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Junior MSC, Bezerra AG, Curado DF, Gregório RP, Galduróz JCF. Preliminary investigation of the administration of biperiden to reduce relapses in individuals with cocaine/crack user disorder: A randomized controlled clinical trial. Pharmacol Biochem Behav 2024; 237:173725. [PMID: 38340989 DOI: 10.1016/j.pbb.2024.173725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Several studies have demonstrated that ACh modulates the dopaminergic circuit in the nucleus accumbens, and its blockade appears to be associated with the inhibition of the reinforced effect or the increase in dopamine caused by cocaine use. The objective of this study was to evaluate the effect of biperiden (a muscarinic receptor antagonist with a relatively higher affinity for the M1 receptor) on crack/cocaine use relapse compared to a control group that received placebo. METHODS This study is a double-blind, randomized, placebo-controlled clinical trial. The intervention group received 2 mg of biperiden, 3 times a day, for a period of 3 months. The control group received identical placebo capsules, at the same frequency and over the same period. All participants were followed for a period of six months. RESULTS The sample comprised 128 people, with 61 in the control group and 67 in the biperiden group. Lower substance consumption was observed in the group that received biperiden treatment two (bT2 = -2.2 [-3.3; -1.0], p < 0.001) and six months (bT4 = -6, 2 [-8.6; -3.9], p < 0.001) after the beginning of the intervention. The biperiden group had a higher latency until a possible first day of consumption, in the same evaluation periods (bT2 = 0.26 [0.080; 0.44], p = 0.004; bT4 = 0.63 [0.32; 0.93], p < 0.001). CONCLUSIONS Despite the major limitations of the present study, the group that received biperiden reduced the number of days of cocaine/crack use and showed an increase in the latency time for relapse. More studies are needed to confirm the utility of this approach.
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Ross EJ, Williams RS, Viamonte M, Reynolds JM, Duncan DT, Paul RH, Carrico AW. Overamped: Stimulant Use and HIV Pathogenesis. Curr HIV/AIDS Rep 2023; 20:321-332. [PMID: 37971597 DOI: 10.1007/s11904-023-00672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation. RECENT FINDINGS Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.
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Affiliation(s)
- Emily J Ross
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renessa S Williams
- University of Miami School of Nursing and Health Sciences, Coral Gables, FL, USA
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dustin T Duncan
- Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, #407, Miami, FL, 33199, USA.
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Winstanley EL. Through the Looking Glass: Crack Pipes, Crackpots, and Crazy Ideas on How to Reduce Drug-Related Harms. J Stud Alcohol Drugs 2022; 83:623-624. [PMID: 35838442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Erin L Winstanley
- Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, West Virginia
- Department of Neuroscience, West Virginia University, Morgantown, West Virginia
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Gohil H, Miskovic M, Buxton JA, Holland SP, Strike C. Smoke Gets in the Eye: A systematic review of case reports of ocular complications of crack cocaine use. Drug Alcohol Rev 2022; 41:347-355. [PMID: 34337815 DOI: 10.1111/dar.13366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/23/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
ISSUES Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight-threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer-reviewed literature. APPROACH A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. KEY FINDINGS Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. IMPLICATIONS Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. CONCLUSION Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing.
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Affiliation(s)
- Hemant Gohil
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Miroslav Miskovic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Simon P Holland
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Antoniazzi RP, Palmeira RV, Schöffer C, Dos Santos BZ, Zanatta FB, Feldens CA. Use of crack cocaine increases tooth loss. Am J Dent 2021; 34:317-321. [PMID: 35051319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the occurrence of tooth loss among crack cocaine users. METHODS A cross-sectional study was conducted with 106 crack cocaine users and 106 controls matched for age, gender, and tobacco use. Data were collected on socio-demographic characteristics, drug use, use of dental services, dental caries, periodontal disease, and the outcome (tooth loss). RESULTS Crack cocaine users had a greater frequency of tooth loss (55.7% vs. 36.8%), severity of dental caries and periodontal disease and less use of dental services than the controls (P< 0.05). After adjustments, tooth loss was 46% more frequent among crack cocaine users (PR= 1.46; 95%, CI: 1.10-1.93) as well as significantly more frequent among non-whites, those older than 24 years of age and those with high dental caries severity. Occurrence of tooth loss was significantly higher among crack cocaine users. These findings can contribute to the planning and implementation of prevention strategies and oral health care for individuals with a chemical dependence. CLINICAL SIGNIFICANCE The use of crack cocaine had a negative impact on the oral health of its users, leading to tooth loss and a greater severity of dental caries. These findings should be considered when planning prevention strategies to improve oral health in individuals addicted to crack cocaine.
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Affiliation(s)
| | | | - Caroline Schöffer
- Department of Stomatology, Federal University of Santa Maria, RS, Brazil
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Bittencourt AML, Bampi VF, Sommer RC, Schaker V, Juruena MFP, Soder RB, Franco AR, Sanvicente-Vieira B, Grassi-Oliveira R, Ferreira PEMS. Cortical thickness and subcortical volume abnormalities in male crack-cocaine users. Psychiatry Res Neuroimaging 2021; 310:111232. [PMID: 33621927 DOI: 10.1016/j.pscychresns.2020.111232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 02/05/2023]
Abstract
Crack-cocaine offers a higher risk of abuse than intranasal and intravenous use of cocaine. Yet, current treatments remain disappointing and our understanding of the mechanism of crack-cocaine neurotoxicity is still incomplete. Magnetic resonance images studies on brain changes of crack-cocaine addicts show divergent data. The present study investigated gray matter (GM) abnormalities in crack-cocaine dependents (n = 18) compared to healthy controls (n = 17). MRI data was analysed using FreeSurfer and voxel-based morphometry (VBM). FreeSurfer analysis showed that CD had decreased cortical thickness (CT) in the left inferior temporal cortex (lTC), left orbitofrontal cortex (lOFC) and left rostro frontal cortex (lRFC), enlargement in left inferior lateral ventricle, and smaller GM volume in right hippocampus and right ventral diencephalon. VBM analysis showed that CD had significantly decreased GM volume in left Putamen and left nucleus accumbens. Furthermore, we found a negative correlation between duration of crack-cocaine use and lTC CT. These results provide compelling evidence for GM abnormalities in CD and also suggest that duration of crack-cocaine use may be associated with CT alterations.
