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Santana-Melo I, Caixeta DC, Aguiar EMG, Cardoso-Sousa L, Pacheco ALD, Santos YMOD, da Silva JT, Santana AEG, Carneiro MG, Castro OWD, Sabino-Silva R. Photonic platform coupled with machine learning algorithms to detect pyrolysis products of crack cocaine in saliva: A proof-of-concept animal study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2025; 329:125635. [PMID: 39729705 DOI: 10.1016/j.saa.2024.125635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/08/2024] [Accepted: 12/18/2024] [Indexed: 12/29/2024]
Abstract
The non-invasive detection of crack/cocaine and other bioactive compounds from its pyrolysis in saliva can provide an alternative for drug analysis in forensic toxicology. Therefore, a highly sensitive, fast, reagent-free, and sustainable approach with a non-invasive specimen is relevant in public health. In this animal model study, we evaluated the effects of exposure to smoke crack cocaine on salivary flow, salivary gland weight, and salivary composition using Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy. The exposure to crack cocaine was performed in an acrylic box apparatus with a burned activation of crack/cocaine 400 mg for 10 min for 14 consecutive days. Crack/cocaine exposure increased the salivary secretion without changes in parotid and submandibular weights. Hierarchical Clustering Analysis (HCA) was applied to depict subgrouping patterns in infrared spectra, and Principal components analysis (PCA) explained 83.2 % of the cumulative variance using 3 PCs. ATR-FTIR platforms were coupled to AdaBoost, Artificial Neural Networks, Naïve Bayes, Random Forest, and Support Vector Machine (SVM) algorithms tool to identify changes in the infrared salivary spectra of rats exposed to crack cocaine. The best classification of crack cocaine exposure using the salivary spectra was performed by Naïve Bayes, presenting a sensitivity of 100 %, specificity of 80 %, and accuracy of 90 % between crack cocaine and control rats. The SHAP features of salivary infrared spectra mostly indicate the vibrational modes at 1331 cm-1 and 2806 cm-1, representing CH2 wagging commonly linked in lipids and C-H stretch often attributed to the CH2 or CH3 groups in lipid molecules, respectively, as the main responsible vibrational modes for crack cocaine exposure discrimination. In summary, the present pre-clinical findings indicate the potential of the ATR-FTIR platform coupled with machine learning to effectively detect changes in salivary infrared spectra promoted by exposure to crack cocaine.
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Affiliation(s)
- Igor Santana-Melo
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceio, AL, Brazil
| | - Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
| | - Emília Maria Gomes Aguiar
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
| | - Leia Cardoso-Sousa
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
| | | | | | - Jefté Teixeira da Silva
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
| | | | | | - Olagide Wagner de Castro
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceio, AL, Brazil.
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil.
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de Melo Bastos Cavalcante C, Bruno Oliveira K, Maria Araújo de Souza F, Maria Jatobá Hasten Reiter M, Rodrigues Melo da Silva B, Lavínia da Silva Oliveira K, Vinicius Dos Santos Sales M, Larissa Dias Pacheco A, Santos Siqueira E, de Araújo Costa M, Gomes Dos Santos Neto J, Gabriely Duarte Torres R, Catarina R Leite A, Santana de Melo I, Salgueiro Machado S, Duzzioni M, Leite Góes Gitaí D, Wagner de Castro O. Crack cocaine inhalation increases seizure susceptibility by reducing acetylcholinesterase activity. Epilepsy Behav 2024; 156:109832. [PMID: 38761450 DOI: 10.1016/j.yebeh.2024.109832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
Crack cocaine is a highly addictive and potent stimulant drug. Animal studies have shown that the cholinergic system plays a role in neurotoxicity induced by cocaine or its active metabolites inhalation. Behavioral alterations associated with crack cocaine use include hyperactivity, depressed mood, and decreased seizure threshold. Here we evaluate the acetylcholinesterase (AChE) and reactive oxygen species (ROS) activity, behavioral profile, and the threshold for epileptic seizures in rats that received intrahippocampal pilocarpine (H-PILO) followed by exposure to crack cocaine (H-PILO + CRACK). Animals exposed to H-PILO + CRACK demonstrated increased severity and frequency of limbic seizures. The AChE activity was reduced in the groups exposed to crack cocaine alone (CRACK) and H-PILO + CRACK, whereas levels of ROS remained unchanged. In addition, crack cocaine exposure increased vertical locomotor activity, without changing water and sucrose intake. Short-term memory consolidation remained unchanged after H-PILO, H-PILO + CRACK, and CRACK administration. Overall, our data suggest that crack cocaine inhalation reduced the threshold for epileptic seizures in rats submitted to low doses of pilocarpine through the inhibition of AChE. Taken together, our findings can be useful in the development of effective strategies for preventing and treating the harmful effects of cocaine and crack cocaine on the central nervous system.
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Affiliation(s)
| | - Kellysson Bruno Oliveira
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Fernanda Maria Araújo de Souza
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | | | - Bianca Rodrigues Melo da Silva
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | | | | | - Amanda Larissa Dias Pacheco
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Edite Santos Siqueira
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Maisa de Araújo Costa
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - José Gomes Dos Santos Neto
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Rayssa Gabriely Duarte Torres
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Ana Catarina R Leite
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Igor Santana de Melo
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Sônia Salgueiro Machado
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Marcelo Duzzioni
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Daniel Leite Góes Gitaí
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Olagide Wagner de Castro
- Department of Physiology, Institute of Biological Science and Health of Federal University of Alagoas, Maceió, Alagoas, Brazil.
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Magalhães LS, dos Santos KC, Diniz e Silva BV, da Silva Filho GF, da Costa e Silva GR, Guimarães RA, Pillon SC, Caetano KAA, Martins RMB, Carneiro MADS, Cook RL, Teles SA. Cocaine/crack and cannabis use among transgender women in Goiás, Central Brazil. PLoS One 2024; 19:e0304219. [PMID: 38843195 PMCID: PMC11156409 DOI: 10.1371/journal.pone.0304219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.
