Prevalence of cocaine use among residents of New York City who committed suicide during a one-year period

Cocaine and Psychiatric Symptoms

BACKGROUND: Cocaine is an addictive drug that produces numerous psychiatric symptoms, syndromes, and disorders. The symptoms include agitation, paranoia, hallucinations, delusions, violence, as well as suicidal and homicidal thinking. They can be primary to the drug's effect or secondary to exacerbation of comorbid psychiatric disorders. DATA SOURCES: A computerized literature search was conducted using MEDLINE to identify reports of psychiatric symptoms secondary to cocaine use. Additional reports were found via bibliographies of various published reports. DATA SYNTHESIS: The use of cocaine in the "crack" form is often associated with more frequent and intense symptoms. Paranoia occurs in 68% to 84% of patients using cocaine. Cocaine-related violent behaviors occur in as many as 55% of patients with cocaine-induced psychiatric symptoms. Homicide has also been associated with cocaine use in as many as 31% of homicide victims. In suicide, cocaine has been found to be present in as high as 18% to 22% of cases. Many patients with cocaine dependence have also been found to have a comorbid psychiatric disorder. CONCLUSION: Cocaine can produce a spectrum of psychiatric symptoms with which primary care practitioners need to be familiar. Comorbid psychiatric disorders are frequent in patients with cocaine use disorders and can worsen with cocaine use. Nonaddictive medication may be necessary to treat comorbid conditions such as anxiety and depressive disorders. Primary care practitioners need to be familiar with the treatment programs for patients with cocaine use disorders so appropriate referral can easily take place and follow-up care can be understood and maintained.

Medical consequences of substance abuse

Given the preceding review, differentiating the complications of parenteral drug use, HIV disease, and the toxicity of the drugs such as alcohol or cocaine may be a difficult matter for clinicians. The risk for coexisting morbidities is high. Thus, obtaining accurate and complete medical histories is of paramount importance. Drug-abuse treatment and follow-up medical care after an acute complication often involves multiple health care providers. The integration of primary prevention plans with the reinforcement of drug abstinence requires time, commitment, and the coordination of services. This integration should be a priority for individual patients as well as for public health planning.

Fatal poisoning with alcohol and drugs in the Greater Amman County

A study of fatal poisoning due to alcohol and drugs was carried out, to examine the mortality resulting from alcohol and drugs in the Greater Amman County, Jordan. A retrospective review of all autopsy records and certified deaths issued by the Department of Forensic Medicine at Jordan University Hospital in the greater Amman county was undertaken. During the 18 years (1978-1996) 6109 postmortem cases were performed in our department. A total of 60 cases were identified and analyzed according to age, race, sex, manner of death of the victims along with blood alcohol concentration, the drug detected at autopsies, the scene circumstances, and the geographic location of the accident and death.

Alterations in serotonergic responsiveness during cocaine withdrawal in rats: similarities to major depression in humans

BACKGROUND

Withdrawal from long-term cocaine use is accompanied by symptoms resembling major depression. Because acute cocaine affects serotonin (5-HT) neurons, and 5-HT dysfunction is implicated in the pathophysiology of depression, we evaluated the effects to 5-HT agonists in rats withdrawn from repeated injections of cocaine (15 mg/kg i.p., b.i.d., 7 days) or saline.

METHODS

In the first study, prolactin (PRL) responses elicited by the 5-HT-releasing agent fenfluramine, the 5-HT1A agonist (+/-)-8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), and the 5-HT2A/2C agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane hydrochloride (DOI) were examined as indices of postsynaptic 5-HT receptor function. In a second study, specific responses induced by 8-OH-DPAT, namely inhibition of brain 5-HT synthesis and stimulation of feeding, were examined as correlates of 5-HT1A autoreceptor function.

