Cannabis and Pregnancy

THC is a substance which passes from the mother’s blood to that of the foetus. This means that THC can cause direct damage to the foetus during pregnancy. (THC is also passed on to the infant via breast-milk.) Animal experiments have shown a number of very serious effects on the gestation of, and on the young born to, females which have been given cannabis or THC during gestation. These findings have naturally given rise to questions concerning the risks to which the human foetus is exposed if the mother smokes hashish or marijuana during pregnancy (). Researchers are here confronted with the usual problems of finding a reliable design for their studies, including comparable control groups. Further, research of this type is faced with particular difficulties as regards finding means of excluding other factors that might explain damage that has been observed, such as other drugs (including alcohol and tobacco), inadequate nutrition and infections during pregnancy. Moreover, it is also difficult to find suitable methods of measurement with sufficient sensitivity to detect even damage of a subtle nature. The conceivable – and suspected – harmful effects of cannabis can be divided into the following categories: Effects Read more […]

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 […]

Treatment of Nicotine Dependence

There are an increasing number of options available for the treatment of nicotine dependence. As noted above, nicotine dependence is a chronic, relapsing disorder, and treatment should be approached from this perspective. The U. S. Public Health Service’s Clinical Practice Guideline on Treating Tobacco Use and Dependence is a comprehensive review of smoking cessation research, with recommendations based on numerous meta-analyses. It is the best resource for evaluating currently available treatments, and therefore it is the basis for most of the conclusions that we present here. Pharmacotherapies To date, there are seven FDA-approved medications that reliably increase long-term abstinence rates. These includefive nicotine replacement therapies (NRT) (gum, transdermal patch, inhaler, nasal spray, and lozenge), and two non- nicotine medications (bupropion SR, and varenicline). NRTs are designed to wean smokers gradually off nicotine in a manner that reduces the severity of withdrawal symptoms and cravings to smoke. They are typically used during the first 8–12 weeks of tobacco abstinence. Although the products vary in their routes of nicotine delivery (with the patch providing the most consistent delivery and stable Read more […]

Human Dependence on Tobacco and Opioids: Common Factors

Recent years have seen increasing acceptance of the notion that tobacco is an addictive or dependence-producing substance, particularly as it is used in cigarette smoking. This idea is supported by the observations that tobacco serves as a reinforcer (i.e., it maintains behavior leading to its use) and that most people who smoke cigarettes would like to quit but cannot, even in the face of well documented health risks and economic sacrifices (Surgeon General’s Report 1979). The term “drug dependence” suggests that (1) the drug serves as a reinforcer, (2) behavior occurs which is maintained by the opportunity to take the drug, and/or (3) other reinforcers are sacrificed as a consequence of taking the drug (). Many cigarette smokers in some degree satisfy these criteria for drug dependence (). Since cigarette smoking has only recently been conceptualized as an instance of drug dependence, it should be useful to systematically compare cigarette smoking with another more thoroughly studied dependence process such as opioid dependence or narcotic addiction. At first blush, cigarette smoke and opioid drugs appear to produce vastly differing pharmacological and behavioral effects: large doses of opioids can produce Read more […]

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 […]

Policy Implications of Multiple Drug Use

Public policies that deal with the use and abuse of alcohol and drugs are very fragmented, reflecting in many ways the history of various substances as well as the role played by the substances in this society. Alcohol is a good example. Because the impact of alcohol on traffic fatalities is so painfully obvious, public interest in the control of alcohol has increased in the recent past. There have been a number of initiatives at Federal, state, and local levels concerning enforcement of minimum age drinking and dram shop liability laws and a push in some areas for raising the driving age. However, very little public policy attention has been directed toward the other control strategies that might have a larger impact on alcohol consumption and its relationship to traffic accidents and fatalities (i.e., changes in laws that would eliminate tax deductions for advertising, restriction of advertising of various types of alcoholic beverages, or substantial increases in the tax placed on alcoholic beverages and thus on the price). After all, when the economics of alcohol is examined it is easy to see how thoroughly interwoven alcohol is in society. The value of alcohol in the advertising, trucking, and agricultural sectors 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 […]

Drug Impairment Reviews: Opiates and Minor Tranquilizers

STUDY: Gordon, N.B. Reaction Times of Methadone-Treated Heroin Addicts. Psychopharmacologia, 16:337-344. 1970. Site: Rockefeller University and Yeshiva University, New York City, New York. Subjects: The subjects were divided into six groups. Groups 1 and 3 both had been maintained for at least 1 year on methadone for the treatment of heroin addiction. Group 1 had 18 males whose average age was 32.5 years; group 3 had 9 females whose average age was 33.5 years. Group 2 consisted of 20 unpaid male volunteers who did not use drugs; they averaged 32.5 years. The participants in groups 4 and 5 had recently withdrawn from narcotic drugs. The 20 males in group 4 averaged 31.5 years and had withdrawn 14 days earlier. The 19 males in group 5 averaged 30 years and had withdrawn 4 days earlier. Group 6 consisted of 9 females whose average age was 23 years. They were paid volunteers from the nonprofessional hospital staff, and did not use drugs. Method: Measurements were taken under controlled laboratory conditions; urines were tested (details were not given) for drugs to assure conformity to group. Variations of reaction time were tested in a button-pressing situation: (a) simple reaction time (one of six stimuli); (b) Read more […]