Rapid assessment of drug abuse in Cameroon

The present paper describes a rapid assessment that was carried out in Cameroon from March to November 1994 and presents a summary of the findings and recommendations. It was the first rapid assessment study conducted by Cameroon in collaboration with the Economic Community of Central African States, with technical assistance from the World Health Organization and the support of the United Nations International Drug Control Programme. It was hoped that the study would help to fill gaps in the information available on drug abuser profiles, the types of drugs abused and the response of the community to drug abuse in Cameroon. In focus group discussions, key informant interviews and interviews with drug abusers, it was revealed that Cameroon was not only used by drug traffickers as a transit country, but was also a drug-consuming country. The drug consumers were both males and females from all age groups. The drugs consumed ranged from traditional drugs to imported cocaine and heroin. Cannabis was the most frequently consumed drug, followed by amphetamine-type tablets and a broad range of pharmaceuticals. Solvents were mainly consumed by street children in northern Cameroon. Local beer and gin also held a special place in society. In order to tackle the existing problems, programmes offering preventive education and alternative forms of recreation for youth were necessary, and national policies on demand and supply reduction should be harmonized.     

A comparative study of drug-related attentional bias: Evidence from Iran.

The Addiction-Stroop test has been widely used to investigate the attentional correlates of alcohol and drug abuse; however, the majority of the studies have been conducted with European and American participants. The present study tested whether Iranian drug abusers show higher attentional bias for drug-related stimuli. Participants included drug abusers (N = 53; 100% male), with a clinical history of opium and heroin abuse, who were in a Methadone Maintenance Therapy program. Only nonabusers (N = 71; 71, 54% male) with a history of having never abused of drugs or alcohol participated in the study as controls. All participants completed a computerized Persian version of classic and addiction Stroop tests. The results of a multivariate analysis of covariance (MANCOVA) showed that drug abusers had a higher attentional bias for drug-related stimuli than nonabusers, after the effects of age and education had been controlled. The results of repeating the MANCOVA (a) limited to men only, and (b) to men and women in the nonabuser sample showed that the observed difference in the drug-related attentional bias of drug-abusers and nonabusers was not an artifact of gender imbalance. Our findings support the idea that drug-related attentional bias is culture-free. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social context and perceived effects of drugs on sexual behavior among individuals who use both heroin and cocaine.

Researchers have identified the association between the use of cocaine and sexual behavior as an important risk factor for HIV infection and have attempted to elucidate the nature of this association. Several lines of research have suggested that facilitation of sexual behavior during intoxication with cocaine may be because of the direct pharmacological effects of the drug (e.g., increase in sexual desire), whereas others have pointed to the importance of factors related to the context of drug use (e.g., opportunities for sexual behavior, expectations about the effects of the drug, social norms). The present study explored the perceived effects of cocaine and heroin on sexual behavior, as well as the social context of drug use as a function of drug type (cocaine vs. heroin), among 46 inner-city drug users who reported a history of regular use of both crack cocaine and heroin. Results indicated that compared to heroin, cocaine had deleterious effects on participants' perceived sexual desire and performance. Despite such deleterious effects on sexual behavior, cocaine was more frequently used with an intimate partner than heroin. Furthermore, participants did not differ in the extent to which they used the two drugs in other social contexts (e.g., with friends, family, or neighbors). These preliminary results suggest that the relationship between cocaine and sexual behavior, especially among long-term cocaine users, may be facilitated by opportunities for sex that exist in the context of cocaine use, rather than by the pharmacological effects of the drug. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of heroin and cocaine concentrations in saliva with concentrations in blood and plasma

