Loosening the Grip: a handbook of Alcohol Information 9th

Chapter 13 Drugs of Abuse Other than Alcohol

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Chapter 13 Drugs of Abuse Other than Alcohol

Basic References

Arnold G. The International Drugs Trade. New York: Routledge, 2005. (280 pp.)

This book sets out the dimensions and nature of the illicit drug trade world-wide. It begins with an overview of drug use throughout history and the factors which prompted drug use, be in for relaxation, as an aphrodisiac, or for medical purposes. It then examines the use of illicit drugs in the West and the problems which are prompted by drug use. The drug trade as a business/economic venture is also discussed, and the fact that it represents one of the major global 'industries.' The role of government, whether openly or covertly is also described, along with the failure of enforcement efforts to curtail supply or treatment/prevention to diminish demand-side features. Individual chapters are devoted to the primary sources of drugs -- cocaine from South America, heroin from both the Golden Crescent in Asia and the Golden Triangle. The role that is played by Europe, not only as a major consumer, but also in its role in economics of the drug trade and in money laundering. In the process of examining the success and failures of current anti-drug initiatives, alternative approaches are also presented. Copyright 2006, Project Cork

Brick J, ed. Handbook of the Medical Consequences of Alcohol and Drug Abuse. Binghamton NY: Haworth Medical Press, 2005. (329 pp

This edited volume, with 20 contributors and organized into ten chapters, deals with the range of medical consequences of alcohol and other drug use. The first five chapters deal with alcohol: it's basic pharmacology; the medical sequelae in terms of accidental injury, and impact on major body systems; the neuropsychological consequences; the acute and chronic effects on the brain; and fetal alcohol syndrome/fetal alcohol effects. Individual chapters are devoted to the medical consequences of opiates, marijuana, cocaine and other stimulants, and inhalants, addressing both the acute and chronic effects. There is also a chapter on the effects of prenatal drug exposure of tobacco, cocaine, marijuana, and opiates. Copyright 2005, Project Cork

Donovan DM, Marlatt GA, eds. Assessment of Addictive Behaviors, 2nd ed. New York: Guilford Press, 2005. (480 pp.)

This edited volume, with 13 chapters and 33 contributors, examines the assessment issues related to addictive disorders and compulsive behaviors. Interestingly it begins with consideration of relapse prevention and assessment issues to accomplish this. The following chapter deals with the epidemiology of addictive disorders in racial and ethnic groups. The next six chapters focus upon assessment for those involved with a specific drug -- alcohol, nicotine, cocaine, amphetamines, opioids, marijuana -- followed by one dealing with hallucinogens, inhalants and steroid use. The concluding four chapters deal with assessment, not of psychoactive drugs, but with compulsive behaviors -- gambling, disordered eating and obesity, sexual offender relapse, and high risk sexual behavior. Incorporated within the discussion is consideration of screening and assessment tools, as well as assessment of comorbid psychiatric disorders and other related medical co-occurring conditions. Copyright 2006, Project Cork

Graham AW, Shultz TK. Principles of Addiction Medicine, 3rd ed. Chevy Chase, MD: American Society of Addiction Medicine, 2003.

A reference work on all aspects or alcohol and drug use and associated problems and their treatment.

Henry JA. Management of drug abuse emergencies. Journal of Accident & Emergency Medicine 13(6): 370-372, 1996. (17 refs)

This provides a succinct overview of the presentation and management of drug abuse emergencies as these occur in emergency services. There are separate sections that address opioids, benzodiazepines, cocaine, LSD, amphetamines, and ecstasy (amphetamine derivatives.) There is also attention directed to initial assessment, signs and symptoms suggestive of drug use, and the likely range of purity different drugs. The issues associated with body stuffing (swallowing drugs to avoid apprehension) and body packing (ingestion of drugs or insertion into body cavities as part of drug trafficking) are also noted. Copyright 1998, Project Cork

Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future: National Survey Results on Drug Use, 1975–2005. Volumes I and II. Bethesda MD: National Institute on Drug Abuse, 2006.

