At Home Drug Withdrawal

Sobriety Success

The dependence on sobriety is defined as the state of sobriety. When a person is sober, they can live on a daily basis without their thoughts and behaviors being controlled by substance dependence. They do not feel obliged to use it because they manage to live without it. They see and appreciate so much the benefits of living without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. The success product of sobriety is a step-by-step manual for everyone. The product has been said to be beneficial for many people around the world. The reason why the product is gaining so much popularity among individuals. They see and appreciate so much the benefits of life without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. This strategy encourages you to maintain the long-term vision of recovery. Recognize that this is not a one-off thing, something you try for a few weeks to several months, then return to your previous life. You will be in recovery if you decide it's the life you want to live for the rest of your life. As such, there is no immediate timeline to which you must adhere, nor should you strive to achieve goals that you are clearly not ready to face. More here...

Sobriety Success Summary


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Concommitant Cocaine And Ethanol Consumption

A survey conducted in 1991, found that 9 million people in the US abuse cocaine and ethanol simultaneously 55 , The combined use of cocaine and ethanol appears to be associated with increased morbidity and mortality over either drug alone. Their simultaneous use increased the risk of drug-induced sudden death 18fold 56 , Deaths due to drug overdose involving the use of ethanol were associated with cocaine blood concentrations that were lower than those measured in subjects dying of cocaine overdose alone (900 vs. 2,800 mg L, respectively) 57 , This is suggestive of an additive or synergistic effect of ethanol on cocaine-induced catastrophic events 57 , Several hypotheses have been proposed to account for this synergistic effect. Since the combined use of both drugs in human volunteers produces a greater increase in heart rate than either substance alone, the combination may do more than either of its individual constituents to substantially increase the determinants of myocardial...

Early discharge without accepting treatment by a young diabetic patient addicted to crack cocaine

A 28-year-old man with type 1 diabetes mellitus for 18 years attended the casualty department complaining of a painful foot. He was well known to the hospital and was addicted to crack cocaine. He had severe infection of the left hallux, and deep, infected ulcers over both 1st metatarsal heads (Fig. 5.27). He was admitted to the ward for intravenous antibiotics and possible surgical debridement but walked off the ward 2 h later before treatment was started and was lost to follow-up. Three weeks later he presented again at casualty and accepted admission. He explained that he was a crack cocaine addict and had self-discharged because he was fleeing from his dealer to whom he owed money. In the meantime he had accepted treatment from another hospital two hundred miles away where he received a short course of intravenous antibiotics. Again he self-discharged when his supply of drugs ran out. Back at home he did not seek further treatment until he developed wet necrosis of the hallux and...

Cocaine Cardiotoxicity

As cocaine abuse has become widespread, the number of cocaine related cardiovascular events, such as angina pectoris, myocardial ischemia and infarction, cardiac myopathy, left ventricular hypertrophy, and sudden death has increased substantially 1-15 , These occur in young subjects, a significant percentage of whom had no evidence of atherosclerotic coronary artery disease on subsequent angiography 10,11,18-21 . Twice as many men as women experience cocaine related cardiac ischemic events, at least partly caused by a greater frequency of cocaine use in men. The concomitant use of cigarettes and or ethanol is pervasive, with up to 75 of cocaine users admitting to each. Although myocardial ischemia, infarction, and sudden death are most likely to occur in chronic cocaine users, they have been reported in first time users as well. These events can occur from any route of administration and with a large or small amount of the drug 3,4,8,9,20-29 , It is thought that the pathophysiology of...

Mechanisms of cocaine cardiotoxicity

Cocaine abuse induces coronary vasospasm 1-5 , myocardial infarction 6-8 , hypertension 9,10 , stroke 7,H , and fatal cardiac rhythm disorders, including ventricular fibrillation 12-15 , Chronic cocaine abuse has also been shown to cause dilated cardiomyopathy 16,17 , and left ventricular hypertrophy in normotensive cocaine users 18-20 , It is only since modern electrocardiographic techniques have come into widespread use that the effect of cocaine on cardiac rhythm has been effectively studied. These techniques were the first to demonstrate that cocaine produced severe intractable ventricular arrhythmias that resulted in death during routine nasal surgery 21 , Cocaine functions as a strong cardiac stimulant that potentiates the actions of the sympathetic nervous system by inhibiting both peripheral and central neuronal catecholamine uptake 22-24 , The resulting changes in cardiac autonomic neural balance may significantly contribute to the formation of arrhythmias, since increased...


Cocaine poisoning leads to local accumulation of the neurotransmitters norepinephrine (noradrenaline), dopamine, epinephrine (adrenaline) and serotonin. Accumulation of norepinephrine and epinephrine leads to tachycardia which increases myocardial oxygen demand while reducing the time for diastolic coronary perfusion. Vasoconstriction causing hypertension results from the accumulation of neurotransmitter at peripheral fi-adrenergic receptors and peripheral 5-HT receptor stimulation causes coronary artery vasospasm. In addition, cocaine stimulates platelet aggregation. Together, these changes can produce what is effectively a coronary event in a child or adolescent. Acute coronary syndrome producing chest pain and varying types of cardiac rhythm disturbances is the most frequent complication of cocaine use which leads to hospitalisation. Cocaine is also a sodium channel inhibitor, similar to a type I anti-arrhythmic agent so can prolong the QRS duration and impair myocardial...

Cocaine abuse

Cocaine is an alkaloid present in the shrub, Erythroxylon coca. It has an onset of action of about 11 min and a half-life of 78 min, and produces CNS stimulation, euphoria and hallucinations.As a sympathetic stimulant, it acts by preventing the uptake of catecholamines into sympathetic nerve endings. In addition, it may release catecholamines from body stores.Whilst there is evidence that it has been used as a euphoriant in the Central Amazon from as early as the ninth century, the last 30 years has seen a notable increase in its use. It has been said to produce emotional, but not physical dependence. However, more recently, the use of chemically modified forms (paste, crack and freebase) for inhalation or smoking, has resulted in higher blood concentrations.These forms appear to be producing dependence. The consumption of cocaine for recreational purposes has been more prevalent in the USA than in the UK. The greatly increased production and illicit trade from South America is...

