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Marijuana Cannabis Hashish Cannabis sativa Cannabaceae

Cannabis sativa (hemp) is the most widely used illegal drug in the world. Although the cannabis plant is now ubiquitous, it is probably native to Central Asia. Its spread all over the world is no doubt due to a combination of cultural and natural factors. Cannabis, not only a psychoactive plant, but also of major technological importance as the source of a fiber for rope and other cordage, and was probably a popular trade item from a very early date, although its mention is scarce in archaeological records until the Iron Age in Europe (ca. 400 bc). Cannabis spread via different routes east to China, south to India and southeast Asia, and west to Europe, Africa, and eventually the Americas. The earliest of the Chinese pharmacopoeias, the P n Ching (written in the first century bc but containing much older material), makes it clear that the ancient Chinese knew of the psychoactive effects of cannabis. The Taoists used it by combining it with other ingredients, which were then inhaled...

Chronic Marijuana Toxicity

Marijuana is an oily, dried fibrous material obtained from the Indian hemp plant, Cannabis sativa. Delta-9-THC is the psychoactive component. Hashish (smoked in pipes) and hashish oil (mixed with tobacco and smoked) All are Cannabis derivatives that contain higher concentrations of THC.

Hemp Cannabis sativa Cannabaceae

In the 1890s, hemp was produced all over the world. There were many cordage plants referred to as Russian hemp, Manila hemp, and sisal hemp, but true hemp Cannabis sativa was the standard to which all other cordage fibers were compared. In the United States, up to the 1930s hemp was used to make paper, rope, twine, clothing, and sail canvas. However, in the 1930s its role was threatened by petroleum companies wanting to develop and produce synthetic fibers for rope and textiles. These petroleum companies launched negative advertising campaigns against the hemp industry. It is no secret that hemp (cannabis) leaves and seeds have narcotic effects, but the rope and textile fibers produced from the stems have no narcotic content. Even today, the stigma associated with hemp as a narcotic in general is a by-product of these campaigns. The large lumber and newspaper conglomerates also launched similar anti-hemp advertising because they felt that hemp was the greatest threat to the woodfiber...


Marijuana refers to the dried-out leaves, flowers, stems, and seeds of the hemp plant, Cannabis sativa. The plant is a common weed that grows freely in most areas of the world. Marijuana, also known as cannabis, is also probably the most commonly used, abusable substance in the world, with the U.N. World Drug Report (1997) estimating 140 million daily users. It is most frequently smoked in small, hand-rolled cigarettes called joints (Schwartz, 2002). Alternatively, users employ regular pipes or water pipes called bongs. The resin from the flowering tips, hashish, is more potent and may also be smoked (Abel, 1980). Marijuana can also be ingested usually this occurs when it's baked into lipid-rich foods, such as brownies. Peak popularity occurred in the late 1970s, then steadily declined until 1992. Since that time, marijuana's use has been on the rise, and whether its current level of use has reached a plateau phase is still a subject of debate. Marijuana has many purported uses in...

Addictionsubstance abuse

DSM-IV-TR defines 11 classes of commonly abused substances (see 6.07 Addiction). These include alcohol, amphetamine and amphetamine-like compounds, caffeine, cannabis, hallucinogens, inhalants, nicotine, opioids, phencyclidine, and the class of drugs defined as sedatives, hypnotics, or anxiolytics. Substance dependence is defined as a pattern of repeated self-administration that can result in tolerance, withdrawal, or compulsive drug-taking behavior, and has as a basis an anhedonia, the inability to gain pleasure from normally pleasurable experiences. Tolerance is evident as either a need for increased amount of substance to produce a desired effect, or the diminished effect of the same dose of substance over time. All substances of abuse produce tolerance, but the actual degree of tolerance varies across classes. Withdrawal involves maladaptive physiological changes that occur with declining drug concentrations. These changes tend to be unpleasant and produce cognitive and behavioral...

Neuronal Nicotinic Receptor Agonists

The incidence of smoking is high in patients with schizophrenia, a rate at least three times higher than the general population. In fact, nicotine appears to produce a modest transient improvement in cognitive and sensory deficits in these patients. It has been suggested that smoking in schizophrenia represents an attempt to self-medicate.39 However, these views must be interpreted with caution. Overall, schizophrenic patients have a high degree of comorbid abuse of a variety of substances including nicotine, alcohol, cannabis, cocaine, and amphetamine. Importantly, the rate of substance abuse is higher than in the general population for all of these substances in spite of the fact that such abuse is associated with poorer outcomes, exacerbation of positive symptoms, increased hospitalization, and increased frequency of homelessness. This increased propensity to abuse a variety of substances regardless of consequences suggests that there may be a disregulation of reward systems in...

Descriptive Epidemiology of Herbal and Vitamin Poisonings

The most popular herb sales in the United States include Echinacea (10 ), garlic (10 ), goldenseal* (7 ), ginseng (6 ), Ginkgo (4.5 ), and saw palmetto (4.4 ). * Goldenseal is often used illicitly in unsuccessful attempts to disguise urinary marijuana (THC) metabolites. There are no toxicologic databases on herbal and vitamin toxicity in the United States. In Hong Kong, herbal medicine toxicity accounts for less than 1 of all acute hospital admissions, and Western medicine toxicity and drug-drug interactions account for 4.4 of all acute hospital admissions. Fatalities have resulted from megadoses of the fat-soluble and lipophilic (stored in liver and brain) vitamins A, D, and E and therapeutic (homeopathic) doses of niacin and tryptophan.

Preface to the first edition

Finally, readers of the book will notice two important omissions alcohol and marijuana. The reason for not dealing with the former is that alcohol requires its own book. The reason for not discussing the latter is that there isn't enough good anatomic pathology to write about, although recently there have been some interesting studies dealing with marijuana toxicology. I hope this subject can be added in future editions.

