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 […]

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 […]

Anesthetics and Foreign Tranquilizers: Anesthetics

The rapid increase of hospital expenses taking place in all western countries has forced the expansion of outpatient services. This trend has imposed new requirements on the methods used for anesthesia and sedation. Hospitals should use anesthetics which lack cardiovascular side effects and which allow for a rapid recovery after the medical procedure is over (). This is of particular importance in countries such as the United States, where personal cars provide the most convenient transportation for local travel. Cur knowledge concerning the recovery of psychomotor skills related to driving after anesthesia is increasing, but we are still far from the goal of being able to predict the duration of the aftereffects of an anesthetic on an individual patient. There are several methods to choose for outpatient anesthesia, depending on the type of operation or procedure and the habits and preferences of the anesthetist. Local anesthetics can be suggested for outpatient use whenever possible. Lidocaine in high doses does not impair psychomotor performance for more than 2 hours (), and combining the anesthetic with epinephrine can reduce the adverse psychomotor effects of the drug by slowing its absorption from the site Read more […]

Driving After IntraMuscular Lidocaine, Bupivacaine and Etidocaine

STUDIES: 1. Korttila, K. Psychomotor Skills Related to Driving After IntraMuscular Lidocaine. Acta Anaesth. Stand., 18:290-206. 1974. 2. Korttila, K., S. Hakkinen, M. Linnoila. Side Effects and Skills Related to Driving After Intramuscular Administration of Bupivacaine and Etidocaine. Acta Anaesth. Stand., 19:384-391. 1975. Site: Department of Anaesthesia and Pharmacology, University of Helsinki, Helsinki, Finland, and Department of Industrial Psychology, Institute of Technology, Espoc, Finland. These two experimental, clinical studies are reviewed together because the methodology in them is essentially the same, and the main problem in both is the effect of intramuscularly administered local anaesthetics on psychomotor skills related to driving. Subjects: Thirty healthy student volunteers, 20 to 25 years of age, participated in study number 1. The subjects were of normal weight as to their height, ± 10 percent (according to Home Economics Research Report, No 10, ARS, USDA). The three experimental groups were controlled as to their sex distribution as well. None of the subjects had a history of mental illness. They had not been on drugs for at least a month prior to the study. There were 24 males and 6 Read more […]

Diazepam Sedation for Outpatient Dentistry

Healy, T.E.J., H. Lautch, N. Hall, P.J. Tomlin, M.D. Vickers. Interdisciplinary Study of Diazepam Sedation for Outpatient Dentistry. Brit. Med. J., 3:13-17, 1970. Site: Department of Clinical Investigation and Research, Dudley Road Hospital, Birmingham 18, Great Britain. Subjects: Forty-four anxious dental patients were subjected to a total of 54 courses of treatment. Their ages ranged from 15 to 54 years. Before the tests, the patients completed the Eysenck personality inventory. They were observed to resemble the original group of Eysenck’s neurotic subjects as to their anxiety. Method: This study can be characterized as a partially controlled clinical experiment. The duration of the operation and presumably its painfulness, as well, varied from patient to patient. This must have increased the variability of the results. Body sway, auditory flutter fusion, visual reaction time, memory functions, and coordination in the form of writing and manual dexterity were measured between 45 and 165 minutes after anesthesia. The measurements were repeated eight times, except for the handwriting and memory tests, which were measured only three times, at 60 and 90 minutes after anesthesia and a week later. Several vital Read more […]

Drug-Drug Interactions of Cocaine

Alcohol Cocaine abusers have reported that alcohol prolongs the euphoriant properties of cocaine, while ameliorating the acutely unpleasant physical and psychological sequelae, primarily paranoia and agitation. It may also lessen the dysphoria associated with acute cocaine abstinence. It has also been proposed that concurrent alcohol abuse may be an integral part of cocaine abuse. The combination of cocaine with alcohol can cause enhanced hepatotoxicity and enhanced cardiotoxicity. Trauma in patients who use cocaine plus alcohol has been reported. Those who use cocaine plus alcohol are 3-5 times more likely to have homicidal ideation and plans; this is particularly prominent in patients with antisocial personality disorder. A large high school survey by the Centers for Disease Control and Prevention showed that illicit substance abuse, prevalence of weapon carrying, and physical fighting were higher among the adolescents who reported recent use of cocaine, marijuana, alcohol, and corticosteroids. Among 215 female homicide offenders, 70% had been regular drug users at some time before imprisonment. Alcohol, crack, and powdered cocaine were the drugs most likely to be related to these homicides. In a double-blind Read more […]

Cocaine-Related Disorders

DSM-IV-TR describes both cocaine use disorders (cocaine dependence and cocaine abuse) and cocaine-induced disorders (cocaine intoxication, cocaine withdrawal, cocaine intoxication delirium, cocaine-induced sexual dysfunction, cocaine-induced psychotic, mood, anxiety, and sleep disorders). Epidemiological Characteristics An estimated 193,034 U.S. emergency department visits solely for cocaine use were documented in the 2001 Drug Abuse Warning Network (Office of Applied Studies 2003), and cocaine is the most frequently reported drug in emergency department visits. Frequent reasons for psychiatric consultation in the medical setting are cocaine overdose, positive results of a urine toxicological screen, cocaine-induced depression, cocaine-induced cardiac problems, and cocaine-induced psychosis. According to the 1998 National Household Survey on Drug Abuse, 1.8 million individuals in the United States had used cocaine during a 1-month period. Use of crack cocaine is especially high in poor urban areas, but its use is widespread among other populations, such as rural migrant workers. Many cocaine users are polysubstance abusers. Pharmacological Characteristics Cocaine hydrochloride is a white crystalline powder derived Read more […]