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Affiliation(s)
| | | | | | | | | | | | - Sandra Cristina Pillon
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
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Duhart Clarke SE, Victor G, Lynch P, Suen LW, Ray B. Cannabis donation as a harm reduction strategy: a case study. Harm Reduct J 2024; 21:58. [PMID: 38449029 PMCID: PMC10916026 DOI: 10.1186/s12954-024-00974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The United States (US) continues to experience unprecedented rates of overdose mortality and there is increased need to identify effective harm reduction practices. Research from Canada describes cannabis donation through harm reduction agencies as an adjunctive strategy to mitigate the negative consequences of more harmful drugs. This case study describes the operational logistics, feasibility, and potential benefits of a cannabis donation program that was operated through a harm reduction program in rural Michigan. CASE PRESENTATION We applied a community driven research approach to gather information from harm reduction program staff about the implementation and evolution of cannabis donation efforts in Michigan. We also examined 20-months (September 2021 through May 2023) of administrative data from a cannabis company to compare the sale and donation of cannabis products. Ten cannabis-experienced harm reduction clients received cannabis donations, with clinical staff determining client interest and appropriateness, and providing weekly pick-up or delivery. To expand product availability and sustainability, we examined administrative data from a commercialcannabis company that volunteered to provide donations. This administrative data suggests that while flower products constitute most of the adult and medical sales, edible, oil, and topical products predominated donations. Further, cost analysis suggests that donations represent only 1% of total gross sales and account for much less than the expected yearly donation amount. CONCLUSIONS Research suggests there is potential to reduce alcohol and drug use related harms of more dangerous substances through substitution with cannabis. This case study is the first to document cannabis donation as a harm reduction practice in the US and suggests potential for sustainability dependent on state laws. Findings from this case study provide a starting point for inquiry into cannabis donation as a harm reduction strategy in the US; future research is needed to fully understand the individual-level outcomes, public health impacts, necessary legal regulations, and best practices for cannabis donation programs through harm reduction organizations.
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Affiliation(s)
| | - Grant Victor
- School of Social Work, Rutgers University, 120 Albany Street, New Brunswick, NJ, 08901, USA
| | - Pamela Lynch
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, 2540 23rd Street, San Francisco, CA, USA
| | - Bradley Ray
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA
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Mok J, Milloy MJ, Grant C, Lake S, DeBeck K, Hayashi K, Kerr T, Socías ME. Use of Cannabis as a Harm Reduction Strategy Among People Who Use Drugs: A Cohort Study. Cannabis Cannabinoid Res 2023; 8:670-678. [PMID: 35647886 PMCID: PMC10442679 DOI: 10.1089/can.2021.0229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: While substance use contributes to a substantial burden of disease, access to evidence-based harm reduction interventions remains limited or inaccessible. Preliminary research suggests that some individuals use cannabis to reduce the harms associated with their use of other substances, including opioids and stimulants. This study examines factors associated with the self-reported use of cannabis for harm reduction among people who use drugs (PWUD). Methods: We drew data from three prospective, community-recruited cohorts of PWUD in Vancouver, Canada, between June 2016 and May 2018. Multivariable generalized linear mixed-effects modeling was used to examine factors associated with the primary outcome of "use of cannabis for harm reduction," defined as self-reported use of cannabis to substitute for other substances, treat withdrawal, or come down off other drugs. Results: One thousand nine hundred thirty-six participants contributed 5706 observations. In adjusted analyses, daily methamphetamine use (adjusted odds ratio [AOR]=1.43, 95% confidence interval [CI]: 1.09-1.89), experiencing barriers to accessing addiction treatment (AOR=1.92, 95% CI: 1.21-3.03), and enrollment in addiction treatment modalities other than opioid agonist therapy (AOR=1.64, 95% CI: 1.17-2.29) were positively associated with using cannabis for harm reduction. Older age was negatively associated (AOR=0.97, 95% CI: 0.95-0.98). Among 1281 (66.2%) participants who use cannabis, daily cannabis use and obtaining cannabis from unregulated dispensaries were also independent correlates of using cannabis for harm reduction. Discussion and Conclusions: Individuals who were more likely to use cannabis for harm reduction reported difficulty accessing addiction treatment or used substances, such as methamphetamines, where effective treatments are limited. These findings highlight the need to better understand the potential harm-reducing impacts of cannabis among PWUD in these scenarios.
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Affiliation(s)
- Janice Mok
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Daldegan-Bueno D, Lindner SR, Kovaleski D, Fischer B. Cannabis use, risk behaviours and harms in Brazil: A comprehensive review of available data indicators. Drug Alcohol Rev 2023; 42:318-336. [PMID: 36443987 DOI: 10.1111/dar.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 12/02/2022]
Abstract
ISSUES Cannabis use and related health/social outcome indicator data for Brazil-where non-medical cannabis is generally illegal-are limited. APPROACH Towards a comprehensive overview of relevant indicators, we searched primary databases by combining MeSH-index terms related to cannabis, geographic location and subtopic terms (e.g., use, health, mortality) focusing on cannabis use and key outcome indicators in Brazil since 2010. In addition, relevant 'grey literature' (e.g., survey reports) was identified. Key indicator data were mainly narratively summarised. KEY FINDINGS Overall, cannabis use has increased somewhat since pre-2010, with (past-year) use rates measured at 2-3% for general population adults, yet 5% or higher among youth and/or (e.g., post-secondary) student populations. For key risk behaviours, the presence of tetrahydrocannabinol-positivity among motor-vehicle drivers has been measured at <2%. While the prevalence of cannabis use disorder appears to have decreased, the relative proportion of treatment provided for cannabis-related problems increased. National- and local-based studies indicated an association of cannabis use with mental health harms, including depression and suicidality. Although some non-representative and/or local studies contain information, other monitoring data, including cannabis-related risks and harms (e.g., cannabis-related driving, mortality, hospitalisations), are limited in availability. IMPLICATIONS AND CONCLUSION The prevalence of cannabis use in Brazil is comparably low (e.g., relative to elsewhere in the Americas). Data on numerous key cannabis-related indicators is absent, or limited in scope for Brazil. Considering ongoing evolutions in cannabis control and its status as the most common illicit drug, more comprehensive surveillance of cannabis use and related outcomes is advised.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Sheila R Lindner
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Douglas Kovaleski
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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Bonfiglio NS, Portoghese I, Renati R, Mascia ML, Penna MP. Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16759. [PMID: 36554643 PMCID: PMC9779802 DOI: 10.3390/ijerph192416759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Substance Use Disorders (SUDs) pose significant challenges to both individuals and society at large. The primary focus of existing research with clinical SUD populations has been on individual substances, but research is required to better understand the profiles of individuals who use different substances simultaneously. The purpose of the current study was, therefore, to identify patterns of use among subjects (n = 1025) who reported using multiple substances by adopting a Latent Class Analysis (LCA) methodology. The Addiction Severity Index (ASI-lite) was included as a measure of substance misuse, we performed LCA to identify patterns of substance use through the administration of the ASI-Lite. Responses were collected from the following substances: alcohol, cannabis/cannabinoids, opioids and heroin, and cocaine. Results identified two latent classes: (1) alcohol use dominant, and (2) poly-abuser use dominants. Class 1 represented 60.0% of the sample and refers to individuals with the dominant use of alcohol, of those a higher proportion (47%) reported low-frequency use (1 to 7 days per month) and 26% reported a frequency of use of 24 to 30 days per month. Furthermore, 18% used alcohol in combination with cocaine. Class 2 represents 40.0% of the sample. This class is characterized by low-frequency and high-frequency users of several substances. The results obtained highlight the importance of deepening the study of the concomitant use of substances in individuals with SUDs to better understand the health risk of the combined use of two or more substances.
