Crack Cocaine Use Research Articles

Correlates of Depressive Symptoms Among Homeless Young Adults

Adolescent homelessness has received increasing attention because of its fast growth throughout the United States and the poor mental outcomes experienced by homeless young people. This cross-sectional study (N = 156) identified correlates of depressive symptomatology among homeless young adults and investigated how depressive symptoms are influenced by the coping strategies these young adults use. The findings are based on analysis of baseline data collected for a hepatitis vaccination intervention pilot study conducted in partnership with a young adult's drop-in center in Santa Monica, California. Standardized tools assessed drug use history, coping ability, and psychiatric symptomatology. Linear regression modeling was used to identify correlates of depressive symptom severity. Poor perceived physical health, recent crack cocaine use, and recent use of tranquilizers were significantly associated with increased severity of depressive symptoms. Self-destructive escape, nondisclosure/avoidance, passive problem solving, and thoughts of harming self were also associated with increased severity of depressive symptoms.

Gender and Age Patterns in HSV-2 and HIV Infection Among Non-Injecting Drug Users in New York City

To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City. Subjects were recruited from patients entering the Beth Israel drug detoxification program. Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behavior was administered, and a blood sample was collected for HIV and HSV-2 antibody testing. A total of 1418 subjects who had never (lifetime) injected drugs (NIDUs) were recruited between July 2005 through June 2009. Subjects were primarily male (76%), and black (67%) or Hispanic (25%), reported recent crack cocaine use (74%), and had a mean age of 42 years. Eleven percent of males reported male-with-male sexual (MSM) behavior. The prevalence of both viruses was high: for HSV-2, 61% among the total sample, 50% among non-MSM males, 85% among females, and 72% among MSM; for HIV, 16% among the total sample, 12% among non-MSM males, 20% among females, and 46% among MSM. HSV-2 was associated with HIV (OR = 3.2, 95% CI: 2.3-4.5; PR = 2.7, 95% CI: 2.0-3.7). Analyses by gender and age groups indicated different patterns in mono- and coinfection for the 2 viruses. HSV-2 and HIV rates among these NIDUs are comparable with rates in sub-Saharan Africa. Additional prevention programs, tailored to gender and age groups, are urgently needed. New platforms for providing services to NIDUs are also needed.

Sexual Activity in HIV-Positive African American Crack Cocaine Smokers

The AIDS epidemic in the United States continues to disproportionately affect minorities of color, especially African Americans. The purpose of this study was to explore the sexual behaviors of a sample of African American HIV positive crack smokers aware of their serostatus. Participants (100 men, 37 women) were included in this study based on the following criteria: a minimum age of 18years, HIV positive serostatus, treatment with HIV antiretroviral medications for a minimum of 3months prior to interview, crack cocaine use at least once in the 7days prior to being interviewed, willingness to provide a urine sample to confirm recent drug use, and vaginal or anal sex at least once in the past 7days. The questionnaire was a compilation of other reliable surveys and was designed to collect sociodemographic data, drug use, sexual behavior, condom use intentions and motivators, STD and HIV infection history, HIV medications, and adherence requirements. Participants reported having 1,266 different partners in the 30days prior to the interview and had traded sex for money or drugs with 68%. A total of 79 participants had multiple partners and accounted for 1,247 partnerships. Rates of consistent condom use across partnerships were low, indicating that more interventions in this at-risk population are needed.

Is Crack Cocaine Use Associated with Greater Violence than Powdered Cocaine Use? Results from a National Sample

Background: The question of whether crack cocaine use is associated with increased violence compared to powdered cocaine use has not been adequately explored in large nationally representative general population samples. Methods: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to 1) determine the comparative prevalences of violent behaviors among crack cocaine users and powdered cocaine users, 2) examine these differences while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders (a majority of cocaine users use other substances), and levels of crack cocaine and powdered cocaine use. Results: The likelihood of violence associated with crack cocaine users was greater compared to powdered cocaine users at the bivariate level. However, these differences were almost uniformly statistically nonsignificant when demographic, mood and non-cocaine substance use disorders were controlled for. Conclusions: The substantial attenuation of the association of crack cocaine use with violence after adjustment suggests that the sociodemographic characteristics, psychiatric variables, and non-cocaine substance use disorders that make some individuals more likely to use crack cocaine than powder cocaine are responsible for the increased prevalence of violence observed among crack users, rather than crack itself.

