separation, a supersonic molecular beam GC/MS interface and hyperthermal surface ionization (HSI). The technique has been successfully employed for the detection of cocaine in as little as a 1-mm section of hair using selected ion monitoring (SIM). Unambiguous full scan mass spectra of cocaine and 6-MAM were obtained on a single hair for cocaine and heroin users, respectively. HSI was found to be almost 3 orders of magnitude more selective than electron impact ionization for cocaine compared with the major hair constituents, with a minimum detected concentration of approximately 10 ppb in the SIM mode. Results obtained for 12 drugs users showed full qualitative agreement with similar results using rigorous solvent extraction followed by electrospray-liquid chromatography/mass spectrometry analysis. However, quantitative studies showed only partial agreement. No false positives were observed for 10 drugs free subjects. This method enables fast drug monitoring along the hair length which permits time correlation studies.

Topics: Adult; Chromatography, High Pressure Liquid; Cocaine; Cocaine-Related Disorders; Female; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Heroin Dependence; Humans; Male; Morphine Derivatives; Substance Abuse Detection

Drug use histories and treatment outcomes were compared for age, race and gender-matched samples of intravenous (IV; n = 28) versus intranasal (IN; n = 28) opiate abusers entering a 3-day inpatient detoxification unit. Data were derived from the Addiction Severity Index (ASI) interview. Both groups reported daily heroin use prior to detoxification, but IV users reported more days of alcohol and multiple drug use during the past 30 days. Despite age matching, IV users also started using alcohol at an earlier age and accumulated more lifetime months of regular alcohol, cocaine and multidrug use. IV users were more likely to enter treatment following the detox, but no significant outcome differences were noted at 1 and 3 months post-detoxification. The results show that intravenous, as compared to intranasal, opiate users have both a more severe pattern and a more extensive history of the use of non-opiate drugs.

Topics: Administration, Intranasal; Adult; Alcoholism; Cocaine-Related Disorders; Comorbidity; Female; Heroin; Heroin Dependence; Humans; Male; Substance Abuse Detection; Substance Abuse, Intravenous; Treatment Outcome

Topics: Cocaine; Cocaine-Related Disorders; England; Heroin; Substance-Related Disorders; Toxicology

Topics: Adolescent; Cocaine; Cocaine-Related Disorders; Heroin; Humans; Psychotherapy; Psychotherapy, Group; Substance Withdrawal Syndrome; Substance-Related Disorders