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 […]

Cannabis and Chronic Non-Schizophrenic Psychoses

On the basis of their studies, some researchers have maintained that cannabis smoking can also give rise to longer-lived psychoses, sometimes referred to as “cannabis psychoses”. The conditions in question have been psychoses whose clinical picture has differed in certain respects from that of schizophrenia. Still, despite the fact that studies have been carried out which support this position, the overall impression is that there is not sufficient evidence to support the existence of this alleged side-effect of cannabis smoking. In other words: what appears to be a separate type of functional psychosis is probably schizophrenia. A number of scientific studies have been carried out to answer the question of whether cannabis smoking can provoke long-lived, possibly chronic, psychoses. This, then, does not refer to a toxic psychosis which is maintained by means of continued cannabis smoking, but rather to psychotic conditions which remain after the toxic effect has ceased, often for a long period of time unless the condition is stopped through successful treatment. Simplifying slightly, it can be said that these reports and the discussions that they have given rise to have dealt with two different questions: a) Read more […]

Epidemiology of Drug Use Among Adolescents

This review of the epidemiology of adolescent drug use focuses on typical stages of the drug use career and assesses the diversity of experience that my characterize special subgroups of youth. As shown by earlier longitudinal studies (), drug use during the adolescent years is a dynamic, multistage phenomenon which my best be understood by a conceptualization of progressive stages of involvement. The most recent data on dominant patterns of drug use in the 12 to 21 age group are provided by two series of nationwide surveys: the national survey of high school seniors () and the national survey of household population aged 12 and older (). Both of these surveys are cross-sectional, but because many of the data consist of retrospective drug use histories, nationwide patterns of use in 1979 can be described in terms of sequential stages of drug experience. As Kandel has noted, the study of stages of adolescent drug use does not imply “that the use of a drug causes the progression to the next level. Nor can we assume that once started adolescents will progress through the entire sequence” (). Rather, during the adolescent years, each stage of the drug use career represents a risk factor with regard to more serious stages Read more […]

Update on Naltrexone Treatment

Our group in Philadelphia has used naltrexone in the treatment of 201 narcotic addicts in 258 separate treatment episodes as of 1 July 1977. The antagonist treatment program is an important part of our overall multimodality program which includes methadone or propoxyphene maintenance treatment, inpatient detoxification, long-term therapeutic community, family, group, and individual therapies, and a variety of behavioral treatments. Narcotic antagonist treatment, of course, appeals only to those patients who are genuinely interested in becoming drug free. It is not nearly as popular as methadone treatment, but it occupies an important niche — amounting to 5-10 percent of our total patient population at some time in their treatment careers. Our narcotic antagonist patients are demographically similar to our other patients: mean age 27, 60 percent black, more than 95 percent male, and more than 95 percent veterans of military service. Our methods for detoxification from narcotics and institution of antagonist therapy have been reported elsewhere (2, 4); they are similar to those described by others. We use intravenous naloxone prior to the first naltrexone dose to detect residual physical dependence and thus reduce Read more […]

The Addicts

In the early 1950’s, the addict population of Baltimore was relatively small, largely black and almost entirely male. The number of narcotic addicts, according to police files, did not exceed a few hundred (). Between 1951 and 1959, most of the individuals who were entering the drug scene were largely from black inner-city neighborhoods, primarily in west Baltimore, and were raised in working-class families. During the ensuing years the major changes have been in the direction of an increase in the total number as well as an increase in the proportion of whites and of females. By 1970, the addict population had increased more than ten-fold, and the trend toward increasing proportions of whites and of women (particularly among blacks) continued. In the 1950’s and earlier 1960’s, the black and white addict populations tended to form rather disparate and non-interacting groups (apart from necessary drug-buying transactions) but with the passage of time and the advent of social changes such as urban renewal and trends toward integration, there has been a slight decline in the separation of black and white addicts. However, over time, there has been a continued tendency for the existence of two separate drug subcultures, Read more […]

Multimodality Treatment of Narcotic Addiction

George E. Woody, M.D., Charles P. O’Brien, M.D., Ph.D., and Robert Greenstein, M.D. A major commitment of time and resources has been made in the treatment of narcotic addiction during the last fifteen years. This contrasts with addiction treatment prior to the 1960’s when long-term therapy at Lexington, Kentucky, or Ft. Worth, Texas, or detoxification in a local hospital were the only treatments available. In those times, many hospitals excluded addicts, and there was little interest from most of the medical community in applying its expertise toward developing effective treatments for addiction. The more recent efforts and the current high level of interest have produced great changes, and many options are now available. As a result, treatment is easier to obtain, and the outlook for this once discouraging condition has been improved. Pharmacological treatments and therapeutic communities have provided the backbone of the present-day therapeutic approaches, but interest is growing in outpatient psychological therapies. This paper will discuss the treatments being used now and will present an overview of the field. Multimodality Treatment of Narcotic Addiction: Pharmacologic Therapies Behavioral Therapies Contingency Read more […]