These are reports on an annual national survey of drug use among adolescents and adults. available online

Office of National Drug Control Policy. The Economic Costs of Drug Abuse in the United States, 1992–2002.Washington DC: Executive Office of the President, 2004. (62 refs.) (Publication No. 207303)

Roffman RA, Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. London: Cambridge University Press, 2006. (402 pp.)
Cannabis is the most widely used illicit drug in the U.S. In respect to public policy, there are a number of questions that have been raised, from review of its legal status, with some proposing legalization or de-criminalization of small quantities, to making provision for medical use for those with chronic illness. There has also been increasing research on cannabis, its relationship to the emergence of schizophrenia, to clarification of the existence and nature of withdrawal phenomenon with abstinence after long-term heavy use. This edited volume, with 15 chapters and 26 contributors, is intended as a comprehensive review of cannabis use, the associated problems, and related policy questions. It is organized into five parts. The first part deals with cannabis dependence: the pharmacological basis, epidemiology, diagnosis, and associated medical and psychological morbidity. Part II considers interventions with cannabis dependent adults. Five different approaches are reviewed: cognitive-behavioral and motivational enhancement therapies, contingency-management, the marijuana check-up, guided self-change (a brief motivational technique), and supportive-expressive psychotherapy. Part III addresses interventions with cannabis-dependent adolescents and young adults. One chapter reviews the findings and treatment models from the 'Cannabis Youth Treatment Study', another describes the teen cannabis check-up and strategies for reaching young marijuana users, and another deals with probation-referred cannabis-abusing young adults. Part IV is directed to the policy implications of cannabis dependence; and Part V deals with the implications for research and policy. Copyright 2006, Project Cork

Smith DE, Seymour RB. Clinicians Guide to Substance Abuse. New York: McGraw-Hill, 2001. (346 pp)

This volume is organized in 12 chapters. The initial three chapters consider the nature of addictive disease, the biological basis of addiction, and basic pharmacology of addictive substances. This is followed by chapters directed to the signs and symptoms of abuse and addiction, common associated medical complications, diagnosis and assessment, as well as consideration of the nature of treatment and the clinician's role. The final chapters address the issue that confront the family, as well as the special needs of women, children and adolescents in treatment. The final chapter addresses the process of recovery and specialized efforts to support recovery, including nutritional counseling. Copyright 2002, Project Cork

Substance Abuse and Mental Health Administration. Results from the 2005 National Survey on Drug Use & Health. National Findings. NSDUH Series H-30. Rockville MD: Substance Abuse and Mental Health Administration, 2006. (DHHS Publication No. SMA 06-4194.)

This is the first report based on the 2005 National Survey of Drug Use and Health, an annual survey conducted by the Substance Abuse and Mental Health Services Administration. It is the primary source of information on the use of alcohol, tobacco, and illicit drugs among the US population age 12 and older. The report is organized into nine chapters. Following an initial introduction setting forth the highlights of the report, the first chapter summarizes the nature of the survey, how the data is presented, and other sources of survey data and reports. Chapters 2 through 4 deal with illicit drug use, alcohol use, and tobacco use with data on use patterns by age, gender, racial and ethnic groups, geographic area, employment status, association with other substance use, and relation to driving. Chapter 5 provides data on the initiation of use of the major drug classes. Chapter 6 provides information related to prevention efforts: perceptions of risks associated with use, perceived availability, attitudes toward peers' substance use, parental attitudes toward use, exposures to prevention efforts, and parental involvement. Chapter 7 sets forth information on treatment, risk factors for abuse and dependence, treatment history, and the needs for specialty treatment. Chapter 8 addresses the prevalence of co-occurring psychiatric illness, with discussion of the prevalence of different mental disorders, treatment history in both the adult and adolescent (age 12-17) populations. The concluding chapter discusses trends in substance use among adolescents and young adults. The Report is accompanied by seven appendices, with information on methodology, statistical analysis, references, and selected prevalence tables. Data is presented in 146 figures and tables. Copyright 2006, Project Cork
Available online < www.drugabusestatistics.samhsa.gov/drugs.cfm>

Other Resources and Readings

Al-Hebshi NN, Skaug N. Khat (Catha edulis): An updated review (review). Addiction Biology 10(4): 299–307, 2005. (112 refs.)

