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Objective: To evaluate the nutritional status of crack users and to analyze its correlation with drug use profiles., Methods: Cross-sectional study with 108 crack users. Anthropometric data were assessed through body mass index (BMI) and bioimpedance (BIA) measurements. A blood test to analyze hematocrit, hemoglobin, glucose, and lipid profiles was also performed. Crack use was determined through a standardized interview., Results: Based on BMI and BIA, most individuals were eutrophic (about 70%). Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal for 32.4 and 30.6% of patients, respectively. Considering normal parameters, a large part of the sample (60.2%) had low levels of HDL cholesterol and high levels of triglycerides (38%). There were no significant correlations between drug profile and nutritional variables., Conclusion: This is a pioneering study that examines the nutritional status of crack users. Our results showed that most crack users present normal anthropometric findings and the prevalence of underweight is low. However, blood analysis showed changes and a specific type of malnutrition.

Background: The aim of this study was to compare sociodemographic characteristics, patterns of drug use, and risky sexual behaviour among female and male users of crack cocaine., Methods: Between 2012 and 2013, we conducted a cross-sectional study of 919 crack cocaine users (783 men and 136 women) in Central Brazil using face-to-face interviews. Blood samples were collected to test for syphilis. The Chi-Square Automatic Interaction Detector (CHAID) was used to explore the differences between genders. We implemented two models: the first model included previous incarceration and variables related to patterns of drug use, and the second model included variables related to sexual risky behaviours and syphilis exposure., Results: Women consumed more crack cocaine than men on a regular basis; however, poly-drug use was more common among men. More women than men reported exchanging sex for money and/or drugs and inconsistent condom use during sexual intercourse; women also reported more sexual partners. In addition, the frequency of sexual violence was higher for women than men. A higher proportion of women than men were positive for syphilis (27.2% vs. 9.2%; p < 0.001). The CHAID decision tree analysis identified seven variables that differentiated the genders: previous incarceration, marijuana use, daily crack cocaine consumption, age at first illicit drug use, sexual violence, exchange of sex for money and/or drugs, and syphilis exposure., Conclusion: Our findings demonstrate a difference in patterns of crack cocaine consumption and sexual risky behaviours between genders, thus indicating a need for gender-specific interventions in this population.

