Cocaine Consumption Research Articles

Dental injuries in Swiss soccer supporters: A comparative study of regular fans, ultras, and hooligans for public health strategies.

Violence among soccer supporters continues to pose a significant public health concern in many parts of the world. In Switzerland, hooliganism is largely uninvestigated. This study aimed to examine incidents of violence and associated dental injuries among different groups of soccer supporters, as well as assess the impact of intoxicants on their behavior, using survey data from regular fans, ultras, and hooligans in the Swiss Football League. A cross-sectional survey using a standardized questionnaire was conducted among distinct factions of soccer supporters in the Swiss Football League in 2022. A total of 165 participants self-identified as belonging to one of three subgroups: "regular fan," "ultra," or "hooligan." Data were gathered on physical altercations, dental injuries, possession of mouthguards, intoxicant use, and medical assistance. Descriptive statistics, logistic regression models, and significance tests were used for data analysis (α = .05). Hooligans had a higher frequency of dental injuries resulting from fights than ultras and regular fans. Hooligans with 11-20 fights per soccer season had a 9.6 times higher probability of dental trauma than those with 0-5 fights (p = .048). Possession of a mouthguard was associated with a lower risk of dental injuries for hooligans but an increased risk for ultras. Additionally, hooligans were found to differ significantly from other groups in their consumption of amphetamines and cocaine (p < .001). The study found a strong link between physical altercations and dental injuries among soccer supporters. To promote better prevention, there is a necessity for enhanced educational initiatives facilitated by dentists to amplify the dissemination of mouthguards. Furthermore, it is crucial to raise awareness regarding their proper fitting to minimize the occurrence of combat-related dental injuries. Health authorities and other stakeholders should take a comprehensive approach to addressing some of the root causes of violent behavior, which include alcohol abuse and illicit substance consumption.

Chronic oral methylphenidate plus fluoxetine treatment in adolescent rats increases cocaine self-administration

BackgroundDepression and attention deficit hyperactivity disorder are known to be comorbid. Treatment of these commonly coexisting diseases typically involves the combined prescription of methylphenidate (MP), a psychostimulant, and fluoxetine (FLX), a selective serotonin reuptake inhibitor (SSRI). MP and cocaine have similar mechanisms of action and this study examined the effects of chronic treatment of MP combined with FLX on cocaine consumption in rats. MethodsFour groups of rats received access to drinking solutions of water (control), MP (30/60 mg/kg/day), FLX (20 mg/kg/day), or the combination of MP (30/60 mg/kg/day) plus FLX (20 mg/kg/day), during 8 h per day for one month. Following these drug treatments, rats were allowed to self-administer cocaine for 14 days. ResultsOur results showed that, during the first week of cocaine self-administration, the MP-treated rats had significantly greater numbers of active lever presses (plus 127%) and increased consumption of cocaine compared to the control rats. In contrast, during week two of cocaine self-administration, the rats treated with the MP + FLX combination showed significantly more lever presses (plus 198%) and significantly greater cocaine consumption (plus 84%) compared to the water controls. ConclusionChronic oral treatment during adolescence with the combination of MP plus FLX resulted in increased cocaine use after 2 weeks of cocaine self-administration in rats. These novel findings suggest that the combined exposure to these two drugs chronically, during adolescence, may produce increased vulnerability towards cocaine abuse during young adulthood.

Exploring drug consumption patterns across varying levels of remoteness in Australia