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Affiliation(s)
- Augusto Martins Lucas Bittencourt
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil.
| | - Vinicius Faccin Bampi
- SW - Adult Community Mental Health Service, Hertfordshire Partnership University NHS Foundation Trust, St, AL3 5TQ St Albans, United Kingdom
| | - Rafael Canani Sommer
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Vanessa Schaker
- Federal University of Rio Grande do Sul, 90040-060, Porto Alegre, Brazil
| | | | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeberg, NY, 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Breno Sanvicente-Vieira
- Lab of Individual Differences and Psychopathology (LaDIP), Psychology Department - Pontifical Catholic University of Rio de Janeiro (PUC-Rio), 22453900, Rio de Janeiro, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Medicine and Health Sciences - Neuroscience, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 90619900, Porto Alegre, Brazil; Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, 90619900, Porto Alegre, Brasil
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Perrenoud LO, Oikawa KF, Williams AV, Laranjeira R, Fischer B, Strang J, Ribeiro M. Factors associated with crack-cocaine early initiation: a Brazilian multicenter study. BMC Public Health 2021; 21:781. [PMID: 33892673 PMCID: PMC8063477 DOI: 10.1186/s12889-021-10769-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs. METHODS This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure. RESULTS Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = - 3.81, - 0.22; crack-cocaine: p < 0.001, 95% CI = - 7.40, - 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = - 2.57, - 0.14) remained independent predictors of early age of crack-cocaine initiation. CONCLUSIONS Early onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.
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Affiliation(s)
- Luciane Ogata Perrenoud
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil, Rua Major Maragliano, 241, SP 04017030 São Paulo, Brazil
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD), São Paulo State Secretary of Health, Rua Prates, 165, 01121000 São Paulo, Brazil
| | - Koki Fernando Oikawa
- Department of Statistics, Brazil University, São Paulo, Brazil, Rua Ibipetuba, 130, SP 03127-180 São Paulo, Brazil
| | - Anna Virginia Williams
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK, 4, Windsor Walk Denmark Hill, SE5 8AF London, UK
| | - Ronaldo Laranjeira
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil, Rua Major Maragliano, 241, SP 04017030 São Paulo, Brazil
| | - Benedikt Fischer
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil, Rua Major Maragliano, 241, SP 04017030 São Paulo, Brazil
- 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 and Addiction, Simon Fraser University (SFU Faculty of Health Sciences, 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
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK, 4, Windsor Walk Denmark Hill, SE5 8AF London, UK
| | - Marcelo Ribeiro
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil, Rua Major Maragliano, 241, SP 04017030 São Paulo, Brazil
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD), São Paulo State Secretary of Health, Rua Prates, 165, 01121000 São Paulo, Brazil
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Roglio VS, Borges EN, Rabelo-da-Ponte FD, Ornell F, Scherer JN, Schuch JB, Passos IC, Sanvicente-Vieira B, Grassi-Oliveira R, von Diemen L, Pechansky F, Kessler FHP. Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil. PLoS One 2020; 15:e0232242. [PMID: 32365094 PMCID: PMC7197800 DOI: 10.1371/journal.pone.0232242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches. Methods This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender. Results The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PRM = 1.56, PRW = 1.27) and hallucinations (PRM = 1.80, PRW = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious. Conclusions Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.
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Affiliation(s)
- Vinícius Serafini Roglio
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo Nunes Borges
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Center for Computational Sciences, Universidade Federal do Rio Grande, Porto Alegre, Brazil
- * E-mail:
| | - Francisco Diego Rabelo-da-Ponte
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jaqueline Bohrer Schuch
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ives Cavalcante Passos
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Breno Sanvicente-Vieira
- Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Russell C, Neufeld M, Sabioni P, Varatharajan T, Ali F, Miles S, Henderson J, Fischer B, Rehm J. Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada. PLoS One 2019; 14:e0225548. [PMID: 31805082 PMCID: PMC6894813 DOI: 10.1371/journal.pone.0225548] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Illicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study. METHODS This study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14-25) who live in Northern Ontario and use illicit drugs. Interviews with 'key informants' who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures. RESULTS A total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported 'fair' mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling. CONCLUSIONS Although each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maria Neufeld
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Sabioni
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Translational Addiction Research Lab, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Thepikaa Varatharajan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Joanna Henderson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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11
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Sanvicente-Vieira B, Rovaris DL, Ornell F, Sordi A, Rothmann LM, Niederauer JPO, Schuch JB, von Diemen L, Kessler FHP, Grassi-Oliveira R. Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users. PLoS One 2019; 14:e0218334. [PMID: 31226126 PMCID: PMC6588218 DOI: 10.1371/journal.pone.0218334] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
Crack cocaine use disorder (CUD) has been related to sex differences. This work aimed to compare the severity of drug use and the severity of other negative related outcomes in males and females with CUD. A total of 1344 inpatients (798 males and 546 females) with crack cocaine use disorder (CUD) were evaluated by a detailed multidimensional clinical assessment, including addiction severity and trauma exposure. Linear regression predicted higher drug use severity (β = 0.273, p < 0.001) and more problems in domains related to childcare issues (β = 0.321), criminal involvement (β = 0.108), work-related problems (β = 0.281) and social support impairments (β = 0.142) for females, all with p < 0.001. Alcohol problems were predicted to be higher in males (β = -0.206, P < 0.001). Females had higher rates of other mental disorders, particularly trauma and stress-related disorders (OR: 3.206, CI: 2.22, 4.61). Important sex differences also emerged in trauma history and HIV infection prevalence. CUD has a more severe clinical presentation among females facing early abstinence. Sex differences in the CUD course indicate the need for consideration of sex-specific interventions and research.