Unique Identify Factors

Another common way of transporting controlled substances is to package the controlled substance in brick-size, 1 kg, packages for shipment to the U.S. This is often the case with shipments of heroin, cocaine, and marijuana, and the packages are usually wrapped in paper or tape. Sometimes a logo, serving as a type of trademark for the illicit distributor, will be affixed. Logos can take the form of any number of designs . They are applied using a stamping or printing device. Some commonly encountered designs include, but are not limited to, animals, symbols from Greek mythology, replications of brand name product logos, replications of the names of polictical figures, cartoon characters, and numbers.

Epidemiology of Reproductive Toxicology

Antimicrobials, antiemetics, theophylline, caffeine, ethanol, and nicotine. From 15 to 25 of pregnant women report licit drug use (ethanol nicotine), or illicit drug use (marijuana cocaine heroin), or have positive urine drug screens during pregnancy. Analgesics, vitamins, iron, antibiotics, theoph-ylline, and psychotropic medications account for 50 to 80 of all reported toxic ingestions by pregnant women.

Testing Programs in Occupational Settings

The five substances routinely tested for include marijuana, cocaine, amphetamines, opiates, and PCP. Other drugs, such as alcohol, may be added to the panel if suspected by the employer from objective evidence (i.e., slurred speech, alcohol on the breath). Keeping with the Rule of Fives, there are five situations in which drug testing is conducted (1) preemployment, (2) random, (3) postaccident, (4) probable cause, and (5) return to work follow-up. The employer may request testing for additional substances in the case of postaccident, reasonable suspicion, and return-to-work situations. In order to undergo this additional testing, the employee must be notified via an official Employee Drug Policy document. Recognizing the high prevalence of alcohol abuse, ethanol testing was mandated in a 1994 amendment. There are separate regulations for alcohol testing, including not requiring MRO participation.

Unsafe Driving Habits

Never drive under the influence of alcohol. It slows your reaction times, distorts your vision, and impairs your judgment. And never use other psychoactive drugs (those that alter your mind or behavior, such as marijuana or methamphetamine) while driving. Be sure to read the labels on all prescription and over-the-counter medications for warnings about how they could affect your ability to drive.

Problemsolving process

In the course of therapy Gabriel and his parents redefine the rules that guide their living together. Although Gabriel consumed cannabis several times after a self-imposed period of abstinence, the relationship to his father is more relaxed. The mother decides to stop work in the father's consulting business and takes up her profession as a seamstress again. At the same time the number of arguments between the parents regarding their own relationship increases. Both feel, however, that they can solve these marital problems themselves without therapeutic support.

Identifying and Quantitating Controlled Substances

Phencyclidine, more properly identified as phenylcyclohexylpiperidine (PCP), is usually submitted to the laboratory as an exhibit of PCP base in diethly ether, a powder, or sprayed or coated on marijuana. The analysis of PCP is relatively direct by GC MS. The resulting mass spectrum is specific. The GC FTIR spectrum of PCP is not as specific when one compares this spectrum with that of PCP analogues and precursors such as phenylcyclohexyl carbonitrile (PCC) and phenylcyohexyl pyrrolidine (PCPy). FTIR spectrophotometry of the solid in a potassium bromide matrix is very specific. A word of caution is in order for anyone handling PCP. PCP is a substance that is believed to be easily absorbed through the skin of the analyst. Minimum handling is recommended.

Analyzing Drugs In The Forensic Science Laboratory

Occassionaly an experienced forensic analyst can just look at an exhibit in a drug case and determine the probable nature of the substance. However, probable natures are not enough for an identification, and most examiners will usually conduct more than one test before reporting the presence of a controlled substance. The morphology of botanical substances such as marijuana and the peyote cactus are familiar enough to many laboratory analysts. Marijuana is one of those controlled substances which is examined with such frequency in the laboratory that a preliminary identification is probable based on the morphology of the botanical substance, gross physical appearance, texture, and odor. However, even after a microscopic examination of the cystolithic hairs using a micrcoscope, the modified Duquenois-Levine test is usually run to corroborate the identification. The peyote cactus with its button-like appearance is also unique. In a like manner, the identification of the opium poppy...

Psychotomimetics Psychedelics Hallucinogens

Lucinogens such as LSD, psilocin, psilocy-bin (from fungi), bufotenin (the cutaneous gland secretion of a toad), mescaline (from the Mexican cactuses Lophophora williamsii and L. diffusa peyote) bear a structural resemblance to 5-HT (p. 116), and chemically synthesized amphetamine-derived hallucinogens (4-methyl-2,5-dimethoxyamphetamine 3,4-di-methoxyamphetamine 2,5-dimethoxy-4-ethyl amphetamine) are thought to interact with the agonist recognition site of the 5-HT2A receptor. Conversely, most of the psychotomimetic effects are annulled by neuroleptics having 5-HT2A antagonist activity (e.g. clozapine, risperidone). The structures of other agents such as tetrahydrocannabinol (from the hemp plant, Cannabis sativa hashish, marihuana), muscimol (from the fly agaric, Amanita muscaria), or phencyclidine (formerly used as an injectable general anesthetic) do not reveal a similar connection. Hallucinations may also occur as adverse effects after intake of other substances, e.g., scopolamine...

Causes of Motor Vehicle Accidents

At least 15.9 of drivers, in some areas, are under the influence of marijuana at the time of the crash, though what the significance of specific levels of the active ingredients of marijuana means is not known at the present time, just that the active ingredients of marijuana are detectable in the blood.1

Negotiating Childrens Autonomy

Some of the time, mothers experience a positive give-and-take with their children and are able to come to agreement with them. They make bargains with their children and trust that their children will do as they promise. As one mother said, We have a lot of trust. I don't know what we would do if we lost that trust with any of the kids if we found them smoking marijuana in their room or something. Many mothers, however, are challenged by at least one of their teenage children. Challenges come at all ages, but particularly when children become teenagers and no longer automatically accept everything their mothers say and are eager to go places outside the home, especially to be with friends (Larson and Richards 1994).