Introduction: A single LC-MS equipment was used to validate three methods for simultaneously analyzing cocaine (COC), benzoylecgonine (BZE), cocaethylene (CE), anhydroecgonine methyl ester (AEME) and anhydroecgonine (AEC) in oral fluid (OF), urine and plasma., Methods: The methods were carried out using a Kinetex HILIC column for polar compounds at 30°C. Mobile phase with isocratic condition of acetonitrile: 13mM ammonium acetate pH 6.0: methanol (55:35:10 v/v/v) at 0.8mL/min flow rate was used., Results: After buffer dilution (OF) and protein precipitation (urine and plasma), calibration curve ranges were 4.25-544ng/mL for oral fluid and 5-320ng/mL for urine and plasma with correlation coefficients (r) between 0.9947 and 0.9992. The lowest concentration of the calibration curves were the lower limit of quantification. No major matrix effect could be noted, demonstrating the efficiency of the cleaning procedure., Discussion: The methods were fully validated and proved to be suitable for analysis of 124 cocaine and/or crack cocaine users. Among the subjects, 56.5% reported daily use of cocaine in the previous three months. Results show a high prevalence of the analytes, with BZE as the most prevalent (94 cases), followed by COC (93 cases), AEC (70 cases), CE (33 cases) and AEME (13 cases). In addition, the concentration of BZE in urine was higher compared to OF and plasma found in the real samples, showing the facility of accumulation in chronic users in matrices with a large detection window., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To describe the clinical characteristics of adolescents with crack cocaine dependence and possible predictors of transition from drug experimentation to crack cocaine dependence., Methods: This cross-sectional study enrolled a consecutive sample of 90 adolescents admitted to a psychiatric inpatient unit in the city of Porto Alegre in southern Brazil for crack cocaine detoxification between May 2011 and November 2012. Comorbid psychological conditions were assessed using the Kiddie-SADS-Present and Lifetime Version, and severity of drug use was assessed using the Teen Addiction Severity Index (T-ASI). Comorbidities were compared with those in a community sample of non-drug using controls (n = 81)., Results: Patients' mean age was 15.6 years (85.6% boys, 14.4% girls). Seventy-nine (93.2%) met criteria for cocaine dependence (DSM-IV-TR), while 78 (91.8%) had symptoms consistent with cocaine abuse. All patients had experimented with at least 1 other addictive substance before crack cocaine: 61.4%, tobacco (mean age at first use = 11.61 years); 44.3%, alcohol (age at first use = 12.43 years); and 54.5%, cannabis (age at first use = 12.15 years). Patients had used crack cocaine 23.2 days in the last month, and the mean age at first use of crack cocaine was 13.38 years. The most common psychiatric comorbidity was conduct disorder (81.8%), followed by oppositional defiant disorder (52.3%) and attention-deficit/hyperactivity disorder (44.3%), all of which were more prevalent in the patient population than in controls (P < .001). The T-ASI questionnaire showed severe consequences of drug use in most areas of life assessed. The mean time between onset of drug experimentation and crack cocaine dependence was 2.53 (SD = 1.96) years. When Cox regression models were applied, we found that predictors of earlier progression to using crack cocaine were age at first use of any drug (hazard ratio [HR] = 0.79 [95% CI, 0.71-0.88]; P < .001) and age at admission (HR = 0.7 [95% CI, 0.57-0.87]; P = .001)., Conclusions: Patients were found to have a multitude of comorbid conditions, which supports the idea of treatment by a multidisciplinary health care team. For each year of delay in the age at first drug use, the chance of crack cocaine initiation is reduced by 18%. Prevention programs aimed at delaying experimentation with addictive substances, especially "gateway" drugs, could delay the progression to crack cocaine dependence., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Due to the complexity of crack -cocaine addiction treatment, the identification of biological markers that could help determining the impact or outcome of drug use has become a major subject of study. Therefore, we aim to evaluate the association of Brain-Derived Neurotrophic Factor (BDNF) and Thiobarbituric Acid Reactive Substances (TBARS) levels in crack -cocaine users with treatment adherence and with drug addiction severity. A sample of 47 male inpatient crack- cocaine users were recruited in a treatment unit, and blood samples were collected at admission and discharge in order to measure BDNF and TBARS serum levels. Subjects were split into 2 groups: treatment non-completers (n=23) and treatment completers (n=24). The completer group had a tendency of higher levels of BDNF than non-completers at admission (16.85±3.24 vs. 14.65±5.45, p=0.10), and significant higher levels at discharge (18.10±4.88 vs. 13.91±4.77, p=0.001). A negative correlation between BDNF levels at admission and years of crack use was observed. We did not find significant changes in TBARS levels during inpatient treatment, although the completer group tended to decrease these levels while non-completers tend to increase it. These findings suggest an association between higher levels of BDNF and better clinical outcomes in crack- cocaine users after detoxification. We believe that the variation in BDNF and TBARS found here add evidence to literature data that propose that such biomarkers could be used to better understand the physiopathology of crack- cocaine addiction., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Abusive use of drugs is a public health problem worldwide. The use of these substances by pregnant or lactating women can have many serious side effects in newborns. Among the commonest causes of addiction in drug users is cocaine in powdered form, inhaled, intravenously injected or smoked form (crack). Fast screening and a confirmation test using high specificity and sensitivity instruments such as LC-MS or GC/MS, can provide data to qualify and quantify chemical substances present in biological samples such as breast milk or meconium. Cocaine and/or crack can be detected through biomarkers or the unchanged molecule, enabling the form of cocaine use to be distinguished through the analytes. These methods must be carefully developed and validated according to internationally recognized guidelines. Thus, the study of biological matrices in which it can be detected through the development of simple and quick analytical methods can help prevent intoxication and diagnose the symptoms of dependency such as seizures, especially in babies, providing appropriate medical care., (Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Rationale: Preclinical studies have shown that cocaine exposure and withdrawal are associated with cellular oxidative stress damage. However, the impact of crack-cocaine dependence on oxidative stress biomarkers remains unclear. Here, we assessed peripheral oxidative stress and antioxidant defences during two periods of crack-cocaine detoxification treatment and associated these changes with psychological morbidity., Methods: Thirty female inpatients were recruited, and plasma samples were collected at the 4th and 18th days of abstinence; 30 healthy controls were also recruited. Plasma levels of protein carbonyl, protein thiol content, superoxide dismutase (SOD), glutathione peroxidase (GPx), reduced reduced (GSH) and total reactive antioxidant potential (TRAP) were measured by standard methods; the questionnaires Cocaine Selective Severity Assessment, Beck Depressive Inventory and the Addiction Severity Index were applied., Results: We report higher oxidative stress damage after 4 days of detoxification, as shown by increased total thiol content and protein carbonylation when compared with control group and after 18 days of detoxification. After 18 days of treatment, we observed a recovery of the oxidative stress damage and increase of the antioxidant defences, as shown by higher levels of SOD, GPx, GSH and TRAP. There was a positive correlation between protein carbonylation and psychological variables; in contrast, there was a negative correlation between TRAP levels and clinical assessments., Conclusions: Taken together, these results suggest that drug rehabilitation treatment was effective in decreasing oxidative damage represented by the reduction in biological markers, which are closely related to the severity of withdrawal symptoms.