Modelling crack cocaine use trends over 10 years in a Canadian setting

Crack cocaine use among illicit drug users is associated with a range of health and community harms. However, long-term epidemiological data documenting patterns and risk factors for crack use initiation remain limited especially among injection drug users. We investigated longitudinal patterns of crack cocaine use among polydrug users in Vancouver, Canada. We examined the rate of crack use among injection drug users enrolled in a prospective cohort study in Vancouver, Canada between 1996 and 2005. We also used a Cox proportional hazards regression analysis to identify independent predictors of crack use initiation among this population. In total, 1603 injection drug users were recruited between May 1996 and December 2005. At baseline, 7.4% of participants reported ever using crack and this rate increased to 42.6% by the end of the study period (Mantel trend test P < 0.001). Independent predictors of crack use initiation during the study period included frequent cocaine injection, crystal methamphetamine injection, residency in the city's drug using epicenter and involvement in the sex trade (all P < 0.05). These findings demonstrate a massive increase in crack use among injection drug users in a Canadian setting. Our findings also highlight the complex interactions that contribute to the initiation of crack use among injection drug users and suggest that evidence-based interventions are urgently needed to address crack use initiation and to address harms associated with its ongoing use.

Non-injected illicit drugs and alcohol and HIV-related high-risk sexual behaviors in a street-recruited sample of non-injecting drug users in New York City

Methods Among the Non-Injecting Drug Users (NIDUs) in the South Bronx and Harlem, New York City questionnaires were administered about the past use and within last three months use of crack cocaine and powder cocaine, alcohol, marijuana/hashish, and heroin and HIV-related sexual behaviors. Sexual behavior was summarized as a single variable, the Vaginal Equivalent Episode (VEE) score; VEE scores above and below the median were categorized as high and low sexual risk respectively.

Crack Cocaine Use in Barcelona: A Reason of Worry

In Spain, crack cocaine use is silently increasing. In Barcelona, an intentional sample was selected to describe the general characteristics of this consumption. Participants were submitted to an interview and data were analyzed through qualitative research procedures. Users are young males and of low socioeconomic status and formal education. The major pattern of use is compulsive. Illegal income activities are the choice for crack cocaine or money acquisition, increasing individual and social health costs. Polydrug use is a matter of concern. Although these findings can not be generalized, they should be considered for the development of public policies to adequately address crack cocaine users’ needs.

Predictors of crack cocaine initiation among Montréal street youth: A first look at the phenomenon

Background Crack cocaine use is increasing in Montréal. However, initiation risk factors among street youth are unknown. The goal of this project is to estimate the incidence of first crack cocaine use among these youth and to identify the associated risk factors. Methods A prospective cohort study of HIV and hepatitis C incidence was conducted among street youth from 2001 to 2005. A questionnaire on sexual and drug use behaviours was administered every 6 months. Incidence was estimated (a) for youth who had never used crack cocaine at recruitment ( n = 203) and, among them, (b) for those who had snorted cocaine before ( n = 122). The risk factors for initiation of crack use as well for initiation into a new route of cocaine administration among youth who had snorted cocaine before were determined using Cox regression. Results Incidence rates for crack cocaine use were (a) 136.6/1000 person-years (p-y) (95% confidence interval [CI]: 104.5–175.5) and (b) 205.8/1000 p-y (95% CI: 150.2–275.3). The number of substance types used recently increased the risk of initiating crack use (adjusted hazard ratio [AHR] = 1.84 per substance type, 95% CI: 1.55–2.18), whereas having a parent with a substance abuse problem decreased that risk (AHR = 0.48, 95% CI: 0.26–0.89). The risk factors were identical among youth who had snorted cocaine before. Conclusions Our analyses show a high incidence of crack use among street youth. It is important to delve more deeply into the phenomenon of initiation if we wish to develop effective prevention measures for these young people.