Assessing Alcohol and Substance Abuse in the Elderly

Unfortunately, there is no good way of assessing the dependence on prescription tranquilizers (principally benzodiazepines) in the elderly unless withdrawal symptoms, such as extreme anxiety and irritability, occur since dependence is not typically associated with dose increase. Such dependence is more frequent among elderly women than men. Signs of toxicity from long-term use are easily mistaken for other disorders of the elderly, such as memory loss and other cognitive impairments, as well as problems with mobility. It is likely that alcohol and drug abuse may reflect the levels of stress in elders' lives.

Behavioral Epidemiology

Major nongenetic contributors to mortality were examined in an important analysis in 1993 by McGin-nis and Foege. They identified several behaviors that account for large numbers of deaths. A summary of the estimates for actual causes of death in the United States is presented in Table II. Tobacco use is associated with more than 400,000 deaths each year, and diet and activity patterns account for an additional 300,000. These dwarf the number of deaths associated with problems that the public is generally concerned about, such as illicit drug use. The McGinnis and Foege analysis challenged society to think differently about health indicators in the United States. Only a small fraction of the trillion dollars the United States spends annually on health care is devoted to the control of the major factors that cause premature mortality in the United States. Estimates suggest that less than 5 of the total annual health care budget is vehicle accidents, and about 20,000 deaths can be...

The Rationale for Ambulatory Monitoring

Besides the cost and resource concerns, LTAM proved to be far more convenient for most patients. In some centers, including our own, inpatient monitoring became primarily utilized for patients whose seizures could only be recorded in the setting of anticonvulsant drug withdrawal. It was also used when simultaneous video recording was essential for diagnosis or surgical evaluation or in the setting where invasive electrodes needed to be used.

Individual Differences

Besides age, many factors can influence interindividual variability in drug responsivity, susceptibility to negative side effects, and potential drug abuse liability. These factors include biological (e.g, genetics, gender, ethnicity, disease state), environmental (e.g., stress, culture), and behavioral (e.g., diet, drug use, drug history) influences as well as the interactions of any two or more of these variables. The mechanisms by which these variables influence the actions of drugs can be molecular, biological, pharmacokinetic, pharmacodynamic, psychological, or social in nature. The identification of individual difference variables and their contribution to drug action are relevant to the clinical administration of medications as well as to our understanding of the mechanisms underlying drug addiction.

Fears Due to Inadequate Understanding

Unrealistic fears of the diagnosis and treatment are also a problem for many, and those who do not understand that ADHD is a complicated and significantly impairing problem are not likely to learn enough about the disorder to alleviate those fears. For example, many parents worry that if they provide stimulant treatment for their son or daughter with ADHD, the child might have an increased risk of drug addiction later in life. Ironically, by not seeking information about ADHD treatment, they are not likely to find out that a child who has ADHD, if untreated or inadequately treated, has double the risk of suffering, at some point in life, from substance abuse severe enough to warrant diagnosis. Indeed, five scientific studies involving almost a thousand children with ADHD have demonstrated that children whose ADHD is consistently treated with appropriate medications during childhood and adolescence have their elevated risk of substance abuse reduced, essentially to that of a child...

Ventral Tegmental Area Dopamine Neurons

Glutamate plays an important role in stimulating catecholamine release at the somatic level. Disturbances at the level of the dopamine cell body may occur at a very early stage of development, giving rise to subsequent impaired dopamine neuron function in terminal areas such as the nucleus accumbens. The development of ADHD symptoms could be analogous to the process of drug addiction. Children who have been exposed prenatally to drugs of abuse exhibit ADHD-like behavior (66). Exposure to drugs of abuse increases the extracellular dopamine concentration, which activates D1- and D2-like receptors in the ventral tegmental area of the midbrain, which in turn increases glutamate-driven activity in dopamine-containing neurons (67). The mechanism is suggested to involve increased AMPA receptor-mediated excitatory transmission in ventral tegmental area dopamine neurons (67,68). Increased activation by glutamate initially causes sensitization of ventral tegmental dopamine neurons with...

Problemsspecial considerations

Problems may be related to the maternal effects of drug use, including acute intoxication, chronic organ impairment and the risk of HIV infection and endocarditis for intravenous drug users the control of drug use and withdrawal during pregnancy and labour and the effects of drug abuse on the fetus and neonate. Because delivery

Studies Of Aids Patients

Early reports of heterosexual transmission to the female sexual partners of men with AIDS in the United States (CDC, 1983) were confirmed by reports of AIDS among black African males and females with no history of drug abuse or homosexual sex (Clumeck, Mascart-Lemone, De Maubeuge, et al., 1983 Clumeck, Sonnet, Taelman, et al., 1984) and by similar reports of heterosexual transmission to females and to males in the United States (Redfield, Markham, Salahuddin, et al., 1985). Likewise, immunodeficiency was reported among infants whose mothers were at high risk of AIDS or had already developed immune deficiency (CDC, 1982e Oleske, Minnefor, Cooper, et al., 1983 Rubinstein, Sicklick, Gupta, et al., 1983). However, the mere existence of an unusual cluster of cases is not proof of a sexually transmitted infectious agent. Auerbach, Darrow, Jaffe, and Curran (1984) compared AIDS cases who had had sex with other AIDS cases (linked AIDS case) to unlinked AIDS cases. Linked AIDS cases were more...

Druginduced Parkinsonism

Is important to wait 3 months after withdrawal of medication before diagnosing drug-induced parkinsonism. The withdrawal of the suspected drug is usually followed 4-8 weeks later by the disappearance of clinical symptoms. In some cases, the parkinsonian symptoms, however, persist and these cases are suspected to have preclinical PD, in which the initial symptoms were triggered by the exposure to the dopamine receptor-blocking drug (76). There are a variety of drugs including dopam-ine depletors, dopamine blockers, antihypertensives such as methyldopa and amiodarone, calcium channel blockers such as flunarizine and cinnarazine, and serotonine selective reuptake inhibitors such as fluoxetine, all of which can cause drug-induced parkinsonism. Drug-induced parkinsonism can be treated by withdrawal of the causative agent, but in some cases amantadine and levodopa have been useful (77). Drug-induced parkinsonism is associated with other involuntary movements including...

