Human Dependence on Tobacco and Opioids: Physiologic Dependence

Physiologic dependence is a factor of significance in opioid dependence and of suspected significance in cigarette smoking. There are three primary aspects of physiologic dependence. The first is important in the maintenance of opioid-taking behavior, in which the emergence of the withdrawal syndrome is correlated with increasingly intense craving scores (). Some analogous findings in animal studies are that the onset of the opioid withdrawal syndrome is correlated with increased rates of drug-taking behavior () and increases in the reinforcing efficacy of opioid drugs (). The second aspect of physiologic dependence to opioids is the increasing propensity of a person in withdrawal to become anxious and to emit aggressive and antisocial acts (). The third aspect of physiologic dependence is the phenomenon of protracted abstinence (), which, in the most rigorous use of the term, refers to physiologic withdrawal signs that are present for more than six months following the onset of opioid abstinence (). Protracted abstinence to opioids has also been well documented in animal studies (). With regard to cigarette smoking, it has been recently postulated that withdrawal phenomena occur and are similar in certain respects Read more […]

Multiple Drug Use Epidemiology, Correlates, and Consequences

The initial focus is on the conceptual issues essential to the understanding of multiple drug use. This is followed by a discussion of the developmental nature of multiple drug use and the various strategies that have been designed to measure multiple use. The third section of the paper contains a review of the extent of multiple drug use in various segments of society with data from the Monitoring-the-Future surveys of high school seniors, the National Survey on Drug Abuse, and the Treatment Outcome Prospective Study of drug abuse treatment clients. The conclusion is that multiple drug use is pervasive. The next section deals with several consequences associated with multiple drug use: automobile accidents, delinquency, and emergency room visits. The final section outlines some of the prevention and treatment implications of multiple drug use from a public policy perspective. In a study of the effects of a single drug upon behavior, the implications are manifold. Dosage levels, modes of administration, baseline states, the expectations of the subjects and of the investigators, the environment in which the drug is taken — all these variables, and others as well, make human psychochemical studies difficult and complex. Read more […]

Consequences of Multiple Drug Use: Specifying the Causes

In order to illustrate these points, three specific consequences of drug use will be discussed in some detail below. These three consequences are traffic accidents, involvement in delinquent/criminal acts by youth and young adults, and emergency room visits related to drug abuse. Traffic Accidents The Monitoring-the-Future surveys contain several questions concerning traffic accidents. The seniors are first asked how many accidents (i.e., a collision involving property damage or personal injury — not bumps or scratches in parking lots) they had while they were driving in the past 12 months. If the answer is one or more, the senior is asked how many occurred after he/she was drinking alcoholic beverages and then how many occurred after he/she was smoking marijuana or hashish. By piecing together the information from these separate questions, it is possible to estimate the proportion that would be due to alcohol, to marijuana, and to alcohol and marijuana. The data in Table “Motor Vehicle Accidents and Their Connection to Use of Alcohol, Use of Marijuana, and Use of Both Alcohol and Marijuana” are for seniors in the class of 1980 classified according to the extent of alcohol and marijuana use reported during the 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 […]

Measuring the Developmental Nature of Multiple Drug Use

There have been a number of studies in which attempts have been made to measure or assess multiple drug use. Some of these are from general populations while others are focused on specific subpopulations of users. The studies are grouped more on the basis of the approach taken to assessing multiple drug use than on the patterns uncovered. There are at least four different groupings of studies and some studies fit into more than one grouping. Developmental Patterns of Onset of Use One of the most influential attempts to describe patterns of multiple drug use is the “stages of drug use” model developed by Kandel. Kandel posited that persons proceed from licit to illicit drugs and from use of less to more serious drugs. The stages of drug use involvement that she identified were: (1) no use of any drugs; (2) use of beer or wine; (3) use of cigarettes and/or hard liquor; (4) use of marijuana; and (5) use of illicit drugs other than marijuana. Although it is not made explicit by Kandel, there is an implication that the drugs from the earlier stages of development are “carried forward” into the later stages of drug involvement. Thus, a marijuana user is likely to continue his or her use of cigarettes/hard liquor and beer Read more […]

