Showing papers in "Journal of Psychoactive Drugs in 1991"
TL;DR: This article reports on the comparison of self-reported cocaine use with urinalysis outcomes and radioimmunoassay of hair samples for cocaine, and affirms a relatively high degree of underreporting of cocaine use.
Abstract: This article reports on the comparison of self-reported cocaine use with urinalysis outcomes and radioimmunoassay of hair samples for cocaine. The data is based on a voluntary sample of approximately 300 arrestees, tested and interviewed anonymously. The study reports high rates of request compliance for both urine and hair samples, and affirms a relatively high degree of underreporting of cocaine use. Radioimmunoassay of hair appears to detect considerably larger degrees of cocaine use than are detected by urinalysis. The differential rates of detection between hair and urine are less dramatic in subjects who appear to be high rate users.
134 citations
TL;DR: It is evident from the findings of numerous studies that when the physical, psychological, and socioeconomic issues of pregnant opioid-dependent women and their children are coupled with MMT, the potential physical and behavioral effects of psychoactive drugs on the mother, the fetus, the newborn, and the child may be markedly reduced.
Abstract: Opioid dependence has been studied with regard to its effects on the woman, the fetus, and the child for the past three decades, and it continues to be a serious problem that must be recognized and addressed by the health care delivery system in order to provide optimal medical care. The use of pharmacotherapy, such as methadone maintenance treatment (MMT), is only one of a variety of treatment modalities to provide optimal services for opioid-dependent women. The complete schema for treating opioid dependence in the perinatal period is complex and intense, but MMT serves multiple purposes. Primarily, it removes the addicted woman from the drug-seeking environment, eliminates the necessary illicit behavior, and prevents the peaks and valleys in the maternal heroin level that may occur throughout the day. In addition, maternal nutrition is usually improved and MMT patients become amenable to prenatal care and psychosocial rehabilitation. It is evident from the findings of numerous studies that when the physical, psychological, and socioeconomic issues of pregnant opioid-dependent women and their children are coupled with MMT, the potential physical and behavioral effects of psychoactive drugs on the mother, the fetus, the newborn, and the child may be markedly reduced.
127 citations
116 citations
TL;DR: Evaluated ethnographic data on crack use in Dayton, Ohio, a small midwestern city of less than 200,000 people, sketches the basic outlines of crack use among African-Americans and examines high-risk behaviors for the transmission of HIV and other sexually transmitted diseases.
Abstract: The use of crack cocaine and its associations with high-risk sexual behavior in view of the AIDS epidemic is reported commonly for major East and West Coast urban centers. This article describes and analyzes ethnographic data on crack use in Dayton, Ohio, a small midwestern city of less than 200,000 people. The results of 15 tape-recorded interviews are employed to sketch the basic outlines of crack use among African-Americans. A major focus is placed on analyzing the characteristics of the exchange of crack for sexual favors. High-risk behaviors for the transmission of HIV and other sexually transmitted diseases are explored.
107 citations
TL;DR: It is indicated that the development of smoking-cessation programs for methadone clients merits further study and that such programs should stress relapse prevention techniques tailored to the specific needs of this population.
Abstract: Substance abusers in treatment have cigarette-smoking rates about three times that found in the general adult population, yet there is a paucity of published studies exarnining smoking-cessation programs for these clients. Accordingly, a behaviorally based smoking-cessation program for methadone maintenance clients was developed. and the efficacy of a methadone dose increase as a pharmacological adjunct was tested in a doubleblind placebo-controlled study. While no significant difference between experimental and control subjects in reported abstinence rates was found, subjects receiving a methadone increase reported significantly more nicotine craving and other withdrawal symptoms during the first week of abstinence than did controls. Measures of smoking rates indicated that experimental subjects smoked significantly more than controls throughout the 10-week study period. Although the initial smoking abstinence rate of 65% was encouraging, most subjects returned to smoking by the end of the study...
77 citations
TL;DR: The results of an ongoing ethnographic study into the drug-taking rituals of heroin addicts are presented, namely the ritual sharing of drugs through a practice termed "frontloading," which is embedded in a broader pattern of the sharing of resources among addicts.
