Blocking Out Drugs?

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Seven people in Alberta have developed a form of immune system suppression after consuming cocaine laced with a chemical compound

Seven people in Alberta have developed a form of immune system suppression after consuming cocaine laced with a chemical compound, public health officials said Friday.The individuals developed agranulocytosis, a condition that makes the immune system incapable of fighting off infections.It makes common infections become serious, even fatal, quite quickly."We are advising anyone who develops a fever or other signs of infection and has used cocaine to seek medical attention quickly," Dr. Gerry Predy, Alberta's Acting Chief Medical Officer of Health, said in a news release."Any skin abscess or lung infection that develops rapidly should also be treated immediately."Officials have linked the cases to cocaine laced with levamisole, a chemical compound developed to treat intestinal worms in humans and animals.The cases were reported in Edmonton, Red Deer, and in undisclosed locations in southern and northern Alberta.Doctors in Alberta have been advised they should test and treat patients for this condition if they complain of a fever or other signs of infection after using cocaine.
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Voters in Switzerland go to the polls to decide whether to make a controversial heroin prescription programme a permanent, nationwide health policy

Voters in Switzerland go to the polls on Sunday to decide whether to make a controversial heroin prescription programme a permanent, nationwide health policy
The Swiss government supports the idea but opponents say it encourages drug addiction, and sends the wrong message to young people.
Throughout the 1980s and early 1990s Switzerland had one of the highest rates of heroin addiction in Europe.Open drug scenes in cities such as Zurich, Basel and Bern were common, with addicts injecting and dealers selling publicly in the streets and parks.Users often shared needles, leading to a sharp rise in HIV infection rates, and in the spread of Hepatitis.In an attempt to reduce the spread of such diseases, if nothing else, the Swiss health department began introducing needle exchanges, followed by clean injection rooms where addicts could take heroin in a safe environment, supervised by a nurse.For many health professionals, the next logical step was to start prescribing heroin to those addicts, many of them already ill, who really did not seem able to get off drugs.
I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead
In 1998 Switzerland introduced an experimental 10-year heroin prescription programme. Today around 1,300 patients across the country are on the programme.
Dr Christoph Buerki says his clinic in Bern serves 210 such patients."Their average age is 40 now, and they have an average of 13 years of heroin addiction before they enter this programme. Basically we are aiming at a group of people where everything else has failed," he says.Dr Buerki's patients have to have tried abstinence treatments at least twice before being eligible for heroin prescription.
The majority have also tried and failed to stay on a methadone maintenance programme. Methadone in fact remains the more common maintenance treatment in Switzerland, with over 16,000 patients.Dr Christoph Buerki says his patients have some chance of a normal life
Jan, 33, is one of the clinic's first patients on a Thursday morning. He has been an addict since he was 20, and for the last eight years he has been on the heroin prescription programme."At first I didn't want to come here," he says, as he rolls up his trouser leg to make the injection."I thought this was just the lowest of the low but, well, I am an addict. And I've got a job now, and two sons, so I live a pretty normal life."My kids just know that Dad is sick and has to take medicine every day, that's all."And Dr Buerki shares the view that long term addicts like Jan are actually ill, and need to be treated as such."These are patients with a chronic, relapsing disease that might go with them for the rest of their lives," he says.
But opponents of heroin prescription, like Sabine Geissbuhler of the association Parents Against Drugs, say that attitude is exactly what is wrong."When heroin prescription was first introduced, it was touted as a 'treatment'," she says."But treatment means the goal should be people get off drugs eventually - they stop being addicts - and that's just not happening.""It's an outrage," she continues, "that the state should give addicts heroin - it's poison. You don't give people poison to make them better.""It would be more shocking if we just let them die," counters Maria Chiara Saraceni, a drugs policy expert with the Swiss federal health department.
Heroin was very 'in'... But now people who take heroin have the image of losers, of junkies."It's the government's responsibility to help everyone, and not to judge them."If this is what they need to live a more stable life, and to get off the streets, then that is what we should offer."But Ms Geissbuhler is not convinced.
"That's not a life," she insists. "I have four children, and I would never, never, put them into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead."But whether a life is worth living or not can be a very personal, subjective thing.Jan, who leaves the clinic every day to go to work, then returns in the evening for a second injection before picking up his son from nursery, views his life as normal, and even contented."I'm just like everyone else," he insists. I get up in the morning, I go to work, I do my job responsibly, I go home to my family in the evening. And at the weekend I'm the Dad my kids want me to be."But the fact remains that Jan may well be on heroin for the rest of his life.
Very few patients on the programme have so far managed to get off the drug for good, and in that sense heroin prescription does not fit with Switzerland's chief goal on drug use, which is abstinence.Doctors like Christoph Buerki accept that their patients will be with them for many years to come. Instead he points to another, unexpected side effect of the programme.The heroin clinic dispels any myth of heroin being glamorous"Heroin was a very 'in' and fashionable thing to do in the 1980s and early 1990s," he explains. "But now people who take heroin have the image of losers, of junkies."I mean look at this place," he says, gesturing to his small, rather run-down clinic, and the lines of patients, most of them middle aged, waiting for injections.
"Nobody thinks this is a good thing - it's not cool to go to a clinic like ours to get heroin twice a day."We've medicalised heroin in Switzerland - it has the image of an ugly illness, and that is why, I think, numbers of new addicts are falling.Very few young people are turning to heroin in Switzerland these days."And that is the argument that may well sway many Swiss voters.Keeping hundreds of people on heroin through old age and right to the ends of their lives is a rather shocking prospect, but polls suggest the Swiss may accept it, if it means their streets are free of illegal drug use, and their young people see heroin not as a glamorous rock star's drug, but as a sad, banal, old people's habit.
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David Marks, 47, admitted burgling two homes, stealing two cars and asked for a further 19 burglaries to be taken into consideration.