There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Rationale: An important goal of addiction research is to discover neurobiological markers that could predict the severity of addiction and help to determine appropriate treatment. Brain-derived neurotrophic factor (BDNF) and thiobarbituric acid reactive substances (TBARS) are being related to cerebral plasticity and impairment caused by substance abuse., Objectives: This study aims to evaluate alteration of TBARS and BDNF levels among crack cocaine users during early drug withdrawal and its relationship to severity of drug use., Methods: Forty-nine adults crack cocaine users were recruited at a public psychiatric hospital with a specialized addiction treatment unit. Blood sample was collected at intake and discharge for the analysis of TBARS and BDNF measures. Information about drug use was assessed by the Addiction Severity Index 6th Version (ASI-6). Detailed information about crack cocaine use was obtained through the "Profile of the crack cocaine user." Severity of crack use was estimated using information from age of first crack use, years of crack use, and crack rocks used in the previous 30 days., Results: There is a positive correlation between TBARS levels and severity of crack cocaine use (R = 0.304, p = 0.04) and a negative correlation between BDNF and severity of crack cocaine use (R = -0.359, p = 0.01) at discharge. Also, we found an inverse correlation between TBARS and BDNF levels (R = -0.294, p = 0.004) at discharge., Conclusions: Our findings suggest that BDNF and TBARS could be possible markers for the severity of drug use. Further studies may show how those markers could be related to staging, prognosis, and treatment in crack cocaine dependence.

Mortality is a significant outcome among Brazilian crack/cocaine-dependent patients yet not well understood and is under investigated. This study examined a range of mortality indicators within a cohort of 131 crack/cocaine-dependent patients admitted into treatment and meeting criteria for dependence of crack (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). After 12 years of treatment discharge, 107 individuals were reassessed and 27 death cases were confirmed by official records, wherein in its majority were caused by homicide (n = 16). In this group, survival rate was 0.77 (95% confidence interval [CI] = 0.74-0.81) and previous history of IV cocaine use was identified as a predictor of mortality (2.5, 95% CI = 1.08-5.79). High mortality rates among Brazilian crack/cocaine-dependent patients, exposure to violence, and HIV/AIDS were topics discussed in this study. This research highlights the importance of ongoing programs to manage crack/cocaine use along with other treatment features within this population., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This study describes binge use of crack cocaine, binge users, and their sexual risk behaviors in a sample of 303 African-American, HIV-positive users. Recent binge use was defined as, "using as much crack cocaine as you can, until you run out of crack or are unable to use any more" in the last 30 days. Fifty-one percent reported a recent crack binge. The typical crack binge lasted 3.7 days and involved smoking 40 rocks on average. Nearly two-thirds reported their last binge was in their own or another's home. Seventy-two percent had sex during the last binge, with an average of 3.1 partners. In multivariable logistic regression analyses, recent bingers were more likely than non-bingers to consider themselves homeless, to have any income source, to have used crack longer, and to score higher on risk-taking and need for help with their drug problem. In multivariable ordinal and logistic regression analyses, recent bingers had more sex partners in the last six months and 30 days and were more likely to have never used a condom in the last 30 days. Among male users, recent bingers were more likely to report lifetime and recent exchange of money for sex and drugs for sex. Among both male and female users, recent bingers were more likely to report lifetime trading of sex for drugs. African-American, HIV-positive binge users of crack cocaine appear to be at increased risk for HIV transmission. Further investigations of binge crack use and sexual risk behaviors and interventions targeting and tailored to this group should be considered.

Background: Little is known about the possible role that smoking crack cocaine has on the incidence of HIV infection. Given the increasing use of crack cocaine, we sought to examine whether use of this illicit drug has become a risk factor for HIV infection., Methods: We included data from people participating in the Vancouver Injection Drug Users Study who reported injecting illicit drugs at least once in the month before enrolment, lived in the greater Vancouver area, were HIV-negative at enrolment and completed at least 1 follow-up study visit. To determine whether the risk of HIV seroconversion among daily smokers of crack cocaine changed over time, we used Cox proportional hazards regression and divided the study into 3 periods: May 1, 1996-Nov. 30, 1999 (period 1), Dec. 1, 1999-Nov. 30, 2002 (period 2), and Dec. 1, 2002-Dec. 30, 2005 (period 3)., Results: Overall, 1048 eligible injection drug users were included in our study. Of these, 137 acquired HIV infection during follow-up. The mean proportion of participants who reported daily smoking of crack cocaine increased from 11.6% in period 1 to 39.7% in period 3. After adjusting for potential confounders, we found that the risk of HIV seroconversion among participants who were daily smokers of crack cocaine increased over time (period 1: hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.57-1.85; period 2: HR 1.68, 95% CI 1.01-2.80; and period 3: HR 2.74, 95% CI 1.06-7.11)., Interpretation: Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among people who were injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine.