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Affiliation(s)
- Natale Salvatore Bonfiglio
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Renati
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Maria Lidia Mascia
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
| | - Maria Pietronilla Penna
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
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“Virado”: Why Are Crack Cocaine Users Migrating to This New Form of Crack Cocaine? A Brief Report. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Daldegan-Bueno D, Maia LO, Glass M, Jutras-Aswad D, Fischer B. Co-exposure of cannabinoids with amphetamines and biological, behavioural and health outcomes: a scoping review of animal and human studies. Psychopharmacology (Berl) 2022; 239:1211-1230. [PMID: 34613429 PMCID: PMC9110457 DOI: 10.1007/s00213-021-05960-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/02/2021] [Indexed: 02/04/2023]
Abstract
RATIONALE The growing prevalence of psychostimulant (including amphetamine) use and associated health harms, with limited treatment options, present a global challenge. There is an increasing availability and medical applications of cannabinoids, and growing interest in their therapeutic potential for addictive disorders. OBJECTIVES The objective of this study is to review available data regarding cannabis/cannabinoid co-use or exposure on amphetamine-related outcomes. METHODS Towards the present scoping review, we systematically searched four databases (Medline, Web-of-Science, CINAHL Plus and PsycInfo) using cannabis/cannabinoid and amphetamine text-terms identifying peer-reviewed, English-language studies published in 2000-2020 involving multiple methods approaches among both human and animal study samples, assessing the association of co-use/administration of cannabis/cannabinoids products with non-medical amphetamines on biological, behavioural or health outcomes. RESULTS Twenty-five articles were included. Pre-clinical studies (n = 15) found mostly protective effects of single or repeated cannabinoids administration on rodents in amphetamine addiction models, amphetamine-induced models of human mental disorders (e.g. schizophrenia) and amphetamine-induced neurotoxicity. Human studies (n = 10) were more heterogeneously designed (e.g. cross-sectional, case-control, longitudinal) and assessed natural ongoing cannabis and methamphetamine use or dependence, showing mostly enhanced harms in a diversity of outcomes (e.g. mental health, methamphetamine use, cognition). CONCLUSIONS While human studies suggest cannabis use as an adverse risk factor among non-medical amphetamine users, pre-clinical studies suggest therapeutic potential of cannabinoids, especially cannabidiol, to alleviate amphetamine addiction and harms, including treatment outcomes. Given increasing psychostimulant harms but lack of care options, rigorous, high-quality design studies should aim to translate and investigate pre-clinical study results for potential therapeutic benefits of cannabinoids for amphetamine use/abuse in human subjects.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Lucas O Maia
- Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, 515 W. Hastings Street,, Vancouver, BC, V6B 5K3, Canada
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand
| | - Didier Jutras-Aswad
- Centre de Recherche, Centre Hospitalier Universitaire de Universite de Montreal (CHUM), 1051 Rue Sanguinet, Montréal, QC, H2X 3E4, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
- Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, 515 W. Hastings Street,, Vancouver, BC, V6B 5K3, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8Th Floor, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), R. Dr. Ovídio Pires de Campos, Sao Paulo, 785 05403-903, Brazil.
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Daldegan-Bueno D, Maia LO, Glass M, Jutras-Aswad D, Fischer B. Co-exposure of cocaine and cannabinoids and its association with select biological, behavioural and health outcomes: A systematic scoping review of multi-disciplinary studies. Eur Neuropsychopharmacol 2021; 51:106-131. [PMID: 34273801 DOI: 10.1016/j.euroneuro.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/18/2023]
Abstract
Cocaine use entails severe health- and social-related harms globally. Treatment options for cocaine dependence are highly limited. Benefits of cannabinoids for addiction have been documented, making it opportune to examine existing data on the possible outcomes associated with cannabinoids and cocaine co-use. We conducted a systematic scoping review following the PRISMA guidelines of peer-reviewed, English-language studies published from 2000 to 2021 in four databases (Medline, Web-of-Science, CINAHL Plus, and PsycInfo), assessing the co-exposure of cannabis/cannabinoids with cocaine on behavioural, biological or health outcomes. Both quantitative and qualitative, as well as humans and pre-clinical animals' studies (n=46) were included. Pre-clinical studies (n=19) showed mostly protective effects of cannabidiol (CBD) administration on animal models of addiction (e.g., cocaine-craving, -relapse, and -withdrawal) and cocaine-toxicity. Tetrahydrocannabinol (THC) had more inconsistent results, with both protective and counter-protective effects. Human studies (n=27) were more heterogeneous and assessed natural ongoing cannabis and cocaine use or dependence. Quantitative-based studies showed mostly enhanced harms in several outcomes (e.g., cocaine use, mental health); two available clinical trials found no effect upon CBD administration on cocaine-related treatment outcomes. Qualitative data-based studies reported cannabis use as a substitute for or to alleviate harms of crack-cocaine use. While pre-clinical studies suggest a potential of cannabinoids, especially CBD, to treat cocaine addiction, the few trials conducted in humans found no benefits. Cannabis co-use by cocaine users commonly presents a risk factor, entailing enhanced harms for users. More rigorous, controlled trials are still necessary to investigate cannabinoids' potential considering pre-clinical findings and reported benefits from specific drug users.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lucas O Maia
- Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, Vancouver, Canada
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Otago, New Zealand
| | - Didier Jutras-Aswad
- Centre de Recherche, Centre Hospitalier Universitaire de Universite de Montreal (CHUM), Montreal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
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11
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Teodósio Valois-Santos N, de Almeida RBF, Jacques IDJAA, Santos DDP, Silva KSDBE, Nappo SA, de Brito AM. Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use. PLoS One 2021; 16:e0256414. [PMID: 34473735 PMCID: PMC8412309 DOI: 10.1371/journal.pone.0256414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with “alcohol use with the effect of increasing the effect of crack/crack craving” were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin’s content analysis technique. Results 871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13–2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01–2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91–5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26–2.71); and to commit physical violence (OR:1.67; 95%CI:1.08–2.56). Conclusion The findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.
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Affiliation(s)
- Naíde Teodósio Valois-Santos
- Departamento de Saúde Coletiva, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
- * E-mail:
| | | | | | - Daianny de Paula Santos
- Programa de Pós-Graduação em Saúde Pública, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
| | - Keila Silene de Brito e Silva
- Núcleo de Saúde Coletiva, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória, Pernambuco, Brazil
| | - Solange Aparecida Nappo
- Centro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID), Departamento de Medicina Preventiva and Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
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12
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Mok J, Milloy MJ, Grant C, Lake S, DeBeck K, Hayashi K, Socías ME. Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada (2016-2018). Am J Public Health 2021; 111:969-972. [PMID: 33734849 DOI: 10.2105/ajph.2021.306168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To characterize the prevalence and reasons for the use of cannabis as a strategy to reduce the harms arising from other substances.Methods. We drew data about recent cannabis use and intentions from 3 prospective cohort studies of marginalized people who use drugs based in Vancouver, Canada, from June 2016 to May 2018. The primary outcome was "use of cannabis for harm reduction," defined as using cannabis for substitution for licit or illicit substances such as heroin or other opioids, cocaine, methamphetamine, or alcohol; treating withdrawal; or coming down off other drugs.Results. Approximately 1 in 4 participants reported using cannabis for harm reduction at least once during the study period. The most frequent reasons included substituting for stimulants (50%) and substituting for illicit opioids (31%).Conclusions. The use of cannabis for harm reduction is a common strategy among people who use drugs in our setting. Further research into the factors associated with this strategy is needed. Better characterization of the risks and benefits of substitution strategies, including for opioids and stimulants, may prompt new treatment options for PWUD.
