Cocaine-abusing Patients Research Articles

A Preliminary Investigation of Lamotrigine for Cocaine Abuse in HIV-Seropositive Patients

Theoretical considerations as well as pre-clinical data suggest a potential role for glutamate-inhibiting agents in the treatment of cocaine addiction. At present, however, there is little clinical data to inform the use of these agents for this application. In this preliminary study eighteen HIV-seropositive cocaine dependent, opiate-agonist maintained patients received lamotrigine (300 mg/day), an indirect glutamate release inhibitor, on either a standard (n = 8) or accelerated (n = 10) induction schedule for 12 weeks. Results showed a significant decrease in percentage of cocaine-positive urine screens in the standard induction lamotrigine group but not in the accelerated induction group. There were fewer reports of side-effects and fewer dropouts in the standard-induction lamotrigine group compared to the accelerated induction group. Neuropsychological assessments suggested a decrement in the Trail Making Tests, but no other decreases in cognitive functioning. We conclude that standard-induction lamotrigine warrants further investigation for the treatment of cocaine abuse in this patient population.

Recurrent personal memories during intoxication reported by patients with alcoholism.

Experimental studies have demonstrated that alcohol has state-dependent effects on learning and memory. We, therefore, sought to determine if alcohol intoxication triggers selective retrieval of memories which could alter patterns of alcohol use. Eighteen alcoholic patients were studied as well as a comparison group of 12 patients who abused cocaine, a drug not associated with memory state-dependence. Patients underwent a semi-structured interview to elicit information about recurrent personal memories experienced when intoxicated. Recurrent memories experienced during craving were also studied as a comparison condition. The prevalence of recurrent personal memories during intoxication was reported to be much higher for alcoholic patients compared with the cocaine-abusing patients. These experiences occurred more frequently than during craving, generally reflected prior disturbing events and were often reported to promote continued drinking. The association of recurrently experienced personal memories with intoxication in alcoholic patients suggests, but does not establish, pharmacological state-dependence. Further studies of this memory phenomenon are indicated.

Cardiac complications of cocaine abuse.

Cardiac complications of cocaine abuse and a rational approach to evaluating and managing them are described. Cardiac abnormalities reported among asymptomatic cocaine abusers include echocardiographic left ventricular hypertrophy and segmental wall motion abnormalities. Electrocardiogram may reveal increased QRS voltage, ST-T changes, and pathologic Q waves. Episodes of ST elevation may be seen during Holter monitoring. The management of cocaine-abusing patients who present to an emergency room with acute chest pain is controversial because the two reported studies yielded conflicting results regarding the incidence of myocardial infarction (MI). Even in the absence of infarction, electrocardiographic abnormalities are common among these patients, which complicates the decision-making regarding hospitalization. Pathophysiology of cocaine-related MI is discussed. Distinct clinical features of cocaine-related MI make it clear that the association between the two is not just temporal. However, considering the number of persons abusing cocaine, it is a rarity. Beta-adrenergic blockers should be avoided in the treatment of cocaine-induced myocardial ischemia which is best treated with nitrates and calcium-channel blockers. Reports of cocaine-induced myocarditis and cardiomyopathy are reviewed. Experimental studies and clinical case reports suggest that cocaine may cause lethal arrhythmias. Cocaine prolongs repolarization by a depressant effect on potassium current and may generate early afterdepolarizations. It is possible that cocaine-associated arrhythmias are secondary to vasospasm-related ischemia and reperfusion as well.

Physiology and management of cocaine exposure preceding emergency anesthesia and surgery

Cocaine abuse is associated with multiple medical complications. As cocaine-abusing patients may require anesthesia more frequently than non-users, an understanding of the many consequences of the abuse is essential. The goal of this review is to familiarize the anesthesiologist with the current knowledge and understanding of cocaine abuse.

Cerebral perfusion and neuropsychological consequences of chronic cocaine use.

Research indicates that cocaine significantly constricts the cerebral vasculature and can lead to ischemic brain infarction. Long-term effects of intermittent or casual cocaine use in patients without symptoms of stroke or transient ischemic attack were investigated. Single-photon emission computed tomography with xenon-133 and [99mTc]hexamethylpropyleneamine oxime, magnetic resonance imaging, and selected neuropsychological measures were used to study cerebral perfusion, brain morphology, and cognitive functioning. Patients were drug free for at least 6 months before evaluation. All showed regions of significant cerebral hypoperfusion in the frontal, periventricular, and/or temporal-parietal areas. Deficits in attention, concentration, new learning, visual and verbal memory, word production, and visuomotor integration were observed. This study indicates that long-term cocaine use may produce sustained brain perfusion deficits and persistent neuropsychological compromise in some subgroups of cocaine-abusing patients.

Conditioned responses to cocaine-related stimuli in cocaine abuse patients.

Subjects with a history of free-basing and smoking cocaine but no history of opiate injections were exposed to three sets of stimuli. They received cocaine-related stimuli in one session, opiate-related stimuli in a second session, and non-drug stimuli on a third occasion. Compared to the opiate and non-drug cues, the cocaine-related events caused reliable decreases in skin temperature and skin resistance, and reliable increases in heart rate, self-reported cocaine craving, and self-reported cocaine withdrawal. Furthermore, control subjects lacking a history of cocaine or opiate use failed to show such differential responding. These results suggest that cocaine-related stimuli evoke Pavlovian conditioned responses in cocaine abuse patients. Such findings encourage continuing efforts to develop drug treatment strategies based on conditioning principles.

The Many Faces of Cocaine

Cocaine abuse is a major social health problem in the United States. However, much too frequently, cocaine abuse is overlooked by social workers, physicians, and other health team members who are busy directing their interventions at solving and treating the biological and psychosocial effects of taking cocaine, but fail to see the connection between these symptoms and cocaine use. In order to help social workers in health care settings recognize and deal effectively with cocaine-abusing patients, the author presents a three stage practice model. The first two stages focus on strengthening assessment skills via symptom identification and diagnosis confirmation, with attention to patterns and severity of illness. The third stage highlights the referring process leading to appropriate treatment resources.

Cocaine Use and Help-Seeking among Methadone Patients

To better understand the causes of cocaine abuse among methadone patients, the research compared 207 current cocaine users with 78 currently cocaine-free patients. A majority of both samples were using cocaine at the time of program admission. Although most users ceased or decreased cocaine use after entry, for some this respite was only temporary. Pleasure, stimulation, stress relief and self-medication for depression were the main factors precipitating cocaine use. Most of the current cocaine users held distinctly negative attitudes toward cocaine and were seeking help for their problem. The study makes several recommendations for improved services for cocaine-abusing patients.

Cocaine Abuse Treated with Phenelzine

Cocaine abuse, a destructive and deadly worldwide problem, can be controlled effectively and inexpensively. Highly successful results in treating 26 cocaine-abusing patients, most of whom failed other treatment modalities, were achieved with the use of phenelzine (Nardil, Parke-Davis). Phenelzine was chosen because cocaine is contraindicated in patients taking the medication and also because it reduces the craving for cocaine. Phenelzine is thought to correct the biochemical defects caused by chronic cocaine use, namely the depletion of brain dopamine, norepinephrine, and serotonin. Failure of treatment of cocaine abuse with other pharmacological agents is also presented.

Fatal agranulocytosis in a chronic schizophrenic patient treated with carbamazepine

A chronic schizophrenic patient developed a fatal agranulocytosis 1 month after beginning to take carbamazepine for aggression. Routine hematological monitoring was not carried out. This case highlights the need for psychiatrists' increased awareness of the possible hematological complications of carbamazepine.