Cocaine and speedball users: differences in psychopathology

Depressive Symptoms Following Recent Sexual Assault: The Role of Drug and Alcohol Use, Acute Stress, and Assault Characteristics

Sexual assault is a common traumatic experience that can have a wide-ranging impact on psychological functioning, including experience of depressive symptoms. Although many studies have examined lifetime rates of depression among those with sexual assault history, less is known regarding risk factors for depressive symptoms following recent sexual assault. The study examined whether drug use history is uniquely related to depressive symptoms following recent assault. N = 65 individuals, 95.4% female; 73.8% White; M(SD)_age = 28.89 (10.29), who had recently experienced sexual assault (less than 60 days) and completed a SAMFE (sexual assault medical forensic examination) were interviewed via phone and completed questionnaires regarding depressive and acute/post-traumatic stress symptoms and substance use history. Demographic information as well as information related to the assault was also collected. 68.7% of the sample reported clinically significant levels of depressive symptoms (PHQ-9, Patient Health Questionnaire, scores ⩾ 12). In a linear regression adjusted for acute/post-traumatic stress (b = 0.26, p < .01) and other variables, polydrug use was significantly associated with depressive symptoms (b = 3.26, p = .04). Single-drug use (b = 0.96), physically forced sexual assault (b = -1.11), victim-perpetrator relationship (b = 0.15), prior sexual assault (b = -1.02), alcohol misuse (b = -0.09), age (b = 0.07), race (b = 2.78), and days since assault (b = -0.02) were not significantly associated with depressive symptoms (all ps > .05). Results highlight the potential role of drug use history in increasing risk of experiencing clinically significant depressive symptoms following recent assault.

Methamphetamine Use and Its Correlates among Individuals with Opioid Use Disorder in a Midwestern U.S. City

Background: U.S. is experiencing a surging trend of methamphetamine use among individuals who use opioids. More research is needed to characterize this emerging "twin epidemic." Objectives: The study aims to identify social and behavioral characteristics associated with methamphetamine use among individuals with opioid use disorder (OUD) in the Dayton, Ohio, area, an epicenter of the opioid crisis and an emerging frontier of methamphetamine epidemic. Methods: 357 adult individuals with current OUD were recruited using targeted and respondent-driven sampling. Structured interviews collected information on social and drug use characteristics. Multivariable Logistic Regression was used to identify characteristics associated with the past 6-month use of methamphetamine. Results: 49.7% were female, and 88.8% were non-Hispanic whites. 55.6% used methamphetamine in the past 6-months, and 84.9% reported first use of methamphetamine after initiation of illicit opioids. Methamphetamine use was associated with homelessness (aOR = 2.46, p = .0001), lifetime history of diverted pharmaceutical stimulant use (aOR = 2.97, p < .001), injection route of heroin/fentanyl use (aOR = 1.89, p = .03), preference for fentanyl over heroin (aOR = 1.82, p = .048), lifetime history of extended-release injectable naltrexone (Vivitrol)-based treatment (aOR = 2.89, p = .003), and more frequent marijuana use (aOR = 1.26, p = .04). Discussion: The findings point to the complexity of motivational and behavioral pathways associated with methamphetamine and opioid co-use, ranging from self-treatment and substitution behaviors, attempts to endure homelessness, and greater risk taking to experience euphoria. More research is needed to understand the causal relationships and the association between methamphetamine and Vivitrol use. Public health responses to the opioid crisis need to be urgently expanded to address the growing epidemic of methamphetamine use.

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally representative sample involving primarily prescription opioid misuse would expand knowledge.

METHODS

Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N = 839). Cocaine-only, opioid-only, and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric, and medical conditions/events.

RESULTS

Opioid-only users were the largest group (n = 622), followed by cocaine-only (n = 144) and co-users (n = 73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions, or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment.

