ATLANTA — Twenty-five years after the first AIDS cases jolted the world, scientists think they soon may have a pill that people could take to keep from getting the virus that causes the global killer.

Two drugs already used to treat HIV infection have shown such promise at preventing it in monkeys that officials last week said they would expand early tests in healthy high-risk men and women around the world.

“This is the first thing I’ve seen at this point that I think really could have a prevention impact,” said Thomas Folks, a federal scientist since the earliest days of AIDS. “If it works, it could be distributed quickly and could blunt the epidemic.”

Condoms and counselling alone have not been enough HIV spreads to 10 people every minute, 5 million every year. A vaccine remains the best hope but none is in sight. If larger tests show the drugs work, they could be given to people at highest risk of HIV from gay men in American cities to women in Africa who catch the virus from their partners.

People like Matthew Bell, a 32-year-old hotel manager in San Francisco who volunteered for a safety study of one of the drugs. “As much as I want to make the right choices all of the time, that’s not the reality of it,” he said of practicing safe sex. “If I thought there was a fallback parachute, a preventative, I would definitely want to add that.”

Some fear that this could make things worse. “I’ve had people make comments to me, ‘Aren’t you just making the world safer for unsafe sex?'” said Dr. Lynn Paxton, team leader for the project at the Centers for Disease Control and Prevention.

The drugs would only be given to people along with counseling and condoms, and regular testing to make sure they haven’t become infected. Health officials also think the strategy has potential for more people than just gay men, though they don’t intend to give it “to housewives in Peoria,” as Paxton puts it. Some uninfected gay men already are getting the drugs from friends with AIDS or doctors willing to prescribe them to patients who admit not using condoms. This kind of use could lead to drug resistance and is one reason officials are rushing to expand studies.

“We need information about whether this approach is safe and effective” before recommending it, said Dr. Susan Buchbinder, who leads one study in San Francisco.

The drugs are tenofovir (Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by Gilead Sciences Inc., a California company best known for inventing Tamiflu, a drug showing promise against bird flu.

Unlike vaccines, which work through the immune system the very thing HIV destroys, AIDS drugs simply keep the virus from reproducing. They already are used to prevent infection in health care workers accidentally exposed to HIV, and in babies whose pregnant mothers receive them. Taking them daily or weekly before exposure to the virus the time frame isn’t known yet may keep it from taking hold, just as taking malaria drugs in advance can prevent that disease when someone is bitten by an infected mosquito, scientists believe.

Monkeys suggest they are right. Specifically, six macaques were given the drugs and then challenged with a deadly combination of monkey and human AIDS viruses, administered in rectal doses to imitate how the germ spreads in gay men. Despite 14 weekly blasts of the virus, none of the monkeys became infected. All but one of another group of monkeys that didn’t get the drugs did, typically after two exposures.

“Seeing complete protection is very promising,” and something never before achieved in HIV prevention experiments, said Walid Heneine, a CDC scientist working on the study.

What happened next, when scientists quit giving the drugs, was equally exciting.

“We wanted to see, was the drug holding the virus down so we didn’t detect it,” or was it truly preventing infection, said Folks, head of the CDC’s HIV research lab. It turned out to be the latter. “We’re now four months following the animals with no drug, no virus. They’re uninfected and healthy.” Years of previous monkey studies using tenofovir alone had shown partial protection. The scientists thought to add the second drug, FTC, when Gilead’s combination pill, Truvada, came on the market last year.

The results, announced at a scientific meeting last month in Denver, so electrified the field that private and government funders alike have been looking at ways to expand human testing. “This is an approach we’ve considered for a long, long time,” but didn’t try sooner because AIDS drugs had side effects and risks unacceptable for uninfected people, said Dr. Mary Fanning, director of prevention research at the National Institute of Allergy and Infectious Diseases.

Tenofovir changed that when it came on the market in 2001. It is potent, safe, stays in the bloodstream long enough that it can be taken just once a day, doesn’t interact with other medicines or birth control pills, and spurs less drug resistance than other AIDS medications. The CDC last year launched $19 million worth of studies of it in drug users in Thailand, heterosexual men and women in Botswana, and gay men in Atlanta and San Francisco. A third U.S. city, not yet identified, will be added, CDC announced last week.

Because of the exciting new monkey results, the Botswana study now will be switched to the drug combination; the others are well under way with tenofovir alone. Farthest along is a study of 400 heterosexual women in Ghana by Family Health Initiative. The Bill & Melinda Gates Foundation funded it and others in Cambodia, Nigeria, Cameroon and Malawi, but the rest were doomed by rumours, including fears that scientists wanted to deliberately expose people to HIV or that study participants who got infected might not have access to treatment. In other cases, activists demanded better health care or clean needles for drug users as a condition for allowing the studies to proceed.

Such problems are “part of the HIV prevention landscape” in many foreign countries, said Dr. Helene Gayle, who formerly oversaw AIDS research for the Gates Foundation. Expense also could limit use of the drugs. Gilead donated them for the studies and sells them in poor countries at cost _ 57 cents a pill for tenofovir and 87 cents for Truvada, the combination drug. That’s more than the cost of condoms, available for pennies and donated by the truckload in Africa, but often unused. In the United States, wholesale costs are $417 for a month of tenofovir and $650 for Truvada. Still, health officials are hopeful the drugs could fill an important gap.

The National Institutes of Health is starting a tenofovir study in 1,400 gay men in Peru. Private and government funders are considering others. Tenofovir also is being tested in microbicide gels that women could use vaginally to try to prevent catching HIV. “If you’re in an area where there’s a really high HIV incidence, something that’s even 40 percent effective could have a huge impact,” Paxton said. And in the Atlanta labs where Heneine, Folks and others are still minding the monkeys, “the level of enthusiasm is pretty high,” Heneine said. “This is very promising. For us to be involved in a potential solution to the big HIV crisis and pandemic is very exciting.”
Source:www.chron.com March 2006

The present study investigated whether maternal cigarette smoking and marijuana use during pregnancy were associated with an increased risk of initiation and daily/regular use of such substances among one hundred fifty-two 16- to 21-year-old adolescent offspring. The participants were from a low risk, predominately middle-class sample participating in an ongoing, longitudinal study. Findings indicated that offspring whose mothers reported smoking cigarettes during their pregnancy were more than twice as likely to have initiated cigarette smoking during adolescence than offspring of mothers who reported no smoking while pregnant. Offspring of mothers who reported using marijuana during pregnancy were at increased risk for both subsequent initiation of cigarette smoking (OR=2.58) and marijuana use (OR=2.76), as well as daily cigarette smoking (OR=2.36), as compared to offspring of whose mothers did not report using marijuana while pregnant. There was also evidence indicating that dose-response relationships existed between prenatal exposure to marijuana and offspring’s use of cigarettes and marijuana. These associations were found to be more pronounced for males than females, and remained after consideration of potential confounds. Such results suggest that maternal cigarette smoking and marijuana use during pregnancy are risk factors for later smoking and marijuana use among adolescent offspring, and add to the weight of evidence that can be used in support of programs aimed at drug use prevention and cessation among women during pregnancy.
Porath AJ, Fried PA. Department of Psychology, Carleton University, Ottawa, Ontario, Canada K1S 5B6. aporath@ccs.carleton.ca

Source: PMID: 15734278 [PubMed – indexed for MEDLINE

The number of HIV-positive drug users who inject has reached its highest level for more than a decade.

Official data from 2005 shows that one in 62 injecting drug users (1.6%) in England and Wales are HIV-positive. This compares with one in 110 in 2002.

Last year the number of HIV diagnoses among injecting drug users rose and rates among new users are also up.

The Health Protection Agency said the rise was partly due to an increase in the numbers injecting crack cocaine.

The level of HIV infection among injecting drug users remained stable in London but saw a six-fold increase in areas outside the English capital from one in 500 (or 0.2%) in 2002 to one in 83 (1.2%) in 2005.
Source: BBC News 17th March 2006

DRUG misuse is leading more young people than ever before to show up at hospital A&E departments with chest pain.

While chest pain is perceived as being associated with older generations, the increase in heroin and cocaine abuse is becoming more and more evident in hospitals as large numbers of young people present with symptoms mimicking heart related illnesses as a direct consequence of drug misuse.

“We are seeing a big increase in the abuse of cocaine and heroin and we are now also seeing it show up in our hospitals,” said Tony Barden, regional drugs co-ordination with the HSE South East.

“Young people are now coming in with chest pains association with drug misuse. This is an indication of heart and lung damage but we are just in our infancy where damage is concerned. The picture of just how serious the problem is will become a lot clearer over the next 18 months or so.”

Tony Barden says that serious health problems associated with cocaine and heroin abuse will only get worse and lead to more heart and lung complaints among those who use drugs.

“A lot of people are going out and having seven or eight, even 10 pints, and then mixing it with cocaine,” he said. “We need to be moving towards a scenario where we are working on testing for drugs as well as alcohol among motorists.”

The recently published Drugs Misuse Report 2005 showed that while the numbers coming forward for alcohol abuse treatment had dipped, there had been a marked increase in those seeking help for heroin and cocaine.