Abstract: Injecting drug users may now be the largest group at risk for contracting HIV, mainly through the sharing of drug injection equipment (including lending, borrowing, and renting). This article presents the results of an ongoing ethnographic study into the drug-taking rituals of heroin addicts. A possible additional route of HIV contamination is presented, namely the ritual sharing of drugs through a practice termed “frontloading,” which is embedded in a broader pattern of the sharing of resources among addicts. It is hypothesized that in the Netherlands this practice may be responsible for a substantial proportion of HIV spread among injecting drug users.
61 citations
TL;DR: A stronger basis is developing for regarding methadone maintenance as a means of replacing a neurohormonal deficiency, and three practical conclusions can be drawn.
Abstract: The neurobiology of drug addiction is being clarified. Research is revealing the anatomic pathways of primary drug reinforcement (reward) in the brain and the molecular architecture of the receptors on which addictive drugs act. All addictive drugs mimic (or occasionally block) the actions of some neurotransmitter; in the case of heroin or methadone an endogenous opioid, probably beta-endorphin. The groundwork is being laid for understanding Dole and Nyswander's "metabolic disease" concept as a concrete neurochemical abnormality of the endogenous opioid system. Thus, a stronger basis is developing for regarding methadone maintenance as a means of replacing a neurohormonal deficiency. Three practical conclusions that can be drawn from this model are: (1) methadone dosage must be adequate (never less than 50-80 mg); (2) it should be more widely accepted that some patients may require lifelong methadone maintenance; and (3) longer-acting, better stabilizing methadone congeners, such as LAAM and its metabolites, should be brought into general use.
60 citations
TL;DR: Interviews were conducted with a sample of jailed intravenous opioid users who were not in treatment at the time of their arrest and who were admitted to an in-jail methadone maintenance program, and subjects who stated that they were not afraid of methamphetamine, frequently injected drugs, and rarely used crack were more likely to express intentions to enroll and remain in community methamphetamineadone treatment.
Abstract: Interviews were conducted with a sample of jailed intravenous opioid users who were not in treatment at the time of their arrest and who were admitted to an in-jail methadone maintenance program. At release, subjects were to be referred to dedicated slots in participating community methadone programs. Virtually all subjects were daily injectors of heroin and cocaine. Although the majority of subjects had previous episodes of methadone maintenance, most reported anxieties about methadone, such as bone decalcification and possible overdosing. Women and subjects who shared needles were more likely to report fears about methadone. Only 52% of the subjects stated that they intended to report to a methadone program after their release and 45% did not expect to remain in treatment for more than one year. Subjects who stated that they were not afraid of methadone, frequently injected drugs, and rarely used crack were more likely to express intentions to enroll and remain in community methadone treatment....
57 citations
TL;DR: It was found that the medication-treated depressed patients had a dramatic decrease in their reported cocaine usage and cocaine craving and a dramatic increase in the percentage of cocaine-free urines compared to the placebo-treated patients who actually decreased their percentage of Cocaine free urines.
Abstract: Depression is the most common psychiatric disorder in substance abusers, and results in a poorer prognosis and response to traditional chemical dependence and mental health treatment approaches. This article focuses on the use of pharmacotherapy in the treatment of the cocaine addict with secondary depression and provides general clinical treatment guidelines. It also reports on a study in which depressed, methadone-maintained cocaine addicts were treated in a 12-week placebo-controlled trial that compared two pharmacological agents. Patients were randomly assigned to receive placebo, amantadine (a dopamine agonist) or desipramine (a tricyclic antidepressant). The effects of pharmacotherapy were assessed on program retention, cocaine craving, cocaine usage, and depressed mood. Compared to the placebo-treated patients, it was found that the medication-treated depressed patients had a dramatic decrease in their reported cocaine usage (84% versus 17%) and cocaine craving (48% decrease versus 29% increase). Also, the medication-treated depressed patients dramatically increased the percentage of cocaine-free urines compared to the placebo-treated depressed patients who actually decreased their percentage of cocaine-free urines. A measure of depressive symptoms (Beck Depression Index score) increased 100% for the placebo-treated depressed patients, yet remained stable for the medication-treated depressed patients.