Wastewater-based epidemiology (WBE) relies on representative sampling that is typically achieved with autosamplers that collect time, flow, or volume proportional samples. The expense, resources and operational know-how associated with autosampler operation means they are only typically available at major wastewater treatment plants (WWTPs). This results in a lack of data on consumption levels in regional and remote areas, or in countries that lack the financial means. The aim of this study was to estimate and investigate trends in drug consumption across varying levels of remoteness in Australia. Field-calibrated, microporous polyethylene passive samplers were deployed over 2 periods (Aug/Sept 2019 and 2020) at 43 treatment plants covering all five categories of remoteness, as per Australian Bureau of Statistics definitions (Major cities, Inner regional, Outer regional, Remote, and Very remote). The per capita consumption of cocaine, methylamphetamine, nicotine, oxycodone and MDMA were estimated. No spatial trends between remoteness and drug consumption were observed, except for cocaine, where Major cities had a 5-to-10-fold higher consumption compared to the other levels of remoteness in 2019 and 2020, respectively. Outer regional sites had the highest and lowest methylamphetamine consumption. The variance in drug use among sites was much higher in Remote (and Inner/Outer regional) sites when compared with Major cities. A significant and consistent decrease in oxycodone consumption was observed at all sites between 2019 and 2020, possibly related to regulatory changes and the COVID-19 pandemic where elective surgeries were suspended. The majority of sites experienced a decrease in cocaine and methylamphetamine consumption, possibly due to border restrictions or changes in supply and demand dynamics. This was the first extensive passive sampling study to assess drug consumption in urban, regional, and remote locations, demonstrating that passive samplers can facilitate extension of wastewater-based drug monitoring programs to sites where other representative sampling options are very difficult to implement.

Cocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence.

Cocaine consumption has increased over the last decade. The potent sympathomimetic effects of the drug can lead to serious neurovascular complications in the form of ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). This systematic review and meta-analysis were designed to describe the clinical features and outcomes of patients suffering from IS, ICH, or SAH occurring in the context of cocaine use. The PubMed, Embase, Cochrane, and Web of Science libraries were queried in December 2022. Studies were included if they provided information regarding the epidemiology, clinical presentation, or outcomes in cocaine-associated strokes. Odds ratios (OR) were pooled using a random-effects model. A total of 36 papers were included. Strokes associated with cocaine use were more prevalent in younger populations and those of African American descent. Cocaine use increased the odds of IS, ICH, or SAH (OR = 5.05, p < 0.001). The odds of mortality (OR = 1.77, p = 0.0021), vasospasm (OR = 2.25, p = 0.0037), and seizures (OR = 1.61, p < 0.001) were also worse when strokes were associated with cocaine use. In addition to counseling patients on the benefits of drug cessation, clinicians should remain vigilant of the potential complications in patients who are hospitalized with cocaine-associated strokes.

Concomitant Drug Use among Opioid-Dependent Patients with and without Attention Deficit Hyperactivity Disorder: Does Methylphenidate Merit a Trial?

Introduction: Concomitant drug use is common among opioid-dependent patients in maintenance therapy. Attention deficit hyperactivity disorder (ADHD), a common comorbidity among opioid users, is associated with a higher risk of concomitant drug use. Earlier studies showed that methylphenidate (MPH) can reduce cocaine consumption among patients with ADHD. The use of MPH as an agonist-replacement or maintenance therapy in cocaine-dependent patients without ADHD is also common in Switzerland, despite a lack of supporting evidence. The aim of this study was to assess concomitant cocaine, amphetamine, MDMA, MPH, and heroin use among patients in opioid maintenance therapy either with or without comorbid ADHD. We expected stimulant consumption to be higher in patients with cocaine dependence and comorbid ADHD and that use of MPH would not lead to a reduction in cocaine consumption in patients without ADHD. We therefore evaluated correlations between use of MPH and cocaine consumption and between MPH consumption and cocaine craving within the two groups. Methods: This cross-sectional study included 94 opioid-dependent patients in maintenance therapy in an outpatient department of the Psychiatric Hospital of Zurich. The patients were divided into two groups based on comorbid ADHD; a group with ADHD (N = 27) and a group without ADHD (N = 67). Drug use was assessed using 3-month hair analysis. Results: We did not find significant differences in the number of patients using cocaine, amphetamine, MDMA, or heroin between groups with or without ADHD. With respect to cocaine use, 85.2 percent of patients in the ADHD group and 73.1 percent in the non-ADHD group were users. The non-ADHD group showed a significant positive correlation between the concentration of MPH and cocaine in hair samples (p < 0.05), and a positive correlation between cocaine craving and the concentration of MPH in hair samples (p = 0.065). These two trends were not evident in the ADHD group. Conclusion: Among patients without ADHD, use of MPH correlates with higher cocaine consumption and craving. Conversely, no significant correlation was found between MPH and cocaine use in patients with ADHD. Our study adds to the evidence that MPH confers negative effects in cocaine users without ADHD and should thus have no place in the treatment of these patients.