Initial Evaluation Of The Patient With Substance Use Disorders

Team and be used to develop the safest possible treatment plan. The clinician should ask about specific illicit substances such as heroin, cocaine, marijuana, and the club drugs (see below). For taking a history of alcohol use, some clinicians have suggested the use of the CAGE questionnaire (Ewing, 1984) 1. Can you cut down on your drinking 2. Are you annoyed when asked to stop 3. Do you feel guilty about your drinking 4. Do you need an eye-opener when you wake up in the morning One should also ask about sedative or stimulant use, whether prescribed or nonprescribed, and any dietary supplements or herbs the patient may be taking. A substance abuse review of systems, focusing on renal, cardiac, gastrointestinal, and, for HIV patients especially, neurological symptoms, is essential. Other points of inquiry are the date the substance was first used patterns, amount, and frequency of use and routes of administration and reactions to the use. The time of last use is important to know to...

Drugdrug Interactions

Alcohol consumption has been shown to significantly increase the blood serum level of abacavir by competing for alcohol dehydrogenase (McDowell et al., 2000) however, with chronic use, alcohol can induce CYP 3A4 and may decrease levels of some antiretrovirals (Caballeria, 2003). Ritonavir, and possibly other protease inhibitors, can inhibit the metabolism of alprazolam, which can lead to oversedation and respiratory depression if this drug is being abused. Inhaled marijuana has been shown to decrease the bioavailability of indinavir and nelfinavir, although the precise mechanism is unknown (Kosel et al., 2002).

New Research Areas

The ability of marijuana to stimulate appetite in humans has been well known for centuries.19 Administration of cannabinoids, the active ingredients in marijuana, has been established to stimulate food intake in animal models of feeding. Central and peripheral administration of anandamide (Figure 9), one of the major endocannabinoids, also increases food intake in preclinical models. The cannabinoid receptor 1 (CB1) is present in brain regions known to control food intake. Cannabinoid-induced feeding can be antagonized by the use of CB1 antagonists and starvation-induced feeding can be reduced by the administration of CB1 antagonists. Interestingly, CB1 knockout mice are leaner than wild-type controls primarily due to decreased food intake and lipogenesis in white fat during early postnatal development. In older animals, increased peripheral energy expenditure appears to be the predominant defense against increased adiposity in the knockout animals. The CB1 receptor is expressed...

Physiological Effects

Cannabis intoxication commonly heightens the user's sensitivity to external stimuli, thus making colors seem brighter and smells more pungent. It also distorts, sometimes severely, the user's sense of time. The term temporal disintegration (Mathew, Wilson, Humphreys, Lowe, & Weithe, 1993) has been coined to describe this slowing of subjective time after use of marijuana. In addition, at least in low doses, marijuana causes mild euphoria and feelings of relaxation. It is also know to increase appetite. There is some controversy over whether individuals intoxicated with cannabis pose a hazard, as they seem to be attracted to thrill-seeking behavior and are usually subdued. Some people have argued that individuals who smoke marijuana are less likely to drive fast however, reaction time to complex and unforeseen situations is slowed, and muscle strength and hand-eye coordination is decreased. Because it delays reaction time, alters time perception, and for many other reasons, marijuana...

Studies in MS and Other Conditions

The biologic effects of the chemicals in marijuana, known as cannabinoids, have been extensively investigated. These chemicals bind to proteins in the central nervous system (CNS) that decrease nerve cell activity. These proteins are known as CB1 receptors. Theoretically, binding to CB1 receptors could decrease some multiple sclerosis (MS)-associated symptoms, such as pain and spasticity. Also, cannabinoids bind to another type of protein known as CB2 receptors. Binding to these proteins, which are present on immune cells, may mildly suppress the immune system and could thus potentially slow down the disease course in MS. Other effects of cannabi-noids, including antioxidant properties and inhibitory effects on a harmful process known as excitotoxicity, could also theoretically be beneficial for MS. The effects of marijuana, THC, and nabilone have been studied in many diseases, including MS. Some of the recent interest in marijuana was generated by a 1999 report by the National...

Mechanism of Action

Several lines of evidence support the hypothesis that GHB is a neurotransmit-ter. GHB temporarily suppresses the release of dopamine in the mammalian brain. This is followed by a marked increase in dopamine release, accompanied by the increased release of endogenous opioids (Hechler, Goebaille, & Maitre, 1992). GHB also stimulates pituitary growth hormone (GH) release, although the mechanism by which GHB stimulates GH release is not known. Dopamine activity in the hypothalamus stimulates pituitary release of GH, but GHB inhibits dopamine release as it stimulates GH release. While GH is being released, serum prolactin levels also rise in a similar, time-dependent fashion. GHB has several different actions in the CNS, and some reports indicate that it antagonizes the effects of marijuana (Galloway et al., 1997). The consequences of these physiological changes are unclear, as are the overall health consequences for individuals who use GHB.

Toxicology in Motor Vehicle Accidents

In all fatal motor vehicle accidents, a complete toxicologic screen for alcohol and drugs, and in certain circumstances carbon monoxide, should be performed on both drivers and passengers. Tests for alcohol alone are not sufficient. Drugs tested for should include alcohol carbon monoxide acid, basic, and neutral drugs. Marijuana testing is optional. In select cases, analysis for opiates is indicated.

