Factors associated with recreational drug use

This study aimed to examine demographic, lifestyle, mental health and personality factors associated with illicit recreational drug use, heavy alcohol consumption and smoking in a community-based population sample. A postal questionnaire survey was conducted of people who were selected at random from the Electoral registers of Cardiff and Merthyr Tydfil. Illicit drug use was associated with risk taking, neuroticism, being male, having a higher education qualification, not being married, being unemployed, being aged under 25 years, smoking, heavy alcohol consumption and living in Cardiff. Smoking was associated with anxiety, depression, being female, lower income and educational qualifications, looking after the family or home, being aged over 25 years, illicit drug use and heavy alcohol use. Heavy alcohol consumption was associated with not being depressed, experiencing sleeping problems, risk taking, being male, higher income, no higher educational qualification, not being married, being a student, being aged under 25 years, smoking and illicit drug use. Illicit drug use, smoking and heavy alcohol use were strongly associated with each other. Illicit drug use was associated with alcohol use and, to an even greater extent, with smoking. Illicit drug and alcohol use were associated with similar characteristics, but smoking was associated with a rather different demographic combination.     

Negative cocaine effect expectancies are associated with subjective response to cocaine challenge in recreational cocaine users

Although many studies have shown that cognitive effect expectancies are associated with drug use and drug treatment outcomes, few studies have compared effect expectancies with drug response following drug challenge. Healthy male and female volunteers (n=19, ages 21-35) who reported using cocaine 1-4 times per month completed the Cocaine Effect Expectancy Questionnaire (CEEQ: [Schafer, J. and Brown, S.A. (1991). Marijuana and cocaine effect expectancies and drug use patterns. Journal of Consulting and Clinical Psychology, 59, 558-565.]), were challenged with cocaine (0.9 mg/kg, i.n.), then completed a series of visual analog scales (VAS) and the Addiction Research Center Inventory (ARCI) at 15 min intervals for 3 h following cocaine administration. Significant positive correlations were found between global negative expectancies and peak responses on the VAS measures "Good," "Happy," "High," "Stimulated," and "Desire to Use Cocaine," and on the LSD subscale of the ARCI post-cocaine administration, and between global positive expectancies and the MBG subscale of the ARCI, and on VAS items "Anxious" and "Good" post-cocaine administration. Global positive expectancies also were positively correlated with peak systolic blood pressure, and global negative expectancies with peak heart rate after cocaine administration. These results suggest that negative and positive effect expectancies both play a complex role in the subjective experience of cocaine effects, and thus likely in the progression of non-use to recreational use, in the transition to abuse, and in individualized treatment strategies.     

Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review

Methaemoglobinaemia can cause significant tissue hypoxia, leading to severe, potentially life-threatening clinical features and/or death. Over recent years there have been increasing reports of methaemoglobinaemia related to recreational drug use. There have been 25 articles describing methaemoglobinaemia related to recreational use of volatile nitrites (poppers) and more recently, four reports of methaemoglobinaemia in association with recreational cocaine use. In this article we discuss the mechanisms by which methaemoglobinaemia occurs in relation to the use of both volatile nitrites and cocaine, and summarize the published cases of recreational drug-related methaemoglobinaemia. The volatile nitrites can cause methaemoglobinaemia directly through their activity as oxidizing agents. However, with cocaine, methaemoglobinaemia is related to adulterants such as local anaesthetics or phenacetin, rather than to the cocaine itself. Clinicians managing patients with acute recreational drug toxicity should be aware of the potential for methaemoglobinaemia in these patients, particularly in patients with cyanosis or unexplained low oxygen saturations on pulse oximetry, and ensure that appropriate and timely management is provided, including, where appropriate, the use of methylthioninium chloride (methylene blue).     

Neuropsychological effects of formaldehyde use

This study compared five individuals who intentionally ingested formaldehyde (possibly laced with PCP) in marijuana cigarettes to a control group on measures of cognitive ability. Formaldehyde, a major component in embalming fluid, is legal to purchase and possess and has become popular due to its euphoric properties. In significant doses, the chemical is a neurotoxin. The effects of inadvertent exposure are fairly well known, but the effects of intentional ingestion have only recently been investigated. In addition, there has been little research on the effects of formaldehyde use specific to intellectual ability and cognitive intactness. The results of this study indicate intentional ingestion may cause a decline in neuropsychological intactness, as measured by performance on the Shipley Institute of Living Scale.     