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Affiliation(s)
- Janice Mok
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M-J Milloy
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Cameron Grant
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Stephanie Lake
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Kora DeBeck
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Kanna Hayashi
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M Eugenia Socías
- All of the authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
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13
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Udo MSB, da Silva MAA, de Souza Prates S, Dal'Jovem LF, de Oliveira Duro S, Faião-Flores F, Garcia RCT, Maria-Engler SS, Marcourakis T. Anhydroecgonine methyl ester, a cocaine pyrolysis product, contributes to cocaine-induced rat primary hippocampal neuronal death in a synergistic and time-dependent manner. Arch Toxicol 2021; 95:1779-1791. [PMID: 33674969 DOI: 10.1007/s00204-021-03017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 01/11/2023]
Abstract
Crack cocaine users are simultaneously exposed to volatilized cocaine and to its main pyrolysis product, anhydroecgonine methyl ester (AEME). Although the neurotoxic effects of cocaine have been extensively studied, little is known about AEME or its combination. We investigated cell death processes using rat primary hippocampal cells exposed to cocaine (2 mM), AEME (1 mM) and their combination (C + A), after 1, 3, 6 and 12 h. Cocaine increased LC3 I after 6 h and LC3 II after 12 h, but reduced the percentage of cells with acid vesicles, suggesting failure in the autophagic flux, which activated the extrinsic apoptotic pathway after 12 h. AEME neurotoxicity did not involve the autophagic process; rather, it activated caspase-9 after 6 h and caspase-8 after 12 h leading to a high percentage of cells in early apoptosis. C + A progressively reduced the percentage of undamaged cells, starting after 3 h; it activated both apoptotic pathways after 6 h, and was more neurotoxic than cocaine and AEME alone. Also, C + A increased the phosphorylation of p62 after 12 h, but there was little difference in LC3 I or II, and a small percentage of cells with acid vesicles at all time points investigated. In summary, the present study provides new evidence for the neurotoxic mechanism and timing response of each substance alone and in combination, indicating that AEME is more than just a biological marker for crack cocaine consumption, as it may intensify and hasten cocaine neurotoxicity.
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Affiliation(s)
- Mariana Sayuri Berto Udo
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Sara de Souza Prates
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Leandro Ferreira Dal'Jovem
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Stephanie de Oliveira Duro
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Fernanda Faião-Flores
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Raphael Caio Tamborelli Garcia
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, SP, Brazil
| | - Silvya Stuchi Maria-Engler
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Tania Marcourakis
- Departament of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
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14
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Fischer B, O’Keefe-Markman C, Lee A(MH, Daldegan-Bueno D. 'Resurgent', 'twin' or 'silent' epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America. Subst Abuse Treat Prev Policy 2021; 16:17. [PMID: 33588896 PMCID: PMC7883758 DOI: 10.1186/s13011-021-00350-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 01/16/2023] Open
Abstract
In the early 2000s, increasing prevalence of psycho-stimulant (e.g., crack/cocaine, methamphetamine) use and related harms, including severe adverse health outcomes, was observed among - mostly marginalized - populations of persons using illicit drugs in North America, underscoring an urgent need for interventions options towards improved prevention and treatment. By about 2010, however, the 'opioid crisis', featuring unprecedented use and public health burden, had accelerated into full force in North America, largely muting attention to the psycho-stimulant issue until recently. Recent surveillance data on drug use and related mortality/morbidity from the present decade has documented a marked resurgence of psycho-stimulant use and harms especially in at-risk populations, commonly in direct combination with opioids, across North America, resulting in a 'twin epidemic' comprised of opioids and psycho-stimulants We briefly review select epidemiological data indicators for these developments from the United States and Canada; in the latter jurisdiction, related evidence has been less prevalent and systematic but corroborating the same trends. Evidently, the (widely ongoing) focus on the 'opioid epidemic' as a 'mono-type' drug problem has become an anachronism that requires urgent and appropriate correction. We then briefly consider existing, evidence-based options for - prevention and treatment - interventions targeting psycho-stimulant use and harms, which are substantially more limited and/or less efficacious than those available for problematic opioid use, while presenting major gaps and challenges. The observed resurgence of psycho-stimulants may, indirectly, relate to recent efforts towards curtailing (medical) opioid availability, thereby accelerating demand and supply for both illicit opioids and psycho-stimulants. The presently unfolding 'twin epidemic' of opioids and psycho-stimulants, combined with limited intervention resources, presents an acute challenge for public health and may crucially undermine actively extensive efforts to reduce opioid-related health harms in North America.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023 New Zealand
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, M5T 1R8 Canada
- Department of Psychiatry, Federal University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, SP 05403-903 Brazil
| | - Caroline O’Keefe-Markman
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Angelica (Min-Hye) Lee
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023 New Zealand
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15
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Bitencourt RM, Takahashi RN, Carlini EA. From an Alternative Medicine to a New Treatment for Refractory Epilepsies: Can Cannabidiol Follow the Same Path to Treat Neuropsychiatric Disorders? Front Psychiatry 2021; 12:638032. [PMID: 33643100 PMCID: PMC7905048 DOI: 10.3389/fpsyt.2021.638032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022] Open
Abstract
Although cannabis has been known for ages as an "alternative medicine" to provide relief from seizures, pain, anxiety, and inflammation, there had always been a limited scientific review to prove and establish its use in clinics. Early studies carried out by Carlini's group in Brazil suggested that cannabidiol (CBD), a non-psychotropic phytocannabinoid present in Cannabis sativa, has anticonvulsant properties in animal models and reduced seizure frequency in limited human trials. Over the past few years, the potential use of cannabis extract in refractory epilepsy, including childhood epilepsies such as Dravet's syndrome and Lennox-Gastaut Syndrome, has opened a new era of treating epileptic patients. Thus, a considerable number of pre-clinical and clinical studies have provided strong evidence that phytocannabinoids has anticonvulsant properties, as well as being promising in the treatment of different neuropsychiatric disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), addiction, neurodegenerative disorders and autism spectrum disorder (ASD). Given the advances of cannabinoids, especially CBD, in the treatment of epilepsy, would the same expectation regarding the treatment of other neuropsychiatric disorders be possible? The present review highlights some contributions from Brazilian researchers and other studies reported elsewhere on the history, pre-clinical and clinical data underlying the use of cannabinoids for the already widespread treatment of refractory epilepsies and the possibility of use in the treatment of some neuropsychiatric disorders.