Acquired alterations in nucleus accumbens responsiveness to a cocaine-paired discriminative stimulus preceding rats’ daily cocaine consumption

Resumption of drug taking is a primary focus for substance use disorder research and can be triggered by drug-associated environmental stimuli. The Nucleus Accumbens (NAc) is a key brain region which guides motivated behavior and is implicated in resumption. Yet, there remains a pressing need to characterize NAc neurons’ responsiveness to drug associated stimuli during withdrawal and abstinence. We recorded discriminative stimulus (DS) induced NAc activity via in vivo single-unit electrophysiology in rats that self-administered cocaine. Male and female rats implanted with a jugular catheter and a microwire array in NAc Core and Shell self-administered cocaine under control of a 30s auditory DS for 6 hours per session across 14 consecutive days. Rats acquired tone discrimination within 4 sessions. To exclude pharmacological effects of circulating cocaine from all neuronal analyses, we studied changes in DS-induced firing only for trials preceding the first infusion of cocaine in each of the 14 sessions, which were defined as “pre-drug trials.” NAc neuron responses were assessed prior to tone-evoked movement onset. Responsiveness to the DS tone was exhibited throughout all sessions by the NAc Core population, but only during Early sessions by the NAc Shell population. Both Core and Shell responded selectively to the DS, i.e., more strongly on drug taking trials, or Hits, than on Missed opportunities. These findings suggest that NAc Core and Shell play distinct roles in initiating cocaine seeking prior to daily cocaine consumption, and align with reports suggesting that as drug use becomes chronic, cue-evoked activity shifts from NAc Shell to NAc Core.

Physical Activity Levels, Eating Habits, and Well-Being Measures in Students of Healthcare Degrees in the Second Year of the COVID-19 Pandemic.

When the first cases of COVID-19 (caused by SARS-CoV-2 virus infection) were discovered, exceptional norms to fight the spread of the virus were established by applying movement restrictions (lockdown) in many countries. These unprecedented norms led to sedentary behaviours and less healthy diets which could persist for much longer after lockdown. The aim of this study was to analyse the physical activity, eating habits, self-perceived well-being, and toxic habits, as well as the perceived changes of these habits with respect to the pre-pandemic period, in a population of university students in the second year of the COVID-19 pandemic. A single-centre, cross-sectional study was conducted in a population of university students of healthcare degrees. A total of 961 students (639 (66.5%) women and 322 (33.5%) men) signed the informed consent and completed the questionnaire. The study was conducted through an anonymous survey, which was voluntarily self-completed by the students on an online platform. The questionnaire was based on the Spanish Health Survey and it was divided into six main parts: demographic and anthropometric characteristics, physical activity, eating habits, well-being measures (sleeping habits, health state, and stress), toxic habits, and perception of the influence of the COVID-19 pandemic on the variables described. The results showed that, during the second year of the pandemic, statistically significant dependence was identified for those students that showed higher levels of physical activity with greater perceived physical activity (p < 0.05), healthier eating habits (p < 0.05), and a better self-perceived health state (p < 0.05), with respect to the 12 months before the COVID-19 pandemic. On the other hand, there was a negative correlation between the sedentary students and greater perceived physical activity (p < 0.05). With regard to toxic habits and physical activity, a significant correlation was only detected between sedentary behaviour and cocaine consumption (p < 0.05). Analysing eating habits, it was observed that the students who smoked, consumed alcohol, and binge drank had low adherence to the Mediterranean diet (p < 0.05). In addition, those students with high stress levels slept less than 7 h (p < 0.05).