Data from the Liaison Officer at WRH, contained in the report, showed that 409 people admitted to the hospital after collapsing, hurting themselves or suffering serious ill-health, were then referred onto addiction services.
Source: Waterford News & Star 2nd June 2006

How likely you are to becoming a cocaine addict could well depend on your genetic make up, say researchers from the Institute of Psychiatry. Some people have a gene variation which stops the production of a protein that regulates dopamine in the brain.

The researchers said that if you have two copies of this gene variation, your chances of becoming addicted to cocaine are 50% higher.

You can read about this study in the Proceedings of the National Academy of Sciences. The study was funded by the Medical Research Council (UK).

The researchers studied the DNA of 1550 people. 700 of them were cocaine abusers while 850 were not.

We all produce a protein called DAT. DAT controls the removel of excess dopamine from the brain. Cocaine inhibits the action of DAT leading to dopamine overload. The dopamine overload is what gives the cocaine abuser the “high” feeling.

Part of our genetic code controls the production of DAT. The researchers found that people who had two copies of the variant that controls DAT production were 50% more likely to become cocaine addicts.

Obviously, if you have two copies of this variant and never touch cocaine your chances of becoming addicted to it are zero. Everyone will eventually become addicted to cocaine, if they take it often enough and for long enough. People with this gene variant are more likely to become addicted sooner.

Dr Gerome Breen, head researcher, said “This study is the first large scale search for a genetic variant influencing the risk of developing cocaine addiction or dependence. The target we investigated, DAT, is the single most important in the development of cocaine dependence. It made sense that variation within the gene encoding DAT would influence cocaine dependence.”

It was found that people who had the genetic variant were more likely to inhibit the DAT response when taking cocaine.

Hopefully, this new finding may eventually help in the designing of new drugs for the treatment of cocaine addiction, say the researchers.

Written by: Christian Nordqvist, Editor: Medical News Today

Source: http://www.medicalnewstoday.com/healthnews.php?newsid=39415

Children exposed to secondhand smoke at home are more likely to carry the streptococcus pneumonia bacteria in their nose and throat, according to Israeli researchers.

A study involving more than 200 children and their mothers found that 76 percent of children exposed to secondhand smoke carried the bacteria in their noses and throats, compared to 60 percent of those not exposed to smoking. The bacteria can cause minor illnesses like ear infections or more dangerous conditions like sinusitis, pneumonia, and meningitis.

Among the mothers, 32 percent of smokers carried the bacteria, compared to 15 percent of nonsmokers exposed to tobacco smoke and 12 percent of nonsmokers not exposed to secondhand smoke.

“Since carriage in the nose is the first step in causing disease, the increased rate of carriage suggests more frequent occurrence of the disease. Indeed, active and passive smoking are associated with increased rate of respiratory infectious diseases,” said lead study author David Greenberg, M.D. “This should definitely encourage the parents not to smoke in the presence of their child, especially if this child has predisposing factors such as asthma.”
Source: Journal Clinical Infectious Diseases. April 1, 2006

Research Summary

Researchers have found that infants as young as three months old accumulate nicotine and carcinogens in their bodies when they are exposed to tobacco smoke, the Guardian reported May 12.

Authors of the study — the first to test smoke exposure on children so young — said that parents who smoking around infants could raise children’s’ risk of addiction, cancer, and other health problems later in life. “The take-home message is that parents should not smoke around their children, because they will suffer from the exposure,” said Stephen Hecht of the University of Minnesota cancer center.

The study of 144 children (ages three months to one year) who lived with family members who smoked found that 98 percent had nicotine in their urine, and 93 percent had cotinine, a marker for nicotine metabolism. Further, 47 percent of the infants had detectable levels of NNAL, a carcinogenic metabolite of cigarette smoke.

“Persistent exposure to environmental tobacco smoke in childhood could be related to cancer later in life,” said Hecht

The study appears in the journal Cancer Epidemiology Biomarkers and Prevention.
Source: The Guardian May 15 2006

LONDON (Reuters) British scientists are closer to developing drugs based on cannabis that will take away pain but also take away the “high”.

Researchers from Imperial College in London have separated cannabinoids, the active components of the popular the recreational drug, and shown that they act on both the brain and spinal cord.

The findings will allow scientists used receptors for cannabinoids on the spinal cord, particularly the areas concerned with pain processing.

By delivering drugs directly to the spinal cord to relieve pain they bypass the brain so there are no psychoactive effects.

New drugs based on cannabis are still years away but the findings are an important first step.

Source: Reuters Report July 2000.

The Age (AU)

Smoking three cannabis joints will cause you to inhale the same amount of toxic chemicals as a whole packet of cigarettes, according to research published in France today.

Cannabis smoke contains seven times more tar and carbon monoxide, the French National Consumers’ Institute concluded in research published in the April edition of its monthly magazine.

The institute tested regular Marlboro cigarettes alongside 280 specially rolled joints of cannabis leaves and resin in an artificial smoking machine.

The tests examined the content of the smoke for tar and carbon monoxide, as well as for the toxic chemicals nicotine, benzene and toluene.

“Cannabis smoke contains seven times more tar and carbon monoxide than tobacco smoke,” the institute’s magazine “60 million consumers” said.

Someone smoking a joint of cannabis resin rolled with tobacco will inhale twice the amount of benzene and three times as much toluene as if they were smoking a regular cigarette, the study said.

Smokers of pure cannabis leaves will also inhale more of these chemicals than from a normal cigarette, though the amount varies depending on the quantities.

“Smoking three joints every day — which is becoming frequent — makes you run the same risks of cancer or cardio-vascular diseases as smoking a packet of cigarettes,” the magazine said.

Cannabis is “by far” the most popular illicit drug in France, it said. The number of cigarette smokers and people drinking alcohol fell in 2005, while the number of cannabis users has increased in France over the past five years.

http://www.theage.com.au/news/world/cannabis-more-toxic-than-cigarettes-study/2006/03/27/1143330972537.html#
Source: AFP, Australian Foreign Press March 27, 2006

CANNABIS smokers risk developing emphysema 20 years before it tends to strike tobacco smokers, Australian researchers have found.

Experts say the findings suggest the potentially serious lung condition could be more widespread in cannabis smokers than first thought. The higher temperature of cannabis smoke and different inhalation behaviour may explain the greater risk.

Emphysema reduces the normal elasticity of the lungs’ airways and air sacs. Air inside the lungs has to be forced out, putting pressure on the sacs and in some cases making them collapse. It tends to strike tobacco smokers at an average age of about 65.

Matthew Naughton, head of general respiratory and sleep medicine at Melbourne’s The Alfred hospital, said the research began after a 40-year-old patient came in with a severe chest infection and was found to have large cysts, or holes, throughout the lungs.

The patient was a heavy cannabis user who smoked through a waterpipe.

Mr Naughton said his team then decided to ask other patients whether they smoked cannabis. Over the following year, they found a further 10 similar cases among regular marijuana users, aged from 28 to 50.

In just under half the cases, standard breath tests were normal and 40 per cent also had a normal chest X-ray.

A more sophisticated technique, called a computed tomography or CT scan, picked up the problems in 90 per cent of the cases, but this test would not routinely be ordered to detect emphysema.

“The pattern we were seeing with marijuana smoking was different to that seen in tobacco smoking,” Mr Naughton said.

“A tobacco smoker generally has smaller holes in the top of the lungs. What we were seeing (in marijuana smokers) was larger holes in the top and mid-part of the chest.

“It’s occurring 20 years earlier and is more advanced.”

Factors accelerating the emphysema might include the “incredibly hot” smoke from cannabis, particularly when smoked through waterpipes, compared with the smoke from filtered cigarettes, he said.

Cannabis smokers also tended to inhale more deeply and hold the smoke for longer, and marijuana might also contain other chemicals that worsened the lung damage.
Source: The Australian. March 28th 2006

“Drug abuse treatment can have important positive public health benefits even if the outcomes are less than perfect,” lead study author DL George Woody told Reuters Health. “The 12-step oriented combination of group and individual counselling worked the best, though all patients reduced their risk.”

Woody urged everyone to “support substance abuse treatment. It can do a lot of good both in the short and long term.”

In an article in the Journal of Acquired Immune Deficiency Syndromes, Dr. Woody who is at the University of Pennsylvania in Philadelphia and his colleagues report on changes in HIV risk among 487 people undergoing treatment for cocaine addiction.

Treatment was associated with an average reduction of cocaine use from 11 days per month to one day per month after six months, the authors report, with participants who received both individual and group drug counselling faring best.

Treatment participation was also associated with significant reductions in risky sex and the total risk of HIV infection, the report indicates.

Those who completed treatment showed a trend toward less sex risk and significantly less total risk than did patients who dropped out before completing their program, the researchers note.

HIV risk reduction corresponded to reductions in drug use and to improvements in psychiatric symptoms, the results indicate. This improvement was similar regardless of race, gender, sexual orientation or the presence of antisocial personality disorder.