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Affiliation(s)
- Rafael M. Bitencourt
- Laboratory of Behavioral Neuroscience, Graduate Program in Health Sciences, University of Southern Santa Catarina, University of Southern Santa Catarina (UNISUL), Tubarão, Brazil
| | - Reinaldo N. Takahashi
- Post Graduate Program in Pharmacology, Department of Pharmacology, Federal University of Santa Catarina, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Elisaldo A. Carlini
- Centro Brasileiro de Informações Sobre Drogas Psicotrópicas (CEBRID), Department of Preventive Medicine, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
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16
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[Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]. Salud Colect 2021; 17:e3041. [PMID: 33822543 DOI: 10.18294/sc.2021.3041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.
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17
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Liu Y, Cheong J, Setlow B, Cottler LB. Cocaine and Marijuana Polysubstance Use and Cocaine Use Disorder: Investigating Mediated Effects through Patterns of Cocaine Use. J Dual Diagn 2021; 17:23-33. [PMID: 33300839 PMCID: PMC7902454 DOI: 10.1080/15504263.2020.1849887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cocaine use is on the rise and it is comorbid with marijuana use. We examined the association between lifetime cocaine + marijuana polysubstance use (CM PSU) versus cocaine only and lifetime cocaine use disorder (CocUD) and examined the potential mediation by cocaine use patterns. Methods: A total of 2,968 lifetime cocaine users were identified from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Mediation analysis was utilized to examine cocaine use quantity, frequency, and duration as potential mediators in the association between CM PSU and CocUD. A parallel multiple mediator model and a structural equation model were used, respectively, to examine: (1) the individual contribution of cocaine use quantity, frequency, and duration, and (2) combined contribution as a set specified by a latent variable. Results: Cocaine users were divided into 2,782 (93.7%) CM polysubstance users and 186 (6.3%) cocaine only users. CM PSU was associated with decreased risk of CocUD, but after including the mediators, the association was no longer significant. Examined separately, only quantity was found to be a significant mediator over and above frequency and duration, while the latent variable with three cocaine use pattern indicators explained 56.6% of the total association between CM PSU and CocUD. Conclusions: Compared to cocaine only users, CM polysubstance users were less likely to use cocaine heavily; this lower intensity of cocaine use was in turn associated with decreased risk of CocUD. Future research is warranted to determine the nature of the association between CM PSU and reduced CocUD.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Barry Setlow
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
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18
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Meneses-Gaya CD, Crippa JA, Hallak JE, Miguel AQ, Laranjeira R, Bressan RA, Zuardi AW, Lacerda AL. Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:467-476. [PMID: 33146345 PMCID: PMC8555645 DOI: 10.1590/1516-4446-2020-1416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
Objective: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. Methods: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. Results: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. Conclusion: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.
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Affiliation(s)
- Carolina de Meneses-Gaya
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - José A. Crippa
- Divisão de Psiquiatria, Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Jaime E. Hallak
- Divisão de Psiquiatria, Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - André Q. Miguel
- Instituto Nacional de Políticas Públicas do Álcool e Drogas (INPAD), UNIFESP, Brazil
| | - Ronaldo Laranjeira
- Instituto Nacional de Políticas Públicas do Álcool e Drogas (INPAD), UNIFESP, Brazil
| | - Rodrigo A. Bressan
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Antonio W. Zuardi
- Divisão de Psiquiatria, Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Acioly L. Lacerda
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), Brazil
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19
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Reddon H, DeBeck K, Socias ME, Lake S, Dong H, Hayashi K, Milloy MJ. Frequent Cannabis Use Is Negatively Associated with Frequency of Injection Drug Use Among People Who Inject Drugs in a Canadian Setting. Cannabis Cannabinoid Res 2020; 6:435-445. [PMID: 33998862 DOI: 10.1089/can.2019.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: High levels of morbidity and mortality associated with injection drug use continue to represent a significant public health challenge in many settings worldwide. Previous studies have shown an association between cannabis use and decreased risk of some drug-related harms. We sought to evaluate the association between high-intensity cannabis use and the frequency of injection drug use among people who inject drugs (PWID). Methods: The data for this analysis were collected from three prospective cohorts of PWID in Vancouver, Canada, between September 2005 and May 2018. Generalized linear mixed-effects models were used to analyze the association between daily cannabis use and the frequency of injecting illegal drugs (i.e., self-reported average number of injections per month). Results: Among the 2,619 active PWID, the frequency of injection drug use was significantly lower among people who use cannabis daily compared with people who use it less than daily (adjusted odds ratio [AOR]=0.84, 95% confidence interval [CI]: 0.73-0.95). Sub-analyses indicated that this effect was restricted to the frequency of illegal opioid injection (AOR=0.78, 95% CI: 0.68-0.90); the association between daily cannabis use and the frequency of illegal stimulant injection was not significant (AOR=1.08, 95% CI 0.93-1.25). Discussion: The findings from these prospective cohorts suggest that people who use cannabis daily were less likely to report daily injection of illegal drugs compared with people who use it less than daily. These results suggest the potential value of conducting experimental research to test whether controlled administration of cannabinoids impacts the frequency of illegal opioid injection among PWID.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Arts and Social Sciences, School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Maria-Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Health Sciences, Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, Vancouver, Canada
| | - Michael-John Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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20
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Rodrigues LA, Caroba MES, Taba FK, Filev R, Gallassi AD. Evaluation of the potential use of cannabidiol in the treatment of cocaine use disorder: A systematic review. Pharmacol Biochem Behav 2020; 196:172982. [DOI: 10.1016/j.pbb.2020.172982] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/09/2022]
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21
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Reddon H, DeBeck K, Socias ME, Lake S, Dong H, Karamouzian M, Hayashi K, Kerr T, Milloy MJ. Frequent Cannabis Use and Cessation of Injection of Opioids, Vancouver, Canada, 2005-2018. Am J Public Health 2020; 110:1553-1560. [PMID: 32816538 DOI: 10.2105/ajph.2020.305825] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives. To evaluate the impact of frequent cannabis use on injection cessation and injection relapse among people who inject drugs (PWID).Methods. Three prospective cohorts of PWID from Vancouver, Canada, provided the data for these analyses. We used extended Cox regression analysis with time-updated covariates to analyze the association between cannabis use and injection cessation and injection relapse.Results. Between 2005 and 2018, at-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio [AHR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). A subanalysis revealed that this association was only significant for opioid injection cessation (AHR = 1.26; 95% CI = 1.12, 1.41). At-least-daily cannabis use was not significantly associated with injection relapse (AHR = 1.08; 95% CI = 0.95, 1.23).Conclusions. We observed that at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids. This finding is encouraging given the uncertainty surrounding the impact of cannabis policies on PWID during the ongoing opioid overdose crisis in many settings in the United States and Canada.
