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 […]

The Epidemiology of Multiple Drug Use

How much multiple drug use is there? What proportion of the population at any one point in time is using/abusing multiple substances? Has use of multiple substances become more normative in the recent past as opposed to exclusive use of a favorite drug? What are the principal consequences of multiple drug use? Do these consequences differ according to pharmacological parameters for interactive potential or are there other parameters of almost equal predictive value? To what extent are the consequences attributed to single drugs (traffic accidents labeled as alcohol related) really the result of impaired judgment and performance from ingestion of multiple substances? These are just a few of the questions that need to be addressed within the scientific and public policy communities. In the following section some epidemiological data pertinent to understanding the “extent” of multiple drug use are presented. Monitoring-the-Future Studies Each year since 1975, researchers at the Institute for Social Research at the University of Michigan have administered questionnaires to about 17,000 high school seniors attending schools randomly chosen to be representative of all high schools in the continental United States. These Read more […]

History of Drug Exposure as a Determinant of Drug Self-Administration

The purpose of this paper is to review how a drug’s effectiveness in initiating and maintaining self-administration can be influenced by a subject’s past experience with drugs. Drug self-administration by humans and laboratory animals is considered an instance of operant behavior (), controlled by the subject’s genetic constitution, past history, and the current circumstances of drug availability (of Skinner, 1938). The influence of history of drug exposure on current drug-maintained behavior may be controlled, in turn, by the particular drugs and doses employed and the conditions under which the drug is administered. This discussion will focus on the ways in which a history of drug exposure can control later drug self-administration in laboratory animals. Effects of history of drug exposure on initiation of drug self-administration In order to study drug self-administration by laboratory animals, an experimenter must set up a situation in which subjects are exposed to some contingency between the occurrence of a specific response and delivery of a particular drug. For many drugs, no explicit behavioral or pharmacologioal history is necessary for the drug to maintain behavior. In one initial study, for example, Read more […]

Marijuana and Driving

Alcohol continues to be, and will most likely always be, the principal drug which causes deterioration of driving performance. In North Carolina for over 10 years, the bloods of more than half of the operators (57%) killed in single vehicle crashes contained more than 0.09% alcohol. The effects of drugs other than alcohol on driving are virtually unknown. Only recently have attempts been made to see if other drugs have adverse effects that could lead to accidents. The contribution of other drugs with and without alcohol should be ascertained. There is concern that the use of marijuana may increase the risk of having an accident. In order to establish this scientifically, it will be necessary to show that operators are being adversely affected by the drug and that they are over-represented in the group of drivers having accidents compared to a non-accident group. To obtain such information it is necessary to analyze bloods from a random sample of the non-accident driving population and also from operators involved in crashes. It is becoming increasingly difficult to obtain blood from living operators. This is not true of operators killed in crashes. If a drug is rarely found or occurs at a non-influencing concentration Read more […]

WHO’s Response to International Drug Control Treaties

I should like to review briefly the activities undertaken by WHO since I last reported to you in Philadelphia June 1979: Scheduling Activities WHO’s recommendations to the Secretary-General of the UN regarding the control status of eight substances were reviewed by the 6th Special Session of the UN Commission on Narcotic Drugs in February 1980 in Vienna. Tilidine and Sufentanil were placed in schedule I of the 1961 Convention while Dextropropoxyphene was placed in schedule II of the same Convention. The Commission agreed with the recommendations of WHO that Phencyclidine continue to be controlled under schedule II of the 1971 Convention as it is needed in veterinary practices. It was also decided that three analogues of PCP (TEP, PHP or PCPY and PCE) be controlled under schedule I and Mecloqualone under schedule II of the 1971 Convention. In September 1980, WHO plans to review the status of a group of 9 substances (anorectics). These are: Phentermine Chlorphentermine Chlortermine Benzphetamine Mazindol Fenfluramine Amfepramone Phenmetrazine Phendimetrazine Phenmetrazine and Amfepramone are already controlled under schedule II and IV respectively of the 1971 Convention. Technical Cooperation Read more […]

Adolescence and Drug Abuse: Biomedical Consequences

Many facets of the biomedical aspects of substance abuse in adolescents have not yet been adequately researched. Little is known about the biological elements, if any, that contribute to the genesis of substance abuse. In the instance of alcoholism a genetic vulnerability appears to be established from the studies of identical twins, one raised by the natural parent and the other placed at an early age in the home of nonalcoholic foster parents. In the studies conducted both in this country () and in Denmark () the incidence of problem drinking of both groups of twins was similar. It is well established that among people of Mongolian descent, a widespread sensitivity to alcohol, based upon the rapid accumulation of acetaldehyde, is observed (). Facial flushing and more upsetting symptoms, including asthma and hypotension, can be present. In those with marked discomfort after drinking small amounts of ethanol, a certain preventive role is probably played by this inborn racial change in the ability to metabolize alcohol. Such genetic factors have not yet been uncovered for other psychoactive drugs. With the recent identification of opiate () and benzodiazepine () receptor sites, and the hint that other drug-specific Read more […]