David Marks, 47, admitted burgling two homes, stealing two cars and asked for a further 19 burglaries to be taken into consideration. Judge John Lafferty jailed the drug addict for 65 weeks, but suspended the sentence for two years. The judge told Lafferty, who has 42 previous convictions for 92 house break-ins: "You have been given a chance. "If you don't take this chance, you and I will meet again."
Snaresbrook Crown Court heard Marks "relapsed" in April and May this year when he returned to crime. Marks, who offered advice as a "recovering addict" to young and homeless people through the Christian charity, failed to practise what he preached when he found himself sleeping rough. He was arrested on April 17 this year in Barking Road, Plaistow, after police spotted him behind the wheel of the Italian hatchback. Later that month, Marks targeted a four-bedroom terraced house in Portway, Stratford, east London, smashing a front door window, but failing to gain entry as the entranceway was double locked. Marks was tracked using DNA evidence after cutting himself and smearing blood on the inside door of the porch. On May 9, Marks ransacked a home in New North Road, Hainault, Essex. Marks was arrested on June 25 after his fingerprint was found on a plastic bag containing a crowbar in the hallway. Judge Lafferty ordered Marks complete a six-month rehab programme, comply with an 18 months' supervision in the community, and reside in hostel accommodation for the duration of his treatment.
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Drug Dealing in Japan

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Steven Page to face drug charges today in New York court

News Barenaked Ladies frontman Steven Page to face drug charges today in New York court FAYETTEVILLE, N.Y. - Barenaked Ladies frontman Steven Page is set to appear in a New York state court Tuesday to face drug possession charges laid after his July arrest in upstate New York. The 38-year-old singer, his 27-year-old girlfriend Christine Benedicto and her 25-year-old roommate Stephanie Ford were all charged in July after police found cocaine at a Fayetteville apartment.
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Asian elephant spent three years in rehab for heroin addiction in southwest China