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Affiliation(s)
- Hudson Reddon
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Kora DeBeck
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M Eugenia Socias
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Stephanie Lake
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Huiru Dong
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Mohammad Karamouzian
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Kanna Hayashi
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Thomas Kerr
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M-J Milloy
- All authors are with the British Columbia Centre on Substance Use, Vancouver, BC, Canada
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Rosário BDA, de Nazaré MDFS, Estadella D, Ribeiro DA, Viana MDB. Behavioral and neurobiological alterations induced by chronic use of crack cocaine. Rev Neurosci 2020; 31:59-75. [PMID: 31129656 DOI: 10.1515/revneuro-2018-0118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
Crack cocaine is the crystal form of cocaine and can be smoked, and rapidly absorbed, and, in part for this reason, is potently addictive. It is hypothesized that crack cocaine is able to induce important changes in different tissues and organs, and thus dramatically alter behavior. Nevertheless, which alterations in the central nervous system are related to its frequent use is still a matter of discussion. The present study is a literature review of articles published between the years 2008 and 2018 on the theme 'crack cocaine and brain' available in PUBMED, MEDLINE, EMBASE, and Google scholar databases. The results show that the use of crack cocaine induces important behavioral, neuroanatomical, and biochemical alterations. The main behavioral sequelae include cognitive and emotional changes, such as increased anxiety and depressive symptoms, attention and memory deficits, and hyperactivity. Among the neurobiological alterations are reductions in the activity of the prefrontal, anterior cingulate cortex, and nucleus accumbens. Molecular changes include decreases in neurotrophic factors and increases in oxidative stress and inflammatory cytokines, which may be responsible for the morphological alterations observed. It is also hypothesized that these neurobiological changes might explain the emotional and cognitive dysfunctions experienced by crack cocaine addicts.
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Affiliation(s)
- Bárbara Dos Anjos Rosário
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | | | - Débora Estadella
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Daniel Araki Ribeiro
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Milena de Barros Viana
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil, e-mail:
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Lake S, Nosova E, Buxton J, Walsh Z, Socías ME, Hayashi K, Kerr T, Milloy MJ. Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis. PLoS One 2020; 15:e0233463. [PMID: 32437443 PMCID: PMC7241718 DOI: 10.1371/journal.pone.0233463] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Cannabis use is common among marginalized people who use illicit drugs (PWUD) but reasons for use remain poorly investigated. We sought to explore how different intentions for cannabis use relate to social, structural, and behavioural factors among PWUD in Vancouver, Canada. Methods We used data from cannabis-using participants in two community-recruited prospective cohort studies of PWUD. Using latent class analysis, we identified discrete cannabis-using groups based on self-reported intentions for use. Generalized estimating equations were used to examine correlates of class membership. Results Between June 2016 and December 2018, 2,686 observations from 897 participants cannabis-using PWUD were analyzed. Four latent classes of cannabis use emerged: Class 1 (31.6%), characterized by non-medical purposes; Class 2 (37.5%), characterized by non-pain therapeutic use (e.g., stress, nausea/loss of appetite, and insomnia); characterized by Class 3 (21.9%) predominantly pain relief; and Class 4 (9.0%), characterized by a wide range of therapeutic uses in addition to pain management, including insomnia, stress, nausea/loss of appetite, and harm reduction. Class-specific structural, substance-, and health-related differences were observed, including indicators of better physical and mental health among the “recreational” class, despite evidence of more structural vulnerabilities (e.g., homelessness, incarceration). Conclusions Our findings demonstrate a wide spectrum of motivations for cannabis use among PWUD. We observed important health-related differences between latent classes, demonstrating possible unmet healthcare needs among PWUD reporting therapeutic cannabis use. These findings inform ongoing policy surrounding access to cannabis for harm reduction purposes and applications of medical cannabis for PWUD.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M. J. Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
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Valleriani J, Haines-Saah R, Capler R, Bluthenthal R, Socias ME, Milloy MJ, Kerr T, McNeil R. The emergence of innovative cannabis distribution projects in the downtown eastside of Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102737. [PMID: 32289590 PMCID: PMC7308205 DOI: 10.1016/j.drugpo.2020.102737] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/25/2020] [Accepted: 03/16/2020] [Indexed: 01/23/2023]
Abstract
The ongoing overdose crisis in the United States and Canada has highlighted the urgent need for innovative interventions to reduce drug-related harms. This, in turn, has led to increased interest in the potential of cannabis as a harm reduction strategy. While Canada has recently legalized cannabis, meaningful barriers to accessing legal cannabis remain for people who use drugs (PWUD) from marginalized communities. In the Downtown Eastside of Vancouver, Canada, innovative, grassroots cannabis distribution programs that dispense cannabis and cannabis products from unregulated sources to PWUD for free have recently emerged. In this study, we draw upon 23 in-depth qualitative interviews and ethnographic fieldwork with PWUD who access these programs. We found that these distribution programs play an important function in bridging access to cannabis for PWUD in a structurally disadvantaged neighborhood and do so by implementing few restrictions on who can access, providing a variety of cannabis products that would otherwise be inaccessible, and distributing cannabis at no cost. In addition, many people reported the program spaces provided an avenue to socialize and connect. Most of our participants reported that legal cannabis was inaccessible both through the legal medical and non-medical systems. Considering Canadian governments have made important regulatory changes in regards to cannabis, understanding emerging patterns and the structural barriers to accessing legal cannabis will be critical to maximizing the potential uses of cannabis as a harm reduction tool and ensuring equitable access to structurally disadvantaged populations. Examining the impact of cannabis use on PWUD and ensuring these groups have access to cannabis is an important component in determining whether cannabis deregulation reduces drug-related harms.
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Affiliation(s)
- Jenna Valleriani
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N1N4, Canada
| | - Rielle Capler
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ricky Bluthenthal
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States.
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Janssen E, Cadet-Taïrou A, Gérome C, Vuolo M. Estimating the size of crack cocaine users in France: Methods for an elusive population with high heterogeneity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102637. [PMID: 31881370 DOI: 10.1016/j.drugpo.2019.102637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite several sources corroborating an expanding market and increased visibility and greater diversity in users' profiles, very little is known about the number of crack cocaine users in France. METHOD The estimates rely on a single data source capture-recapture method. Annual data are extracted from treatment centres nationwide. To account for heterogeneity, we use an innovative zero-truncated geometric, regression-based estimator controlling for individual and centre characteristics. We use the well-known Zelterman estimator as a benchmark. RESULTS The number of crack cocaine users received in treatment centres increased dramatically, from 3388 in 2010 to 5143 in 2017 (+52%). The estimated number of crack cocaine users is believed to have tripled over the course of the same period (from 9775, 95% CI [8288-11530] to 28983 [24876-33766], respectively), with prevalences below 1‰, similar to other European countries. The coverage rate (observed number/estimated number of users) decreased in a similar fashion, indicating lower utilization. In particular, females and younger users are underestimated by data from treatment centres. CONCLUSION The prevalence of crack cocaine use is fairly low but steadily increasing. The diversity in users' profiles is a challenge to prevention and public health policies that should expand their scope to a more inclusive perspective of what defines crack cocaine users. Our method overcomes several methodological issues (data sources, data linkage, heterogeneity) and can be easily applied to a wide range of settings.