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Affiliation(s)
- Breno Sanvicente-Vieira
- Developmental Cognitive Neuroscience Lab, School of Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Brain Institute of Rio Grande do Sul, Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Diego Luiz Rovaris
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
- Attention Deficit Disorder Outpatient Program, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anne Sordi
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Melo Rothmann
- Developmental Cognitive Neuroscience Lab, School of Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Brain Institute of Rio Grande do Sul, Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - João Paulo Ottolia Niederauer
- Developmental Cognitive Neuroscience Lab, School of Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Brain Institute of Rio Grande do Sul, Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Jaqueline Bohrer Schuch
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Immunosenescence, Graduate Program in Biomedical Gerontology, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab, School of Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Brain Institute of Rio Grande do Sul, Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
- * E-mail:
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12
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Affiliation(s)
- F D Giacomi
- From the Respiratory Unit, Cardio-Thoracic-Vascular Department, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - N Srivali
- Division of Pulmonary Medicine, St. Agnes Hospital, Baltimore, MD, USA
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13
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Abstract
BACKGROUND Since 2000, heroin use patterns have shifted within the United States. How this change may relate to polydrug use among local heroin users is unknown. Although polydrug use has been studied, user perceptions of drug use in terms of health risks, arrest risk, availability, cost, liking, and dependence have not been considered. METHODS Data are presented from a brief, face-to-face survey conducted in 2016 of 200 non-in-treatment heroin users from Cleveland, OH. We assessed the use of and attitudes on alcohol, marijuana, methamphetamine, heroin, crack cocaine, powder cocaine, and prescription drugs. We estimated polydrug (concurrent past month) use with cluster analysis and latent profiles. Regression analysis estimated the strength of relationships between attitudes and frequency of use. RESULTS We identified five clusters: Cluster 1 used heroin concomitantly with alcohol and occasionally crack; Cluster 2 used heroin and crack cocaine daily; Cluster 3 used heroin daily and almost exclusively; Cluster 4 used heroin and marijuana daily; and Cluster 5 were part-time drug users. Drug use frequency was associated with liking and being anxious when drugs could not be obtained. High perceived availability of heroin and cocaine and low cost facilitated polydrug use. CONCLUSIONS Understanding polydrug use clusters among heroin users is important for addressing the larger opioid epidemic. Users' perceptions of a drug's availability and cost appeared to facilitate polydrug use and justify more detailed future research on drug access.
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Affiliation(s)
- Georgiy Bobashev
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27606 USA.
| | - Kira Tebbe
- IBM Research, 75 Binney Street, Cambridge, MA 02142, USA.
| | - Nicholas Peiper
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27606 USA.
| | - Lee Hoffer
- Department of Anthropology, Case Western Reserve University, 11220 Bellflower Rd., Cleveland, OH 44106, USA.
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14
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Boyd AS, Ortleb M. Levamisole-induced vasculopathy with gastric involvement in a cocaine user. Cutis 2018; 102:169-176. [PMID: 30372707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Reports of levamisole-induced vasculopathy (LIV) secondary to use of levamisole-contaminated cocaine largely have been limited to the skin. We report the case of a 35-year-old woman with painful purpuric lesions affecting the cheeks, nose, ears, arms, and legs of several days' duration. She recently had used crack cocaine. A biopsy of a lesion on the right arm demonstrated leukocytoclastic vasculitis. She also reported abdominal pain and gastric reflux of recent onset but denied any history of gastrointestinal tract disease. An upper gastrointestinal endoscopy was performed and demonstrated hemorrhagic erosions of the esophagus and stomach similar in appearance to the cutaneous lesions. Because dermatologists often are the specialists making the diagnosis of LIV, it is important they inform other involved clinicians that the skin may not be the sole repository of vascular insult.
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Affiliation(s)
- Alan S Boyd
- Department of Pathology, Department of Dermatology, Vanderbilt University, Nashville, Tennessee, USA
| | - Melanie Ortleb
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee, USA
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15
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França DDDS, Del-Rios NHA, Carneiro MADS, Guimarães RA, Caetano KAA, Reis MNDG, Martins RMB, Motta-Castro ARC, Stefani MMDA, Teles SA. HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics. PLoS One 2018; 13:e0199606. [PMID: 30016324 PMCID: PMC6049907 DOI: 10.1371/journal.pone.0199606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 06/09/2018] [Indexed: 12/11/2022] Open
Abstract
Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18-68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.
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Affiliation(s)
| | | | | | | | | | | | | | - Ana Rita Coimbra Motta-Castro
- Center of Biological and Health Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail: ,
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16
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Klega AE, Keehbauch JT. Stimulant and Designer Drug Use: Primary Care Management. Am Fam Physician 2018; 98:85-92. [PMID: 30215997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Approximately 10% of the U.S. population 12 years and older reported using illicit substances in 2015. This article reviews the clinical effects and treatment of persons who use cocaine, methamphetamines, 3,4-methylenedioxymethamphetamine (MDMA), synthetic cannabinoids, and synthetic cathinones ("bath salts"). Cocaine blocks the reuptake of the monoamine transporters dopamine, norepinephrine, and serotonin. Immediate clinical effects include increased energy and euphoria, as well as hypertension and arrhythmias. Acute myocardial infarction, seizures, hallucinations, hyperthermia, and movement disorders are among the possible adverse effects. Like cocaine, methamphetamine blocks reuptake of monoamine transporters, but also stimulates dopamine release and has a longer duration of action. Methamphetamine misuse is associated with severe dental problems. MDMA is a stimulant and psychedelic with a chemical structure similar to serotonin. Adverse effects include serotonin syndrome, hyponatremia, long-term memory impairment, and mood disorders. Synthetic cannabinoids can have a more intense and long-lasting effect than natural cannabis. Acute intoxication may cause severe cardiac and respiratory complications and seizures. Synthetic cathinones are marketed as cheap substitutes for other stimulants. Their effects are similar to those of other stimulants, and they are addictive. Psychosocial intervention is the main form of treatment for addiction to these substances. Promising therapies include disulfiram and substitution therapy for cocaine misuse disorders, and mirtazapine for methamphetamine use disorder.
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Affiliation(s)
- Ann E Klega
- Florida Hospital Family Medicine Residency, Winter Park, FL, USA
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17
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Dos Santos JF, de Melo Bastos Cavalcante C, Barbosa FT, Gitaí DLG, Duzzioni M, Tilelli CQ, Shetty AK, de Castro OW. Maternal, fetal and neonatal consequences associated with the use of crack cocaine during the gestational period: a systematic review and meta-analysis. Arch Gynecol Obstet 2018; 298:487-503. [PMID: 29951712 DOI: 10.1007/s00404-018-4833-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Crack cocaine consumption is one of the main public health challenges with a growing number of children intoxicated by crack cocaine during the gestational period. The primary goal is to evaluate the accumulating findings and to provide an updated perspective on this field of research. METHODS Meta-analyses were performed using the random effects model, odds ratio (OR) for categorical variables and mean difference for continuous variables. Statistical heterogeneity was assessed using the I-squared statistic and risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Ten studies met eligibility criteria and were used for data extraction. RESULTS The crack cocaine use during pregnancy was associated with significantly higher odds of preterm delivery [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.59-3.10], placental displacement (OR, 2.03; 95% CI 1.66-2.48), reduced head circumference (- 1.65 cm; 95% CI - 3.12 to - 0.19), small for gestational age (SGA) (OR, 4.00; 95% CI 1.74-9.18) and low birth weight (LBW) (OR, 2.80; 95% CI 2.39-3.27). CONCLUSION This analysis provides clear evidence that crack cocaine contributes to adverse perinatal outcomes. The exposure of maternal or prenatal crack cocaine is pointedly linked to LBW, preterm delivery, placental displacement and smaller head circumference.