Current Status of Testing Drugs for Disease Modification

Phase 3 testing for drugs designed to alter rate of change in AD also differs from the designs used to test drugs with symptomatic effects. First, the trials are much longer, since a separation of slope between drug-treated and placebo subjects is needed. These trials are generally 12 to 18 months in length or longer. Secondly, clinical trial maneuvers are often utilized to demonstrate a disease-modifying effect (Mani 2004). Three clinical maneuvers most commonly utilized involve the use of the randomized withdrawal design, the randomized start design, or the presence of a persistent difference in slope over time. It is hypothesized that if a drug has a disease-modifying effect and it is withdrawn, the individuals treated with the drug throughout the trial will have gained an advantage over those on placebo that will be sustained and will not disappear upon drug withdrawal. Thus, a persistent drug placebo difference should persist even after withdrawal of the agent. Similarly, in a...

Substance Use Disorders

Substance use disorders, which are characterized by abuse of or dependence on alcohol, marijuana, heroin, cocaine, methamphetamine, or a variety of other drugs, significantly disrupt one's motivation to pursue education or work, interact with others, and maintain one's self and household. Often the long-term goals and more immediate intentions of these individuals are seriously interrupted as they crave, seek, use, and react to substances of abuse. Persons given this diagnosis often suffer from excessive arousal, being excessively hyped-up in certain phases of drug use while being excessively slowed down or somnolent in other phases of abuse or dependence. These disruptions of motivation and arousal appear to be closely connected to anticipated, immediate, and delayed effects of the abused substances on the brain.

Suxamethonium apnoea see also

Prolonged apnoea and neuromuscular blockade may occur following the administration of suxamethonium or mivacurium, either from the presence of a genetic variant of plasma cholinesterase, or as a result of low levels of the normal enzyme. Plasma cholinesterase levels decrease during pregnancy and do not return to normal until 6 weeks postpartum (Davis et al 1997). Since cocaine is metabolised by plasma cholinesterase, the individual with a deficiency is more susceptible to the toxic effects of cocaine.

The Coca botanical family Erythroxylaceae

Alkaloids also occur in many other plant families. It is relevant to mention the Coca plant family (Erythroxylaceae L.), distributed in the tropics and endemic to South America, especially in the regions of Peru and Bolivia, where the coca bush (Erythroxylum coca) has been known for at least 5000 years109. Typical characteristics of this family are elliptic, light green leaves (4-7 x 3-4 cm), small, white flowers and small, reddish-orange drupes318. Nowadays, it is distributed in the Andean region, the African tropics and in Southern Asia. There are many L-ornithine-derived alkaloids in this plant family, from which three species, the aforementioned E. coca and also Erythroxylum truxilense and Erythroxy-lum novagranatense, contain cocaine, ecgonine, cinnamylcocaine, a-truxilline, truxilline, methylecgonine, tropine, hygrine, hygroline and cuscohygrine. These strong alkaloids are commonly used as drugs in mainstream medicine and are also, at times, the object of pathological or...

Analgesia and anaesthesia

Both 'cardiac' (high-dose opioid) general anaesthesia and epidural anaesthesia have been used successfully for Caesarean section. The major concerns with general anaesthesia are uncontrolled hypertensive response to tracheal intubation, risks of potentially life-threatening arrhythmias (particularly in cocaine users) and need for postoperative ventilatory support because of the high doses of opioids used.

C LDopa and Other Tracers

PET can also be used with other radiolabels so that receptor binding sites can be imaged. For example, F18 can be attached to L-dopa, a drug that binds to dopamine receptors. This fluorinated L-dopa can then be used to make images of dopamine system function. Such images have been used to study Parkinson's Disease, a disease of dopamine deficiency, and schizophrenia, a brain disorder treated with dopamine acting drugs. This kind of neuroimaging research has potential for predicting drug response of individual patients. For example, Buchsbaum and colleagues reported that schizophrenics with low GMR in some dopamine-rich brain areas (i.e., the basal ganglia) may show a good clinical response to a dopamine acting drug whereas a similar patient without low basal ganglia GMR will not respond to the same drug. In other studies, fluorinated cocaine has been used to image drug abusers to help understand the mechanism of addiction and, possibly, vulnerability to addiction. Many other...

Management options

If abusers of cocaine require general anaesthesia, pretreatment with antihyper-tensive drugs should be considered, since severe hypertension and arrhythmias may follow tracheal intubation. Labetalol has been suggested as the drug of choice since pure b-blockade may precipitate severe hypertension via unopposed a stimulation. Glyceryl trinitrate has also been used. Benzodiazepines have been recommended to reduce sympathetic activity. Drugs causing sympathetic

How does MS affect sexual function

Fatigue is a major symptom in MS and contributes to sexual dysfunction, as it does in healthy men and women. Modification of lifestyle to conserve energy and the use of amantadine or other medications to increase energy are helpful. Amphetamine (speed), Ritalin, and cocaine are dangerous and should not be considered. Patients should be cautious of the plethora of products flooding the health food market because some of these agents could actually contain harmful ingredients.

Research Applications

Other tracers also may be used to measure presynaptic dopaminergic terminals and these can be divided into those that mark presynaptic dopamine transporter sites, vesicular transport sites, or also reflect decarboxylase activity like FD. Various cocaine-like analogs bind to dopamine transport sites and have been used with PET or single photon emission tomography (Hantraye et al. 1992) to demonstrate loss of uptake after MPTP administration in monkeys. Vesicular monoamine transport sites can be labeled with 11C dihydrotetrabenzine ( 11C DTBZ) and may be less prone to regulation than dopamine transport sites (Wilson et al. 1996) although no peer-reviewed reports have been published on MPTP-treated monkeys. Finally, 18F 6-fluoro-l-m-tyrosine (FMT) uptake, like FD, mainly reflects the decarboxylase activity of residual dopaminergic neurons. Its imaging characteristics may have some benefits compared to FD, but direct comparisons have not been made. Nevertheless, application of this tracer...

