Progression on drug use and its intervening factors among crack users

OBJECTIVE: To establish a progression on drug use and its intervening factors among crack users. METHODS: A qualitative methodology was applied for an in-depth investigation, taking into consideration the interviewees' viewpoint of the problem. Long interviews using a semi-structured questionnaire were conducted. A purposeful sampling was outlined to create a criterion sampling. For theoretical saturation, 31 crack users and former users were interviewed. RESULTS: Two distinct phases of drug use were identified. In the first phase there predominate licit drugs, mostly alcohol and tobacco, encouraged by the parents and friends and the users' need of self-assurance. An early age start and heavy use of one or both drugs are determinant for the progression to illicit drugs. Marijuana is the first drug used in the second phase, characterized by an active attitude towards drugs which are regarded as a source of satisfaction. DISCUSSION: The progression on drug use seems to be more associated to external decisions (e.g. peer pressure, drug dealers' encouragement, etc.) than to users' preference. Two different kinds of progression were identified: in younger users (<30 years old): tobacco and/or alcohol, marijuana, snorted cocaine, and crack; in older users (>30 years old): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack.     

Into the world of illegal drug use: exposure opportunity and other mechanisms linking the use of alcohol, tobacco, marijuana, and cocaine

Drawing upon an "exposure opportunity" concept described by Wade Hampton Frost, the authors studied two mechanisms to help account for prior observations about the "stepping-stone" or "gateway" sequences that link the use of alcohol, tobacco, marijuana, and cocaine. Data were obtained from four nationally representative and independent cross-sectional samples of US household residents (n = 44,624 persons aged 12-25 years). Data were gathered using standardized self-report methods and were analyzed via survival methods. Results indicated that users of tobacco and alcohol were more likely than nonusers to have an opportunity to try marijuana and were more likely to actually use marijuana once a marijuana opportunity had occurred. Opportunity to use cocaine was associated with prior marijuana smoking. Among young people with a cocaine opportunity, those who had used marijuana were more likely to use cocaine than were those with no history of marijuana use. The observed associations did not seem to arise solely as a result of young drug users' seeking out opportunities to use drugs. Applying Frost's epidemiologic concept of exposure opportunity, the authors offer new epidemiologic evidence on the sequences that link earlier use of alcohol and tobacco to later illegal drug involvement.     

Online Illegal Drug Use Information: An Exploratory Analysis of Drug-Related Website Viewing by Adolescents

Given the uncertain effects of antidrug media campaigns, and the ease of finding online illegal drug information, research is needed on the Internet role in disseminating drug information to youths. This exploratory study analyzes National Survey of Parents and Youth (NSPY) data on drug website viewing among 12–18 year olds (N = 7,145). Approximately 10.4% reported drug-related website exposure: 5.4% viewed only websites that communicated how to avoid drugs or bad things about drugs (antidrug websites); 1.7% only viewed websites that communicated how to use drugs and good things about drugs (prodrug websites); and 3.2% viewed both types of websites. The low rates of viewing antidrug websites occurred despite efforts in the National Youth Antidrug Media Campaign (NYAMC) to encourage youths to visit such websites. Prodrug website viewers had used inhalants and been offered marijuana, perceived little risk in trying marijuana, intended to use marijuana, had close friends who used drugs, reported low parental monitoring, and had been exposed to antidrug media messages. Viewing antidrug websites was related to gender, income, likelihood of using marijuana in the next 12 months, having close friends who use drugs and talking to friends about avoiding drugs, parental monitoring, and drug prevention exposure. Prior prevention exposure increased drug website viewing overall, perhaps by increasing general curiosity about drugs. Because adolescents increasingly seek health information online, research is needed on how they use the Internet as a drug information source, the temporal relationships of prevention exposure and drug website viewing, and the effects of viewing prodrug websites on drug risk.     