The habit of chewing fresh leaves and twigs of khat (Catha edulis) for their stimulating amphetamine-like effects is highly prevalent in East Africa and southwest on the Arabic peninsula. There is an extensive literature on khat providing information about its history, botany, production, geographical distribution, chemistry and pharmacology, and exploring the social, economic, medical., psychological and oral aspects related to its use. Some of this literature dates as early as the 11th century; however, most of it appeared after the first scientific description of khat by Peter Forskal in 1775. This review provides a panorama of khat and the various aspects of its use. A non-technical description of the plant chemistry and pharmacology is included. The medical, psychological and oral aspects are emphasized, and the current knowledge about the microbiological effects of khat is also presented. Copyright 2005, Taylor and Francis Ltd.

Anglin D, Spears KL, Hutson HR. Flunitrazepam and its involvement in date or acquaintance rape. Academic Emergency Medicine 4(4): 323–326, 1997. (21 refs.)

An estimated 1 in 4 women in the United States will be raped in their lifetimes. Approximately 75% of all rapes are date or acquaintance rapes. Recently the illegal use of flunitrazepam (Rohypnol), a benzodiazepine, as a prelude to the assault has been reported. Flunitrazepam readily dissolves, and once in solution, is colorless, odorless, and tasteless. The predominant clinical manifestations are drowsiness, impaired motor skills, and anterograde amnesia. Due to the amnestic effects of flunitrazepam, historical clues of the rape event are difficult to obtain. Patients with a complaint of sexual assault who appear intoxicated or have anterograde amnesia should be suspected of unknowingly ingesting flunitrazepam. In addition to adhering to standard rape protocols, a urine specimen should be analyzed for flunitrazepam metabolites using gas chromatography/mass spectrometry. If the hospital, local, or forensic laboratory is unable to analyze for flunitrazepam, Hoffmann-La Roche Inc., the manufacturer of Rohypnol, should be contacted. Hoffmann-La Roche has a mechanism for definitive testing for flunitrazepam, at no cost, for health care providers, rape treatment centers, and law enforcement agencies. A network of organizations is attempting to reduce the abuse of flunitrazepam in association with date rape. Copyright 1997, Society for Academic Emergency Medicine

Anglin MD, Rawson RA, eds. The CSAT Methamphetamine Treatment Project. Journal of Psychoactive Drugs 32(2): 135–136, 2000.

Britt GC, McCance-Katz EF. A brief overview of the clinical pharmacology of “club drugs.” Substance Use & Misuse 40(9–10): 1189–1201, 2005. (56 refs.)
Four different "club drugs" are reviewed: MDMA (methylenedioxymethamphetamine, "Ecstasy"), GHB (gamma-hydroxybutyrate), ketamine, and Rohypnol (R) (flunitrazepam). The neurobiology, clinical pharmacology, and treatment issues for each are discussed. Copyright 2005, Marcel Dekker, Inc

Brouette T, Anton R. Clinical review of inhalants. American Journal on Addictions 10(1): 79-94, 2001. (66 refs.)

While the rate of inhalant abuse continues to rise in this country, it remains one of the the least studied or discussed groups of abused substances. This review focuses on the current knowledge of the epidemiology, pharmacology, and sequela of inhalant abuse. We will discuss three groups inhalants: volatile solvents, nitrous oxide, and nitrites. We will then conclude by proposing means by which inhalant abuse may be prevented and treated.

Budney AJ, Hughes JR.The cannabis withdrawal syndrome. Current Opinion in Psychiatry 19(3): 233–238, 2006. (51 refs.)

Purpose of review: The demand for treatment for cannabis dependence has grown dramatically. The majority of the people who enter the treatment have difficulty in achieving and maintaining abstinence from cannabis. Understanding the impact of cannabis withdrawal syndrome on quit attempts is of obvious importance. Cannabis, however, has long been considered a 'soft' drug, and many continue to question whether one can truly become dependent on cannabis. Skepticism is typically focused on whether cannabis use can result in 'physiological' dependence or withdrawal, and whether withdrawal is of clinical importance. Recent findings: The neurobiological basis for cannabis withdrawal has been established via discovery of an endogenous cannabinoid system, identification of cannabinoid receptors, and demonstrations of precipitated withdrawal with cannabinoid receptor antagonists. Laboratory studies have established the reliability, validity, and time course of a cannabis withdrawal syndrome and have begun to explore the effect of various medications on such withdrawal. Reports from clinical samples indicate that the syndrome is common among treatment seekers. Summary: A clinically important withdrawal syndrome associated with cannabis dependence has been established. Additional research must determine how cannabis withdrawal affects cessation attempts and the best way to treat its symptoms. Copyright 2006, Lippincott, Williams & Wilkin

Castellanos FX, Rapoport JL. Effects of caffeine on development and behavior in infancy and childhood: A review of the published literature. Food and Chemical Toxicology 40(9): 1235–1242, 2002. (35 refs.)