“The fact that all treatments consisted of no more than three weekly outpatient sessions that included risk reduction counselling is worth noting,” the authors conclude, “because it suggests that reductions in cocaine use and HIV risk can be achieved at a relatively low cost, at least for a portion of the patients who seek treatment for cocaine dependence.”

SOURCE: Journal of AIDS (news -web sites) 2003;33:82-87.

Published: Monday, 20-Feb-2006

A fifth of young adults whose blood vessels ruptured inside their brain abused drugs and more than 40% had malformed blood vessels, according to a study reported Feb. 17 at the American Stroke Association’s International Stroke Conference 2006 in Kissimmee, FL.

The study included 307 patients with intracerebral hemorrhage (ICH) — a stroke caused by a blood vessel bursting inside the brain. Of the 75 patients 49-years-old or younger, 20% had drugs in their system.

“The dominant drug of abuse was cocaine, long recognized as a risk factor for ICH,” said Michael Hoffmann, MD, lead author of the study and director of the stroke program at the University of South Florida-Tampa General Hospital. “Marijuana was another frequently abused drug and is beginning to emerge as a risk factor for stroke. Amphetamines also were commonly abused.”

How these drugs make brain blood vessels prone to rupture is not clear, but is being studied, Dr. Hoffmann said.

The study analyzed the causes and outcomes of ICH patients. 24% of ICH patients in a registry at Tampa General Hospital were ages 18 to 49. Half were women, about two thirds were Caucasian, 15% were black and 12% were Hispanic.

ICH is often linked with high blood pressure in people over age 50, and in this study, 57% of those age 50 and older had it. Only 33% of ICH patients ages 18 to 49 had high blood pressure.

Of the younger patients in the study, 41% had malformed blood vessels, known as arteriovenous malformations, aneurysms or other vascular disorders. Cerebral arteriovenous malformation occurs when blood vessels in the brain develop in an abnormal tangle in which the arteries connect directly to the veins without the normal capillaries between them. A cerebral aneurysm is the bulging of the wall of an artery in the brain. Both these conditions weaken blood vessels and increase the risk of a hemorrhagic (bleeding) stroke.

The good news is that patients under age 50 who experience this vessel rupture inside the brain have better outcomes than older patients.

“Surprisingly, our study showed a low mortality rate compared to population studies,” said Dr. Hoffmann, professor of neurology at USF.

The 30-day mortality was 14.6% for the younger group, significantly lower than for older patients, whose mortality rate was 21%, he said. Previously, national population studies have found a high 30-day mortality rate for stroke patients with ICH. Some epidemiological data have suggested a 45% to 50% mortality rate, Dr. Hoffmann said.

ICH has traditionally been associated with older age groups and higher mortality rates.

Dr. Hoffmann attributes the low mortality rate in younger ICH patients to intensive neurocritical care management at Tampa General. The protocol includes decreasing intracranial pressure and using drains to prevent hydrocephalus, mechanical ventilation, sepsis control, blood pressure control and cooling.

The younger patients came into the emergency room, then were rapidly transferred to a neurocritical care unit within six hours. Typically, patients are hospitalized in the neurocritical care unit for one to eight weeks. Patients were evaluated by MRI, CT and angiography.

“This new way of thinking about how to manage patients with ICH is an important approach, and patients are reaping benefits,” Dr. Hoffmann said.

Most of the younger patients were able to live independently three to six months after their ICH, with only mild to moderate cognitive impairment that tends to improve over time, he said.

Dr. Hoffmann said the degree and nature of disability at six months is now the focus of the extension of this study.

“Intensive neurocritical care is the key to successful outcome,” Dr. Hoffmann said. “Good medical care can salvage a high quality of life after a stroke.”

The study was funded by USF Health and the Tampa General Hospital Stroke Registry. Co-author is Ali Malek, MD, USF assistant professor of neurology.
Source: http://www.hsc.usf.edu ; News-medical.net

Club drug hinders long-term recollection, while marijuana limits short-term memory By Steven Reinberg.

Adding to an already hefty body of evidence a new study finds ecstasy users suffer from long-term memory problems while marijuana smokers struggle with short-term memory lapses. The study found those who regularly took the popular club drug ecstasy were 23% more likely to report problems with remembering things than people who are drug-free. And marijuana smokers reported up to 20% more memory problems than non-users.

“There is a lot of evidence that ecstasy users are likely to use other drugs, including cannabis. Users of both substances may therefore be vulnerable to a myriad of memory afflictions, which may represent a time bomb of cognitive problems for later life,” says lead researcher Jacqui Rodgers Rodgers is with the School of Neurology, Neurobiology and Psychiatry at the University of Newcastle in England. The findings appear in the January issue of the Journal of Psychopharmacology.

Collecting data through a Web site, Rodgers and colleagues used a standard questionnaire to assess drug use among the 763 individuals who responded. They also looked closely at a subgroup of 81 ‘typical’ ecstasy users who had taken the drug at least 10 times.

The people were asked about their short-term and long-term memory. They were also asked to rank the probability of scenarios such as finding a television story difficult to follow or forgetting to pass a message on to someone.

The group of ‘typical’ ecstasy users reported their long-term memory to be 14% worse than the 483 people who had never taken ecstasy, and 23% worse than the 242 non-drug users.

“We found that people who regularly take ecstasy report experiencing long-term memory difficulties, and are 23% more likely to report problems with remembering things than nonusers,” she says.

“We also found that people who use cannabis regularly report up to 20% more memory problems than non-users, in terms of short-term memory performance,” Rodgers adds.

Rodgers team also noted the number of mistakes the people made when titling out the questionnaire.

Users of ecstasy – also known as MDMA –made 21% more mistakes on the questionnaire compared with non-ecstasy users and 29% more mistakes than people who did not take drugs at all.

These differences were the same for men and women.

“Our findings may help drug services in the U.K. and elsewhere explain the potential consequences of use, so that people can make an informed decision as to whether to take ecstasy or not,” Rodgers says.

“Users may think that ecstasy is fun and that it feels fairly harmless at the time. However, our results show slight but measurable impairments to memory as a result of use, which is worrying,” she notes. “It’s equally concerning that we don’t realy know what the long-term effects of ecstasy use will be, as it is still a poorly understood drug,” Rodgers adds. “The findings also suggest that ecstasy users who take cannabis are suffering from a double whammy, where both their long-term and short-term memory is being impaired.

“Rodgers team is planning to launch a Web site within the next two months that will include memory tests that may determine whether self-reported memory impairment is actually detectable by objective measurement.

Dr Stephen Koesters, a clinical assistant professor at the College of Medicine and Public Health at Ohio State University, says, “The study has a number of limitations, but does seem to support other studies that have been released in the past.”

“While the specific effects of MDMA are difficult to pinpoint in light of multiple drug use by many patients, self- reporting of the amount and the frequency of drug use, there is certainly a trend in the available literature that suggests memory impairment is a real side effect of MDMA use” he adds.

Whether these effects are cumulative is difficult to determine, Koesters adds.

“Current evidence does suggest that MDMA can be dangerous, both with acute ingestion and to longer-term memory impairment,” Koesters says. “With the current rate that MDMA is being abused, it is not safe to wait 30 or 40 years to see if we have a true epidemic,” he adds.

Source: Journal of Psychopharmacology. Jan 2004 Reported on www.healthday.com

Published: Monday, 20-Feb-2006

A fifth of young adults whose blood vessels ruptured inside their brain abused drugs and more than 40% had malformed blood vessels, according to a study reported Feb. 17 at the American Stroke Association’s International Stroke Conference 2006 in Kissimmee, FL.

The study included 307 patients with intracerebral hemorrhage (ICH) — a stroke caused by a blood vessel bursting inside the brain. Of the 75 patients 49-years-old or younger, 20% had drugs in their system.

“The dominant drug of abuse was cocaine, long recognized as a risk factor for ICH,” said Michael Hoffmann, MD, lead author of the study and director of the stroke program at the University of South Florida-Tampa General Hospital. “Marijuana was another frequently abused drug and is beginning to emerge as a risk factor for stroke. Amphetamines also were commonly abused.”

How these drugs make brain blood vessels prone to rupture is not clear, but is being studied, Dr. Hoffmann said.

The study analyzed the causes and outcomes of ICH patients. 24% of ICH patients in a registry at Tampa General Hospital were ages 18 to 49. Half were women, about two thirds were Caucasian, 15% were black and 12% were Hispanic.

ICH is often linked with high blood pressure in people over age 50, and in this study, 57% of those age 50 and older had it. Only 33% of ICH patients ages 18 to 49 had high blood pressure.

Of the younger patients in the study, 41% had malformed blood vessels, known as arteriovenous malformations, aneurysms or other vascular disorders. Cerebral arteriovenous malformation occurs when blood vessels in the brain develop in an abnormal tangle in which the arteries connect directly to the veins without the normal capillaries between them. A cerebral aneurysm is the bulging of the wall of an artery in the brain. Both these conditions weaken blood vessels and increase the risk of a hemorrhagic (bleeding) stroke.

The good news is that patients under age 50 who experience this vessel rupture inside the brain have better outcomes than older patients.