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Affiliation(s)
- Jucilene Freitas Dos Santos
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil
| | - Cibelle de Melo Bastos Cavalcante
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil
| | - Fabiano Timbó Barbosa
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil
| | - Daniel Leite Góes Gitaí
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil
| | - Marcelo Duzzioni
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil
| | - Cristiane Queixa Tilelli
- Central-West Campus Dona Lindu, Federal University of São João del-Rei (UFSJ), Divinópolis, MG, Brazil
| | - Ashok K Shetty
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, Texas A&M Health Science Center College of Medicine, College Station, TX, USA
| | - Olagide Wagner de Castro
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Av. Lourival de Melo Mota, km 14, Campus A. C. Simões, Cidade Universitária, Maceió, AL, CEP 57072-970, Brazil.
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18
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Pinheiro RS, Carneiro MAS, Martins RMB, Caetano KAA, Carvalho PMRS, Ferreira CC, Matos MA, Teles SA. Hepatitis B, HIV, and Syphilis in Female Crack Cocaine Users in Central Brazil. J Assoc Nurses AIDS Care 2017; 28:438-442. [PMID: 28286007 DOI: 10.1016/j.jana.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/03/2017] [Indexed: 11/17/2022]
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19
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Khanapara DB, Panwala A, Dedania B, Naut ER. Levamisole-Adulterated Cocaine-Induced Skin Lesions: A Case Report and Literature Review. Conn Med 2017; 81:95-98. [PMID: 29738153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Levamisole is used as an agent to increase the total weight of street cocaine. We report the case of a 28-year-old female who presented with multiple painful, ulcerating lesions. She tested positive for cocaine and levamisole. Her skin lesions improved with abstinence from cocaine. Patients with levamisole-induced toxicity most often present with skin manifestations or joint pain. Leukopenia, neutropenia, and agranulocytosis are common lab abnormalities seen in these patients. Complete resolution of the skin lesions are observed approximatelythree weeks after abstinence. Patients known to use street drugs, who present with unexplained skin rash, neutropenia, and multiple immunological abnormalities, should be tested for both cocaine and levamisole. Urine toxicology screen is positive for cocaine approximately 72 hours after ingestion. Levamisole requires specialized testing that is not readily available commercially andis positive forless than 48 hours after exposure.
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20
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Oldenburg CE, Mitty JA, Biello KB, Closson EF, Safren SA, Mayer KH, Mimiaga MJ. Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men. AIDS Behav 2016; 20:1451-60. [PMID: 26462669 DOI: 10.1007/s10461-015-1226-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Alcohol and stimulant use are independently associated with increased HIV acquisition among men who have sex with men (MSM). We assessed differences in acceptability and perceived barriers to uptake of pre-exposure prophylaxis (PrEP) among stimulant and alcohol-using MSM in Boston. From September 2012-2013, a quantitative assessment was conducted with 254 MSM respondents who reported recent condomless sex in the context of concurrent stimulant (crack/cocaine and crystal methamphetamine; n = 132) or alcohol use (n = 122). Thirteen (5.1 %) reported previous PrEP use. In multivariable models, stimulant users were more likely to be concerned that substance use would affect PrEP adherence (aRR = 2.79, 95 % CI 1.63-4.77), and were less concerned about HIV stigma as a barrier to PrEP uptake (aRR = 0.52, 95 % CI 0.30-0.90) compared to alcohol users. Barriers to PrEP uptake and adherence differ by type of substance used. Different strategies may be required for PrEP implementation among MSM who use stimulants and alcohol.
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Affiliation(s)
- Catherine E Oldenburg
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jennifer A Mitty
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katie B Biello
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Community Health, Boston, MA, USA.
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
- Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
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21
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Hueza IM, Ponce F, Garcia RCT, Marcourakis T, Yonamine M, Mantovani CDC, Kirsten TB. A new exposure model to evaluate smoked illicit drugs in rodents: A study of crack cocaine. J Pharmacol Toxicol Methods 2016; 77:17-23. [PMID: 26391341 DOI: 10.1016/j.vascn.2015.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/11/2015] [Indexed: 01/30/2023]
Abstract
The use of smoked illicit drugs has spread dramatically, but few studies use proper devices to expose animals to inhalational abused drugs despite the availability of numerous smoking devices that mimic tobacco exposure in rodents. Therefore, the present study developed an inexpensive device to easily expose laboratory animals to smoked drugs. We used crack cocaine as the drug of abuse, and the cocaine plasma levels and the behaviors of animals intoxicated with the crack cocaine were evaluated to prove inhaled drug absorption and systemic activity. We developed an acrylic device with two chambers that were interconnected and separated by a hatch. Three doses of crack (100, 250, or 500 mg), which contained 63.7% cocaine, were burned in a pipe, and the rats were exposed to the smoke for 5 or 10 min (n=5/amount/period). Exposure to the 250-mg dose for 10 min achieved cocaine plasma levels that were similar to those of users (170 ng/mL). Behavioral evaluations were also performed to validate the methodology. Rats (n=10/group) for these evaluations were exposed to 250 mg of crack cocaine or air for 10 min, twice daily, for 28 consecutive days. Open-field evaluations were performed at three different periods throughout the experimental design. Exposed animals exhibited transient anorexia, increased motor activity, and shorter stays in central areas of the open field, which suggests reduced anxiety. Therefore, the developed model effectively exposed animals to crack cocaine, and this model may be useful for the investigation of other inhalational abused drugs.