Sedatives

An assessment of the relationship between sedatives and driving accidents requires the survey of literature dealing with: (1) the effects of sedatives on actual driving behaviors, (2) the epidemiological studies of sedatives and traffic accidents, and (3) the physiological, psychological, and behavioral effects of sedatives on factors related to driving. Only a few studies have tested the effects of sedatives either in a simulator or in the field. Loomis and West () tested eight subjects in a driving simulator from 1 to 6 hours after they were given various drugs. The simulator consisted of an automobile steering wheel and brake accelerator pedals arranged as in a standard automobile. The steering wheel operated a model car placed on a moving belt 150 ft. long and 30 in. wide with an opaque l-in. strip running down it lengthwise, which simulated the road bed. The strip was shifted randomly, moving smoothly from side to side as the belt advanced. Accelerator and brake pedals actuated and controlled the rate of belt movement, and the steering wheel controlled the position of the model car. A light source placed 14 in. above the car was capable of producing an amber, red, or green light. The subject was required to Read more […]

Opioid Use by Adolescents: Prevention and Pharmacotherapy

Non-Opioid-Dependent Teens Primary Prevention When prescribing opioid medications, clinicians should provide anticipatory guidance. Teens and parents should be advised that although pain medications are highly effective and safe when used as prescribed, they are also highly addictive and can be dangerous when misused. Parents should monitor use to ensure that medications are always used as directed. Any leftover medication should be discarded by returning it to the pharmacy. Medications should never be shared or given to anyone other than the patient for whom the prescription was written. Pain medication can be safe for use even in patients with substance use disorders, and pain should not be left untreated because of a history of substance abuse or dependence. However, in these situations clinicians should require increased supervision and monitoring to avoid misuse. Parents should be asked to hold, dispense, and observe all medication doses. When treating chronic pain the clinician should insist on the patient receiving all prescriptions from a single prescriber, open communication among all treating physicians, and use of a single pharmacy to fill all prescriptions. A parent should bring in remaining medication Read more […]

Regional Variations in Use of Drugs

Data on the Locations where men were Living at the time of the interview became available late in the process of preparing this report. The computer tape has not been checked with the interview schedules, but it is known that the Location of one respondent is Listed incorrectly. Consequently, data are available for 2,509 rather than 2,510 men. The importance of the available data justify inclusion of a brief discussion of regional variations. Data on the Lifetime use of all drugs except tobacco and alcohol are presented in Table “Lifetime Drug Use by Regions and Divisions of U.S. in Which Respondents Lived at Time of Interview (Percentages)” in terms of the four regions and nine major divisions of the United States. The percentages for the regions are offset and enclosed in parentheses to facilitate comparisons. For five of the drugs the rank order of the regions is the same; the West had the highest percentage, and was followed by the Northeast, North Central and the Southern regions. This pattern was observed for marihuana, psychedelics, stimulants and sedatives; it also held for cocaine, as the apparent tie between the North Central and Southern regions disappeared when an extra decimal place was used. Read more […]

Multiple Drug Use

In this post attention is focused on multiple drug use or the reported use of at least two of the drug classes examined in this study. This is an initial report, and the question whether use of one drug leads to or “causes” use of another drug is not addressed, but the data can be used to establish the temporal order of usage. Use of pairs of drugs One tactic used by previous researchers to study multiple drug use is to examine all of the possible combinations of drug classes, note how many cases are observed for each combination and determine if some combinations are observed more frequently than would be expected by chance. As an example, one possible pattern is that none of the nine drug classes were used. It should be noted that in this and later analyses in this chapter, quasi-medical use of stimulants, sedatives and opiates was treated as no use of the drugs. In addition, there are nine different patterns in which one, and only one, drug class was used. If one adds the patterns in which two, three or more of the nine classes were used, the total number of possible patterns is 512. Only 86 of the 512 patterns actually emerged. This clearly established that it is not a matter of chance which drugs are found together Read more […]

A Review of Drug Abuse Data Bases

This chapter will identify and describe briefly data sources which may be used to project nonmedical drug use among young adults in future years. A wide variety of sources have potential utility in this regard. They range from individual studies conducted by local school districts or States to major national surveys involving thousands of respondents. Because of the proliferation of research on drug use in recent years, it was necessary to place some limitations on the data to be presented here. First, it was decided that since a complete review was conducted in 1974 (), it was unnecessary to duplicate those efforts. () The studies reviewed here are more recent and, with the exception of the earliest National Surveys, were not covered in the 1974 review. Second, this review is limited to those data bases which are national in scope. State and local surveys have severe limitations for purposes of making national projections of nonmedical drug use. For example: 1. The definitions used for nonmedical use often vary from one local or State survey to another. 2. Various local and State surveys are conducted in different time periods, so that it is often difficult to piece together a national profile. 3. The Read more […]