Background: An 18-year-old adolescent with cystic fibrosis developed massive gastrointestinal bleeding., Methods: History, physical examination, upper and lower endoscopy and wireless capsule endoscopy were performed., Results: Upper and lower endoscopy did not reveal cause of persistent bleeding. Wireless capsule endoscopy revealed pan-gastrointestinal ischemic injury. Further discussion with the patient revealed recent cocaine ingestion., Conclusion: Most reported cases of gut injury following cocaine abuse describe juxtapyloric and colonic injury; this case demonstrates that ischemic gut injury after cocaine use can be extensive and may be the reason for the associated high mortality.

Crack cocaine is a highly addictive drug. To learn more about crack addiction, long-term crack smokers who had never met the DSM-IV criteria for lifetime cocaine dependence were compared with those who had. The study sample consisted of crack users (n=172) from the Dayton, Ohio, area who were interviewed periodically over 8 years. Data were collected on a range of variables including age of crack initiation, frequency of recent use, and lifetime cocaine dependence. Cocaine dependence was common with 62.8% of the sample having experienced it. There were no statistically significant differences between dependent and non-dependent users for age of crack initiation or frequency of crack use. In terms of sociodemographics, only race/ethnicity was significant, with proportionally fewer African-Americans than whites meeting the criteria for cocaine dependence. Controlling for sociodemographics, partial correlation analysis showed positive, statistically significant relationships between lifetime cocaine dependence and anti-social personality disorder, attention deficit/hyperactivity disorder, and lifetime dependence on alcohol, cannabis, amphetamine, sedative-hypnotics, and opioids. These results highlight the importance addressing race/ethnicity and comorbid disorders when developing, implementing, and evaluating interventions targeting people who use crack cocaine. Additional research is needed to better understand the role of race/ethnicity in the development of cocaine dependence resulting from crack use.

A typical approach to categorizing substance users for epidemiologic purposes or to identify substance use problems at treatment admission is by indicating the primary substance used and/or for which treatment is sought. But does such singular focus on the primary drug limit the validity of conclusions from longitudinal analysis of drug use patterns over time? This analysis combined data from five longitudinal studies conducted in California and examined 10-year patterns of heroin, cocaine, methamphetamine (meth), marijuana, and alcohol use for primary users of heroin (n=629), cocaine (n=694), and meth (n=474). Results suggest relatively low levels of use of non-primary heroin, cocaine, and meth, but moderate levels of alcohol and marijuana use. Growth models showed declining primary drug levels for heroin and meth users and relatively consistent levels over 10 years for cocaine users, while levels of non-primary drugs remained at consistently low levels or declined in tandem with the primary drug. Results indicate that group descriptions of primary heroin, cocaine, or meth use trajectories over time may present valid information about drug use patterns in general.

Crack cocaine use is associated with risky sexual behaviors and sexually transmitted infections (STIs), including HIV. We investigated sociodemographic and behavioral characteristics and infection rates in female crack cocaine users from impoverished communities of Salvador, Bahia, Brazil. A sample of 125 female crack cocaine users was recruited. Overall, the interviewees had low educational level and high rate of unemployment (close to 90%). One-third (37%) reported having traded sex for money or drugs, and 58% reported that they had not used condoms during intercourse in the last 30 days. The prevalence of infections was low: HIV-1.6%; HCV-2.4%; HBV- 0.8%; HTLV I/II-4.0%; and syphilis-4.0%. The combination of dire poverty and high prevalence of risk behaviors turn such populations a preferential target of initiatives aiming to reduce drug-related harm and promote social development. Low infection rates should not be viewed with complacency, but as a window of opportunity to implement prevention initiatives and reduce social marginalization.

Objectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose., Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months., Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age., Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.

Over the past two decades, the use of crack cocaine has become an enduring part of the social ecology of many cities across the United States. The purpose of this exploratory study is to describe patterns of crack use drawing on life history interviews conducted with 18 women in Dayton, Ohio, between 1998 and 2000. Ten of the women were African American, and eight were white. Age ranged between 23 and 47. The women were at very different stages of their crack-cocaine careers. We focus on understanding the social factors, life history, and everyday circumstances that participants related to their current patterns and levels of crack use. Implications for intervention are discussed.