“Surprisingly, our study showed a low mortality rate compared to population studies,” said Dr. Hoffmann, professor of neurology at USF.

The 30-day mortality was 14.6% for the younger group, significantly lower than for older patients, whose mortality rate was 21%, he said. Previously, national population studies have found a high 30-day mortality rate for stroke patients with ICH. Some epidemiological data have suggested a 45% to 50% mortality rate, Dr. Hoffmann said.

ICH has traditionally been associated with older age groups and higher mortality rates.

Dr. Hoffmann attributes the low mortality rate in younger ICH patients to intensive neurocritical care management at Tampa General. The protocol includes decreasing intracranial pressure and using drains to prevent hydrocephalus, mechanical ventilation, sepsis control, blood pressure control and cooling.

The younger patients came into the emergency room, then were rapidly transferred to a neurocritical care unit within six hours. Typically, patients are hospitalized in the neurocritical care unit for one to eight weeks. Patients were evaluated by MRI, CT and angiography.

“This new way of thinking about how to manage patients with ICH is an important approach, and patients are reaping benefits,” Dr. Hoffmann said.

Most of the younger patients were able to live independently three to six months after their ICH, with only mild to moderate cognitive impairment that tends to improve over time, he said.

Dr. Hoffmann said the degree and nature of disability at six months is now the focus of the extension of this study.

“Intensive neurocritical care is the key to successful outcome,” Dr. Hoffmann said. “Good medical care can salvage a high quality of life after a stroke.”

The study was funded by USF Health and the Tampa General Hospital Stroke Registry. Co-author is Ali Malek, MD, USF assistant professor of neurology.
Source: http://www.hsc.usf.edu ; News-medical.net

(The Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network ( DAWN ) found that the most common single-drug suicide deaths involved opiates, followed by antidepressants and then cocaine, sedatives and anti-anxiety medications.

DAWN information showed that 7 out of 10 of the suicide deaths involved multiple drugs. The highest rates included combinations of alcohol and antidepressants, anti-anxiety medications and opiates, alcohol and opiates, and then antidepressants with opiates. One quarter of the overall deaths in the metropolitan areas and states involved multiple antidepressants.

“What this data shows is what we teach in our education presentations,” comments a supervisor at Narconon Arrowhead, which is one of the nation’s largest and most successful drug rehabilitation and education programs, “that all drugs are basically poisons and that enough of any drug can cause extreme adverse reactions and even death.”

The DAWN study of 32 metropolitan areas and six states also looked for mortality rates for drug abuse. Of the cities that were examined, Baltimore and Albuquerque had the highest rates with more than 200 deaths per million people. Another 14 metropolitan areas had drug misuse death rates that exceeded 100 per 1,000,000.

In the six states, the number of deaths related to drug misuse or abuse ranged from 74 to 697. After adjusting for population differences, the rates of drug misuse/abuse deaths ranged from 88 deaths per 1,000,000 in Maine and New Hampshire to 162 deaths per million in New Mexico.

The Drug Abuse Warning Network is a public health surveillance system that monitors drug-related hospital emergency department visits and drug-related deaths to track the impact of drug use, misuse, and abuse in the U.S.

This survey did not include any deaths from adverse reactions to drugs. Such cases would include the consequences of using a prescription or over-the-counter pharmaceutical for therapeutic purposes and include deaths related to adverse drug reactions, side effects, drug-drug interactions, and drug-alcohol interactions.

Source: I-Newswire.com Jan.2006

Medical News Today 04 Jan 2006

Young people who view more alcohol advertisements tend to drink more alcohol, according to a new study in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA Archives journals.

Young people are beginning to drink at an earlier age than ever before and their actions can have consequences ranging from poor grades to alcoholism and car accidents, according to background information in the article. Several studies have found an association between exposure to alcohol advertisements and youth drinking, but have not been able to establish causality, the authors write. The alcohol industry has no federal restrictions on its advertising but is subject to voluntary codes dictating that 70% of the audience for their advertisements be adults older than age 21. The authors report that these ads still appear frequently in media aimed at young people.

Leslie B. Snyder, Ph.D., of the University of Connecticut, Storrs, and colleagues interviewed a random sample of young people aged 15 to 26 years in 24 U.S. media markets four times between 1999 and 2001. The researchers interviewed 1,872 young people in the first wave, 1,173 of the same respondents in the second, 787 in the third and 588 in the fourth.

Young adults who reported viewing more alcohol advertisements on average also reported drinking more alcohol on average–each additional advertisement viewed per month increased the number of drinks consumed by 1%. The same percentage increase, 1% per advertisement per month, applied to underage drinkers (those younger than age 21) as well.

The authors also analyzed youth drinking in relation to advertising dollars spent in respondents’ media markets, based on information purchased from an industry source. They also purchased information about total alcohol sales in each state. “It is important to control for total alcohol consumption levels because markets with greater sales may attract more alcohol advertising from brands competing to sell in markets with more heavy drinkers,” they write. Even with this control, young people drank 3% more per month for each additional dollar spent per capita in their market. Youth in markets with high advertising expenditures ($10 or more per person per month) also increased their drinking more over time, reaching a peak of 50 drinks per month by age 25.

“Given that there was an impact on drinking using an objective measure of advertising expenditures, the results are inconsistent with the hypothesis that a correlation between advertising exposure and drinking could be caused entirely by selective attention on the part of drinkers,” the authors report. “The results also contradict claims that advertising is unrelated to youth drinking amounts: that advertising at best causes brand switching, only affects those older than the legal drinking age or is effectively countered by current educational efforts. Alcohol advertising was a contributing factor to youth drinking quantities over time.”
Source: (Arch Pediatr Adolesc Med. 2006;160:18-24) www.jamamedia.org

The chance of Dutch teenagers using hard drugs later in life is six times greater among those who use cannabis than among those who don’t. This is the conclusion of a study from Amsterdam’s Free University.

The authors of the study, which was published online ahead of print on 10 January in Behavior Genetics (www.springerlink.com, doi: 10.1007/s10519-005-9023-x), say that preventing teenagers under 18 using cannabis can be important in ensuring that they don’t move to hard drugs later.

The study casts doubt on one of the main arguments underpinning the tolerant policy towards cannabis in the Netherlands. This policy is designed to separate the markets of soft and hard drugs, thus protecting cannabis users from the criminal environment of hard drugs.

Its findings are similar to that of another study that was conducted in Australia, where cannabis remains illegal (JAMA 2003;289: 427-33
Source: BMJ 2006;332:197 (28 January)

Over 160,000 people admitted for drug addiction treatment in 2003 started using drugs before the age of 13.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a report from ongoing monitoring of the Treatment Episode Data Set (TEDS) showing an increase in the number of people in treatment for drug addiction who started at an earlier age.

The report tracked treatment admissions from 1993 to 2003 and the percentage of people in treatment who started using drugs before the age of 13 had increased from 12% to 14% during that time span. The total number of people jumped from about 114,000 to more than 162,000.

In a SAMHSA release, Administrator Charles Curie exclaimed, “Age at first use is an important predictor of the potential for serious substance abuse problems later in life. The increase in the proportion of the admissions for drug use before age 13 should be a wake-up call to parents to speak with their children early and often about the dangers of drug use.”
Source: (PRWEB) February 1, 2006

Methadone substitution has long been used as a treatment for heroin addiction. But a new 33-year follow-up study has found that equally satisfactory results are possible without recourse to long-term prescribing of opioids.

Until now there has been no long-term study of people addicted to injected heroin who have been treated without the prescribing of methadone substitute.

This study set out to look at the outcome for patients treated for injected heroin 33 years after they were first seen, and 26 years after they were first followed up. Measures included sustained abstinence from heroin, continued maintenance on methadone and deaths.

86 people with heroin addiction first seen in 1966-67 in a small town in the south-east of England were studied. At the time of diagnosis the patients were aged between 16 and 20, were single and living at home with their parents. They all injected heroin.

All the patients were treated in the local general psychiatric service, which differed from most other UK services for heroin addiction in that it did not prescribe methadone substitute for 23 years after recruitment of the patient group (i.e. until 1989).

The main provisions of the service were immediate help in times of crisis; personal counselling; regular follow-up; an ongoing relapse prevention group; and symptomatic relief with drugs other than methadone.

The first follow-up took place after six years. At that assessment 13% of the patient group were judged to have stopped using any illegal drugs, 51% were still injecting, 6% had died and 12% had experienced alcohol-related problems.

For this follow-up study, 45 of the original patient group were located and their clinical state assessed using multiple sources, including personal interviews with some of them.

It was found that 42% of the group had been abstinent for at least 10 years. 10% were taking methadone and were classified as addicted. 22% had died. 8% of the group could not be located.

The authors of this study compared their results with three other British studies. They found the death rates comparable (15%-20%), but the rates of abstinence and methadone dependency differed.

The researchers comment that it is encouraging that trend studies show agreement that the proportion of people maintaining sustained abstinence rises with time, whilst the proportion of those still addicted declines.