Saliva is an alternate biological matrix for drug testing that has several advantages over more traditional fluids such as blood and urine. Collection is rapid, noninvasive, and relatively easy to obtain. Several reports have detailed the appearance of drugs of abuse in saliva, but few have compared the excretion profiles of drugs administered by different routes. In this study, subjects were administered three smoked and three intravenous doses of heroin in an ascending dose design. Blood and saliva were collected periodically after drug administration and analyzed by gas chromatography-mass spectrometry (GC-MS) for heroin, 6-acetylmorphine, and morphine. In a second study, subjects were administered a single, smoked dose of 40 mg cocaine base and an intravenous dose of 44.8 mg cocaine HO on separate occasions. Plasma and saliva were collected and analyzed by CC-MS for cocaine, anhydroecgonine methyl ester (AEME), and seven additional metabolites. Heroin and 6-acetylmorphine were detected in the first saliva sample collected (2 min) following drug administration by both routes. Peak heroin concentrations were achieved quickly, between 2 and 5 min after intravenous administration and at 2 min after smoke heroin. Peak heroin concentrations in saliva after smoking heroin base ranged from 3534 (2.6 mg) to 20,580 ng/mL (5.2 mg), and after intravenous administration, concentrations ranged from 6 (10 mg heroin HCl to 30 ng/mL (12 mg heroin HCl. Saliva concentrations of heroin declined rapidly after intravenous administration, reaching the limit of sensitivity of the assay (1 ng/mL) by 60 min. Heroin concentrations in saliva after smoking declined slowly; detection times ranged from 4 to 24 h. Cocaine was the major analyte detected in saliva and plasma after smoked and intravenous administration. Peak saliva cocaine concentrations after intravenous administration ranged from 428 to 1927 ng/mL (N = 7); after smoking, they ranged from 15,852 to 504,880 ng/mL (N = 7). Peak plasma cocaine concentrations after intravenous administration ranged from 122 to 442 ng/mL A = 7), and after smoking, concentrations ranged from 46 to 291 ng/mL A = 7). The thermal degradation product of cocaine, AEME, was detected in saliva but not in plasma after smoking. Peak saliva AEME concentrations were achieved at 2 min and ranged from 558 to 4374 ng/mL (N = 7). These are the first reported observations of heroin and metabolites in saliva following heroin smoking and of AEME in saliva after smoking cocaine base. The presence of AEME in saliva may be useful as a marker of the smoked route following cocaine administration.     

Scaling drug use: An examination of the popular wisdom.

Examines the literature dealing with the relationship between the smoking of marihuana and the use of heroin reveals that the literature almost exclusively deals with previous marihuana smoking among heroin addicts while taking little account of marihuana smokers who do not go on to use heroin. The other drugs involved in the progression from marihuana to heroin are frequently implied but otherwise ignored. The present study examined the drug-using patterns, based on self-reports, of 1,606 adolescent students in halifax in terms of scalogram analysis (guttman scaling). Results indicate that drug use is not a unidimensional phenomenon. Several attempts were made at scaling the use of drugs, but they failed to meet the criteria for guttman scales. It was possible, however, to scale the drug use of 1 subgroup of students, those who had smoked marihuana. This 4-item scale (containing 2 contrived items) had a coefficient of reproducibility of .92. The 4 items were stimulants, tranquilizers (barbiturates and lsd), other hallucinogens, and opiates. (french summary) (37 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences in criminal activity between heroin abusers and subjects without psychiatric disorders--analysis of 578 detainees in Bilbao, Spain

The association between drug abuse and criminal activity has been deeply established, but the nature of this relationship is controversial. The incidence and types of criminal activity were analyzed in 837 arrests of 578 subjects who were also interviewed for psychiatric diagnosis and evaluation of criminal responsibility. There was a significant prevalence of heroin abuse/dependence (50.5%) in the sample. Another 124 subjects (21.5%) in whom no psychiatric disorder could be observed were considered as the control group. Heroin abusers were younger (26 years, SD 5.9) than controls (29 years, SD 11.2) and showed some different ethnic characteristics. Heroin abuse/dependence was the most important risk factor (O.R. = 10.15) for criminal recidivism. Females were more related to nonviolent criminal activity than males. There was a higher incidence of offenses against property among heroin abusers (burglary 57.8%; robbery 19.5%) than in the control group (burglary 15.3% robbery 4.8%). In contrast, aggression or resistance to police authorities and nonfatal offenses against persons were more frequent among controls (12% and 13.7%, respectively) than among heroin abusers (3.7% and 3%, respectively). The results of this study confirm the hypothesis of a relationship between criminal activity and heroin abuse/dependence, probably based on financial needs. However, the association seems not to be a single and direct cause-effect relationship, as other factors show influence on the criminal activity.     