RESULTS

Prior treatment with cocaine did not modify fenfluramine-evoked PRL release; however, the PRL secretory response to 8-OH-DPAT was blunted and the PRL response to DOI was potentiated after chronic cocaine treatment. Cocaine exposure did not alter the inhibitory effect of 8-OH-DPAT on 5-HT synthesis. 8-OH-DPAT-induced feeding was influenced by prior cocaine, but this effect was secondary to pronounced baseline hyperphagia in the cocaine-treated group.

CONCLUSIONS

These data indicate that withdrawal from chronic cocaine renders specific subpopulations of postsynaptic 5-HT1A receptors subsensitive and 5-HT2A/2C receptors supersensitive. No evidence for cocaine-induced changes in 5-HT1A autoreceptor responsiveness was found. A survey of the literature reveals similarities in the profile of 5-HT dysfunction between rats withdrawn from cocaine and humans diagnosed with depression. We propose that withdrawal from chronic cocaine in rats may serve as a useful animal model of depressive disorders.

Suicide attempts, substance abuse, and personality

The prevalence and relevance of a positive suicide attempt history among 103 subjects who had entered a substance abuse program and participated in a study of personality was examined. Twenty subjects had a positive suicide attempt history. Women were more likely to attempt suicide. Attempters were more likely to have additional psychiatric diagnoses, such as major depression. Attempters had higher addiction severity scores, abused more substances, and were more likely to have abused alcohol and sedative hypnotics than were nonattempters. DSM-III-R and Eysenck personality measures were compared across groups. Attempters had significantly higher neuroticism and borderline scores. Impulse dysregulation may predispose this group to more severe addictions.

Studies of the biogenic amine transporters. VII. Characterization of a novel cocaine binding site identified with [125I]RTI-55 in membranes prepared from human, monkey and guinea pig caudate

[125I]RTI-55 is a cocaine analog with high affinity for dopamine (DA) and serotonin (5-HT) transporters. Quantitative ligand binding studies revealed a novel high affinity [125I]RTI-55 binding site assayed under 5-HT transporter (SERT) conditions which has low affinity for almost all classic biogenic amine transporter ligands, including high affinity 5-HT transporter inhibitors such as paroxetine, but which retains high affinity for cocaine analogs. This site, termed SERT(site2) for its detection under 5-HT transporter conditions (not for an association with the SERT) occurs in monkey caudate, human caudate, and guinea pig caudate membranes, but not in rat caudate membranes. SERT(site2) is distinguished from the DA transporter (DAT) and SERT by several criteria, including a distinct ligand-selectivity profile, the inability to detect SERT(site2) in cells stably expressing the cloned human DAT, and insensitivity to irreversible ligands which inhibit [125I]RTI-55 binding to the DAT and SERT. Perhaps the most striking finding about SERT(site2) is that a wide range of representative antidepressant agents have very low affinity for SERT(site2). The affinity of cocaine for this site is not very different from the concentration cocaine achieves in the brain at pharmacological doses. Viewed collectively with the observation that ligands with high affinity for SERT(site2) are mostly cocaine analogs, these data lead us to speculate that actions of cocaine which differ from those of classic biogenic amine uptake inhibitors may be mediated in part via SERT(site2).

Identification of suicide risk factors using epidemiologic studies

Suicide is a complex outcome of multiple, inter-related factors. This article presents the epidemiology of completed and attempted suicide and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Mental and addictive disorders, frequently in co-occurrence, are the most powerful risk factors for suicide in all age groups, accounting for over 90 percent of all completed suicides. In combination with proximal risk factors such as access to firearms or other lethal means, recent and severe stressful life events, and intoxication, they can form the necessary and sufficient conditions for suicide.

Childhood, adolescent, and young adult predictors of suicidal behaviors: a prospective study of African Americans

This study examined the lifetime prevalence of suicidal behaviors and their relation to social integration, depression, and aggression/substance use in a cohort of African Americans followed prospectively from first grade to age 32. Lifetime depressive moods in adulthood, lifetime use of cocaine, and frequent mobility were associated with suicidal behaviors for both males and females. For males, having been in a mother-alone or mother-absent family at age 6, childhood psychopathology, and not being married were related to suicidal behaviors. Females who reported high assault behavior in adolescence were more likely to report suicide attempts. The results suggest that social integration, depression, and aggression/drug use are important risk factors for suicidal behaviors in this African American population.

