Increase In Cocaine Use Research Articles

Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial

A 4-week, double-blind, placebo-controlled trial of amantadine was conducted in 61 cocaine dependent outpatients. Subjects received 100 mg of amantadine 3 times daily. A follow-up visit was conducted at week 8. There were no significant differences between groups in treatment retention, or in the number of benzoylecgonine positive urine samples. Self-reported drug and alcohol use declined in both groups. At week 8 follow-up, self-reported drug use was significantly lower in the placebo group. Amantadine was not effective, and discontinuation of it may have been associated with an increase in cocaine use.

Ultrasound diagnosis of fetal anomalies associated with in utero cocaine exposure: further support for cocaine-induced vascular disruption teratogenesis.

The dramatic increase in cocaine use over the past decade has led to a concern about its possible teratogenicity. We have identified 6 structural fetal anomalies which we postulate may have cocaine-induced vascular accidents as the teratogenic mechanism: 2 complex choroid plexus cysts, gastroschisis, meconium peritonitis, urethral stenosis, and radial hypoplasia. Two additional anomalous neonates were born to perinatal cocaine users. Eight of 51 (15.7%) cocaine-exposed perinates exhibited anomalies versus 120 of 2,194 (5.4%) perinates without known cocaine exposure during this time period. This represents a 3-fold relative risk (RR = 2.87, OR = 3.22, chi square = 9.68, p < 0.005) for the cocaine-exposed fetus. Subjects were all identified as cocaine users prior to ultrasound-detected anomaly and ultrasonologists were blinded to maternal drug history. The vascular disruption model as the plausible mechanism for cocaine-associated teratogenesis is supported by the type of anomalies reported. In addition, cocaine use was prospectively determined to have occurred at the critical developmental period in each case.

A review of pulmonary pathology and mechanisms associated with inhalation of freebase cocaine ("crack").

The use of cocaine in the United States has reached near epidemic proportions. A major factor responsible for the dramatic increase in cocaine use is the ability to freebase cocaine and extract essentially pure drug to be smoked as crack. As a result, a variety of respiratory problems temporally associated with crack inhalation have been reported. Cocaine may cause changes in the respiratory tract as a result of its pharmacologic effects exerted either locally or systemically, its method of administration (smoking, sniffing, injecting), or its alteration of central nervous system neuroregulation of pulmonary function. These changes include such diverse disorders as thermal airway injury, pulmonary edema and hemorrhage, hypersensitivity reactions, and interstitial lung disease. However, a review of the pulmonary pathology and dysfunction associated with crack and/or cocaine use indicates that the reported changes are most likely multifactorial, even idiosyncratic, and fails to reveal common features diagnostic of cocaine use. It is likely that the spectrum of cocaine-induced pulmonary disease will continue to enlarge.

Rapid cycling patients: conceptual and etiological factors.

The concept of rapid cycling is confusing in terms of its definition, clinical features, course of illness and the outcome. To complicate the matter further, rapid cycling has been reported to be drug resistant. Currently this condition has been reported to be secondary to lithium, tricyclic antidepressants and other agents such as cyproheptadine, a serotonin antagonist, piribedil, propranolol and levodopa. The increase in rapid cycling has coincided with the rapid increase in cocaine use in the society even though such an association cannot prove a causal relationship. Clinical or subclinical hypothyroidism as well as hyperthyroidism have been implicated in rapid cycling. In addition to the lack of specific knowledge on the etiology, a number of heterogeneous disorders has been grouped under this entity. It is useful to attempt a classification to ascertain whether clinically distinguishable subgroups have a common or different pathophysiology and to tailor the treatment that is most desirable for each subgroup.

Cardiovascular Effects of Cocaine Abuse

According to the 1988 National Household Survey conducted by the National Institute on Drug Abuse, cocaine use among the total population has decreased. This same survey also reported an increase in cocaine use among chronic abusers of the drug. As cocaine use has increased among the abuser population, so has the number of emergency room admissions for cocaine-related complaints; moreover, these patients were admitted with primarily cardiovascular complaints. It is important for the nurse practitioner to recognize the cardiotoxic effects of cocaine abuse. Cocaine abuse should be part of the differential diagnosis in patients with cardiovascular complaints.

The Syphilis Epidemic in Connecticut

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.

Risk factors for syphilis: cocaine use and prostitution.