52 citations
TL;DR: Although doctors in this specialty are more at risk for manifesting addiction to alcohol and other drugs, California's experience demonstrates that they have an equal chance of recovery and contradicts the pessimism about recovery in anesthesiologists.
Abstract: This article examines the effectiveness of the rehabilitation of anesthesiologists who are addicted to alcohol or other drugs. There has been some concern and discussion about allowing anesthesiologists who are addicted to alcohol or other drugs to continue practicing in their specialty. This article analyzes success rates, relapse rates, and failure rates among the anesthesiologists and residents of anesthesiology in the California Physicians Diversion Program for chemically dependent doctors. Of the 255 physicians who have successfully completed the program during the ten years prior to March 1990, 35 were practicing anesthesiologists, including six resident anesthesiologists. Although doctors in this specialty are more at risk for manifesting addiction to alcohol and other drugs, California's experience demonstrates that they have an equal chance of recovery and contradicts the pessimism about recovery in anesthesiologists.
TL;DR: Starting at the latter part of the nineteenth century and through the early twentieth century, events are reviewed to provide a sense of the climate and setting in which early methadone research was conducted.
Abstract: Starting at the latter part of the nineteenth century and through the early twentieth century, events are reviewed to provide a sense of the climate and setting in which early methadone research was conducted. The discovery of methadone by the Germans in the later stages of World War II is described. At that time, methadone was not recognized to be a narcotic analgesic. The first report of the properties of methadone published in the United States in 1947 is summarized, and its early use in the treatment of the opioid abstinence syndrome is noted. However, the utility of methadone as a maintenance drug was not recognized until 14 years later. Despite strong resistance from the U.S. Bureau of Narcotics, research progressed from the recognition of the unique properties of methadone to substantial clinical application. Finally, methadone is placed in a current context describing a second wave of acceptance based not solely on the reduction of crime but on the prevention of the spread of AIDS.
TL;DR: This article reviews the application process, obstacles and their solutions, and the local and federal issues involved of N,N-dimethyltryptamine (DMT) to humans.
Abstract: Legitimate human research with hallucinogenic drugs, although of great theoretical and practical interest, involves daunting regulatory hurdles that have discouraged investigators from attempting such work. Using the example of the author's own application for and receipt of federal permission to administer N,N-dimethyltryptamine (DMT) to humans, this article reviews the application process, obstacles and their solutions, and the local and federal issues involved. Further human research with hallucinogens is possible if a persistent and collaborative effort is made with the relevant institutions that oversee the performance of this type of research.
TL;DR: It is indicated that social worlds greatly influenced which qualities of the MDMA experience were most pursued and valued, and the importance of social worlds and context in studying drug-using behavior is underscored.
Abstract: The use of MDMA as an adjunct to spiritual pursuit among New Ager seekers is examined. These study respondents indicated that social worlds greatly influenced which qualities of the MDMA experience were most pursued and valued. In contrast to recreationally oriented respondents, who saw minimal long-term benefits accruing from MDMA use, New Agers typically believed that carefully planned experiences possessed significant potential for lasting spiritual and/or therapeutic value. While many New Agers eschew the use of alcohol and other drugs, these respondents were generally impressed with MDMA. Nevertheless, they differed in their motivations for use and their perceptions of its influence in their lives: some employed MDMA as a sacramental adjunct for following specific spiritual paths; others viewed it as aiding their spiritual growth in more general ways. Because the approaches to and motivations for using MDMA differ so markedly for New Agers and recreationally oriented users, the importance of social worlds and context in studying drug-using behavior is underscored.
TL;DR: The Street Addict Role: A Theory of Heroin Addiction as discussed by the authors is a theory of addiction that is based on the street addict role and the role of the street addict.
Abstract: (1991). The Street Addict Role: A Theory of Heroin Addiction. Journal of Psychoactive Drugs: Vol. 23, No. 3, pp. 299-300.