Obstetric And Developmental Effects

A stable, negative, cocaine-specific effect on language functioning was found through age 7, after controlling for sex, age, prenatal exposure to alcohol, marijuana and tobacco, and over 20 other medical and demographic factors (Bandstra et al., 2002). Similarly, Azuma and Chasnoff (1993) reported lower

The Neurobiology of Substance Dependence

Brain abnormalities resulting from chronic use of nicotine, stimulants, opioids, alcohol, hallucinogens, inhalants, cannabis, and many other abused substances are underlying causes of dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). Most of the abnormalities associated with dependence resolve after detoxification, within days or weeks after the substance use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects for example, stress, the social context of initial opiate use, and psychological conditioning and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid-dependent.

Medical Use And Abuse

Workplace drug testing is usually limited to identification of marijuana, cocaine, morphine-codeine, amphetamine-methamphetamine, and phencycli-dine (PCP). However, benzodiazepines and barbiturates may be added to the test panel. Laboratory positive test results for patients with legitimate prescriptions for benzodiazepines and barbiturates are reported to employers by medical review officers (MROs) as negative, as are other laboratory results that reflect appropriate medical treatment with other controlled substances (MacDonald, DuPont, & Ferguson, 2003).

Defining Multiple Substance Use Diagnostic Approaches

Although there was a diagnostic category of mixed substance abuse in DSM-III (American Psychiatric Association, 1980, p. 179), there is no diagnosis of polysubstance abuse in DSM-IV-TR (American Psychiatric Association, 2000). There may not be many people who abuse multiple substances over time with clinically significant impact, for whom no one substance is sufficient to make formal abuse criteria. This is because one needs only to satisfy one of the four DSM-IV criteria to pass the threshold for a substance abuse diagnosis related to that particular substance. However, it is conceivable that one could meet a criterion for substance abuse based on use of multiple substances, but not on one in particular. For example, a person could have two arrests for driving under the influence, one for alcohol and the other for cannabis, in the same year.

Descriptive Approaches

Most broadly, the literature frequently describes polydrug use or poly-substance use. This nondiagnostic designation generally describes the use of multiple substances rather than framing the use and its effects in clinical terms, which is the intent of diagnosis. As such, polydrug use describes, at minimum, the use of multiple substances, whether licit or illicit. In the treatment research literature, polydrug use is often used to describe the lifetime number of drugs regularly used to a threshold SUD, in addition to the index substance (Ball, Carroll, Babor, & Rounsaville, 1995 Feingold, Ball, Kranzler, & Rounsaville, 1996). However, in other than addiction or mental health treatment settings, the expressions polysubstance use or polysubstance abuse are frequently meant to describe the use by subjects of as few as two substances, such as cocaine and alcohol, alcohol and cannabis, or opiates and cocaine (Ross, Kohler, Grimley, & Bellis, 2003). In a more differentiated...

Population Based Studies

Adolescent substance users are a subgroup who have been identified as high risk for concurrent polysubstance use, and with that, progression to hazardous use, abuse, or dependence (Brook, Brook, Zhang, Cohen, & Whiteman, 2002). Compared with older age groups, younger users in treatment settings are more likely to report polydrug use (Substance Abuse and Mental Health Services Administration SAMHSA , 2003b). The NHSDA oversamples subjects who are from 12 to 34 years old, offering community substance use data on adolescents who are not typically covered in other national surveys (Kandel et al., 1997). Although males overall are more likely than females to use or be dependent upon alcohol, cannabis, or cocaine, Kandel and colleagues (1997), using NHSDA data to determine abuse and dependence by proxy, demonstrated that these gender differences for rates of use and of dependence rates among users are largely attenuated among adolescents. Adolescent girls who use alcohol or illicit drugs...

Gender Ethnicracial And Life Span Considerations

Drug use and abuse are prevalent across the life span from young adolescents to the elderly. Increasing numbers of the elderly are abusing drugs as a way of coping with the stressors of aging. Young teens are vulnerable to experimentation as they attempt to conform to group norms and peer pressure. The typical users of barbiturates, sedatives, and tranquilizers are middle-class, middle-aged women. Cocaine use is often seen in younger adult professionals, entertainers, and business executives. Marijuana usage is seen most frequently in teens and young adults, but there is no propensity for any race or ethnicity. Rates of current cocaine use are slightly higher for African Americans and Hispanic Latinos as compared with other populations. Males have a higher rate of current cocaine and marijuana use than females.

Genetic And Family Studies

Much of the evidence for the heritability of the general and specific vulnerability for SUD is taken from studies of familial aggregation. Bierut and colleagues (1998) compared siblings of probands with alcohol dependence and those of a control group for the presence of lifetime SUDs. Siblings of alcoholic probands were not only more likely to have a lifetime alcohol use disorder, but they also had an increased risk of cannabis, cocaine, and nicotine dependence. Fifty percent of the alcohol-dependent siblings of alcohol-dependent probands had an additional diagnosis of cannabis and or cocaine dependence. What is compelling with respect to understanding the risk for multiple substance dependence is that the siblings of cannabis-dependent probands had an increased risk of cannabis dependence, siblings of cocaine-dependent probands had an increased risk for cocaine dependence, and siblings of habitual smokers were at higher risk for nicotine dependence (Bierut et al., 1998). In another...

Opioid Dependence and Opioid Maintenance Treatment

Polydrug use is the norm among heroin users. In a study of 329 primary heroin users by Darke and Hall (1995), the most prevalent drugs used during the preceding 6 months were tobacco (94 ), cannabis (84 ), alcohol (78 ), benzodiazepines (64 ), amphetamines (42 ), cocaine (24 ), and hallucinogens (22 ) the mean number of drug classes used was 5.2. However, it appears that as they grow older, illicit drug users reduce their range of drugs Age is inversely correlated in IDUs with the number of current dependence diagnoses, and young males who are not in treatment, and who inject amphetamines, are at higher risk for polysubstance use (Darke & Hall, 1995 Darke & Ross, 1997). Cannabis Cannabis use among patients in methadone treatment programs has recently been investigated in an attempt to answer the practical question of whether cannabinoid-positive urine toxicology examinations predict poor treatment outcome. Both a recent Israeli study (Weizman, Gelkopf, Melamed, Adelson, & Bleich,...

