Indicators Of Drug Use Research Articles

Detection of Antidepressant and Antipsychotic Drugs in Postmortem Human Scalp Hair

The presence of therapeutic drugs in postmortem human scalp hair was investigated. Hair samples from 21 cadavers known to have taken antidepressant and antipsychotic drugs were solubilized in 1 M sodium hydroxide. Drugs were extracted using solvent extraction procedures and analyzed by gas chromatography-mass spectrometry (GC-MS) and high performance liquid chromatography (HPLC). Antidepressant drugs detected were amitriptyline, dothiepin, doxepin, imipramine, trimipramine, and mianserin. Antipsychotic drugs detected were haloperidol, chlorpromazine and thioridazine. Concentrations of these drugs and their metabolites ranged from 1.3 to 242 ng/mg hair. Segmental analysis demonstrated that the drug concentrations detected were either consistent with the known dosing regime of the deceased, or were able to provide an indication of drug use within the last few months prior to death. This study reinforces the potential of hair as a useful tissue in forensic investigations, in establishing a history of past exposures to therapeutic drugs.

Poverty, Crack, and Crime: A Cross-City Analysis

Many observers have attributed recent increases in violent crime rates to the arrival of crack cocaine on the urban scene. However, little hard evidence exists to support this contention. This study examines the relationship between arrestee cocaine use and homicide, robbery, and burglary rates for the 24 cities participating in the Drug Use Forecasting (DUF) Program. To isolate the effects of rates of cocaine use among arrestees on crime rates, the analysis incorporates controls for additional city-level characteristics, including population composition and selected indicators of economic deprivation and social disorganization. Multivariate analyses reveal that arrestee cocaine use has a positive and significant effect on city robbery rates, net of other predictors. The effect of arrestee cocaine use on homicide is more modest, and no effect was found for burglary. Although these results must be interpreted cautiously, they do suggest that cocaine use elevates city violent crime rates beyond levels expected on the basis of known sociodemographic determinants. Serious consideration should be given to community-level indicators of drug use in formulating theories to explain inner-city violence and policies to reduce it.

Field tests for rational drug use in twelve developing countries

Increasing efforts are being made to improve drug-use practices and prescribing behaviour in developing countries. An essential tool for such work is an objective and standard method of assessment. We present here a set of drug-use indicators produced and tested in twelve developing countries. We describe practical applications, which include the use of indicators to increase awareness among prescribers in Malawi and Bangladesh, to identify priorities for action (eg, polypharmacy in Indonesia and Nigeria, overuse of injections in Uganda, Sudan, and Nigeria, and low percentage of patients who understood the dosage schedule in Malawi), and to quantify the impact of interventions in Yemen, Uganda, Sudan, and Zimbabwe.

Neuroleptic Prescriptions for Acutely Ill Geriatric Patients

Use of neuroleptic medication by the general population of acute care hospitals and in geriatric populations in long-term care has been described. This study examines the use of neuroleptics in acutely ill medical/surgical geriatric patients. Chart review was performed for geriatric patients prescribed a neuroleptic drug during a 2-month study period. Patient characteristics, indications for drug use, and evaluations of cognitive or behavioral dysfunction were noted. For the patients who received only haloperidol, the type of order was described and prescription strategies were identified. Ninety-one (10.7%) of 848 patients received a neuroleptic order. They were older and stayed longer than the rest of the geriatric population. Fifty-eight percent were demented or delirious but 31.9% were simply described as agitated or had no reason identified for drug use. Haloperidol was the sole neuroleptic prescribed for 91.2% of patients. The rationale behind the strategies for drug prescription (loading, maintenance, sporadic) was not clear. This study raises concerns about the quality of documentation around drug use and the adequacy of diagnostic evaluation prior to drug prescription. The strategies of drug treatment do not consistently reflect a working knowledge of the pharmacology of the drug or a diagnosis-based plan of treatment. Future research should focus on physician education and the efficacy of diagnosis and management of the agitated elder.