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Affiliation(s)
- Isis M Hueza
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo (ICAQF-UNIFESP), Diadema, S.P., Brazil; Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, S.P., Brazil.
| | - Fernando Ponce
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, S.P., Brazil
| | - Raphael C T Garcia
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo (ICAQF-UNIFESP), Diadema, S.P., Brazil; Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, S.P., Brazil
| | - Tânia Marcourakis
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, S.P., Brazil
| | - Maurício Yonamine
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, S.P., Brazil
| | - Cínthia de C Mantovani
- Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, S.P., Brazil
| | - Thiago B Kirsten
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, S.P., Brazil
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22
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Affiliation(s)
- R Shah
- SUNY Upstate Medical University, 50 Presidential Plaza, Syracuse, NY 13202, USA
| | - A Patel
- SUNY Upstate Medical University, 153 Summerheaven drive, East Syracuse, NY 13057, USA
| | - O Mousa
- SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA
| | - D Manocha
- SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA
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23
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Bissonette S, Behrouz R. [Internal carotid artery dissection following cocaine use]. Rev Neurol 2015; 61:46. [PMID: 26108909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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24
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Seabright A, Britt-Dewyer R. Painful purpura and cutaneous necrosis. Cutis 2015; 95:E1-E3. [PMID: 25942031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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25
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Boyd AS. Fixed-drug reaction secondary to cocaine use. Skinmed 2015; 13:153-154. [PMID: 26137747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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26
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Ammar AT, Livak M, Witsil JC. Old drug new trick: levamisole-adulterated cocaine causing acute kidney injury. Am J Emerg Med 2014; 33:309.e3-4. [PMID: 25195046 DOI: 10.1016/j.ajem.2014.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/01/2014] [Indexed: 11/18/2022] Open
Abstract
Levamisole is an agent previously used in humans and later withdrawn from the US drug market due to concerns of agranulocytosis.It is currently used as an adulterating agent in cocaine, bringing to light toxicities typically manifested by vasculitis and skin necrosis.We report a case of a 36-year-old crack cocaine user who presented with a purpuric rash on her face and limbs. Levamisole-induced vasculitis was suspected, and she therefore underwent an extensive work-up. In addition to these findings, she also presented with acute kidney injury of unknown etiology, which was later attributed to levamisoleadulterated cocaine.
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Affiliation(s)
- Abeer T Ammar
- John H. Stroger, Jr Hospital of Cook County, Department of Pharmacy, Chicago, IL, USA.
| | - Mark Livak
- John H. Stroger, Jr Hospital of Cook County, Department of Emergency Medicine, Chicago, IL, USA.
| | - Joanne C Witsil
- John H. Stroger, Jr Hospital of Cook County, Department of Pharmacy, Chicago, IL, USA; John H. Stroger, Jr Hospital of Cook County, Department of Emergency Medicine, Chicago, IL, USA.
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Narvaez JCM, Jansen K, Pinheiro RT, Kapczinski F, Silva RA, Pechansky F, Magalhães PVS. Violent and sexual behaviors and lifetime use of crack cocaine: a population-based study in Brazil. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1249-55. [PMID: 24519271 DOI: 10.1007/s00127-014-0830-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the prevalence of lifetime use of crack cocaine and to assess associations with violent and sexual behaviors in young adults selected from the general population of Pelotas, Southern Brazil. METHODS This cross-sectional population-based study included 1,560 participants aged 18-24 years. The use of alcohol and other substances, including crack cocaine, was assessed using the alcohol, smoking and substance involvement screening test. Other variables included violent behaviors, firearm possession, and sexual risk behaviors. The frequency of antisocial personality disorder was also investigated. Associations were analyzed using a crude model and models adjusted for sex, social class, and the use of snorted cocaine. RESULTS Lifetime prevalence of crack cocaine use was 2.51 %, and it was higher among males and individuals coming from more vulnerable social classes (D or E). In the final multivariate models, lifetime use of crack cocaine was associated with episodes of aggression and firearm possession, as well as with a higher chance of not having used condom in the last sexual intercourse. In less conservative models, crack cocaine use was associated with other violent and sexual risk behaviors. DISCUSSION The strong association observed between lifetime use of crack cocaine and different violent and sexual risk behaviors underscores relevant characteristics of people who use crack cocaine. Improving our understanding of possible causal chains leading to such associations should be a priority in future studies.
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Affiliation(s)
- Joana C M Narvaez
- Laboratório de Psiquiatria Molecular, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-003, Brazil,
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Abstract
OBJECTIVES To evaluate family problems among crack/cocaine users compared with alcohol and other substance users. METHODS A cross-sectional multi-center study selected 741 current adult substance users from outpatient and inpatient Brazilian specialized clinics. Subjects were evaluated with the sixth version of the Addiction Severity Index, and 293 crack users were compared with 126 cocaine snorters and 322 alcohol and other drug users. RESULTS Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p=0.004), having trouble getting along with partners (61.5%× 64.6%× 48.7%, p=0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p=0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p=0.011). CONCLUSIONS Brazilian treatment programs should enhance family treatment strategies, and childcare services need to be included.
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Affiliation(s)
- Helena Ferreira Moura
- Center for Drug and Alcohol Research, Hospital de Clínicas of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniela Benzano
- Center for Drug and Alcohol Research, Hospital de Clínicas of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research, Hospital de Clínicas of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Meyer VJ, Little DM, Fitzgerald DA, Sundermann EE, Rubin LH, Martin EM, Weber KM, Cohen MH, Maki PM. Crack cocaine use impairs anterior cingulate and prefrontal cortex function in women with HIV infection. J Neurovirol 2014; 20:352-61. [PMID: 24760360 DOI: 10.1007/s13365-014-0250-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
Crack cocaine use is associated with impaired verbal memory in HIV-infected women more than uninfected women. To understand the neural basis for this impairment, this study examined the effects of crack cocaine use on activation of the prefrontal cortex (PFC) and strategic encoding during a verbal memory task in HIV-infected women. Three groups of HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study were compared: current users of crack cocaine (n = 10), former users of cocaine (n = 11), and women who had never used cocaine (n = 9). Participants underwent functional magnetic resonance imaging during a verbal memory task and completed a neuropsychological test of verbal memory. On the neuropsychological test, current crack users performed significantly worse than other groups on semantic clustering, a measure of strategic encoding, p < 0.05. During encoding, activation in left anterior cingulate cortex (ACC) was lower in current and former cocaine users compared to never users. During recognition, activation in bilateral PFC, specifically left dorsal medial PFC and bilateral dorsolateral PFC, was lower in current and former users compared to women who had never used cocaine. Lower activation in left dorsolateral PFC was correlated with worse performance on the recognition task, p < 0.05. The verbal learning and memory deficits associated with cocaine use in women with HIV may be partially accounted for by alterations in ACC and PFC function.
