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 […]

Methamphetamine and the Courts: Evaluation of Defendants and Context

Purposes of Evaluation All forensic evaluation and analysis takes place within a legal context and properly focuses on the questions before the court. As the foregoing section illustrated, there are relevant precedents that constrain both questions and variables, which may be entertained by the court. It is within that context that evaluation takes place. Mitigation in sentencing involves the notion that some agreed-upon level of punishment for the crime committed can be adjusted in the direction of leniency if factors particular to the person and situation warrant such consideration. Mitigation is a basic part of all legal codes and has been present either in content (by defining offenses according to some set of standard factors to be greater or lesser) or by reference to modifying conditions (the Code of Hammurabi written about 1700 B.C.e. contained such specifics) (). More currently, the resurrection of capital punishment after Furman (1972) created sets of definitions of mitigatory factors and a body of case law further elaborating what could or should be brought to the attention of the jury or judge. Following Lockett v. U.S (1978), inclusion of individually based information resulted in drug related factors Read more […]

Drug-Drug Interactions of MDMA

Alcohol The pharmacokinetic and pharmacodynamic interactions of single doses of ecstasy 100 mg and alcohol 0.8 g/kg have been investigated in nine healthy men (mean age 23 years) in a double-blind, double-dummy, randomized, placebo-controlled crossover design. Each underwent four 10-hour experimental sessions, including blood sampling, with 1 week between each. For the task used to test the recognition and recording of visual information, the conditions involving ethanol yielded significantly more errors and fewer responses than ecstasy alone or placebo alone. The combination of ecstasy with ethanol reversed the subjective effect of sedation caused by alcohol alone. In addition, the combination extended the sense of euphoria caused by ecstasy to 5.25 hours. The addition of ethanol caused plasma ecstasy concentrations to rise by 13%. These results show that the combination of ecstasy with alcohol potentiates the euphoria of ecstasy and reduces perceived sedation. However, psychomotor impairment of visual processing caused by alcohol is not reversed. This is a concern for road safety, as people who take both drugs would feel sober, but their driving would still be compromised, although the extent of driving impairment Read more […]

Club Drugs and Hallucinogens

The term club drugs comes from the association of several drugs with use in dance clubs or all night dance parties (“raves”). Popular club drugs are methamphetamine (see earlier section, “Amphetamine-Related Disorders”), lysergic acid diethylamide (LSD; “acid”), 3,4-methylene-dioxymethamphetamine (MDMA; “Ecstasy” or “X”), gamma-hydroxybutyrate (GHB; “liquid X”), ketamine (“special K”), Rohypnol (“roofies”), and dextromethorphan (“DMX”) (). Emergency department visits due to MDMA and GHB use increased dramatically starting in the late 1990s. In the United States in 2002, emergency department visits for MDMA-related disorders numbered 4,026 and for GHB-related disorders numbered 3,330. Hallucinogenic drugs include LSD, mescaline, psilocybin, and synthetic derivatives such as 3,4-methylenedioxyamphetamine (MDA). The popularity of hallucinogens began to wane in the mid-1970s, but a modest resurgence in use occurred in the early 1990s, particularly among youth. MDMA (“Ecstasy”) MDMA, called “Ecstasy,” was promoted in the 1960s and 1970s as a “mood drug” without the distracting perceptual changes of other hallucinogens. MDMA is usually taken orally but can be taken in-tranasally (snorted). The purity of the drug in tablets Read more […]

Brain Impairment And Illicit Drug Abuse

Studies of General and Polydrug Abuse Our more recent understanding of how drug addiction occurs involves the interference of brain reward circuits, resulting in an increase in the desire to use. In particular, it is posited that the amygdala and subregions of the basal forebrain are involved in a mesolimbic dopamine system that activate mesolimbic dopamine function. Repeated use alters dopamine production, resulting in a dysregulation of the brain reward circuitry. The result is a biological addiction to the drug. With such brain involvement and alteration of the brain circuitry, alterations in neuropsychological functioning is likely. A preliminary report of neuropsychological functioning in polydrug abusers by Grant and colleagues noted a study in which 15 polydrug users were administered a comprehensive neuropsychological battery including neuropsychological tests from the Halstead-Reitan Neuropsychological Test Battery, as well as the Wechsler Adult Intelligence Scale and the Minnesota Multiphasic Personality Inventory (MMPI). The 15 polydrug users were compared to a group of 66 psychiatric inpatients. Although both groups demonstrated severe psychopafhology, as measured by the MMPI, the patterns of neuropsychological Read more […]

The Neuropsychological Consequences of Amphetamines and MDMA (Ecstasy)