Disseminated Necrotic Suppurative Ulcers as a Manifestation of Cocaine Abuse.

Pyoderma gangrenosum is an immune-mediated illness that can be caused by several affections, such as inflammatory bowel disease, rheumatoid arthritis, and drug use. We present a rare case of pyoderma gangrenosum induced by levamisole-adulterated cocaine. There have been few cases of this disease reported in the world. Levamisole is an anthelmintic drug used to adulterate cocaine to boost its effect. It also has immune-modulating effects causing, among others, vasculitis and dermatological problems. Clinical case of a 46-year-old man admitted to the hospital University Marqués de Valdecilla in Santander, Spain, in August 2022. We diagnosed pyoderma gangrenosum based on clinical, analytical, and histological parameters. We report a case of pyoderma gangrenosum induced by consumption of levamisole-adulterated cocaine. This patient suffered from a rare and extensive immune-mediated affection with characteristic primary lesions in the form of suppurative ulcers that responded to immunosuppressive treatment. Behind pyoderma gangrenosum there may be underlying conditions such as inflammatory bowel disease, or pyoderma gangrenosum may be secondary to identifiable causes such as cocaine use as in this patient. Pyoderma gangrenosum induced by levamisole-adulterated cocaine has the following features:History of cocaine use.Exaggerated skin injury occurring after minor trauma (pathergy).Characteristic histopathologic findings.

Estimation of legal and illegal drugs consumption in Valencia City (Spain): 10 years of monitoring

Wastewater-based epidemiology (WBE) approach provides objective, quantitative, near real-time profiles of illicit drug consumption by monitoring the concentration of unchanged parent drugs or their metabolites entering the municipal sewage system. Valencia is the third most populous city in Spain (an important country for the use and transit of several of these drugs). Estimations of consumption over long periods of time will help get better understanding of spatial and temporal trends in the use of licit and illicit drugs. Accordingly, applying the “best practice” protocol, 16 drugs of abuse and metabolites were monitored in this study, and 8 were daily measured during one-two weeks between 2011 and 2020 at the inlet of three wastewater treatment plants of Valencia City. Analysis of the selected compounds was performed by liquid chromatography-triple quadrupole mass spectrometry, and the concentrations obtained were used to back-calculate the consumption data. Cannabis, tobacco, and cocaine were the most consumed drugs whereas opioids were less used. Cannabis and cocaine consumption are on average 2.7–23.4 and 1.1–2.3 g/day/1000inh, respectively, and their use tended to increase since 2018. Weekly profiles were characterized by higher consumption of cocaine, ecstasy, and heroin during weekends compared to weekdays. Similarly, during “Las Fallas” (main local festivity), increased use of cocaine and amphetamine-type stimulants, mainly MDMA, was measured. WBE proved to be an objective and useful methodology to get more insight on temporal drugs of abuse consumption, and the changes derived from local festivities.

Untargeted metabolomic study by liquid chromatography–mass spectrometry in brain tissues on the effects of combined cocaine and ethanol self-administration in male and female young rats

The combined use of ethanol and cocaine is frequent among drug-abuse users and leads to further exacerbation of health consequences compared to individual consumption and this is of special concern during the transition to adulthood. Despite its high prevalence, the effect of combined consumption of cocaine and ethanol has been scarcely studied. In this work, we report the first untargeted metabolomic study in brain tissues to contribute to the advancement in the knowledge of the possible neurobiological effects of this polysubstance dependence. Liquid Chromatography coupled to high resolution Mass Spectrometry was employed to analyze three different brain tissues samples, prefrontal cortex, striatum and hippocampus, from male and female young rats exposed intravenously to a self-administration of these drugs. After optimizing the best sample treatment and selecting the chromatographic and detection conditions to find the maximum number of significant features (possible biomarker metabolites), the high resolution of the Orbitrap analyzer used in this work has made it possible to find up to 761 significant features with assigned molecular formula, of which up to 190 were tentatively identified and 44 unequivocally confirmed. The results demonstrated that the altered metabolic pathways are involved in multiple functions: receptor systems, such as the Glutamine-Glutamic acid-GABA axis or the catecholamine pathway, purinergic and pyrimidine pathways, fatty acids or oxidative stress, among others.