The risk of psychotic symptoms associated with recreational methamphetamine use

Introduction and Aims. To determine whether recreational methamphetamine use is associated with an increased risk of psychotic symptoms. Design and Method. A cross‐sectional survey of 157 people attending dance events in Sydney, Australia. Participants were assessed for psychotic symptoms in the past year using items from the Psychosis Screen. Participants with and without psychotic symptoms were compared on methamphetamine use, polydrug use and other demographic factors. An ordinal logistic regression was used to determine the probability of psychotic symptoms by methamphetamine use and level of polydrug use. Results. Psychotic symptoms in the past year were predicted by methamphetamine use and heavier polydrug use in the past year, and a history of a psychotic disorder (schizophrenia, schizoaffective or bipolar affective disorder). After removing participants with a history of a psychotic disorder (n = 16) and adjusting for polydrug use, methamphetamine use increased the probability of two or more psychotic symptoms (indicative of psychosis risk) from 9% to 21%. There was a non‐significant increase in the risk of psychotic symptoms with higher levels of polydrug use. Methamphetamine use was typically monthly or less often (83%), and most users described their use as recreational (85%). Discussion and Conclusions. Within the context of polydrug use, recreational methamphetamine use is associated with a twofold to threefold increase in the probability of psychotic symptoms.[McKetin R, Hickey K, Devlin K, Lawrence K. The risk of psychotic symptoms associated with recreational methamphetamine use. Drug Alcohol Rev 2010]     

Fetal and newborn death associated with maternal cocaine use

Data collected from 25 cases of fetal or newborn death associated with maternal cocaine use are reported. The average week of gestation at which fetal death occurred was week 30. Abruptio placentae was observed in 7 cases and placental infarct was found in 4 cases. The average fetal blood cocaine and benzoylecgonine levels were 0.26 and 1.73 micrograms/mL. The average maternal levels were 0.14 and 1.80 micrograms/mL, respectively.     

Placental abruption associated with cocaine use: case report

The medical problems associated with cocaine ingestion, most notably cardiovascular side effects, have become evident as its use has become epidemic in the United States. Its effects on pregnancy and the developing fetus are similarly being recognized as more women of childbearing age are abusing cocaine. A case of placental abruption at 33 weeks' gestation following cocaine use is reported. A review of the pharmacodynamics, medical complications, teratogenic potential and effects in pregnancy is included.     

Delayed onset of seizures and toxicity associated with recreational use of Bromo-dragonFLY

Introduction

Many countries have specific legislation, such as the Controlled Substances Act (1970) in the United States and the Misuse of Drugs Act (1971) in the United Kingdom to control recreational drugs. There is a growing market and supply of “novel” recreational drugs, which include the misuse of pharmaceutical compounds and research chemicals. These are often not covered under current legislation, despite the fact that they often have both similar chemical structures and/or clinical effects to controlled recreational drugs.

Case Report

A male patient presented to an emergency department with delayed of severe agitation, hallucinations, and tonic-clonic seizures following the use of Bromo-dragonFLY and an unknown white powder. He settled following IV benzodiazepines and supportive care, and was discharged with no evidence to long-term sequelae: Analysis of the white powder by gas chromatography/mass spectrometry (GC/MS), ultraviolet/visible spectrophotometry (UV/VIS) and thin layer chromatography (TLC) showed the presence of Bromo-dragonFLY (1-(8-bromobenzol[1,2-b;4,5-b’]difuran-4-yl)-2-aminopropane); serum analysis by GC/MS and liquid chromatography with tandem mass spectrometry (LC/MS/MS)_confirmed that a combination of Bromo-dragonFLY (0.95 ng/mL). ketamine (20 ng/mL) and canabis had been used by the patient. No other recreational drugs were detected in an extensive toxicological screen of serum and urine samples.

Discussion

This is the first confirmed case to be reported of toxicity with delayed onset of severe agitation, hallucinations and tonic-clonic seizures associated with recreational use of Bromo-dragonFLY (1-(8-bromobenzol[1,2-b;4,5-b’]difuran-4-yl)-2-aminopropane) in combination with ketamine and cannabis. In our view, this case provides further support for the need for a systematic approach to toxicological screening of patients with recreational drug toxicity, to identify emerging drugs and provide evidence for legislative authorities to assist in revising the legal status of emerging recreational drugs.     