Adolescents Club Drugs and the Rave Scene

Ders, as well as attention-deficit hyperactivity disorder. Although club drugs originally got their name from nightclubs and raves, adolescents and young adults now use club drugs in both club and nonclub settings (Rosenthal & Solhkhah, in press). Overall, studies of typical MDMA users reveal high rates of multiple drug use (Parrott, Milani, Parmar, & Turner, 2001 Parrott, Sisk, & Turner, 2000 Rodgers, 2000 Schifano, Di Furia, Forza, Minicuci, & Bricolo, 1998). Among treatment seekers, heavy MDMA use is associated with increased psychopathology (Parrott et al., 2000 Schifano et al., 1998). In addition to use of alcohol and cannabis, the heavier the MDMA use, the more likely is the co-use of stimulants and hallucinogens (Scholey et al., 2004). MDMA as a sole drug of abuse is an uncommon phenomenon thus, it is a reasonable proxy for abuse of multiple substances (Rodgers, 2000).

Other CAM Therapies

Homeopathy is a low-risk approach of uncertain effectiveness for sleep problems. Several supplements are promoted for insomnia. As discussed elsewhere in this book, melatonin may be beneficial, but in people with MS it is associated with a theoretical risk because of its immune-stimulating activity. 5-HTP, another supplement, has unclear effectiveness for insomnia and may be harmful. Marijuana has produced positive results in some studies. However, it also may cause significant side effects and is illegal in most states. Kava kava sometimes is recommended for insomnia, but most studies of this herb have actually only evaluated its effectiveness for anxiety. In any case, kava kava should be avoided because of possible liver toxicity.

Drugs Prescribed For Gun Shot Wounds

Common drugs of abuse encountered in death cases include ethyl alcohol, barbiturates, pain killers, stimulants such as cocaine and methamphetamine, heroin, morphine, LSD, marijuana, and antidepressants. These drugs can readily be discovered through routine postmortem drug screens by testing blood, urine, or other tissues. Chemicals such as carbon monoxide and cyanide may be involved. Blood and urine are not usually tested for these chemicals however, the circumstances of death may lead the examiner to suspect these chemicals as a cause of death (such as carbon monoxide in fire). Special samples such as hair may be needed to test for cases of heavy metal poisoning, such as arsenic.

Pathology encountered in crack smokers

Corneal Pathology From Smoking Crack

Cocaine users who smoked cocaine free base or crack may forcefully blow smoke into another user's mouth to augment the drug's effect. Smokers also prolong the Valsalva maneuver to avoid expiring the precious cocaine smoke. The resulting increased intra-alveolar pressure ruptures the alveolar walls, allowing air to dissect along the perivascular tissues into the mediastinum and surrounding cavities. These mechanisms have produced various forms of barotrauma including pneumothorax, pneumo-mediastinum,12-14 pneumopericardium,15 pneu-moperitoneum,16 and subcutaneous emphysema. In the few cases,17 where the duration of cocaine use prior to clinical symptoms was accurately known, patients freebased cocaine for 8 to 12 hours and snorted cocaine for 1 to 2 hours. The clinical course of cocaine-associated barotrauma is generally non- fatal. This barotrauma is not specific for cocaine smokers and has been described in marijuana smokers.18 The long-term pulmonary effects and pathology of smoking...

Treatment Considerations

H., Begleiter, H., Crowe, R. R., Hesselbrock, V., Nurnberger, J. I., et al. (1998). Familial transmission of substance dependence Alcohol, marijuana, cocaine and habitual smoking. Arch Gen Psychiatry, 55, 982-988. Epstein, D. H., & Preston, K. L. (2003). Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment Past findings and more evidence against. Addiction, 98, 269-279. Kandel, D., Chen, K., Warner, L. A., Kessler, R. C., & Grant, B. (1997). Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population. Drug Alcohol Depend, 44, 1129. Weizman, T., Gelkopf, M., Melamed, Y., Adelson, M., & Bleich, A. (2004). Cannabis abuse is not a risk factor for treatment outcome in methadone maintenance treatment A 1-year prospective study in an Israeli clinic. Aust NZJ Psychiatry, 38, 4246.

Mussen 1997 On Drug Abuse

MDMA, ketamine, and GHB are by no means the only drugs found at clubs, raves, or circuit parties. They are, however, the most emblematic. Attendees also use more traditional drugs, such as LSD and other hallucinogens. Marijuana is perennially popular, and alcohol use is also common. Furthermore, each week seems to bring a report of some new drug of abuse. Often this is just an older, well-known drug, packaged differently or with a new name, but the effect on a new generation of users will be just as devastating. When the evidence of MDMA's neurotoxicity was lacking, and what research existed on GHB and marijuana was not as compelling, individuals concerned with the public's safety could afford to be less alarmed. The mount- Abel, E. L. (1980). Marijuana The first twelve thousand years. New York Plenum Press. American Academy of Ophthalmology. (1992, June). The use of marijuana in the treatment of glaucoma. Statement by the Board of Directors of the American Academy of Ophthalmology,...