Depressive Symptoms and Patterns of Drug Use Among Street Youth

PurposeRates of depression among street youth are poorly characterized, particularly as they pertain to concurrent drug use. We sought to assess associations between drug type and degree of depression in this population.MethodsBetween October 2005 and November 2007, data were collected from a cohort of street-recruited youth aged 14–26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiological Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regression. Logistic regression was also used to assess adjusted odds of CES-D score ≥22.ResultsAmong 447 youth, mean CES-D score was the highest among heroin users (adjusted mean: 22.7; standard deviation [SD]:1.2), followed by crystal methamphetamine users (adjusted mean: 21.8; SD: 1.1), then cocaine and/or crack users (adjusted mean: 19.1; SD: 1.0), and finally, marijuana users (adjusted mean: 18.3; SD: 1.1), resulting in a difference that was significant among groups (p < .001). When compared with daily marijuana users, odds of CES-D score ≥22 were higher among heroin users (adjusted odds ratio [AOR]: 2.64; 95% confidence interval [CI]: 1.39–4.99) and crystal methamphetamine users (AOR: 1.88; 95% CI: 1.04–3.42), but not among cocaine/crack users (AOR: 1.41; 95% CI: .79–2.52).ConclusionTo our knowledge, this is the first report of drug use typologies and depression among street youth. Policymakers might heed the apparent vulnerability of heroin and crystal methamphetamine users to even greater degrees of depression than their peers.     

Individual differences and context: factors mediating recall of anti-drug public service announcements

A sample of 597 participants was surveyed to examine factors that influence recall of antidrug public service announcements (PSAs). High sensation-seekers and polydrug users recalled somewhat more antidrug PSAs than low sensation-seekers and nonusers. Regression analyses indicated that total hours of television viewing did not predict recall of televised antidrug PSAs; instead, recall was predicted by preference for specific program genres, such as sports, news shows, action programs, sitcoms, and stand-up/comedy channel programs, and individual-difference variables such as sensation-seeking, drug use, and gender. The findings provide more evidence for the sensation-seeking targeting (SENTAR) approach and demonstrate the relevance of selective exposure and program contexts in reaching potential drug users.     

From beer to crack: developmental patterns of drug involvement.

OBJECTIVES. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. METHODS. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models. RESULTS. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. CONCLUSIONS. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.     

Drug abuse prevalence among secondary school students in São José do Rio Preto, São Paulo State, Brazil

This study investigates the prevalence of drug consumption among secondary school students in S?o José do Rio Preto, S?o Paulo State, Southeast Brazil, and its distribution in relation to gender and grade in school. A cross-sectional survey was carried out in S?o José do Rio Preto. A self-applied questionnaire was answered by a proportional sample of 1,041 teenagers enrolled in 9th, 10th, and 11th grades in public schools. Lifetime consumption of psychoactive substances was: alcohol 77%, tobacco 28.7%, solvents 18.1%, marijuana 12.1%, amphetamines 3.7%, cocaine 3.3%, hallucinogens 3.1%, and crack 1.4%. Weekly use of marijuana was the highest (2.8%), followed by solvents (1.3%). Males consumed more alcohol, marijuana, cocaine, and crack than females. Nighttime use of tobacco, marijuana, cocaine, and hallucinogens was observed. In the present study, prevalence of psychoactive substance use was observed in S?o José do Rio Preto at rates similar to those found in other Brazilian studies.     

Individual Differences and Context: Factors Mediating Recall of Anti-Drug Public Service Announcements

A sample of 597 participants was surveyed to examine factors that influence recall of antidrug public service announcements (PSAs). High sensation-seekers and polydrug users recalled somewhat more antidrug PSAs than low sensation-seekers and nonusers. Regression analyses indicated that total hours of television viewing did not predict recall of televised antidrug PSAs; instead, recall was predicted by preference for specific program genres, such as sports, news shows, action programs, sitcoms, and stand-up/comedy channel programs, and individual-difference variables such as sensation-seeking, drug use, and gender. The findings provide more evidence for the sensation-seeking targeting (SENTAR) approach and demonstrate the relevance of selective exposure and program contexts in reaching potential drug users.     