The impact of law enforcement activity on a heroin market

It may be argued that seizing large quantities of heroin being imported into the country should decrease its supply and hence increase its price, resulting in a reduction in the quantity of the drug being purchased or consumed. To date, however, there has been no empirical evidence that heroin seizures in Australia have any effect on the price of heroin at street level. This article describes a 2-year research study during which the price and purity of street-level heroin were regularly monitored. It was found that heroin seizures had no effect on the price, purity or perceived availability of heroin at street level. It was further found that admissions to methadone treatment were not affected by the price or perceived availability of heroin or by local arrests for heroin use/possession, nor was any relationship found between these arrests and the price of street-level heroin. Nevertheless, two-thirds of those who sought entry to local methadone programmes indicated the price as a reason for stopping using heroin. This paper argues that supply-side law enforcement should only be used as a strategy for maintaining high heroin prices if the demand for heroin can be shown to be price-elastic and, further, that the costs of such a strategy need to be weighted against the benefits.     

Personal social networks and HIV status among women on methadone

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.     

Illicit drug use by persons with disabilities: insights from the National Household Survey on Drug Abuse

OBJECTIVES: This study sought to evaluate the association of drug use with disability in a representative sample of the US household population. METHODS: The use of illicit drugs and alcohol reported by respondents in the 1991 National Household Survey on Drug Abuse who identified themselves as "disabled, unable to work" was compared with respondents without disabilities. RESULTS: Among younger adults (18-24 years), persons with disabilities were more likely than those without disabilities to report that they had used heroin (adjusted odds ratio [OR] = 6.89; 95% confidence interval [CI] = 1.35, 35.1) or crack cocaine (OR = 6.38; 95% CI = 1.05, 38.6). Among older adults (35 years and older), persons with disabilities were more likely to report the use of sedatives (OR = 2.46; 95% CI = 1.21, 4.94) or tranquilizers (OR = 2.18: 95% CI = 1.08; 4.42) not medically prescribed. CONCLUSIONS: These results suggest that use of illicit drugs is a potentially serious problem among persons with disabilities and requires both research and clinical attention.     

The effects of housing costs on polydrug abuse patterns: A comparison of heroin, cocaine, and alcohol abusers.

This study evaluated how price of housing affects hypothetical purchasing decisions. Participants (26 heroin, 28 cocaine, and 15 alcohol abusers, and 25 controls) were exposed to 4 conditions in which they "purchased" drugs, food, housing, and entertainment. Whereas income remained constant, housing prices varied across conditions. Except for 23% of heroin abusers, participants purchased housing regardless of cost, so that income increased as housing cost decreased. Demand for food was income inelastic, whereas demand for entertainment was income elastic. Each group showed income elastic demand for their drug of choice. Hypothetical choices were reliable; drug choices were correlated with urinalysis results, and willingness to forgo housing in the simulation was correlated with time spent homeless in real life. This study shows that changes in housing prices may affect choices for drug and nondrug reinforcers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Single- Versus Dual-Drug Target: Effects in a Brief Abstinence Incentive Procedure.

The number of drugs targeted may have an important influence on the ability of drug abusers to abstain during motivational incentive procedures. The authors investigated outcomes in methadone maintenance patients (n = 58), who had evidence of both opiate and cocaine use, when continuous abstinence from cocaine only (single target) or from both cocaine and heroin (dual target) was required to earn $200 in voucher incentives over a 4-day period. Study patients were equally likely to initiate and sustain abstinence from cocaine under the single- versus the dual-drug target. They were more likely to initiate opiate abstinence under the dual-target condition, demonstrating sensitivity to reinforcer effects. Results suggest that adding a second drug target does not impede short-term cocaine abstinence initiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoked heroin and cocaine based (speedball) combinations in Rhesus monkeys.