Drug Tolerance Dependence And Withdrawal

Locus Ceruleus Withdrawal

From a clinical standpoint, withdrawal can be one of the most powerful factors driving dependence and addictive behaviors. This seems particularly true for opioids, alcohol, benzodiazepines, nicotine, and to a lesser extent stimulants such as cocaine. For hallucinogens, cannabinoids, or inhalants, withdrawal Tolerance occurs because the brain cells that have receptors or transporters on them gradually become less responsive to the stimulation by the exogenous substances. For example, more opioid is needed to inhibit the cyclic AMP system in the N-Ac neurons, as well as to stimulate the VTA brain cells of the mesolimbic reward system to release the same amount of DA in the N-Ac. Therefore, more opioid is needed to produce pleasure comparable to that provided in previous drug-taking episodes. The mechanism for this reduction in response is related to the cyclic AMP coupling for opioids, but direct reductions in the number of receptors or increases in the number of transporters can...

Risk Taking and Substance Abuse

Substrate Nigra Dopamine

Although people who have affective disorders might use drugs as a form of chemical self-treatment, independent of this possible relationship between drugs and affective disorders, the same brain anomaly that makes people susceptible to drug abuse might serve to enhance curiosity, risk taking, and creativity. For example, studies of large cohorts of college students found that the students who use marijuana tend to be novelty seeking and more creative than the students who did not use this drug (Eisenman, Grossman, & Goldstein, 1980). The mechanism underlying the relationships between substance abuse, novelty seeking, risk taking, and creativity has not been determined. One hypothesis, however, is that drugs enhance creative performance, but studies of creativity under normal states versus intoxicated states do not reveal that drugs enhance the production of creative works (Lang, Verret, & Watt, 1984). As I mentioned, depression might not enhance creative...

History Of Substance Abuse Treatment

Beginning with Galenic medicine, a key strategy has been to identify certain syndromes as having their etiology in alcohol and drug abuse. Once the etiology is determined, the specific treatment (i.e., cessation of substance abuse) can be prescribed. Examples of such substance-associated disorders include delirium tremens (i.e., alcohol and sedative withdrawal), withdrawal seizures, morphinism (i.e., opioid withdrawal), cannabis-induced acute psychosis, stimulant psychosis, and various fetal effects, such as fetal alcohol syndrome. Thus, description of pathophysiological and psychopathological processes, together with diagnostic labeling, has been a crucial historical step in the development of modern assessment and treatment for substance use disorders (Rodin, 1981).

Jute Corchorus capsularis and C olitorius Tiliaceae

Corchorus Capsularis Seeds

Hemp Cannabis sativa Cannabaceae There are two main subspecies of Cannabis subsp. sativa and subsp. indica. It is sativa that is used for the production of textile fibers. Subspecies indica (known as Indian hemp) is the plant that yields the narcotic but is not used for commercial textiles. It has been suggested that the two subspecies have no real specific difference, but when the plant is grown in a hot climate it gives rise to the intoxicating resinous extract within the plant. The name hemp is often used in connection with other plant fibers, especially with some of the leaf fibers such as abac (from Musa textilis), which is often called Manila hemp. The reason may well be that they were used in the same way as the true hemp (C. sativa). In fact there are forty-nine hemp plants listed in Matthews Textile Fibers that represent fibers from plants other than Cannabis sativa.

Identification Of Problems Among Longterm Benzodiazepine Users

Medical and nonmedical substance use. Is the benzodiazepine dose the patient is taking reasonable Is the clinical response to the benzodiazepine favorable Is there any use of nonmedical drugs, such as cocaine or marijuana Is there any excessive use of alcohol (e.g., a total of more than four drinks a week, or more than two drinks a day) Are other medicines being used that can depress CNS functioning 2. Medical and nonmedical substance use. Is the dose of the benzodiazepine the patient is taking reasonable Is the clinical response to the benzodiazepine favorable Is there any use of nonmedical drugs, such as cocaine or marijuana Is there any excessive use of alcohol (e.g., a total of more than four drinks a week, or more than two drinks a day) Are there other medicines being used that can depress the functioning of the CNS

Psychiatric Comorbidity And Sequelae

The most frequent co-occurring substance use disorder is alcoholism 29 of cocaine abusers have a current alcoholism diagnosis, and 62 a lifetime alcoholism diagnosis (Rounsaville et al., 1991). These findings are alarming considering that individuals with comorbid cocaine and alcohol use disorders manifest a more severe form of cocaine dependence, and comorbid alcohol abuse is associated with poorer retention in treatment and poorer treatment outcomes for both disorders (Brady, Sonne, Randall, Adinoff, & Malcolm, 1995). Cocaine use disorders also are common among opioid abusers. In addition, 66 of methadone-maintained patients abuse cocaine (Kosten, Rounsaville, & Kleber, 1987), and 75 of the heroin addicts admitted to methadone programs identify cocaine as their secondary drug of abuse (New York State Division of Substance Abuse Services, 1990). A national survey of 15 clinics (General Accounting Office, 1990) revealed continued cocaine use in as many as 40 of patients after 6 months...

Distinguishing Medical And Nonmedical Use Of Benzodiazepines

What is the pattern of the controlled substance use Typical medical use of controlled substances is similar to the use of penicillin or aspirin, in that it occurs in a medically reasonable pattern to treat an easily recognized health problem other than addiction. Typical use of nonmedical drugs (e.g., alcohol, marijuana, or cocaine), in contrast, takes place at parties or in other social settings. Medical substance use is stable and at a moderate dose level. Nonmedical use of a controlled substance is usually polydrug abuse at high and or unstable doses (Juergens & Cowley, 2003).

Trends In Treatment And Prevention

This approach is not extinct, as exemplified by the frequent recommendation in the 1970s that alcoholics substitute cannabis smoking for alcohol. Currently, methadone is used for chronic opiate addicts who have failed attempts at drug-free treatment. Despite aversive selection factors, methadone maintenance patients tend to do well as long as they comply with treatment. Chopra, G. S., & Smith, J. W. (1974). Psychotic reactions following cannabis use in East Indians. Arch Gen Psychiatry, 30, 24-27.

