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PubMed2003

[Methods of use and behavior of cocaine addicts consulting medical-legal emergency units in Paris. Clinical aspects and urinary toxicology profile].

OBJECTIVE: Establish the epidemiological characteristics and urinary toxicological profiles of a population of cocaine addicts under police custody. METHOD: A series of 60 cocaine addicts consulting the medico-legal emergency unit of the Hôtel-Dieu hospital in Paris was studied prospectively on the following elements: clinical characteristics, method of cocaine administration and association with other licit or illicit substances. Urinary toxicological analysis, using immuno-chemistry and chromatography linked to a mass spectrometer was systematically proposed to each patient. RESULTS: Half of the 17 to 26 year-old patients declared having consumed cocaine for the past 2 to 5 years. Inhalation of the vapours and the intravenous route were used more than the cigarette or nasal route. The majority of 26 to 35 year-olds were multi-drug addicted, generally associating cocaine, heroine and tobacco. Analysis of the urine provided an objective assessment of the cocaine consumption of these persons under police custody in Paris. CONCLUSION: Screening for urinary toxicity gives better knowledge on the consumption of addictive products by the person in whom urine was sampled. This study was conducted in cocaine addicts under police custody, and for the majority were social misfits. In this population, the consumption of crack by inhalation predominated.

Administration, Inhalation↗
PubMed2004

First household survey on drug abuse in São Paulo, Brazil, 1999: principal findings.

CONTEXT: In order to establish prevention programs regarding psychotropic drug use that are adapted to specific populations it is, first of all, important to have data on the realities of such consumption. Single data points are not enough for drawing up a profile of society in relation to drugs. OBJECTIVE: The aim of this household survey was to determine the incidence of illegal drug, alcohol, tobacco and psychotropic medication use, and thus the number of persons dependent on drugs, alcohol and nicotine, and to evaluate their perception regarding how easy it is to obtain psychotropic drugs. TYPE OF STUDY: Epidemiological survey. SETTING: All of the 24 cities in the State of Sao Paulo with more 200,000 inhabitants participated in the study. METHOD: The sampling was constructed from weighted probabilistic stratified conglomerates obtained via two-stage selection. In each municipality sampled, census sectors (generally 200-300 households) were first selected. Then, households and a respondent were selected to provide information from his/her point of view. The SAMHSA questionnaire (Substance Abuse and Mental Health Services Administration) of the U.S. Department of Public Health was used, after translation and adaptation to Brazilian conditions. RESULTS: A total of 2,411 persons aged 12-65 years old were interviewed, of whom 39.9% were men. Lifetime use of any psychotropic drug other than alcohol and tobacco was 11.6%: much less than in the U.S. (34.8%). The alcohol dependence rate was 6%, similar to findings from other countries. Marijuana was the illegal drug most cited as used daily (6.6%): a prevalence much lower than in the U.S. (32.0%): Inhalant use was next in frequency of use (2.7%): about 10 times less than in the United Kingdom (20%). Cocaine use (2.1%) was about 5 times less than in the U.S. (10.6%). There was no report of heroin use, although there was a surprisingly high perception regarding the case of obtaining heroin: 38.3% sold if was easy to obtain. CONCLUSION: This study supports the implementation of better prevention programs regarding drug abuse in Sõ Paulo state.

Adolescent↗
PubMed2006

[Role of the monoamine system in the brain on the development of psychological dependence on toluene].

Abuse of volatile organic solvents among youth remains a major social problem in Japan. Organic solvents are cheap and relatively easy to obtain, so they carry the risk of becoming a so-called "gate-way drug" for users. Psychological dependence assessment systems have been established for drug inhalation using the conditioned place preference (CPP) procedure. We found toluene produced the rewarding effect in this new CPP system. The mesolimbic dopamine pathway, which includes dopaminergic neurons in the ventral tegmental area (VTA) of the midbrain and their targets in the limbic forebrain, especially the nucleus accumbens (NAC), is one of the most important substrates for the development of psychological dependence on drugs such as stimulants, cocaine, and heroin. Recently, it has indicated that the VTA-NAC pathway (monoamine system) may play an important role of the expression of psychological dependence on the volatile organic solvent toluene. Clarification of organic solvent's mechanism for the development of psychological dependence focusing on the monoamine system can be exploited for the new medicine and useful treatments for dependence on toluene.