Mood state and recent cocaine use are not associated with levels of cocaine cue reactivity

Eighty-one cocaine-dependent outpatients were assessed for their reactions to cocaine-related cues in a laboratory setting. All subjects contributed a urine sample prior to the session. Compared with non-drug control cues, the cocaine stimuli produced increases in physiological arousal, self-reports of high, craving, and withdrawal, and self-reports of negative mood. Subjects who tested cocaine-positive on the day of testing differed only in skin resistance responding from those who tested cocaine-negative. Changes in cue-induced physiological and self-report measures were also not associated with between-subject variations in mood as measured by the Profile of Mood States (POMS) questionnaire administered prior to cue assessment. Thus, variations in baseline mood and recent cocaine use history do not introduce an additional source of variability in cue reactivity measurements. However, negative mood states at the start of a session were associated with higher levels of self-reported craving, high, and withdrawal both before and after cue exposure.     

Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine

Purpose  

Long-term regular use of ketamine has been reported to be associated with severe symptomatic urinary tract problems. Methoxetamine, an arylcyclohexylamine derivative of ketamine, is marketed as a “bladder safe” derivative of ketamine, and no cases of acute toxicity following analytically confirmed methoxetamine use have been reported to date. We report here a case series of three individuals with acute toxicity related to the analytically confirmed use of methoxetamine.     

Memory deficits associated with recreational use of “ecstasy” (MDMA)

Evidence from both animal, and human, studies suggests that repeated administration of 3,4-methylenedioxymethamphetamine (MDMA; “ecstasy”) produces lasting decreases in serotonergic activity. Serotonin is believed to play a modulatory role in a variety of psychological processes, including learning and memory. There are recent reports that polydrug users, who have used ecstasy recreationally, exhibit selective impairments in memory. However, these studies did not compare ecstasy users with polydrug users who had not taken ecstasy, leaving open the possibility that the memory deficits may be associated with a history of use of other illicit drugs.  The present study used the Rivermead Behavioural Memory test to investigate immediate and delayed recall in: 25 polydrug-users who had taken more than 20 tablets of ecstasy (MDMA group), 22 participants (polydrug controls) who had never taken ecstasy, but, otherwise has personal characteristics (e.g. age, gender, education, height, weight), and illicit drug use histories, that were generally not significantly different from those of the MDMA group, and 19 participants who had not used illicit drugs but who also had similar personal characteristics (non-drug controls). Participants in the MDMA group recalled significantly fewer ideas (approximately 75% of the number of ideas recalled by participants in either of the other two groups), in both immediate and delayed recall conditions. The two illicit drug-using groups did differ in their estimated IQ scores and their duration of use of LSD, but only the latter proved to be a statistically significant covariate, and the difference in recall performance between the MDMA and polydrug controls groups remained statistically significant when this variable was treated as a covariate. The present findings provide the first evidence that deficits in memory performance in recreational ecstasy users are primarily associated with past exposure to ecstasy, rather than with the other legal and illicit drugs consumed by these individuals, and are consistent with reduced serotonergic modulation of mnemonic function as a result of long-term neurotoxic effects of MDMA in humans. Received: 12 January 1998/Final version: 14 May 1998     

Hematological effects associated with beta-lactam use

Beta-lactam antibiotics have continued to be the mainstay of antiinfective treatment. Newer agents, such as the third-generation cephalosporins or ureidopenicillins, have the advantage of a broader antimicrobial spectrum and improved pharmacokinetics. The beta-lactams are often promoted as alternatives to more toxic antibiotic regimens. However, several of the beta-lactams have been shown to produce hematological effects, some of which can be life threatening. The primary hematological effects appear to be inhibition of normal platelet function and the coagulation cascade, which is reflected by changes in bleeding times and increases in prothrombin time and activated partial thromboplastin time, respectively. Although not all patients will develop bleeding problems associated with these agents, close monitoring of patients with risk factors for bleeding and dosage adjustments may help to avert these drug-induced hematological problems.     

Adverse effects associated with SonoVue use

Conventional ultrasonography (US) has limited accuracy in the detection and characterisation of solid focal liver lesions (FLL). Contrast-enhanced ultrasound (CEUS) significantly improves the diagnostic performance of US in the assessment of FLL. Rare reports of serious adverse events have been reported with CEUS. The rates of adverse reactions reported from the use of ultrasound contrast agents seem comparable to, or lower than, those observed for other imaging modalities that use contrast agents such as computed tomography and magnetic resonance imaging. Improved diagnostic results and diagnostic confidence achieved in conventional CEUS studies of the liver and during the investigational use in the intraoperative CEUS exploration appear to justify the use of this promising modality.     