Cultural and Social Change

In recent centuries, political, commercial, and technical advances have influenced the types, supply, cost, and availability of psychoactive substances, along with modes of administration (Westermeyer, 1987). International commerce, built on cheaper and more efficient transportation, and increasing income have fostered drug production and distribution. Increasing disposable income has resulted in greater recreational intoxication (Caetano, Suzman, Rosen, & Voorhees-Rosen, 1983). Development of parenteral injection for medical purposes was readily adapted to recreational drug self-administration in the mid-1800s, within several years of its invention. Purification and modification of plant compounds (e.g., cocaine from the coca leaf, morphine and heroin from opium, and hashish oil from the cannabis plant) produced substances that were both more potent and more easily smuggled and sold illicitly. Laboratory synthesis has produced drugs that closely mimic naturally occurring substances...

Origins Of Drug Liking

For example, opioids and cannabinoids can inhibit activity in N-Ac directly, whereas stimulants such as cocaine and amphetamine act indirectly by binding to various DA transporters and either inhibiting the reuptake of DA into the VTA neurons (cocaine) or actively pumping DA out of the VTA (amphetamine) at its synapse with the N-Ac neurons (Kosten, 2002 Stahl, 1998). Since stimulation of the DA D2 receptor inhibits the cyclic AMP system, this increase in DA in the synapse leads to relative inhibition of the N-Ac neuron. The mechanism is more complex than this, however, since the D1 receptor has the opposite effect on the cyclic AMP system (e.g., it increases the amount of cyclic AMP) and both D1 and D2 receptors are present on the N-Ac neurons. The presumption is that the D2 receptor effects predominate perhaps simply due to more D2 receptors, or due to a higher affinity of the D2 than the Dt receptors for DA. Other substances may be even more indirect in their stimulation. For...

Social And Selfhelp Movements

Abstinent societies not tied to specific religions began to appear in the 18th and 19th centuries. Examples include the Anti-Opium Society in China and the Women's Christian Temperance Union in the United States. These groups engaged in political action, public education, social pressure against addiction or alcoholism, and support for abstinence. These led eventually to prohibition movements that sought legal strictures against the production, sale, and or consumption of psychoactive substances outside religious or medical contexts. In Asia, these movements began against tobacco (which was viewed in the 1600s and 1700s as a slothful habit associated with political sedition) and then later changed to oppose primarily opium. In Northern Europe and the United States, prohibition laws first involved opiates and cannabis but later

Patterns of Psychoactive Substance

Socially sanctioned, episodic psychoactive substance use may involve heavy use, with marked intoxication or drunkenness (Bunzel, 1940). In a low-technology environment, this pattern may cause few problems, although psychotomimetic drugs such as cannabis can cause toxic psychosis (Chopra & Smith, 1974). In a high-technology environment, with modern methods of transportation and industrial machinery, intoxication even at mild traditional levels may be life threatening (Stull, 1972). Binge-type alcohol problems include delirium tremens, fights, sexually transmitted disease, and falls.

Phosphorus Pentachloride Lysergic Acid Diethylamide Mail

Substance abuse monitoring, 455-521 abused substances, 457, 465-469 alcohol testing, 457, 476 procedures, 476 random alcohol testing, 476 Americans with Disabilities Act, 458 amphetamines, 469, 483, 485 cannabinoids, 482 chain of custody, 457, 478-484 chemical dependency, 457, 464 litigation package, contents of, 481 lysergic acid diethylamide, 467-468 marijuana, 461, 467 medical review officers, 457, 471-472 methamphetamine, 481 Miranda rights, 485-487 morphine, 482 MRO responses, 457 negative specimen, 480 Omnibus Transportation Employee Testing Act, 462, 474-475 opiate metabolism, 482-484 opiates, 465-466 opioid intoxication, 465 opioid overdose, 465 opioid withdrawal, 466 opioids, 465-466 PCP, 483


The prognosis for an individual with an anxiety disorder is dependent on the category and severity of the disorder. However, with combined pharmacological and behavioral interventions, the outlook is moderate to good even with the most severe cases of GAD. To satisfy current unmet medical need, efforts are being focused on new chemical entities (NCEs) that have the efficacy of BZs but lack the associated adverse effects. Such agents include g-amino-butyric acid (GABAa) receptor subunit selective 'BZ-like' NCEs12 including neurosteroids (e.g., ganaxolone), direct acting GABAa agonists like gaboxadol, and newer approaches to anxiety including cannabinoids, metabotropic glutamate receptor modulators, nicotinic receptor agonists, and modulators of the corticotrophin-releasing factor (CRF) family of receptors.

Disease Basis

Like the majority of central nervous system (CNS) disorders, the initial understanding of the factors causing schizophrenia was based on serendipity, in this instance, the finding that chlorpromazine, the first drug used for the treatment of the disease, was a dopamine (DA) receptor antagonist.3 Since then it has been well established that schizophrenia is a multifactorial disease involving both genetic and epigenetic factors7 that may also exist in several distinct subtypes. Identified risk factors for schizophrenia include winter birth low socioeconomic status cannabis use obstetric complications and intrauterine infection related to birth immigration living in a city (urbanicity) and the neighborhood cognitive social capital8 low intelligence quotient and a family history of the disorder. There is increasing data81 that schizophrenia can be associated with autoimmune diseases, e.g., celiac disease, acquired


Anthropological studies of preliterate societies have shown the almost universal use of psychoactive substances. Tribal and peasant societies of North and South America focused on the development of stimulant drugs (e.g., coca leaf, tobacco leaf, and coffee bean) and numerous hallucinogenic drugs (e.g., peyote). They used hallucinogens for ritual purposes and stimulant drugs for secular purposes, such as hard labor or long hunts. New World peoples discovered diverse modes of administration, such as chewing, nasal insufflation or snuffing, pulmonary inhalation or smoking, and rectal clysis (DuToit, 1977). African and Middle Eastern ethnic groups produced a smaller number of stimulants, such as qat, and hallucinogens, such as cannabis (Kennedy, Teague, & Fairbanks, 1980). Groups across Africa and the Eurasian land mass obtained alcohol from numerous sources, such as honey, grains, tubers, fruits, and mammalian milk. Certain drugs were also used across vast distances, such as opium...