Sewage analysis as an alternative tool for assessing drug of abuse and new psychoactive substances in Tunisia

Many studies attest to the pollution of wastewaters by organic molecules including drug of abuse (DAs) residues and new psychoactive substances (NPS) at trace levels. The occurrence of these emerging micropollutants in influent wastewaters (IWW) from three Tunisian Wastewater Treatment Plants (WWTPs) was assessed. Influent wastewater composite samples (24 h) were collected over 7 consecutive days in November 2019. The determination and quantification of 11 drug of abuse or their metabolites was performed by the application of an optimized multi-residue method liquid chromatography tandem mass spectrometry (LC–MS/MS). MDMA, THC and the cocaine metabolite benzoyl ecgonine were the most detected substances across the three investigated sewage plants. A new wastewater-based epidemiology (WBE) approach was applied in this study to estimate illicit drug consumption. This innovative approach was used to calculate and to assess collective drug consumption of illicit drug at a community level, based on the concentration of selected illicit substances and their major metabolites in influent wastewater. The average MDMA consumption found in the selected cities ranged between 35,8–1531,1 mg day− 1/1000 inhabitants and increased during the weekends. Cocaine consumption varied from 24.5 to 179.8 mg day− 1/1000 inhabitants.Complementary qualitative investigation of new psychoactive substances was monitored for the first time for an African country, examining the occurrence of 33 NPS in wastewaters samples. Out of 33 totals screened NPS across all sampling sites, 16 were tentatively identified with this approach. The 16 detected NPS covered most of the representative and used molecules of different NPS classes; including synthetic opioids, synthetic cathinones, amphetamines derivatives and synthetic cannabinoids.

Long-term wastewater-based surveillance and impacts of the COVID-19 pandemic on drug use trends in a U.S. Northeast rural town

Herein we discuss the findings of a two-year wastewater-based drug use surveillance from September 2018 to August 2020 and present objective evidence on the impacts of the COVID-19 pandemic on drug use in a rural community. 24-h composite wastewater samples were collected twice each month from a university town in Northeastern United States and were analyzed for ten priority opioids and stimulants: morphine, codeine, hydrocodone, methadone, fentanyl cocaine, methamphetamine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA). All target drugs were detected at 100 % frequency in wastewater samples. On a mass basis, the average estimated per capita drug consumption were highest for cocaine, morphine, and amphetamine, and lowest for MDMA, MDEA, and hydrocodone. Furthermore, the estimated per capita consumption of fentanyl was higher than previous reports from rural and university settings in the U.S. Generally, drug consumption was higher during the spring semesters, with year-on-year semester increases also noted over the 2-y study period. Except for methadone and cocaine, the estimated average per capita consumption of drugs increased over the pandemic period, with the highest increase noted for MDMA (286 % increase compared to baseline, p = 0.016). Estimated average consumption of methadone and cocaine decreased slightly by 6 % and 7 %, respectively. These results demonstrate the utility and strength of wastewater-based approaches in capturing long-term and evolving trends in drug use within communities. Our study findings reflect the regionwide problem with opioid-related overdoses and increasing stimulant prescription rates. Our findings also provide objective data and insights for health policymakers on the effects of the pandemic period on community drug use in a rural U.S. town.