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Hulka LM, Eisenegger C, Preller KH, Vonmoos M, Jenni D, Bendrick K, Baumgartner MR, Seifritz E, Quednow BB. Altered social and non-social decision-making in recreational and dependent cocaine users. Psychol Med 2014; 44:1015-1028. [PMID: 23870112 DOI: 10.1017/s0033291713001839] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Maladaptive decision-making is assumed to be a core feature of cocaine addiction. Indeed, numerous studies have reported deficits in non-social decision-making tasks and reward-related impulsivity in dependent cocaine users. However, social decision-making has not been examined in cocaine users yet. Moreover, it is unknown if even recreational and non-dependent cocaine use is linked to decision-making deficits. Therefore, we investigated whether recreational and dependent cocaine users exhibit alterations in social and non-social decision-making. METHOD The performance of healthy controls (n = 68), recreational cocaine users (n = 68) and dependent cocaine users (n = 30) in classical decision-making paradigms (Iowa Gambling Task, Delay Discounting) and in social interaction paradigms (Distribution Game, Dictator Game) was assessed. RESULTS Decisions in the social interaction tasks of both cocaine user groups were more self-serving compared with controls as cocaine users preferred higher monetary payoffs for themselves. In the Iowa Gambling Task, only dependent cocaine users were more likely to choose disadvantageous card decks, reflecting worse decision-making. They were also more likely to choose immediate smaller rewards over larger delayed rewards in the Delay Discounting task. CONCLUSIONS Our results imply that both recreational and dependent cocaine users are more concerned with their own monetary gain when interacting with another person. Furthermore, primarily dependent cocaine users are less foresighted and more impulsive regarding immediate reward. Overall, social interaction deficits are already present in recreational users, while non-social decision-making deficits occur predominantly in dependent cocaine users. Thus, social interaction training and cognitive remediation strategies may improve treatment success and quality of life in cocaine dependence.
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Affiliation(s)
- L M Hulka
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - C Eisenegger
- Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, Cambridge, UK
| | - K H Preller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - M Vonmoos
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - D Jenni
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - K Bendrick
- Department of Economics, University of Konstanz, Konstanz, Germany
| | - M R Baumgartner
- Institute of Legal Medicine, University of Zurich, Zurich, Switzerland
| | - E Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - B B Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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31
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Francke ID, Viola TW, Tractenberg SG, Grassi-Oliveira R. Childhood neglect and increased withdrawal and depressive severity in crack cocaine users during early abstinence. Child Abuse Negl 2013; 37:883-889. [PMID: 23988085 DOI: 10.1016/j.chiabu.2013.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 02/13/2013] [Accepted: 04/18/2013] [Indexed: 06/02/2023]
Abstract
Studies have shown that environmental factors, such as exposure to childhood maltreatment, might shift the course of addiction. Little is known, however, about whether childhood physical neglect (PN) influences the severity of withdrawal and depressive symptoms during the detoxification period. This is a 3 weeks follow-up study. The participants were divided into 2 groups: those with a history of PN (PN+) (n=32) and those without a history of PN (PN-) (n=48). Clinical variables were assessed with the SCID-I, BDI-II, Childhood Trauma Questionnaire, Addiction Severity Index and Cocaine Selective Severity Assessment. Depressive symptom assessments were repeated at three time points. Withdrawal symptom assessments were repeated at five different points following detoxification. A repeated measures analysis of covariance indicated that the PN+ group exhibited a significantly lower reduction in the severity of withdrawal symptoms compared to the PN- group (p<0.05). Post hoc analyses showed that after 12 days of treatment, the severity of withdrawal symptoms in the PN+ group did not decrease in the same level as was observed in the PN- group. Moreover, a strong correlation was found between the severity of depression and the intensity of the abstinence symptoms during treatment. Patients who reported more depressive symptoms also exhibited more severe withdrawal symptoms. The ASI-6 indicated higher severity problems related to alcohol and psychiatric disorders in the PN+ groups. Our data support the role of childhood PN in the contingencies of the detoxification process of crack cocaine-dependent women.
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Affiliation(s)
- Ingrid D'avila Francke
- Centre of Studies and Research in Traumatic Stress, Post-Graduate Program in Psychology and Biomedical Research Institute, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, prédio 11, sala 936, 90619-900, Porto Alegre, RS, Brazil
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Larrosa-Campo D, Ramon-Carbajo C, Benavente-Fernandez L, Alvarez-Escudero R, Zeidan-Ramon N, Calleja-Puerta S, Pascual J. [Diagnosis of stroke due to cocaine and its complications]. Rev Neurol 2013; 57:167-170. [PMID: 23884871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION. Cocaine is an independent cerebrovascular risk factor both for ischaemic and haemorrhagic events, above all among persons under 55 years of age. CASE REPORT. A case report of stroke due to the consumption of cocaine is used to review its pathophysiology and the complexity involved in the management and diagnosis of the associated complications. One of these complications reported in relation to the consumption of cocaine is vasospasm. This condition shares findings observed in ultrasound imaging studies with other conditions, such as early-onset post ischaemic hyperperfusion. Yet, there are important differences between the two as regards their treatment and prognosis. CONCLUSIONS. The consumption of cocaine is associated with cerebrovascular disease through a number of different mechanisms, which each give rise to different complications. By identifying these complications, correct management can be implemented.
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MESH Headings
- Adult
- Aphasia/etiology
- Cerebrovascular Circulation/drug effects
- Cocaine/adverse effects
- Cocaine-Related Disorders/complications
- Crack Cocaine/adverse effects
- Hemianopsia/etiology
- Humans
- Infarction, Middle Cerebral Artery/chemically induced
- Infarction, Middle Cerebral Artery/complications
- Infarction, Middle Cerebral Artery/diagnosis
- Infarction, Middle Cerebral Artery/physiopathology
- Magnetic Resonance Angiography
- Male
- Nimodipine/therapeutic use
- Smoking/adverse effects
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Transcranial
- Vasodilator Agents/therapeutic use
- Vasospasm, Intracranial/chemically induced
- Vasospasm, Intracranial/physiopathology
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Affiliation(s)
- D Larrosa-Campo
- Hospital Universitario Central de Asturias, 33006 Oviedo, Espana.