CONCLUSIONS/IMPORTANCE

This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

An exploration of alcohol use severity and route of drug administration among persons that use heroin and cocaine

BACKGROUND

Alcohol use is prevalent among populations of persons that use illicit drugs. Problematic alcohol use among persons that use heroin and cocaine has been associated with poor treatment adherence, abstinence maintenance, and mental health concerns. Fully exploring how alcohol use severity interacts with route of administration (ROA) may be of notable importance in development of treatment protocols for persons that use heroin and cocaine.

METHODS

Data from a neurological and sociobehavioral assessment of risk factors among injection and noninjection drug users known as the NEURO-HIV Epidemiologic Study was used in the analyses. Participants (N = 551) included those who reported their level of past-30-day alcohol use and past-6-month heroin and cocaine use.

RESULTS

Multiple logistic regression analyses found that both problematic and moderate alcohol users were significantly less likely than abstainers to report injecting heroin and cocaine. Both problematic and moderate alcohol users were significantly more likely than abstainers to snort substances.

CONCLUSIONS

Alcohol use may play a role in promoting or impeding the use of substances through certain ROAs. Treatment protocols that transition persons that use injection heroin and cocaine to noninjection use of these substances may be used in conjunction with treatments that reduce alcohol consumption as a means to reduce noninjection drug use.

Powerful behavioral interactions between methamphetamine and morphine

Use of drugs of abuse in combination is common among recreational users and addicts. The combination of a psychomotor stimulant with an opiate, known as a 'speedball,' reportedly produces greater effects than either drug alone and has been responsible for numerous deaths. Historically, the most popular speedball combination is that of cocaine and heroin. However, with the growing popularity of methamphetamine in recent years, there has been increased use of this drug in combination with other drugs of abuse, including opiates. Despite this, relatively little research has examined interactions between methamphetamine and opiates. In the current research, behavioral interactions between methamphetamine and the prototypical opiate, morphine, were examined across a variety of dose combinations in Sprague-Dawley rats. The combination of methamphetamine and morphine produced stimulation of behavior that was dramatically higher than either drug alone; however, the magnitude of the interaction was dependent on the dose of the drugs and the specific behaviors examined. The results demonstrate complex behavioral interactions between these drugs, but are consistent with the idea that this combination is used because it produces a greater effect than either drug alone.

Behavioral economic analysis of opioid consumption in heroin-dependent individuals: effects of alternative reinforcer magnitude and post-session drug supply

This study investigated the extent to which hydromorphone (HYD) choice and behavioral economic demand were influenced by HYD unit price (UP), alternative money reinforcement magnitude and post-session HYD supply. Heroin-dependent research volunteers (n=13) stabilized on buprenorphine 8 mg/day first sampled two HYD doses (12 and 24 mg IM, labeled Drug A [session 1] and Drug B [session 2]). In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio (PR) task and could earn a HYD unit dose (2 mg, fixed) or money ($2 or $4, varied across sessions), administered immediately after the work session. Before the PR task, volunteers were told which HYD supplemental dose (none, Drug A or B) would be available 3h after receiving the PR-contingent dose. PR-contingent HYD choice significantly decreased when $4 relative to $2 was concurrently available. Information about the post-session HYD supplement moderated this effect: when subjects were told a supplemental dose was available, HYD-seeking behavior decreased when the money alternative was smaller ($2), but this information did not further attenuate HYD choice, which was already low, when the money alternative was higher ($4). HYD demand elasticity was only increased by the $4 relative to $2 alternative without the HYD supplement. In summary, opioid-seeking behavior is influenced by the availability of concurrent non-drug and drug alternatives. These findings show that drug availability and non-drug alternatives interact to modulate drug-seeking behavior.