Asian elephant that spent three years in rehab for heroin addiction in southwest China has been declared unfit to be returned to
the wild, zoo authorities have said.The four-year-old elephant, Xiguang, was captured from the China-Myanmar border in March 2005 by illegal traders who fed him heroin-laced bananas. Five other elephants along with Xiguang were also captured by the smugglers, but the animals were captured by police two months later. Four of them, including Xiguang, were later sent to a wild animal protection centre in the southern Hainan Island. Xiguang was cured of his addiction after a three-year treatment that included methadone injections five times stronger than human doses.
The four elephants were brought back to the Yunnan Wild Life Park last month and will spend the winter at the Xishuangbanna Wild Elephant Valley in Yunnan. "Three years of domestic life and a huge amount of rehabilitation medication has changed the physical situations, odours and habits of Xiguang and the other elephants," said Pan Hua, the park's deputy manager. "They may become the target of attacks by other beasts if they are sent back to the wild. Some are easily irritable now and may hurt humans. They can't go back to the wild anymore," he said. The elephants will stay in the valley and be cared for by zoo keepers. The Asian elephant is the largest land animal in the region, with an estimated 50,000 living in the wild throughout the continent.
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Jeff Dubay to be charged Wednesday in Ramsey County District Court with possessing a small amount of cocaine.


attorney for KFAN Radio personality Jeff Dubay said he expects his client to be charged Wednesday in Ramsey County District Court with possessing a small amount of cocaine. Dubay was arrested last Wednesday night after his car was pulled over in Maplewood. Incorrect reports as to what charges he could face appeared on a news website, indicating a connection to methamphetamine. At least one television report also mentioned Dubay in connection with meth."On behalf of Mr. Dubay we're relieved that the formal charges will be brought forward so all the misinformation that was swirling in the press can be clarified and dispelled," said Mark D. Kelly, a St. Paul-based attorney. "I think there was a lot of distress when the allegations regarding methamphetamine and the misinformation on [the] website was posted that this was something that it wasn't. People relied on that to their detriment and to Jeff's detriment."Kelly said Dubay would have no comment Tuesday.The incorrect information linked Dubay to a crime that, according to Kelly, carries with it a presumptive prison sentence and involves six or more grams of something that could include methamphetamine.Dubay was arrested on suspicion of a fifth-degree possession of a controlled substance, which is a felony. Dubay could end up in a pre-trial diversion program, meaning the matter would stand to be dismissed after 12 months without any criminal conviction on his record provided he complies with the conditions the court imposes. Dubay, who has co-hosted the "PA and Dubay show" with Paul Allen on KFAN (1130 AM) since 1998, has not been on the air since his arrest and is currently on a leave from the station. Dubay also does work on Gophers men's hockey games for FSN North but did not appear last weekend. He was off the KFAN airwaves for an extended period this summer.Executives from the Clear Channel-owned station have had no comment about Dubay's job status. Allen did read a statement about his co-host on Monday morning that essentially expressed his support.
If the charges are filed against Dubay, the next step will be for a court date to be set. He likely will appear before a judge in the next few weeks in Ramsey County District Court."We will respond to the charges in due course," Kelly said. "There were multiple media outlet sources that got this story wrong and repeated it incorrectly. It was basically one source and that was somebody who had misread the Minnesota statute with regards what was put on the [Ramsey County] booking website."
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Interesting video of jungle based cocaine factory

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Actor Ryan O'Neal faces felony drug possession charges in his arrest last month at his Malibu home, his lawyer said.

Actor Ryan O'Neal faces felony drug possession charges in his arrest last month at his Malibu home, his lawyer said. O'Neal is best known for his roles in the movies "Love Story" and "Paper Moon." the 67-year-old actor and his 23-year-old son Redmond were formally charged Wednesday.They were arrested Sept. 17 for alleged drug possession after sheriff's deputies said they found methamphetamine during a probation visit to the house in a previous drug case involving Redmond.Redmond is said to have been in possession of drugs when investigators arrived while a vial of methamphetamine allegedly was found in Ryan O'Neal's room.Both father and son are facing one count of felony possession of a controlled substance, two misdemeanor counts of possession of drug paraphernalia and one count of illegal possession of pepper spray, Those were not Ryan's drugs, he doesn't use drugs, and has nothing to do with them," the actor's lawyer Mark Werksman told People magazine shortly after his arrest. "It's a dangerous assumption for deputies to have arrested Ryan just because he was in proximity to the drugs. ... I have full confidence that Ryan will be vindicated." O'Neal's attorney didn't offer an explanation as to how the drugs might have ended up in his bedroom as police said, or to whom they may have belonged.
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Redmond O'Neal ordered into a two-week treatment program Wednesday after admitting that he had relapsed.

