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PubMed2000

Discrimination of prohibited oral use of salbutamol from authorized inhaled asthma treatment.

BACKGROUND: The administration of salbutamol is permitted only by inhalation by the International Olympic Committee (IOC) for the management of asthma and exercise-induced asthma in athletes. The establishment of criteria to distinguish between the (IOC) authorized use (inhaled) and the (IOC) prohibited use (oral) of salbutamol appeared possible using simultaneous evaluation of variables based on the concentration of nonconjugated enantiomers of salbutamol excreted in urine. METHODS: Urine was collected from asthmatic and nonasthmatic swimmers who had received various preexercise doses of oral (five doses of 4 mg) or inhaled (two doses of 100 microgram) salbutamol. Urine was also obtained from subjects who had received the maximum dosage of inhaled salbutamol advisable for competing athletes to provide protection from exercise-induced asthma and treatment of asthma (1600 microgram in 24 h, 800 microgram being in the last 4 h). All samples were analyzed to determine the total amount of unchanged salbutamol excreted in urine and the ratio between the S: and R: enantiomers. RESULTS: The discriminant function D = -3.776 + 1.46 x 10(-3) ([S:(+)] + [R:(-)]) + 1.012 ([S:(+)]/[R(-)]) can be used to classify data into two groups, inhaled and oral. The confirmatory criterion suggested (cutoff at D = 1.06, 4 SD from the mean D value of the inhaled distribution) has been verified in different sets of samples showing suspicious concentrations by conventional screening procedures in doping control. An 11.8% false-negative (oral classified as inhaled) rate is assumed with the confirmatory criterion proposed, but virtually no false positives (inhaled classified as oral) are obtained (<1 in 33 000). CONCLUSIONS: The overall procedure recommended is to screen all samples and to apply the confirmation criterion proposed to samples showing free racemic salbutamol concentrations >500 microgram/L by gas chromatography-mass spectrometry or free + conjugated racemic salbutamol concentrations >1400 microgram/L by ELISA.

Administration, Inhalation↗
PubMed1996

Drug and alcohol use among lesbian and gay people in a southern U.S. sample: epidemiological, comparative, and methodological findings from the Trilogy Project.

The Trilogy Project is a longitudinal study of lesbian and gay people living in and around two metropolitan areas in a southern state. The study was specifically designed to provide (1) epidemiological data on the lifetime, past year, and past month prevalence rates for the use of 6 illicit, 4 psychotherapeutic, and 2 licit drugs, and (2) comparative data to the National Household Survey on Drug Abuse (NHSDA). Self-report data were collected on 1067 respondents using multiple sampling strategies and a research design that yielded response rates averaging over 50%. Results indicated some age group differences in the prevalence of certain drugs by gay men compared to lesbians. When comparisons were made to the NHSDA, Trilogy Project respondents were found to have significantly higher prevalence rates for the past year use of marijuana, inhalants, and alcohol but not cocaine. While lesbian and gay people drink alcohol more frequently during the month than NHSDA respondents, few differences occurred between the two samples for heavy alcohol consumption. Research questions suggested by the data and theoretical directions for future research are discussed.

Adult↗
PubMed1994

Female adolescent alcohol, cigarette, and marijuana use: similarities and differences in patterns of use.

Five categories of variables were examined as predictors of alcohol, cigarette, and marijuana use in a sample of 1,416 girls aged 13 to 17 years in Northwestern Ontario. A similar pattern of unique predictors emerged for the three drugs for three of the categories: the concurrent use of another drug, conventional educational attitudes and behaviors, and rebellious behaviors. A different pattern was found for the social and demographic categories between the inhaled drugs and alcohol. These differences emphasize the need to determine the specific predictors of drug use for each substance before planning regionally based drug prevention programs.

Adolescent↗
PubMed1994

Correlates of sexual risk-taking among gay male substance abusers.

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Fatal mephenesin intoxication.