Cocaine-induced plasticity, motivation, and cue responsivity do not differ in obesity-prone vs obesity-resistant rats; implications for food addiction

RationaleCompared to obesity-resistant rats, obesity-prone rats consume more food, work harder to obtain food, show greater motivational responses to food-cues, and show greater striatal plasticity in response to eating sugary/fatty foods. Therefore, it is possible that obesity-prone rats may also be more sensitive to the motivational properties of cocaine and cocaine-paired cues, and to plasticity induced by cocaine.ObjectiveTo examine baseline differences in motivation for cocaine and effects of intermittent access (IntA) cocaine self-administration on cocaine motivation, neurobehavioral responsivity to cocaine-paired cues, and locomotor sensitization in male obesity-prone vs obesity-resistant rats.MethodsIntravenous cocaine self-administration was used to examine drug-taking and drug-seeking in males. Motivation for cocaine was measured using a within session threshold procedure. Cue-induced c-Fos expression in mesocorticolimbic regions was measured.ResultsDrug-taking and drug-seeking, cue-induced c-Fos, locomotor sensitization, and preferred level of cocaine consumption (Q0) were similar between obesity-prone and obesity-resistant groups. Maximal responding during demand testing (Rmax) was lower in obesity-prone rats. IntA experience enhanced motivation for cocaine (Pmax) in obesity-prone rats.ConclusionsThe results do not support robust inherent differences in motivation for cocaine, cue-induced cocaine seeking, or neurobehavioral plasticity induced by IntA in obesity-prone vs obesity-resistant rats. This contrasts with previously established differences seen for food and food cues in these populations and shows that inherent enhancements in motivation for food and food-paired cues do not necessarily transfer to drugs and drug-paired cues.

Short- and Long-Term Effects of Cocaine on Enteric Neuronal Functions.

Cocaine is one of the most consumed illegal drugs among (young) adults in the European Union and it exerts various acute and chronic negative effects on psychical and physical health. The central mechanism through which cocaine initially leads to improved performance, followed by addictive behavior, has already been intensively studied and includes effects on the homeostasis of the neurotransmitters dopamine, partly mediated via nicotinic acetylcholine receptors, and serotonin. However, effects on the peripheral nervous system, including the enteric nervous system, are much less understood, though a correlation between cocaine consumption and gastrointestinal symptoms has been reported. The aim of the present study was to gain more information on the effects of cocaine on enteric neuronal functions and the underlying mechanisms. For this purpose, functional experiments using an organ bath, Ussing chamber and neuroimaging techniques were conducted on gastrointestinal tissues from guinea pigs. Key results obtained are that cocaine (1) exhibits a stimulating, non-neuronal effect on gastric antrum motility, (2) acutely (but not chronically) diminishes responses of primary cultured enteric neurons to nicotinic and serotonergic stimulation and (3) reversibly attenuates neuronal-mediated intestinal mucosal secretion. It can be concluded that cocaine, among its central effects, also alters enteric neuronal functions, providing potential explanations for the coexistence of cocaine abuse and gastrointestinal complaints.

Detection of coca alkaloids in oral fluid from coca leaf (tea) consumers: using solid phase extraction to improve validation parameters and widen the detection window.

Hygrine and cuscohygrine, two coca leaf alkaloids, have been previously proposed as markers to differentiate legal and illegal cocaine consumption. This is a very common problem in some countries of South America, where the consumption of coca leaves has a long tradition. Analytical methods focusing on the assessment of coca leaf alkaloids, such as cuscohygrine, hygrine, tropacocaine and t-cinnamoylcocaine, in oral fluid are virtually non-existent in forensic toxicology laboratories worldwide due to their lack of application. However, the problem of differentiating legal and illegal cocaine use in criminal justice, DUID (drug-impaired driving) and WDT (workplace drug testing) programs is growing. Therefore, researchers are obliged to develop methods to measure coca leaf alkaloids (cuscohygrine, hygrine and t-cinnamoylcocaine) in biological matrices for further validation for routine analyses in forensic toxicology laboratories. This work aims to optimize a previously published separation method by protein precipitation in oral fluid by using solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) operating in multiple reaction monitoring (MRM) mode. The use of SPE allowed the matrix effect and the background to be reduced in the chromatograms due to the obtained cleaner extracts. Consequently, improved detection and quantification limits were reached. Findings showed that the detection windows for coca leaf alkaloids were longer than three hours in real oral fluid samples from volunteers who drank a cup of coca tea. These detection windows are quite higher than those previously obtained when using the method based on separation by protein precipitation.