Polydrug use among club-going young adults recruited through time-space sampling

The Club Drugs and Health Project was supported by a grant from the National Institute on Drug Abuse (R01-DA014925-02, Jeffrey T. Parsons, Principal Investigator). Christian Grov was supported as a postdoctoral fellow in the Behavioral Sciences training in drug abuse research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) with funding from the National Institute on Drug Abuse (T32 DA07233). The authors recognize the contributions of the Club Drug and Health Project team-Michael Adams, Virginia Andersen, Anthony Bamonte, Jessica Colon, Armando Fuentes, Sarit A. Golub, Chris Hietikko, Eda Inan, Juline Koken, Jose E. Nanin, Anthony Surace, Julia Tomassilli, Jon Weiser, Brooke E. Wells, and the recruitment team. An earlier version of this paper was presented at the 2008 meeting of the College on Problems of Drug Dependence (CPDD). Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18-29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the "universal compliment" as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.

Predictors and comparisons of polydrug and non-polydrug cocaine use in club subcultures

BACKGROUND/OBJECTIVES

Club drug users have been shown to tend towards patterns of polydrug use, which has been linked to adverse health outcomes, such as impaired mental health, overdose, dependence, infectious disease exposure, and decreased cognitive functioning.

METHODS

We analyzed data from the Club Drugs and Health Project, a study designed to examine the patterns and contexts of club drug use among young adults. Four-hundred recent club drug users were recruited through time-space sampling.

RESULTS

Among recent cocaine users (n = 361), 61.2% were polydrug users. Male gender was predictive of polydrug cocaine use (OR = 1.66). Gay, lesbian, and bisexual (GLB) sexual orientation, White race, and Non-Latino ethnicity were not. No differences in mental health factors were found between cocaine polydrug users and users of only cocaine. However, polydrug users were significantly more likely to score high on drug-related sensation seeking as well as to use drugs to deal with unpleasant emotions and to have pleasant times with others.

CONCLUSIONS

Prevention and intervention efforts should account for contextual and motivational factors in attempting to reduce polydrug use and its negative effects.

Psychiatric comorbidity in young cocaine users: induced versus independent disorders

AIMS

To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions.

DESIGN

Cross-sectional study.

SETTING

Barcelona, Spain.

PARTICIPANTS

A cohort of 139 young (18-30 years) adult current regular cocaine users.

MEASUREMENTS

The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders).

FINDINGS

Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders.

CONCLUSIONS

This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.

High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities

Injection drug users (IDUs) acquire the majority of new hepatitis C virus (HCV) infections and frequently use alcohol. Alcohol abuse accelerates liver disease among HCV-infected persons, can reduce the effectiveness of treatment for HCV infection and may be a contraindication for HCV treatment. HCV seropositive, HIV-negative IDUs aged 18-35 years in Baltimore, New York City and Seattle who were enrolled in a behavioral risk-reduction intervention trial underwent computerized self-interviews to assess baseline alcohol use and dependence and medical history. We measured problem alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT) scale. Of 598 participants, 84% responded "false" to: "it is safe for a person with HCV to drink alcohol". Problem drinking, defined as score > or =8 on AUDIT, was identified in 37%. Correlates of scoring > or =8 on AUDIT included homelessness, male gender, primarily injecting speedballs, having injected with used needles, prior alcohol treatment and depression. Although most HCV seropositive IDUs in our sample appear informed about their increased risk of liver disease from alcohol, two-fifths screened positive for problem alcohol use. These findings underscore the importance of referring HCV-positive persons to effective alcohol treatment programs to reduce future liver damage and improve eligibility for and effectiveness of treatment of HCV.

Heroin attenuates the negative consequences of cocaine in a runway model of self-administration

It has been presumed that the combination of cocaine (COC)+heroin (HER) is more reinforcing than either of the two drugs alone, thus leading to their coadministration ("speedballing"). An alternative hypothesis is that HER serves to attenuate the undesired negative effects of COC. To test this notion, male Sprague-Dawley rats (n=31) were trained to run a straight alley for a daily intravenous (IV) injection of COC (1.0 mg/kg/injection) for 14 trials. Studies in our laboratory have shown that such animals begin to exhibit approach-avoidance behaviors ("retreats") stemming from concurrent positive and negative associations with the goal box (which, in turn, are the result of COC's immediate rewarding and subsequent dysphoric actions). Thus, retreats can be used as a reliable index of COC's anxiogenic side effects. Following 14 COC-reinforced trials, animals were split into three groups matched on mean retreat frequency. One group (n=11) received IV COC (1.0 mg/kg/injection) for seven additional trials; the remaining two groups (n=10 each) received an IV injection of COC mixed in a single solution with either a low dose (0.025 mg/kg/injection) or a high dose (0.1 mg/kg/injection) of HER. It was hypothesized that adding HER would attenuate the negative consequences of COC administration and thereby produce a reliable decrease in the occurrence of retreats. The resulting data were consistent with this hypothesis, suggesting that "speedballing" in human addicts may be motivated by a desire to reduce the negative impact of COC use.