Pediatric Pharmacology: The Path Clears for a Noble Mission

Unlabeled use of drugs in children occurs frequently and contributes to the therapeutic orphan dilemma. This situation can no longer be condoned; few acceptable reasons still exist for not evaluating potentially effective drug therapy in children. An apparent lack of research funds is not one of these reasons; only allocation of these funds to pediatric pharmacology is found wanting. Availability of clinical pharmacology programs, pediatric pharmacology manpower, sensitive analytical techniques, and acceptable ethical approaches to pediatric research reveal that drug evaluation is feasible in children. Studies readily include the required therapeutic indication for drug use in pediatrics. Efforts of academia, government and industry are now converging to show that the path for the noble mission of pediatric pharmacology--rational use of FDA approved drugs for children--is now clear for action.

Discrepant values, correlated measures: cross-city and longitudinal comparisons of self-reports and urine tests of cocaine use among arrestees

The validity of offenders' reports of illegal drug use has been challenged with data from the Drug Use Forecasting (DUF) program showing large discrepancies between arrestees' self-reports of cocaine use and the results of urine tests. The underreporting of drug use within populations, however, does not invalidate self-reports as indicators of drug use across populations if the ratio between self- reports and more objective indicators is reasonably stable. The study reported here tested this hypothesis with cross-sectional data from 13 DUF sites and longitudinal data from the St. Louis DUF program. The cross-city and longitudinal analyses both show a strong relationship between self-reports and urine tests for recent cocaine use by male arrestees that holds up under alternative model specifications and sample configurations. If these results are reproduced in subsequent research, they may have wide application in criminal justice settings and could reduce reliance on drug testing to estimate drug use for populations.

Toward a Causal Model of Drug Use

Drug use remains a serious concern in neighborhoods and at all levels of government. Formulating drug policy requires sound information regarding the indicators of drug use and its consequences. To date, efforts to integrate drug use measures as a means to predict drug use trends have been minimal. This research describes a statistical modeling procedure that attempted to demonstrate the association between drug use in the justice and health systems to determine if drug use in the criminal justice system could forecast drug use in the larger community. Results of the path analysis suggested that integration of indicators was not useful for determining future drug use due to the weak associations among variables.

Are Lower Penalties a Green Light for Drug Users?

It is probable that DAWN reporters have become more thorough over the years and that the police have become more active in the drug arena during the first half of the 1980's. If this is in fact the case, both sets of statistics would suggest that marijuana use has declined while the use of other illegal drugs, for which possession is penalized as heavily as ever, has risen substantially--although not quite so much as the statistics imply. In sum, the two best statistical indicators of drug use in California show that lowering penalties for marijuana possession did not cause a rise in the use of that drug. On the contrary, these indicators point to a stable situation regarding marijuana use in the decade after the implementation of the Moscone Act, while the use of other illegal drugs soared.

Developing drug-use indicators with a computerized drug database and a personal computer software package

The use of a multihospital drug- and patient-database system, a personal computer (PC), and a standard PC software package to monitor drug-use indicators is described, and a five-step method for analyzing a set of data is presented. An integrated spread-sheet, database, and graphics program (Lotus 1-2-3), which is compatible with an IBM PC, can manipulate data obtained from a multihospital database system. To demonstrate the utility of this system, a previously published procedure for analyzing drug-use indicators (e.g., length of stay, drug cost per patient, number of drugs received) for patients in two diagnosis-related groups was repeated using the database and PC software. The records of patients in each DRG were randomly selected from the database. The following steps were applied to the data: (1) data (as a whole) were characterized statistically, (2) data were examined to identify subgroups of interest, (3) groups of data were characterized statistically and compared with each other, (4) the effect of changing the characteristics of one or more subgroups was predicted, and (5) the results of the data manipulations were presented in tables and graphs. A multihospital database can serve as a source for obtaining large quantities of hospital-specific data. These data can be manipulated and presented in tabular or graphic form on a personal computer and used by hospitals to monitor various drug-use indicators.