Animals↗
PubMed1997

The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems.

Clinical experience has shown that concomitant diseases and risk factors have a significant influence on the patient's outcome. Since none of the currently available score systems consider the impact of concomitant diseases or risk factors on burn trauma mortality, the present study was planned to further evaluate the role of these factors. Four hundred and ninety-eight patients could be included in this retrospective analysis of prospectively collected data. Parameters documented were: sex, age, weight, height, laboratory data, TBSA, inhalation trauma (IHT), full thickness (3 degrees) burn and pre-existing conditions. Single-variable analysis (SVA), logistic regression and CART analysis were performed. The data confirm the role of age and TBSA as the strongest prognostic variables. Chronic alcohol abuse and smoking, IHT and pre-existing cardiac and neurologic conditions were also found to be significant. Borderline groups could be identified in the ABSI score (7-10), where the risk factors cause 'mortality-shifting'. It can be concluded that risk factors and pre-existing conditions have a significant impact on the prognosis of burn mortality and should be incorporated into further refinements of burn admission scores.

Adolescent↗
PubMed2004

Changes in route of drug administration among continuing heroin users: outcomes 1 year after intake to treatment.

This study investigates the type and extent of changes in route of drug administration among heroin users after treatment: whether injectors move to other routes of use; whether changes in route for one drug influence routes used for other drugs; and associations between changes in route of administration and other substance use outcomes. The sample comprised 641 heroin users recruited to 54 UK treatment programmes. At intake, the main routes of heroin use were injecting (61%) and "chasing the dragon" (37%). After 1 year, 81% of those using heroin took it by the same route as at intake, while 19% reported a change, with 14% switching from injecting to chasing. Changes from injecting to chasing were associated with improvements in other substance use behaviours. Changes in route represent an important aspect of drug-taking behaviours. Interventions to prevent the change to injecting should be developed and offered to noninjectors. "Reverse transitions" (from injecting to chasing) may represent a useful intermediate treatment goal for drug injectors who cannot achieve abstinence.

Administration, Inhalation↗
PubMed2001

Toluene increases acute thermonociception in mice.

Toluene is an abused solvent widely used in several commercial products. Recent evidence indicates that this solvent is a non-competitive inhibitor of NMDA receptors. Since NMDA receptors have been implicated in pain, this paper describes studies of the effects of increasing concentrations of inhaled toluene on nociception. Swiss Webster mice were exposed to toluene (500-8000 ppm) in static exposure chambers for 30 min. After completing the exposure period, animals were tested for nociception using the hot plate test. Toluene dose-dependently increased nociception as reflected by shorter latencies for the reflex, paw-lick and escape responses in toluene-treated mice with respect to their controls (animals exposed to air). In order to determine the possible role of opioids in this response, morphine (1-10 mg/kg) was injected before toluene inhalation. Toluene was not able to block morphine-induced antinocieption, however, it produced a shift of the morphine dose-response curve to lower effects, suggesting a physiological antagonism. No potentiation was seen when toluene was administered in combination with naloxone. Present results suggest that toluene increases nociception via neurotransmitter systems others than the glutamatergic.

Administration, Inhalation↗
PubMed1997

Fatal inhalation of 1,1,1-trichloroethane.

A 13-year-old male was found dead in the woods subsequent to 1,1,1-trichloroethane (TCE) inhalation. Autopsy findings included tissue congestion of lung, liver and kidney. Certain precautions were taken in collecting and storing biological samples in order to prevent loss of TCE by evaporation. The availability of volatile solvents coupled with the increase of volatile substance abuse makes it easy for abusers to obtain.

Adolescent↗
PubMed1991

Passive inhalation of marijuana smoke: a critical review.

A number of research studies have been published which have attempted to determine the relationship of the passive inhalation of marijuana smoke to the consequent production of urinary cannabinoids. At least superficially, most of these studies appear to support the proposition that passive inhalation should be seriously considered as a possible explanation for a positive urine test for marijuana. Examination of the experimental conditions that are required to produce positive test results indicates that passive inhalation does not have a major effect outside the laboratory and should not affect drug test results in the workplace.