The Medline literature on the behavioral effects of caffeine in infants and children are reviewed. There has been little recent work in this area. Generally, caffeine is well tolerated in usual dietary amounts, and there is evidence that individuals differ in their susceptibility to caffeine-related adverse effects, which in turn may influence their consumption. Overall, the effects of caffeine in children seem to be modest and typically innocuous. Copyright 2002, Pergamon-Elsevier Science Lt

Caulkins JP, Pacula RL. Marijuana markets: Inferences from reports by the household population. Journal of Drug Issues 36(1): 173–200, 2006. (37 refs.)

Generally more is known about drug use and demand than about markets and supply, in large part because population survey data are available while market data are not. Although the household population represents a relatively small proportion of users of hard drugs, it represents a large proportion of the population using marijuana and participating in marijuana markets. This paper provides a description of marijuana market and acquisition patterns as reported by participants in the 2001 National Household Survey on Drug Abuse. We find that most respondents obtain marijuana indoors (87%), from a friend or relative (89%), and for free (58%). Retail marijuana distribution appears to be embedded in social networks rather than being dominated by "professional" sellers. Despite these contrasts with stereotypical street markets for cocaine and heroin, there are also similarities, such as evidence of quantity discounts and a minority of users accounting for the majority of purchases. We estimate that there are on the order of 400 million retail marijuana purchases in the U.S. each year and that the average purchase size is small, about six or seven joints. Copyright 2006, Journal of Drug Issues Inc

Centers for Disease Control and Prevention, Arant T, Henry C, Clifford W, Horton DK, Rossiter S. MMWR. Anhydrous ammonia thefts and releases associated with illicit methamphetamine production—16 states, January 2000–June 2004. Morbidity and Mortality Weekly Report 54(14): 359–361, 2005. (9 refs.)

Anhydrous ammonia, a colorless gas with a pungent, suffocating fumes, is used primarily as an agricultural fertilizer and industrial refrigerant. It is also a key ingredient for illicit methamphetamine (meth) production in makeshift laboratories. Exposure to anhydrous ammonia can be immediately dangerous to life or health. Anhydrous ammonia generally is not available for sale to the public; states require a license for purchase. Because of this, many illicit meth producers (i.e., "cookers") resort to stealing anhydrous ammonia. If released into the environment, anhydrous ammonia can cause acute injuries to emergency responders, the public, and the cookers themselves. In addition, when handled improperly, anhydrous ammonia can be explosive and deadly. As liquid anhydrous ammonia is released into ambient air, it expands substantially, forming large vapor clouds that behave as a dense gas. This dense gas can travel along the ground instead of immediately rising into the air and dispersing, thereby increasing the potential for exposure to humans. Symptoms of anhydrous ammonia exposure include eye, nose, and throat irritation; dyspnea; wheezing; chest pain; pulmonary edema; pink frothy sputum; skin burns; vesiculation; and frostbite. Exposure can be fatal at high concentrations. Farmers and merchants often are unaware of an anhydrous ammonia theft unless a large-scale release occurs . Nearly half of these HSEES events occurred during agricultural season. In addition, 38% occurred during early morning hours, and 19% occurred on Sundays, when commercial establishments usually are closed. Furthermore, the amount of anhydrous ammonia stolen in each event was small compared with the total volume of the tank. Several additives are being developed and used to help curb anhydrous ammonia thefts and releases, such as one that when mixed into the ammonia, would rendering it useless for meth production. This report describes examples of anhydrous ammonia thefts associated with illicit meth production, summarizes ammonia theft events reported to the Agency for Toxic Substances and Disease Registry (ATSDR), and suggests injury. The information in this report is based on events reported to Hazardous Substances Emergency Events Surveillance (HSEES) system to collect and analyze data about the public health consequences (i.e., morbidity, mortality from 16 state health departments† during January 1, 2000--June 30, 2004. The 85 persons injured (victims) had 110 reported injuries, most frequently respiratory irritation (68 [62%]) and eye irritation (19 [17%]). Of the 1,791 meth events, at least 164 (9%) were known to have been caused by anhydrous ammonia theft with the intention of meth production. These ammonia theft events were reported in 10 of the 16 HSEES states, with Iowa (64 [39%]) and Missouri (57 [35%]) reporting the most events. The most common locations of ammonia theft events were commercial (88 [52%]) and agricultural areas. Of the 164 ammonia theft events, 36 (22%) resulted in a total of 85 injured persons. Persons most frequently injured were members of the general public (38 [45%]) and police officers (27 [32%]).Most (48 [56%]) victims were treated at a hospital but not admitted, and 18 (21%) were treated on the scene. No deaths occurred. Public Domain

