Cocaine Smoking Research Articles

FREQUENCY OF UTERINE CURETTAGE AS A RISK FACTOR AMONG PATIENTS WITH PLACENTA PREVIA PRESENTING AT TERTIARY CARE HOSPITAL

Placenta previa is the placenta lying entirely or in part in the lower uterine segment. Its incidence is about 0.28–2%. In local studies, a frequency of 0.51–3.5% has been reported. Advancing maternal age, multiparity, previous cesarean sections, miscarriages, uterine curettage cocaine use, smoking, and previous history of placenta previa have all been attributed as risk factors for placenta previa. Objective: To determine the frequency of uterine curettage leading to placenta previa among women presenting to tertiary care hospitals. Methods: This Descriptive cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Lady Reading Hospital Peshawar from 2/10/2020 to 2/4/2021. In this study, a total of 136 patients were observed. History was taken from the patient (bleeding, pain in abdomen to exclude other causes). Placenta previa was defined as placenta covering or reaching within 2 cm of internal or detected by the last trans-abdominal ultrasonography before delivery. Results: Our study shows that among 136 women mean age was 34 years with SD ± 8.91. 30(22%) patients were primi para while 106(78%) patients were multi para. 27(20%) patients were primi gravida while 109(80%) patients were multi gravida. More than 29(21%) patients had uterine curettage while 107(79%) patients didn’t have uterine curettage. Conclusion: Our study concludes that the frequency of uterine curettage in patients presented with Placenta previa was 21% in our setup.

Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England

BackgroundOver 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact.MethodsThe SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms.Anticipated impactSIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally.ConclusionPeople who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform.Trial registration: ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454

Opium, phencyclidine, and crack cocaine smoking associations with lung and upper aerodigestive tract cancers: exploratory findings from a case-control study in Los Angeles County

ABSTRACT Background: Illicit drug use has become a global epidemic, yet it is unclear if drug smoking increases the risk of tobacco-related cancers. Objectives: We aimed to evaluate hypothesized associations between smoking three drugs – opium, phencyclidine (PCP) and crack cocaine and lung and upper aerodigestive tract (UADT) cancers. Methods: A population-based case-control study with 611 lung cancer cases (50% male), 601 UADT cancers cases (76% male), and 1,040 controls (60% male) was conducted in Los Angeles County (1999–2004). Epidemiologic data including drug smoking histories were collected in face-to-face interviews. Associations were estimated with logistic regressions. Results: Adjusting for potential confounders, ever vs. never crack smoking was positively associated with UADT cancers (aOR = 1.56, 95% CI: 1.05, 2.33), and a dose-response relationship was observed for lifetime smoking frequency (p for trend = .024). Heavy (> median) vs. never crack smoking was associated with UADT cancers (aOR = 1.81, 95% CI: 1.07, 3.08) and lung cancer (aOR = 1.58, 95% CI: 0.88, 2.83). A positive association was also observed between heavy PCP smoking and UADT cancers (aOR = 2.29, 95% CI: 0.91, 5.79). Little or no associations were found between opium smoking and lung cancer or UADT cancers. Conclusion: The positive associations between illicit drug use and lung and/or UADT cancers suggest that smoking these drugs may increase the risk of tobacco-related cancers. Despite the low frequency of drug smoking and possible residual confounding, our findings may provide additional insights on the development of lung and UADT cancers.

Smoked cannabis reduces peak cocaine plasma levels and subjective effects in a controlled drug administration study of polysubstance use in men