The 23-year-old son of Ryan O'Neal and Farrah Fawcett, who was arrested along with his dad last month on suspicion of methamphetamine possession, was ordered into a two-week treatment program Wednesday after admitting that he had relapsed."You're a stand-up guy to come here and deal with your problem," Los Angeles Superior Court Judge Scott Millington told Redmond, who also checked into rehab in 2004 to treat a heroin addiction. "I want you to stay clean…You better stay clean or the hammer is going to fall."An attorney for the O'Neals didn't immediately respond to a request for comment.No criminal charges have been filed against either Redmond or his dad in connection with their Sept. 17 bust at the elder O'Neal's Malibu home during a routine probation checkup. Officers allegedly found Redmond to be in possession of what looked like meth, as well as a small vial of the stuff in his father's bedroom.
At the time of their arrest, Redmond was about two months into a three-year probation sentence for DUI and possessing heroin and crystal meth.Ryan O'Neal has maintained his innocence in the affair, his lawyer telling reporters that his client would no doubt be vindicated."Those were not Ryan's drugs, he doesn't use drugs, and has nothing to do with them," attorney Mark Werksman said. "It's a dangerous assumption for deputies to have arrested Ryan just because he was in proximity to the drugs."Redmond, meanwhile, characterized the situation as a "major misunderstanding. "Life goes on, you know," he told a pack of paparazzi who followed him home from a market the day after his arrest. "It's all I have for you, really...If I knew more, I'd tell you more."
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According to new government figures, around 12m people in the UK drink hazardously

According to new government figures, around 12m people in the UK drink hazardously – over the recommended guidelines of two to three units a day for women and three to four units a day for men, the equivalent of two to three small glasses of wine a day. Over 800,000 people (four times the estimate 10 years ago) are hospitalised in the UK annually because of alcohol-related illnesses and accidents, at a cost of £2.7 billion. Around 600,000 underage Britons are estimated to be drinking alcohol recklessly and illegally. Pressure groups, like the Alcohol Health Alliance, blame the government’s liberal drink policies, especially the availability of alcohol 24/7 from many supermarkets. Yet immediate access to alcoholism treatment is available for only five in every hundred alcoholics (one in a hundred in the northeast). And there’s no dedicated budget for alcoholism. Contrast that with the UK’s 300,000 drug users, whose treatment access is virtually 100%, with a budget this year of £600m. This access mismatch, in the view of specialists and GPs, reflects the perception that alcoholism is largely the responsibility of those afflicted. As a result, according to a survey conducted by Mori and a London teaching hospital, a third of Britain’s GPs are encouraging alcoholics to detox by themselves at home without professional help. Professor Ian Gilmore, president of the Royal College of Physicians, warns of the dangers of unsupervised detoxes. “It’s hazardous, and things can go badly wrong,” he says. “In any case, detox is just the first step on a long rehab journey requiring professional help.” Colin Drummond, professor of addiction psychiatry at the Maudsley hospital, south London, echoes that warning: “A detoxed person is like a car without wheels; it’s the weeks and months of follow-up counselling and talk therapy that matter. And self-detox is dangerous.” So what are the dangers? There are no hard figures for detox deaths. They melt into the 20,000-plus alcohol-related fatalities in the UK each year: deaths caused by everything from liver failure to road accidents, from brain seizures to suicides. The detox hazards lurk within a set of arcane percentage stats. According to data provided to The Sunday Times Magazine by Professor Drummond, about 20% of patients with high alcohol consumption will have epileptic fits, or seizures, on a detox withdrawal. This proportion is considerably higher in people, like Tom, with many previous detoxes as well as severe alcohol dependence. Of those who have seizures during detox, about 3% progress to a prolonged epileptic state lasting 20 minutes or more. This in turn carries a mortality rate of 20%. About 5% of patients in alcohol withdrawal also develop delirium tremens, which can be fatal in about 35% of cases if untreated. A further claimed danger involves brain damage due to a lack of thiamine, vitamin B1, during detox. “Hence it’s dangerous,” says Professor Drummond, “to expect a severely alcohol-dependent patient to self-administer, or an untrained relative or friend to oversee, withdrawal drugs without medical supervision.”
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CNN reporter Richard Quest has returned to the cable news channel after a hiatus stemming from his drug arrest and court-ordered counseling

