Common Illicit Drugs Research Articles

Perioperative care of the cocaine-dependent neurosurgical patient

Introduction Cocaine is the most commonly abused drug among patients presenting to hospital emergency departments [1] and the one most associated with drug-related mortalities [2]. Cocaine is a common illicit drug with the highest prevalence rate in North American and an estimated 14 million cocaine users (ages 15- 64 years) worldwide

Prevalence of psychoactive substances, alcohol, illicit drugs, and medicines, in Spanish drivers: A roadside study

Following population, geographic, road type and time criteria, Spain has carried out random, roadside controls of 3302 representative sample of Spanish drivers, including saliva analysis for 24 psychoactive substances and alcohol breath tests. The 81.4% of the drivers were male, with an average age of 34.8±11.8 (mean±SD). The 17% of the drivers were found to be positive to any of the substances analysed. The 6.6% of the drivers found positive to alcohol (>0.05mg/l in breath), 11% were found positive to any illicit drug, and 2% were positive to one of the medicines analysed. Some drivers were positive in more than one substance. The most common illicit drugs among Spanish drivers were cannabis (7.7%), or cocaine (3.5%), either alone or combined with other substances. The most prevalent medicines were the benzodiazepines (1.6%). As a tendency, higher figures for positive cases were observed among males than in females (being statistically significant the differences for alcohol, cannabis and cocaine). Alcohol and cocaine positive cases were more frequently found among drivers of urban roads. Alcohol positive cases (alone, >0.05mg/l), were more likely found as age increase (OR=1.02), those driving in urban roads (OR=2.13), and driving at any period than weekdays, while alcohol+drugs cases were more likely found among males (OR=2.819), those driving on urban road (OR=2.17) and driving at night periods. Finding a medicines positive case was more likely as elder the driver was (OR=1.05). There have been differences in the prevalence of positive cases of alcohol, cannabis and cocaine, in relation to the period of the week: in three cases the highest prevalence seen in night time. This study shows the high prevalence of psychoactive substances and alcohol in Spanish drivers, mainly illicit drugs (cannabis). This question requires a response from the authorities and from society, with an integral and multi-disciplinary approach that can heighten the population's awareness of the risks of driving under the influence of certain substances.

The prevalence of substance use among patients at a dental school clinic in Michigan

Problematic alcohol use and illicit drug use are associated with a number of physical health consequences, including poor oral health. The authors evaluate the prevalence of problematic alcohol use and illicit drug use in adults who visited a dental school clinic. The authors recruited patients from the waiting area of the clinic. During recruitment, 85.9 percent of patients (n = 384) who the authors approached consented to participate in the study. Overall, 20.6 percent of the participants reported either recent problematic alcohol use or illicit drug use; 7.4 percent of reported problematic alcohol use and 18.6 percent reported illicit drug use. The most common illicit drugs participants reported that they used were marijuana (16.8 percent), amphetamines (2.6 percent) and cocaine (1.1 percent). Participants who reported recent problematic alcohol use or illicit drug use were more likely to identify as white, were younger and did not have a spouse or partner. There was a high prevalence of illicit drug use and problematic alcohol use among the patients seen at dental school clinic. These rates were higher than those in the general population. The findings suggest that dental clinics are appropriate settings in which to identify and provide interventions for adults at risk of experiencing problems due to alcohol or drug use.

Drug Interactions between Common Illicit Drugs and Prescription Therapies

Objective: The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Methods: Medline, Iowa Drug Information Service, International Pharmaceutical s, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug–drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. Results: The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent’s therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Conclusion: Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Scientific Significance: Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000–2006

To study the prevalence of use of illicit drugs by women of reproductive age before and during pregnancy and the changes in rates of illicit drug use in pregnancy over recent years. All pregnant women attending the public antenatal clinic over a 7 year period (2000-2006) were routinely interviewed about their use of illicit drugs by a midwife at the antenatal booking visit. Records for 25,049 women, who self-reported previous and current use of cannabis, amphetamines, ecstasy and heroin, were included in the study. Cannabis was the most common illicit drug used before and during pregnancy; 9.3% of women were engaged in regular use prior to pregnancy and 2.5% were users during pregnancy. A very low proportion of women reported use of amphetamines, ecstasy or heroin in pregnancy. There was an increase in ever regular use and any past use of cannabis, amphetamines and ecstasy over time. The prevalence of illicit drug use by young women prior to becoming pregnant is of concern. While pregnancy appears to be a strong motivator for women to cease substance use, there is a need to study whether women resume drug use after their baby is born.

