Validation of cocaine and marijuana effect expectancies in a treatment setting

This study sought to establish the validity of the Cocaine Effect Expectancy Questionnaire (CEEQ), and the Marijuana Effect Expectancy Questionnaire (MEEQ) in discriminating between patterns of drug use in a clinical population. Prior research with these questionnaires has involved primarily nonclinical samples. Expectancy literature has yielded ambiguous results in demonstrating the role of both positive and negative expectancies in regards to drug use patterns. The sample consisted of 149 males on an inpatient V.A. substance abuse unit. On the CEEQ, cocaine users, particularly frequent users, endorsed fewer global positive cocaine expectancies than infrequent or nonusers. Present-infrequent users endorsed greater arousal effects than either present-frequent or nonusers. Nonusers of cocaine endorsed greater relaxation than present users. On the MEEQ, nonusers expected more negative effects from marijuana than users. Present users expected greater relaxation and craving effects than past users or nonusers. These results indicate different roles for positive and negative expectancies in cocaine and marijuana use.     

Subjective reactions to cocaine and marijuana are associated with abuse and dependence

Subjective effects of marijuana and cocaine use are associated with amount of drug use and potentially with risk of abuse and dependence. We used Latent Class Analyses (LCA) to examine subjective responses to two categories of drugs and link these to abuse and dependence. In 1992, subjective responses were queried of 2506 marijuana and 661 cocaine lifetime users who were members of the Vietnam Era Twin Registry. LCA was used to identify classes of subjective effects. Multinomial logistic regression models were computed to test for an association between classes and marijuana and cocaine abuse or dependence. The best LCA solution for marijuana identified 6 distinct classes characterized as positive, relaxed, reactive, adverse, low and very reactive. The best LCA solution for cocaine identified 5 distinct classes characterized as positive, alert, adverse, low and very reactive. Marijuana abuse and dependence were significantly associated with each latent class. Cocaine abuse was associated with the reactive class (OR=3.9; 95% CI: 1.6-9.5). Cocaine dependence was associated with reactive (OR=15.3; 95% CI: 7.1-32.6), adverse (OR=9.7; 95% CI: 4.5-21.0) and very reactive (OR=18.7; 95% CI: 5.6-62.6) classes. We found evidence for both qualitative and quantitative subjective effect profiles. Subjective effects, both positive and adverse are associated with lifetime risk for marijuana and cocaine dependence.     

Maternal recall of alcohol, cocaine, and marijuana use during pregnancy.

Alcohol, cocaine, and marijuana use during pregnancy was reported antenatally and at 13 months postpartum by 361 black inner city mothers. The two reports were moderately related for all three substances, but levels reported retrospectively were substantially higher. MAST scores did not differ for the two interviews. Most of the correlations of the antenatal and retrospective reports with maternal and infant characteristics were similar in magnitude; those that differed were somewhat stronger for the antenatal measures. Although the retrospective reports may provide a better indication of mean levels of fetal exposure, they may be less precise in rank ordering among individuals for purposes of correlational analysis. Women with higher MAST scores were particularly prone to report higher levels of both alcohol and cocaine when interviewed retrospectively, and more severely depressed mothers were more likely to report higher levels retrospectively for all three substances. These data suggest that women reporting more than 1.3 drinks/week antenatally (AA/day greater than 0.1) may actually be drinking at levels at risk for alcohol-related birth defects.     

Contingency management is efficacious and improves outcomes in cocaine patients with pretreatment marijuana use

Background

Marijuana use is common in patients seeking treatment for cocaine use. Nevertheless, few studies have examined effects of marijuana use on treatment outcomes in general, and even fewer with respect to contingency management (CM) treatment, which has been criticized for potentially increasing non-reinforced drug use.

Methods

Data from three randomized clinical trials of CM versus standard treatment (ST) in cocaine-abusing patients were examined ( [Petry et al., 2004], [Petry et al., 2005a] and [Petry et al., 2006a]; N = 393) to assess effects of pretreatment marijuana use on outcomes. Patients were divided into two groups: (1) no self-reported marijuana use (No Pre-M; n = 315) and (2) any self-reported marijuana use (Pre-M; n = 78) in the 30 days pretreatment.