One worrying feature, however, is the high proportion of premature deaths, mainly due to overdoses. As overdose with opioid drugs is often mentioned as a cause of death, there is a need for closer monitoring of these drugs, and regular health screening and intervention to reduce premature deaths.

The advantages of long-term substitute prescribing of methadone are obvious in terms of increased social stability and reduction of crime. However, the researchers were struck not only by the number of premature deaths in people taking methadone, but also by the negative perceptions of life among those who are currently prescribed this opioid.

The findings of this study highlight the need to compare outcomes between people prescribed substitute drugs for addictions, and those who are not.

Reference Nehkant H, Rathod R, Addenbrooke WM and Rosenbach AF (2005) Heroin Dependence
in an English town: 33-year follow-up. British Journal of Psychiatry, 187, 421-425

Need for meth treatment programs growing dramatically

Two new surveys released today by the National Association of Counties (NACo) show that methamphetamine abuse continues to have a devastating effect on America’s communities.

One survey, “The Effect of Meth Abuse on Hospital Emergency Rooms,” revealed that there are more meth-related emergency visits than for any other drug and the number of these visits has increased substantially over the last five years. The second survey, “The Challenge of Treating Meth Abuse,” showed that the need for treatment programs for meth addiction is growing dramatically and lack of funding is an obstacle in meeting this demand.

“There is no question that meth abuse is having a devastating effect on America’s communities,” said Bill Hansell, President of NACo and Commissioner in Umatilla County, Ore. “Some states have enacted legislation that has been effective in reducing the number of local labs that produce meth. But officials in two of those states have said that the number of users has not been reduced. We still have a fight on our hands. The vast majority of meth being used today is being imported into our country. We have to find a way to treat those people that have become addicted and prevent others from becoming addicted.”

Both surveys were conducted in late 2005. The results of the emergency room survey are based on 200 responses from hospital emergency room officials in 39 states. Most of the hospitals participating in the survey are either county owned or operated. The second survey asked 200 county behavioral health officials in 26 states about drug treatment programs and how they have been affected by the meth epidemic.

A factor affecting treatment programs is that treatment for meth addiction is different from other drugs. 54% of the officials reported that the success rate is different and 44% said that the length of time in the program is longer for meth addicts. Meth users seeking treatment require special protocols and longer treatment periods than users of other drugs. said. “We hope that he will recognize the need for more funding for treatment.”

This is the second set of surveys that NACo has released on meth abuse. In July 2005, NACo released the results of two surveys it conducted on the impact of meth. The surveys reported responses from county sheriffs and police departments and from child welfare officials. The survey of 500 sheriffs and police departments showed that meth abuse is the top drug problem facing counties in America.

In an alarming number of meth arrests, there is a child living in the home. Often, these children suffer from neglect and abuse. 40% of the counties where child welfare activities are the responsibility of the county reported that out of home child placements have increased because of meth, according to the second survey released in July.
Source: www.naco.org January 18, 2006

THE connection between mental illness and the use of cannabis and amphetamines has been exposed by a World Health Organisation report that finds almost 50% of prisoners entering South Australia’s penal system had both drug and mental health problems.

Results from the study, obtained by The Australian, show that 67% of the 250 prisoners questioned at Yatala Labour prison, Adelaide Remand Centre and Adelaide’s Women’s Prison had used cannabis in the previous three months and 52% had used amphetamines.

Of the prisoners interviewed, 117 – or 47% – revealed they had a mental health disorder and a drug problem, with depression the most common illness.

They also reported having suffered anxiety and panic attacks and having harmed themselves.

The results lend weight to warnings by government and researchers that the so-called soft drugs, cannabis and amphetamines, are creating havoc in the mental health system, prisons and hospitals.

The study, which completed its first phase in October, was developed at the Royal Adelaide Hospital in conjunction with WHO and is a world-first examination of the link between drug use and mental health of people entering prison.

The “alcohol, smoking substance involvement screening test”, or ASSIST, will involve interviews with about 1200 prisoners by the end of June, or one-third of those entering South Australia’s prison system, and make referrals to drug and alcohol and mental health services.

The test results follow an agreement on Friday by federal, state and territory leaders to overhaul the mental health system, with a major focus placed on tackling the abuse of soft drugs. They also come in the wake of an announcement by the South Australian Director of Public Prosecutions, Stephen Pallaras QC, that he intends to review recent research that has linked drug use to mental health problems.

South Australian forensic psychiatrist Craig Raeside said the high rate of drug-taking by prisoners only increased the burden of mental illness.

“Crime and mental illness and drugs are part of the same triangle,” Dr Raeside said.

“If you increase the drugs then you would expect greater mental illness and greater crime.

“People who are crazy and psychotic will often do something illegal when they are affected.”

In October, Dr Raeside released figures from consultations with about 2000 people accused of crimes and referred to him by the courts. He found that 61% of marijuana users and 71% of amphetamines users had mental illnesses.

Dr Raeside then warned that cannabis and amphetamines were driving higher rates of mental illness and violence. The same month, the National Drug and Alcohol Research Centre at the University of NSW released a report on the Sydney amphetamine market and warned that users were at 11 times the risk of a psychotic episode than non-users.

The report also confirmed that ambulance and hospital emergency staff and police were often left to treat mentally disturbed amphetamines users. South Australian head of mental health services John Brayley has estimated that between 20 and 30% of patients in the state’s community mental health clinics have drug problems.

He called for more funding for social workers trained in both problems.
Source: http://www.theaustralian.news.com.au/common/story_page/0,5744,18152362% 255E23289,00.html Jeremy Roberts February 15, 2006

In a recent double-blind, placebo-controlled study, using both smoked marijuana and THC infusions, Mathew et al studied the effect of tetrahydrocannabinol (THC) on blood pressure, pulse rate and blood flow to the brain to determine the extent of the phenomenon of dizziness or faiting associated with blood pressure drop when standing up after smoking a joint. A blood pressure drop that results in fainting ‘has considerable clinical relevance. In healthy individuals, it can cause injuries including lacerations and fractures. In individuals with pre-existing cerebrovascular disorders it can lead to stroke and sudden death’. Further it complicates a variety of diseases including multiple sclerosis, diabetes mellitus, Shy Drager syndrome, nephrosis, chronic fatigue syndrome, Parkinsonism, organic dementia and cervical myelopathy’. In ‘elderly ambulatory men’ it was found to be a significant and independent predictor of mortality. 28% of those studied reported severe symptoms, both with smoked marijuana and the THC infusions. The study found that the most marked autonomic change caused by marijuana was increased pulse rate. ‘ The results of the study clearly show loss of cerebral autoregulation and postural syncope (fainting when standing up) after ingestion of marijuana/THC. However the mechanism responsible for these phenomena is unclear.

Note: the 29 subjects were all experienced marijuana smokers. The study was reviewed and approved by the Institution Review Board (IRB) at Duke University Medical Center.
Source: A transcranial Doppler study of the hemodynamics. R J. Mathew et al Pharmacology:
Biochemistry and Behavior 75 (2003) 309-318

According to the just released 46-nation Council of Europe annual report, both countries have a higher proportion of cocaine users than anywhere except Spain and Ireland tops the League’s Table for ecstasy. About 185 million people worldwide – 3% of the global population – use illegal drugs. Nearly 80% use cannabis, 20% use ecstasy and amphetamines, 7% use cocaine and 3% use heroin. The situation is now so bad that Europe is the most profitable market in the world for production and trafficking of drugs…
Source: The Scotsman, January 25, 2005.

Inbred strains of rats differ in how aggressively they seek cocaine after a few weeks of use, researchers say. The finding, posted online Jan. 18 by Psychopharmacology, is another piece of evidence that genetics plays a role in the relapse of drug-seeking behavior in humans, says Dr. Paul J. Kruzich, behavioral neuroscientist at the Medical College of Georgia and lead study author.

It also fingers glutamate, a neurotransmitter involved in learning and memory, as an accomplice in stirring the cravings and uncontrollable urges that drive some drug users to use again, he says.

“Given the right environmental stimuli, all persons addicted to psychostimulants can relapse, but potentially some people are a little more susceptible than others * it’s all about gene-environment interaction,” says Dr. Kruzich.

He took two strains of inbred rats – Fischer 344 and Lewis – with known genetic differences, enabled each to self-adminster cocaine for 14 days, then took the drug away for a week but not the levers the animals used to access it. During that hiatus, he adminstered a drug that stimulates glutamate receptors, possible targets for drugs of abuse.

He found that the F344 strain worked harder to get cocaine than the Lewis rats following treatment with the glutamate drug, suggesting they were more susceptible to relapse.

“Maybe 12-step programs and faith-based programs will be enough to keep some people from relapsing,” says Dr. Kruzich. “For others we may have to come up with medical treatments we can use on top of those to keep them from taking drugs again.”

He says there are many different versions of the hundreds of genes that may play a role in increasing the risk of relapse.

It’s known that some people become addicted more quickly than others, some literally with their first use, he says. The hardest part is not getting people to stop taking drugs: that happens when they are checked in a clinic or put in jail. The real work is keeping them from relapsing when they are out of such restricted environs, he says.