The past two decades have witnessed a steady increase in the use of crack cocaine in the UK. In response to this trend the government produced Tackling Crack: A National Plan (Home Office, 2002a), which is designed to run parallel with the updated drug strategy (Home Office, 2002b). While all class A drugs have the potential to undermine individual health and the social stability of communities, it is believed crack has a particularly high potential due to its association with violent crime and community disorder (Home Office, 2005).

This article reports on the prevalence of probable mental health disorders among clients entering outpatient substance abuse treatment, their clinical characteristics, and past access to substance abuse and mental health care. Four hundred fifteen individuals (74% of those eligible) entering three publicly funded outpatient substance abuse treatment facilities in Los Angeles County were screened for a probable mental health disorder. Of the 210 with a positive screener (just over 50% of those screened), 195 (93%) were interviewed. Depression and anxiety were the most common disorders, and more than a third had two or more probable disorders. Close to 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. Our results indicate high rates of co-occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access.

The Diagnostic Interview Schedule for DSM-IV was used to assess the lifetime prevalence of psychiatric disorder among not-in-treatment crack cocaine users (N = 313). The most common dependencies involved cocaine (59.7%), alcohol (37.7%), and cannabis (12.1%). The most common nondependency disorders were antisocial personality disorder (ASPD; 24%), depression (17.8%), and posttraumatic stress disorder (PTSD; 11.8%). Comorbidity was present in 36.4% of the sample. Proportionately more white than black users were dependent on cocaine, alcohol, amphetamine, and sedative-hypnotics. More white than black users experienced ASPD, depression, PTSD, and attention deficit disorder. Proportionately fewer black users suffered comorbid disorders. Proportionately more men had ASPD, whereas more women had PTSD and phobias. Multinominal modeling revealed that black users and users with a high school education were less likely to have comorbid disorders; married users were less likely to have nondependency disorders. White crack users were more likely to have comorbidity, complicating their treatment.

Objective: Although cocaine use is a significant public health problem, there is relative paucity of scientific data on long-term neurocognitive consequences of the exposure to the substance., Methods: This study examined the association between crack cocaine dependence and neuropsychological performance. An extended battery of neuropsychological tests was administered to 15 abstinent cocaine abusers, inpatients in abstinence for two weeks, and 15 non-drug-using control subjects matched for age, gender, education, socio-economic status, handedness and IQ., Results: The preliminary findings showed statistical significance (p<0.05) on differences of performance in attention, verbal fluency, verbal memory, visual memory, learning ability and executive functions., Conclusions: These results represent evidences that cocaine abuse is associated with decrements in cognitive functioning, similar to cognitive disorders associated to prefrontal and temporal brain impairments. Knowledge of specific cognitive deficits in cocaine abusers may be useful for designing more effective substance abuse prevention and treatment programs.

A continuing social problem is presented by the large number of individuals who use crack cocaine. Recent research has identified unique pyrolysis products of crack or burned cocaine as anhydroecgonine methylester (AEME) and ecgonidine (ECD) through gas chromatography/mass spectrometry (GC/MS) that allow for the detection of crack use distinct from other cocaine use. However, there have been no large-scale studies to document the presence and prevalence of these substances in sweat. A new sweat-testing appliance called a fastpatch was developed for this study. Through mild heating and a slightly larger collection pad than a standard Pharmchek( trade mark ) sweat patch, this product shows the promise of shorter required wear periods than standard sweat patches, and possibly longer time-periods of detected use. One hundred and eighty subjects wore 360 fastpatch prototypes (one per hand). However, subsequent analysis determined that only one patch per subject was needed to obtain sufficient sweat eluate for GC/MS. Cocaine use was detected in sweat of 92% of subjects through GC/MS, comparing favorably with 91% with EMIT urinalysis. Crack metabolites were detected in 54% of subjects. The predominant analyte detected was AEME. There were no significant differences in detection rates between 15-, 20- and 30-minute wear periods. All wear periods detected both cocaine use in general and crack use successfully. These results suggest that crack use as distinct from other cocaine use can be detected in sweat and that fastpatches are a promising new way to detect drugs of abuse.

This article reports findings from a study that investigated treatment outcomes among crack/cocaine users over a 18-month period. From a cohort of 229 subjects, three groups emerged: (1) those who had reported ongoing, stable abstinence from crack/cocaine; (2) those who had consistently used during the period; and (3) those who reported cycling between abstinence and use during the follow-up period. Analyses of variance (ANOVA) were conducted to compare the three groups in terms of intake characteristics, including demographic profile, previous treatment, motivational factors, and functioning in seven Addiction Severity Index (ASI) domains. Length of time involved in aftercare and Twelve Step participation after treatment were also contrasted among the three groups. Results showed that subjects who achieved sustained abstinence from crack/cocaine also did better in other domains such as employment, family, legal, and psychiatric than others. Stable abstinence was also significantly associated with a longer period of aftercare and frequent attendance at Twelve Step programs. Logistic regression analyses further estimated the significant impact of the posttreatment factors on the achievement of sustained abstinence. The implications of these findings for treatment services research are discussed.

