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PubMed2001

Midfacial osteomyelitis in a chronic cocaine abuser: a case report.

We describe the case of a 56-year-old man who was admitted for treatment of a progressive destruction of his hard palate, septum, nasal cartilage, and soft palate that had been caused by chronic cocaine inhalation. Biopsy of the bony septum revealed acute osteomyelitis and an extensive overgrowth of bacteria and Actinomyces-like organisms. There was no evidence of granuloma or neoplasm. The patient received intravenous ampicillin/sulbactam for 6 weeks, followed by lifetime oral amoxicillin. When there was no further evidence that destruction was progressing, the patient underwent nasal reconstruction with a cranial bone graft. The surgery was completed with no complications. To our knowledge, this is the first reported case of midfacial osteomyelitis associated with chronic cocaine abuse. The severity of this patient's complications, coupled with the success of his reconstructive surgery, makes this case particularly interesting. We believe that it is important for physicians to understand that septal perforation in a cocaine abuser should not be underestimated because it could result in a secondary bone infection. Nasoseptal destruction secondary to intranasal cocaine abuse is a result of cocaine's vasoconstrictive properties, and a decrease in the oxygen tension of intranasal tissue can facilitate the growth of anaerobic pathogens.

Administration, Intranasal↗
PubMed1996

Potentiation of occupational carbon tetrachloride toxicity by ethanol abuse.

1. Two separate cases of acute occupational poisoning following exposure to vapours of a fire extinguishing liquid are described. Analytical, clinical, pathological and toxicological data leave little doubt that toxicity was due, in both cases, to inhalation of carbon tetrachloride present at high concentrations ( > 15% and 78% by weight, respectively) in the fire extinguishing liquid. 2. Both subjects were admitted to hospital, 4 and 8 days after exposure, respectively, and developed severe hepato-nephrotoxicity with hepatomegaly, increased values of serum transaminases, blood urea nitrogen (BUN), creatinine, gamma-glutamyl-transpeptidase (gamma-GT), bilirubin and uric acid and, finally, anuria. They recovered in about three to four weeks, after several haemodialytic sessions. 3. Interestingly, in both cases the other workers exposed under the same conditions and for the same period of time as the two patients showed no signs or symptoms of toxicity. The reason for the observed different susceptibility to CCl4 is attributable to an abnormally high ethanol abuse by the two workers, as reported in the clinical records and confirmed by their relatives and colleagues (120 and 250 g per day, respectively). Daily ethanol intake by the coworkers was less than 50 g for all subjects. 4. Although the potentiating effect of ethanol on the toxicity of CCl4 is well known in experimental animals, as a result of cytochrome P-450 induction, direct evidence in humans reported in the literature so far was limited by the lack of information, in all published reports, on the presence or absence of effects in non-alcoholic exposed "controls', when these were present.

Adult↗
PubMed1987

A review of psychoactive substance use and abuse in schizophrenia. Patterns of drug choice.

We reviewed studies measuring unsupervised use of psychoactive substances in schizophrenic and control populations and organized the results by substance class. Despite much variation in their methodologies, these studies broadly agreed that schizophrenic groups' use of amphetamines and cocaine, cannabis, hallucinogens, inhalants, caffeine, and tobacco was significantly greater than or equal to use by control groups consisting of other psychiatric patients or normal subjects. Schizophrenic groups' use of alcohol, opiates, and sedative-hypnotics was significantly less than or equal to use by control groups. We discuss the implications of this nonrandom pattern of drug choice for the hypothesis of substance abuse as a form of self-medication in schizophrenia.

Adolescent↗
PubMed2001

The use of medication for relapse prevention in substance dependence disorders.

