Amlodipine reduces blood pressure and headache frequency in cocaine-dependent outpatients

Pooled Urine Analysis at a Belgian Music Festival: Trends in Alcohol Consumption and Recreational Drug Use

BACKGROUND

Recreational drug use has become more and more accepted in society. Availability and purity are rising and new psychoactive substances (NPS) are popping up.The aim of this study was to provide objective data on illicit drug use at a Belgian festival in order to report on arising trends. This may provide additional information to help develop preventive strategies.

METHODS

A cross-sectional study took place during a music festival in the summer of 2019, where 43 samples of pooled urine were collected at four different locations and at different moments of the day. Analysis was performed using gas chromatography with a flame ionization detector (GC-FID) to determine ethanol concentrations. Drugs of abuse were quantified using liquid chromatography-tandem mass spectrometry. A qualitative analysis was performed using high-resolution mass spectrometry.

RESULTS

Median ethanol concentration was 0.88g/L. Cocaine, 3,4-methylenedioxymethamphetamine (MDMA), amphetamines, ketamine, and cannabis were detected in almost every sample and often in high concentrations. Furthermore, two NPS were detected and a variety of over-the-counter medication and adulterants were also found.

DISCUSSION

The findings were largely in-line with trends outlined in the European Drug Report. Striking were the relatively high concentrations of MDMA and ketamine and detection of two synthetic cathinones. Two possible adulterants of cocaine were detected, namely flecainide and amlodipine.

CONCLUSION

Music festivals are considered a high-risk setting for alcohol consumption and illicit drug use. Analysis of pooled urine samples at a festival therefore provides a valuable method to evaluate trends and to screen for new substances. Wide-spread use of classical drugs and identification of two NPS were observed during a major international music festival in Belgium. Results need to be interpreted carefully, taking into account the possibilities and limitations of the used techniques and a standardized sampling is required.

Cocaine-Induced Headache: A Review of Pathogenesis, Presentation, Diagnosis, and Management

Cocaine is a vasoactive substance, and its consumption has increased throughout the world. There are many neurological complications caused by chronic cocaine use, which include headache, aneurysmal formation, ischemic stroke, hemorrhagic stroke (subdural and subarachnoid hemorrhage), seizures, etc. Headache is one of the most common symptoms that appear after cocaine use. It may occur due to dopaminergic and serotoninergic system impairment. Cocaine causes vasoconstriction by stimulation of the sympathetic nervous system and decreases the reuptake of epinephrine, norepinephrine, serotonin, and dopamine. Reversible cerebral vasoconstriction syndrome (RCVS) is well accepted with cocaine use, which occurs most commonly in middle-aged adults and females. The relation between cocaine consumption and time of occurrence of headache has been described according to which some people suffer from headaches immediately after the cocaine use, some within 40 to 90 minutes of a cocaine binge, and some even after the cocaine abstinence for long period. The diagnosis of a cocaine-induced headache depends on history, physical examination, and cerebrovascular imaging findings. And its management is done according to cause that is responsible for headache.

EEG and cerebral blood flow velocity abnormalities in chronic cocaine users

EEG and cerebral blood flow abnormalities have been documented in chronic cocaine abusers. To identify possible relationships between EEG and blood flow changes and their relationship to the intensity of cocaine use, we recorded the resting eyes-closed EEG and anterior (ACA) and middle (MCA) cerebral artery blood flow velocity during systole (V(S)) and diastole (V(D)) by transcranial Doppler (TCD) sonography of 99 (76 male, 23 female; mean [SD] age 34.3 [5.2] years, 8.6 [5.5] years of cocaine use, 17.8 [7.7] days of cocaine use in month prior to screening) cocaine users within 5 days of admission to a closed research unit. Forty-two non-drug-using, age-matched control subjects (22 male, 20 female) were tested as outpatients. A 3-minute period of resting EEG was recorded from 16 standard scalp electrodes. Artifact-free EEG was converted to six frequency bands (delta, theta, alpha1, alpha2, beta1 and beta2) using a Fast Fourier Transform. Pulsatility index (PI) was calculated as a measure of small vessel resistance. Cocaine users had decreased VD and increased PI in the MCA, with no difference in V(S), and reduced EEG theta, beta1 and beta2 absolute power in posterior brain regions. Recent cocaine use was positively associated with MCA PI (r = 0.27, p < 0.001) and negatively associated with low frequency EEG power (delta power: r = -0.25, p < 0.002; theta power: r = -0.29, p < 0.001). EEG beta1 (r = -0.211, p < 0.05) and beta2 (r = -0.176, p < 0.05) power measures were correlated with PI. These observations suggest that EEG and TCD changes reflect related physiological processes during early cocaine abstinence.