Treatment Of Adolescents

Minimal disruption is caused to the patient's schooling - for example, dosing three or four times daily or attending the GUM clinic for daily injections may not be feasible. It is important to elicit a full drug history from patients, particularly with regard to alcohol and illicit drug use. The need for parental consent and the patient's need for confidentiality combine to form a complex issue that is covered in another part of this book.

Reducing Behavioral Risk Factors

Epidemiologic studies have been successful in identifying and quantifying modifiable, behavioral risk factors (e.g., cigarette smoking, lack of physical activity, sexual practices, illicit drug use, lack of screening utilization) for many diseases. These risk factors can be considered voluntary since, for

Effects of Maternal Medication

Newborn Short Upturned Nose

During pregnancy, the average fetus is exposed to four physician-prescribed and five self-prescribed drugs. Every drug administered or taken by a pregnant woman presents the mother with both risks and benefits. The risks include the drug's potential as a teratogen or as a cause of toxicity in the fetus. Most human teratogens affect the embryo during a very narrow period of early development as illustrated by the time (24 to 33 days gestation) during which the fetus is susceptible to limb reduction defects caused by thalidomide. Several human teratogens, such as alcohol, androgens, cocaine, diphenylhydantoin, radiation, tetracycline, valproic acid, and warfarin have serious side effects beyond the period of organogenesis. These effects may include cell deletion, vascular disruption, necrosis, physiologic decompensation, organ pathology, and intrauterine growth retardation. Drugs taken in the third trimester may not have teratogenic effects, but may be toxic to the fetus. Some examples...

Surgical Treatment of Infected Aortic Aneurysms

Ruptured Mycotic Aneurysm

In 1885 Sir William Osler1 presented a comprehensive analysis of infected aneu-rysms and coined the term mycotic aneurysm specifically to refer to patients who presented with infected aneurysms secondary to endocarditis. Since then, however, the term has been used to refer to infected aneurysms regardless of pathogenesis. The fact that other sources of infection could also cause infection in the arterial wall was suggested by Stangel and Wolfed in 1923,2 describing 30 of 213 patients in whom there was no evidence of bacterial endocarditis and yet they demonstrated infected aneurysms. The potential for bacteremia leading to an infected aneurysm was proposed. In essence arterial wall infection can be caused by bacteremia of any source. It tends to affect more commonly segments of an artery with atherosclerosis or a congenital abnormality. Whether or not an aneurysm forms will depend on the clinical course and the institution of effective antibiotic therapy. When the infection is not...

Ornithinederived alkaloids

L-methionine to S-adenosylmethionine. In this process a positively charged sulphur is produced and facilitates the nucleophilic reaction. By the activity of diamine oxidase, the N-methyl-A1-pyrrolinium cation is formed and after that the first alkaloid, hygrine. From hygrine, by way of acetyl CoA, hydrolysis and intramolecular Mannich reactions, other pyrrolidine and tropane alkaloids are synthesized cuscohygrine, hyoscyamine or tropinone, tropine and cocaine. The Mannich reaction involves the combination of an amine, an aldehyde or a ketone with a nucleophilic carbon. This reaction is typical in alkaloid synthesis, and can be written as follows The synthesis of tropine from tropinione requires dehydrogenase NADPH+. Similarly, the synthesis of cocaine requires the Mannich reaction, SAM and NADPH+. Putrescine is a biogenic amine. Other biogenic amines also participate in alkaloid synthesis, for example cadaverine in the case of lysine alkaloids. Aniszewski et al.214 drew attention to...

Prodrugs With Other Benefits

Therapeutically beneficial effects of controlled substances have not been fully utilized because of the potential for drug abuse through intravenous and nasal administrations. Efforts to deal with these issues using prodrugs have recently been reported. Dextroamphetamine (66) was derivatized to a peptidic prodrug NPR-104 (67) that displayed excellent oral bioavailability of the parent in animals, combined

Triggers Of Dissection

Among predisposing factors and besides connective tissue disorders, untreated arterial hypertension is encountered in 80 of acute aortic syndromes. Hypertension may not just weaken the aortic media layer but accelerate sclerosis of the vasa vasorum or the nutrient intramural vessels. The triggering role of hypertension is supported by observational evidence that coarctation predisposes to acute aortic syndrome as do other scenarios, such as congenital bicuspid or unicommisural aortic valves or acquired aortic valve disease (especially late after aortic valve replacement surgery at the site of previous aor-totomy). Acute aortic syndromes have also been found associated with Turner and Noonan's syndrome and with giant cell arteriitis. Similarly, some association with the use of crack or cocaine has been postulated in young male individuals probably via episodes of highly elevated blood pressure. Conversely, in young females, especially with Marfan syndrome, the elevated risk for...

Cannabis Consumption At Age 18 And Later Risk Of Schizophrenia

Cannabis Schizophrenia Age Risk

The relationship between substance misuse and schizophrenia is complex. Many drugs of abuse, such as ketamine, amphetamine, cocaine, and LSD, are psychotomimetic and can induce an acute schizophrenia-like psychosis. Psychoactive substance misuse both precedes and follows the onset of psychotic symptoms. Some patients state that they receive transient symptom relief and are using the drugs as a form of 'self-medication'. However, it is also clear that abuse of certain drugs can increase the risk of schizophrenia. Evidence concerning cannabis comes from the Swedish army study19 in which army recruits were interviewed about their drug consumption and then followed-up for a decade and a half. Those who admitted taking cannabis on more than 50 occasions had a risk of later schizophrenia some six times that of non-abusers (Figure 2.12).