Longitudinal relationship between psychological distress and multiple substance use: results from a three-year multisite natural-history study of rural stimulant users.

Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states. Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site. On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p < .0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers. Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse.

Women's health and use of crack cocaine in context: Structural and ‘everyday’ violence

Background There is increasing public health evidence that women who use crack cocaine and are street-involved experience significant health problems and are more isolated with regards to accessing harm reduction and other health-related services. Simultaneously, there is growing acknowledgement that structural and ‘everyday’ violence are significant factors influencing the health of women who use illegal drugs. Little research has examined how these social processes play out for women who use crack cocaine. Methods A critical ethnography informed by the theoretical constructs of structural and everyday violence and intersectionality was undertaken to explore women's use of crack cocaine within an inner-city neighbourhood in Western Canada. Data collection included baseline survey ( n = 126), participant observation and field notes, informal interviews ( n = 53), and in-depth interviews ( n = 13). Results Based on thematic and theoretical analysis two interrelated themes were identified that reflected the interrelationships between women's use of crack, poverty, discrimination, racism, gendered relations of power, and legal policies and practices: (a) the context of health care; and (b) the smoking context. Conclusions Structural inequities and ‘everyday’ violence are perilously damaging for women who use crack. Interventions to reduce these inequities are urgently needed if we are to reduce the significant suffering of women who are street-involved and use crack cocaine.

Opiate and crack cocaine use: A new understanding of prevalence

Aims: The aim of this study was to establish prevalence estimates of problem drug use, defined as opiate and/or crack cocaine use by persons aged 15 to 64 years, for England and for each of the 149 administrative areas responsible for commissioning drug interventions.Methods: Indirect estimation techniques, the capture–recapture and multiple indicator methods, were used to obtain estimates. Information on problem drug users presenting to healthcare settings and/or recorded by the criminal justice system, and drug-related indicator data were used in the analyses.Findings: There were an estimated 332,090 problem drug users in England during 2005/06 (95% CI 324,546 to 346,345), equivalent to 9.97 (95% CI 9.74 to 10.40) problem drug users per thousand population aged 15 to 64 years. Prevalence varied by geographic region and age group: the highest rates were observed in London and for those aged 25 to 34 years.Conclusions: This study has produced estimates of the prevalence of problem drug use in England that are more robust, more precise, and suggest a higher prevalence than previous studies. The estimates provide a basis on which to formulate policy, plan services, and measure service performance.

Social context and perceived effects of drugs on sexual behavior among individuals who use both heroin and cocaine.

Researchers have identified the association between the use of cocaine and sexual behavior as an important risk factor for HIV infection and have attempted to elucidate the nature of this association. Several lines of research have suggested that facilitation of sexual behavior during intoxication with cocaine may be because of the direct pharmacological effects of the drug (e.g., increase in sexual desire), whereas others have pointed to the importance of factors related to the context of drug use (e.g., opportunities for sexual behavior, expectations about the effects of the drug, social norms). The present study explored the perceived effects of cocaine and heroin on sexual behavior, as well as the social context of drug use as a function of drug type (cocaine vs. heroin), among 46 inner-city drug users who reported a history of regular use of both crack cocaine and heroin. Results indicated that compared to heroin, cocaine had deleterious effects on participants' perceived sexual desire and performance. Despite such deleterious effects on sexual behavior, cocaine was more frequently used with an intimate partner than heroin. Furthermore, participants did not differ in the extent to which they used the two drugs in other social contexts (e.g., with friends, family, or neighbors). These preliminary results suggest that the relationship between cocaine and sexual behavior, especially among long-term cocaine users, may be facilitated by opportunities for sex that exist in the context of cocaine use, rather than by the pharmacological effects of the drug.

Neuropsychological Assessment of Current and Past Crack Cocaine Users

Background: Cognitive changes due to crack cocaine consumption remain unclear. Methods: For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out. Results: Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). Conclusion: Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.