“Something happens, either they see an old colleague they have used with, they go into an old environment, they have a huge stressor in life and they start to want the drug. They have drug hunger, what we call drug craving,” says Dr. Kruzich. “When it gets bad enough, they engage in drug-seeking behavior.” His lab is working to identify the relapse trigger to use as a target for developing ways to curb craving and subsequent relapse.

His studies focus on an area of the brain called the nucleus accumbens core, a target for drugs of abuse long considered a pleasure center, Dr. Kruzich says. Drugs such as cocaine and methamphetamine stimulate release of dopamine in the nucleus accumbens. Dopamine is a neurotransmitter believed responsible for the euphoria that come with drug use. In fact, animals given dopamine blockers won’t self-adminster drugs of abuse, and dopamine has long been a focus of drug-abuse studies.

“These drugs impinge upon the reward centers of the brain that normally food, sex, survival and adaptation impinge upon,” says Dr. Kruzich. “When you are having that great piece of cheesecake and thinking, ‘Oh man,’ that is the kind of response these drug of abuse are evoking but much more so than that cheesecake could ever do.”

Glutamate, also released in the nucleus accumbens core, may play an equally important role in drug relapse, he says. Drugs such as cocaine appear to alter glutamate neurotransmission in the core, which may contribute to the rewiring of the brain that occurs with drug use. “It’s not that these drugs just damage neurons, which they can, but they rewire the circuitry of the brain so no longer is your spouse or your job or other things in your life important to you. Your brain is tricked into thinking that drugs are the most important thing for your survival,” Dr. Kruzich says.

Unfortunately, drugs that restore glutamate function also produce seizures, so scientists are looking for an indirect approach to restore the misdirected rewiring.

Source: mcg.edu/news/2006NewsRel/Kruzich011806.html

Mon Mar 24, 5:33 PM

NEW YORK (Reuters Health) – A new study in rats suggests that prenatal exposure to marijuana may affect offsprings’ behavior and memory, Italian researchers announced Monday.

The findings reaffirm advice for pregnant women and lactating women to avoid marijuana use, according to one of the study’s authors.

“We cannot say that findings in rats can be directly translated to humans,” said Dr. Vincenzo Guomo of the University “La Sapienza’ Roma in Rome via e-mail. “But we know that animal studies can generate predictive information on various aspects of human brain function and could represent an essential step in the development of interventions to manage human diseases.”

“In this regard, our findings suggest that both pregnant and lactating women should avoid the use of marijuana,” Cuomo said.

The findings are pub]ished in the advance online edition of the journal Proceeding of the National Academy of Sciences (news – web sites).

Although marijuana is one of the most widely used illegal drugs, studies of its effects on pregnant women and their offspring have had conflicting results, said Cuomo.

This may be explained by possible impurities in the drug and by the use of tobacco along with marijuana, according to Cuomo. Rigorous studies on the effects of marijuana in pregnancy are reratively rare, Cuomo said.

However, some researchers have for many years been following relatively large numbers of children whose mothers smoked marijuana during pregnancy, according to the Italian researcher. In general, their findings suggest that exposure to marijuana during pregnancy is related to later adverse effects on mental and motor development, Cuomo said.

In the current study, Cuomo’s team injected pregnant rats with a synthetic compound that is similar to a chemical found in marijuana. The daily dose in rats corresponded to the low-to-moderate dose people get when they smoke marijuana.

Among the rats born to exposed mothers, the researchers identified memory and behavioral problems. The offspring of exposed mothers were hyperactive, though this difference in behavior was not long lasting. However, rats whose mothers bad been exposed to the marijuana-like compound did have memory problems, according to the report.

The results of the study, Cuomo said, are in line with clinical data showing that the use of marijuana by women during pregnancy has negative consequences on the mental function and behavior of their children.

SOURCE: Proceedings of the National Academy of Sciences 2003/lO1073/pnas.05378491 30.

LONDON (Reuters) – Cocaine can cause serious abdominal problems as well as chest pain and breathing difficulties, a leading surgeon said on Friday.

“Abdominal complications from cocaine abuse are life-threatening and require emergency surgery,” said Luke Meleagros, of North Middlesex University Hospital, in Britain’s Journal of the Royal Society of Medicine.

With an estimated 344,000 people using cocaine and 17,000 taking crack cocaine each month in Britain, Meleagros and his colleagues fear health problems in drug users will increase, particularly in London where drug abuse is more common.

“As the number of cocaine abusers rises, we expect the accompanying health problems to spread across the country,” Meleagros said in a statement.

Cocaine is an addictive stimulant drug. Crack is a form of cocaine that comes in a rock crystal. The name derives from the crackling sound it produces when heated.

The drug can increase heart rate and blood pressure, as well as constrict blood vessels. Many cocaine-related deaths result from cardiac arrest or seizure.

“Abdominal complications are more common with users of crack cocaine and in poor, inner city areas,” said Meleagros.

“However, we suspect that there is an under-reporting or misrecognition of the problem in other areas, particularly affluent areas, as these complications occur in cocaine users as well.”

Symptoms of abdominal problems, which can occur within an hour of taking the drug, include pain, tenderness, nausea, vomiting and bloody diarrhoea.

Source: February issue (Vol. 99) of the Journal of the Royal Society of Medicine.

Cannabis use by children increases the risk of aggressive behaviour, but does not lead to them becoming withdrawn, a Dutch study says.

Previous research on the drug has linked it to “internalised” problems such as depression.

But the British Journal of Psychiatry study of 5,000 children said it was more likely to cause external problems such as delinquency and aggression.

UK experts said the “jury was still out” about such an effect.

The findings comes as figures show more UK children are being exposed to cannabis.

Last year, a report by the Schools Health Education Unit, a government research team which has been tracking young people’s experience of drugs since 1987, found over half of 14 and 15-year-olds had been offered cannabis, with one in four having taken it.

The latest study, by a team at the Trimbos Institute, a mental health research centre in the Netherlands, analysed the results of questionnaires filled in by 5,551 young people aged 12 to 16.

They found 17% had used the drug in the previous year.

Researchers found the strength of the link increased with higher use of cannabis.

However they found children who had used cannabis, but not in the previous year, were not at higher risk that those who had never used cannabis.

They also found more heavy cannabis users – children who used the drug 40 times a year or more – reported poorer school grades than those who did not use the drug.

Liberal

And researchers added that, while no link was found between cannabis and mental health problems such as depression, that did not mean there was no connection between the two for some vulnerable people

Previous studies has found that long-term cannabis use can increase the risk of depression.

Report author Harald Wychgel said the findings could be even more acute in countries which did not have such a liberal approach to cannabis – the drug is not illegal in the Netherlands.

He said: “At young ages the use of cannabis is already strongly associated with delinquent and aggressive behaviour even after controlling for strong confounders such as alcohol and smoking.”

Paul Corry, of mental health charity Rethink, said researchers were beginning to look at the links between aggression and mental health.

“There have been some studies which have found similar things, but I would say the jury is still out. What is not clear is where it is cause or effect. “Are these children already aggressive and the environment they are in increases the risk of them using cannabis?

“We have much more evidence that cannabis use is linked to feelings of anxiety and hallucinations.”
Source: BBC News January 2006

Smoking cannabis is strongly associated with delinquent and aggressive behaviour in young teenagers, a major study has found.

Researchers in the Netherlands revealed the link after surveying more than 5,500 adolescents aged 12 to 16.

The results showed that “externalising” problem behaviour, such as criminality and aggression, increased with higher use of cannabis. No similar association was found with “internalising” problems of withdrawal and depression.

The scientists, led by Ms Karin Monshouwer, from the Trimbos Institute in Utrecht, accounted for confounding influences including social background, regular smoking and alcohol consumption.

They wrote in the British Journal of Psychiatry: “This study shows that at young ages the use of cannabis is already strongly associated with delinquent and aggressive behaviour, even after controlling for strong confounders such as alcohol use and smoking.

“The strength of the associations increased with higher frequency of use, and significant associations were only present among those who had used cannabis recently.”

Cannabis users who had not taken the drug in the preceding year did not show any more signs of delinquency than teenagers who had never smoked a joint. “Heavy” cannabis use was also associated with thought and attention problems.

Marjorie Wallace, chief executive of the mental health charity Sane, said: “In the past, it has been claimed that cannabis is of less concern than it might be because it can make people withdrawn rather than aggressive.

“Some recent studies, however, have been linking aggressive behaviour with heavy use of cannabis, particularly among young people.

“Aggression can worsen the symptoms and outcomes of those who may be developing mental illness.”
Source: www.Scotsman.com 6.2.06

JULIE A. CHACKO, JARED G. HEINER, WENDY SIU, MARIE MACY, AND MARTHA K. TERRIS

ABSTRACT

Objectives: Marijuana smoking has been implicated as a causative factor in traditionally tobacco-related tumours of the head and neck and of the lung. When associated with marijuana use, such tumours occur in a much younger patient population than do similar tumours in tobacco smokers. Owing to the large number of young men with a history of marijuana presenting with transitional cell carcinoma to VA facilities, this study was designed to compare the marijuana use among young (aged less than 60 years) transitional cell carcinoma patients with that among age-matched controls.