The Relaxation Response And Behavior Change

Ably, the cause of this stress disinhibition effect'' is a depletion in the cognitive and emotional resources required to maintain self-regulation. Increased stress and anxiety lead to immediately gratifying, but ultimately damaging behaviors, such as dietary indiscretions, alcohol or drug abuse, and an increase in smoking. Relaxation training has proved to be effective as an acute coping strategy to reduce anxiety. See Coping with Stress.

Localization Studies For Pheochromocytoma

False-negative scans occur in about 15 of both benign and malignant pheochromocytomas. False-negative scans are more common in patients who, within 6 weeks, have taken tricyclic class drugs, for example, antidepressants or cylcobenzaprine (Flex-eril). Other drugs can cause false-negative scans if taken within 2 weeks amphetamines, cocaine, phenylpropanolamine hydrochloride, haloperidol, phenothiazines, thiothixene, reserpine, nasal decon-gestants, and diet pills. Labetalol causes some decreased uptake, but the scan can still be done with reasonable sensitivity (Table 9-3). Inhibitors of type I catecholamine uptake cocaine, tricyclic

The Editors

Watson attended the University of Idaho but graduated from Brigham Young University in Provo, Utah with a degree in chemistry in 1966. He completed his Ph.D. degree inl971 in biochemistry at Michigan State University. His postdoctoral schooling in nutrition and microbiology was completed at the Harvard School of Public Health and included a 2-year postdoctoral research experience in immunology. He was an assistant professor of immunology and did research at the University ofMississippi Medical Center in Jackson from 1973 to 1974. He was an assistant professor of microbiology and immunology at the Indiana University Medical School from 1974 to 1978 and an associate professor at Purdue University in the Department ofFood and Nutrition from 1978 to 1982. In 1982, Dr. Watsonjoined the faculty at the University of Arizona in the Department ofFamily and Community Medicine. He is also a research professor in the University of Arizona's newly formed College ofPublic Health. He is a member...

Amphetamine abuse

The need for sleep.They act both directly and indirectly on the sympathetic nervous system, via the peripheral nerve endings. Catecholamines are released within the CNS, and catecholamine re-uptake by adrenoceptor nerve endings is prevented.Tolerance readily occurs.A number of synthetic amines, which share structural similarities to methamphetamine, are used for their ability to produce euphoria and sociability. These include methylenedioxy-methamphetamine (MDMA, 'Ecstasy', 'E', 'XTC','Adam') and 3,4-methylenedioxy-ethamphetamine (MDEA,'Eve'),'Ice' or 'Blue ice' (crystalline methamphetamine).The use of these has been associated with deaths (Dowling et al 1987), and with a syndrome of convulsions, hyperthermia, hyperkalaemia and rhabdomyolysis, resembling MH, but unrelated to it (Brown & Osterloh 1987, Singarajah & Lavies 1992,Tehan et al 1993).There is evidence that serotoninergic mechanisms cause an increased heat production that is exacerbated by high ambient temperatures this...

Da Receptors

DA D2Rs represent the major target of antipsychotic drugs and are involved in various neu-ropathological conditions, including PD, Tourette's syndrome, and drug addiction (87,102,103). D4R KO mice (81,126) show reduced behavioral responses to novelty (126). This is consistent with the hypothesis that a lack of D4R function may lead to decreased novelty-seeking in humans (121,122). D4 KO mice show also increased locomotor response to ethanol, cocaine, and methamphetamine (128). These mice also have increased DA synthesis and its conversion to DOPAC in the CPu (128). An association between polymorphisms of the D4R gene and personality profile of the novelty-seeking trait (121,122) is in agreement with D4R role in modulating behavioral responses to novelty. Moreover, behavioral disorders, such as drug abuse (133,134), pathological gambling (135), and ADHD (136,137), have recently been correlated to the same D4R alleles that are associated with novelty-seeking.

Realistic Overview

Must be viewed in context and compared with our similarly poor success in treating other chronic conditions and addictions (ie, cigarette smoking and drug abuse). In fact, if one views the chronic pleasurable overconsumption of food energy as a kind of addiction, an instructive distinction between food and other reinforcing substances appears. The cigarette smoker need never smoke again the obese person, however, must learn to coexist with the offending substances in order to live. In this light, the treatment of obesity should be likened not to the cure of an infectious disease but to the control of a chronic condition. As such, we cannot expect many complete cures and will need to be constantly on the alert for relapses in those who appear to be in remission.

Figure 723

Largely black intravenous (IV) drug abusers, a group of patients in whom heroin nephropathy was prevalent. Thus, concern existed that this entity merely represented the older heroin nephropathy now seen in HIV-infected IV drug abusers. However, in a Miami-based population of adult non-IV drug users with glomerular disease and HIV infection, 55 of Caribbean and American blacks had severe glomerulosclerosis, 9 had mild focal glomerulosclerosis, and 27 had diffuse mesangial hyperplasia. In contrast, two of 12 (17 ) whites had a mild form of focal glomerulosclerosis, 75 had diffuse mesangial hyperplasia, and none had severe glomeru-losclerosis. These morphologic differences were reflected in more severe clinical presentations, with blacks more likely to manifest proteinuria in the nephrotic range (> 3.5 g 24 h) and renal insufficiency (serum creatinine concentration (> 3 mg dL). Whites often had proteinuria under 2 g 24 h and serum creatinine values less than 2 mg dL 162 . In blacks,...

Figure 1048

Sequence homology of more than 95 with the hepatitis GV sequence. The virus has been shown to be transmitted by transfusions, including plasma products, by frequent parenteral exposure, including intravenous (IV) drug abuse, by sexual exposure, and by mother to child transmission. In the United States, the prevalence of hepatitis G virus is 1.7 among healthy volunteer blood donors, 8.3 among cadaveric organ donors, and 33 among IV drug abusers. Among chronic hemodialysis patients, the prevalence of hepatitis G virus RNA has been variable, ranging from 3.1 in Japan to 55 in Indonesia and some areas in France. Likewise, the reported incidence of co-infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is extremely variable.