Foreign body aspiration in adults has a variety of clinical presentations and often goes unrecognized. We describe the case of a patient who experienced crack cocaine aspiration and presented with symptoms of an acute asthma exacerbation requiring mechanical ventilation until the eventual diagnosis and bronchoscopic removal of the foreign body.

Bilateral thumb burns on a young woman admitted to the hospital with the diagnosis of community-acquired pneumonia led us to consider the diagnosis of crack lung despite the fact that the woman denied cocaine use. Cocaine was found on a urine toxicology study, and its use was subsequently confirmed by history. The patient was treated for crack lung with complete resolution of her symptoms and radiographic findings. Inspection of the hands for burns consistent with handling cocaine pipes should prompt a consideration of crack lung in patients with pulmonary infiltrates.

Schizophrenia patients show alarmingly high rates of substance use disorders. These patients experience neurocognitive and social deficits that make it difficult for them to benefit from effective treatment strategies designed for less-impaired populations. Previously, we described Behavioral Treatment for Substance Abuse in Schizophrenia and discussed how the program was adapted for this population. Here we provide an update of BTSAS, discuss our clinical experience running the intervention, and review how it has changed over five years of development. We present attendance, participation, and substance use data on patients who consented to attend (n = 42), completed (n=14), and dropped out (n = 14) of the program. Outcome data are provided for 14 patients, and comparisons are made between good (n = 5; > or = 67% of urine tests clean from a goal drug over 6 months) and poor (n = 9; < or = 66% of urine tests clean) progress patients. Implications for the treatment are discussed.

The Medical Outcomes Study Short Form 36 (SF-36) was administered to 443 not-in-treatment, crack-cocaine smokers to explore the relationship between frequency of crack, alcohol, and tobacco use, addiction to these drugs, and health status. The reliability of the SF-36 with crack smokers was also assessed. Statistically significant, negative associations emerged between frequency of crack use and all SF-36 subscales except physical functioning. There were not significant associations between frequency of alcohol or tobacco use and any SF-36 subscale. Self-assessed addiction to crack was strongly and negatively associated with all SF-36 subscales: alcohol and tobacco addiction were also negatively associated with health status, but not to the degree of crack. The SF-36 produces reliable data on the health status of crack users and, as such, may have a useful role in assessments involving crack-using populations.

Currently, little research has investigated psychosocial functioning among juvenile crack dealers, and there appear to be few studies comparing dealers to nondealing juvenile offenders. The current study examined whether juvenile crack dealers display more severe conduct-disordered behavior than their nondealing delinquent peers. The records of 130 adolescent males committed to a residential training school were studied. Analyses indicated that crack dealers were younger when first arrested, had more arrests and commitments, and met more DSM-III-R conduct-disorder criteria than their nondealing delinquent peers. In addition, the DSM-III-R conduct-disorder criteria met by dealers were more severe, and dealers were more likely to be rearrested within six months following release. Overall, significant differences between crack dealers and nondealing juvenile offenders were found; dealers displayed a more delinquent history and a more serious and violent conduct disorder than their nondealing yet delinquent peers.

The study evaluated the relationship between age and frontal and temporal lobe volumes in young cohorts of cocaine-dependent (CD), amphetamine-dependent (Am), and normal control subjects. Ten CD, nine Am, and 16 age- and gender-matched control subjects underwent magnetic resonance imaging (MRI). The volume of the frontal and temporal lobes was measured from an identically positioned slab of seven contiguous 3-mm-thick coronal images. Follow-up measures of the gray and white matter subcomponents of these volumes were also obtained. Both CD and Am groups had a significantly smaller temporal lobe volumes, but only the CD group demonstrated a significantly greater decline in temporal lobe volume with age (intracranial volume, education, and race were controlled for in all statistical analyses). Segmenting the brain regions into gray and white matter revealed that the negative correlation between age and temporal lobe volume of CD patients was mostly due to a significant age-related decline in the gray matter subcomponent. Negative trends between age and gray matter volumes were also observed in the Am and normal groups. In the frontal lobes, age was negatively correlated with gray matter volume in the control, CD, and Am groups. Unlike the consistent decreases in gray matter volumes, white matter showed non-significant increases in volume with age. The data suggest that CD patients may have an accelerated age-related decline in temporal lobe gray matter volume and a smaller temporal lobe volume compared to normal controls. In the frontal lobe, age-related gray matter volume reductions occur in all three groups. These age-related cortical gray matter volume reductions may be a biological marker for the risk of addictive behavior, which also decreases with age.