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33
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Bassiouny MA. Dental erosion due to abuse of illicit drugs and acidic carbonated beverages. Gen Dent 2013; 61:38-44. [PMID: 23454320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Consumption of illicit drugs and the abusive intake of acidic carbonated beverages (particularly soda) often are associated with similar types of damage to the human dentition, the most common of which is dental erosion. The dentitions of individuals who are addicted to methamphetamines or crack cocaine can be misdiagnosed as dental caries rather than generalized dental erosion, a condition that also is associated with chronic excessive consumption of soda. Failing to identify the causative etiology could lead to a wrongful diagnosis that could in turn adversely affect treatment planning and misdirect a specified prevention protocol. This article seeks to identify the unique clinical features of each one of these conditions, highlight the resemblances between them, and recognize the unambiguous differences in their fundamental characteristics. Three representative cases-involving a methamphetamine user, a crack cocaine addict, and an avid consumer of diet soda-are presented. In each case, the patient has admitted to the cause of their poor oral health. The dental, oral, and paraoral manifestations of each case are documented and differentiated from one another, and the factors that contributed to the associated disease process are discussed.
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Affiliation(s)
- Mohamed A Bassiouny
- Department of Restorative Dentistry, School of Dentistry, Temple University in Philadelphia, Pennsylvania, USA
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Abstract
Illicit drugs are known for their deleterious effects upon the central nervous system and more specifically for how they adversely affect hearing. Objective This study aims to analyze and compare the hearing complaints and the results of brainstem evoked response audiometry (BERA) of former drug user support group goers. Methods This is a cross-sectional non-experimental descriptive quantitative study. The sample consisted of 17 subjects divided by their preferred drug of use. Ten individuals were placed in the marijuana group (G1) and seven in the crack/cocaine group (G2). The subjects were further divided based on how long they had been using drugs: 1 to 5 years, 6 to 10 years, and over 15 years. They were interviewed, and assessed by pure tone audiometry, acoustic impedance tests, and BERA. Results No statistically significant differences were found between G1 and G2 or time of drug use in absolute latencies and interpeak intervals. However, only five of the 17 individuals had BERA results with adequate results for their ages. Conclusion Marijuana and crack/cocaine may cause diffuse disorders in the brainstem and compromise the transmission of auditory stimuli regardless of how long these substances are used for.
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Associação Brasileira de Psiquiatria. Abuse and addiction: crack. Rev Assoc Med Bras (1992) 2012; 58:141-53. [PMID: 22569607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Vogenthaler NS, Hadley C, Rodriguez AE, Valverde EE, del Rio C, Metsch LR. Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS Behav 2011; 15:1520-6. [PMID: 20099017 PMCID: PMC2934749 DOI: 10.1007/s10461-010-9668-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Depression contributes to worse general and HIV-related clinical outcomes. We examined the prevalence of and factors associated with depressive symptomatology among HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit is an Opportunity for Prevention and Engagement with HIV-positive Crack Users). We used multiple logistic regression to determine sociodemographic correlates associated with screening in for depression. Among 291 participants, three-quarters (73.5%) were identified as depressed. Higher odds of screening in for depression was associated with food insufficiency and monthly income below $600. Alcohol and crack use were not associated with screening in for depression. Depressive symptomatology is extremely prevalent among HIV-infected crack cocaine users and is associated with food insufficiency and lower income. Screening for depression and food insecurity should be included in HIV prevention and treatment programs. Improved recognition and mitigation of these conditions will help alleviate their contribution to HIV-related adverse health outcomes.
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Affiliation(s)
- Nicholas S Vogenthaler
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Timpson SC, Williams ML, Bowen AM, Atkinson JS, Ross MW. Sexual activity in HIV-positive African American crack cocaine smokers. Arch Sex Behav 2010; 39:1353-8. [PMID: 20628803 PMCID: PMC2970740 DOI: 10.1007/s10508-010-9653-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 02/26/2010] [Accepted: 02/26/2010] [Indexed: 05/26/2023]
Abstract
The AIDS epidemic in the United States continues to disproportionately affect minorities of color, especially African Americans. The purpose of this study was to explore the sexual behaviors of a sample of African American HIV positive crack smokers aware of their serostatus. Participants (100 men, 37 women) were included in this study based on the following criteria: a minimum age of 18 years, HIV positive serostatus, treatment with HIV antiretroviral medications for a minimum of 3 months prior to interview, crack cocaine use at least once in the 7 days prior to being interviewed, willingness to provide a urine sample to confirm recent drug use, and vaginal or anal sex at least once in the past 7 days. The questionnaire was a compilation of other reliable surveys and was designed to collect sociodemographic data, drug use, sexual behavior, condom use intentions and motivators, STD and HIV infection history, HIV medications, and adherence requirements. Participants reported having 1,266 different partners in the 30 days prior to the interview and had traded sex for money or drugs with 68%. A total of 79 participants had multiple partners and accounted for 1,247 partnerships. Rates of consistent condom use across partnerships were low, indicating that more interventions in this at-risk population are needed.
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Affiliation(s)
- Sandra C. Timpson
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, 7000 Fannin, Suite 2516, Houston, TX 77030, USA
| | - Mark L. Williams
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, 7000 Fannin, Suite 2516, Houston, TX 77030, USA
| | - Anne M. Bowen
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | - John S. Atkinson
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, 7000 Fannin, Suite 2516, Houston, TX 77030, USA
| | - Michael W. Ross
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, 7000 Fannin, Suite 2516, Houston, TX 77030, USA
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Abstract
This study examined sociodemographic and drug-related predictors of depressive symptoms among a rural, multistate sample of not-in-treatment stimulant drug users (n=710). Participants were recruited using respondent-driven sampling in Ohio, Arkansas, and Kentucky. The Patient Health Questionnaire (PHQ-9) was used to measure symptoms of depression. Moderate to severe depressive symptomatology was reported by 43.0% of the sample. Cumulative logistic regression analysis showed that daily and nondaily crack use as well as the daily use of cocaine HCl increased the odds of depressive symptoms. Methamphetamine use had no significant association with depression. The daily use of marijuana, the illicit use of tranquilizers, light/moderate cigarette smoking, and injection drug use also increased the risk of depressive symptoms. Living in Kentucky or Ohio (compared to Arkansas), having unstable living arrangements, and being White, female, and older were related to higher odds of depressive symptoms. These results suggest that a host of drug and nondrug factors need to be considered when addressing depressive symptoms in stimulant users.