Motivational effects of compounding discriminative stimuli associated with food and cocaine

 In previous experiments, the compounding of two discriminative stimuli associated with the same reinforcer increased rats’ responding approximately three-fold, regardless of whether the reinforcer was food, water, cocaine, or shock-avoidance. Compounding a discriminative stimulus associated with food with one associated with water increased responding two-fold. In the present experiment, compounding a discriminative stimulus associated with food with one associated with cocaine increased responding two-fold. These results support the hypothesis that 1) the effects of stimuli associated with reinforcers from the same incentive class (appetitive or aversive) are mutually enhancing, and 2) the combined effects of stimuli associated with two different reinforcers from within the same class are not as strong as those of two stimuli associated with the same reinforcer. These results also suggest that discriminative stimuli associated with non-drug reinforcers may increase the motivation to self-administer cocaine when encountered in combination with drug-related stimuli. Received: 20 June 1997 / Final version: 19 August 1997     

Prenatal cocaine use associated with down regulation of receptors in human placenta

Cocaine use during pregnancy has been associated with abruptio placentae and spontaneous abortions. These effects may be secondary to the vasoconstrictive effects of cocaine or to other alterations. Since it has been demonstrated that the use of opiates during pregnancy alters placental receptors, the effects of cocaine on placental receptors was studied. Women who used cocaine during pregnancy showed a significant lowering of the total number of beta-adrenergic receptor binding sites and delta-opiate receptor binding sites. The decreases in Bmax for each of these receptors was not associated with a decrease in the Kp. The potential causes for the receptor down regulation and effects are discussed.     

Impaired fear recognition in regular recreational cocaine users

Introduction

The ability to read facial expressions is essential for normal human social interaction. The aim of the present study was to conduct the first investigation of facial expression recognition performance in recreational cocaine users.

Materials and methods

Three groups, comprised of 21 cocaine naïve participants (CN), 30 occasional cocaine (OC), and 48 regular recreational cocaine (RC) users, were compared. An emotional facial expression (EFE) task consisting of a male and female face expressing six basic emotions (happiness, surprise, sadness, anger, fear, and disgust) was administered. Mean percent accuracy and latencies for correct responses across eight presentations of each basic emotion were derived. Participants were also assessed with the “Eyes task” to investigate their ability to recognize more complex emotional states and the Symptom CheckList-90—Revised to measure psychopathology.

Results

There were no group differences in psychopathology or “eyes task” performance, but the RC group, who otherwise had similar illicit substance use histories to the OC group, exhibited impaired fear recognition accuracy compared to the OC and CN groups. The RC group also correctly identified anger, fear, happiness, and surprise, more slowly than CN, but not OC participants. The OC group was slower than CN when correctly identifying disgust. The selective deficit in fear recognition accuracy manifested by the RC group cannot be explained by the subacute effects of cocaine, or ecstasy, because recent and less recent users of these drugs within this group were similarly impaired. Possible parallels between RC users and psychopaths with respect to impaired fear recognition, amygdala dysfunction, and etiology are discussed.

     

Daily stressor sensitivity, abuse effects, and cocaine use in cocaine dependence

This study highlights respondent sensitivity to daily hassles as it relates to situational cocaine use and perceived long-term effects of adverse events in childhood. Data were drawn from a larger study on stress reactivity in cocaine dependent individuals. Participants (n=104) were cocaine dependent men and women without comorbid posttraumatic stress disorder (PTSD). They completed the Early Trauma Inventory (ETI), the Daily Hassles Scale (DHS), the Inventory of Drug-Taking Situations (IDTS), and the Time-Line Follow-Back (TLFB; for 90 days prior to interview). There were no gender differences in the amount or frequency of cocaine use, although the patterns of use differed between male and female users. Overall, there were some associations in the patterns of cocaine use and sensitivity to daily hassles, particularly the use in response to conflict with others. Early negative life events were positively related to response to daily hassles, but current triggers were more relevant. Reactivity to cocaine cues was related to daily hassle sensitivity among women only. Limitations and implications of the findings are discussed.