Archive for category Cocaine'

Changing Patterns of Cocaine Use: Longitudinal Observations, Consequences, and Treatment

In 1858 the Austrian frigate Novara was sent to South America on a most unusual mission. The Novara was named after the city in which the Austrians had defeated the Italians, thereby stopping a threatening cultural and political renaissance. On board the Novara was a trade expert, Doctor Scherzer, who was intrigued by another Italian “renaissance” started by Milan neurolgist Paola Mantegazza. Mantegazza had published an 1857 paper proclaiming the medical importance of coca that he had chewed while a resident of Peru (Mantegazza 1857). The paper was the newest curiosity of the European medical community which even awarded Mantegazza a prize for this work in 1859 (Mortimer 1901). The Novara stopped in Peru and Scherzer took a quantity of coca leaves back to the great chemist Wohler at the University of Gottingen in Germany. Wohler’s assistant, Albert Nieman, named the isolated alkaloid “cocaine” in 1859/1860 (). The isolation and naming of the alkaloid signalled the start of 125 years of changing patterns of cocaine use. Prior to that time, only coca products were available, and the patterns of their use had not changed substantially in over 4700 years. For most of its early history, cocaine remained hidden Read more […]

Cocaine: Short-term observations of users (1970-1983)

A number of studies have provided observations of contemporary patterns of cocaine use in the period 1970 to 1983. These studies have concentrated on selected populations of users that were seen at only a single point of time during this period. When reviewed chronologically, these observations suggest that patterns of cocaine use were changing rapidly throughout the period 1970 to 1983 and in particular for long-term users. For individuals engaged in continued use this change was characterized by increased dosage and frequency of use resulting in decreasing positive effects and increasing negative reactions including physical and psychological dysfunction. This changing pattern is also examined () in a series of longitudinal observations made on a sample of users studied at multiple points of time during this sane period. Users entered the 1970s with attitudes that supported their beliefs that cocaine was a “safe recreational drug.” Gay and Inaba () suggested that the rediscovery of cocaine in the 1970s was inevitable because its effect of euphoria and stimulation “reinforces and boosts what we recognize as the highest aspirations of American initiative, energy, frenetic achievement, and ebullient optimism” (). Phillips Read more […]

Cocaine: Longitudinal study of users (1975-1983)

Methods A total of 118 cocaine users were recruited for study in 1974. Of these, 19 were selected for interview and questionnaire study while 99 (85 males, 14 females) were selected for a more comprehensive longitudinal study. All 99 users (18-38 years old) were social-recreational users who met the initial requirement of having used a minimum of 1 gram of cocaine per month for 12 months (range 1-4 grams). The majority of users were students (73 percent,) while others listed their occupations as housewives, business people, writers, attorneys, physicians, secretaries, teachers, or unemployed. Exaninations and tests were performed on each subject at 6-month intervals for 4 years (1975, 1976, 1977, 1978) and then at approximately 18-month intervals for another 5 years. Examination procedures included a personal history questionnaire, drug history questionnaire, subjective drug effects questionnaire, mental status exanination, the Minnesota Multiphasic Personality Inventory (MMPI), the Experiential World Inventory (EWI), in-depth interviews, and physical examinations (for most subjects). In addition, assays were performed on samples of cocaine used by these subjects. An important caveat is that a number of users dropped Read more […]

Adverse Effects of Cocaine Abuse

Specific, consequences of cocaine abuse on health and psycho-social functioning were assessed in 55 cocaine-abusing subjects who called a telephone “helpline.” Results showed a high incidence and wide range of adverse consequences including: (a) impairment of job functioning, interpersonal relationships, and financial status; (b) disturbances of mood and cognitive functioning; (c) psychiatric symptoms of depression, paranoia, and increased suicidal/violent tendencies; and (d) physical symptoms of exhaustion, weight loss, sleep problems, and seizures. Cocaine-related automobile accidents, suicide attempts, and violent acts, including a cocaine-related homicide, were also reported. Intranasal users reported no fewer and no less severe adverse consequences than free-base smokers or intravenous users. Our findings challenge popular notions that cocaine is a benign “recreational” drug and that the intranasal route of administration guarantees protection against addictive patterns of use and adverse effects. Introduction Cocaine use has escalated to epidemic proportions in the U.S. in recent years. Nationwide surveys estimate that over 22 million American have used cocaine and the numbers continue to soar at an alarming Read more […]

Cocaine Abuse: A Review of Current and Experimental Treatments

Cocaine abuse is a recently revived drug problem that is again generating great popular concern. Unfortunately, scientific evaluation of cocaine abuse treatment has been surprisingly sparse kind no consensus exists regarding optimal treatment strategies. This review summarizes current treatment issues and regimens. as well as preliminary data on new, approaches to cocaine abuse treatment. Since this chapter will deal with treatment of the cocaine abuser, it is important from the outset to define what is meant by that term. Although in some settings any use of illegal drugs equals abuse such a definition is more legal than medical and will not he used here. Instead the definition of drug abuse found elsewhere in the field will be employed namely…“the nonprescription use of psychoactive chemicals by an individual to alter his her psychological state in a situation in which the individual or society incurs some harm” (). The great majority of cocaine users applying for treatment fit into this definition. The most common exception is the individual who defines his use as recreational controlled and nonharmful but is brought to treatment by another (e.g. spouse, parent), while the significant other views the cocaine Read more […]