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Affiliation(s)
- Raminta Daniulaityte
- Center for Interventions, Treatment, and Addiction Research, Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA.
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Ribeiro LA, Sanchez ZM, Nappo SA. Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug. BMC Public Health 2010; 10:671. [PMID: 21050465 PMCID: PMC3091576 DOI: 10.1186/1471-2458-10-671] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 11/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users. METHOD A qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software. RESULTS There was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival. CONCLUSIONS The strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.
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Affiliation(s)
- Luciana A Ribeiro
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
| | - Zila M Sanchez
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
| | - Solange A Nappo
- Universidade Federal de São Paulo/Psychobiology Department, Brazilian Center of Information of Psychotropic Drugs (CEBRID), Rua Napoleão de Barros, 925 - Vila Clementino, São Paulo, Brazil
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Mohammedi K, Yersin B, Staeger P, Gonzalez M, Carron PN. [Cocaine use and pneumothorax]. Rev Med Suisse 2010; 6:1678-1681. [PMID: 20939403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cocaine use, often not recognized, is a frequent cause of consultation in the emergency room or by primary care physicians. The use of cocaine causes numerous cardiovascular and pulmonary side effects. In this context, the occurrence of a pneumothorax represents a specific complication, often misunderstood by primary care physicians. We describe here three cases of patients who suffered from subcutaneous emphysema and pneumothorax after taking cocaine and emphasize the importance of always keeping in mind the possibility of illicit substance use in such cases, especially among young and healthy patients.
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Ruiz-Tovar J, Candela F, Oliver I, Calpena R. Sigmoid colon stenosis: a long-term sequelae of cocaine-induced ischemic colitis. Am Surg 2010; 76:E178-E179. [PMID: 21396279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
This article explores differences in the social context in which crack sales and use and HIV risk take place in seven low-income communities in San Salvador, and structural factors that may influence these differences. The organization of drug selling varied among the communities on a number of dimensions including: whether drug sales were open or closed systems; the type of drug-selling site; and the participation of drug users in drug-distribution roles. Drug-use sites also varied according to whether crack was used in private, semiprivate, or public spaces, and whether individuals used drugs alone or with other drug users. Three patterns of drug use and selling were identified based on the dimensions outlined above. Structural factors that influenced these patterns included the geographic location of the communities, their physical layout, gang involvement in drug sales, and police surveillance. Implications for HIV risk and prevention are explored for each pattern.
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Affiliation(s)
- Julia Dickson-Gomez
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, USA
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Viana BDM, Moura ADS, Moreira JM, Prais HAC, Cardoso F. Ataxia and dementia due to thinner abuse. Mov Disord 2009; 24:1850-2. [PMID: 19609910 DOI: 10.1002/mds.22696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Usdan SL, Schumacher JE, Milby JB, Wallace D, McNamara C, Michael M. CRACK COCAINE, ALCOHOL, AND OTHER DRUG USE PATTERNS AMONG HOMELESS PERSONS WITH OTHER MENTAL DISORDERS. The American Journal of Drug and Alcohol Abuse 2009; 27:107-20. [PMID: 11373029 DOI: 10.1081/ada-100103121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study examined the co-occurrence of cocaine, alcohol, marijuana, and other drug use among treatment seeking homeless persons to determine whether alcohol use predicted cocaine use differently than marijuana and other drugs predicted cocaine use. Participants were 141 homeless persons with substance use and other nonpsychotic mental disorders seeking drug treatment at a metropolitan health care agency for homeless persons. They were 72.3% male, 27.7% female, 82.7% African American, 17.3% Caucasian, with an average age of 37.7 (SD 7.1) years and had 13.1 (SD 2.4) average years of education. Results supported the assertion that cocaine use was strongly associated with extent of alcohol use and that the association between cocaine and alcohol was stronger than the association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol disorders were retained longer in treatment than disorders of cocaine only with no differences in abstinence outcome. The findings should drive further research into the use of alcohol as a trigger or predictor of cocaine use, the deleterious effects of the combined use of cocaine and alcohol, and specialized treatments for polysubstance users.
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Affiliation(s)
- S L Usdan
- The University of Alabama at Birmingham School of Medicine, Division of Preventive Medicine, USA.
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Abstract
BACKGROUND The presence of anthracotic pigment (carbon) in pleural fluid cytologic samples is unusual and to date has only been reported in individuals who are crack (freebase cocaine) smokers. We report the cytologic finding of carbon-laden macrophages in pleural fluid unrelated to crack abuse. CASES Two patients were identified with anthracotic pigment within their pleural fluid on cytologic review; an 88-year-old human immunodeficiency virus (HIV)-negative man with a transudative effusion and a 46-year-old HIV-positive man with a history of crack abuse who presented with an exudative effusion. Dense black pigment within macrophages was identified in both the ThinPrep slide and cell block material. This pigment failed to stain for iron and was present within the cytoplasm of KP-1 immunoreactive and TFF-1 negative macrophages. CONCLUSION Carbon-laden macrophages can be found in exudative and transudative pleural effusions and may be seen without any relationship to crack abuse. Because this finding may be secondary to a subclinical pneumothorax, its identification and reporting may be of clinical significance.
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Affiliation(s)
- Liron Pantanowitz
- Division of Cytopathology, Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, Massachusetts 01199, USA.
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Göregen M, Akgül M, Aras MH. Comments on "Cytomorphometric analysis of crack cocaine effects on the oral mucosa". ACTA ACUST UNITED AC 2009; 107:451. [PMID: 19327636 DOI: 10.1016/j.tripleo.2008.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 07/24/2008] [Indexed: 11/18/2022]
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50
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Abu-kishk I, Rosenfeld-Yehoshua N. Massive pulmonary hemorrhage in an adolescent. Isr Med Assoc J 2008; 10:593-594. [PMID: 18847158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ibrahim Abu-kishk
- Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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