Drug use in pregnancy in Ireland’s capital city: A decade of trends and outcomes

ObjectiveThe aim of this study was to present contemporary trends in opiate use disorder (OUD) and substance use in pregnancy in Ireland, with associated obstetric outcomes, over the last ten years. Study designThis retrospective observational cohort study was conducted at an Irish tertiary maternity unit. All women with OUD or substance use in pregnancy delivered under this service between 2010 and 2019 were included. Drug-exposure was self-reported. Data was collected by combining electronic and hand-held patient records. Trends and outcomes were analysed by year of delivery. Approval for the study was granted by the institution’s clinical governance committee. ResultsOf the 82,669 women delivered, 525 had OUD or substance use in pregnancy (1 in every 160 women booking). 11.6% were homeless, 20.0% were in full-time employment and 91.0% smoked tobacco in pregnancy. 66.3% had a history of psychiatric disorders.Over the ten years, there was a significant reduction in women delivered with OUD or substance use in pregnancy (0.8 % to 0.4 %, RR 0.55, 95 % CI 0.36–0.85), significant reduction in the proportion of women on Opioid-Substitute-Treatment (OST, RR 0.66 95 % CI 0.51–0.87) and an increase in mean maternal age (30.7to32.0 years). Rates of cocaine and cannabis consumption increased (20.6 %, RR 3.8, 95 % CI 1.57–9.44: 24.0 %, RR 3.7, 95 % CI 1.58–8.86 respectively).The maternal mortality rate was 380.9:100,000 births. The perinatal mortality rate was 15.6:1000 births. The preterm birth rate was 17.9 %, with a mean birth weight of 2832 g. The rate of NICU admission was 52.0 % and the mean length of stay was 22.4 days. Amongst the smaller OUD population, the rate of NICU admission for Neonatal Abstinence Syndrome (NAS) and treatment for NAS increased over the study timeframe (36.0 %, RR 2.97, 95 % CI 1.86–4.75: 28.5 %, RR 2.92, 95 % CI 1.70–5.0 respectively). ConclusionsThe obstetric population attending an Irish antenatal service with opiate use disorder or substance exposure is reducing in size with older patients, less opioid substitute therapy and increasing cocaine and cannabis use. These women have high rates of maternal and perinatal morbidity and mortality. Specialist antenatal addiction services, coordinated by the drug-liaison midwife, are critical in adapting care to respond to this dynamic and vulnerable patient cohort.

Association of prescribed oral stimulants on cocaine use among patients enrolled in opioid agonist treatment: A retrospective longitudinal cohort study.

The objective of this study was to measure the association of prescribed oral stimulants with the consumption of cocaine among a population of patients receiving Opioid Agonist Therapy (OAT). The study was a retrospective clinical cohort study using the medical records of all patients receiving OAT who attended treatment clinics within the Canadian Addiction Treatment Centers (CATC) in Ontario from April 2014 to February 2021. Linear mixed-effects models were fit for the exposure of prescribed oral stimulants, and the outcome of a positive urinalysis drug screen for cocaine. Covariates for age, sex, and a random effect for patients were fitted to account for differences between and within patient observations over time. Among patients receiving OAT therapy n = 314 patients were prescribed oral stimulants and n = 11,879 patients were not prescribed oral stimulants among Ontario CATC clinics (n = 92, n = 145 physicians), the mean age at enrollment for patients receiving oral stimulants was 37.0, SD = 8.8, with 43.6% female patients and for patients not receiving oral stimulants mean age was 36.6, SD = 10.7, with 39.6% female patients. Linear mixed effects models showed no difference in cocaine-positive urine tests over time for fixed effects B = 0.001, however, when considering the Interclass correlation coefficient (ICC) between the fixed effects, we found that time since the prescription of an oral stimulant was associated with a decrease of ICC = -0.14 in cocaine positive urine tests. Increasing age at prescription ICC = -0.92, and being male ICC = -0.23 were associated with decreasing cocaine-positive urine. The use of oral stimulant prescriptions to treat cocaine use had no clinically significant benefit in a real-world setting. Patients who receive prescriptions for oral stimulants consume more cocaine before and after treatment compared to patients without an oral stimulant prescription. We also observed that cocaine use was reduced with increased time since treatment initiation.