In Philadelphia, a large increase in syphilis among minority group heterosexuals began in 1986 and preceded similar increases elsewhere in the United States. To determine reasons for this increase, we conducted a case-control study in the metropolitan sexually transmitted diseases clinic during 1987 and 1988. Cocaine use (odds ratio [OR] 3.1; 95% confidence interval [95% CI] = 1.5, 6.5 among men; OR 5.8; 95% CI = 1.5, 33 among women) and exchange of drugs for sex (OR 3.5; 95% CI = 1.4, 8.7 among men) were risk factors for syphilis. Although cocaine users reported more sexual partners and more frequently reported sex with prostitutes, cocaine use remained a risk factor after adjustment for these behaviors. These data suggest that sexual behavior or another factor, such as availability or utilization of health care, among cocaine users leads to increased risk of syphilis in this population. Increases in cocaine use may be partly responsible for recent increases in syphilis incidence in the United States.

ANOTHER POSSIBLE SIDE EFFECT OF FREE-BASING COCAINE.

Because of the recent increase in cocaine use, more of its side effects are becoming apparent. These authors report the case of a 20-year old woman in

Cocaine use among young adults.

The use of cocaine has become quite prevalent among many segments of society, with increasing public concern and personal difficulties resulting from it. This study examines a large group of young adults to determine how cocaine users differ from nonusers. Fully one-third of the sample had used cocaine in the past six months, with about 5% reporting weekly or more use. Numerous important differences were found between users and nonusers in regard to sociodemographic characteristics, use of other licit and illicit drugs, deviant attitudes and behavior, social context of use, physical health, mental health, and life satisfaction. Differences increased with greater involvement with the drug, to the point where cocaine abusers were strikingly different than nonusers. The largest distinctions were noted in regard to cocaine users having more difficulty in the successful acquisition of adult role responsibilities, greater use of other drugs, engaging in more deviant behaviors, and immersion in a social context conducive to use. Smaller but noteworthy differences revealed that cocaine users had poor physical and emotional health statuses and lowered life satisfaction, compared to nonusers. Finally, several personality traits, and in particular a lack of law abidance, predicted a significant increase in cocaine use from adolescence to young adulthood.

Cocaine abuse and dependence: the scope of the problem.

The dramatic increase in cocaine use over the past 20 years has been of epidemic proportions. Cocaine is an extremely attractive and captivating drug that is a powerful reinforcer, induces strong psychological dependence and produces marked adverse behavioral changes. These characteristics, for planning purposes, would seem to suggest that the problem will continue to expand in scope. What we still do not know is the extent to which this increased use translates into a need for treatment. If as few as 10% of the users become problem users, as occurs with alcohol, we may be faced with a tremendous surge in demand for services such as occurred in the late sixties and for which we are similarly unprepared. We need to launch a major national effort to gain much more basic epidemiologic data, monitor the course of the epidemic, and support the development of new preventive and treatment approaches specifically tailored to cocaine, based on its particular advantages and disadvantages and the characteristics of its user population.

The nontherapeutic use of psychotherapeutic drugs among the college age group: the sedatives and tranquilizers.

Abstract The sedatives and minor tranquilizers comprise two large groups of prescription drugs widely used without medical supervision by the college age group. Within the sedative group, the barbiturates and methaqualone are currently the most popular. An estimated nine million Americans have used sedatives without medical supervision, approximately five and one-half million of whom are within the college age group. The appeal of barbiturates to college students is that these drugs produce a “high” similar to that of alcohol, relieve feelings of stress, and produce a temporary sense of well-being. Tolerance and dependence develop quickly; high doses impair motor coordination and judgment. Barbiturates are frequently implicated in auto accidents and in suicides. Methaqualone continues to be popular among students because of its purported aphrodisiac effects and because it is frequently used to bring the cocaine user “down.” Its increase in use has therefore paralleled the increase in use of cocaine. The use of tranquilizers has doubled between 1972 and 1982. Valium, the most popular of tranquilizers, continues to be widely used among students because of its ability to be absorbed rapidly into the bloodstream and to produce its effects of euphoria and acute intoxication quickly. Though Valium is considered to be a relatively safe drug, it can be fatal if taken in large doses with alcohol. Tolerance and both psychological dependence and physiological addiction may occur and cause students to use increasing doses of the drug. A detailed knowledge of the adverse psychological and biological effects of the sedatives and tranquilizers will prove helpful to all those working within the college health facilities.