Dronabinol↗
PubMed1985

Progression of addiction careers in young adult solvent misusers.

Four case histories of a representative sample of young adult glue sniffers who had progressed to using illicit drugs or abusing alcohol or both contained several common factors that may have been relevant in the transition. For example, all had suffered parental deprivation or rejection in childhood leading to a state of chronic stress, and all had progressed from sniffing glue to inhaling heroin and thence to "snorting" and injecting heroin. The exact reason for the transition from glue sniffing to misusing other substances was not clear. Nevertheless, although these cases represent only a minority of glue sniffers, the problem of transition may be more common than hitherto supposed.

Adolescent↗
PubMed1991

Cocaine-induced psychosis.

BACKGROUND: Chronic stimulant use can produce a paranoid psychosis that is similar to acute paranoid schizophrenia. While this phenomenon has been systematically explored in amphetamine abusers, it has been relatively unexplored in a systematic fashion in cocaine abusers. METHOD: The experience of cocaine-induced psychosis was evaluated in 55 individuals consecutively admitted for treatment of DSM-III-R cocaine dependence. Each subject was interviewed about their experiences of psychosis while intoxicated by means of a standardized, semistructured interview. RESULTS: Fifty-three percent (29/55) of those interviewed reported experiencing transient cocaine-induced psychosis. There was no significant difference in lifetime amount of cocaine use or amount of cocaine use in the month before admission between those who experienced psychosis and those who did not. The psychosis-positive group used significantly more cocaine in the year prior to admission (p less than or equal to .02) and had a longer duration of use (p less than or equal to .01). Males were significantly (p less than or equal to .05) more likely than females to develop psychosis. Ninety percent (26/29) developed paranoid delusions directly related to drug use. Ninety-six percent (28/29) of the subjects experienced hallucinations: 83% (24/29), auditory hallucinations; 38% (11/29), visual hallucinations; and 21% (6/29), tactile hallucinations. Twenty-seven percent (15/55) of subjects developed transient behavioral stereotypies. CONCLUSION: Cocaine-induced paranoia is a common experience among chronic users. Amount and duration of use are related to its development. Implications for a kindling model of cocaine-induced psychosis will be discussed.

Administration, Inhalation↗
PubMed2006

Concurrent crack and powder cocaine users from Sao Paulo: do they represent a different group?

BACKGROUND: Cocaine abuse is a serious and socially damaging illegal drug problem. Different routes of administration are associated with a specific progression of use, different degrees of abuse liability, propensity for dependence and treatment response. There have been relatively few studies comparing different cocaine users groups and no studies into the characterization of the group of individuals reporting concurrent use of powder cocaine and crack cocaine. METHODS: Six hundred and ninety-nine cocaine users were assessed during the period August 1997 to October 1998 in one outpatient and six inpatient clinics located in the São Paulo, Brazil. Patients were interviewed using a structured questionnaire schedule in Portuguese, designed specifically for the Brazilian population. The statistical analyses were performed using either ANOVA or a chi-squared test and focusing on their preferred form of use/route of administration and other variables. RESULTS: For 83% of the variables tested in this study, the Dual Users subgroup (using both powder and crack cocaine) demonstrated statistical differences from the single drug user subgroups. Those differences include the initiation of cocaine, the abuse of other illicit drugs, and rates of criminal history. CONCLUSION: These data suggest cocaine-dependent individuals who report use of both powder and crack cocaine are an at least partially, distinct subgroup. However, further studies will be necessary to confirm this and to determine if they also show a different treatment response.

Administration, Inhalation↗
PubMedDate not supplied

Self-inflicted burns.

Over a 3-year period 17 people were admitted for intentionally self-inflicted burns. The mean total body surface area burn was 29.5%, and 59% of the patients sustained an inhalation injury. Two patients died from their injuries (one male and one female). The method most often used (59%) was a flammable liquid ignited by a flame. Of those patients, 50% used gasoline. Fifty-nine percent of the patients were current substance abusers, with alcohol (80%) being the favored drug. Aside from substance abuse, psychiatric abnormalities were present in 53% of the patients. Schizophrenia/schizoaffective disorders was the primary psychiatric diagnosis (44%), with most patients having undergone previous psychiatric treatment. All had diagnosed disorders (using the Diagnostic and Statistical Manual III--Revised) including substance abuse and/or other psychiatric disorders. Actual stated suicidal intent was present in 41% of the cases, and another 41% were irrational attempts to escape from or control emotional pain.