This report describes a death related to the abuse of and intoxication by mephenesin. To the best of our knowledge, this is the first report case of lethal intoxication involving solely mephenesin and reporting mephenesin blood concentrations. The victim was a 48-year-old woman found unconscious at home. Resuscitation was unsuccessful. Toxicological analysis was performed on a blood sample collected during resuscitation. The results being negative, the body was exhumed for an autopsy, which revealed bronchial inhalation syndrome. Analysis in a second laboratory has revealed the presence of mephenesin in samples collected during autopsy. No other drug/toxin was found, and alcohol was negative. Reanalysis of the peripheral blood collected during resuscitation found a mephenesin concentration of 15.81 microg/mL (15-fold greater that the maximum concentration that would result from a single intake of a 500 mg formulation). The pathologist has concluded on a bronchial inhalation syndrome consecutive to a mephenesin overdose as the cause of death. The manner of this death is discussed in the light of the toxicological hair analysis and the medical past of the victim.

Bronchial Diseases↗
PubMed1998

Treatment of inhalant-induced psychotic disorder with carbamazepine versus haloperidol.

OBJECTIVE: The efficacy and adverse effects of carbamazepine and haloperidol were compared in the treatment of inhalant-induced psychotic disorder. METHODS: Forty male patients admitted to an acute psychiatric unit for treatment of inhalant dependence and inhalant-induced organic mental disorder, as diagnosed by DSM-III-R, were randomly assigned to receive five weeks of treatment with carbamazepine or haloperidol in identical-appearing capsules. The Brief Psychiatric Rating Scale and the DiMascio Extrapyramidal Symptoms Scale were administered weekly. RESULTS: Both treatment groups improved significantly over time. A reduction of symptom severity of 48.3 percent in the carbamazepine group and 52.7 percent in the haloperidol group was observed. Approximately half the patients in each group were considered treatment responders at the end of the study. Adverse effects were significantly more common and more severe in the haloperidol group. CONCLUSIONS: Carbamazepine appears to have comparable efficacy but fewer adverse effects than haloperidol for the treatment of inhalant-induced psychotic disorder.

Adult↗
PubMed2000

Feeding problems, sleep disturbances, and negative behaviors in a toddler.

Tiffany, a 3-year-old girl, was referred to the developmental and behavioral pediatrics service for evaluation of significant and persistent negative behaviors associated with refusal to eat at meal time and constant snacking during the past 3 months. She lost 2 pounds, but her weight for her height was at the 50th percentile. Her mother indicated that Tiffany had frequent night awakenings (>10) and late sleep onset (between 12:00 and 1:00 a.m.). Her mother described her as being "easily frustrated," getting upset and angry very quickly. Tiffany was identified at an early intervention program as having mild to moderate developmental delays in pragmatic speech, gross and fine motor skills, and social interaction skills. Tiffany was born at 33 weeks gestation and was hospitalized for 10 days without significant perinatal problems. She was readmitted at 2 months of age when she was diagnosed with gastroesophageal reflux, lactose intolerance, sleep apnea, and bradycardia. She was discharged with an apnea monitor. A seizure disorder was diagnosed at 1 year of age and reactive airway disease at 2 years of age. At the time of the referral to the developmental and behavioral pediatrics service, Tiffany was followed by multiple services, including cardiology, neurology, gastroenterology, psychology, and pulmonary. Pharmacologic therapies included albuterol and cromalyn inhalers, phenobarbital, valproic acid, levocarnitine, ranitidine, and an inhaled steroid. She continued to use the apnea monitor each night, although three sleep studies demonstrated a normal sleep pattern with no evidence of apnea or bradycardia. A recent electroencephalogram was normal. Tiffany lives with her mother and maternal grandparents. Her mother is morbidly obese with a history of asthma and depression. She was infertile for a 10-year period, which she attributed to the stress associated with living with an abusive man. Tiffany was the result of a subsequent, brief relationship with another man; she has not had contact with her father. Her mother is a licensed practical nurse who has not worked as a nurse since Tiffany's birth. An interdisciplinary treatment approach to Tiffany's multiple biological and behavioral problems was implemented by admitting her to a collaborative care unit at a children's hospital.

