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At least 19 recordsLinked to original sources
PubMed1998

Premorbid brain size is a determinant of functional reserve in abstinent crack-cocaine and crack-cocaine-alcohol-dependent adults.

Studies of Alzheimer's disease patients show that individuals with larger premorbid brains have a later onset of disease, or a lessened severity of cognitive impairment, or both. This may be due to a "functional reserve" associated with the greater number of neurons and synapses available in larger brains. We used magnetic resonance imaging and the MicroCog Assessment of Cognitive Functioning to examine the association between intracranial volume (premorbid brain size) and neuropsychological function in abstinent crack-cocaine and crack-cocaine-alcohol dependent individuals. There were no significant differences between the crack-only and the crack-alcohol dependent participants in neuropsychological performance or in intracranial volume. The abstinent cocaine-dependent individuals (both crack-only and crack-alcohol) were significantly impaired in many neuropsychological domains. Intracranial volume accounted for a significant proportion of the variance in neuropsychological performance. This result is consistent with the finding in the Alzheimer's literature that larger brains can maintain function to a greater degree, or for a longer period of time, in the face of cerebral disease or insult. Functional reserve may be a heretofore little recognized protective mechanism of the brain that has consequences for the severity of expression of cerebral disease or insult throughout life.

Adult↗
PubMed2002

Neuropsychological performance of individuals dependent on crack-cocaine, or crack-cocaine and alcohol, at 6 weeks and 6 months of abstinence.

BACKGROUND: Little data exist on the neuropsychological effects of crack-cocaine dependence or crack-cocaine and alcohol dependence. This study examined cognitive function in abstinent crack dependent and crack and alcohol dependent individuals at 6 weeks and 6 months abstinence. METHODS: a comprehensive neuropsychological battery, including the MicroCog computerized assessment, was administered to 20 abstinent crack dependent subjects, 37 abstinent crack and alcohol dependent subjects, and 29 normal controls. Depression was examined as a covariate, and the association between substance use variables and neuropsychological performance was examined. RESULTS: the two substance dependent groups had similar neuropsychological profiles at 6 weeks abstinent, with both groups exhibiting significant cognitive impairment in a wide range of functions compared to controls. The substance dependent groups were still impaired significantly at 6 months of abstinence. Only mild effects of depression on neuropsychological performance were observed. CONCLUSIONS: crack dependence and crack and alcohol dependence may lead to severe and persistent neuropsychological deficits over a wide range of domains. The strongest predictor of brain damage associated with substance dependence in this sample was dose (particularly quantity and duration of peak dose).

Adult↗
PubMed1999

Necrotizing infection of the face secondary to intranasal impaction of "crack" cocaine.

"Crack" is a crystalline form of cocaine that is readily available and sold in the form of small granules. The authors report a unique case of forced intranasal impaction of crack cocaine with subsequent extensive necrosis of the nose and upper lip accompanied by a necrotizing infection of the subcutaneous soft tissue of the cheeks, forehead, and temporal regions. The treatment of extensive facial necrosis resulting from infection and ischemia centers around the early diagnosis of the infectious process, prompt and aggressive surgical debridement, and the administration of broad-spectrum antibiotics.

Anti-Bacterial Agents↗
PubMed2005

Capturing crack cocaine use: estimating the prevalence of crack cocaine use in London using capture-recapture with covariates.

AIM: To estimate the prevalence of crack cocaine use in 12 London Boroughs (and London as a whole). SETTING: Twelve London Boroughs, 2000-01. METHODS: (1) Covariate capture-recapture techniques applied to three data sources of subjects reporting crack cocaine use: specialist drug treatment (2905), arrest referral (1188) and accident and emergency and community survey (531); and (2) ratio-estimation multiplier, using an estimate of number of injecting drug users and proportion that use crack cocaine. FINDINGS: After matching, 4117 individuals aged 15-44 were identified. The best-fitting model estimated 16 855 unobserved crack cocaine users, giving an overall estimate of approximately 21 000 [95% confidence interval (CI) 13 000-43,000] and a prevalence of 1.5% (95% CI 1.0-3.2%). Prevalence of crack cocaine use was 2.4% (95% CI 1.5-5.0%) among men and 0.7% (95% CI 0.5-1.0%) among women, and similar by age groups 15-29 and 30-44 years. Overall, approximately 11 900 (57%) of the estimated number of crack cocaine users were also opiate users. In London as a whole there may be 46,000 (1.3%) crack cocaine users aged 15-44 years, with 28 000 (1.9%) in inner London-four times higher than estimates from population surveys. Some corroboration was provided by the ratio-estimation method, which estimated 23 000 users in the 12 Boroughs. CONCLUSIONS: Capture-recapture can be applied to crack cocaine and obtain better estimates than population surveys. The size of the crack cocaine-using population in London is large, although currently the majority are also opiate users. Given that half of current users are under 30 the problems associated with crack cocaine use are likely to increase in the future.