Results

CM was especially efficacious in enhancing retention in Pre-M patients such that retention nearly doubled among Pre-M patients assigned to CM versus those assigned to ST. In contrast, CM exerted only modest benefits on retention in No Pre-M patients. Pretreatment marijuana use was not related to during-treatment abstinence from cocaine, opioids, and alcohol, or abstinence at a Month 9 follow-up. However, CM treatment and longest duration of abstinence achieved during treatment were significant predictors of Month 9 abstinence. Pre-M patients also evidenced more improvements in drug problems over time when randomized to CM.

Conclusions

CM was especially efficacious in facilitating retention and improving severity of drug-related problems in those who used marijuana in the month before initiating treatment.     

Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents

Objective

The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair.

Results

Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients. 40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine, and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals.

Conclusion

Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children.     

Comparative epidemiology of initial drug opportunities and transitions to first use: marijuana, cocaine, hallucinogens and heroin

The earliest stages of involvement with illicit drugs have been understudied. In a recent report, we examined initial opportunities to try marijuana and transitions from first opportunity to first use of that drug. This report extends that work by investigating early involvement with cocaine, heroin, and hallucinogens as well. We examine sex and race ethnicity differences in estimates of having a drug opportunity, and in the probability of progressing from having an opportunity to try a drug to actually using the drug. Self-report interview data collected for the National Household Surveys on Drug Abuse (NHSDA) from 1979 to 1994 were analyzed. Results showed that an estimated 51% of US residents have had an opportunity to try marijuana; comparative estimates for cocaine, hallucinogens, and heroin are 23, 14, and 5%, respectively. Among those who eventually used each drug, the vast majority made the transition from first opportunity to first use within 1 year. Males were more likely than females to have opportunities to try these drugs, but were not more likely than females to progress to actual use once an opportunity occurred. Time trends indicate recent increases from 1990 to 1994 in the estimated probability of using an illicit drug once an opportunity occurs, particularly for hallucinogens. Exploratory analyses on race ethnicity yielded some interesting leads for future research. This study sheds light on the epidemiology of the earliest stages of drug involvement in the USA. Implications for prevention efforts and for our understanding of sex differences in drug involvement are discussed.     

The effects of combinations of intranasal cocaine, smoked marijuana, and task performance on heart rate and blood pressure

Eight adult male research volunteers received cocaine and marijuana, alone and in combination during experimental sessions. Following the determination of baseline cardiovascular indexes, a one-gram marijuana cigarette (0-2.9% delta 9-THC w/w) was smoked, and cocaine hydrochloride (4-96 mg) was inhaled five minutes after completion of marijuana smoking. Subjects performed a learning task 25 and 70 minutes after initiating marijuana smoking. Cocaine increased heart rate, which averaged 68 bpm under resting baseline conditions, by up to 15 bpm, marijuana increased heart rate by up to 27 bpm, and task performance increased heart rate by 5 bpm. The combination of cocaine and marijuana produced increases in heart rate that were similar to those seen with marijuana alone. During task performance in combination with cocaine and marijuana administration, however, heart rate was elevated by 37 bpm. Although more variable, the largest increases in blood pressure were observed following combinations of cocaine, marijuana, and task performance. These findings suggest that the self-administration of cocaine and marijuana under nonresting conditions has greater cardiovascular effects than the self-administration of these drugs under resting conditions.     

Prevalence of cocaine and marijuana use in the last trimester of adolescent pregnancy: socio-demographic, psychosocial and behavioral characteristics

Objective

To evaluate the prevalence of cocaine and marijuana use during the third trimester of pregnancy in a population of 1000 teenage women of a public hospital in São Paulo, Brazil using hair analysis in order to avoid underestimation of data that could happen by the use of self-report questionnaires and describe socio-demographic, psychosocial and behavioral characteristics of the drug users.