Cingulate cortical thickness in cocaine use disorder: mediation effect between early life stress and cocaine consumption.

The cingulate gyrus is implicated in the neurobiology of addiction, such as chronic cocaine consumption. Early life stress (ELS) is an important moderator of cocaine use disorder (CUD). Therefore, we investigated the effect of CUD on cingulate cortical thickness and tested whether a history of ELS could influence the effects of CUD. Participants aged 18-50 years (78 with CUD due to crack cocaine consumption and 53 healthy controls) underwent magnetic resonance imaging and the cingulate thickness (rostral anterior, caudal anterior, posterior, and isthmus regions) was analysed. The clinical assessment comprised the Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index. Group comparisons adjusting by sex, age, and education were performed. Mediation models were generated where lifetime cocaine use, CTQ score, and cortical thickness corresponded to the independent variable, intermediary variable, and outcome, respectively. Group comparisons revealed significant differences in six out of eight cingulate cortices, showing lower thickness in the CUD group. Furthermore, years of regular cocaine use was the variable most associated with cingulate thickness. Negative correlations were found between CTQ scores and the isthmus cingulate (right hemisphere), as well as with the rostral anterior cingulate (left hemisphere). In the mediation analysis, we observed a significant negative direct effect of lifetime cocaine use on the isthmus cingulate and an indirect effect of cocaine use mediated by CTQ score. Our findings suggest that a history of ELS could aggravate the negative effects of chronic cocaine use on the cingulate gyrus, particularly in the right isthmus cingulate cortex.

Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus

Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus

Abstract 13921: Substance Use Disorders and Prevalence of Stroke Amongst the US Population

Introduction: Globally, stroke is one of the top five leading causes of death. Although it was being mostly reported in the elderly population, recently a significant number of young adults are being diagnosed with stroke. The increasing prevalence of comorbidities like diabetes, &amp; hypertension, along with a rise in substance use disorders (SUDs) could be attributed to increased stroke diagnosis among young adults. Aims &amp; Objectives: The aims of the study include an evaluation of the prevalence of stroke in the US population &amp; prevalence of SUDs amongst patients with a history of Stroke. Methods: Our population was obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. We identified respondents who were diagnosed with stroke &amp; SUDs based on the questionnaire. We performed univariate analysis using chi-square &amp; Mann-Whitney tests using SAS software (Version 9.4). A p-value of &lt;0.05 was considered statistically significant. Results: 264,740 respondents were included in this study, of which 10435 (3.94%) had a history of stroke. Respondents with history of stroke were older (median age: 68 years) &amp; more prevalent among males (3.98% vs 3.90% females), non-Hispanic Blacks (5.07% vs 4.76% non-Hispanic Whites vs 2.92% other Hispanics), population, &amp; those belonging to lower annual household income (6.76% $0-$25,000 vs 1.50% &gt;$100,000).(p&lt;0.0001). Consumption of cocaine [89.91% vs 95.56%], marijuana/hashish [63.72% vs 52.97%], methamphetamine [45.81% vs 39.71%], alcohol use disorder-heavy drinking [36.44% vs 47.21%], heroin [23.43% vs 15.21%], e-cigarettes [12.71% vs 17.09%], &amp; injectable drugs [4.21% vs 2.49%] were prevalent amongst people had stroke in comparison to without stroke history. Conclusions: The use of marijuana was most prevalent among respondents with a history of stroke followed by the use of methamphetamine &amp; heroin. With the legalization of marijuana in 19 states for recreational use, the government should plan appropriate policies to lessen the stroke burden among the population with SUDs in the USA. Recall bias &amp; geographic variations in response rate by participants of the study were the limitations of our survey-based study.