Gender differences in crack users who are research volunteers

This study compared gender differences in a non-treatment sample of crack cocaine users interested in participating in a research study on addiction. Data was collected from initial telephone screening interviews of women and men responding to cocaine research recruitment in a midwest urban environment over a two-year period. Female respondents (n = 88) were age- and race-matched with men interviewed over the same time period, for a total sample size of 176. Mean age of the female sample was 33 years and the majority were African-American. Basic demographics were similar for both genders. Respondents had first used cocaine at 24 years of age and currently smoked 2 g cocaine/day for 5 days/week, a rate higher than that found in many treatment samples. Women were found to have significantly higher rates of cigarette smoking, headaches and history of suicidal ideation, and significantly more women reported emergency room visits following crack use than did men. Equal numbers of men and women had been convicted of a crime (56%), with significantly fewer women reporting having committed a crime involving violence. Nearly all respondents (94%) reported that crack use had negative effects on their value systems, and significant numbers of both genders reported involvement with bartering crack and sex. Two-thirds of women able to become pregnant used no method of birth control and the use of barrier methods was infrequent. Forty-two percent admitted to using cocaine during pregnancy. These data indicate that while patterns of crack use per se do not differ between women and men in this sample, community outreach programs may benefit from focusing on other associated behaviors that do show differences between genders.

Fatal injuries after cocaine use as a leading cause of death among young adults in New York City

BACKGROUND

Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries.

METHODS

Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause.

RESULTS

Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City.

CONCLUSIONS

Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

HIV seropositivity as a major risk factor for suicide in the general hospital

The purpose of this study was to assess the suicide rate in people infected with the human immunodeficiency virus (HIV) in the general hospital population. A retrospective study of 2,363 psychiatric consultations was done in 1989 and 1990 at an urban municipal teaching hospital in New York City. The sample included 2,363 patients admitted to adult general care from January 1, 1989, to December 31, 1990, for whom consultations were requested from the consultation-liaison psychiatry service. Suicidal behavior was the reason for consultation in 21.8% of HIV-positive persons and in 19.8% of persons with acquired immunodeficiency syndrome. It was the reason for consultation in only 13.9% of persons with unknown HIV serostatus. This difference is statistically significant. The authors conclude that HIV seropositivity may be a significant risk factor for suicide in the general hospital patient population.

Gender differences in completed and attempted suicides

Attempted suicides occur primarily among women, while completed suicides occur primarily among men. Risk factors for both attempted and completed suicides include mental and addictive disorders, disrupted family environments, and precipitating events. This article presents an overview of findings on gender differences from epidemiologic studies of completed and attempted suicides, with a focus on suicide attempts among women, and discusses possible reasons for gender differences in suicidal behaviors.

The phenomenon of abusable psychotropic use among North American youth

Abusable psychotropic use can, and does, affect all North American youth, either directly or indirectly, regardless of age, gender, culture, ethnic background, education, race, or socioeconomic status. Over the last decade, the morbidity and mortality associated with abusable psychotropic use among youth have become staggering. A current overview of the phenomenon of abusable psychotropic use among youth in North America, including the use of alcohol, cannabis, cocaine, LSD, nicotine, and polyabusable psychotropic use, is presented with attention to the expanding role of clinical pharmacologists in relation to both prevention and treatment. The Mega Interactive Model of Abusable Psychotropic Use Among Youth is presented as a heuristic device to assist clinical pharmacologists, and other health care providers, in addressing the multifactorial interactive aspects of this complex phenomenon as observed in the pediatric age group. In this regard, attention is given to the interaction of the Abusable Psychotropic Dimension, including the Abusable Psychotropic Variables (e.g., pharmacokinetics, abuse potential) and Pattern of Use Variables (e.g., social use, abuse, compulsive use), with the Young Person, Societal, and Time Dimensions.