BackgroundDespite the high prevalence of polysubstance use, outcomes and potential risks associated with common drug combinations are not well characterized. Many individuals who use cocaine also use cannabis, yet little is known about how interactions between the two drugs might contribute to continued co-use. MethodsThe aim of this double-blind, placebo-controlled study was to determine the physiological and subjective effects of smoked cannabis with smoked cocaine, to identify variables that may contribute to the continued use of this drug combination. Healthy, non-treatment seeking volunteers who reported smoking both cocaine and cannabis (N = 9, all males) completed a 13-day inpatient protocol. On session days, cannabis [0.0 or 5.6 % tetrahydrocannabinol (THC)] was administered 28 min prior to cocaine (0, 12, or 25 mg). Dependent measures included pharmacokinetic assessment of THC and cocaine and their respective metabolites, in addition to subjective and cardiovascular effects. ResultsActive cannabis (5.6 % THC) increased plasma levels of THC and the metabolite 11-nor-9-carboxy-Δ9-THC (THCCOOH), as well as subjective ratings of cannabis effects and heart rate relative to inactive cannabis. Cocaine dose-dependently increased plasma cocaine and metabolites and subjective ratings of cocaine effects. Active cannabis pre-treatment decreased plasma levels of cocaine and metabolites. Furthermore, active cannabis attenuated cocaine-related reductions in ‘Hunger’ and ‘Calm.’ ConclusionsCannabis pre-treatment altered the subjective experience of smoked cocaine and reduced peak plasma levels of cocaine. Future studies should explore additional doses of each drug and whether these changes also impact cocaine’s reinforcing effects.

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

Using Crack or Smoking Cocaine, That Is the Question: The Association of Sociodemographic Factors with Self-Labeling Choices in France  

Using Crack or Smoking Cocaine, That Is the Question: The Association of Sociodemographic Factors with Self-Labeling Choices in France  

Using Crack or Smoking Cocaine, That Is the Question: The Association of Sociodemographic Factors with Self-Labeling Choices in France

ABSTRACT The label “crack user” is profoundly stigmatizing. Such labels are foundational to an individual’s identity, affecting how others view them, their self-perceptions, and subsequent behavior. Individuals can also resist labels such as “crack user,” creating distinctions for the same behavior. To elucidate characteristics associated with self-application of stigmatizing labels, we use data from individuals (N = 50,721) serviced for smoking cocaine in French drug treatment centers (N = 263) from 2010–2020 to assess who self-labels their behavior “crack use” or does not in favor of “smoked cocaine,” which are identical behaviors. Multilevel models reveal higher odds of using the less stigmatizing “smoked cocaine” in earlier years, among those with less risky cocaine use profiles, and among those not using other stimulants. Importantly, this less stigmatizing label is more common among those of high SES and outside the Paris region. An interaction demonstrates that even within Paris, those of high SES have higher odds of using this label than their lower SES Parisian counterparts. Those in privileged positions may use this alternative label to avoid stigmatization of the “crack user” label. Such distinctions potentially perpetuate inequalities associated with the more stigmatized label. We suggest that treatment centers can act as sites to combat these differences.

Individual and Combined Association Between Prenatal Polysubstance Exposure and Childhood Risk of Attention-Deficit/Hyperactivity Disorder

Polysubstance use among pregnant women has increased because of the opioid epidemic and the increasing legalization of cannabis along with persistent tobacco and alcohol consumption. Previous research on prenatal substance use and the child's risk of attention-deficit/hyperactivity disorder (ADHD) has mostly focused on single-substance exposures; simultaneous examination of multiple substance use and assessment of their synergistic health consequences is needed. To assess the consequences of the use of specific substances during pregnancy, investigate whether the interaction of multiple prenatal substance exposures is associated with increases in the risk of childhood ADHD, and estimate the aggregate burden of polysubstance exposure during gestation. This cohort study analyzed data from the Boston Birth Cohort from 1998 to 2019. The sample of the present study comprised a multiethnic urban cohort of mother-child pairs who were predominantly low income. A total of 3138 children who were enrolled shortly after birth at Boston Medical Center were included and followed up from age 6 months to 21 years. Substance use during pregnancy was identified based on self-reported tobacco smoking, alcohol consumption, and use of cannabis, cocaine, or opioids in any trimester of pregnancy. Diagnostic codes for neonatal opioid withdrawal syndrome or neonatal abstinence syndrome from the International Classification of Diseases, Ninth Revision, and the International Classification of Diseases, Tenth Revision, were also used to identify opioid exposure during gestation. ADHD diagnosis in the child's electronic medical record. Among 3138 children (1583 boys [50.4%]; median age, 12 years [IQR, 9-14 years]; median follow-up, 10 years [IQR, 7-12 years]) in the final analytic sample, 486 (15.5%) had an ADHD diagnosis and 2652 (84.5%) were neurotypical. The median postnatal follow-up duration was 12 years (IQR, 9-14 years). Among mothers, 46 women (1.5%) self-identified as Asian (non-Pacific Islander), 701 (22.3%) as Hispanic, 1838 (58.6%) as non-Hispanic Black, 227 (7.2%) as non-Hispanic White, and 326 (10.4%) as other races and/or ethnicities (including American Indian or Indigenous, Cape Verdean, Pacific Islander, multiracial, other, or unknown). A total of 759 women (24.2%) reported the use of at least 1 substance during pregnancy, with tobacco being the most frequently reported (580 women [18.5%]). Cox proportional hazards models revealed that opioid exposure (60 children) had the highest adjusted hazard ratio (HR) for ADHD (2.19; 95% CI, 1.10-4.37). After including main statistical effects of all individual substances in an elastic net regression model, the HR of opioids was reduced to 1.60, and evidence of a statistical interaction between opioids and both cannabis and alcohol was found, producing 1.42 and 1.15 times higher risk of ADHD, respectively. The interaction between opioids and smoking was also associated with a higher risk of ADHD (HR, 1.17). The findings of this study suggest that it is important to consider prenatal concurrent exposure to multiple substances and their possible interactions when counseling women regarding substance use during pregnancy, the future risk of ADHD for their children, and strategies for cessation and treatment programs.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Addictive inhalants-Achallenge for the lungs