Results

Hair analysis has detected use of cocaine and/or marijuana in the third trimester of pregnancy in 6% of the patients: 4.0% used marijuana, 1.7% used cocaine and 3% used both drugs. They were about 17 years old, from low-income, poorly educated, unemployed, financially dependent and they had not planned the pregnancy. 10% of miscarriages have occurred in this population.

Conclusion

This study shows the psychosocial impairment associated to teenage pregnancy and use of cocaine and marijuana during gestation by this low-income population with reliable data of prevalence obtained through hair analysis.     

Re-engineering butyrylcholinesterase as a cocaine hydrolase

To address the problem of acute cocaine overdose, we undertook molecular engineering of butyrylcholinesterase (BChE) as a cocaine hydrolase so that modest doses could be used to accelerate metabolic clearance of this drug. Molecular modeling of BChE complexed with cocaine suggested that the inefficient hydrolysis (k(cat) = 4 min(-1)) involves a rotation toward the catalytic triad, hindered by Tyr332. To eliminate rotational hindrance and retain substrate affinity, we introduced two amino acid substitutions (Ala328Trp/Tyr332Ala). The resulting mutant BChE reduced cocaine burden in tissues, accelerated plasma clearance by 20-fold, and prevented cocaine-induced hyperactivity in mice. The enzyme's kinetic properties (k(cat) = 154 min(-1), K(M) = 18 microM) satisfy criteria suggested previously for treating cocaine overdose (k(cat) >120 min(-1), K(M) < 30 microM). This success demonstrates that computationally guided mutagenesis can generate functionally novel enzymes with clinical potential.     

Receiving Marijuana and Cocaine as Gifts and Through Sharing

This paper presents estimates of the probability that individuals who use marijuana and cocaine receive some of their drug as a gift or through sharing. The analysis utilizes data from the National Household Survey of Drug Abuse in the United States of America. This research expands upon the observation of field researchers that sharing and gift giving are common distribution mechanisms in drug markets. The likelihood an individual marijuana or cocaine user receives drug gifts or receives drugs through sharing by others depends on age, race, gender, income and the amount they consume. These findings should assist policy makers designing drug abstinence programs and drug rehabilitation administrators trying to prevent relapse.     

Examining the link between psychological distress,mental health disorders and sharing behaviors among cocaine users

BackgroundPsychiatric problems and cocaine use are associated with heightened vulnerability for HIV and Hepatitis C infections. Little is known regarding the relationship between psychiatric symptoms, psychiatric diagnoses and injection risk behaviors among cocaine users. We examined the association between psychological distress and injection material sharing among cocaine users, while accounting for comorbid anxious and mood disorders.MethodsParticipants included cocaine users who inject drugs recruited in a prospective cohort study in Montreal, Canada. Diagnosis of mood and anxiety disorders in the year preceding baseline were established using the Composite International Diagnostic Interview (CIDI) questionnaire. Psychological distress based on the Kessler scale and injection material sharing in the past 3 months were assessed at baseline and at each of the five follow-up visits at 3-month intervals. Statistical analyses were conducted using generalized estimation equation.ResultsOf the 387 participants (84.5% male; 80.1%, ≥ 30 y.o.), 35% reported severe psychological distress, 43% qualified for an anxiety disorder diagnosis and 29% for a mood disorder diagnosis at baseline. Psychological distress was not associated with any injection risk behavior when adjusting for socio-demographic and psychiatric disorders. Participants with anxiety disorders were more likely to share needle (adjusted odds ratio: 1.89, 95% CI: 1.17–3.03). Sharing of injection material other than needle was not associated with psychiatric disorders or with psychological distress in multivariate analyses.ConclusionsAnxiety disorders are associated with needle sharing among cocaine users. Our results suggest the importance of screening for anxiety disorders as part of preventive interventions to decrease blood-borne viruses' transmission.     

