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 […]

Statutory and Case Law Relative to Substance Abuse and Mitigation in Sentencing

Two major levels of consideration pertain when it comes to sentencing schemes. One involves state codes and the case law that defines and guides their implementation by judges. The second is the federal law and a very special ongoing operation that has created a complex but not particularly flexible decision-making process. Aspects of how these levels operate with respect to substance abuse, particularly methamphetamine abuse, and sentencing are detailed below. State Codes and Cases In the state sentencing processes, somewhat greater potentials for mitigatory findings are evident. Cases in Ohio from 1997 to the present that have had appellate review were accessed. Table Methamphetamine and Sentencing: Ohio Appeals 1996-2002 Cases provides information regarding the types of cases, issues involved, and outcomes. Table Methamphetamine and Sentencing: Ohio Appeals 1996-2002 Cases Citation Type Major Issue Outcome State ex rel, ‘Wright v. Ohio Adult Parole Authority 75 0S3d 82 661 N.E. 2d728, 1996 Revocation of conditional release Restrictions in search and seizure; under prior precedent unreasonably obtained evidence not admissible Evidence obtained unreasonably is admissible State v. Cossin Read more […]

Survey of Methamphetamine Cases Evaluated in a Court Clinic

Although assessment and treatment options in the county from which the below cases were reviewed are better than many, they are generally available only to defendants for whom a mandatory prison sentence is not involved. The general inclination of judges at this court is to refer whenever they perceive questions about treatment-related issues. It is the impression of the court psychologist that defendants referred for a pre-sentence psychological evaluation often are seen as having greater potential for treatment than incarceration. The focus for psychological evaluations as the psychologist reported it is to develop information relevant to the mitigation and sentencing issues and to the risk of violation of probation where a treatment package is recommended. In his opinion, further evaluation of the substance-related and other treatment aspects of referred defendants should be a component of any ongoing treatment facility. The major sources of referral are the judges on their own initiatives, motions by defense counsel, or the request of the probation department where initial psychosocial history leads to a question of psychological status. The majority of referred persons with substance-related issues attend 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 […]

The Resurgence of Hallucinogens

Hallucinogens are ancient drugs. They have been used for thousands of years in religious ceremonies, as sources of inspiration for artists, as medicines, and of course for some simply as a means of altering their perceptions of the physical world. In America, although the consumption of certain hallucinogens has been a part of religious practice among native peoples for many generations, to the general public, the decade of the 1960s is most closely linked with these drugs, popularly called psychedelics. During this decade, widespread experimentation with LSD, peyote, and “magic mushrooms” influenced many aspects of American pop culture. San Francisco emerged as the mecca for psychedelic “love-ins,” beatnik poetry readings, and music called acid rock and psychedelic rock. The image of long-haired hippies wearing beads and tie-dyed clothes and speaking in psychedelic-influenced language is etched in popular memory. Many people flocked to hear the guru of LSD, Timothy Leary, urge everyone in San Francisco’s Golden Gate Park to take the opportunity to experience hallucinogens’ weird effects firsthand. Thanks in part to the advice of Leary and others, the 1960s was a decade of unprecedented psychedelic drug use. The Read more […]

A Strange Class of Drugs

Hallucinogens are drugs that, when ingested, trigger a variety of strange and unpredictable sensations and experiences. Normally, such bizarre perceptions are experienced only in dreams, during periods of extreme emotional and physical stress, or as part of severe mental disorders such as schizophrenia. Psychoactive Chemicals There are dozens of different types of hallucinogens, some of which are produced naturally by plants and some of which are synthesized in laboratories or other facilities. There are many different hallucinogens used today, but the best known are mescaline and psilocybin, which come from plants, and LSD, ecstasy, and ketamine, which are manufactured in laboratories. What these drugs have in common is an ability to alter the functioning of the brain in such a way as to either modify the user’s perceptions or create entirely artificial perceptions. Users of hallucinogens experience a range of odd sensations, from mild distortions of information affecting the senses of sight, hearing, smell, taste, and touch to highly animated and dramatic sensory distortions — the hallucinations that give this class of drugs its name. Altered Perceptions Typically, users of hallucinogens characterize these sensations Read more […]

Rave Drugs

Just as LSD came to be associated in the public’s mind with the culture of the 1960s, two other hallucinogenic drugs, ecstasy and ketamine, have come to be associated with the so-called rave culture of the late twentieth and early twenty-first centuries. These two drugs, which the DEA classifies as hallucinogens, are popular among those who attend impromptu wide-open parties called raves. “Ravers” who take ecstasy and ketamine claim that although these drugs produce perceptual distortions, the effects are mild enough to allow them to dance and converse with friends. Users of ecstasy and ketamine believe that within the rave environment these drugs enhance the experience of dancing to loud music and light shows as well as the enjoyment of being emotionally connected with the large numbers of people who attend raves. Raves Raves are cultural phenomena that have sprung up in nearly every urban setting in America and Europe. Hundreds of rave websites promote the parties and provide information about the rave culture, personal experiences, and rave paraphernalia. Initially, raves were known for their remote natural settings at beaches and wooded mountain retreats. They rarely started before midnight, and they frequently Read more […]