Medial prefrontal gray matter volume reductions in users of amphetamine-type stimulants revealed by combined tract-based spatial statistics and voxel-based morphometry

Amphetamine-type stimulants (ATS) refer to a group of drugs whose principal members include amphetamine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA). Worldwide, ATS are among the most common illicit drugs. Therefore, understanding whether and to what extent ATS exposure affects brain structure and functioning in recreational users has become a critical public health issue. We studied gray and white matter densities in 20 experienced users of ATS (more than 100units MDMA and/or 50g of amphetamine lifetime dose), 42 low exposure users with very limited ATS experience (less than 5units lifetime dose) and 16 drug-naive controls. A tract-based spatial statistics (TBSS) analysis of fractional anisotropy images was applied to diffusion magnetic resonance imaging (MRI) data. Furthermore, alignment invariant white matter tract representations acquired from the TBSS analysis were used as a reference for inter-subject brain registrations in a voxel-based morphometry (VBM) analysis of gray matter volume, reducing characteristic alignment inaccuracies associated with this voxel-wise gray matter investigation approach. Between-group white matter comparison revealed no significant results. However, compared to low exposure users, experienced users showed several regions of lower gray matter volume in medial frontal regions, in particular the orbital and medial frontal cortex. Differences are likely to reflect effects of repeated ATS exposure even in recreational users. However, differences in pre-existing or confounding factors might also account for between-group differences.

Amelioration of the acute cardiovascular effects of cocaine by a longer acting mutant cocaine esterase in freely moving rhesus monkeys

Cocaine is the most common illicit drug related to emergency room admissions, with the majority of visits due to cocaine‐associated chest pain resulting from increases in blood pressure (BP) and heart rate (HR). These studies were aimed at characterizing the capacity of a longer acting mutant form of cocaine esterase (T172R/G173Q; DM CocE) to ameliorate the cardiovascular effects of cocaine in four freely moving rhesus monkeys implanted with radio‐telemetric probes (DSI; D70‐PCT) capable of collecting continuous measures of BP and HR. DM CocE (0, 0.032, 0.1, 0.32, 1.0, or 3.2 mg/kg; IV) was administered 10 min after a dose of 3.2 mg/kg; IV cocaine (M2 was tested at 1.0 mg/kg; IV), and BP and HR were recorded for the 120 min following cocaine administration. DM CocE dose‐dependently, and rapidly decreased cocaine‐induced elevations in BP in each of the four monkeys, with saline‐like levels observed within the first 5 min. Similarly, DM CocE dose‐dependently decreased cocaine‐induced elevations in HR in three of the four monkeys, although over a slightly longer timecourse. These results suggest that DM CocE may provide a novel, and effective therapeutic for the treatment of acute cocaine toxicity.Supported by NIDA grant DA 023213

Illegal Route Estimation of the Seized Illicit Drug, Methamphetamine, by the Comparison of Striation Marks on Plastic Packaging Films

In Japan, the most common illicit drug is methamphetamine. It is possible to trace the origin of this drug by analyzing its organic and inorganic impurities and/or byproducts using several methods, such as GC, GC/MS, and inductively coupled plasma-mass spectrometry (ICP-MS). As reported here, one other method includes comparison of the striation lines of polymer sheet layers from packaging using a polarized light method. Other alternative methods include analyzing the heat sealer pattern, layer thickness surface characteristics, and/or components of polymer sheet layers using infrared spectroscopy. Several of these alternative methods were used to analyze the origins of 29 packages confiscated from three regions over a 1000 km distance in Japan. Results indicated that packages seized from different regions had some polymer sheet layers which contained striation lines and heat sealer patterns that were similar.