Anxiety↗
PubMed2004

Saccade dysfunction associated with chronic petrol sniffing and lead encephalopathy.

BACKGROUND: In chronic petrol sniffers, recent exposure to high levels of leaded petrol may give rise to a lead encephalopathy characterised by tremor, chorea, ataxia, hyperreflexia, convulsive seizures, and death. Neurological abnormalities associated with lead encephalopathy involve the cortex, basal ganglia, cerebellum, and brain stem. OBJECTIVE: To use saccadic eye movement tasks as an experimental tool to determine which CNS changes are associated with chronic petrol sniffing and which with a history of lead encephalopathy, and to what extent these changes are reversible. METHODS: Saccade function was assessed in chronic petrol sniffers with a history of lead encephalopathy (encephalopathic sniffers), chronic petrol sniffers who had never suffered lead encephalopathy (chronic sniffers), individuals who had sniffed petrol in the past but had not done so for more than six months (ex-sniffers), and individuals who had never sniffed petrol (non-sniffers). RESULTS: Chronic sniffers showed increased latency of visually guided saccades and antisaccades and increased antisaccade errors which suggested cortical and basal ganglia dysfunction. These abnormalities returned to normal in ex-sniffers. Encephalopathic sniffers showed the same abnormalities as chronic sniffers but with greater severity and additional saccadic signs including dysmetria, gaze evoked nystagmus, and saccade slowing which usually indicate cerebellar and brain stem dysfunction. CONCLUSIONS: Chronic petrol abuse is associated with cortical and basal ganglia abnormalities that are at least partially recoverable with abstinence. Additional long term cerebellar and brain stem abnormalities are associated with lead encephalopathy.

Adolescent↗
PubMed1989

[Beta-2 adrenergic stimulants in the treatment of asthma: myths and realities].

In this review paper the authors describe the reasons, sometimes complex, which have given birth to such myths as the abuse of beta 2-stimulants generating status asthmaticus, or patients developing clinical tachyphylaxis to this type of drug. While there is no solid ground to believe that beta 2-stimulants can be blamed for the overmortality due to asthma, and while the indications of beta 2-stimulants delivered by metered-dose aerosols can be extended to chronic asthma, it is still necessary to apply certain safety rules when these drugs are inhaled in high doses or given parenterally. Some patients must be encouraged to use inhaled beta 2-stimulants prophylactically, sometimes combined with cromolyn or inhaled corticosteroids, but these patients, their relatives and their doctor should be taught to evaluate lung function by means of a peak-flow meter. A lack of response to beta 2-stimulants must be taken as a warning that systemic corticosteroids and in some cases admission to hospital are needed.

Adrenal Cortex Hormones↗
PubMed2005

The cocaine-using patient: perioperative concerns.

Cocaine is an extremely addictive agent which can produce stimulation of the sympathetic nervous system due to the inhibition of catecholamine reuptake at the synaptic junction. Probability of a patient presenting to the operating theatre with acute cocaine intoxication is increasingly likely. The physiological effects of even chronic cocaine abuse on various organ systems have an impact on anesthetic management. A preoperative review of major organ systems is essential. Nitroglycerin has been used in the management of hypertension associated with coronary vasoconstriction. Controversy exists regarding management of ventricular dysrhythmias and asystole. The use of epinephrine to treat asystole is controversial in the presence of a state of excess catecholamines induced by cocaine. General anesthesia may include barbiturates, nitrous oxide, and opioids, but inhalational agents must be used with caution due to their myocardial depressant effects. Regional anesthesia may be a good choice if coagulopathies and hypovolemia are corrected.

Anesthesia↗
PubMed2007

Spinal cord infarction secondary to cocaine use.