Substance abuse is a significant problem in itself and can greatly complicate the symptomatology and treatment of comorbid psychiatric disorders. In the article, the authors review literature concerning the use of medication to prevent relapse to substance abuse or decrease substance use. Five different general strategies are employed for this purpose: 1) use of a drug with pharmacological properties similar to the substance of concern (i.e., agonist or substitution therapy); 2) use of a receptor antagonist to block or lessen the effects of the substance of concern; 3) use of a medication that produces a conditioned aversive reaction to the substance of concern; 4) use of a medication to reduce the reinforcing properties of the substance of concern; and 5) use of a substance to increase the metabolism or clearance of the substance of concern from the body. The authors review pharmacological treatments that have been studied for the treatment of dependence on the following types of substances: alcohol, sedative-hypnotics, opioids, stimulants, nicotine, hallucinogens, cannabis, inhalants, anabolic steroids, phencyclidine, and designer drugs. The article ends with a brief discussion of the importance of including psychosocial and behavioral interventions in any substance abuse treatment program.

Journal Article↗
PubMed1993

Cocaine's time action profile on regional cerebral blood flow in the rat.

Cocaine is a powerful psychostimulant the high abuse liability of which in man appears to be linked, at least in part, to its pharmacokinetic properties. For example, intravenous and inhalation routes of administration result in appreciably higher level of dependence than either the oral or intranasal route, while cocaine's behavioral and physiologic profile is both route- and time-dependent. Therefore, to determine if various aspects of the drug's profile of effects are due to alterations in regional neuronal activity, we measured the effects of cocaine on regional cerebral blood flow (rCBF) 1, 2, 5, 15 and 45 min after a single 1.0 mg/kg i.v. cocaine injection. rCBF is known to directly reflect the state of local neuronal activity and, when measured autoradiographically using the method of Sakurada et al., can be resolved with a very high temporal resolution (30 s). A heterogeneous pattern of cerebral activation was seen. Of those regions which responded to cocaine, all but three did so with a threshold to effect of less than 1 min. Several groups of structures were evident: (1) those regions where blood flow returned to baseline prior to the 5 min measurement group (including several amygdaloid nuclei and lateral septum); (2) those returning to baseline prior to the 15 min sacrifice point (including limbic cortex); (3) regions activated for at least 15 but less than 45 min (including such motor-related regions as the caudate, substantia nigra and globus pallidus); and (4) those demonstrating persistent rCBF alterations for the entire 45 min observation period (including nucleus accumbens, olfactory tubercle, hippocampus, various thalamic nuclei and medial prefrontal cortex). It thus appears that cocaine's duration of action varies heterogenously across both time and brain structure, with many limbic regions displaying either very brief or prolonged duration of action while many motor-related structures display intermediate times of action. This regionally distinct time-course may reflect the diverse behavioral profile seen after cocaine administration in the rat.

Animals↗
PubMed1980

Patterns of drug use amongst Malaysian secondary schoolchildren.

A representative sampling of the secondary school population of two states of Malaysia (sample size 16166) indicated that 11% of students had had experience of drug use. Use of a single drug was the common pattern, with cannabis reported most often by older students, and sedatives most often by younger students. A quarter of those who had used drugs reported experience with four or more substances and were likely to have progressed rapidly to heroin. This progression may be facilitated by the ready availability of heroin and the local tradition of smoking or inhaling rather than injecting opiates. Descriptions of drug migration patterns based on Western samples are not fully appropriate worldwide, because the youthful abuser is much influenced both by local market forces and by cultural traditions, even though the epidemic of youthful drug abuse is itself worldwide.

Adolescent↗
PubMed1995

Beyond performance enhancement: polypharmacy among collegiate users of steroids.

The extremely low prevalence of steroid use among college students makes it virtually impossible to conduct analyses on any single college campus. By studying a cohort of 58,625 college students from 78 institutions that administered the Core Alcohol and Drug Survey in 1990 and 1991, a critical mass of 175 users on which it was possible to conduct statistical analyses was identified. Compared with a randomly selected group of nonusers, the steroid users reported consuming dramatically more alcohol and demonstrated higher rates of binge drinking. In addition, a significantly higher percentage of steroid users reported using tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, and designer drugs. A higher percentage of steroid users than nonusers also reported experiencing negative consequences as a result of substance abuse, and a greater percentage of the steroid users reported family histories of abuse of alcohol and other drugs. Implications from the standpoint of student development are discussed.

Adult↗
PubMed2005

Autoerotic accident by inhalation of propane-butane gas mixture.