Recent trends in the progression of the AIDS epidemic in the United States indicate that women's rates of acquiring HIV are escalating more rapidly than are men's. Consequently, there has been both an increasing interest in and a need for research targeting substance-abusing women's involvement in HIV risk behaviors. In recent years, strong suggestive evidence has arisen to suggest that women who use crack cocaine are at an elevated risk for acquiring HIV, probably as a result of their involvement in high-risk sexual behaviors. The present study is based on a sample of 1723 women from 22 locales around the United States who used crack cocaine at least once during the previous 30 days but who reported never having injected drugs at any point in their lifetime. Women were divided into four groups based on their frequency and intensity of using crack. In subsequent analyses, this grouping was used to predict the extent to which female crack users engage in five sexual risk behavior measures (number of sexual partners, number of drug-injecting sexual partners, number of times having sexual relations while high on alcohol and/or other drugs, number of times trading sex for drugs and/or money, and proportion of all sexual acts involving the use of protection). The data revealed that the women who used crack with the greatest frequency and the greatest intensity were the most heavily involved in risky sexual behaviors. They differed quite sharply from their lower-intensity and/or lower-frequency crack-using counterparts in terms of their HIV risk behavior involvement and in terms of their actual HIV seroprevalence rates.

Clinical observations have indicated that alcohol may be employed by cocaine/crack users to attenuate negative effects of cocaine, especially when "coming down" from a cocaine binge. This issue was examined by interviewing 66 dual cocaine/alcohol users, with opiate dependence histories, enrolled in methadone treatment. A path analysis model was specified to test several hypotheses concerning the possible modulating effects of alcohol use on cocaine use. About 60% of the subjects reported often employing alcohol to ameliorate discomfort associated with tapering or ceasing cocaine/crack use. The main findings were: (a) more intense cocaine/crack craving and feeling that cocaine/crack use was out of control both led to increased use of alcohol to come down; (b) the more frequently alcohol was used to come down, the less use of cocaine/crack; and (c) more cocaine/crack use and more use of alcohol to come down both led to increased heavy alcohol use. Thus, treating alcohol abuse in this population must take into account the important function it serves in modulating cocaine/crack use.

Background and Purpose: Cocaine and its metabolites can produce vasospasm, and cocaine-dependent patients are at increased risk for stroke. Based on previous case reports, we hypothesized that the incidence of hyperintense brain lesions observed on T2-weighted MR images would also be increased in asymptomatic cocaine-dependent individuals., Methods: Sixty-two male "crack" (smoked) cocaine-dependent participants ranging in age from 25 to 66 years were compared with 116 normal male control participants ranging in age from 25 to 80 years. Those with histories of neurologic symptoms or illnesses were excluded. The severity of hyperintense lesions was rated on a 0- to 3-point scale, and ratings of 3 were used in the data analysis as an indicator of a probable pathologic process. Three regions were separately rated: the cerebral white matter, insular subcortex white matter, and subcortical gray matter (basal ganglia and thalamus region)., Results: Significantly increased risk of severe lesions was observed in the two white matter regions of the cocaine-dependent group (odds ratio of 16.7 and 20.3) but not in the subcortial gray matter region (odds ratio of 1.4). In the insula subcortex white matter, the risk of lesions increased with age in the cocaine-dependant sample, but remained essentially absent among normal controls through the age of 80 years. In the cerebral white matter, the relationship of age and risk of lesion among normal participants was similar in shape to that in cocaine-dependent participants, but equivalent risk was seen 20 years earlier among cocaine-dependent participants., Conclusions: Cocaine-dependent participants had a significantly increased age-related risk of white matter damage. The possible clinical implications of this damage are discussed.

This article presents an outcome study of the Family Rehabilitation Program (FRP), a unique network of community-based programs in New York City that provides comprehensive services to families with drug-dependent parents, most caring for prenatally cocaine-exposed newborns. An admission sample of 173 mothers in 17 FRP sites was studied for one year; substance use was assessed by hair analysis and self-report. Mean length of retention was 10 months; half the clients were still active in the program at follow-up. Mothers completing or still active in FRP had higher rates of abstinence and substantially lower average levels of cocaine in their hair at follow-up than those exiting prematurely. The percent of families with children out of their homes did not increase significantly between admission and follow-up, and completing or remaining active in the program were associated with less out-of-home placement at follow-up.