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Affiliation(s)
- Eric Janssen
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France.
| | - Agnès Cadet-Taïrou
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Clément Gérome
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et Toxicomanies - OFDT), 69 rue de Varenne, 75007 Paris, France
| | - Michael Vuolo
- Department of Sociology, Ohio State University, 238 Townsend Ave, 1885 Neil Avenue Mall, Columbus, OH 43210, USA
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Oliveira HPD, Gonçalves PD, Ometto M, Santos BD, Malbergier A, Amaral R, Nicastri S, Andrade AGD, Cunha PJ. Distinct effects of cocaine and cocaine + cannabis on neurocognitive functioning and abstinence: A six-month follow-up study. Drug Alcohol Depend 2019; 205:107642. [PMID: 31683245 DOI: 10.1016/j.drugalcdep.2019.107642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Cannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association. METHODS We examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge. RESULTS Both groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months. CONCLUSION Our results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.
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Affiliation(s)
- Hercílio Pereira de Oliveira
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Priscila Dib Gonçalves
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Serviço de Psicologia e Neuropsicologia, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Mariella Ometto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Bernardo Dos Santos
- Escola de Enfermagem, Universidade de Sao Paulo, 419 Av. Dr. Enéas de Carvalho Aguiar - Cerqueira César, São Paulo, SP, Brazil.
| | - André Malbergier
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Ricardo Amaral
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Sergio Nicastri
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Arthur Guerra de Andrade
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
| | - Paulo Jannuzzi Cunha
- Grupo Interdisciplinar de Estudos sobre Álcool e Drogas (GREA), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 785 Rua Dr Ovidio Pires de Campos, São Paulo, SP, Brazil.
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Fischer B, Malta M, Messas G, Ribeiro M. Introducing the evidence-based population health tool of the Lower-Risk Cannabis Use Guidelines to Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:550-555. [PMID: 31116260 PMCID: PMC6899352 DOI: 10.1590/1516-4446-2018-0239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022]
Abstract
Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content - including their original recommendations translated into Portuguese - to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.
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Affiliation(s)
- Benedikt Fischer
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Monica Malta
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Departamento de Ciências Sociais, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Guilherme Messas
- Departamento de Saúde Mental, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Marcelo Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Governo do Estado de São Paulo, São Paulo, SP, Brazil
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A latent class analysis of the past-30-day substance use patterns among lifetime cocaine users: Findings from a community sample in North Central Florida. Addict Behav Rep 2019; 9:100170. [PMID: 31193730 PMCID: PMC6542739 DOI: 10.1016/j.abrep.2019.100170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 01/03/2023] Open
Abstract
Objectives Cocaine use is increasing and many cocaine users engage in polysubstance use. Within polysubstance use, relationships among use of individual substances are necessarily complex. To address this complexity, we used latent class analysis (LCA) to identify patterns of polysubstance use among lifetime cocaine users and examine associations among these patterns, demographics, and risk profiles. Methods Members of HealthStreet, an ongoing community engagement program, were asked about lifetime and past 30-day use of cocaine, alcohol, tobacco, marijuana, and prescription medications, mental health conditions, recent Emergency Department (ED) visits and demographics. LCA was used to identify classes of past 30-day polysubstance use among individuals who endorsed lifetime cocaine use. Multinomial logistic regression identified factors associated with these classes. Results Among 1797 lifetime cocaine users, a five-class LCA model was identified: 1) past 30-day tobacco use only (45%), 2) past 30-day alcohol, marijuana and tobacco use (31%), 3) past 30-day tobacco, prescription opioid and sedative use (13%), 4) past 30-day cocaine, alcohol, marijuana and tobacco use (9%), 5) past 30-day cocaine and multiple polysubstance use (2%). Demographics, ED visits and mental health conditions were associated with class membership. Conclusions Approximately 11% of lifetime cocaine users used cocaine in the past 30 days with two different concurrent substance use patterns. Prescription medication (opioids and sedatives) and complex polysubstance use patterns were stronger indicators of negative outcomes than current cocaine use. Cocaine was not used frequently with other stimulants. In addition to polysubstance use, prescription medication use should be targeted for intervention among lifetime cocaine users.
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Day M. Cannabis use as harm reduction in the Eastern Caribbean. DRUGS AND ALCOHOL TODAY 2018. [DOI: 10.1108/dat-06-2018-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to present evidence of the therapeutic value of cannabis as a harm reduction intervention with people who smoke crack cocaine.
Design/methodology/approach
A desk study of published peer-reviewed material supporting the use of cannabis as therapeutic in mitigating some of the harms associated with crack cocaine smoking.
Findings
The use of cannabis as a harm reduction strategy for crack cocaine use has been commented on in the scientific literature since the 1980s. The officially scheduling of cannabis as having no medicinal value hampered further study despite the reporting of positive findings and numerous calls for more research.
Practical implications
There are currently no approved pharmaceutical substitutions for crack cocaine. Cannabis has shown itself effective in mitigating harms for 30–40 per cent of people. Cannabis is inexpensive and readily available and should be allowed for those people who want to use it.
Originality/value
Poly drug use is often framed in a negative context. In this paper, the author shows that with cannabis and crack, the poly drug use is actually a valid harm reduction strategy.
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Cruz JI, Nappo SA. Is Ayahuasca an Option for the Treatment of Crack Cocaine Dependence? J Psychoactive Drugs 2018; 50:247-255. [DOI: 10.1080/02791072.2018.1447174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Joselaine Ida Cruz
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Solange Aparecida Nappo
- Brazilian Center on Psychotropic Drugs (CEBRID), Department of Preventive Medicine, Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, São Paulo, Brazil
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Guimarães RA, de Oliveira Landgraf de Castro V, do Valle Leone de Oliveira SM, Stabile AC, Motta-Castro ARC, dos Santos Carneiro MA, Araujo LA, Caetano KAA, de Matos MA, Teles SA. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry 2017; 17:412. [PMID: 29282091 PMCID: PMC5745789 DOI: 10.1186/s12888-017-1569-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to compare sociodemographic characteristics, patterns of drug use, and risky sexual behaviour among female and male users of crack cocaine. METHODS Between 2012 and 2013, we conducted a cross-sectional study of 919 crack cocaine users (783 men and 136 women) in Central Brazil using face-to-face interviews. Blood samples were collected to test for syphilis. The Chi-Square Automatic Interaction Detector (CHAID) was used to explore the differences between genders. We implemented two models: the first model included previous incarceration and variables related to patterns of drug use, and the second model included variables related to sexual risky behaviours and syphilis exposure. RESULTS Women consumed more crack cocaine than men on a regular basis; however, poly-drug use was more common among men. More women than men reported exchanging sex for money and/or drugs and inconsistent condom use during sexual intercourse; women also reported more sexual partners. In addition, the frequency of sexual violence was higher for women than men. A higher proportion of women than men were positive for syphilis (27.2% vs. 9.2%; p < 0.001). The CHAID decision tree analysis identified seven variables that differentiated the genders: previous incarceration, marijuana use, daily crack cocaine consumption, age at first illicit drug use, sexual violence, exchange of sex for money and/or drugs, and syphilis exposure. CONCLUSION Our findings demonstrate a difference in patterns of crack cocaine consumption and sexual risky behaviours between genders, thus indicating a need for gender-specific interventions in this population.