Der Konsum inhalativer psychotroper Substanzen ist in unserer Gesellschaft weit verbreitet. Neben der Vielzahl an tabakhaltigen Rauchwaren werden E‑Zigaretten, Cannabis, Schnüffelstoffe sowie Kokain und Heroin inhalativ konsumiert. Die schädigenden pulmonalen Auswirkungen sind zwar für die meisten tabakhaltigen Rauchwaren hinreichend erforscht, für viele andere inhalativ konsumierte Substanzen mangelt es jedoch noch an wissenschaftlich fundierten Erkenntnissen. Insbesondere für die neuartigen Produkte wie E‑Zigaretten und Tabakerhitzer fehlen unabhängige standardisierte Daten, die ein suggeriertes geringeres gesundheitliches Risiko im Vergleich zu herkömmlichen Zigaretten belegen. Auch bezüglich langfristiger Folgen von Cannabiskonsum auf Lunge und Atemwege sind eindeutige Schlussfolgerungen derzeit nicht ausreichend möglich. Für den inhalativen Gebrauch von Kokain und Heroin hingegen wurden insbesondere bei ausgiebigem und chronischem Konsum erhebliche Schädigungen der Lunge belegt.

Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial.

Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the "Crackland" region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n=48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n=50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p<0.01). Participants receiving Contingency Management also had higher odds of achieving three or more weeks of continuous abstinence (OR= 8.07; 95% CI [2.48, 26.24]), achieved longer durations of abstinence (B=2.14; 95% CI [0.67, 3.61]), submitted a higher percentage of negative urinalysis (B=19.85; 95% CI [6.89, 32.82]), and were retained in treatment for a longer period (B=3.00; 95% CI [1.04, 4.97]), compared to those receiving URH alone (p<0.01 for all). The incorporation of Contingency Management was effective in promoting cocaine abstinence and treatment retention. The large-scale dissemination of Contingency Management may be an effective strategy to treat Brazilians with cocaine use disorders.