The purpose of this investigation was to compare the self-administration of heroin and cocaine base, alone and in combination, in rhesus monkeys (Macaca mulatta) self-administering a combination of heroin (0.1 mg/kg/delivery) and cocaine base (1.0 mg/kg/delivery) via the smoking route. Smoke deliveries were contingent on completion of a chained fixed ratio (FR; lever press), FR 5 (inhalation) schedule. The lever press FR values (64, 128, 256, 512, and 1,024) represented increasing drug price. Demand functions (Consumption x Price) were obtained for the heroin and cocaine combination and compared with previously determined demand functions for smoked heroin and cocaine alone. As the FR increased and the number of responses emitted increased, the number of drug deliveries decreased. The demand functions were not different for heroin versus cocaine alone or for cocaine alone versus the cocaine-heroin combination. However, the demand for heroin alone was significantly less than the demand for the cocaine-heroin combination, suggesting that smoked cocaine base enhances the behavioral effects of smoked heroin. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marijuana use by heroin abusers as a factor in program retention.

20 primary heroin abusers who remained in a voluntary drug-free treatment program for an average of 9 mo were carefully matched with 20 not-retained control Ss. Retained Ss reported their extent of marihuana use (but not other drugs) at time of admission to be significantly greater than matched controls. Additional analyses using 100 other Ss supported these findings concerning 2-mo retention. Results indicate that marihuana was used by the retained Ss as a heroin substitute and that those who used marihuana were more apt to remain in the treatment program than those who did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An MMPI comparison of polydrug and heroin abusers.

Researchers recently have resurrected the relevance of the addiction-prone personality hypothesis for explaining drug abuse by faulting previous studies for failing to control non-drug-related S background characteristics. This notion was tested by comparing MMPI clinical and content scores of 122 polydrug and 132 heroin abusers under conditions in which covariates were controlled and not controlled. The covariates age, education, socioeconomic status, and admission status interacted significantly but did not change results. Polydrug abusers consistently scored higher than heroin users on clinical scales, but differences for multivariate ANOVAs and analyses of covariance were either not significant or not large enough to be clinically meaningful. The variety of personality types found for both heroin and polydrug abusers is interpreted as refuting the notion that one personality type is addiction-prone. Contributions of personality to drug abuse remain suspected but as yet unspecified. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments

OBJECTIVE: To evaluate an experimental heroin maintenance programme. Design: Randomised trial. SETTING: Outpatient clinic in Geneva, Switzerland. SUBJECTS: Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. INTERVENTION: Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance). Main outcome measures: Self reported drug use, health status (SF-36), and social functioning. RESULTS: 25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up. CONCLUSIONS: A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.     

Socio-familial characteristics of black male heroin addicts and their nonaddicted friends

To determine whether family, peer, and school variables are associated with divergent heroin-use patterns or career outcomes, we interviewed 183 black male heroin addicts, experimenters, and non-heroin users from Chicago's south side. While subgroup differences on socio-familial variables generally were not statistically significant, we did observe a number of trends in the expected direction. For example, addicts were more likely than experimenters or nonusers to come from broken homes, to have friends who were involved in serious types of drug use and other illegal activities, and to drop out of high school. At the same time, the pervasiveness of some of our measures of "social disharmony" across the sample suggest that, at least in some inner-city black neighborhoods, these patterns are perhaps becoming the norm.     

Dependent opioid users assessed for methadone treatment in Otago: patterns of drug use

AIMS: To provide detailed information about the types of drugs used and the patterns of drug use for injecting drug users presenting for methadone treatment. METHODS: A retrospective case note review was carried out for 126 consecutive clients who were assessed for methadone treatment in the Otago province over a 2 year period. Patterns of drug use in the three months prior to presentation were recorded. RESULTS: Over 60% of those presenting were using three or more opioid drugs, with the most common being homebake (63%), sustained release morphine sulphate tablets (62%), buprenorphine (52%), opium poppies (50%) and methadone (41%). Use of diacetylmorphine (heroin) was reported primarily by those returning from recent overseas travel. Most clients reported the regular use of multiple other of clients using benzodiazepines daily. Almost 80% of the group were regular tobacco smokers and 11% showed evidence of alcohol disorders (abuse or dependence). Low levels of use were reported for cocaine, amphetamines, and hallucinogens. CONCLUSION: These patterns of drug use have important implications for the planning of methadone treatment programmes.