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Affiliation(s)
- Rafael Alves Guimarães
- 0000 0001 2192 5801grid.411195.9Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás Brazil ,0000 0001 2192 5801grid.411195.9Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás Brazil
| | | | | | - Andréa Cristina Stabile
- 0000 0001 2163 5978grid.412352.3Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul Brazil
| | - Ana Rita Coimbra Motta-Castro
- 0000 0001 2163 5978grid.412352.3Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul Brazil ,0000 0001 0723 0931grid.418068.3Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul Brazil
| | | | - Lyriane Apolinário Araujo
- 0000 0001 2192 5801grid.411195.9Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás Brazil
| | | | - Marcos André de Matos
- 0000 0001 2192 5801grid.411195.9Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás Brazil
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Cannabis and cue-induced craving in cocaine-dependent individuals: A pilot study. Addict Behav 2017; 73:4-8. [PMID: 28431292 DOI: 10.1016/j.addbeh.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/05/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cannabis consumption is common among cocaine users; however, little is known about its effect on cocaine craving. The objective of this study was to assess whether cannabis co-use is associated with lower cue-induced cocaine craving in non-treatment-seeking cocaine-dependent individuals. METHODS Data from twenty-eight cocaine-dependent men were analyzed in this pilot study. Cocaine-dependent subjects (n=12) were compared with cocaine-dependent subjects who also abused or were dependent on cannabis (n=16). After at least 72h of cocaine abstinence, verified using the Timeline Followback and a drug screening test, subjects participated in a functional magnetic resonance imaging session during which neutral and drug cue video sequences were presented. Each sequence comprised four video blocks alternating with resting blocks. We report here subjective craving measures that were collected using the Visual Analog Scale, administered before and after each video block as per standard craving measurement paradigms. RESULTS Cocaine craving was successfully induced, with no significant difference in cue-induced craving between the two groups. However, post-hoc analyses revealed a significant increase in pre-video cocaine craving scores over time among individuals with cannabis use disorders. CONCLUSION We could not highlight significant differences in cocaine craving induction between groups, but we observed a possible deficit in craving decay in the cocaine and cannabis group. In light of this finding, methodology of craving assessment in non-treatment-seeking users, particularly when different substances are combined, should possibly include outcomes linked to craving decay. Studies examining the association between cocaine craving decay and other outcome measures, such as relapse, are also warranted.
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Socías ME, Kerr T, Wood E, Dong H, Lake S, Hayashi K, DeBeck K, Jutras-Aswad D, Montaner J, Milloy MJ. Intentional cannabis use to reduce crack cocaine use in a Canadian setting: A longitudinal analysis. Addict Behav 2017; 72:138-143. [PMID: 28399488 DOI: 10.1016/j.addbeh.2017.04.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND No effective pharmacotherapies exist for the treatment of crack cocaine use disorders. Emerging data suggests that cannabinoids may play a role in reducing cocaine-related craving symptoms. This study investigated the intentional use of cannabis to reduce crack use among people who use illicit drugs (PWUD). METHODS Data were drawn from three prospective cohorts of PWUD in Vancouver, Canada. Using data from participants reporting intentional cannabis use to control crack use, we used generalized linear mixed-effects modeling to estimate the independent effect of three pre-defined intentional cannabis use periods (i.e., before, during and after first reported intentional use to reduce crack use) on frequency of crack use. RESULTS Between 2012 and 2015, 122 participants reported using cannabis to reduce crack use, contributing a total of 620 observations. In adjusted analyses, compared to before periods, after periods were associated with reduced frequency of crack use (Adjusted Odds Ratio [AOR]=1.89, 95% Confidence Interval [CI]: 1.02-3.45), but not the intentional use periods (AOR=0.85, 95% CI: 0.51-1.41). Frequency of cannabis use in after periods was higher than in before periods (AOR=4.72, 95% CI: 2.47-8.99), and showed a tendency to lower frequency than in intentional cannabis use periods (AOR=0.56, 95% CI: 0.32-1.01). CONCLUSIONS A period of intentional cannabis use to reduce crack use was associated with decreased frequency of crack use in subsequent periods among PWUD. Further clinical research to assess the potential of cannabinoids for the treatment of crack use disorders is warranted.
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Martínez-Mesa J, González-Chica DA, Duquia RP, Bonamigo RR, Bastos JL. Sampling: how to select participants in my research study? An Bras Dermatol 2017; 91:326-30. [PMID: 27438200 PMCID: PMC4938277 DOI: 10.1590/abd1806-4841.20165254] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/02/2015] [Indexed: 11/21/2022] Open
Abstract
Background In this paper, the basic elements related to the selection of participants
for a health research are discussed. Sample representativeness, sample
frame, types of sampling, as well as the impact that non-respondents may
have on results of a study are described. The whole discussion is supported
by practical examples to facilitate the reader's understanding. Objective To introduce readers to issues related to sampling.
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Affiliation(s)
| | | | - Rodrigo Pereira Duquia
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) - Porto Alegre (RS), Brazil
| | - Renan Rangel Bonamigo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) - Porto Alegre (RS), Brazil
| | - João Luiz Bastos
- Universidade Federal de Santa Catarina (UFSC) - Florianópolis (RS), Brazil
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Scherer JN, Silvestrin R, Ornell F, Roglio V, Sousa TRV, Von Diemen L, Kessler FHP, Pechansky F. Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers. Drug Alcohol Depend 2016; 168:255-262. [PMID: 27736679 DOI: 10.1016/j.drugalcdep.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Substance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC). METHOD A multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview. RESULTS Seventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the "psychiatric", "legal", and "family problems" subscales from the ASI-6, and lower scores in the "family social support" subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities. CONCLUSION The high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.
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Affiliation(s)
- Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil.
| | - Roberta Silvestrin
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Vinícius Roglio
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Tanara Rosangela Vieira Sousa
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
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- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Lisia Von Diemen
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs - HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Professor Álvaro Alvim, 400, 90420-020, Porto Alegre, RS, Brazil
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Fischer B, Kuganesan S, Gallassi A, Malcher-Lopes R, van den Brink W, Wood E. Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1177-82. [DOI: 10.1016/j.drugpo.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
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