Response to marijuana as a function of potency and breathhold duration

The present study examined the effects of systematic manipulation of breathhold duration (0 and 20 s) on the physiological and subjective response to active (M; 2.3% delta-9-THC) and placebo (P; 0.0% delta-9-THC) marijuana in a group of ten regular marijuana smokers. During the eight-session experiment, subjects were exposed twice to each of four experimental conditions (P0, P20, M0, M20), scheduled according to a randomized block design. A controlled smoking procedure was used in which the number of puffs and puff volume were held constant. Expired-air carbon monoxide (CO) levels were used to monitor smoke intake. Breathhold duration affected CO absorption; significantly more CO was absorbed from both P and M smoke after 20 s of breathholding (mean CO boost=6.9 ppm) than after no breathholding (mean=4.4 ppm). Heart rate was minimally affected by the breathhold manipulation. Effects of marijuana on mood were not consistently affected by breathhold duration. The results confirm previous findings that prolonged breathholding does not substantially enhance the effects of inhaled marijuana smoke.     

Violent behavior as related to use of marijuana and other drugs

The relationship of the degree of use of each of ten types of illicit drugs with each of eight types of violent criminal offenses, is reported for an African-American, inner-city, low SES, young adult study sample (N = 612). Prospective data from the time of birth was available for the statistical analyses, to provide 51 control variables on factors other than substance use which might predict to later violent behavior Findings: Greater frequency of use of marijuana was found unexpectedly to be associated with greater likelihood to commit weapons offenses; and this association was not found for any of the other drugs, except for alcohol. Marijuana use was also found associated with commission of Attempted Homicide/Reckless Endangerment offenses. Cocaine/crack and marijuana were the only two types of drugs the frequency of use of which was found, for this sample, to be significantly related to the frequency of being involved in the selling of drugs. These findings may not apply to a middle-class African-American sample.     

The differential relationship between cocaine use and marijuana use on decision-making performance over repeat testing with the Iowa Gambling Task

Decision-making deficits are a robust cognitive correlate of substance abuse, but few studies have addressed the long-term differential associations of cocaine use and marijuana (MJ) use on decision-making. This study utilized the Iowa Gambling Task (IGT), a widely used measure of decision-making, to investigate the relationship between cocaine and MJ use and IGT learning. We analyzed between and within group differences across two consecutive testing sessions in abstinent users of either MJ or cocaine. We assessed long-term correlates of the use of these drugs by evaluating users after 25 days of enforced abstinence. Results showed that both cocaine users and MJ users performed worse than controls on the total IGT net score. All groups showed learning between Session 1 and Session 2, but the cocaine users showed the smallest increase in performance. The pattern of learning from the beginning to the end (block x block) of the IGT (Session 2) was different for the drug groups, with the cocaine group showing more learning than the MJ group. Dose-related measures of cocaine use (g/week) and MJ use (joints/week) predicted IGT performance (the heavier the drug use the lower the performance). Differential correlates of cocaine use and MJ use on decision-making learning may have important implications for the development of novel treatment interventions.     

The latent structure of marijuana and cocaine use disorders: results from the National Longitudinal Alcohol Epidemiologic Survey (NLAES)

To better understand the underlying concepts of substance dependence and abuse, the present study examines the factor structure of DSM-IV lifetime criteria for cannabis and cocaine use disorders. Data for this study were drawn from the National Longitudinal Alcohol Epidemiologic Survey (NLAES), a large nationally representative U.S. sample aged 18 years and older. Exploratory factor analysis (EFA) examined the factor structure for each substance and the factors were related to background covariates using latent variable modeling techniques. Separate analyses were conducted for lifetime marijuana and cocaine users. A two-factor solution was identified for each substance and was similar to DSM-IV abuse and dependence. The factors were highly correlated for both cannabis (r=0.73) and cocaine (r=0.77). Background variables accounted only for a modest amount of factor variance. In conjunction with the findings in alcohol use disorders, these results support the use of consistent criteria across substances in DSM-IV and ICD-10, and suggest that the consistent finding of two correlated factors across substances needs to be better understood.