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Cocaine is a psychotropic tropane alkaloid and stimulant drug. Nasal insufflation of cocaine powder is a common route of administration. In Germany, cocaine is frequently adulterated with levamisole, an anthelminthic drug with immunomodulatory effects. Both substances are linked to various autoimmune conditions. Cocaine-induced midline destructive lesions cause a progressive destruction of osteocartilaginous structures within the upper respiratory tract and can mimic localized granulomatosis with polyangiitis. In addition, systemic vasculitis due to cocaine and levamisole has been reported. Differentiation of these conditions from primary vasculitis can be challenging because antineutrophil cytoplasmic antibodies (ANCA) are commonly detected. Early diagnosis of these conditions is crucial as clinical improvement is closely related to drug cessation., (© 2022. The Author(s).)

Background: The online study presented surveyed occasional users, high-risk users and non-consumers of psychotropic substances for relationships between consumer type and emotion regulation (ER), health-related quality of life (HRQOL) and coping strategies., Methods: A total of 199 people participated in the survey. The sample was split into three groups depending on a substance list and a detailed questionnaire regarding the consumption habits: 28 individuals had no illicit drug experience, 127 were occasional users and 44 frequent (high-risk) users. The sample set was tested using the (1) emotion regulation inventory, (2) the coping inventory for stressful situations and (3) the medical outcomes study (MOS) 36-item short-form health survey., Results: Regarding ER the occasional users showed no significant differences to the two reference groups, except for the scale of re-evaluation where the high-risk consumers scored higher than the occasional users. Regarding HRQOL no significant differences were observed between the three groups; however, significant differences were observed between persons with strong and weak physical and mental HRQOL scores and satisfaction with own emotion regulation. The search for predictors showed a significant predictive value for gender, the number of inhabitants at the place of residence and the ER strategy of re-evaluation in negative emotions for the allocation to a consumer type. Neither substance consumption as an ER strategy nor a relationship between consumer type and coping strategy and/or HRQOL could be observed., Discussion: With respect to ER the only significant difference observed was that of high-risk users employing the strategy of re-evaluation more often than occasional users. A possible explanation is reality embellishment and a down-playing function of this strategy associated with drug consumption. Therefore, the assumed relationship between affective dysfunction and drug addiction could not be observed.

A 19 year old patient presented with the typical constellation of sarcoidosis. In the presence of indefinable pulmonary infiltrates, hypercalcemia, raised angiotensin converting enzyme and even evidence of giant and epitheloid cell granulomas, cocaine abuse should be considered. Chronic inhalative cocaine abuse can cause foreign body associated granulomatosis of the lung and other organs. It is important to establish this differential diagnosis by confidential interview and systematic polarisation microscopy to detect foreign material in tissues: unnecessary therapies with potential side effects should be avoided and drug weaning with rehabilitation of the patient should be initiated. However the potential for rapid progressive respiratory failure should not be underestimated.

Cocaine and the opiates are--together with alcohol--involved in the genesis of the "three great addictions". The medical conceptualisation of the dependence phenomenon has evolved on the grounds of a critical observation of different ways of use and treatment endeavours, mainly during the last three centuries. Whereas the prohibitionists favoured (and still favour) total abstinence from all psychotropic drugs, defect theoreticians emphasise analytically-oriented psychotherapeutic procedures aiming at healing a supposed underlying self-defect. Contrarily, proponents of the "Metabolic Theory" of the addictions suggest a mainly medication-based approach in order to normalise a--in their eyes causal--still in some aspects hypothetical metabolic defect. Based on a short survey of recently emerging trends of consumption patterns (speed-balling, chasing, multi-substance-use) in Europe, the most important newer treatment types and forms are presented. Finally, a multimodal, integrated, and individualized approach is recommended.

Recent investigations of possible associations between attention deficit hyperactivity disorder (ADHD) and substance-use disorders are reviewed. ADHD seems to represent a possible risk factor for developing a substance abuse, up to 50% of patients with on continuing ADHD symptoms from childhood were found to develop a substance-use disorder. Based on possible pathophysiological similarities, especially cocaine and nicotine dependence are of focused interest in adolescents and adults with ADHD. The presence of ADHD may influence adolescent and adult substance-use disorders in different ways: earlier age of onset, higher frequency, longer duration of substance abuse and transition from alcohol-abuse to other substance-use disorders. Possible pharmacological and non-pharmacological therapeutic strategies in patients with ADHD and substance abuse are discussed.

Introduction: In Austria, methadone, buprenorphine as well as oral slow-release morphine are used for the treatment of opioid dependence. This controlled examination marks the first time that oral slow-release morphine hydrochloride is applied for maintenance therapy in opioid dependent subjects., Methods: In order to evaluate the effectiveness of this psychopharmacological medication, we examined patients over a three-week period. Outcome measures were retention rate, additional consumption and the evaluation of opioid withdrawal 24 hours after the last oral medication., Results: Sixty-seven patients were included; sixty-four patients completed the study, representing a retention rate of 94%. During the three-week period, a significant improvement in well-being and a significant reduction in heroin, cocaine and benzodiazepine craving (p < 0.0001) was evaluated. Furthermore, there was a significant reduction of additional consumption of benzodiazepines in supervised urinalysis. Additional consumption of cocaine remained unchanged. Laboratory results showed a significant reduction of CK over the course of investigation., Discussion: The high retention rate of 94% implies a good acceptance and efficacy of the substance. The reduced CK is consistent with a reduction in intravenous application of illegal substances. However, randomized double-blind, double-dummy studies with oral slow-release morphine are needed in order to meet criteria for evidence based medicine.

Objective: The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts., Methods: In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview., Results: Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %., Conclusions: The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

We report the history of a 39-year-old-man who suffered from refractory arterial hypertension and who was referred to us for the diagnosis of phaeochromocytoma due to increased urinary free catecholamines. The work-up revealed the diagnosis of cocaine-induced arterial hypertension. The pathogenesis of cocaine-induced arterial hypertension as well as the differential diagnosis of increased urinary catecholamines will be discussed.

We report a 29 year old female drug addict seen in the emergency room with neck abscesses, dysphagia and a symmetric ptosis. Initially misinterpreted as adverse effect of illegal drug intake these symptoms were due to myasthenia gravis. This case shows an important differential diagnosis of ptosis common in drug addicts.

Drug-associated/-induced neurological complications are well known in the literature. Cocaine is of major interest due to its widespread use. On the basis of a case report, we discuss the broad spectrum of medical and, in particular, neurological complications. The risk of cerebrovascular damage and epileptic seizures is indicated. The pathophysiological mechanisms of cerebrovascular complications are not well understood.

Cocaine is a frequently used drug with many known effects on the cardiovascular system. It leads also to structural changes of the coronary arteries that can result in severe chest pain or even acute myocardial infarction. We discuss two patients with infarction, differentiate between chest pain and infarction and suggest some important therapeutic measures.