CNN reporter Richard Quest has returned to the cable news channel after a hiatus stemming from his drug arrest and court-ordered counseling, a spokesman for the Atlanta-based network said on Friday.Quest, known for his boisterous and quirky reporting, returned to CNN International in late June and has been producing general news segments and working on the August edition of "CNN Business Traveler," the show he hosted before his arrest, said Nigel Pritchard, a spokesman for CNN.
"We're very pleased to have him back," Pritchard said.Police stopped Quest, 46, in April for being in New York's Central Park past curfew, and they discovered a bag of methamphetamines on the British reporter.A judge ordered him to undergo six months of counseling in exchange for having the case dismissed.
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Locklear, a former star of drama show Melrose Place, was arrested on Sunday (Monday NZ time) after allegedly driving eratically down a Santa Barbara freeway.She was found by police sitting in her car blocking traffic.News agency Associated Press reported the woman who reported Locklear to police was photographer Jill Ishkanian, who sold photos of the star's arrest for US$27,000.a spokesman for Ishkanian said the photographer called police because she felt it was her "civic duty" and feared for Locklear's safety."The fact she witnessed Ms Locklear's erratic driving and reported it to the police did not mean she was disqualified from reporting the story, which she in fact did," the spokesman said.
Santa Barbara County prosecutors are waiting for test results to decide whether to pursue charges against Locklear.
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Boy George says the best thing about Narcotics Anonymous meetings


Boy George says the best thing about Narcotics Anonymous meetings is that “you can sit down and not say a word”. That I would love to see. He is impossibly candid, his tumbling words roughened by that gravelly, camp brogue and flurries of laughter: half-nervy, half-playful. Despite all the therapy and self-help he has immersed himself in, he’s as opinionated and indiscreet as ever. Today he’s got advice for Amy Winehouse and George Michael. He claims to have renounced drugs for good. He bellows across a car park for a cigarette lighter. George says he gave up drugs – specifically cocaine – last October, after returning from New York, where he swept the streets in orange overalls as his punishment for wasting police time. He had admitted to falsely reporting a burglary at his Manhattan apartment; when the police arrived prosecutors said they found 13 plastic bags of cocaine. Boy George said they weren’t his and charges of cocaine possession were later dropped. “It was surreal and quite fun,” he says of the street sweeping, apparently now inured to being the centre of media firestorms, although the US authorities continue to deny him a work visa, which means he cannot tour there. “But that’ll be sorted out,” he says airily. He has a new single. He’s just starting a UK tour. “Everything’s great.” Is it? There’s a rather large elephant in the room. George, 47, is due back in court next month in London, charged with falsely imprisoning a 28-year-old man in a flat he lived in temporarily in East London in April 2007. “I will be pleading not guilty, of course,”
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Heather Locklear arrested in California for allegedly driving under the influence


Heather Locklear,has been arrested in California for allegedly driving under the influence.The 47-year-old actress is best known for her television roles on "Spin City," "Melrose Place" and "Dynasty." She was arrested for suspicion of DUI and being under the influence of a controlled substance Saturday.
"Around 4:30 p.m., a female witness saw Heather Locklear driving erratically while leaving a parking lot in Montecito," California Highway Patrol spokesman Tom Marshall told People magazine. "The witness said Locklear was revving her engine loudly and backed over a pair of sunglasses several times. ... The witness called 911 because she was concerned for Locklear's safety. When a CHP officer arrived, Locklear was found seated inside her vehicle, which was partially blocking the roadway."Marshall said Locklear was taken to a nearby police station because she seemed "disoriented and impaired.""Alcohol was ruled out as a factor but, based on the officer's observations, we believe Locklear was under the influence of prescription medication," Marshall said.
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sensor that changes color in the presence of cocaine