Prevalence of HPV and HIV among female drug addicts attending a drop-in center in Tehran, Iran

⁎ Corresponding author. Masih Daneshvari Hospital, Darabad, Niavaran Tehran, Iran. E-mail address: s.mirzendehdel@gmail.com (S. Mirzendehdel). Understanding the prevalence of HIV and HPV infection among drug-addictedwomen and detecting high-risk HPV types could lead to integration of prevention and treatment into public health planning. This cross-sectional study of HPV and HIV prevalence was performed between 2007 and 2008 among women attending a drop-in center in Southern Tehran, Iran, that provides food and methadone to drugaddictedwomen.All addictedwomenattending the centerwere included in the study. All study participants were interviewed and their method of drug use was determined. After obtaining consent, a gynecological exam was conducted and a cervical swab sample was obtained for laboratory studies. If participants had vaginal discharge or there was clinical suspicion of pelvic infection, appropriate tests and treatment were provided. A 2 mL-sample of blood was obtained from the study participants and tested for HIV using an ELISA test (Adaltis Inc, Montreal, Canada). Positive screens were followed by western blot for confirmation. If test results were positive for HIV, referral was made to specialty clinics for further evaluation and possible treatment. Cervical swabs and scrapes obtained for HPV detection in all cases were transferred into tubes and transported at 8°C to the Virology Research Center of the National Research Institute of Tuberculosis and Lung Disease, Tehran. At the laboratory the cervical samples were resuspended in 500 μL of phosphate-buffered saline, immediately centrifuged, and the pellet was stored at −70 °C until further processing. For detection of HPV genotypes, nested polymerase chain reaction (PCR) analysis was performed using MY09/MY11 as the outer primers and GP5+/GP6+ as the inner primers, as previously described and with minor modification [1]. The positive samples were genotyped using a GP-E6/E7 nested multiplexPCRassay [1].HPVgenotypesweredivided into3groups: highrisk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68); lowrisk genotypes (6–11, 42, 43, 44); and genotypes that could not be identified. The study protocol was approved by the scientific and ethics committee of the National Research Institute of Tuberculosis and Lung disease, Tehran. Data were analyzed using SPSS version 15.0 (SPSS, Chicago, IL, USA). Continuous variables were expressed as group means±SD. The χ test without Yates correction and a Fisher exact test were used as appropriate. All reported P values are two-sided. Pb0.05was considered statistically significant. Multivariate logistic regression was used to determine the independent risk factors for HPV and high-risk genotypes. A total of 118 women were included in the study. The average age of the participants was 35.06±1.16 years (range, 15–61 years). There were 15participantswithahistoryof intravenousdruguse.A total of 91 (77.1%) women had a history of crack cocaine use. Ten (8.5%) participants had a history of crack cocaine abuse and intravenous drug use. A total of 29 (24.6%) women had multiple sexual partners. Five (4.2%) women were unmarried, 51 (43.2%) were married, 51 (43.2%) were divorced, and 11 (9.3%) were widowed. Seventeen (14.4%) women were illiterate, 89 (75.4%) had a level of education below diploma level, and 12 (10.2%) participants had a diploma or higher level of education. Vaginal discharge was reported by 64 (54.2%) women. Candidiasis was found in 22 (18.6%) women and discharge caused by other infection was found in 44 (35.6%) participants. A total of 8 participants (6.8%) tested positive for HIV. The vaginal swab samples of 59 (50%)women testedpositive forHPV. More than one type of HPV virus was identified in 16 (13.6%) women. There were 26 (22%) cases of high-risk HPV, 9 (7.6%) cases of both high-

New Findings: Crack Cocaine And Powered Cocaine Use Among Opioid Addicts In A Low Threshold Methadone Maintenance Program: Is All Cocaine The Same?

New Findings: Crack Cocaine And Powered Cocaine Use Among Opioid Addicts In A Low Threshold Methadone Maintenance Program: Is All Cocaine The Same?