A 27-yr-old woman recreationally inhaled cocaine. Several hours later, she noted chest tightness, back and neck pain, and later bilateral upper-extremity weakness. Physical examination revealed flaccid paresis of the upper extremities. Spasticity at 2 mos after injury, but no detectable weakness, developed in the lower extremities. Cocaine was detected in her urine. Magnetic resonance imaging showed hyperintensity in the anterior cervicothoracic spinal cord. Electrodiagnostic studies of the upper extremities were consistent with anterior horn cell death. Cocaine abuse is associated with cerebrovascular events; spinal cord effects are rarely reported. The patient seems to have an infarct in the anterior spinal artery distribution, with clinical, imaging, and electrodiagnostic findings of upper-extremity lower-motor neuron injury, accompanied by spasticity of the lower extremities. Gray matter has increased susceptibility to ischemia compared with white matter, producing flaccid weakness in the cervical region with isolated arm weakness. Although uncommon, cocaine abuse can cause spinal cord infarction.

Adult↗
PubMed2003

Deaths from drug abuse in northwestern Spain, 1992 - 97.

A total of 338 cases of death from acute reactions to drugs in Galicia (NW Spain) from 1 June 1992 to 31 July 1997 were examined. The average annual mortality rate was close to 70 cases. Male victims (90%) prevailed over female ones, the average age at death being 28.8 years. Most of the victims were habitual users who died in their own homes (40%) or nearby (30%). Polydrug use was the most common pattern, the most frequently detected drugs being opioids (281 cases), followed by alcohol (128 cases), benzodiazepines (92 cases) and cocaine (75 cases). Although the intravenous route prevailed (91%), oral and inhalation consumption of the drugs were also significant--the latter has grown significantly in recent times in relation to opioids and other drugs. How accurate the certificate of death can be depends on how thorough the investigation at the crime scene, autopsy room and laboratory are, as well as appropriate knowledge of the individual's history. The coordinated action of different health care institutions and use of available resources are crucial with a view to obtaining such data.

Adolescent↗
PubMed1991

Substance misuse among native and rural high school students in Quebec.

A questionnaire exploring the smoking habits, past and current use of alcoholic beverages, cannabis, and other illicit drugs was distributed among Francophone and Native high school students in a rural area of Quebec. The lifetime prevalence figures indicated that use of illicit drugs was significantly higher among Native students. This held true particularly for stimulants and inhalants (p less than .001). Figures for the 1-year prevalence indicated that use of stimulants in Native students remained still significantly higher (p less than .01). However, consumption of alcoholic beverages was more important in Francophone students (p less than .05). A gender difference was observed in Native students, females reporting an earlier involvement with most substances under study. This tendency decreased with age. The implications of this study for the prevention of alcohol and substance abuse among rural and Native youths are discussed.

Adolescent↗
PubMed2003

Drug use among two American Indian populations: prevalence of lifetime use and DSM-IV substance use disorders.

American Indians (AIs) have often reported higher rates of drug use than have other racial/ethnic groups. However, the majority of these studies have focused on drug use among high school adolescents, with little attention to pathological use such as drug abuse or dependence. This study is among the first to report lifetime drug use and disorder (abuse/dependence) information from community samples of two culture groups of AI people-one in the Southwest (SW), one in the Northern Plains (NP)-ranging in age from 15 to 57 years old. Analyses were conducted within four groups: SW men, SW women, NP men, and NP women. Across the four groups, lifetime use rates for marijuana (36.9-57.5%), cocaine (4.3-21.5%), and inhalants (3.6-17.0%) were the highest drug use rates; heroin (0.5-2.1%), the lowest. Lifetime drug disorder rates were highest for marijuana (4.5-14.1%), cocaine (1.1-2.3%), and stimulants (0.7-1.7%). Lifetime polydrug use disorder rates from 1.2 to 4.5%. Women generally had lower prevalence rates than did men in their culture group. The SW women generally had the lowest rates of use and disorder. Lifetime use and disorder rates among the youngest group were often not different from rates of the older groups. Overall, 40-60% had never used any drugs; 85-95% had not developed any drug disorder. Despite widespread concern and rhetoric about drug problems among AIs, many who had used various drugs either were using them without serious consequences or had quit use altogether.