Adult↗
PubMed2001

Importance of glottic configuration in the development of posterior laryngeal granuloma.

Posterior laryngeal granuloma is frequently related to 3 predisposing factors: vocal abuse, gastroesophageal reflux disease, and orotracheal intubation. It is strongly predominant in men and rare in women, except under postintubation circumstances, in which the incidence is higher in women. The aim of this study was to characterize laryngeal conformations for each sex that, whenever associated with different causes, may lead to the onset and particular location of granulomas, according to a main predisposing factor. Sixty-six subjects whose ages ranged from 18 to 73 years were studied. They were distributed into 4 groups according to the predominant cause of granuloma: intubation, vocal abuse, gastroesophageal reflux, and idiopathic causes. The larynx was evaluated during breathing, and the glottic proportion (GP) was measured. Glottic proportion is the mathematical ratio between the midsagittal dimension of the intermembranous region and that of the intercartilaginous region of the larynx during inhalation. Its measurement was feasible in 57 patients. The groups that had a causative factor other than laryngeal orotracheal intubation had GP values statistically similar to those of each other and to the control group of men, ie, close to 1.2. The postintubation group had GP values similar to the control group of women, ie, close to 1.0; this proportion protects the arytenoid region in women's larynges when there is effort during vocal production, but makes women susceptible to orotracheal postintubation granuloma.

Adolescent↗
PubMedDate not supplied

Pattern of substance use among secondary school students in Rivers State.

BACKGROUND: The problem of substance use in our secondary schools with cultism has negatively affected learning [corrected]. The aim of this study was to determine the commonly used substances and the factors that influence their use in these adolescents. METHODOLOGY: One thousand and forty-nine students of four secondary schools in Port Harcourt were screened using a self administered 117 items-substance use questionnaires. RESULTS: Males constituted 57.2% and females, 42.8% of the study population. Eighty-seven percent were using at least one substance, at the time of the survey while 3% were past users in the last one-year. Ten percent had never used any of the substances. The substances commonly used included alcohol 65%, kolanut 63.1%, cigarettes 61%, paracetamol 41.5%, butazolidine 39.3%, pemoline 28% and cannabis 26%. Others include tetracycline 25.7% and ampicillin 24.3% and valium 24%. Those that were least used included, heroine, cocaine, latex, petrol, pethidine and ativan. The mean age of onset for alcohol was 4 years, kolanut 8 years, cigarettes 11 years, paracetamol, tetracycline, valium, cannabis was, 12 years, lexotan and ativan, was 12.5 years and, latex inhalation, petrol, pethidine, ativan, cocaine and heroine was 13.17 years. Males predominated in all the substances used. CONCLUSION: The use of substances/drugs among our youths is assuming a dangerous dimension, hence calls for immediate and enduring measures to curb this disturbing trend of abuse of substances.

Adolescent↗
PubMed1999

n-Hexane neuropathy caused by addictive inhalation: clinical and electrophysiological features.

To assess the clinical and electrophysiological features of n-hexane neuropathy caused by addictive inhalation, 4 patients were studied in the progressive phase. The neurological manifestations were characterized by subacute predominantly motor polyneuropathy and disease progression despite discontinuance of the chemicals, which were similar to those reported in industrial exposure, although with a severer degree associated with anorexia and body weight loss. Electrophysiological studies showed that all showed multifocal conduction block and profound conduction slowing, as well as features of axonal degeneration. Sural nerve biopsy showed axonal loss, axonal swelling, and thin myelin probably due to retraction by axonal swelling. n-Hexane abuse causes severe subacute polyneuropathy. The mixed axonal and demyelinating electrophysiological features were consistent with peculiar pathological findings. Conduction block, probably due to paranodal myelin retraction or ongoing wallerian degeneration, is very frequent and could be responsible for the clinical deficits, especially in the early phase of illness.