Drug Abuse by Adolescents: General Considerations

1. Ximena Sanchez-Samper, MD* 2. John R. Knight, MD* 1. *Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, Mass After completing this article, readers should be able to: 1. Discuss current trends in adolescent substance use and the specific substances used most commonly among 8th, 10th, and 12th graders. 2. Identify risk and protective factors, including genetic and environmental correlates, for the initiation of substance use in adolescents. 3. Discuss the most common concomitant mental health disorders and how they can affect the course of diagnosis and treatment for substance abuse. 4. Delineate the variety of treatment options available. 5. Describe the role of the pediatrician in educating patients and families on substance abuse prevention; performing screening and initial assessments; and providing support, brief counseling, or referrals for in-depth treatment. Adolescence is a time of physical, emotional, and psychological maturation as well as a period of searching for independence and experimentation. One area of experimentation associated with adolescence is substance use. (1) Although many adolescents experiment with drugs and alcohol from time to time without enduring problems, those who develop the disorders of substance abuse and dependence make substance use a major public health concern. The Monitoring the Future Study (MTFS) is a nationwide survey measuring smoking, drinking, and illicit drug use among nearly 50,000 8th, 10th, and 12th graders in more than 400 secondary schools in the United States each year. (2)(3) According to the 2006 overview of findings from the MTFS, approximately one fifth (21%) of today's 8th graders, more than one third (36%) of 10th graders, and nearly half (48%) of all 12th graders reported using an illicit drug at least once during their lifetimes. Despite a minimum legal age requirement to purchase alcohol, 6% of 8th graders, 19% of the 10th graders, and 30% of the 12th graders self-reported drunkenness during the month prior to being interviewed. (2)(3) Among the problems experienced by adolescents who use alcohol and drugs are …

Five-year update on the occurrence of alcohol and other drugs in blood samples from drivers killed in road-traffic crashes in Sweden

According to statistics provided by the Swedish National Road Administration (Vägverket), a total of 1403 drivers were killed in road-traffic crashes in Sweden between 2003 and 2007. Forensic autopsies were performed in ∼97% of all deaths and specimens of blood and urine were sent for toxicological analysis. In 60% of cases ( N = 835) the toxicology results were negative and 83% of these victims were men. The blood-alcohol concentration (BAC) was above the legal limit for driving (>0.2 g/L) in 22% of cases ( N = 315) at mean, median and highest concentrations of 1.7 g/L, 1.7 g/L and 4.9 g/L, respectively. The proportions of male to female drivers with BAC > 0.2 g/L were 93% vs 7% compared with 83% vs 17% for those with drugs other than alcohol in blood. Drivers with a punishable BAC were over-represented in single vehicle crashes compared with multiple vehicle crashes (67% vs 33%). The opposite held for drivers who had taken a prescription drug (39% vs 61%) and also for drug-negative cases (31% vs 69%). Drugs other than alcohol were identified in 253 cases (18%); illicit drugs only in 39 cases (2.8%), both licit and illicit in 28 cases (2.0%) and in 186 cases (13.3%) one or more therapeutic drugs were present. Amphetamine was the most common illicit drug identified at mean, median and highest concentrations of 1.5 mg/L, 1.1 mg/L and 5.0 mg/L, respectively ( N = 39). Blood specimens contained a wide spectrum of pharmaceutical products (mean 2.4 drugs/person), comprising sedative-hypnotics ( N = 93), opiates/opioids ( N = 69) as well non-scheduled substances, such as paracetamol ( N = 78) and antidepressants ( N = 93). The concentrations of these substances in blood were mostly in the therapeutic range. Despite an appreciable increase (12-fold) in number of arrests made by the police for drug-impaired driving after a zero-tolerance law was introduced (July 1999), alcohol still remains the psychoactive substance most frequently identified in the blood of drivers killed in road-traffic crashes.

Trends in driving under the influence of drugs: A register-based study of DUID suspects during 1977–2007

Our aim was to describe the incidence and trends of driving under the influence of drugs (DUID) and to examine the main drug findings and their trends in suspected DUID cases in Finland. A register-based study was conducted of all suspected DUID cases during 1977–2007. The data included 31,963 DUID offenders apprehended by the police with a positive finding for illicit/licit drug impairing driving performance. Toxicological results were analyzed in blood and/or urine specimens in one central laboratory. The incidence of suspected DUID cases increased 18-fold during 1977–2007. Most of the suspects were men (89.7%). However, the male–female ratio decreased from 13.9 to 7.3. The mean age decreased from 36.2 years in 1977 to 29.9 years in 2001 but has since reincreased. Most often found substances were benzodiazepines (75.7%), amphetamines (46.0%), cannabinoids (27.7%) and opioids (13.8%). Most common illicit drugs, amphetamines and cannabinoids, started to appear at the end of the 1980s. Poly-drug findings were common (77.1%). Suspected DUID cases have increased sharply after the introduction of a zero tolerance law, especially in regard to amphetamines. DUID is an increasing problem in Finland, and needs serious attention.

