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 […]

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 […]

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 […]

A Study of the Effects of Certain Tranquilizers and Small Amounts of Alcohol on Driving Performance

STUDY: Clayton, A.B., T.A. Betts, and G.M. Mackay. A Study of the Effects of Certain Tranquilizers and Small Amounts of Alcohol on Driving Performance. European J. Toxicol., 5:254-257. 1972. Site: Departments of Transportation, Environmental Planning, and Psychiatry, University of Birmingham, United Kingdom. Subjects: The 50 males and 50 females were mostly students, the mean age being 28.1 years. Their driving experience varied, and none normally took prescribed psychotropic medications. Method: Subjects performed closed-course driving-tests under controlled conditions. They were generally tested in groups of six, using a fixed routine. On Wednesday afternoon, subjects practiced for 1 hour on all driving tests at the driving site. They then received two unmarked bottles – one containg five drug tablets, the other five placebo tablets – along with directions of how and when to take them. (Both bottles used by the control group contained placebos.) One bottle was to be used first – one tablet Friday evening; three on Saturday (at intervals); and the fifth Sunday morning. Random double-blind administration techniques were used. On Sunday morning, subjects performed three runs on test 1, three runs on Read more […]

Effects of Four Commonly Used Tranquilizers on Low Speed Driving Performance Tests

STUDY: Betts, T.A., A.B. Clayton, and G.M. Mackay. Effects of Four Commonly Used Tranquilizers on Low Speed Driving Performance Tests. Brit. Med. J., 4:580-584. 1972. Site: Departments of Psychiatry and Transportation and Environmental Planning, University of Birmingham, Birmingham, United Kingdom. Subjects: There was a total of 113 volunteers, mostly students, the first 13 of whom were used in a pilot study testing vehicle handling techniques. They ranged in age from 18 to 30 years, and were free from medical or psychiatric problems. All had valid drivers licenses. Further information regarding driving experience was obtained during the testing. Method: The 100 nonpilot subjects (50 men, 50 women) were divided into five groups for testing and data analysis: (1) chlordiazepoxide vs. placebo; (2) haliperidol vs. placebo; (3) amobarbital vs. placebo; (4) trifluoperazine vs. placebo; and (5) placebo vs. placebo. The subjects were tested in groups of six every 2 weeks, with double-blind, randomized administrations. The fixed test procedure was to have the subjects who would be tested during a given fortnight come to a closed-course driving site on Wednesday afternoon. They were given (1) a visual screening test; Read more […]

General Tranquilizers

Current methodology for determining plasma levels of diazepam and its active metabolites employs electron-capture gas chromatography and can measure 1- to 10-ng quantities (). When a group of people are administered diazepam at a particular dose, there is a wide range of plasma concentrations of diazepam (). This range, in 13 subjects administered 15 mg of oral diazepam daily for a week or more, is 16 to 400 ng/ml (). Garattini et al. () found a range of 10 to 250 ng/ml in 27 subjects given a single 15-mg oral dose. A half-life of 38 to 92 minutes has been measured by this group in five female subjects. Kleijn et al. () calculated a half-life of 20 to 42 hours after 10 mg three times a day, about 0.5 mg/kg/day orally in five subjects. This great variability in plasma concentration is a major problem in interpreting drug effects on human performance. Perhaps the factors that influence plasma concentration curves can be identified and controlled. With seven subjects, Linnoila et al. () showed that ingestion of food increases plasma levels of diazepam 6, 7, and 8 hours after intravenous administration of 0.3 mg of diazepam per kg. They suggest that enterohepatic recycling of diazepam is occurring. Kleijn et al. () Read more […]

Drug Impairment Reviews: Anesthetics and Foreign Tranquilizers

STUDY: Doenicke, A., J. Kugler, M. Laub. Evaluation of Recovery “Street Fitness” by E.E.G. and Psychodiagnostic Tests After Anaesthesia. Can. Anaes. Soc. J., 14:567-583. 1967. (This study has been conducted in West Germany, but the address of the authors is not indicated in the reference.) Subjects: The total number of subjects is not evident but it must be above 200. Eighty-one subjects completed the psychomotor test battery. Demographic data on the subjects and descriptions of their health or drug use prior to the study are not given. They are, however, described as healthy volunteers. Method: This is an experimental study conducted in a clinical laboratory. The drugs administered as a single dose were thiobutabarbital (500 mg), methohexital (150 mg), and propanidid and C1-581 in doses which are not reported. Some subjects received repeated anesthesia but their number is not reported, nor is the order of or the interval between the anesthesias. Some subjects also received halothane, diethylether, or nitrous oxide after propanidid. Halothane was administered for 15 minutes. None of the concentrations of the inhalation anesthetics are reported in the text. EEG was continuously recorded for 12 or 24 hours Read more […]