Adolescent↗
PubMed1991

Interstitial pneumonitis associated with "crack" cocaine abuse.

A 33-year-old woman developed acute bilateral pulmonary infiltrates after the intense use of rock cocaine (crack). She subsequently had progressive deterioration of pulmonary function to the point of being ventilator-dependent. Open lung biopsy showed a chronic interstitial pneumonia with extensive accumulation of free silica within histiocytes associated with mild pulmonary fibrosis. This pattern of interstitial pneumonia has not been previously reported in crack users.

Adult↗
PubMed1994

Intersecting epidemics--crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team.

BACKGROUND AND METHODS: The smoking of "crack" cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs. RESULTS: Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). Of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with HIV as compared with 9.1 percent of the 286 other women (prevalence ratio, 3.1; 99 percent confidence interval, 1.9 to 5.1); of the 91 men who had anal sex with other men, 42.9 percent were infected with HIV as compared with 9.3 percent of the 582 men who did not have anal sex with other men (prevalence ratio, 4.7; 99 percent confidence interval, 3.0 to 7.4). In multivariable analyses, these high-risk sexual practices accounted for the higher prevalence of HIV infection among the crack smokers, as compared with those who did not smoke crack. Women who had recently had unprotected sex in exchange for money or drugs were as likely to be infected as men who had had sex with men (40.9 percent vs. 42.9 percent). CONCLUSIONS: In poor, inner-city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection. Crack use promotes the heterosexual transmission of HIV.

Adolescent↗
PubMedDate not supplied

High-risk sex behavior among young street-recruited crack cocaine smokers in three American cities: an interim report. The Multicenter Crack Cocaine and HIV Infection Study Team.

Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have multiple sex partners, trade sex for money or drugs, and rarely use condoms. A cross-sectional survey is being conducted in urban neighborhoods in Miami, New York and San Francisco--where crack use is common--to explore these issues. Indigenous street outreach workers are recruiting men and women who are either current regular crack smokers or who have never smoked crack; each group is further stratified according to whether participants had ever injected drugs. Participants were interviewed about their sexual and drug-use practices. Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nonsmokers, and were more likely than nonsmokers to have exchanged sex for money or drugs or to have had an STD. Differences between crack smokers and nonsmokers were generally greater among non-injectors than among injectors, and generally greater among women than among men. Condom use, although somewhat more common with paying than nonpaying partners, was infrequent overall. Most of the subjects had not been in substance abuse treatment in the preceding 12 months, and a majority had never been in substance abuse treatment. Education and prevention programs specifically targeted at crack smokers not currently in substance abuse treatment are needed to reach these high-risk persons.

Adult↗
PubMed1990

Embolic stroke after smoking "crack" cocaine.

A 39-year-old woman had an embolic upper division middle cerebral artery branch occlusion 3 hours after smoking the free base of cocaine ("crack"). Radionuclide ventriculography demonstrated cardiomyopathy, and echocardiography documented a left atrial thrombus. This case demonstrates that embolism is one mechanism of ischemic stroke after cocaine use, and that cardiomyopathy, possibly cocaine induced, may be the source of embolus. A cardiac source of embolus should be sought in patients with cocaine-associated cerebral infarction.

Adult↗
PubMed1989

Rhabdomyolysis in a case of free-base cocaine ("crack") overdose.

This is the case of a 27-year-old black man who was admitted to Loyola University Medical Center after a one-time experience of smoking free-base ("crack") cocaine. Clinical manifestations of the resulting cocaine intoxication were rhabdomyolysis, acute renal failure, and transient liver failure. This patient came to our attention because of the striking alterations in his blood-chemistry values, which indicated acute tissue damage, and his remarkable recovery within 96 h. We discuss the dramatic changes in the laboratory findings and the clinical course of this patient.

Acute Kidney Injury↗
PubMed1996

Crack cocaine abuse: an epidemic with many public health consequences.

In the mid-1980s a new, smokable form of cocaine, called crack, was introduced in the United States. Soon thereafter, it became apparent that crack cocaine abuse was a serious and important public health concern. Over the past several years, crack cocaine use has increasingly been associated with a myriad of immediate and long-term adverse effects. During this same period, crack cocaine use has progressively moved away from experimentation and recreational use to chronic and compulsive drug use.