Methods: Fifty-two men aged less than 60 years presenting consecutively with transitional cell carcinoma and 104 age-matched controls (defined by having no history of transitional cell carcinoma, hematuria, or irritative voiding symptoms, as well as unremarkable results on urinalysis and urine cytology) completed questionnaires about exposure to various potential carcinogens, including radiation, Agent Orange, smoked or processed meats, dyes, tobacco, and marijuana.

Results: Of the 52 transitional cell carcinoma patients, 46(88.5%) reported a history of habitual marijuana usage, and 72 (69.2%) of the age-matched controls gave a history of habitual marijuana use. This difference was statistically significant (P = 0) In those with transitional cell carcinoma, marijuana use significantly correlated with tumour stage, grade, and number of recurrences.

Conclusions: Marijuana smoking might increase the risk of transitional cell carcinoma.
Source: UROLOGY 61:100—104, 2006. © 2006 Elsevier Inc.

Summary

A causal association has been established between alcohol consumption and cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colon, rectum, and, in women, breast; an association is suspected for cancers of the pancreas and lung. Evidence suggests that the effect of alcohol is modulated by polymorphisms in genes encoding enzymes for ethanol metabolism (eg, alcohol dehydrogenases, aldehyde dehydrogenases, and cytochrome P450 2E1), folate metabolism, and DNA repair. The mechanisms by which alcohol consumption exerts its carcinogenic effect have not been defined fully, although plausible events include: a genotoxic effect of acetaldehyde, the main metabolite of ethanol; increased oestrogen concentration, which is important for breast carcinogenesis; a role as solvent for tobacco carcinogens; production of reactive oxygen species and nitrogen species; and changes in folate metabolism. Alcohol consumption is increasing in many countries and is an important cause of cancer worldwide.
Source: Lancet Oncology 2006; 7:149-156

By MIRIAM TUCKER, Senior Writer The annual incidence of HIV/AIDS among African Americans dropped significantly between 2001 and 2004, the Centers for Disease Control and Prevention reported.

As a result of advances in treatment with highly active antiretroviral therapy, individuals with HIV infection are living longer than before, and progression to AIDS has declined sharply. AIDS surveillance no longer provides an accurate estimate of HIV infection rates, so the CDC now recommends that all states and territories adopt confidential name based surveillance systems to report HIV infection.

Data from 33 state and local health departments with name-based reporting indicate that the incidence of HIV infection among blacks declined about 5% per year, from 88.7/ 100,000 in 2001 to 76.3 in 100,000 in 2004. Nonetheless, the HIV/AIDS rate among blacks in 2004 was still 8.4 times higher than that of whites, the CDC said (MMWR 2005;54:1149-53).

In addition to the statistically significant decline among blacks, there was a significant 9.1% annual drop among injection drug users. Overall, the average annual rate of HIV/AIDS diagnoses dropped in significantly, from 22.8/100,000 in 2001 to 20.7/100,000 in 2004.

An estimated 157,252 individuals were diagnosed with HIV/AIDS in the 33 states during 2001-2004, of whom 71% were male. Blacks accounted for 51 % of those diagnosed with HIV/AIDS, whites 29%, Hispanics 18% and Asian/Pacific Islanders 1%.

Among males, the route of HIV infection was male-to-male contact for 61 %, high-risk heterosexual contact in 17%, and injection drug use in 16%. For females, on the other hand, the majority (76%) were exposed through high-risk heterosexual contact and 21 % through injection drug use. Among black males, approximately one-fourth of HIV transmission occurred via high-risk hetero sexual contact, the CDC noted.

A significant 9% annual increase in HIV/AIDS diagnosis rates occurred among Asian/ Pacific Islanders, from 5.6/100,000 in 2001 to 7.2/100,000 in 2004, although this group continues to racial/ethnic populations.
Source: Internal Medicine News, January 1, 2006

New research shows ecstasy may leave the brain more susceptible to infection and the damage may be permanent. In experiments done on rats, researchers from Boston University Medical School discovered that ecstasy damages the blood brain barrier, which is the group of tightly packed cells which surround and protect the brain.

“What they are saying in this study is that ecstasy essentially breaks down that protection,” said Dr. Robert Margolis, executive director of Solutions Counseling, an adolescent addiction treatment center in Atlanta, Ga. “(It) makes that blood brain barrier more porous, the openings between those cells larger, and (it) makes your brain more vulnerable to having things that you don’t want in your brain like infections and germs and bacteria.”

And now, for all those who took ecstasy at parties or dance clubs, there is a question: Has the drug damaged the barrier that protects their brain?

“The thing that I think you will start to see is looking at long-term epidemiological studies where they start to at least try to find out if ecstasy users have more brain infections (or) have more strokes,” Margolis said.

He said there’s a chance the damage will be permanent. “You do not want to do anything that is going to damage your brain because that is one area of your body that does not regenerate,” he adds. “It does not fix itself.”

Angela was 15 when she first tried ecstasy and soon she was doing it every week. “Everyone always told me it would put holes in your brain and I just ignored them,” said Angela, who is now 21. “I was like, ‘Whatever, I’m not doing it that much.’ Angela and her mom, Peggy, are worried.

“I hope that it doesn’t pan out to be that serious because I want her to have a normal brain and be able to function in life,” Peggy said. “But you know, sometimes we don’t get second chances. If she blew this without knowing what would happen on down the line then that’s a sad thing.”

“Now I have paranoia … that I might have something wrong with me later down the road and I don’t want to have to deal with that,” Angela said. “I mean, I want to be there for my children, I want to be there for my family. I want to be able to have a regular life now, and it wasn’t worth it.”

According to the National Institute on Drug Abuse, ecstasy use is going down. More high school students say they know about ecstasy’s harmful effects.
Source: CWK Network January 2006

A little light relief in amongst all the serious data – there are occasionally sections – which although still serious – can bring a smile to one’s face. One such is this extract from the book ‘Marijuana – Deceptive Weed’ by Professor Gabriel Nahas.

Experiments carried out in Germany by Luff (1972) indicate that driving under the effects of Cannabis intoxication induced by active material is hazardous. Twelve young volunteers Ingested 3.2 gr. of a potent preparation, and were tested under actual driving conditions. They passed through 35 stop signs, ignored three red lights, made 233 parking mistakes, ran through l9 pedestrian crossings, demolished a simulated wall of plastic blocks and ran over a large stuffed lion. The dose of delta-9-THC these volunteers absorbed was certainly elevated (60 – 100 mg) but the results are nevertheless sobering.

Source: ‘Marijuana – Deceptive Weed’ by Professor Gabriel Nahas, O.B.E., Ph.D. Published Raven press NY 1975.

Do smokers crave nicotine to self-medicate their depression? The question has prompted much discussion since a study concluded that smokers are more depressed than nonsmokers, “We thought understanding the smoker’s mind would help us end tobacco use,” said Gerald Markle, an author and sociology professor at Western Michigan University. “But, in some respects, we’ve raised as many new questions as we’ve answered.”

In addition to being nearly five times as likely to suffer from major depression as nonsmokers, smokers also have been found to be more apt to have anxiety disorders, schizophrenia, attention-deficit disorders, or alcohol and other drug addiction problems. Smokers also are seen as more neurotic, greater risk-takers, and having poor impulse control.

Such research has led some employers and even the military to begin viewing smokers as possible problem cases. But others say the findings should be seen as reinforcing the need for treatment. “Smokers are socially isolated and so less likely to search out help,” says David Gilbert, a nicotine researcher at Southern Illinois University. “But these studies suggest that better treatments are out there.”

Treatment could involve using nicotine to treat depression, researchers said.
Source: the Los Angeles Times reported April 26.2006

Schizophrenics who smoked cigarettes experienced improved attention and short-term memory, according to researchers from the Yale School of Medicine.

Smoking appears to aid the memory of people with schizophrenia by stimulating nicotine receptors in the brain, researchers said; no such effect was observed among non-schizophrenics. When schizophrenics were asked to smoke while taking the drug mecamylamine, which blocks nicotine receptors, the memory benefits of smoking disappeared; again, the same was not true of non-schizophrenics.

Researchers said the study suggests that the reason people with schizophrenia are up to three times more likely to smoke as non-schizophrenics is that they are self-medicating with nicotine. “Our findings have significant implications for developing treatments for cognitive deficits and nicotine addiction in schizophrenia,” said study co-author Kristi Sacco.

The study was published in the June 2005 issue of the Archives of General Psychiatry.
Source: Sacco, K., et al. (2005) Effects of Cigarette Smoking on Spatial Working Memory and Attentional Deficits in Schizophrenia: Involvement of Nicotinic Receptor Mechanisms. Archives of General Psychiatry, 62(6): 649-659.

British researchers say that prolonged, heavy smoking appears to impair long-term memory, the BBC reported May 19.

Smokers queried by researchers from five U.K. universities were found to be more forgetful about routine tasks, such as sending out birthday cards, than nonsmokers. Everyday memory, such as misplacing items, also was examined.