The Diagnosis and Treatment of the Phencyclidine Abuse Syndrome

David E. Smith, M.D., Donald R. Wesson, M.D., Millicent E. Buxton, Richard Seymour, M.A., and Honey M. Kramer Our first exposure to Phencyclidine occurred during the summer of 1967 in the Haight-Ashbury District of San Francisco in which the drug was first introduced as the “PeaCe Pill” during a rock concert. We saw that day between twenty-five and thirty acute Phencyclidine toxic reactions. In some respects, these reactions were like the bad LSD trips we were used to treating, but in other respects quite different, with greater physical toxicity and paranoid thinking. We had samples of the “PeaCe Pill” analyzed through a local Bay Area toxicology laboratory and found that the psychoactive drug was PCP. The “PeaCe Pill” was not well received by the majority of individuals in Haight-Ashbury at that time, although Phencyclidine became the drug of choice for a small number of users who continued to use it on a chronic basis. For them most part, Phencyclidine was a drug of deception, usually marketed as “THC” or as one of the psychedelics which were more in demand. Within the past five years, however, Phencyclidine has become increasingly visible as a primary drug of abuse under a variety of street names, including “hog,” Read more […]

Stage I. Acute Phencyclidine Toxicity

In acute Phencyclidine toxicity there are four “C’s”: combativeness, catatonia, convulsions and coma. These effects are dose-related. Combativeness and catatonia are frequently observed together at the lower dosages, while convulsions and coma are related to higher dosage effects. During this stage, one also sees hypertensive crisis sufficiently severe to be fatal, although such crises are relatively rare in our experience. Illusions can dominate: space walking, the detachment of sounds, objects changing in size, shape, and distance. Visual illusions rather than true hallucinations are common, but occasionally auditory hallucinations occur. If the dose of Phencyclidine is high enough, the patient may have many grand mal seizures and coma which require hospitalization and supportive care to stabilize and maintain the respiratory and cardiovascular function. With proper management, most patients who go into a PCP-induced coma survive, although the period of coma may be quite prolonged. Our experience indicates that the usual duration of acute Phencyclidine toxicity is 0 to 72 hours. Lab results indicate that blood is almost always positive and urine is positive. A large number of people clear after stage I, Phencyclidine Read more […]

Stage IV. PCP-induced depression

PCP-induced depressionis a very frequent condition that many clinicians miss, particularly when it comes after a stage III PCP-precipitated psychotic reaction. The clinician is so relieved when the psychosis is over that s/he discharges the patient with relatively little followup and without realizing that in this depression the individual has high suicide liability or may use other types of drugs to alleviate the depression. A paradox with Phencyclidine is that it does give an energizing, numbing, consciousness-altering effect which the patient perceives as antidepressant. Clinically, it appears that many of these patients have prolonged cerebral dysfunction, as well as depression. The complaints of memory impairment subside as the depression clears. The patients who we have treated have indicated that they feel less depressed as they think their “brain damage” is clearing. It becomes very difficult to figure out whether depression clears as the cerebral dysfunction itself clears or as their concern over the cerebral dysfunction waves. In addition, some of the symptoms may be the result of the depression rather than the cause. PCP-induced depression can last from one day to several months, and can follow any of Read more […]

Substance-Related Disorders

The ability to recognize and treat substance use disorders (SUDs) is a core competence in psychosomatic medicine. SUDs are common in both inpatient and outpatient medical settings. Alcohol and tobacco use alone contribute to a host of medical illnesses. Illegal drug use taxes the health care system. Drug and alcohol dependence disorders are best characterized as chronic medical illnesses. Hepatitis C is an example of a potential long-term complication of even brief drug use, injection drug users being at increased risk. Emergency departments have seen a steady increase in overdoses of drugs, including “club drugs” not prevalent until recently. The long-term effects of perinatal drug abuse are becoming known. Devastating complications result from the internal concealment of illicit drugs (e.g., body packing). Core competence in addiction medicine includes the ability to make accurate diagnoses, initiate treatment, and plan and coordinate services. Some hospitals have specialized addiction consultation services, but there is a shortage of board-certified addiction psychiatry specialists. All psychiatrists working in general medical settings are on the front lines of substance abuse and must be sufficiendy knowledgeable. The Read more […]