Chronic Disease↗
PubMed1996

Crack cocaine smokers who turn to drug injection: characteristics, factors associated with injection, and implications for HIV transmission. The Multicenter Crack Cocaine and HIV Infection Study Team.

A survey of 1220 street-recruited crack cocaine smokers revealed that crack smokers may turn to drug injection to ease crack withdrawal. Crack smokers who later injected tended to smoke crack more heavily and for longer periods than those who did not inject. The initiation of injection was significantly associated with ever snorting heroin (prevalence ratio [PR] = 3.4, 95% confidence interval [CI] = 2.0-5.9) or snorting heroin specifically while smoking crack (PR = 2.3, 95% CI = 1.3-4.0), suggesting that snorted heroin use may mediate the transition to injection among crack smokers. Programs to prevent and treat crack dependence may prevent later injection and injection-related infections including HIV.

Adolescent↗
PubMed1996

Crack cocaine and cocaine hydrochloride. Are the differences myth or reality?

OBJECTIVE: To review and discuss the differences and similarities between the use of crack cocaine and cocaine hydrochloride; and to determine how these findings might affect policies on the imprisonment and treatment of cocaine users. DATA SOURCES: English-language publications were identified through a computerized search (using MEDLINE) between 1976 and 1996 using the search terms "smoked cocaine," "crack cocaine," "freebase," and "cocaine-base." In addition, manual searches were conducted on references cited in original research articles, reviews, and an annotated bibliography, and on selected journals. STUDY SELECTION: Only those articles that compared various routes of cocaine administration or types of cocaine (cocaine base or crack cocaine vs cocaine hydrochloride) were examined. DATA EXTRACTION: Studies were reviewed to obtain information on the composition of the 2 forms of cocaine, and the prevalence, pharmacokinetics and pharmacodynamics, abuse liability, pattern of use, and consequences across the various routes of cocaine administration and forms of cocaine. CONCLUSION: Cocaine hydrochloride is readily converted to base prior to use. The physiological and psychoactive effects of cocaine are similar regardless of whether it is in the form of cocaine hydrochloride or crack cocaine (cocaine base). However, evidence exists showing a greater abuse liability, greater propensity for dependence, and more severe consequences when cocaine is smoked (cocaine-base) or injected intravenously (cocaine hydrochloride) compared with intranasal use (cocaine hydrochloride). The crucial variables appear to be the immediacy, duration, and magnitude of cocaine's effect, as well as the frequency and amount of cocaine used rather than the form of the cocaine. Furthermore, cocaine hydrochloride used intranasally may be a gateway drug or behavior to using crack cocaine. Based on these findings, the federal sentencing guidelines allowing possession of 100 times more cocaine hydrochloride than crack cocaine to trigger mandatory minimum penalties is deemed excessive. Although crack cocaine has been linked with crime to a greater extent than cocaine hydrochloride, many of these crimes are associated with the addiction to cocaine. Therefore, those addicted individuals who are incarcerated for the sale or possession of cocaine are better served by treatment than prison.

Administration, Intranasal↗
PubMed2002

Acute aortic dissection related to crack cocaine.

BACKGROUND: Although single case reports have described acute aortic dissection in relation to cocaine use, this condition is not widely recognized, and the features of cocaine-related aortic dissection have not been defined. METHODS AND RESULTS: We reviewed all available hospital charts from 1981 to 2001 with the ICD-9 diagnosis of aortic dissection. Among the 38 cases of acute aortic dissection, 14 (37%) were related to cocaine use. Crack cocaine was smoked in 13 cases and powder cocaine was snorted in 1 case. The mean interval between cocaine use and the onset of symptoms was 12 hours (range, 0 to 24). Patients with cocaine-related dissection were much younger and more likely to undergo surgery compared with patients with aortic dissection without cocaine use. Most in the cocaine group were black, with a history of untreated hypertension. However, the two groups did not differ in other respects, including dissection type. CONCLUSIONS: In an inner city population, acute aortic dissection in the setting of crack cocaine use is common, presumably as a consequence of abrupt, transient, severe hypertension and catecholamine release. This diagnosis should be considered in cocaine users with severe chest pain.

Acute Disease↗
PubMed2006

Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder.

AIM: To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. METHODS: The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. RESULTS: Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. CONCLUSIONS: Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.

Adult↗
PubMed2004

Abdominal complications from crack cocaine.

Not only is cocaine a powerfully addictive and dangerous drug of abuse, the use of the purified cocaine derivative crack has also reached epidemic proportions. Apart from causing fatal cardiorespiratory complications, crack cocaine is capable of producing surgical emergencies, which may or may not be associated with the pharmacology of cocaine itself. This is a report of crack-induced pneumoperitoneum, the mechanism of which seemed to be related to the prolonged Valsalva manoeuvre during crack smoking. Other differential diagnoses of crack related pneumoperitoneum are also discussed.