Emotions and health

Emotion always serves the function of giving information. It can be extreme, unusual, debilitating, painful, and so on, but information is always being provided. Emotional reactions are always simply emotional reactions they can never be abnormal. However, traditionally, emotions have been seen as contributing to the neuroses, the psychoses, to the affective disorders (such as bipolar disorder), to psychopathy and to excessive (or minimal) eating, alcoholism and drug abuse. But even in psychiatric conditions, emotions are perfectly normal with respect to what brings them about. They are just what they are, with no values attached to them. However, it is reasonable to say that emotions can be dysfunctional or dysregulational.


Drug dependence is the physical and psychological dependence on drugs such as opiates, cocaine, lysergide (LSD), benzodiazepines and amphetamines. Any sudden cessation in the consumption of these drugs can lead to physical symptoms of withdrawal. The management of overdose of drugs has already been dealt with earlier in this chapter. Patients may present to MAU with the primary problem of drug withdrawal. This is not usually a medical emergency and requires referral to a specialist in addiction for management. However, some patients attending MAU may, as a result of admission with another medical problem, exhibit symptoms and signs of withdrawal from drugs as a secondary problem. It is therefore important that practitioners are able to recognise and manage this medical problem. Cocaine The DVLA states that anyone with an addiction to heroin, cocaine or benzodi-azepines cannot drive a car until they have been free from the use of these drugs for one year, after which their licence may...

Drugs and Toxins

Totoxins (eg, acetaminophen, Amanita phalloides mushroom poisoning), and those that are idiosyncratic (eg, iso-niazid INH , phenytoin, halothane, troglitazone, some nonsteroidal anti-iflammatory drugs, etc). The idiosyncratic group includes a far larger number of agents and, indeed, almost any drug can potentially be hepatotoxic in any given individual depending on largely undefined genetic and environmental factors. In general, women appear to be more susceptible to drug hepatotoxicity. Drug-induced liver injury appears to be increasingly common, as more drugs are marketed. Currently over 800 drugs have been associated with liver injury, and drug-induced liver injury is the major cause of drug withdrawal from the market, with troglitazone and bromfenac as two recent examples. Non-acetaminophen drug toxicity, which is idiosyncratic In addition to the heat stable toxins of Amanita and other mushrooms, other environmental agents such as the Bacillus cereus emetic toxin, which inhibits...

Causers of locoism

Crude opium has been used in the past as a sleep-inducer and in folk medicine for many purposes and smoked for the feeling of pleasure. The last use has lead to drug dependence and unpleasant withdrawal symptoms. Cocaine Cocaine Narcotics are reportedly among the most widely abused substances in the world, particularly the CNS stimulants cocaine and methamphetamine511. These narcotics are a very serious problem because they may lead to strong drug dependence. Possible treatments for this dependence are relatively difficult. Common ones are based on the so-called dopamine hypothesis, according to which stimulants have the ability to increase extracellular dopamine, which has an additional narcotic effect511'512'513'514. Cocaine has similar affinity for the dopamine transporter (DAT), norepinephrine transporter (NET) and serotonin transporter (SERT)515. Narcotic dependence can be treated with the use of the synthetic compounds, chemically similar to narcotic. Dependence, therefore, is a...

Presenting problems

The cardiovascular effects of cocaine are biphasic.An initial increase in blood pressure and a tachycardia, secondary to sympathetic stimulation, precedes the pronounced depression of the CNS. Sweating, vomiting and restlessness may occur. Sympathetic vasoconstriction can be intense, with increased metabolism, hyperthermia, hypoxia, and convulsions. Ventricular fibrillation or asystole has occurred with doses as low as 30mg.Tachycardia and hypertension occurred during anaesthesia, when a patient injected two speedballs into his infusion just before surgery (Samuels et al 1991). 2. ECG abnormalities may be misinterpreted. Tachycardia, chest pain and large inferior Q waves on ECG in a young cocaine user led to the incorrect diagnosis of myocardial infarction (Lustik et al 1999). In the event she had WPW syndrome and successful ablation of the accessory pathway was accompanied by return to normal of the short PR interval and disappearance of the Q wave. 5. Anaesthetics may interact with...


Although less commonly abused than the above drugs, amphetamines acutely cause similar effects to cocaine, including hypertension, arrhythmias, agitation, fever and confusion. Fetal effects include growth retardation, premature labour and abruption. Acute ingestion may increase the requirement for anaesthetic drugs, whereas chronic abuse may result in central depression and depletion of catecholamine stores. Both regional and general anaesthesia may be accompanied by severe hypotension in chronically abusing patients.

Tropane alkaloids

Tropane alkaloids have a tropane (C4N skeleton +) nucleus. Structurally, these alkaloids synthesize as postcursors of pyrrolines (Figure 57). a, 0, y and x in the tropane pathway are the same as in pyrrolines. Typical tropane alkaloids (e.g., atropine, hyoscyamine, cocaine, tropinone, tropine, littorine and cuscohy-grine) have a strong biological activity, especially as neurotransmitters.

Wound Botulism

Wound botulism has been associated with major soil contamination through compound fractures, severe trauma, lacerations, puncture wound, and hematoma. Of the pediatric cases in the U.S.A. more than half have been associated with compound fracture (10,21,28). Wound botulism was rare in the U.S.A. until the early 1990s. Since that time the incidence increased mostly in the western U.S.A. among deep tissue injectors (skin popping) of black tar heroin (29-32). Minor skin abscesses and paranasal sinusitis (in a heavy user of intranasal cocaine) were the speculated or proved sources of infection and toxin production. Spores may be a contaminant of the drug or from skin (in infection-related cases). The disease has occurred primarily in young males between March and November, the period of maximum outdoor activity. Most cases have been associated with type A toxin-producing organism, although some cases have been associated with type B.