Predictors of Disapproval toward “Hard Drug” Use among High School Seniors in the US

Attitudes toward drug use strongly determine whether an individual initiates use. Personal disapproval toward the use of a particular drug is strongly protective against use; however, little is known regarding how the use of one drug affects attitudes toward the use of other drugs. Since marijuana use is on the rise in the US and disapproval toward use is decreasing, research is needed to determine whether the use of marijuana or other licit or illicit drugs reduces disapproval toward the use of “harder,” more potentially dangerous drugs. The Monitoring the Future study assesses a national representative sample of high school seniors in the US each year. This study investigated predictors of disapproval toward the use of powder cocaine, crack, lysergic acid diethylamide (LSD), heroin, amphetamine, and ecstasy (“Molly”) in a weighted sample of 29,054 students from five cohorts (2007–2011). Results suggest that lifetime use of cigarettes and use of more than one hard drug consistently lowered odds of disapproval. In multivariable models, lifetime alcohol use did not affect odds of disapproval and lifetime marijuana use (without the use of any “harder” drugs) lowered odds of disapproval of LSD, amphetamine, and ecstasy, but not cocaine, crack, or heroin. In conclusion, marijuana use within itself is not a consistent risk factor for lower disapproval toward the use of harder drugs. Cigarette and hard drug use, however, are more consistent risk factors. As marijuana prevalence increases and policy becomes more lenient toward recreational and medicinal use, public health and policy experts need to ensure that attitudinal-related risk does not increase for the use of other drugs.     

Predictive model for cocaine use in prisons in Rio de Janeiro, Brazil

OBJECTIVE: To identify predictors of and groups vulnerable to cocaine use in prison. METHODS: We selected 376 inmates with history of cocaine use in prison (cases) and 938 inmates with no history of drug use (controls) serving sentences in the Rio de Janeiro State prison system in 1998. The analysis included exposure variables divided into three hierarchical levels: distal, intermediate, and proximal. We performed bivariate analysis using logistic regression and multivariate analysis using hierarchized regression; results are given in odds ratios. RESULTS: Variables associated with cocaine use in prison in the proximal level were use of alcohol and marijuana and duration of imprisonment in years. The effect of social vulnerability variables (distal level) was intermediated by variables in the next levels. Considering only the distal and intermediate levels, use of marijuana prior to imprisonment (OR=4.50; 95% CI: 3.17-6.41) and offence in order to obtain drugs (OR=2.96; 95% CI: 1.79-4.90) showed the strongest association with the outcome. For every additional year spent in prison, the odds of cocaine use increase by 13% (OR=1.13; 95% CI: 1.06-1.21). CONCLUSIONS: Considering the distal and intermediate levels, use of marijuana prior to imprisonment and perpetration of offence in order to obtain drugs were the variables with greatest predictive value. The final model showed alcohol and marijuana use in prison and duration of imprisonment as important predictors of the outcome. The prison environment appears as a factor stimulating drug use.     

Recreational drug use and the risk of primary infertility

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.0 to 3.0). The risk was greatest among women who had used marijuana within one year of trying to become pregnant (RR = 2.1, 95% CI = 1.1 to 4.0). No consistent frequency or duration of use effects could be demonstrated, and the risk was confined to low-frequency users. Risks associated with the use of other drugs were not elevated. The risk of infertility from a tubal abnormality associated with cocaine use was greatly increased (RR = 11.1, 95% CI = 1.7 to 70.8). Our results are consistent with animal studies suggesting that smoking marijuana may cause a transient disruption of ovulatory function. The possibility that cocaine exposure influences the development of tubal infertility needs further investigation.     

HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities.

OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection drug users and crack smokers are at high risk for HIV infection.     

Stimulant Use and Sexual Risk Behaviors for HIV in Rural North Carolina

ABSTRACT:  Context: While literature exists on sexual risks for HIV among rural populations, the specific role of stimulants in increasing these risks has primarily been studied in the context of a single drug and/or racial group. Purpose: This study explores the use of multiple stimulants and sexual risk behaviors among individuals of different races and sexual identities in rural North Carolina. Methods: In-depth interviews were conducted with 41 individuals in 3 rural North Carolina counties between June 2004 and December 2005. Interviews were audiotaped, transcribed and reviewed for accuracy. Edited interviews were imported into Atlas.ti and askSam for analysis. Findings: Along with marijuana, stimulants—including powder cocaine, crack, and methamphetamine—were the most frequently used illicit drugs in these counties. Powder cocaine use was more closely associated with white participants, crack with African Americans, and both were more commonly used by female participants. Participants reported 3 overlapping behaviors involving stimulant use that may be associated with increased risk of HIV infection: engaging in sex while using drugs, sex trading and group sex. Nearly half of participants reported engaging in group sex activity. Conclusions: HIV risk through injection appears to be low in these rural counties. However, nearly all study participants reported some form of sexual risk behavior that may increase transmission of HIV and other sexually transmitted infections. Further research is warranted focusing on the nexus between substance abuse and risky sexual behaviors .     