Journal Article•
TL;DR: In studies of patients having maintenance treatment for heroin addiction (stabilized with methadone hydrochloride in high doses of 80 to 120 mg daily), minimal side effects and no toxic effects are found.
Abstract: In studies of patients having maintenance treatment for heroin addiction (stabilized with methadone hydrochloride in high doses of 80 to 120 mg daily), we found minimal side effects and no toxic effects. These studies have included a prospective study of the first consecutive 214 patients admitted to methadone treatment and reevaluation of the 129 patients of this group still in treatment after three or more years. In addition, we studied 1,435 methadone maintenance patients retrospectively and performed special studies on a smaller group. Abnormalities in liver function and serum protein tests, which were found in 57% and 49% of patients at admission, persisted without significant change during treatment. Increased sweating was reported by 48% and persistent constipation by 17% of patients after methadone treatment for three or more years.
TL;DR: The basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methad one maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.
Abstract: The doctor-patient interaction in the methadone maintenance treatment clinic is qualitatively different from general medical settings. The patient presents with a specific request for treatment of opioid dependence, most often having already selected the methadone treatment modality, and the initial contact is centered around obtaining methadone. Addiction and needle use increase susceptibility to life-threatening illnesses, such as syphilis, endocarditis, tuberculosis, and AIDS. The physician is working with counselors, nurses, therapists and 12-Step programs, incorporating the best of the medical, psychodynamic, behavioral, and recovery models into treatment. Federal and state governments also control and regulate methadone treatment. Given this complex picture, the basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methadone maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.
TL;DR: In this paper, the authors present a training guide for treating alcohol dependence in a coping skills training guide, which can be used to cope with alcohol dependency in a practical way.
Abstract: (1991). Treating Alcohol Dependence: A Coping Skills Training Guide. Journal of Psychoactive Drugs: Vol. 23, No. 1, pp. 89-90.
TL;DR: Benzodiazepines are preferred over antidepressants in the treatment of insomnia in individuals without major psychiatric disorder because of fewer side effects and a larger margin of safety.
Abstract: Insomnia is a commonly encountered condition in clinical practice. The prevalence of self-reported poor sleep increases with age and is more common in women. There are clear associations between poor sleep and psychiatric disturbance; however, causality in this regard may be complex, and there are at least some insomniacs who show high somatic tension without marked psychopathology. The development of chronic insomnia can be conceptualized as involving predisposing, precipitating, and perpetuating factors. Pharmacological treatments for insomnia most typically involve judicious and intermittent usage of a benzodiazepine hypnotic. A variety of such medications are available, with varying absorption and elimination characteristics. Benzodiazepines are preferred over antidepressants in the treatment of insomnia in individuals without major psychiatric disorder because of fewer side effects and a larger margin of safety. Nonpharmacological treatments typically rely on elements of sleep hygiene, stimulus control, sleep restriction, and chronotherapy. The establishment of good patient-clinician rapport and the working through of unfounded beliefs and unrealistic expectations of the sleep experience are also important components of the behavioral treatment of insomnia. Use of such techniques, particularly when combined in a treatment package, has shown appreciable benefits in improving sleep.
TL;DR: A comprehensive review is presented of the recreational and accidental ingestion of psychoactive mushrooms in Australia and New Zealand; 15 recognized species are considered from Australia and eight from New Zealand.
Abstract: A comprehensive review is presented of the recreational and accidental ingestion of psychoactive mushroooms in Australia and New Zealand; 15 recognized species are considered from Australia and eight from New Zealand. Common epithets, potency levels, and methods of ingestion are discussed. Legal aspects involving the use of these psychoactive fungi are noted. In addition, medical and psychoactive effects of these mushrooms and treatment for psilocybian mushroom poisoning are described. Numerous case reports, with commentary, are also presented.
TL;DR: Clinical methods to at least partially correct adrenal metabolism may enhance current opioid addiction treatment modalities and provide an explanation for the heroin addict's vulnerability to AIDS and other infectious diseases.