Association Between Narcotic Use and Anabolic-Androgenic Steroid Use Among American Adolescents

Drawing on the data gathered in the 2006 Monitoring the Future study of American youth, the present research examines associations between use of narcotics and use of anabolic–androgenic steroids (AASs) among high-school seniors (n = 2,489). With independent measures and controls including sex, race, media exposure, socializing with friends, participation in recreational and school-sponsored sports, perceptions of drug use among professional athletes, and perceptions of steroid use among close friends, binary logistic regression analyses revealed significant associations between AAS use and the use of alcohol, crack cocaine, Vicodin, gamma-hydroxybutyrate (GHB), Ketamine, and Rohypnol. While use of both AASs and the narcotic drugs generally did not eclipse 5% of the sample, the numbers extend to many thousands in larger populations. Implications for health practitioners and recommendations for future research are offered. The study's limitations are noted.

Perceptions of Sexual Risks and Injection for HIV among African American Women Who Use Crack Cocaine in Nashville, Tennessee

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville,Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV.

Crack cocaine use increases the incidence of AIDS-defining events in French Guiana

We conducted a retrospective cohort study to determine the influence of crack cocaine use on the outcomes of HIV infection. The use of crack cocaine was associated with an increased incidence of AIDS: 27.8 per 100 person-years versus 6.6 per 100 person-years for nonusers, adjusted hazard ratio = 3.8 (1.9-7.5), P < 0.001. More specifically, crack users had a greater incidence of disseminated histoplasmosis, pneumocystosis, pulmonary tuberculosis, bacterial pneumonia, oesophageal candidiasis, cerebral toxoplasmosis, salmonellosis, and genital herpes. The care of HIV-infected crack users is particularly challenging and requires additional efforts to reduce the high morbidity of these patients.

The changing landscape of crack cocaine use and HIV infection

See related research article by DeBeck and colleagues, page [585][1] Use of crack cocaine was first recognized as a major public health problem in the United States two decades ago. It was quickly identified as a risk factor for HIV infection in association with high-risk sexual practices. [1][2]

Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study

Addiction to heroin and crack cocaine is debilitating and persistent, but such disorders are treatable. We present the first effectiveness study of the main community interventions for addiction to heroin and crack cocaine in England, using data from the National Drug Treatment Monitoring System (NDTMS). The study cohort consisted of all adults with a heroin or crack cocaine addiction, or both, who started pharmacological treatment (n=18 428 patients) or psychosocial treatment (n=2647) between Jan 1 and Nov 30, 2008, received at least 6 months' treatment or were discharged by the study endpoint (May 31, 2009), and had outcome data submitted to the NDTMS. Effectiveness was assessed from change in days of heroin or crack cocaine use, or both in the 28 days before the start of treatment and in the 28 days before review. 14 656 clients-74% of the cohort eligible for analysis at review with available data-were analysed at the study endpoint. During the 28 days before review, 37% (5016/13 542) of heroin users abstained from heroin and 52% (3941/7636) of crack cocaine users abstained from crack cocaine. A higher proportion of users of heroin only abstained than did users of both heroin and crack cocaine (42% [2465/5863] vs 33% [2551/7679]; OR 1.46, 95% CI 1.36-1.56), and more users of crack cocaine only abstained than did users of both drugs (57% [295/522] vs 51% [3646/7114]; 1.24, 1.03-1.48). Overall heroin use reduced by 14.5 days (95% CI 14.3-14.7) and crack cocaine use by 7.7 days (7.5-7.9). For clients given pharmacological treatment, reduction in days of heroin use was smaller for users of both heroin and crack cocaine than for users of heroin alone (p<0.0001), but this differential effectiveness was not recorded for psychosocial treatment in heroin or crack cocaine users compared with users of both drugs. The first 6 months of pharmacological or psychosocial treatment is associated with reduced heroin and crack cocaine use, but the effectiveness of pharmacological treatment is less pronounced for users of both drugs. New strategies are needed to treat individuals with combined heroin and crack cocaine addiction. National Treatment Agency for Substance Misuse.