Drug use frequency among street-recruited heroin and cocaine users in harlem and the bronx before and after September 11, 2001

We determined if illicit drug use frequency changes after a disaster by comparing drug use frequency in two street-recruited samples of heroin and cocaine users, ages 15–40 years. The users were interviewed between July 11 and November 11 and divided into before- and after-September 11th groups for analysis. The before and after groups were similar in the mean number of days of drug use per month (sniff cocaine 6.8 days vs. 9.4 days, respectively, P=.17; snorted heroin 13.9 vs. 14.0, respectively, P=.96; smoked crack 16.9 vs. 15.6, respectively, P=.96; and smoked marijuana 17.5 vs. 15.3, respectively, P=.36) and in the proportion of daily users: sniffed cocaine 10% versus 17%, respectively (P=.28); snorted heroin 47% versus 40%, respectively (P=.91); smoked crack 33% versus 37%, respectively (P=.68); and smoked marijuana 47% versus 40%, respectively (P=.41). Among street-recruited heroin and cocaine users in Harlem and the Bronx, the frequency of drug use did not increase following the events of September 11, 2001. Dr. Factor is from the Division of Prevention Research and Analytic Methods in the Epidemiology Program Office at the Centers for Disease Control and Prevention and is assigned to     

Ecstasy use and its Association with Sexual Behaviors Among Drug Users in New York City

In the past two decades, recreational use of ecstasy has become a growing concern in the United States, although most studies assessing ecstasy use have focused on white, middle-class adolescents who use ecstasy during raves and in clubs. We assessed the prevalence of recent ecstasy use among predominantly minority heroin, cocaine, and crack users in New York City and the association between ecstasy and sexual risk above and beyond that of the other drugs. Between 2002 and 2004, injection and non-injection heroin, crack and cocaine users (N = 534) completed a risk behavior questionnaire that included items on ecstasy use. Logistic regression was used to investigate the relation between current ecstasy use and sexual behaviors. Of 534 illicit drug users, 69.7% were aged 25 years or older, 65.2% were Hispanic, 27.9% Black and 77.4% male; 36.7% were injectors. 17.2% of respondents reported recent (last six months) ecstasy use. In a multivariable logistic regression model, current ecstasy use was associated both with initiating sex before age 14 (adjusted odds ratio (AOR) = 1.51) and having two or more partners in the past two months (AOR = 1.86) after adjusting for age at study entry, current cocaine and marijuana use and being an injection drug user. This study suggests that ecstasy use may be more prevalent among urban drug users. Ecstasy use in urban settings, beyond clubs and raves, should continue to be monitored.     

Prevalence of illicit drugs detected in the urine of women of childbearing age in Alabama public health clinics.

Each year, it is estimated that from 350,000 to 739,000 U.S. infants are exposed in utero to one or more illicit drugs. To estimate the prevalence of and risk factors for illicit drug use by women of childbearing age in Alabama, during 2 months in 1991 the authors collected patient-reported histories, clinical histories, and urine specimens from 6,195 women statewide attending public health maternity clinics, family planning clinics, and a high-risk referral obstetrical clinic. Blind drug screening of urine specimens for marijuana, cocaine, opiates, barbiturates, and amphetamines was performed with the use of a fluorescent polarization immunoassay. The overall prevalence of positive results for drugs tested was 10.1 percent, including 8.4 percent of the 3,554 pregnant and 12.3 percent of the 2,571 nonpregnant women screened. The drugs most frequently detected were marijuana and cocaine. Characteristics of the subjects associated with a higher prevalence of positive results for any drug tested or for marijuana included white race, older age, being divorced, nonstudent occupation, having 12 or less years of education, attending a clinic located in a suburban county, self-reported substance use, increased risk for human immunodeficiency virus infection, and reproductive history. Characteristics of women with positive screening for cocaine results were similar to those who tested positive for any drug, except that the prevalence of cocaine was higher among black women and those attending urban county clinics and did not vary by years of education. Patient-reported histories of drug use were insensitive in identifying women who had positive drug screening results (sensitivity, 6.3 percent; specificity, 98.2 percent).(ABSTRACT TRUNCATED AT 250 WORDS)     