Drug Challenges

Both monoamine and GABA systems play a role in the developmental neuro-toxicity of MeHg as reflected in behaving animals 18, 80, 142 . Fully adult rats exposed during gestation to MeHg showed enhanced sensitivity to amphetamine (a dopamine and noradrenergic agonist) and diminished sensitivity to pentobarbital (a GABA agonist) 142 . They did not display sensitivity to a cholinergic or glutamate antagonist, nor did they show altered sensitivity to a dopamine receptor blocker. These effects have been replicated and extended in unpublished studies in which sensitivity to cocaine has been identified but not to arecoline (a muscarinic cholin-ergic agonist) or clomipramine (a serotonergic agonist). Taken together these data indicate that there are long-term, irreversible alterations in some aspect of dopaminergic, GABAergic, and perhaps noradrenergic neurotrans-mitter systems, but not cholinergic, serotonergic, or, perhaps, glutamatergic systems. The absence of an effect of haloperidol (a...


The term addiction is used in two ways. More formally, it tends to be restricted to dependence on drugs, including psychoactive drugs such as heroin or cocaine, and also drugs such as alcohol and nicotine. These are drugs on which the body becomes dependent, in which a clear physiological mechanism is involved. However, at a psychological level, it is also possible to become addicted to almost anything. Certainly, the craving that some people have to gamble or to amass money, that others have to exercise, that some have to follow their sexual predilections and that others have to collect stamps look very much like addicted behaviour.

Brain Da Systems

Other psychostimulants, such as amphetamine and cocaine, when injected into the nucleus accumbens, are rewarding as they induce self-administration and place preference behavior by interaction with presynaptic ML DA terminals (23-26). In addition, opiates are also self-rewarding into the VTA by acting on and A receptors, probably through disinhibition of GABAergic interneurons (27-31).

Vital Statistics

Medical examiners and coroners are excellent sources of data on sudden or unexpected deaths. Data are available at the state or county level and include detailed information about the cause and the nature of death that is unavailable on the death certificate. These data are especially valuable for surveillance of intentional and unintentional injuries, as well as for sudden deaths of unknown cause. Data from the national system have been used to investigate the magnitude of the problem of use of methamphetamine, the most widely illegally manufactured, distributed, and abused type of stimulant drug (Green-blatt et al. 1995).


The medieval prototype of the ''sleep apple'' that appears in the story of Snow White usually contained opium, mandrake, henbane, hemlock, wine, and musk. Usually, the user was expected to inhale the fumes of the apple rather than eating it. The ''soporific sponges'' recommended by medieval surgeons contained similar mixtures. By the sixteenth century, surgeons were describing old favorites like mandrake as poisonous drugs that lulled the senses and made men cowards. In Shakespeare's Antony and Cleopatra, Cleopatra safely used mandrake to sleep away the hours before Antony's return. Shakespeare alludes to various soporific agents, such as poppy, mandragora, and ''drowsy syrups,'' but these agents were unreliable at best. In the real world, surgeons found that drugged patients who slept like the dead during surgery often failed to awaken afterwards. Opium retained its favored status long after mandrake was discarded. Eminent physicians like Thomas Sydenham (1624-1689) and John Hunter...

Local Anesthetic

Amethocaine 1 drops are instilled into the conjunctival fornices. Both lids are infiltrated with lignocaine 1 with 1 200,000 adrenaline. A short length of 1 cm nasal packing soaked in 10 ml of Moffatts solution, consisting of 2 ml of 6 cocaine, 1 ml of 1 1000 adrenaline, 1 ml 8.4 sodium bicarbonate, and 6 ml normal saline (in a 70-kg adult), is placed into the nasal cavity and removed after 5 min, or alternatively cophenylcaine lignocaine hydrochloride 5 w v (50 mg) and phenylephrine hydrochloride 0.5 (5 mg) is used .

Lisfranc amputation

A 50-year-old man with a history of IV drug abuse and type 2 diabetes underwent amputation of his right 2nd toe and was referred to us for surgical management of his infected right foot. Examination revealed several draining ulcers and sinus tracts, extending from the site of his amputated 2nd toe, to beneath the 2nd and 3rd metatarsal heads and into the central plantar space (Fig. 8.33a). Radiographs revealed osteolytic changes in the 2nd and 3rd metatarsals consistent with osteomyelitis. The patient was given the options of a partial foot amputation or below-knee amputation, and he chose to preserve his leg. He was taken to the operating theatre where under spinal anaesthesia and ankle tourniquet, he underwent a Lisfranc amputation of his right foot (Fig. 8.33b). The technical difficulty in this case was related to the poor condition of the plantar skin. We were unable to fashion a healthy long plantar flap. Closure was accomplished by creating a slightly longer dorsal flap. The...

Poisonous Pleasures

1 Drug abuse 1 Prostitution 1 Alcohol to excess 1 Hanging out with bad company 1 Sleeping to excess 1 Watching television endlessly 1 Overeating 1 Sexual promiscuity 1 Excessive caffeine consumption 1 Compulsive exercise 1 Shopping beyond your budget 1 Reckless driving 1 Gambling

True alkaloids

True alkaloids derive from amino acid and they share a heterocyclic ring with nitrogen. These alkaloids are highly reactive substances with biological activity even in low doses. All true alkaloids have a bitter taste and appear as a white solid, with the exception of nicotine which has a brown liquid. True alkaloids form water-soluble salts. Moreover, most of them are well-defined crystalline substances which unite with acids to form salts. True alkaloids may occur in plants (1) in the free state, (2) as salts and (3) as N-oxides. These alkaloids occur in a limited number of species and families, and are those compounds in which decarboxylated amino acids are condensed with a non-nitrogenous structural moiety. The primary precursors of true alkaloids are such amino acids as L-ornithine, L-lysine, L-phenylalanine L-tyrosine, L-tryptophan and L-histidine23 32. Examples of true alkaloids include such biologically active alkaloids as cocaine, quinine, dopamine, morphine and usambarensine...