Researchers in China and Singapore have created a sensor that changes color in the presence of cocaine. The sensor is fast and portable, and even minute quantities of blow will cause the material to change from red to dark blue.The key ingredients in the chemochromic material are gold nanoparticles and DNA aptamers (artificial nucleic-acid receptors that have a high affinity for certain ligands). The aptamer–nanoparticle composite is stable and red in colour. When cocaine is present, it binds to the aptamer, liberating the aptamer from the nanoparticles. This leads to the aggregation of nanoparticles in a salt solution, turning it blue.
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Ian Donohoe collapsed at home while he was watching TV

Ian Donohoe (25), Adare Green, Coolock, Dublin, collapsed at home while he was watching TV on November 1st, 2007, Dublin City Coroner's Court heard yesterday.
His brother John and girlfriend Gemma Howard, with whom he lived, rushed to his aid when they heard strange breathing sounds coming from the sitting room.
There they found Mr Donohoe in difficulties, his face discoloured.He was rushed to the Beaumont Hospital where he was pronounced dead a short time later. A postmortem found Mr Donohoe had an enlarged heart, most likely due to the effects of using cocaine over time, coroner Dr Brian Farrell said.Ms Howard told the court her boyfriend used cocaine regularly until she became pregnant, approximately four months before his death."His death is drug-related, but it's not a drug overdose," Dr Farrelly said. "It's a cardiac event and I believe it's as a result of using cocaine over a period of time. We know cocaine can cause enlargement of the heart."
He recorded a verdict of death by misadventure.The coroner expressed his condolences to the members of Mr Donohoe's family and to his girlfriend and friends on their loss.

"He was a young man of 25 with most of his life ahead of him, but we believe the cocaine caught up with him in the end and caused his death."
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Jade Goody said she took crack in an attempt to dissuade her mother Jackiey, who was addicted.


Former Big Brother contestant said she took the drug in an attempt to dissuade her mother Jackiey, who was addicted
"I decided to show her how nasty and heartbreaking it was to see a member of your family - your own flesh and blood - killing themselves in front of your very eyes," Miss Goody said."I took some of her crack, put it in a Rizla paper to make a joint, and I smoked it. I felt dirty and disgusting. 'How does it make you feel watching me do this?' I asked."However Miss Goody said that her efforts were in vain and that her mother continued to use the drug.In her new autobiography, Miss Goody explained that her mother's boyfriend Danny was a bad influence. She said: "Danny was heavily into coke and liked to beat me up in his spare time."She also admitted that as a young child she regularly saw her father Andrew smoke and inject drugs.The admission follows news last month that Miss Goody, who became famous in 2002 when she appeared on the third series of Big Brother, is suffering from cervical cancer. Shortly after she was told of her condition, her boyfriend, Jack Tweed, was jailed for assault.
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Cocaine is used by more than 13 million people worldwide, about 0.3 percent of the global population age 15 to 64 years.