BULLOUS LUNG DISEASE FOLLOWING COVID-19 INFECTION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in persistent pulmonary complications among survivors. As our understanding of post infectious pulmonary phenomena continues to evolve, it is clear there are multiple difference manifestations of pulmonary lung disease associated with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Here we describe a case of bullous lung disease as a complication of COVID-19. CASE PRESENTATION: A 61-year-old gentleman without significant past medical history presented with worsening shortness of breath of two days duration. Three months prior to presentation he was hospitalized for acute hypoxemic respiratory failure due to COVID-19 requiring Bi-level Positive Airway Pressure which was complicated by pneumomediastinum and right-sided pneumothorax that required chemical pleurodesis. On this presentation, he was hypoxemic and CT scan of the chest showed extensive bullous lung disease (BLD) throughout the right lung with mediastinal shift, not noted on prior imaging. He denied family history of lung disease or connective tissue disease. Prior to COVID-19 infection he was an avid marathon-runner, worked as a civil engineer with no occupational exposures, and never smoked tobacco products, vaped electronic cigarettes, or used illicit drugs. Admission vitals were unremarkable and physical exam revealed decreased breath sounds on the right side. His laboratory data including repeat SARS CoV-2 nasal polymerase chain reaction, alpha-1 antitrypsin and angiotensin-converting enzyme levels were unrevealing. Cardiothoracic surgery was consulted and he successfully underwent Video-Assisted Thoracoscopic surgery with wedge resection of the right lower lobe and chemical pleurodesis. Pathology ruled out a loculated pneumothorax and confirmed the presence of bullae localized within the lung parenchyma. DISCUSSION: Bullous lung disease has been described secondary to cocaine, cigarette or marijuana smoking as well as Emphysema, Sarcoidosis, alpha1-antitrypsin deficiency, Marfan's syndrome, Ehlers-Danlos syndrome and inhaled fiberglass exposure. However, our patient did not have any family history of lung disease, occupational exposures or smoking history, and physical exam was not suggestive of either Marfan's or Ehlers-Danlos syndrome. Since there was no underlying lung disease prior to hospitalization, common etiologies of bullous lung disease were ruled out, and given temporal association with COVID-19 infection, we hypothesized that his lung disease was related to his infection. Although the relationship between bullous lung disease and COVID-19 has yet-to-be defined, case reports have described this emerging association. CONCLUSIONS: Further investigation in the development of chronic lung disease following COVID-19 infection is sorely needed given the growing population of COVID-19 survivors. REFERENCE #1: Berhane S, Tabor A, Sahu A, Singh A. Development of bullous lung disease in a patient with severe COVID-19 pneumonitis. BMJ Case Reports. 2020;13(10):e237455. REFERENCE #2: Sun R, Liu H, Wang X. Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia. Korean J Radiol. 2020;21(5):541-544. REFERENCE #3: Goldberg C, Carey KE. Bullous lung disease. West J Emerg Med. 2013;14(5):450-451. doi:10.5811/westjem.2013.3.16276. DISCLOSURES: No relevant relationships by Kwesi Amoah, source=Web Response No relevant relationships by robert homer, source=Web Response No relevant relationships by Denyse Lutchmansingh, source=Web Response No relevant relationships by Prachi Pednekar, source=Web Response No relevant relationships by Changwan Ryu, source=Web Response

Early onset consumption of coca paste associated with executive-attention vulnerability markers linked to caudate-frontal structural and functional abnormalities

Coca paste is the most popular form of smoked cocaine (SC) in Latin America and also the most widespread among adolescents in vulnerable sectors of society, thus representing a significant public health concern. Despite evidence suggesting that abnormal executive-attention function is predictive of addiction to stimulant drugs, no study to date has compared clinically relevant neuropsychological (NPS) and physiological variables between individuals with histories of smoked cocaine dependence (SCD) and insufflated cocaine hydrochloride dependence (ICD). In this study we evaluated 25 SCD and 22 ICD subjects matched by poly-consumption profiles, and 25 healthy controls (CTR) matched by age, gender, education, and socioeconomic status. An exhaustive NPS battery was used to assess cognitive domains (attention, executive functions, fluid intelligence, memory, language and social cognition). We complemented this assessment with structural (MRI) and functional (fMRI) neuroimaging data. We found that executive function and attention impairments could be explained by the administration route of cocaine, with strongest impairments for the SCD group. SCD also presented reduced grey matter density relative to ICD and CTR in the bilateral caudate, a key area for executive and attentional function. Functional connectivity between left caudate and inferior frontal regions mediated the association between brain structure and behavioral performance. Our results highlight the relevance of assessing the route of administration of stimulants, both in clinical and research settings.