Adult↗
PubMed2006

Concurrent use and order of use of cocaine and alcohol: behavioural differences between users of crack cocaine and cocaine powder.

AIMS: The study investigates patterns of cocaine use and alcohol use when these substances were taken on their own, the order of administration of alcohol and of cocaine when the two substances were taken together, and changes in the doses of alcohol and of cocaine when the two substances were taken together. The study further investigates differences in the combined use of the two substances by users of cocaine powder and crack cocaine. DESIGN: Entry criteria for the study were current (previous 30 days) use of both alcohol and cocaine. Study participants (n = 102) were recruited from clinical and non-clinical settings. Data were collected by face-to-face structured interviews. FINDINGS: Different patterns of combined cocaine and alcohol use were reported by cocaine powder and crack cocaine users. Cocaine powder users tended to take increased doses of both cocaine and alcohol when these were used in combination. During high-dose crack using episodes, crack users tended to drink lower amounts of alcohol than usual. Cocaine powder users tended to use cocaine and alcohol concurrently. Crack users tended to use alcohol at the end of crack-using sessions. CONCLUSIONS: The observed differences are not understood clearly but may be influenced by differential effects of route of administration upon absorption, bioavailability and the balance of euphoric/dysphoric effects. Research studies of the combined use of cocaine and alcohol should distinguish explicitly between the use of cocaine by different routes of administration, and this should be specified in the description of subject samples.

Adult↗
PubMed2003

Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine.

RATIONALE: To estimate the risk of experiencing clinical features of cocaine dependence within 1-2 years of starting cocaine use, and to examine whether crack smoking might increase this risk. METHODS: A national sample of recent-onset cocaine users was identified within public data files of the National Household Surveys on Drug Abuse (NHSDA) for the years 1995 through 1998. The sample included 572 recent-onset users of cocaine HCl powder but not crack, and 190 recent-onset users of crack, some of whom had also started use of cocaine powder no more than 23 months prior to assessment. A separate group of 93 recent-onset crack users was identified; this comparison group had started using cocaine HCl powder 2+ years before assessment. Cocaine dependence was assessed via seven standardized questions about clinical features experienced within 12 months of assessment, such as feeling unable to cut down. Multivariate response regressions were used to evaluate crack-associated excess risk and clinical profiles of cocaine dependence. RESULTS: Among persons who had recently started to use cocaine HCl powder but not crack cocaine, about 5-12% experienced clinical features of cocaine dependence. Most clinical features occurred 2-3 times more often among crack smoking users as compared to those using powder only, even with statistical adjustment for frequency of cocaine use ( P<0.01). This crack-associated excess risk is more prominent for several clinical features of cocaine dependence, including tolerance associated with cocaine use and narrowed behavioral repertoire attributed to cocaine use. CONCLUSIONS: This new epidemiological evidence suggests that crack-smoking may increase risk of cocaine dependence once cocaine use starts, but we cannot rule out the possibility that crack users start out with a greater susceptibility to become cocaine dependent.

Cocaine↗
PubMed1996

Effects of crack cocaine on neurocognitive function.

Because crack cocaine appears to have a preferential effect on the metabolic and electrophysiological activity of the frontal and temporal regions of the brain (Pascual-Leone et al., 1991a, 1991b; Volkow, 1992), we hypothesized that cognitive measures of those regions would be impaired in crack cocaine users relative to measures in normal volunteers. We used logistic regression to determine the relationship of cocaine usage to neuropsychological test performance. We compared 38 patients with an average of 3.6 (SD = 2.5) years of crack cocaine use and 24.5 (SD = 28.1) days of abstinence to 54 normal volunteers on a battery of neuropsychological tests. Statistical adjustments were made for the effects of age, education, socioeconomic class, and level of depression. Our findings were mixed with regard to purported measures of executive/frontal functioning, with worse performance associated with cocaine usage on the Booklet Categories Test, but better performance associated on others (number of categories on the Wisconsin Card Sorting Test, Controlled Oral Word Association). Cocaine usage was associated with impairment on measures of spatial, but not verbal memory, confrontation naming, and Trail-making Test, Part B, a measure of perceptual-motor speed and cognitive flexibility. In summary, it appears that continuous crack cocaine use produces a dissociative pattern in neuropsychological test performance with improvement on some measures, but deterioration on others. The permanence of these effects remains to be determined with longitudinal studies.

Adult↗