Cocaine-Induced Chest Pain and β-Blockade: An Inner City Experience

Cocaine is the most common illicit drug used in patients presenting with chest pain to emergency departments. Data on beta-blockers in cocaine-related chest pain syndrome are sparse. We sought out to study the causal and detrimental effects of beta-blockers in cocaine-related chest pain in a large inner city cohort of patients. All patients presenting to a large inner city emergency department with chest pain, with positive urine drug screen for cocaine were included. The group comprised predominantly young (mean age 46.8 +/- 8.2 years), African American (90.6%) males (73.4%). Evidence of myocardial infarction in the form of elevation of troponin-I was noted in 7.3%. Evidence of myonecrosis (MN) was significantly more likely in those who were taking beta-blockers at presentation as compared with those who were not (14% versus 4.4%, P < 0.01). In the absence of prospective controlled data, our observational findings seem to suggest that routine initiation or continuation or of beta-blockers after admission increased the likelihood of developing MN (23.3% versus 10.7%, P < 0.01) during the course of hospitalization. MN as reflected by elevation of cardiac biomarkers is uncommon in patients presenting with cocaine-related chest pain. Preexisting use of beta-blockers seems to render a higher risk of myocardial injury in patients presenting with cocaine-related chest pain. In addition initiation or continuation of beta-blockers during hospitalization should be discouraged.

Occurrence of ethanol and other drugs in blood and urine specimens from female victims of alleged sexual assault

Results of toxicological analysis of blood and urine specimens from 1806 female victims of alleged non-consensual sexual activity are reported. After making contact with the police authorities, the victims were examined by a physician for injuries and biological specimens were taken for forensic toxicology and other purposes (e.g. DNA). Urine if available or otherwise on an aliquot of blood after protein precipitation was screened for the presence of drugs by enzyme immunoassay methods (EMIT/CEDIA). All positive results from screening were verified by more specific methods, involving isotope dilution gas chromatography–mass spectrometry (GC–MS) for illicit drugs. A large number of prescription drugs were analyzed in blood by capillary column gas chromatography with a nitrogen–phosphorous (N–P) detector. Ethanol was determined in blood and urine by headspace gas chromatography and concentrations less than 0.1 g/L were reported as negative. The number of reported cases of alleged sexual assault was highest during the warmer summer months and the mean age of victims was 24 years (median 20 years), with ∼60% being between 15 and 25 years. In 559 cases (31%) ethanol and drugs were negative. In 772 cases (43% of total) ethanol was the only drug identified in blood or urine. In 215 cases (12%) ethanol occurred together with at least one other drug. The mean, median and highest concentrations of ethanol in blood ( N = 806) were 1.24 g/L, 1.19 g/L and 3.7 g/L, respectively. The age of victims and their blood-alcohol concentration (BAC) were positively correlated ( r = 0.365, p < 0.001). Because BAC decreases at a rate of 0.10–0.25 g/(L h), owing to metabolism the concentration in blood at time of sampling is often appreciably less than when the crime was committed several hours earlier. Licit or illicit drugs were identified in blood or urine in N = 262 cases (15%). Amphetamine and tetrahydrocannabinol were the most common illicit drugs at mean (median) concentrations in blood of 0.22 mg/L (0.1 mg/L) and 0.0012 mg/L (0.0006 mg/L), respectively. Among prescription drugs, sedative-hypnotics such as diazepam and zopiclone were common findings along with SSRI antidepressants and various opiate analgesics. Interpreting the analytical results in terms of voluntary vs. surreptitious administration of drugs and the degree of incapacitation in the victim as well as ability to give informed consent for sexual activity is fraught with difficulties.