Background: Cocaine is an alkaloid prepared from the leaves of the Erythroxylon coca plant. It is widely recognized as one of the most dangerous illicit drugs in use today. The U.S. Substance Abuse and Mental Health Services Administration estimates that 23.5 million Americans have used cocaine at some time in their life. Corneal defects from crack cocaine were first described in 1989 and later named crack eye syndrome in 1993., Case Report: A 40-year-old man reported to the eye clinic reporting vigorous eye rubbing after repeated exposure to and use of crack cocaine. A corneal infiltrate with an overlying epithelial defect developed and the man was treated with ciprofloxacin, homatropine, and diclofenac. This case presents background information concerning the systemic and ocular manifestations of cocaine, as well as the clinical presentations of crack eye syndrome, with recommendations on treatment., Conclusions: A thorough social history should be elicited when patients who have unilateral or bilateral corneal defects of unknown origin are examined, or when treating persons with no other known risk factors for corneal disruption. Prompt recognition and treatment are the main factors in successful management of crack eye syndrome.

Crack cocaine users are at high risk for HIV, with higher frequency crack users engaging in higher rates of HIV-related sexual risk behaviors. This study will assess the variables impacting changes in crack use frequency. Out-of-treatment crack users were street recruited in East Harlem, NY. Subjects (n = 727) were 33% female, 91% minority, and 28% reported recent drug injecting. Baseline and 6-month follow-up interviews were administered. There was a significant reduction in crack use over time (p < .0001). Subjects were categorized according to five groups, based on their change in level of crack use between the two interviews, to predict those who stopped, maintained, or changed their level of use. Discriminant analyses identified six variables as the best predictors of the five groups, including having been in drug treatment since baseline and having been a drug injector (both related to reduced levels of crack use). The overall reduction in crack use for the sample masked the fact that important subgroups remained at high use levels or increased their use. The identification of subgroups who may be most resistant to reducing drug use can be helpful in developing more effective interventions.

The epidemic of cocaine abuse has led to numerous studies on the substance. While extent of use, characteristics of users, patterns of use, and consequences of dependence are well documented for both powder cocaine and crack, few studies have dealt with the sequence or progression of use between the two forms of cocaine. This paper draws on arrestee data collected from county jails in Los Angeles, California. It identifies four sequences of powder cocaine and crack use and examines each sequence in terms of user characteristics, history of use, dependence, contact with the criminal justice system, and concomitant use of other drugs. Findings not only confirm some already established observations, but also offer new knowledge on powder cocaine and crack abuse. For instance, (a) whereas powder cocaine-initiated users are more likely to progress to crack than to restrict their use to powder cocaine only, crack-initiated users tend more often to use crack only than to progress to powder cocaine; and (b) powder cocaine and crack, when used interchangeably, can interact and reinforce each other, resulting in a higher level of use and dependence on both forms of the substance. This paper contributes to the understanding of powder cocaine and crack use among criminal offenders, in particular, and across the adult population, in general. It also sheds light on prevention, treatment, and social control policies of both cocaine abuse and overall illicit drug use.

Despite the significant emergence of research on female addiction over the last two decades, specific research on African-American women substance abusers, particularly crack cocaine users, is limited. The identification of meaningful subgroups of substance abusing populations, particularly minority women is important both clinically, and because of their over-representation in the epidemiological data on crack cocaine use in many urban centers across this country. An extensive battery of instruments was administered to 110 women entering treatment in an intensive outpatient substance abuse treatment program in Philadelphia, serving women who are primarily indigent, African-American, and whose primary substance of abuse is crack cocaine. Factor analysis and cluster analysis procedures were utilized to classify women into subgroups across relevant clinical, behavioral, and background concerns relevant to studying substance abusing populations. Five conceptually meaningful subgroups emerged which classified women across various indicators such as HIV sex risk factors, personality traits/Axis II dimensions, clinical syndromes, psychological symptomatology, lifetime and recent drug and alcohol use, prior physical and sexual abuse, and social context variables such as parental addiction, and whether they live with a substance abuser. Attempts to classify women into identifiable clinical subtypes is essential in order to better inform treatment initiatives designed to serve this group, as well as prevention and community outreach intervention strategies which attempt to bring them into treatment.

This article assesses the reliability and validity of the Cocaine Selective Severity Assessment (CSSA), a measure of cocaine abstinence signs and symptoms. Interrater reliability and scale internal consistency were high. Initial CSSA scores were significantly higher in cocaine-dependent subjects than in alcohol-dependent subjects. Initial CSSA scores were highly correlated with recent cocaine use and with severity measures from the Addiction Severity Index (ASI) including the interviewer severity rating and composite score in the drug section. Among cocaine-dependent subjects, initial CSSA scores were higher for those who failed to achieve abstinence or who subsequently dropped out of treatment. Further, CSSA scores showed consistent and marked declines over time for subjects who continued in treatment and remained abstinent. The CSSA appears to be a reliable and valid measure of cocaine abstinence symptoms and a useful predictor of negative outcomes in cocaine dependence treatment.