Cocaine is used by more than 13 million people worldwide, about 0.3 percent of the global population age 15 to 64 years. Use and abuse are most prevalent in North America (6.3 million people, 2 percent of population older than 14 years) and South America (2.7 million people, 0.94 percent) and in Western Europe (3.4 million people, 1 percent). Current use in the United Kingdom and Spain has reached the levels of the US. There is relatively little cocaine use in Africa, Asia, Eastern Europe, and Oceania. This pattern may be due to supply rather than demand factors, because of the difficulty in obtaining cocaine from its only source in South America and the ready availability of alternative synthetic stimulants such as amphetamines.
Most cocaine use is by urban men age 15 to 35 years. About 126,000 (6.2 percent) current users in the US are adolescents 12 to 17 years old. Cocaine use has declined somewhat among this age group in the last few years, but has remained steady in older groups. More than one-quarter of past year cocaine users (more than 1.5 million) meet psychiatric diagnostic criteria for cocaine abuse or dependence. Yet in 2004, only 884,000 cocaine users received substance use treatment.
Cocaine is the illegal drug most often associated with visits to US hospital emergency departments. In 2005, it was involved in an estimated 31 percent of drug-related emergency department visits (about 450,000 visits), versus about 17 percent (240,000 visits) for marijuana and about 11 percent (165,000 visits) for heroin. Almost one-fifth of cocaine-related visits were by patients seeking detoxification; 3.2 percent were for suicide attempts.
Patterns of use — Cocaine is used in a variety of patterns. The typical “binge” involves short periods of heavy use (eg, payday or weekends) separated by longer periods of little or no use. Others may use for an extended period until their finances are exhausted or access to cocaine is interrupted. A small number of users who are self-medicating an underlying neuropsychiatric disorder, such as attention deficit hyperactivity disorder (ADHD) or narcolepsy, may use low doses daily without dose escalation over time. Most cocaine users living in the community do not use very frequently. Half (49.1 percent) of past year users used less than 12 times in the year; only 2.5 percent used at least 300 times.
Risk factors for use and abuse — While cocaine use occurs in all sociodemographic groups, it is not equally distributed among the US population. The highest prevalence of use is among unemployed men in their 20s with no more than a high school education who live in urban areas. Cocaine use is highly associated with use of other legal and illegal substances and with psychiatric disorders. Cigarette smokers and heavy alcohol drinkers are 10 times more likely than others to be cocaine users. Among current (past month) cocaine users, 92 percent use alcohol and 79 percent smoke cigarettes (73 percent use both). Almost half are heavy drinkers (five or more drinks on the same occasion on at least five days in the past 30 days). Concurrent use of cocaine and alcohol produces a new compound, cocaethylene, which is pharmacologically active. Many cocaine users use other substances either to enhance the “high” (eg, simultaneous use of opiates ["speedballing"]) or to ameliorate adverse effects of intoxication or withdrawal (eg, use of alcohol, cannabis, or benzodiazepines). Current cocaine users are twice as likely as non-users to have symptoms of depressive or anxiety disorders. Among past year cocaine users, almost one-quarter reported serious psychological distress during that year.
Cocaine users are at high risk for abuse or dependence. Community-based interview surveys suggest that up to one in six persons who use cocaine will become dependent. Heavier users and users who take the drug intravenously or by smoking are more likely to become dependent than lighter users or intranasal and oral users. The greater abuse potential of intravenous or smoked cocaine is attributed to the faster rate of drug delivery to the brain (within 10 seconds), and faster onset of psychological effects. This faster onset is associated with a more intense pleasurable response (the so-called “rate hypothesis” of psychoactive drug action).
The environment (including family, religious, and social factors) has the strongest influence on initial cocaine use. Studies of drug use by pairs of fraternal (dizygotic) and identical (monozygotic) twins suggest a significant genetic influence on the risk of developing cocaine abuse or dependence after use has begun. Several promising candidate genes have been identified, including those for dopamine receptors and the dopamine transporter, but no specific gene has been clearly linked with cocaine addiction. Cocaine enhances monoamine neurotransmitter (dopamine, norepinephrine, and serotonin) activity in the central and peripheral nervous systems by blocking the presynaptic reuptake pumps (transporters) for these neurotransmitters. Cocaine’s positive psychological effects and abuse liability are considered to be due to its enhancement of brain dopamine activity, especially in the so-called corticomesolimbic dopamine reward circuit. Thus, cocaine addiction has been termed a disease of the brain’s dopamine reward system.
Cocaine is unique among stimulant drugs in having a second action of blocking voltage-gated membrane sodium ion channels. This action accounts for its local anesthetic effect, and may contribute to cardiac arrhythmias.
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