Addiction Treatment Blog

It is as natural to die as to be born; and to a little infant, perhaps, the one is as painful as the other.

Sir Francis Bacon, 1561-1626, Essays, ‘Of Death’.

Drug Abuse in Pregnancy

It is particularly difficult to study drug abuse in human pregnancy. There are a number of reasons for this.

• Recruitment. Suitable women may be difficult to identify because they may feel guilty about their drug taking, be afraid to tell healthcare staff about illegal drug use and be frightened of reproaches from relatives should this come to light.
• Confounding. The lifestyle of many women who abuse drugs may already predispose them to an adverse pregnancy outcome, e.g. living conditions, general health, reproductive health, nutritional status and socioeconomic group. Separating environmental and personal confounders is particularly difficult when trying to follow-up drug-exposed infants after birth.
• Multi-drug use. It is almost impossible to study any single drug of abuse in complete isolation because multi-drug use is common. Tobacco and alcohol alone are frequently consumed by those who abuse street drugs, and these are known to have adverse effects upon the foetus.
• Identification. Many drug abusers do not know exactly what they are taking, either in terms of identity (due to adulteration) or in terms of dose (due to impurity and dilution).
• Collecting data. Usually studies rely on maternal recall of the extent and nature of drug use during pregnancy and this may not be reliable.
• Changing use. The pattern of use may change during the pregnancy. Mothers may increase or decrease dose or frequency. Read more…

Illness is in part what the world as done to a victim but in a larger part is what the victim has done with his world, and with himself.

Karl Menninger, quoted in ‘Illness as Metaphor’ by Susan Sontag.

Drug abuse is a cause for many serious illnesses, including HIV (AIDS).

From time to time the healthcare professional will encounter an individual with a medical condition who abuses drugs. Although not condoning the taking of these substances, it is desirable that those in a position to advise are able to provide information on whether the drug is liable to exacerbate the condition. The sections below provide brief details which may be helpful in advising those with some of the more common medical conditions. The information given should be used as a guide only. The data available are sparse in most cases and while it is hoped that the details in this chapter will be useful, every patient’s particular circumstances will differ and one should be cautious about extrapolating limited information to all situations in which it could be applicable.

It is difficult to find data in the advisability of drug abuse in those suffering from concomitant medical conditions. The data given here are based upon details of side effects that have been reported in the medical literature and knowledge of drug handling by the body. This information is incomplete because none of the drugs of abuse have been subject to large-scale clinical trials at the doses abused. This is the main mechanism by which side effect profiles of therapeutic drugs are determined. This being the case, most of the data on adverse effects from street drugs are derived from small-scale studies, case reports, surveys and anecdotal evidence. Causality can also be difficult to ascertain because many users employ a variety of drugs simultaneously. Many drug abusers have a poor quality of life due to bad living conditions and/or inadequate nutrition; this may make them more susceptible to various diseases. Read more…

There are three basic methods for drug administration.

There are three basic methods by which drugs of abuse are taken into the body: by injection, by mouth and via the airways.

Injection

Many drugs are commonly given by intravenous injection including cocaine hydrochloride, heroin, amphetamine and temazepam. The intravenous route affords rapid access to the circulation and thence to the brain, allowing fast onset of intense psychoactive effects. However, bypassing the body’s normal defense mechanisms in the gut carries great risks to health. The subcutaneous route is an alternative which is occasionally used if the intravenous route is not available. Intra-arterial injections are usually only given by mistake when a needle misses a vein. The intramuscular route is only used for anabolic steroids.

Oral Administration

For many drugs the oral route is preferred for convenience – ecstasy, LSD, alcohol and caffeine are all usually taken this way. Read more…

There are many international laws aim to prevent drug abuse.

Legal Status of Drugs

In the UK, drugs of abuse are controlled by two main pieces of legislation.

Misuse of Drug Act (1971)

This Act classifies drugs into three classes according to the maximum penalty which an offender can expect to receive if he or she contravenes the law. The Act renders possession, export, import, manufacture or supply of any of these drugs illegal except in certain specified circumstances.

• Class A drugs: Pure cannabinoids (but not cannabis itself), cocaine, LSD, opioids, phencyclidine, psilocybin. Injectable forms of drugs in class B.
• Class B drugs: Amphetamine, barbiturates, cannabis, cocaine, dihydrocodeine, ecstasy, methamphetamine, methylphenidate.
• Class C drugs: Benzodiazepines, cathine, cathinoe, dextropropoxyphene, diethylpropion, anabolic steroids, human chronic gonadothropin and growth hormones.