Crack/cocaine use in a rural county of England

Crack/cocaine use is an increasing problem in the UK. This study is the first to ascertain the magnitude of the crack/cocaine problem in a rural county of the UK and to determine users' needs for treatment services. A questionnaire on drug dependence and risk behaviour was completed by 306 users of drug treatment services, and focus groups were conducted with 45 self-selected crack/cocaine users. It is estimated that 31% (95% C.I., 26% to 37%) of drug users in treatment services have moderate/severe dependence on crack/cocaine. Factors associated with severe crack/cocaine dependence are severe dependence on benzodiazepines, increasing number of drugs used, engaging in sex work and non-white ethnicity. Those with severe dependence have a higher prevalence of hepatitis B and C compared with those with moderate or no dependence. All focus group participants describe a frenzied drug life so when entering treatment they require additional support to give structure to their lives to prevent relapse. Current service provision appears not to provide help to crack/cocaine users. Given the lack of pharmacological treatment, programmes should incorporate a wide range of activities and interventions to provide structure to clients' lives. Learning from ex-users was perceived as an important component of treatment.     

Race/ethnicity differences in the validity of self-reported drug use: Results from a household survey

Data were analyzed from a multistage probability household survey of over 600 adults, ages 18–40 from the city of Chicago conducted during 2001–2002. The survey employed audio computer-assisted self-interviews to obtain information about drug use. To imvestigate racelethnicity differences in reporting validity, drug test results were compared with self-reports of past month drug use for cocaine, marijuana, and a combined indicator of both substances. The main indicators of validity were self-report sensitivity and concordance. Possible theoretical models accounting for potential cultural differences in reporting validity were discussed. Survey variables reflecting these potential explanations were examined as potential mediators of racelethnicity differences in validity and as direct correlates of validity. Socioeconomic status was identified as one potential mediator. With this exception, racelethnicity differences suggesting lower levels of marijuana and cocaine concordance for African Americans as compared with Whites were sustained after controlling for potential mediators. Methodological implications for epidemiological and health disparities research are discussed.     

Can abuse deterrent formulations make a difference? Expectation and speculation

Background

Five cases of severe neutropenia (neutrophil counts < 0.5 per 10⁹ cells/L) associated with exposure to cocaine and levamisole, an antihelimithic agent no longer available in Canada, were identified in Alberta in 2008. Alberta and British Columbia (BC) public health officials issued an advisory and urged health care professionals to report cases to public health. This paper presents the findings of the public health investigations.

Methods

Cases were identified prospectively through reporting by clinicians and a retrospective review of laboratory and medical examiners data from January 1, 2006 to March 31, 2009. Cases were categorized as confirmed, probable or suspect. Only the confirmed and probable cases are included in this paper.

Results

We compare cases of severe neutropenia associated with tainted cocaine (NATC) identified in Alberta and BC between January 1, 2008 to March 31, 2009. Of the 42 NATC cases: 23(55%) were from Alberta; 19(45%) were from British Columbia; 57% of these cases reported crack cocaine use (93% of those who identified type of cocaine used); 7% reported using cocaine powder; and the main route of cocaine administration was from smoking (72%). Fifty percent of the NATC cases had multiple episodes of neutropenia associated with cocaine use. Cases typically presented with bacterial/fungal infections and fever. One Alberta NATC case produced anti-neutrophil antibodies, and four were positive for anti-neutrophil cytoplasmic antibody (ANCA). Analysis of two crack pipes and one drug sample obtained from NATC cases confirmed the presence of both cocaine and levamisole. A further 18 cases were identified through the retrospective review of laboratory and medical examiner data in Alberta

Interpretation

Our findings support a link between neutropenia and levamisole tainted cocaine; particularly from smoking the crack form of cocaine. Some patients may be genetically predisposed to develop levamisole-related neutropenia. Awareness of the differential diagnosis will assist clinicians with case timely detection and appropriate management.