.Lankenau, Stephen E.; Clatts, Michael C.; Goldsamt, Lloyd A.; Welle, Dorinda L.2007-01-01This article examines the behavioral practices and health risks associated with preparing crack cocaine for injection. Using an ethno-epidemiological approach, injection drug users (n=38) were recruited between 1999 and 2000 from public settings in New York City and Bridgeport, Connecticut and responded to a semistructured interview focusing on crack injection initiation and their most recent crack injection. Study findings indicate that methods of preparing crack for injection were impacted by a transforming agent, heat applied to the “cooker,” heroin use, age of the injector, and geographic location of the injector. The findings suggest that crack injectors use a variety of methods to prepare crack, which may carry different risks for the transmission of bloodborne pathogens. In particular, crack injection may be an important factor in the current HIV epidemic. PMID:18079990.Schmittner, John; Umbricht, Annie; Schroeder, Jennifer R.; Moolchan, Eric T.; Preston, Kenzie L.2010-01-01To test whether a combination of contingency management and methadone dose increase would promote abstinence from heroin and cocaine, we conducted a randomized controlled trial using a 2 X 3 (Dose X Contingency) factorial design in which dose assignment was double-blind.

Jan 01, 2006  Crack cocaine is a highly addictive and powerful stimulant that is derived from powdered cocaine using a simple conversion process. Crack emerged as a drug of abuse in the mid-1980s. It is abused because it produces an immediate high and because it is easy and inexpensive to produce-rendering it readily available and affordable. Crack cocaine is a form of cocaine that is made by mixing powdered cocaine with water and either baking soda or another weakly basic substance such as ammonia. The mixture is boiled and then broken into chunks (rocks) that are smoked. The effects are intense but short-lived, and users can quickly become physically and psychologically dependent.

Participants were 252 heroin- and cocaine-abusing outpatients on methadone maintenance. They were randomly assigned to methadone dose (70 or 100 mg/day, double blind) and voucher condition (noncontingent, contingent on cocaine-negative urines, or “split”).

The “split” contingency was a novel contingency that reinforced abstinence from either drug while doubly reinforcing simultaneous abstinence from both: the total value of incentives was “split” between drugs to contain costs. The main outcome measures were percentages of urine specimens negative for heroin, cocaine, and both simultaneously; these were monitored during a 5-week baseline of standard treatment (to determine study eligibility), a 12-week intervention, and a 10-week maintenance phase (to examine intervention effects in return-to-baseline conditions). DSM-IV criteria for ongoing drug dependence were assessed at study exit. Urine-screen results showed that the methadone dose increase reduced heroin use but not cocaine use. The Split 100mg group was the only group to achieve a longer duration of simultaneous negatives than its same-dose Noncontingent control group. The frequency of DSM-IV opiate and cocaine dependence diagnoses decreased in the active intervention groups.

For a split contingency to promote simultaneous abstinence from cocaine and heroin, a relatively high dose of methadone appears necessary but not sufficient; an increase in overall incentive amount may also be required. PMID:19101098.Marinetti, Laureen J; Ehlers, Brooke J2014-10-01The Montgomery County Coroner's Office Toxicology Section and the Miami Valley Regional Crime Lab (MVRCL) Drug Chemistry Section have been receiving case work in drug seizures, death cases and human performance cases involving products marketed as heroin or as illicit fentanyl. Upon analysis by the Drug Chemistry Section, these products were found to contain various drug(s) including illicit fentanyl only, illicit fentanyl and heroin, illicit fentanyl and cocaine and illicit fentanyl, heroin and cocaine. Both the Chemistry and Toxicology Sections began seeing these combinations starting in late October 2013. The percentage of the combinations encountered by the MVRCL as well as the physical appearance of the product, and the results of presumptive screening tests will be discussed. The demographics of the users and the results of toxicology and autopsy findings on the decedents will also be discussed.

According to regional drug task force undercover agents, there is evidence that some of the products are being sold as illicit fentanyl and not just as a heroin product. Also, there is no evidence to support that the fentanyl source is being diverted from pharmaceutical grade fentanyl. The chemistry section currently has over 109 confirmed cases, and the toxicology section currently has 81 confirmed drug deaths, 8 driving under the influence of drugs and 1 suicidal hanging. Both sections are continuing to see these cases at the present time. Jo bheji thi dua singer.

© The Author 2014. Published by Oxford University Press. All rights reserved.

RESULTS:Cocaine users showed more family problems when compared with other drug users, with no significant difference between routes of administration. These problems included arguing (crack 66.5%, powder cocaine 63.3%, other drugs 50.3%, p = 0.004), having trouble getting along with partners (61.5%×64.6%×48.7%, p = 0.013), and the need for additional childcare services in order to attend treatment (13.3%×10.3%×5.1%, p = 0.002). Additionally, the majority of crack/cocaine users had spent time with relatives in the last month (84.6%×86.5%×76.6%, p = 0.011). INTRODUCTIONFirst introduced in Brazil in the early 1990s, crack use had an almost twofold increase in its prevalence (0.4 to 0.7%) between 2001 and 2005, and its use has spread to higher socioeconomic groups (-). Recently, it was found that there are approximately 3 million regular users (in 2012) of cocaine in Brazil, accounting for 20% of its consumption worldwide and Brazil is also the world's largest market for crack.Crack users usually have a worse prognosis, with more severe dependence, involvement with criminality, risky sexual behavior and more social impairments when compared with cocaine snorters and other substance users (-). However, little is known about the characteristics of the family problems associated with this substance and whether it varies between different routes of administration and other substances (,).