We present a case of an accidental autoerotic death involving the inhalation of a propane-butane gas mixture, also known as LPG (liquefied petroleum gas). A 19-year-old male was found dead in supine position in his bed in a residential accommodation one day after he was last seen alive. On a personal computer at the end of the bed, a pornographic movie was still running. On his left shoulder, an empty rubber balloon and on the bedside 2 empty "Kisag-Gas" cartridges were found. Toxicologic investigations revealed an intoxication with propane and butane, together with a recent consumption of cannabis. This case report compares the toxicologic findings with other recently published cases, and the theories of the toxic effects are discussed.

Accidents↗
PubMed1987

Topical treatment of Reinke's oedema with beclomethasone dipropionate (BDP) inhalation aerosol.

Reinke's oedema is a disease which is characterized by oedema of the vocal cords. Women in middle age are particularly prone to this disease, which is encountered mostly in habitual smokers and is often connected with vocal abuse. The condition gives rise to a deep hoarse voice. The traditional treatment is decortication of the vocal cords followed by speech therapy, but the results have so far been disappointing. It has been shown by Moesgaard Nielsen et al. (1985) and Matsuo et al. (1983) that, in the long term, the incidence of recurrence is approximately 60 per cent. Medical treatment of this disease is therefore desirable. It is widely known that topical steroids are often used, but the effects of such treatment have not, so far as we know, been documented. We have found it interesting to observe the effects of BDP inhalation aerosol and placebo in the course of a four-week double-blind randomized trial treatment of Reinke's oedema.

Administration, Inhalation↗
PubMed1986

Talc: understanding its manifestations in the chest.

Four distinct forms of pulmonary disease caused by talc have been defined. The first form, talcosilicosis, is caused by talc mined with high-silica-content mineral. Findings in this form are identical with those of silicosis. Talcoasbestosis closely resembles asbestosis and is produced by crystalline talc, generally inhaled with asbestos fibers. Pathologic and radiographic abnormalities are virtually identical with those of asbestosis, including calcifications and malignant tumor formation. The third form, talcosis, caused by inhalation of pure talc, may include acute or chronic bronchitis as well as interstitial inflammation; radiographically, it appears as interstitial reticulations or small, irregular nodules, typical of small-airway obstruction. The fourth form, due to intravenous administration of talc, is usually associated with abuse of oral medications and production of vascular granulomas manifested by consolidations, large nodules, and masses. Radiographic abnormalities associated with talc can be predicted when there is sufficient history of the nature of exposure, including the region of origin of the talc in cases of inhalation. Radiographic changes, such as diaphragmatic plaques, often attributed to both talc and asbestos have not been documented to be caused by talc alone. The author provides review of 18 well-documented cases.

Adult↗
PubMed1994

Drug abuse and the rapid eye test.

Drug effects contribute to impaired eye movements and visual information processing. Only a small percentage of clinical conditions can cause a positive rapid eye test, therefore, drug use must be suspected and should be confirmed by body fluid analysis. A drug may not reach the urine for one to two hours, while eye signs occur within fifteen minutes after sniffing, inhaling, or injecting the drug. The rapid eye test is inexpensive, nonintrusive, and detects the actual influence of the drug on the body.

Humans↗
PubMed2001

Lack of effects of ethanol pretreatment on the abuse liability of nitrous oxide in light and moderate drinkers.

AIMS: To determine effects of ethanol-use history and ethanol pretreatment on abuse liability of nitrous oxide (N(2)O). DESIGN: Placebo-controlled, double-blind, cross-over design evaluating effects of N(2)O, 0% (100% O(2), placebo) and 30% (in O(2)), in the presence of three doses of ethanol: 0 g/kg (placebo), 0.35 g/kg and 0.7 g/kg. SETTING: Subjects sat in a reclining chair in a hospital laboratory. PARTICIPANTS: Eight healthy light drinkers (one drink or less/week) and eight healthy moderate drinkers (seven or more drinks/week) with no history of drug dependence completed the study. INTERVENTION: On three sessions (1, 3, 5) subjects drank a beverage that contained one of the three ethanol doses, then sampled for 10 minute each 0% and 30% N(2)O. During choice sessions (2, 4, 6), subjects received the same ethanol dose as in the previous session, then chose six times, once every 5 min, between 0% and 30% N(2)O. MEASUREMENTS: Subjective (self-reported) drug effects, reinforcing effects of N(2)O as assessed by choice, and psychomotor effects were measured. FINDINGS: Choice of N(2)O did not differ between light (mean = 3.4 choices) and moderate (mean = 3.2 choices) drinkers and was not influenced by ethanol dose (0 g/kg: 3.3 choices, 0.35 g/kg: 3.5 choices, 0.7 g/kg: 3.1 choices). Subjective effects of N(2)O also did not depend on ethanol-use history or ethanol dose. N(2)O liking and desire to inhale the drug again were positively correlated with N(2)O choice. CONCLUSIONS: Ethanol pretreatment and ethanol-use history had no effect on the abuse liability of N(2)O as assessed in the present study.