Although amphetamine use can result in neurological findings such as hypertension, stroke, brain hemorrhage, or other neuropathy, neuropsychological findings in human subjects have not been well documented, except in the cases of infant and developmental exposure. With the increase of mefhamphetamine use in the United States, patients are presenting with chronic psychotic illnesses likely to be related to vasoconstriction and neurotoxicity resulting in brain damage. The decision-making abilities of chronic amphetamine abusers were studied by Rogers and others. In a computerized decision-making task, chronic amphetamine abusers tended to exhibit longer response times before making their decisions when compared to opiate abusers. In general, the research data suggested that decision-making performances of chronic amphetamine abusers was similar to the performances of patients with focal damage of the prefrontal cortex. In addition, it was found that the chronic amphetamine abusers’ performances were also similar to that of the performances of normal volunteers with induced decreases in plasma tryptophan. This finding helped support the notion that amphetamine abusers may experience reduced levels of serotonin (5-hydroxytryptamine, Read more […]

Physical Effects of Ecstasy

The physical effects of a standard dose of between 80 and 150 milligrams of ecstasy are subtle and variable. Some users report dryness of mouth, jaw clenching, teeth grinding, mild eye twitching, sweating, or nausea. Others report feelings of profound physical relaxation. At higher doses, the physical effects of ecstasy resemble those of amphetamines: fast or pounding heartbeat, sweating, dizziness, and restlessness. Researchers do not yet conclusively know if ecstasy causes long-term neurological changes in humans, although animal tests have suggested there is reason for concern. Scientists hold differing views of the implications of using ecstasy, however. Dr. George Bicaurte of the Johns Hopkins Medical Institutions in Baltimore warns, “We now know that brain damage is still present in monkeys seven years after discontinuing the drug [ecstasy]. We don’t know just yet if we’re dealing with such a long-lasting effect in people.” Dr. Charles Grob, an associate professor of psychiatry and pediatrics at the University of California Los Angeles School of Medicine, noted in 1995, “There’s no apparent pattern of clinical neural degeneration syndromes reported in millions of people who’ve taken MDMA [ecstasy] over the Read more […]

Ecstasy and Gang Violence

Whatever the risks associated with using ecstasy might be, society is faced with other problems created by the drug. For example, the growing popularity of ecstasy has sparked violence in America’s big cities among gangs who fight for control over the trafficking of the drug. In part, the problem lies in the fact that ecstasy is highly profitable. Pills that cost no more than fifty cents to manufacture sell for fifty times that amount on the street. Bridget Brennan, a special narcotics prosecutor for New York City, said in an interview, “With drugs, it’s always about the money and the dealers are starting to see there is so much money in ecstasy that more people are getting involved, and with that comes more violence.” With money and gang violence come deaths. Gang-related homicides related to ecstasy have occurred in most of America’s big cities. Most of these homicides are committed by rival street gangs, but police have reason to believe that organized crime may be behind some of the murders. In May 2001, New York police arrested a former Gambino crime family hit man, Salvatore Gravano, who later pleaded guilty to running a multimillion-dollar ecstasy ring in Arizona. According to the New York Times, “Court Read more […]

Rethinking the Classification of Hallucinogens

One such proponent of reclassifying hallucinogens is Richard B. Karel, a writer who has researched the problems of drug law enforcement. He believes that law enforcement agencies should focus on apprehending users of drugs associated with violent crime rather than pursuing users of hallucinogens. To that end, Karel recommends that hallucinogens should not be considered as dangerous drugs and believes that “Psychedelics, including the naturally occurring plant drugs such as psilocybin and peyote, as well as synthetics such as LSD and MDMA [ecstasy], would be regulated quite differently from all other drug categories.” The idea that hallucinogens are not as great a threat to the American public as addictive drugs is hardly new. The issue was taken up in the early 1980s by the Drug Abuse Council, which commented in the introduction to its report that its board of directors “perceived a pressing need for independent analyses of public drug policies and programs… and that the effectiveness of law enforcement and treatment strategies was often overstated.” The Drug Abuse Council made seven general observations, one of which focused on the need to recognize that, although hallucinogens are widely used, they do not Read more […]

Meth And Other Stimulants

Methamphetamine is a synthetic psychostimulant that physicians have legally prescribed as a treatment for attention deficit disorder under the brand name Desoxyn. The drug can be made easily in clandestine labs with over-the-counter ingredients. For addicts, it is relatively inexpensive to purchase and has desired effects that last for hours. The desired effects of meth use can last from six to eight hours, followed by a coming-down period when the user becomes agitated and potentially violent. Drugs, such as meth, labeled as psychostimulants include a diverse range of CNS (central nervous system) stimulants such as amphetamine, cocaine, methylphenidate (Ritalin), methylene dioxy-methamphetamine (MDMA, or ecstasy), caffeine, and nicotine, to name a few. A number of prescription drugs, in addition to Ritalin, such as Dexedrine (dextroamphetamine), Cylert (pemoline), and Adderall (adderall) are psychostimulants as well. Psychoactive stimulants activate the CNS by increasing pulse rate, alertness, blood pressure, restlessness, euphoria, excitement, increased energy, talkativeness, and other changes. Users of psychostimulants experience euphoria, increased sense of well-being, more energy, more confidence or overconfidence, Read more […]