Uso de canabinóides na dor crônica e em cuidados paliativos

JUSTIFICATIVA E OBJETIVOS: Muitos estudos têm chamado atenção para a Cannabis sativa (Cs), pelo seu potencial analgésico e pela sua capacidade de aliviar sintomas relacionados com doenças do sistema nervoso central. Porém, a maconha, como é popularmente conhecida, por ser a mais popular das drogas ilegais em todo o mundo, gera preconceito tanto entre leigos como entre profissionais que atuam na área da saúde. Objetivou-se pesquisar o nível de conhecimento atual e suas perspectivas de utilização para compreender melhor suas ações e seus efeitos, na pesquisa experimental e na prática médica, em pacientes com doenças degenerativas neurológicas ou naqueles que não tenham possibilidades de cura, atendidos em programas de cuidados paliativos. CONTEÚDO: Seu uso terapêutico não é recente. O presente estudo fornece uma revisão do histórico e farmacologia da Cs, o desenvolvimento de seu uso terapêutico por meio dos canabinóides sintéticos, o conhecimento científico atual, suas conseqüências orgânicas e psíquicas, demonstrando suas opções de uso clínico e perspectivas futuras. CONCLUSÕES: O delta-9-tetrahidrocanabinol (delta9-THC) puro e seus análogos apresentam aplicabilidade clínica, demonstrando benefícios. O desenvolvimento das substâncias sintéticas puras, buscando a atenuação de efeitos psicoativos indesejáveis aponta para perspectivas favoráveis a sua utilização no futuro. Estudos mais detalhados deverão ser realizados. Debates amplos serão necessários para criar normas de formulação e disponibilização com a finalidade médica, por se tratar de uma substância que gera preconceito pela sua comercialização e utilização ilegal e a seu uso ser atribuído misticismo.

1: Association between Media Exposure and Marijuana and Alcohol Use in Adolescents

Adolescents are currently exposed to media for over 8.5 hours per day when accounting for multitasking. Exposure to smoking-related media messages is now known to be independently associated with adolescent smoking initiation. However, little is known regarding the relationship between media exposure and marijuana and alcohol use. This is an important omission in the literature, as marijuana is the most common illicit drug used by children and adolescents in the United States and alcohol is the leading cause of death among adolescents. In January of 2005 we surveyed all students at a large suburban high school regarding exposure to a variety of entertainment media and marijuana and alcohol use. The study was approved by the university Institutional Review Board and the school superintendent. We also assessed essential covariates, including age, race/ethnicity, gender, parental education, authoritative parenting, depression, self-esteem, rebellious behavior, sensation seeking, stress level, and school achievement. We used logistic regression to determine which exposures were independently associated with use of each substance. The mean age of the 1,211 respondents was 15.9 years, about half (48%; N = 572) were male, and 92% (N = 1092) were white. Of the sample, 27% reported smoking marijuana and 60% reported using alcohol. They reported exposure to 8.6 hours of media daily, with greatest exposure to music (2.6 hours), television (2.3 hours), and internet (2.3 hours). Nearly all of the measured covariates were significantly related to use of both marijuana and alcohol. In the fully-adjusted models, music exposure retained a significant dose-response relationship with ever using marijuana. Compared with adolescents with less than an hour of music use per day, those with 3-4 hours of daily music use (OR = 1.90, 95% CI: 1.01, 3.56) and over 4 hours of daily music use (OR = 2.70, 95% CI: 1.57, 4.63) were significantly more likely to have ever used marijuana. Movie exposure was related to alcohol but not marijuana, however. Compared with those exposed to <2 movies in the past 2 weeks, those watching 2-4 movies (OR= 1.65, 95% CI: 1.13, 2.42), 4-6 movies (OR = 2.00, 95% CI: 1.30, 3.07), and >6 movies (OR = 1.87, 95% CI: 1.20, 2.90) were all more likely to have used alcohol. Our findings suggest independent associations between marijuana and alcohol use and media exposure. In particular, music exposure is associated with marijuana use while movie exposure is related to alcohol use. Factors mediating these relationships may include the contexts in which substances of abuse are presented within different media and the social and environmental contexts in which adolescents experience media.

Priapism, Ecstasy, and Marijuana: Is There a Connection?

Priapism is a urological emergency with multiple aetiologies including drug induced. Currently, there have been no reports of priapism induced by the combination of ecstasy and marijuana. We speculated on the potential mechanisms for acute drug-induced priapism resulting from ingestion of these two common illicit drugs.