The relationship of addiction, tolerance, and dependence to alcohol and drugs: A neurochemical approach

Alcohol and drug addiction are defined in behavioral terms as the preoccupation with, compulsive use of, and relapse to drugs that are descriptive and confirmatory. The basis of addiction may involve neurochemical changes in the brain that distort and redirect the drive states (instincts). Tolerance and dependence may only be incidentally associated with addiction as a result of a nonspecific adaptation by the body to the presence of a drug. The cellular adaptation may be the same in all organs. Addiction to alcohol and drugs may have no specific relationship to tolerance and dependence. Addiction occurs in the absence of observable tolerance and dependence to alcohol and drugs. Alcohol and drug addiction is probably more complex than tolerance and dependence. Addiction is difficult to study because of the variability of behavioral phenomena and the underlying intricacies of the neurosubstrates. Tolerance and dependence are still useful as they are indicators of drug use. It is a misconception that long term chronic use is necessary for toierance and dependence to develop. Some studies have shown that tolerance can develop within hours and days to a single dose of alcohol or other drugs. Anxiety, depression and insomnia can occur after a single dose of ethanol in humans. These symptoms of withdrawal from the alcohol or drug constitute dependence. Redefining the criteria for addiction tolerance and dependence to alcohol and other drugs may be in order. A neurochemical model may provide a more definitive and uniform basis for considering addiction, tolerance, and dependence to alcohol and drugs.

Evaluating attitudes of child psychiatry residents to psychotropic medication: implications for training.

The attitudes of child psychiatry residents toward the use of psychotropic medication in child psychiatric practice were studied. Eighteen residents underwent a semistructured interview that covered their experience in child psychiatry, beliefs about etiology of child psychopathology, preferences for treatment, attitude toward and experience with drugs in treating childhood disturbances. The residents favored a psychosocial view of the etiology of child disturbance and preferred family therapy to other forms of treatment. Six had never treated a child with medication and most were uncertain about indications for drug use and felt they had less than average or poor skills in this area. Seven residents, who did not attend department psychopharmacology seminars and had little clinical experience with drugs, had a strong antipathy toward their use. Experience with and attitude toward drug use could not be predicted from the residents' appraisal of their own competence in this field, their experience in child psychiatry, their appreciation of the biological contributions to child psychopathology, or their future practice plans.

Senile dementia of the Alzheimer type

The etiology, pathophysiology, neurochemistry, diagnosis, clinical presentation, and management of senile dementia of the Alzheimer type (SDAT) are discussed. The etiology of SDAT is unclear. The pathophysiologic changes in the brain tissue of patients with SDAT are quantitative rather than qualitative in comparison to normal age-matched controls. The number of neuritic plaques and neurofibrillary tangles are positively correlated to the severity of clinical symptoms and cognitive impairment. There is overwhelming evidence that SDAT is associated with a loss of cholinergic function. Reduction of choline acetyltransferase activity, a cholinergic marker, has been significantly correlated to the severity of dementia. The diagnosis of SDAT is one of exclusion and is based upon clinical presentation and neurological, psychological, and laboratory testing. The clinical presentation of SDAT involves the progressive deterioration of intellectual capabilities. Management of SDAT primarily involves supportive care and symptom control. Attempts to treat the disease with cerebral vasodilators, metabolic enhancers, and neurotransmitter manipulation have been largely unsuccessful. Drug therapy aimed at reversing or retarding the progression of the disease is not recommended. Behavioral disturbances represent the main indication for drug use in patients with SDAT. The antipsychotic agents are considered the drugs of choice. SDAT remains an enigma. The successes in the treatment of the disease are few, but as more information is gathered on the neurochemical abnormalities involved, there is hope that early detection can prevent the disease or at least slow its progression.

AMA Drug Evaluations

The original publication, AMA Drug Evaluations 1971, (AMA-DE) arose out of the atmosphere of severe criticism of drug manufacturers and physicians, engendered on the one side by the great increase of drug usage with its resulting iatrogenic disease, and on the other by congressional hearings such as the Kefauver Investigation of 1959-1962. More recent hearings have continued to be critical and there has been a mandate to produce a that gives clear indications for the safe use of drugs and that would prevent overprescription of useless and dangerous drugs. The first edition of AMA-DE—bacause of publication delays, numerous errors, and a poor format and style—did not seem to catch on either as a bible or otherwise. The present (second) edition (1973) 1 is much more readable and useful. It ought to be at the right hand of every prescribing physician, available at every nursing station and clinic. Pharmacology instructors,

Drug use and sexual activity on a college campus.

A questionnaire study on one college campus revealed that drug users were significantly more likely to engage in sexual intercourse, to engage in it earlier in life, and to engage in it regularly and with a greater variety of partners. This held true regardless of the specific indicator of drug use employed, as well as when the two control variables, gender and class in college, were introduced.