Abstract: Adrenal gland metabolism is markedly altered in heroin addicts. During day-time hours, the addict may suffer corticoid deficiency of the addisonian type, and in the evening, an excess of the cushingoid type. The high plasma levels of cortisol that are found in the evening in addicts antagonize endogenous opioids in a manner similar to naloxone. In the present study, 72% of the heroin addicts who sought treatment demonstrated reduced adrenal cortisol reserve. Effective immune and stress responses are dependent on adrenal cortisol reserve. This finding provides an explanation for the heroin addict's vulnerability to AIDS and other infectious diseases. One of methadone's greatest attributes is that it helps normalize adrenal metabolism. Clinical methods to at least partially correct adrenal metabolism may enhance current opioid addiction treatment modalities.
TL;DR: The article examines helpful clinical strategies when clients continue to use heroin or other drugs, and explores psychological issues that frequently occur, women's issues, and problems that may arise when patients have human immunodeficiency virus-spectrum disease.
Abstract: This article reviews some of the issues and dilemmas faced by methadone maintenance treatment (MMT) programs counselors. The context in which MMT occurs sets the tone and constraints within which clinicians must find ways to be effective; negative attitudes and tensions with regulatory agencies have a strong impact. Coexisting disorders, particularly depression and thought disorders, are discussed and special medication considerations are noted. Counselor collaboration on medical issues, and dosing policies and practices are explored, as well as the clinical approach to tapering off methadone. The article examines helpful clinical strategies when clients continue to use heroin or other drugs, and explores psychological issues that frequently occur, women's issues, and problems that may arise when patients have human immunodeficiency virus-spectrum disease. It also reconsiders the role of family therapy. Several innovative and promising psychoeducational approaches are described and the potential integration of MMT with 12-Step programs is addressed. Recommendations are offered for training and supervision.
TL;DR: Routine treatment of anxiety disorders with psychoactive drugs can be successful in many patients but may lead to iatrogenic dependence in high-risk patients, and proper prescribing practices for high- risk patients are described.
Abstract: Attending physicians routinely encounter patients with signs and symptoms of anxiety and mood disorders as well as psychoactive substance use and psychoactive substance-induced organic mental disorders. These symptoms may represent either primary disorders or pathology that is secondary to other disorders. This article describes some of the relationships between substance use disorders and symptoms of anxiety and depressive disorders. In addition, some patients with these disorders may have a concurrent substance use disorder or be at high risk for developing one. Routine treatment of anxiety disorders with psychoactive drugs can be successful in many patients but may lead to iatrogenic dependence in high-risk patients. Prescribing for high-risk patients should include a stepwise treatment protocol having three progressive levels: (1) conservative, nonpharmacological approaches; (2) nonpsychoactive pharmacotherapy, including the use of anxioselective agents, such as buspirone; and (3) psychoactive pharmacotherapy, such as the use of benzodiazepines. Proper prescribing practices for high-risk patients are described in terms of diagnosis, dosage, duration, discontinuation, dependence, and documentation.
TL;DR: A review of the experience with methadone maintenance treatment for narcotic addiction in Hong Kong is reviewed, finding that decisions by government officials and health care providers may be influenced more by philosophy and intuition than by scientific evidence.
Abstract: The relationship between public policy and scientific investigation is explored by a review of the experience with methadone maintenance treatment for narcotic addiction. The implementation of a widespread treatment effort in Hong Kong in the 1970s is contrasted with recent policies in regard to methadone treatment expansion in the United States. In neither case did research fmdings form the basis for public policy. In Hong Kong, rapid expansion of methadone treatment was initiated before scientific evidence was available to support this course, and in the United States treatment expansion has been rejected despite extensive evidence of its utility and safety. Decisions by government officials and health care providers, as in the case of addiction treatment, may be influenced more by philosophy and intuition than by scientific evidence. Scientists must recognize and address this reality if they are to play a meaningful role in shaping public health policy.
TL;DR: The treatment system could be better utilized if treatment planning was based more on the needs of the addict than on the ideological bias of the clinician; training efforts could be useful in facilitating change in clinician attitudes.