Role of endocannabinoids in regulating drug dependence

This review will discuss the latest knowledge of how the endocannabinoid system might be involved in treating addiction to the most common illicit drugs. Experimental models are providing increasing evidence for the pharmacological management of endocannabinoid signaling not only to block the direct reinforcing effects of cannabis, opioids, nicotine and ethanol, but also for preventing relapse to the various drugs of abuse, including opioids, cocaine, nicotine, alcohol and metamphetamine. Preclinical and clinical studies suggest that the endocannabinoid system can be manipulated by the CB1 receptor antagonist SR141716A, that might constitute a new generation of compounds for treating addiction across different classes of abused drugs.

The Scourge of Methamphetamine: Impact on a Level I Trauma Center

Methamphetamine (METH) use is associated with high-risk behavior and serious injury. The aim of this study was to assess the impact of METH use in trauma patients on a Level I trauma center to guide prevention efforts. A retrospective registry-based review of 4,932 consecutive trauma patients who underwent toxicology screening at our center during a 3-year period (2003-2005). This sample represented 76% of all trauma patients seen during this interval. From the first half of 2003 to the second half of 2005, overall use of METH increased 70% (p < 0.001), surpassing marijuana as the most common illicit drug used by the trauma population. Other illicit drug use did not significantly change during this interval. METH-positive patients were more likely to have a violent mechanism of injury (47.3% vs. 26.3%, p < 0.001), with 33% more assaults (p < 0.01), 96% more gunshot wounds (p < 0.001), and 158% more stab wounds (p < 0.001). They were more likely to have attempted suicide (4.8% vs. 2.6%, p < 0.01), to have had an altercation with law enforcement (1.8% vs. 0.3%, p < 0.001), or been the victim of domestic violence (4.4% vs. 2.1%, p < 0.001). METH users had a higher mean Injury Severity Score (11.2 vs. 10.0, p < 0.01), were 62% more likely to receive mechanical ventilation (p < 0.001), and 53% more likely to undergo an operation (p < 0.001). They were more prone to leave against medical advice (4.9% vs. 2.1%, p < 0.001) and 113% more likely to die from their injuries (6.4% vs. 3.0%, p < 0.001). The average cost of care per METH user was 9% higher than that for nonusers, and METH users were more likely to be unfunded than nonusers (47.6% vs. 23.1%, p < 0.001). The annual uncompensated cost of care of METH users increased 70% during the study period to $1,477,108 in 2005. METH use in trauma patients increased significantly and was associated with adverse outcomes and a significant financial burden on our trauma center. Evidence-based prevention efforts must be a priority for trauma centers to help stop the scourge of METH.

Illicit drug use and responses in six Pacific Island countries

We report here on the illicit drug situation in six Pacific nations: Fiji, Papua New Guinea, Samoa, Solomon Islands, Tonga and Vanuatu. The report is based on the 'Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. The situational analysis was a comprehensive desk-based review; data sources included published and unpublished literature and information from key informants. A range of psychoactive substances have been used traditionally across the Pacific region. Cannabis is the by far the most common and widespread illicit drug used in the six Pacific Islands reviewed. Drugs such as heroin, methamphetamines and cocaine are not used commonly due to their high cost compared to the average income. Currently, there is no overall regional or country-based illicit drug policy for the Pacific and few treatment programs; limited data exist to aid in understanding illicit drug use and the harms associated with its use in the Pacific. This review highlights the urgent need for strategic alcohol and drug research in the Pacific as a foundation for the development of policy.

Uso de psicotrópicos entre universitários da área da saúde da Universidade Federal do Amazonas, Brasil

A survey was conducted with 521 undergraduate health sciences students from the Federal University in Amazonas, Manaus, Brazil. Lifetime alcohol consumption was reported by 87.7% students, as compared to 30.7% for tobacco, with the latter reported more frequently by males (39.7%). The most common illicit drugs were solvents (11.9%), marijuana (9.4%), amphetamines and anxiolytics (9.2% each), cocaine (2.1%), and hallucinogens (1.2%). The main reason for illicit drug use was curiosity. Lifetime use of anabolic steroids was reported by 2.1% of the students. Alcohol abuse in the previous 30 days was reported by 12.4% of the students. Events following drinking included: fights (4.7%), accidents (2.4%), classroom absenteeism (33.7%), and job absenteeism (11.8%). Another important finding was that 47.3% of students drove after drinking. Opinions on drug abuse and patterns agree with those from similar studies in other regions of Brazil.