Cocaine abuse treatment strategies

Strategies devised to treat cocaine abuse have existed since its intractable lure for some first became obvious almost a century ago. During this period no generally accepted or successful treatment has emerged. Chronic cocaine abuse has been assumed to cause no physiologic withdrawal state on discontinuation because of insufficient evidence for an abstinence syndrome of major physiological changes like the classic sort characterizing sedative or opiate withdrawal (). Cocaine abuse has thus been assumed to be a “psychological dependence” rather than one involving neurophysiological adaptations, and currently used treatments consist of psychological strategies aimed at modifying addictive behaviors. Issues related to current psychological strategies will be discussed first, followed by a summary of evidence indicating cocaine abuse may cause neuroadaptation. The latter includes a review of pharmacological strategies, aimed at reversal of such adaptation, which may hold future potential as adjuncts in cocaine abuse treatment. Cocaine abuse treatment strategies: Current treatments Potential New Directions in Treatment Despite the past assumption that cocaine abuse is a “psychological addiction,” it is plausible Read more […]

Cocaine abuse treatment strategies: Current treatments

Only two comprehensive efforts at cocaine abuse treatment are described in the modern literature. Both are nonpharmacological, but each involves a very different approach to treatment. Anker and Crowley () have adapted the behavioral method of contingency contracting () for cocaine abuse. The contract involves such contingencies as the therapist’s holding letters of notification of cocaine abuse or resignation of professional licenses, written by the patient with content chosen specifically because of severe irrevocable personal effects, and mailing them to drug enforcement authorities, employers, or licensing boards upon finding evidence of cocaine use in urinalysis or after missed urinalysis. Such treatment appears to effectively induce abstinence in those willing to take part. Anker and Crowley report 48% of their sample were willing to engage in this treatment, with over 90% cocaine abstinence during the duration of the “contract.” Over half of these patients relapsed following completion of the “contract” (), however, even though the sample was a presumably well motivated and well educated group. The patients declining “contracts” (52%) were treated with supportive psychotherapy which was also used as Read more […]

Illicit Drug Use: Cocaine

Epidemiology of Cocaine Use in Pregnancy Although the epidemic of cocaine and crack use that began in the 1980s has waned, the problem of prenatal exposure to cocaine persists. According to the National Institute on Drug Abuse (NIDA,1996), approximately 2.3 percent of women of childbearing age have used cocaine in the past year and many of these women continue to use when pregnant. This figure may be higher in certain population subgroups and lower in others. In 1994, using blood drawn from a cohort of neonates, about 0.1 percent of all births were reported to have been exposed to cocaine, with a higher incidence among older women, those delivering without prenatal care, and inner-city populations. Most women reporting cocaine use also used tobacco, alcohol, and cocaine, and some combined the use of cocaine or crack with heroin. Because of concerns raised during the “crack baby” period, extensive examination occurred of the teratogenic potential of this drug in both animal models and clinical studies. Although in 1993 one could conclude that inadequate data existed to support conclusions about the effects of this drug, during the latter half of the 1990s many studies were published that provide considerable understanding Read more […]

Medical Consequences of the Use of Cocaine and Other Stimulants

Once thought to be a benign, nonaddicting drug, cocaine now has well-recognized adverse effects. These adverse effects are manifested in nearly all organ systems of the body. It is important to realize that an organ system breakdown in classifying the adverse effects of cocaine is artificial and that multiple organs are often affected by similar mechanisms. In particular, the effects of cocaine on the cardiovascular system help to explain many of the effects on other organs throughout the body. In addition, certain adverse effects may be dependent on the route of administration, or dose of cocaine. The adverse effects of two other stimulant drugs, methamphetamine and phenylpropanolamine, will be summarized at the end of this post. History The history of cocaine use has been well described by a number of authors. Peruvian Indians have a long history of chewing coca leaves to achieve euphoria, combat fatigue, and increase stamina. Sigmund Freud used cocaine and also prescribed it as treatment for alcohol or opiate addiction. At one time, cocaine was a common ingredient in many commercial products, including teas and patent medicines. Although no longer the case, when first introduced, Coca-Cola was formulated using Read more […]

Adverse effects of cocaine

Cocaine is one of the most frequently abused illicit drugs and the adverse effects of cocaine use have been well summarized. According to the 1997 National Household Survey on Drug Abuse (NHSDA) an estimated 1.5 million Americans were current cocaine users (National Institute on Drug Abuse, 1999). Of patients presenting to the emergency department following cocaine use, cardiopulmonary, neurologic, and psychiatric presentations have been shown to be the most common. Although the overall morbidity and mortality of patients presenting with cocaine-associated complaints appears to be low, devastating effects, including death, do occur. Of New York City residents who died between 1990 and 1992 from intentional or unintentional injury, evidence of recent cocaine use was found in one-fourth of cases. Of these deaths, one-third were attributed to cocaine intoxication and two-thirds to traumatic injury. The psychiatric adverse effects of cocaine are likely contributory to trauma-related deaths. Cardiovascular The most significant adverse effects from cocaine use involve the cardiovascular system. In addition, many of the adverse effects in other organ systems are mediated through the effects of cocaine on the cardiovascular Read more […]