Adult↗
PubMed1993

Reinforcing effects of extended inhalation of nitrous oxide in humans.

The subjective, psychomotor and reinforcing effects of nitrous oxide at subanesthetic doses (30% and 40% in oxygen) were determined in normal healthy volunteers using a choice paradigm. Thirty percent nitrous oxide was chosen no more often than oxygen (41.6% choice rate), indicating that, for most of the subjects tested, extended inhalation of this nitrous oxide concentration was no more reinforcing than oxygen inhalation. Forty percent nitrous oxide was chosen significantly less often than oxygen (22% choice rate), indicating that, for most of the subjects tested, extended inhalation of this nitrous oxide concentration was less reinforcing than oxygen. Nitrous oxide produced robust subjective effects (e.g., increased ratings of 'high,' 'tingling,' and 'dizzy'). Subjects who chose nitrous oxide reported pleasant subjective effects and liked it, while those who chose placebo reported unpleasant subjective effects and disliked it. Both concentrations of nitrous oxide impaired psychomotor performance in all subjects. The lack of reinforcing effects noted in the present study, given nitrous oxide's known abuse potential, is discussed.

Administration, Inhalation↗
PubMed1985

Migraine--treatment of acute attack.

The treatment of an acute attack of classical or common migraine is sleep, an antinauseant such as metoclopramide, an analgesic, either aspirin or paracetamol, and in some patients 1 or 2 mg of ergotamine tartrate. Treatment should be given as early in the attack as possible and all drugs should, if possible, be given in a soluble or effervescent form. When vomiting occurs early in the attack, treatment is best given by suppository, inhalation or intramuscular injection. Ergotamine tartrate is only necessary in about one third of attacks and when used is best given by suppository or inhalation. Doses of ergotamine tartrate higher than 2 mg per attack or 6 mgs per week may cause toxic symptoms as may the abuse of analgesics.

Acetaminophen↗
PubMed1981

Measurement of toluene in blood and breath in cases of solvent abuse.

A method was developed for measurement of toluene in blood and breath samples, using Tenax GC columns and a Bendix Flasher (Bendix Corp.) coupled to a flame ionization gas chromatograph. Blood samples were collected from six habitual toluene abusers during a 2-h abstinence period. Blood concentrations were found to range from 9.8 to 31.2 mg/L in samples taken shortly after inhaling. Blood half-lives of toluene were found to be much shorter in the first hour after inhalation (53.5 and 49.3 min) than in the second hour (79.3 and 111.2 min). In one of the subjects, blood:breath ratios were determined and averaged 18.2.

Breath Tests↗
PubMed1987

Skills enhancement to prevent substance abuse among American Indian adolescents.

Skills enhancement programs to prevent drug abuse have shown promise in tests with majority-culture adolescents. To date few applications of this preventive strategy have been evaluated with American Indian youth. A culturally tailored 10-session skills enhancement program was delivered in reservation and nonreservation settings in the Pacific North west. At 6-month follow-up, compared with test-only control condition subjects, intervention condition subjects had better knowledge of drug effects, better interpersonal skills for managing pressures to use drugs, and lower rates of alcohol, marijuana, and inhalant use. Intervention condition subjects were also less likely to label or consider themselves users of these substances. The findings suggest that behavioral skills training approaches hold promise for reducing substance use and abuse among American Indians.

Behavior Therapy↗