Impulsivity in cocaine users compared to matched controls: Effects of sex and preferred route of cocaine use

BackgroundImpulsivity has been identified as playing a role in cocaine use. The purpose of this study was to explore self-report measures of impulsivity in large groups of male and female cocaine users and matched controls and to determine if differences in impulsivity measures within a group of cocaine users related to self-reported money spent on cocaine and route of cocaine use. MethodsEight self-report impulsivity measures yielding 34 subscales were obtained in 230 cocaine users (180 M, 50 F) and a matched group of 119 healthy controls (89 M, 30 F). Correlational analysis of the questionnaires revealed 2 factors: Impulsive Action (Factor 1) consisting of many traditional impulsivity measures and Thrill-seeking (Factor 2) consisting of delay discounting, sensation and thrill seeking. ResultsSex influenced within group comparisons. Impulsive Action scores did not vary as a function of sex within either group. But, male controls and male cocaine users had greater Thrill-seeking scores than females within the same group. Sex also influenced between group comparisons. Male cocaine users had greater Impulsive Action scores while female cocaine users had greater Thrill-seeking scores than their sex-matched controls. Among cocaine users, individuals who preferred insufflating (“snorting”) cocaine had greater Thrill-seeking scores and lower Impulsive Action scores than individuals who preferred smoking cocaine. Individuals who insufflate cocaine also spent less money on cocaine. ConclusionsGreater Impulsive Action scores in males and Thrill-seeking scores in females were associated with cocaine use relative to controls.

Cortical Thickness in Cocaine Use Disorder and its Relation to Age-Related Brain Atrophy

This work aims to investigate cortical thickness and cocaine addiction by comparing it between smoked cocaine users, their age-matched controls and a group of elderly participants.

Assessment of Risk Factors and the Effect of Drug Abuse on the Incidence of Ischemic Heart Disease in Patients Less Than 40 Years Old

Background: in this study, we examined the risk factors and the effects of substance abuse on the incidence of ischemic heart disease in patients less than 40 years old in Shahid Rajaei Hospital in Karaj from 2019-2020. Methods: This case-control study was done on 70 patients in the cases and 70 cases in the control groups. All demographic data, including age, gender, place of residence, weight, height, body mass index, cardiovascular (CVD) risk factors, including hypertension, high levels of blood fats, diabetes, a history of smoking cigarettes, tobacco, crystal meth, and cocaine, alcohol consumption, as well as a history of taking supplements for bodybuilding, and sex-enhancing drugs were obtained. Afterward, blood levels of glucose and fats were evaluated and urine analysis for the presence of drugs, such as amphetamine, methamphetamine, buprenorphine, benzodiazepines, cannabinoids, cocaine, morphine, methadone, tramadol, and tricyclic antidepressants (TCA) was done. SPSS software v. 22 was used for data analysis. Results: Among the studied underlying factors and drugs, family history, high blood pressure, diabetes, smoking, and low-density lipoprotein (LDL) levels above 130 mg/dL were significantly associated with a higher risk of acute myocardial infarction (MI) (P&lt;0.05). Interestingly, alcohol consumption and the use of tobacco, opium, methadone, heroin, cocaine, cannabis, amphetamines, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids were not significantly associated with acute MI under 40 years (P&gt;0.05). Conclusion: according to the results of the present study, it seems that a positive family history of MI under the age of 55, hypertension, diabetes, smoking, and LDL levels above 130 mg/dL are more significant risk factors for acute MI in patients under 40 years of age in comparison with the consumption of alcohol and the use of hookah, opium, methadone, heroin, cocaine, cannabis, amphetamine, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids. It should be noted that further studies in this area are recommended.

Modafinil reduces smoked cocaine self-administration in humans: effects vary as a function of cocaine ‘priming’ and cost