Second, definitions of what constitutes dual diagnosis are far from uniform. Studies of dual diagnosis often employ differing definitions of substance use disorders, making prevalence rates diverse and difficult to compare. For example, definitions of substance abuse vary, ranging from problem use of a substance, to abuse or dependence based on DSM criteria. This is a particularly important issue in terms of diagnostic criteria for both mental and substance use disorders. The publication of DSM-IV (American Psychiatric Association, 1994) and the changes in that system from its predecessor may affect dual diagnosis prevalence rates in both community and clinical samples. These changes include a greater focus on determining that a mental disorder is independent from a substance use disorder by determining that the mental disorder either predated the substance use disorder or persists for at least four weeks following cessation of alcohol or drug use. Others do not specify the exact...


Brain neuroplasticity and sensitizing doses of amphetamine or cocaine (Kolb et al. 2003). Thus, the force-plate actometer should facilitate research involving animal motor behavior in a variety of research contexts. Kolb, B., G. Gorny, Y. Li, A.-N. Samaha, T. Robinson. 2003. Amphetamine or cocaine limits the ability of later experience to promote structural plasticity in the neocortex and nucleus accumbens. Proceedings of the National Academy of Sciences. 100 10523-10528.

Rudra RaiMD

There are approximately 30,000 new cases of acute HCV infection diagnosed each year in the United States. However, the incidence of new infections has declined dramatically over the past decade with improved safety of the blood supply and recognition of potential risk factors. The predominant mode of transmission of HCV has shifted from posttransfusion-associated hepatitis to injection drug use. Other modes of transmission include nosocomial (eg, in hemodialysis units), intranasal cocaine use, tattoos, body piercing, sexual transmission, and perinatal exposure.

Figure 820

However, not all patients with hypertensive encephalopathy have hypertensive neuroretinopathy, indicating the presence of malignant hypertension. In fact, hypertensive encephalopathy most commonly occurs in previously normotensive persons who experience a sudden onset or worsening of hypertension. In acute postinfectious glomerulonephritis, the abrupt onset of even moderate hypertension may cause breakthrough of autoregulation of cerebral blood flow, resulting in hypertensive encephalopathy. Eclampsia can be viewed as a variant of hypertensive encephalopathy that complicates preeclampsia. Moreover, hypertensive encephalopathy is a common complication of cate-cholamine-induced hypertensive crises such as pheochromocytoma, monoamine oxidase inhibitor-tyramine interactions, clonidine withdrawal, phencyclidine (PCP) poisoning, and phenylpropanolamine overdose. Cocaine use also can induce a sudden increase in blood pressure accompanied by hypertensive encephalopathy. In...


Stages Apoptosis

Apoptosis is a genetically programmed cell-demise process that facilitates the elimination of damaged or unwanted cells in various circumstances, including organ and tissue development during embryogenesis, immune system development and function, normal tissue homeostasis, and tissue healing 35, 36 . Under normal conditions, humans lose millions of cells every day via apoptosis, a process that is balanced by the generation of new cells. Apoptosis can be induced by a large number of internal or external stimuli, including UV irradiation 37 , oxidative stress 38 , hypoxia 39 , cytokines such as tumor necrosis factor (TNF) and Fas ligand (FasL) 40 , DNA-damaging drugs 41 , drugs of abuse such as cocaine and heroin 42, 43 , complement attack 44 , nitric oxide 45 , inhibitors of survival proteins 46 , and natural substances such as lycopene and resveratrol 47, 48 .


The rat model continues to be one of the primary models of choice for the study of the cardiovascular effects of cocaine. Recently, the rat model has been utilized to study the acute and chronic effects of cocaine self-administration behavior on cardiovascular function 81 . When rats were self-administered injections of cocaine 0.5 mg kg there was a significant increase in blood pressure. Tolerance developed to this effect within 3 daily sessions. During saline-substitution sessions, a significant (p < 0.05) decrease in blood pressure and heart rate was observed. When the injected doses of cocaine were increased (1.0, 2.0, and 4.0 mg kg per injection)a dramatic increase in blood pressure or heart rate was not produced despite a substantial cumulative cocaine intake(20-27 mg kg). It has thus been hypothesized that operant-conditioned behavior and or the direct reinforcing effects of cocaine modulate the cardiovascular effects of cocaine. The results of thejust described study are in...


Alcohol, the most consumed drug in the world, is often not recognized as a drug or addictive by the public and the media, because of its legal use and acceptance. The public, on the other hand, recognizes cocaine as an addictive drug with traumatic effects on its users. Some users of cocaine begin to mix cocaine with alcohol as together they extend the euphoric sensation. Cocaine plus concomitant ethanol use results in cocaethylene, a compound synthesized in vivo and only identified in 1979 2 , It also has been named in the literature as ethylcocaine, ethylbenzoylecgonine, and benzoylecgonine ethyl ester 2 , Therefore, we will review effects of combined alcohol plus cocaine use as well as cocaethylene in use by 4.5 of 18-25 year olds in the USA in 1988 model studies. In 1990, an NIAAA Survey reported that 5.3 million Americans had used cocaine concurrently (during the same period of time) with alcohol, and 4.6 million simultaneously (on the same occasion) with alcohol 10 , It is...

Toxic myopathies

There is appearance of neuromuscular symptoms after exposure to a specific medication or toxin. There may be an acute episode, with rhabdomyolysis or the disorder may develop over months. The clinical presentations include a focal myopathy, acute painful or painless weakness, chronic painful or painless weakness, myalgia alone, or CK elevation alone. In severe cases, toxic myopathy may be associated with myoglobinuria, inflammation of the muscle, muscle tenderness and myalgia. In cases of mitochondrial or vacuolar damage, the myalgia is usually painless. Steroids cause type 2 fiber atrophy that is painless (Fig. 28). Necrotic myopathies may be due to acute alcohol exposure, amiodarone, chloroquine, cocaine, emetine, clofibrate, heroin, combined neuromuscular blocking agents and steroids, perhexilline, and statins (HMG CoA reductase inhibitors). Other causes of muscle injury in necrotic myopathies include crush injuries occurring in comatose or motionless patients who are taking drugs...

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