Heavy smokers among the 700 people surveyed — those smoking more than 15 cigarettes weekly — reported making the most memory-related errors.

“The study revealed that smokers reported more errors in their long-term memory than nonsmokers, with an additional difference between nonsmokers and heavy smokers,” said researcher Tom Heffernan of Northumbria University. “There was also a significant detrimental effect of cigarette use on everyday memory function. For example a typical heavy smoker reported 22 percent more memory-related problems than a nonsmoker, and around 12 percent more problems than those who smoked only relatively a small number of cigarettes.”

The study appears in the June 1, 2005 issue of the journal Drug and Alcohol Dependence.
Source: Heffernan, T., et al. (2005) Self-rated everyday and prospective memory abilities of cigarette
smokers and non-smokers: a web-based study. Drug and Alcohol Dependence, 78(3): 235-241.

Inbred strains of rats differ in how aggressively they seek cocaine after a few weeks of use, researchers say.

The finding, posted online Jan. 18 by Psychopharmacology, is another piece of evidence that genetics plays a role in the relapse of drug-seeking behavior in humans, says Dr. Paul J. Kruzich, behavioural neuroscientist at the Medical College of Georgia and lead study author.

It also fingers glutamate, a neurotransmitter involved in learning and memory, as an accomplice in stirring the cravings and uncontrollable urges that drive some drug users to use again, he says.

“Given the right environmental stimuli, all persons addicted to psychostimulants can relapse, but potentially some people are a little more susceptible than others … it’s all about gene-environment interaction,” says Dr. Kruzich.

He took two strains of inbred rats – Fischer 344 and Lewis – with known genetic differences, enabled each to self-adminster cocaine for 14 days, then took the drug away for a week but not the levers the animals used to access it.

During that hiatus, he adminstered a drug that stimulates glutamate receptors, possible targets for drugs of abuse.

He found that the F344 strain worked harder to get cocaine than the Lewis rats following treatment with the glutamate drug, suggesting they were more susceptible to relapse.

“Maybe 12-step programs and faith-based programs will be enough to keep some people from relapsing,” says Dr. Kruzich. “For others we may have to come up with medical treatments we can use on top of those to keep them from taking drugs again.”

He says there are many different versions of the hundreds of genes that may play a role in increasing the risk of relapse.

It’s known that some people become addicted more quickly than others, some literally with their first use, he says. The hardest part is not getting people to stop taking drugs: that happens when they are checked in a clinic or put in jail. The real work is keeping them from relapsing when they are out of such restricted environs, he says.

“Something happens, either they see an old colleague they have used with, they go into an old environment, they have a huge stressor in life and they start to want the drug. They have drug hunger, what we call drug craving,” says Dr. Kruzich. “When it gets bad enough, they engage in drug-seeking behavior.”

His lab is working to identify the relapse trigger to use as a target for developing ways to curb craving and subsequent relapse.

His studies focus on an area of the brain called the nucleus accumbens core, a target for drugs of abuse long considered a pleasure center, Dr. Kruzich says. Drugs such as cocaine and methamphetamine stimulate release of dopamine in the nucleus accumbens. Dopamine is a neurotransmitter believed responsible for the euphoria that come with drug use. In fact, animals given dopamine blockers won’t self-adminster drugs of abuse, and dopamine has long been a focus of drug-abuse studies.

“These drugs impinge upon the reward centers of the brain that normally food, sex, survival and adaptation impinge upon,” says Dr. Kruzich. “When you are having that great piece of cheesecake and thinking, ‘Oh man,’ that is the kind of response these drugs of abuse are evoking but much more so than that cheesecake could ever do.”

Glutamate, also released in the nucleus accumbens core, may play an equally important role in drug relapse, he says. Drugs such as cocaine appear to alter glutamate neurotransmission in the core, which may contribute to the rewiring of the brain that occurs with drug use. “It’s not that these drugs just damage neurons, which they can, but they rewire the circuitry of the brain so no longer is your spouse or your job or other things in your life important to you. Your brain is tricked into thinking that drugs are the most important thing for your survival,” Dr. Kruzich says.

Unfortunately, drugs that restore glutamate function also produce seizures, so scientists are looking for an indirect approach to restore the misdirected rewiring.
Source: Psychopharmacology, posted online Jan. 18 2006. Toni Baker Medical College of Georgia http://www.mcg.edu

In 2004, the 28 High Intensity Drug Trafficking Areas (HIDTA) implemented a Performance Management Process (PMP) to measure their performance, identify the outcomes of their efforts, and improve the efficiency and effectiveness of their initiatives. The National High Intensity Drug Trafficking Area Program 2004 Annual Report highlights the initial results of the PMP, including two of sixteen performance measures developed—the number of Drug Trafficking Organizations (DTOs) disrupted or dismantled and the return on investment (ROI).

In 2004, the HIDTA Program received a law enforcement budget of $176,835,426. In that same year, HIDTA initiatives disrupted.or dismantled 3,538 DTOs and seized more than $10.5 billion in drugs and nearly $500 million in assets from DTOs.

Thus, every $1 invested in the HIDTA program yielded an estimated $63 in drugs and assets removed from the market.
SOURCE: Adapted by CESAR from National HIDTA Directors Association, National High Intensity Drug Trafficking Area Program 2004 Annual Report, 2006.
For more information, contact Erin Artigiani at CESAR aterin@cesar.umd.edu

Black adolescents take in far more nicotine with each cigarette they smoke than white youths, and also take longer to get the drug out of their system, according to researchers from the National Institute on Drug Abuse (NIDA).

Previous studies have shown that black adults metabolize nicotine differently than white adults; the latest research shows the same is true for teens. Researchers led by Eric Moolchan of NIDA’s Teen Tobacco Addiction Research Clinic drew their conclusions from a study of 61 white and 30 black adolescent smokers. They found that both groups exhibited similar measures of nicotine dependence and concentrations of the nicotine metabolite cotinine, even though the black youths smoked significantly fewer cigarettes on a daily basis.

“Because nicotine plays an active role in smoking reinforcement, these variations may influence early onset addiction to tobacco,” said NIDA Director Nora Volkow. “Thus, these findings may constitute a strong warning to black youth to keep from smoking in the first place. They also may explain why certain smoking-cessation therapies work better in some populations than in others, and therefore, which treatments should be offered to which teens.”

“An important implication is that black youth may not be offered certain smoking cessation therapies if those treatments are selected largely on the number of cigarettes smoked per day,” added Volkow. “Thus, we need to look at aspects of nicotine dependence other than consumption to guide the selection of appropriate and effective therapies.”
Source: January 2006 issue of the journal Ethnicity and Disease

By Timothy Wilens, M.D.,Psychiatric Times.
The overlap between attention-deficit/ hyperactivity disorder and alcohol or drug abuse or dependence (referred to here as substance use disorders [SUDs]) in adolescents has been an area of increasing clinical, research and public health interest. Appearing in early childhood, ADHD affects from 6% to 9% of children and adolescents worldwide (Anderson et al., 1987) and up to 5% of adults (Kessler, in press). Longitudinal data suggest that childhood ADHD persists into adolescence in 75% of cases and into adulthood in approximately one-half of cases (for review, see Weiss, 1992). Substance use disorders usually appear in adolescence or early adulthood and affect between 10% to 30% of U.S. adults and a less defined, but sizable, number of juveniles (Kessler, 2004). The study of comorbidity between SUDs and ADHD is relevant to both research and clinical practice in developmental pediatrics, psychology and psychiatry with implications for diagnosis, prognosis, treatment and health care delivery.

Overlap Between ADHD and SUD

Structured psychiatric diagnostic interviews assessing ADHD and other disorders in substance-abusing groups have indicated that from one-third to one-half of adolescents with SUDs have ADHD (DeMilio, 1989; Milin et al., 1991). For example, aggregate data from government-funded studies of mainly cannabis-abusing youth indicate that ADHD is the second most common comorbidity with from 40% to 50% of both girls and boys manifesting full criteria for ADHD. Data largely ascertained from adult groups with SUDs also show an earlier onset and more severe course of SUD associated with ADHD (Carroll and Rounsaville, 1993; Levin and Evans, 2001).

Summary

There is a strong literature supporting a relationship between ADHD and SUDs. Both family/genetic and self-medication influences may be operational in the development and continuation of SUDs in ADHD. Adolescents with ADHD and SUDs require multimodal interventions incorporating addiction and mental health treatment. Pharmacotherapy in individuals with ADHD and SUDs needs to take into consideration timing, misuse and diversion liability, potential drug interactions, and compliance concerns.

While the existing literature has provided important information on the relationship of ADHD and SUDs, it also points to a number of areas in need of further study. The mechanism by which untreated ADHD leads to SUDs, as well as the risk reduction of ADHD treatment on cigarette smoking and SUDs, needs to be better understood. Given the prevalence and major morbidity and impairment caused by SUDs and ADHD, prevention and treatment strategies for these adolescents need to be further developed and evaluated.
Source: Psychiatric Times January 2006 Vol. XXV Issue 1