Opponent process properties of self-administered cocaine

Over the past decade, data collected in our laboratory have demonstrated that self-administered cocaine produces Opponent-Process-like behavioral effects. Animals running a straight alley once each day for IV cocaine develop over trials an approach-avoidance conflict about re-entering the goal box. This conflict behavior is characterized by a stop in forward locomotion (usually at the very mouth of the goal box) followed by a turn and 'retreat' back toward the goal box. The results of a series of studies conducted over the past decade collectively suggest that the behavioral ambivalence exemplified by rats running the alley for IV cocaine stems from concurrent and opponent positive (rewarding) and negative (anxiogenic) properties of the drug--both of which are associated with the goal box. These opponent properties of cocaine have been shown to result from temporally distinct affective states. Using a conditioned place preference test, we have been able to demonstrate that while the initial immediate effects of IV cocaine are reinforcing, the state present 15 min post-injection is aversive. In our most recent work, the co-administration of IV cocaine with either oral ethanol or IV heroin was found to greatly diminish the development and occurrence of retreat behaviors in the runway. It may therefore be that the high incidence of co-abuse of cocaine with either ethanol or heroin, stems from the users' motivation to alleviate some of the negative side effects of cocaine. It would seem then that the Opponent Process Theory has provided a useful conceptual framework for the study of the behavioral consequences of self-administered cocaine including the notion that both positive and negative reinforcement mechanisms are involved in the development and maintenance of cocaine abuse.

The pathophysiology of cocaine abuse

Cocaine is a naturally occurring alkaloid that increases dopamine concentrations in the reward centers of the brain. There has been a marked increase in cocaine abuse over the last two decades. A neuropsychological stimulant, cocaine also reduces somnolence, increases alertness and improves concentration. However, cocaine abuse has many pathophysiological consequences. These fall broadly into four groups: pathology associated with a drug abusing lifestyle, pathology that occurs whilst intoxicated with (but not directly due to) the drug, pathology associated with drug administration and pathology resulting from pharmacological action of the drug. This review provides a detailed description of the physiological, pharmacological, and pathological effects of cocaine, and highlights the forensic and medicolegal implications of cocaine abuse.

Understanding polydrug use: review of heroin and cocaine co-use

The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment. The pharmacological reasons for cocaine use in opioid-dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co-use. We reviewed anecdotal evidence suggesting that cocaine is co-used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. 'speedball') does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid-dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self-administering laboratory animals to uncover the neurobiological correlates of specific patterns of co-use.

Four addictions: the MMPI and discriminant function analysis

Over the past twenty years many MMPI studies of substance abuse have investigated the complex relationship between personality profile and drug of choice. This work has repeatedly established that alcoholics, heroin, cocaine and polydrug addicts share 4-2/2-4 (Psychopathy and Depression) or 4-8/8-4 (Psychopathy and Thought Disorder) MMPI profiles, but that the substance abuse populations differ in the plane of severity in that general profile. The alcoholics occupy the least disturbed sector, the polydrug abusers the most disturbed level and the heroin and cocaine addicts positions of moderate disturbance. The vast majority of studies, however, cite only group means to buttress their conclusions. Our work probed more deeply into the data using Discriminant Function Analysis. With this methodology we discovered important differences between the groups, previously hidden, which may carry differential treatment implications.