Adolescent↗
PubMed2001

Comorbidity in a clinical sample of substance abusers.

The sample consisted of 125 male inpatients admitted to one of two substance abuse treatment centers in Iowa. They were diagnosed by means of the Diagnostic Interview Schedule Screening Interview-Quick-DIS version, the Structural Interview for DSM-III-R Personality Disorder (PD), revised, and the Substance Abuse Reporting System. The most frequently diagnosed comorbid Axis I conditions were anxiety and mood disorders, while the most frequently observed Axis II disorders were in Cluster B, borderline PD, and antisocial PD followed by Cluster C, avoidant PD, passive-aggressive PD and obsessive-compulsive PD; and then Cluster A; schizoid PD. Subjects diagnosed with Borderline PD showed the highest rate of comorbid psychopathology, including Axis I disorders of generalized anxiety disorder, major depression, cocaine dependence, and inhalant dependence. The most likely comorbid diagnosis for antisocial PD subjects was bipolar disorder. The schizoid PD and the NoPD groups were less likely to meet criteria for other Axis I disorders. A high rate of comorbid Axis II pathology was also found. Polysubstance dependent subjects were more likely to be diagnosed with anxiety disorder or bipolar disorder than were those who were not polysubstance dependent or were dependent only on alcohol. Polysubstance dependent men were at highest risk for Axis II disorders: 56% of them met criteria for a Cluster B PD, with borderline PD and histrionic PD most frequent.

Alcoholism↗
PubMed2001

Enrichment-toy trauma in a New Zealand White rabbit.

An injury was caused by an enrichment toy (a whiffle ball, which is a perforated hollow ball made of hard plastic) that led to its removal from the rabbit enrichment program. Manipulata and food treats form the basis of the Yale rabbit enrichment program. All singly housed rabbits are given toys such as balls, chains, wood blocks, PVC tubing, Nylabones, and corrugated plastic tunnels. Before they are used, all potential enrichment devices are reviewed for safety and potential veterinary problems. The whiffle ball had been considered safe because it was made of hard non-toxic plastic, had no sharp edges, was too large to be swallowed or inhaled, and was judged too sturdy to be broken by the rabbits. However, the ball became lodged in the incisors of an adult female New Zealand White rabbit, preventing her from eating or drinking for 12 h and causing marked trauma to her gums. Removal of the ball necessitated anesthetizing the rabbit and using bone cutters to cut away the ball. Ideally, environmental enrichment should increase species-specific normal behavior and minimize stereotypies and self- and conspecific-directed abusive behavior. This case illustrates that safety assessments for an enrichment device must include both the inherent properties of the device and the risks if the toy is misused or damaged. Considerations for safety assessment are discussed.

Animal Husbandry↗
PubMed1987

Discriminative stimulus properties of toluene in the mouse.

Little is known about the nature of the acute intoxication produced by exposure to high concentrations of toluene such as that which occurs with spills and in solvent abusers. The intoxication may be similar to that produced by classic central nervous system depressants such as the barbiturates. To investigate this hypothesis, drug discrimination procedures were used to compare the acute effects produced by toluene and pentobarbital (PB). Mice were trained to discriminate toluene (100 mg/kg, ip) from vehicle in a two-lever task in which responding was under the control of a fixed-ratio 20 (FR20) schedule of food presentation. Generalization tests were conducted after 20-min inhalation exposures to toluene (150-3600 ppm) and 20 min after injections with either PB (5-30 mg/kg) or morphine (3-20 mg/kg). Most mice generalized to inhaled toluene and to PB in a concentration- or dose-related fashion, but not to morphine. These results show that the effects of injected toluene can be established as a discriminative stimulus in mice, and that these stimulus effects are independent of route of administration. Shared discriminative stimulus properties with PB suggest that toluene produces an acute intoxication like that of other classic CNS depressants.

Administration, Inhalation↗