BackgroundThe absence of an FDA-approved medication for the treatment of cocaine use disorder (CUD) may, in part, reflect the varying conditions present when the decision to use cocaine is made, with one medication unlikely to work under all conditions. The objective of this double-blind, placebo-controlled, human laboratory study was to test the effects of modafinil, a medication with mixed efficacy for the treatment of CUD, using a novel self-administration procedure designed to model distinct clinical scenarios. MethodsDuring modafinil maintenance (0, 300 mg/day), participants chose to self-administer up to 7 doses of smoked cocaine (25 mg) under 9 conditions: immediately after exposure to: (a) cues associated with cocaine and a non-contingent cocaine administration, i.e. 'prime' (25 mg), (b) only cocaine cues, and (c) neither cues nor cocaine. Each condition was tested when self-administered cocaine cost $5, $10 and $15/dose. ResultsNontreatment-seeking cocaine smokers (3 F,13 M), spending $388 ± 218/week on cocaine and with no history of alcohol use disorder, completed the study. Relative to placebo, modafinil robustly attenuated self-administration when cocaine was expensive ($10,$15/dose) and when there was no 'prime.' Modafinil had no effect on self-administration when cocaine was inexpensive ($5/dose) or when participants received a 'prime.' ConclusionsModafinil's effects on cocaine-taking varied substantially as a function of recent cocaine exposure and cost, which may help explain the mixed clinical findings. Modafinil may be most effective for preventing relapse in abstinent patients, particularly under conditions in which cocaine is costly, rather than initiating abstinence for those continuing to use cocaine.

Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis.

We identified the patterns of cocaine use during individuals' heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns. Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity. Four patterns were identified: a "low use" class (72.6%), a "moderate use" class (8.2%), a "daily use" class (17.9%), and a "very high quantity use" class (1.3%). Relative to non-Hispanic White and the "low use" class, non-Hispanic Black was associated with increased odds to be in the "moderate use" and "daily use" classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the "very high quantity use" class relative to other classes; increased risk of using other substances was associated with the "daily use" class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the "low use" class. People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.

An urgent impetus for action: safe inhalation interventions to reduce COVID-19 transmission and fatality risk among people who smoke crack cocaine in the United Kingdom

Crack cocaine use is rising in the United Kingdom (UK), with smoking the primary form of administration. Provision of safe inhalation equipment for crack cocaine is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, exacerbating COVID-19 transmission and respiratory risk. This is of concern, given high prevalence of respiratory health harms such as chronic obstructive pulmonary disease (COPD) among people who smoke illegal drugs. This commentary draws on scoping review and mixed method empirical evidence to argue for provision of safe crack inhalation equipment in the UK, with commensurate legal reform. Review of crack inhalation interventions illustrates the health protective and service engagement benefits of smoking equipment supply. Survey data generated with 455 people who inject drugs in London illustrate high prevalence of current crack use (66%, n=299). Qualitative accounts illustrate perceptions of relative smoking safety – alongside accounts of severe respiratory-related health harms. To date, injecting drug use has been of primary concern in relation to harm reduction initiatives. It is crucial that people who smoke illegal drugs are considered a vulnerable population in regard to COVID 19 transmission and fatality risk, with innovative harm reduction measures scaled up in response.

COPD and asthma in patients with opioid dependency: a cross-sectional study in primary care

Patients treated for drug addiction have high asthma and COPD prevalence rates. The relative contributions of cigarette smoking, smoking intensity and possible smoking of other substances has not been described. We aimed to describe the prevalence and determinants of asthma and COPD in patients prescribed methadone as opioid substitution therapy (OST). In a cross-sectional study of an anonymised patient-level primary care dataset of UK inner-city general practices (n = 46), 321,395 patients aged ≥18 years were identified. A total of 676 (0.21%) had a record of a methadone ever issued in primary care. The association between respiratory disease and methadone prescribing was examined using logistic regression. Models were adjusted for potential effects of clustering by practice. A total of 97.3% of patients prescribed methadone were cigarette smokers, either current (81.2%) or ex-smokers (16.1%). The prevalences of asthma and COPD were higher in methadone patients (14.2% and 12.4%, respectively) compared to non-methadone patients (4.4% and 1.1%, respectively). Methadone was an independent determinant of asthma, adjusting for smoking status (OR 3.21; 95% CI: 2.52, 4.10) or for smoking intensity (3.08; 2.27, 4.19), and of COPD, adjusting for smoking status (6.00; 4.61, 7.80) or for smoking intensity (5.80; 4.12, 8.17). COPD and asthma prevalence were substantially higher in those prescribed methadone compared to those never prescribed methadone. Prescription of methadone was an independent predictor for both COPD and asthma, even after adjustment for smoking status and smoking intensity. Possible explanations include confounding by association with smoking of heroin or crack cocaine, both of which may have a causal association with COPD and asthma.