Misuse of Drugs Regulations (1985)

These are principally concerned with regulating the legitimate supply and use of abusable substances. Read more…

Once the cocaine is in the United States, its distribution and sale comprises another huge business. Typically, each major city is dominated by one or more criminal organization that controls cocaine selling throughout the city. In some cities, such as Los Angeles, pre-existing gangs have taken on much of the distribution and sale of cocaine. In the mid-1980s, highly organized Jamaican gangs became involved in crack dealing in Miami and New York. These so-called posses were known for their extraordinary violence and mobility; gang members moved to cities throughout the country, starting up new crack businesses. Today, it is estimated that approximately 40 of these posses exist, with a membership of 22,000, controlling one-third of the crack trade in America. Although leaders of these drug-dealing organizations can make hundreds of thousands of dollars a year, the street-level dealers who work for them sometimes make barely enough money to survive and support their own drug addictions. A recent study by the Rand Corporation found that street dealers stood a 1-in-70 chance of getting killed, a 1-in-14 chance of severe injury, and a 2-in-9 chance of going to jail. Despite these odds, many inner-city youths are still attracted to drug-dealing and the prospect of rising through the ranks to make “crazy money”. Read more…

The conversion of the coca leaf to the product that is illicitly marketed on the American street as “cocaine” (the quotation marks are included because the product sold on the street often contains more adulterants than pure drug) involves many steps. It begins with the coca plant itself. Erythroxylon coca, an evergreen shrub approximately three feet tall that grows most commonly in the easter foothills of the Andes Mountains. More than 200 strains of alkaloids, the vast majority contain little, if any, cocaine. The bush thrives at elevations between 1,500 and 5,000 feet and generally contains a relatively small amount of active cocaine; the average Peruvian coca leaf contains approximately one-half of 1% cocaine. The bitter taste of the alkaloids probably contributes to the flourishing growth of the coca bush by making the visually attractive bush an uninviting grazing source for the local animal population.

The coca plant can be harvested between six months and three years after its first planting, depending on the strain that has been planted. Once a growing area has been established, the leaves can be harvested several times a year, simply by stripping the leaves off the bushes. The farmers then take the harvested leaves to local processing plants located in the villages, where initial stage of extraction takes place. Here, coca paste is prepared by macerating coca leaves with kerosene, water, sodium carbonate, and sulfuric acid. Between 100 and 200 kilograms of coca leaves are necessary to produce 1 kilogram (2.2 pounds) of coca paste. The conversion of the leaf to paste thus results in an enormous reduction in bulk as well as an increasingly (40%-91%) pure product now worth four times the price of the original leaves. The decreased bulk enables drug traffickers to transport the paste far more easily than they can move massive quantities of coca leaves. Coca paste is converted into cocaine hydrochloride, the snowy white powder sold on the street, by adding a number of chemicals, which may include hydrochloric acid, potassium permanganate, acetone, ether, ammonia, calcium carbonate, sodium carbonate, sulfuric acid, and more kerosene. Read more…

Coca

Cocaine is a naturally occurring stimulant drug found in the leaves of the coca plant, Erythroxylon coca. Although cocaine was not extracted from the coca leaf until the mid-19th century, archaeologists have discovered coca leaves at Peruvian grave sites dating from approximately 500 A.D., along with other items considered necessities for the afterlife. Thus, although current practices of cocaine use are relatively recent by historical standards, coca leaves have been chewed for at least 15 centuries. Coca leaves have been used in the past for a variety of religious, medicinal, and work-related reasons. They have also been the subject of a great deal of folklore that the leaf was of divine origin, and its use was therefore reserved as an herb provided for members of the upper classes. One Incan myth described coca as an herb provided by the god Inti to allow the Incas to endure their difficult environmental conditions without suffering from hunger or thirst. Another myth alleged that the plant grew from the remains of a beautiful woman who had been executed for adultery, cut in half, and buried. Themes of seductiveness and danger have thus been associated with cocaine for well over a millennium.

After conquering the Incas in the 16th century, the Spanish were initially opposed to cocoa use because they saw worship of the drug as a barrier to religious conversion. However, the conquistadors also recognized that the leaves energized the Indians and enabled them to work long, tedious hours in gold and silver mines with little need for food or sleep. Financial considerations overcame their religious objections, and in 1569 Philip II of Spain declared the coca leaf essential to the health of the Indian. It was not long thereafter that the Spaniards began paying the Indians with being able to treat a variety of medical disorders, including such diverse conditions as venereal diseases, headaches, asthma, rheumatism, and toothaches.