This study aims to evaluate family problems among crack/cocaine users compared with alcohol and other substance users. Sample selectionA target sample of 741 adult substance abusers from outpatient and inpatient clinics who were in evaluation or beginning treatment were interviewed. Inclusions from both settings were made to encompass a wider range of patient characteristics. The patients were enrolled in the study as they were admitted to the clinics and no specific recruitment was performed.

The inclusion criteria were being 18 years old or older, seeking treatment for drug abuse/dependence and using at least one of these substances in the 30 days prior to the interview. Deepa venkat cinespot. In regard to inpatient subjects, the interviews referred to the period prior to admission and not to the day of the interview.

Patients were divided into three groups according to their main substance of use: crack cocaine (293) and snorted cocaine (126) users who sometimes used alcohol and/or marijuana but reported cocaine as the major cause of their problems and need for treatment and users of others substances (322), mostly alcohol, sedatives and marijuana, who did not use cocaine. The exclusion criteria were any neurological or severe psychiatric illness with acute symptoms noted during the interview. Regarding data collection in all centers, eight patients were excluded. Procedure and analysesData were entered in an Access database and exported to SPSS (Statistical Package for the Social Sciences) version 14.0, which was used to perform the analyses.Categorical variables were described by absolute frequencies, and the percentages were compared by the Chi-squared test. Quantitative variables with a symmetric distribution were described by the mean and standard deviation and compared using ANOVA. Those with an asymmetric distribution were presented as the median and interquartile ranges and compared by the Kruskal-Wallis test. Statistically significant data were adjusted for age, gender, treatment setting, living with partner and schooling by logistic regression.

RESULTSIn our demographic findings, cocaine users were predominantly male and younger (mean age 31.1 for crack users) compared with non-cocaine PAS users, with no difference between crack and snorted cocaine users. The three groups were similar with regard to marital and economic status, ethnicity, educational level and treatment setting.

The third group comprised mainly alcohol, sedative and marijuana users. This group also had a higher median for years consuming alcohol compared with crack and snorted cocaine users (15, 5 and 10 years, respectively). Marijuana use was significantly more prevalent among crack cocaine users compared with the other two groups (65%, 28.6% and 22.8%, respectively). There were no significant differences concerning other substances, such as sedatives, stimulants and hallucinogens.As shown in, cocaine users showed more family problems than other drug users, with no significant difference between crack and snorted cocaine users.

These problems included arguing and having problems getting along with partners and the need for additional childcare services in order to attend treatment. Additionally, the majority of crack/cocaine users had spent time with relatives in the last month. However, after logistic regression, differences in “having trouble getting along with” were no longer statistically significant. VariableCrack cocaine users last 30 days n = 293Powder cocaine users last 30 days n = 126Non-cocaine PAS users last 30 days n = 322p-valueMeanAdjusted odds ratio CI95%MeanMeanArguing66.5.)1.70 (1.04-2.79)63.3.)50.3.0.004Having trouble getting along with partner61.5.)1.48 (0.91-2.40)64.6.)48.7.0.013Need for additional childcare services in order to attend treatment13.3.)2.81 (1.35-5.82)10.3.)5.1.0.002Spent time with relatives in the last month84.6.)1.50 (0.93-2.42)86.5.)76.6.0.011. DISCUSSIONOur results show that crack cocaine users have more family problems than other substance users and describe what those problems are. To our knowledge, this is the first study in Brazil to compare crack users to cocaine snorters and other substance users.In our sample, crack and cocaine users have a mean age of greater than 30 years, which is not in agreement with the literature, as crack users are usually described as being less than 30 years of age and younger than cocaine snorters. Because our data were collected in 2006, a period when crack use was starting to increase and our sample comprised mostly former cocaine snorters who were shifting to crack, this may explain the difference in demographics (,).Data regarding family problems suggest that crack users remain attached to their family members, which is in contrast with previous studies that have shown that this population has higher rates of living on the streets and coming from broken homes.

Perhaps, this is a consequence of the recent changes in the profile of crack users in Brazil, with increasing numbers of users from higher socioeconomic groups, especially those who seek treatment (,). However, the results also suggest that these relationships are conflicted because most of the patients complained of arguing with family members. This emphasizes that treatment programs should be prepared to assess and treat family conflicts. This is an important observation because most services in Brazil do not provide this type of service.Having no one to take care of their children may be an important barrier for patients in regard to treatment attendance. The need for additional childcare services in a sample comprising mostly men was a surprising finding that indicates that these services should not be provided only by treatment programs dedicated exclusively or mostly to women.The limitations of this study include its cross-sectional design and clinical sample of mostly men.Brazilian treatment programs should enhance family treatment strategies, as they are poorly developed in most services. Childcare services need to be included because their absence may be a barrier to treatment retention.