Cicero TJ, Inciardi JA, Munoz A. Trends in abuse of OxyContin® and other opioid analgesics in the United States: 2002–2004. Journal of Pain 6(10): 662–672, 2005. (38 refs.)

OxyContin (R) (Purdue Pharma L.P., Stamford, Conn) was approved by the Food and Drug Administration (FDA) in 1995 as a sustained-release preparation of oxycodone hydrochloride and was thought to have much lower abuse potential than immediate-release oxycodone because of its slow-release properties. However, beginning in 2000, widespread reports of OxyContin (R) abuse surfaced. In response, Purdue Pharma L.P. sponsored the development of a proactive abuse surveillance program, named the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS (R)) system. in this paper, we describe results obtained from one aspect of RADARS - the use of drug abuse experts (ie, key informants) - as a source of data on the prevalence and magnitude of abuse of prescription drugs. The results indicate that prescription drug abuse has become prevalent, with cases reported in 60% of the zip codes surveyed. The prevalence of abuse was rank ordered as follows: OxyContin >= hydrocodone > other oxycodone > methadone > morphine > hydromorphone > fentanyl > buprenorphine. In terms of the magnitude of abuse (>= 5 cases/100,000 persons in a 3-digit zip code), modest growth was seen with all analgesics over the 10 calendar quarters we monitored, but was most pronounced with OxyContin and hydrocodone. These results indicate that OxyContin abuse is a pervasive problem in this country, but that it needs to be considered in the context of a general pattern of increasing prescription drug abuse. Perspective: Over the past 5 years, there have been reports, frequently anecdotal, that opioid analgesic abuse has evolved into a national epidemic. In this study, we report systematic data to indicate that opioid analgesic abuse has in fact increased among street and recreational drug users, with OxyContin and hydrocodone products the most frequently abused steps need to be taken to reduce prescription drug abuse, but very great care needs to be exercised in the nature of these actions so the legitimate and appropriate use of these drugs in the treatment of pain is not compromised as a result. Copyright 2005, Churchill Livingstone

Coggans N, Dalgarno P, Johnson L, Shewan D. Long-term heavy cannabis use. Executive summary of research report submitted to the Department of Health (United Kingdom). Drugs: Education, Prevention, and Policy 12(supplement 1): 57–61, 2005.

The purpose of the study was to identify and assess patterns of use and problems associated with prolonged heavy use of cannabis, and to compare heavy long-term users with light long-term users. Among the findings was the absence of strong support for the gateway theory, i.e. that cannabis use predisposed people to use other 'harder' drugs. Heavier cannabis use was not the primary predictor of the development of cannabis dependence. There were no apparent interactions between impulsivity, self-esteem, stress, or social support and cannabis consumption. In respect to attitudes, there was no difference between heavier and lighter users in respect to personal rules for use. Other areas discussed was the relationship of marijuana use to driving, the relationship to sexual practices, the relationship to crime, the impact on employment and education, and implications for health. Copyright 2005, Taylor & Francis

Dasgupta N, Kramer ED, Zalman MA, Carino S, Smith MY, Haddox JD, et al. Association between non-medical and prescriptive usage of opioids. Drug and Alcohol Dependence 82(2): 135–142, 2006. (19 refs.)

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