Sigmund Freud

Despite the imprimatur of the Spainards who brought coca leaves back to Europe, there was very little enthusiasm among the Europeans for coca until 1855, when a German chemist named Gaedacke was able to extract the active ingredient of the coca leaf, which he named erythroxyline. In 1859, another German, Albert Niemann, also isolated the compound and renamed it cocaine. This discovery sparked a flourish of experimentation with the compound, which peaked around the turn of the century Perhaps the most notable of the drug’s champions was Sigmund Freud, who performed a great deal of research on the drug, based both on personal experience and on the observation of others. In July 1884, Freud published his landmark paper entitled, “On Coca.” In this work, he rhapsodized about the effects of cocaine:

The psychic effect of cocaine consists of exhilaration and lasting euphoria, which does not differ in any way from the normal euphoria of a healthy person… One senses an increase of self-control and feels more vigorous and more capable of work; on the other hand, if one works, one misses the heightening of the mental powers which alcohol, tea, or coffee induces. One is simply normal, and soon finds it difficult to believe that one is under the influence of any drug at all… Long lasting intensive mental or physical work can be performed without fatigue; it is as though the need for food and sleep, which otherwise makes itself felt peremptorily at certain times of the day, were completely banished.

Freud also noted the drug’s ability to relieve the pain and thus paved the way for the discovery of cocaine as the first local anesthetic. He also claimed that cocaine might prove useful as a stimulant and as as an aphrodisiac, as well as in the treatment of depression, gastrointestinal disturbances, wasting diseases, alcoholism, morphine addiction, and asthma. None of these predictions was supported by scientific research, however, and Freud was accused of irresponsibility by much of the scientific community because of his enthusiasm for cocaine. When Freud used the drug to treat a colleague for morphine addiction, he was dismayed to find that his patient developed a similar severe dependence on cocaine. This and other developments led Freud to eventually modify his positive feelings about cocaine.

Freud was not the only person in the late 19th century to embrace this new compound. A Corsican chemist named Angelo Mariani understood the power of this newly discovered drug, and Mariani produced a mixture of coca leaves and wine, which he called “Vin Mariani.” This tonic was phenomenally successful: among those who endorsed it were kings, queens, two popes, and such notable figures as Thomas Edison, H. G. Wells, and Jules Verne. Read more…

Cocaine

As we approach the 21st century, cocaine abuse remains a major public health problem in the world. Most people today are aware of the dangers of the cocaine addiction, and as a result occasional use of cocaine has decreased. On the other hand, more individuals are using cocaine frequently and in greater amounts, which has led to an increase in medical complications and deaths due to cocaine overdose, drug-related crime, and cocaine use during pregnancy.

In the early 1980s, the popularity of cocaine appeared to be growing steadily. No other drug was associated with as much glamour, notoriety, and, sadly, misinformation about its potential dangers Even in the medical profession, cocaine was not initially thought to be highly addictive or dangerous if used intermittently. In almost every sector of society, cocaine use increased dramatically. Initially, because of our society were most likely to be cocaine users. With its increasing popularity, however, production and distribution of the drug from South America increased, thus lowering the price from $150 a gram in 1980 to less than half that in most cities by 1993. The introduction of “crack” cocaine, an extremely addictive smokable form of cocaine, made initiation of cocaine use even more affordable, because crack is sold in small quantities costing from $2 to $20. Soon, cocaine use was pervasive in all socioeconomic and age groups in 1985, for example, a national survey found that 17% of American high school seniors had tried cocaine.

Gradually, evidence mounted about the hazards of using cocaine and its addictive potential. Several highly publicized incidents helped to stimulate Americans’ growing awareness that cocaine use was not safe. In 1980, Richard Pryor, was seriously burned while “freebasing” cocaine. Then in 1986, Len Bias, a college basketball star, died of a cocaine overdose. Efforts to educate Americans about the dangers of drug use became widespread. Groups such as the Partnership for a Drug-Free America and the Entertainment Industries Council donated time and money to produce antidrug advertisements. The media, which previously had showed cocaine to be the favorite drug of movie stars and athletes, began to show many of the same celebrities urging other Americans to stay away from cocaine.

The federal government also became more involved in fighting drug use during the 1980s. The government’s “War on Drugs” has focused on reducing both the demand for cocaine and its availability on American streets. Increasing amounts of money have been spent each year; in 1991 alone, more than $10 billion was proposed to fund the federal drug strategy. Most of this money has been spent to reduce the flow of cocaine and other drugs into the United States. This effort has reduced the availability of cocaine to some degree and has probably prevented the cost of cocaine from decreasing even further. Whether this strategy has actually helped to decrease the use of cocaine is still a matter of some debate, especially when inexpensive cocaine in the form of crack is still readily available.

The medical profession has also contributed to curbing cocaine use with efforts to improve the treatment of cocaine dependence. Doctors, too, had previously been fooled into believing that cocaine was relatively harmless. Research and clinical experience, however, showed that cocaine was a powerfully addictive drug, with many serious psychological and medical effects. The experience also helped clinicians to become more skilled at treating cocaine addiction. The testing of many medications to reduce cocaine craving and the development of new psychological strategies such as cognitive and behavioural techniques to prevent cocaine relapse showed promising results. By the end of the 1980s, a growing number of cocaine-dependent people were receiving professional help for their addiction. Read more…