Abstract: Opioid addiction treatment consists of a broad range of treatment modalities, with each playing a valuable role within the overall network of treatment alternatives. Therapeutic communities are often the treatment of choice for addicts who are under legal contingencies and amenable to a rigorous process of life-style change. Methadone maintenance offers the most widely available treatment and is a modality that is compatible with the needs of many injecting heroin users. Outpatient drug-free models offer structure and support to detoxified opioid addicts and nonaddicted opioid abusers. New pharmacotherapies, including clonidine, LAAM, naltrexone and buprenorphine, provide promise for addressing the needs of many opioid abusers who are not currently accessing the treatment system. Furthermore, the treatment system could be better utilized if treatment planning was based more on the needs of the addict than on the ideological bias of the clinician; training efforts could be useful in facilitating change in clinician attitudes.
TL;DR: The educational techniques used in attaining these goals emphasize adult, or andragogical, education, sequencing curricula over the years of medical school and residency training, utilizing a variety of instructional techniques, and evaluating the results after each educational unit.
Abstract: The history of medical education in treating and prescribing for additive disorders is primarily one of omission. This began to change in the 1970s, leading to positive developments in medical education; however, much still remains to be done. Training in writing prescriptions should cover four areas: (1) prescribing to prevent addiction; (2) prescribing for alcohol or other drug dependent patients; (3) prescribing for withdrawal from alcohol or other drugs; and (4) prescribing for patients in recovery from alcohol or other drug addiction. Other areas of importance to medical education are inappropriate prescribing practices, self-prescribing, and prescribing for dual diagnosis patients. Physicians need to know how to avoid becoming duped, dated, impaired or "script doctors." The educational techniques used in attaining these goals emphasize adult, or andragogical, education, sequencing curricula over the years of medical school and residency training, utilizing a variety of instructional techniques, and evaluating the results after each educational unit. The use of clinical vignettes, patient management problems and simulated patients is recommended.
TL;DR: Physicians should be concerned about being censured for misprescribing, because such actions may lead to inclusion in the National Practitioner Data Bank.
Abstract: The physician who prescribes controlled substances is faced with an array of laws, regulatory policies, and professional attitudes about their use. Prescriptions for these scheduled drugs are furthermore monitored by the pharmacists who dispense them. Certain drugs, such as the opioids and the benzodiazepines, are considered so potentially abusive that special programs have been recommended to track the behavior of physician prescribers. Multiple copy programs have been implemented in some states. More recent proposals recommend electronic data transfer (EDT) of pharmacy information to centralized processing points so that misprescribing physicians and doctor-shopping patients can be identified. Regulators concerned about physician behavior and confronted by demands of nonphysicians to prescribe controlled substances may find EDT a good solution. Physicians should be concerned about being censured for misprescribing, because such actions may lead to inclusion in the National Practitioner Data Bank. With all of the regulatory concerns about controlled substances, those physicians who would employ long-term opioid therapy for their chronic pain patients must follow certain basic guidelines to be able to defend themselves against allegations of deviant professional behavior. Such procedures as conducting a history and physical examination, maintaining a written treatment plan, consulting with knowledgeable colleagues, and assessing for addictive behavior can provide the practitioner with safeguards.
TL;DR: The following helped individuals to get off and stay off methadone: avoidance of opioids; treatment affiliation to supply ideology and to structure and fill free time; employment; social supports; and aging and burning out.
Abstract: Methadone maintenance is again receiving attention as an intervention for needle use/sharing among intravenous drug users. A major criticism is that methadone has its own addictive properties; consequently, the client is unable to detoxify and stay off opioids permanently. Study respondents had been off methadone for several years and offered their strategies for success. Motivating forces included the freedom and rewards, such as pride and respect. The following helped individuals to get off and stay off methadone: avoidance of opioids; treatment affiliation to supply ideology and to structure and fill free time; employment; social supports, specifically family and role models; modest plans to avoid disappointment; effective coping skills to avoid depression; and aging and burning out, In addition, those individuals who had immersed themselves in the conventional world, especially those having a higher social class status, had a less difficult time staying off methadone.