Administration, Inhalation↗
PubMed2006

Reinforcing effects of smoked methamphetamine in rhesus monkeys.

RATIONALE: The occurrence of methamphetamine (METH) use by the smoking route is increasing. A nonhuman primate model for examining the reinforcing effects of smoked METH would be valuable for testing potential interventions for treating METH abuse disorders. OBJECTIVE: The purpose of the present study was to examine the reinforcing effects of smoked METH in monkeys. MATERIALS AND METHODS: Four rhesus monkeys were trained to smoke cocaine (COC) under a chain fixed-ratio (FR) 64 lever press, FR 5 inhalation schedule of reinforcement. Upon observing stable levels of self-administration, METH was substituted for COC and a dose-response function for METH (0.08-0.8 mg/kg) was determined. Subsequently, the number of deliveries of COC (1 mg/kg), and 0.2 and 0.8 mg/kg METH were examined across increasing response requirements. RESULTS: METH was dose-dependently self-administered. Higher doses of METH (0.2, 0.4, and 0.8 mg/kg) produced asymptotic levels of responding that were slightly lower than those obtained with 1 mg/kg COC. Numbers of deliveries of COC and METH decreased as response requirement increased. METH, however, maintained fewer deliveries than 1 mg/kg COC at most response requirements. CONCLUSIONS: METH is readily self-administered by smoking in rhesus monkeys when substituted for COC. METH may have a lower reinforcing strength than COC, but further research is needed to fully characterize its relative reinforcing strength.

Amphetamine-Related Disorders↗
PubMed1990

Working with heroin sniffers: clinical issues in preventing drug injection.

Preventing illicit drug injection would be the ideal point for preventing HIV infection and AIDS among illicit drug injectors. This paper reports on clinical issues that arose in a program for intranasal ("sniffer") heroin users who were at high risk of injecting drugs. Extensive field notes were kept by the staff of the project. A generalized mistrust of authorities, denial of problems associated with non-injected drug use, and ambivalence about injecting were the major issues that arose during subject recruitment and the group sessions. The staff underwent trial and error learning, both becoming more confident in working with heroin sniffers, and finding better results for later participants in the study.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Detection times and analytical performance of commercial urine opiate immunoassays following heroin administration.

The Federal Workplace Drug Testing Program changed urine screening and confirmation cutoff concentrations for opiate testing from 300 to 2000 ng/mL in 1998. Morphine was the designated target compound. An additional heroin metabolite, 6-acetylmorphine (6-AM), was added to the testing procedure with a cutoff concentration > or = 10 ng/mL. Testing of 6-AM was required if morphine was positive to assist in medical review. A comparison of the new opiate cutoff concentrations was made with the older cutoff concentration at 300 ng/mL. Six commercial opiate immunoassays, four with a 300-ng/mL cutoff, ONLINE, EMIT, CEDIA and AxSym, and two with 2000-ng/mL cutoffs, ONLINE and EMIT, were selected to test 920 urine samples collected from 11 male human subjects following single doses of heroin. Eight received intravenous doses of 3, 6, and 12 mg heroin HCl and four smoked 3.5-, 5.2-, 10.5-, or 13.9-mg doses of heroin (base). In addition, 183 urine-based blind quality-control specimens were added to the study set to assess linearity, cross-reactivity, and interference. Total morphine, free morphine, and 6-AM were measured in each sample by gas chromatography-mass spectrometry (GC-MS). Linearity, cross-reactivity, and interference results for each immunoassay are described. Detection times, sensitivity, specificity, and efficiency of each assay were determined using data from the specimens collected after heroin administration. Detection times for morphine using the 300-ng/mL cutoff assays was approximately 12 h for low dose and 24 to 48 h for higher doses of heroin. For the two 2000-ng/mL cutoff concentration assays detection time was about 12 h. This was also the detection time for 6-AM by GC-MS. ONLINE had the lowest sensitivity, 60-74%, highest specificity, 98.8-100%, and least interference from a selection of common over-the-counter drugs and opioids. Increasing the cutoff to 2000 ng/mL from 300 ng/mL increased efficiencies of the assays from 72.7 to 82.6% to over 97%.

Administration, Inhalation↗