Consequences of Use: Heroin and Other Narcotics

Irving F. Lukoff, Ph.D Our charge is to say something about the consequences of narcotic use. Our remarks are restricted to the post-World-War-II American experience. Out of the host of issues, we selected those that may have some possible relevance for policy. We first venture a brief, schematic review of current epidemiological findings, because we feel this must serve as a backdrop for anything about the sequel to heroin use. We then highlight the inappropriate tendency to minimize the impact that heroin use has on some communities as knowledge of the self-limiting nature of narcotic use for many persons is noted. The view that alcohol and tobacco undoubtedly inflict more aggregate damage is, in our opinion, a myopic one because it fails to locate the problems with sufficient specificity. Therefore, we will look at one community in order to elaborate our view that overall heroin use rates may be a bit deceiving, and that the problem of heroin use cannot be compared to other forms of abuse by the simple criterion of quantity. Since we were charged to look at the sequel to heroin use, we review, perhaps too critically, the efforts to identify life cycles and various role typological schemes we all find so attractive. Read more […]

The lnstitutional Matrix: Methadone Treatment, Science, and Research

An appraisal of the consequences of heroin use, we suggested earlier, cannot be limited to the examination of the actors in the heroin scene. We reviewed several of the efforts to identify types of adaptations of heroin addicts; however, the conclusion we drew was that this was only a prolegomenon to what has to be done in the future. Our examination of a high risk community suggested that where rates of narcotic involvement are high, the problem can no longer be viewed as confined to a collection of individuals who happen to choose a particular mode of adaptation. Instead, it becomes an issue that reverberates throughout the community and influences the community’s ability to solve its problems of survival. There is still another aspect to the consequence of heroin use, the organizational and institutional one, with its concomitant establishment of a complex public and private system to deal with narcotics. Expenditures for supply reduction alone represent over 350 million dollars annually. There are 276,000 treatment slots provided by federal and local governments and under private auspices (White Paper, 1975). A major industry has been spawned to cope with a problem that may involve between one-quarter to one-half Read more […]

Some Comments on Consequences of Chronic Opiate Use

Charles Winick, Ph.D. Dr. Lukoff’s paper, which has appeared earlier in this report, has presented a very useful analysis of the need to study the details of the subarea prevalence of opiate use as well as the larger national samples of the population. It also contains some trenchant observations on typologies and a number of vigorous assessments of our use of data on methadone maintenance. Prevalence Policymakers and social scientists are especially concerned about that form of opiate use that we can call a chronic relapsing condition. It is more a condition than a disease, because it is so heavily mediated by social and ecospace factors that the disease model, as explicated by researchers like De Alarcon (1969) and Hunt (1973), appears to have limited utility without consideration of social factors. Consider some of the differences in dimensions of opiate use in different communities at the present time (): 1. Street methadone is the primary drug of abuse of 500% more users in New York than in Los Angeles. 2. Texas users are almost 300% more likely to be arrested than New Jersey users. 3. New York users are 200% more likely than Philadelphia users to have a legitimate source of income. 4. Detroit Read more […]

Harvesting and Preparing Marijuana and Hashish

Scientific Foundations To obtain maximum potency, the timing of the harvest is critical. Sometime after the seed has become fully mature, the plant will begin to senesce and die. Cetrahydrocannabinol production begins to decrease and cetrahydrocannabinol begins to degrade into cannabinol (this happens in the living plant as well as after harvest). Unfortunately, a reliable, scientifically-proven method of determining exactly when to harvest in order to maximize cetrahydrocannabinol and minimize cannabidiol has yet to be developed. One approach is to harvest the plants continually by pinching off or pruning the flowering tops. Another is to cut them back severely to within a foot or so of the ground, leaving some leafy branches, which are removed several weeks later when the new branches have sprouted. Outdoor growers who have to deal with climatic fluctuations tend to harvest their whole crop as soon as it’s mature, but in areas where the climate remains mild, large outdoor crops can also be harvested continually for as long as six months. Farmers in Asia sometimes bend the stem of the plant near the base or cut it and insert a small stone or a piece of opium a few days before harvest. They believe that this Read more […]