Early History

Ingested medication in these first documents, especially for medicinal purposes. Mayan, Aztec, and Incan statues and glyphs indicated drug use for ritual reasons (Furst, 1972). Medieval accounts recorded traditional alcohol and drug use. Travelers of that era often viewed use patterns in other areas as unusual, aberrant, or problematic examples include reports of Scandinavian beserker drinkers by the English and reports by Crusaders of Islamic military units or assassins intoxicated on cannabis. Along with animal sacrifice and the serving of meat, the provision of alcohol, betel, opium, tobacco, or other psychoac-tive substances came to have cultural, ritual, or religious symbolism, including hospitality toward guests (Smith, 1965). Affiliation with specific ethnic groups, social classes, sects, and castes was associated with consumption of specific psy-choactive substances. For example, one group in India consumed alcohol but not cannabis, whereas an adjacent group consumed cannabis...


Representative Goldenseal is an herb frequently used as an astringent and to reputedly mask the presence of illicit drugs, especially marijuana, on urine screens. Goldenseal is, however, ineffective as an undetected adulterant and is easily detected by GC MS ( + drug test). Latin Hydrastis canadensis. Toxin Hydrastine. Antidote None.


In most settings, the primary purpose of drug testing is to identify individuals who are using illegal or illicit drugs. Falsely accusing someone of using drugs is highly problematic and undermines the testing program. Similarly, not being able to identify active drug users because of false-negative results renders a program of limited value. It does not deter use or identify users. This is so both for the emergency room physician wondering if the agitated patient used PCP, and for the consultant to the local college track team. For these situations, highly sensitive qualitative screening tests should be employed, even if this leads to some false-positive results. On the other hand, definitive tests should have the highest level of specificity They should exclude as many true negatives as possible. For nonusers who are subjected to drug testing, issues related to false-positive results are of great concern. Questions addressing which foods, prescribed medications, dietary supplements,...

Club Drugs

Lematic in terms of HIV transmission, as the parties often go on for several days, with drug use and sexual activity being the primary objectives. Although some of these parties originally began as fund-raisers for HIV service organizations, most of these organizations have since distanced themselves from such functions and they have taken on independent lives oftheir own through magazines and Web sites. Drugs commonly used at circuit parties include MDMA, ketamine, gamma-hydroxybutyric acid (GHB), methamphet-amine, cocaine, marijuana, and alcohol (Bialer, 2002) The club drugs that are of the most concern in relation to HIV AIDS are MDMA, GHB, and metham-phetamine.

Causes of Crashes

Whether in light or commercial plane crashes, the pilot (flight crew in commercial planes) should have a complete toxicological screen for the presence of alcohol acid, basic, and neutral drugs alkaline drugs narcotics carbon monoxide and, possibly, marijuana. Generally, one is looking for drugs, not in toxic levels, but in therapeutic levels that could impair reflexes and thinking to a degree sufficient to contribute to or cause the accident. Because of this, very sensitive and specific methods of analysis must be utilized in the toxicological screen. Only rarely will natural disease or drugs play a role in airplane crashes. When they do, virtually all instances involve light planes. For the most part, airplane crashes are due to pilot error, mechanical defects, weather, or a combination of these factors. In light planes, there is often use of poor judgment, such as flying in inappropriate weather.

David Mcdowell

Hallucinogens consist of a disparate group of psychoactive substances, and include 3,4-methylenedioxyamphetamine (MDMA), hallucinogens, ketamine, and marijuana. They differ in terms of administration, mechanism of action, and effect. In many cases, they are used by groups of younger people and are taken in various combinations with each other and other classes of substances, usually in social settings (often at raves see Bellis, Hale, Bennett, Chaudry, & Kilfoyle, 2000 or other parties). At some of these events, a substantial majority of rave participants are using MDMA, ketamine, gamma-hydroxy-butyric acid (GHB), or other drugs, such as marijuana and D-lysergic acid diethylamide (LSD). In addition, at times inhalants are used at these events (Lee & McDowell, 2003 McDowell & Kleber, 1994 Winstock, Griffiths, & Stewart, 2001). Polysubstance might be considered the norm at such events, with over 80 of participants using more than one substance (Boys, Lenton, & Norcross, 1997 Winstock et...


Marijuana has been used since antiquity, and it can be found in numerous ancient texts. The oldest known reference to marijuana is in a 15th-century B.C. Chinese text on herbal remedy (Walton, 1938). Also, Assyrian cuneiform tablets from 650 B.C. that contain references to people smoking marijuana are generally regarded as obvious copies of much older texts, according to Walton. Although archeological findings in Berlin, Germany, suggest that marijuana was in Western Europe by 500 B.C., an exact date or extent of use is unknown. However, hemp-based clothing was widespread in central and southern Italy, and the intoxicating effects of marijuana were also recorded in Renaissance texts. In Europe, it was quite popular in 19th-century high society. In the United States, in the beginning of this century, it was popular principally in the West and was mostly associated with ethnic groups and jazz musicians. Marijuana's social stigma, epitomized in the now-popular classic cult film Reefer...


Marijuana withdrawal has been demonstrated in laboratory animals, as well as in humans, and is now well documented. Chronic heavy users of cannabis may experience some withdrawal in the form of irritability, general discomfort, disrupted sleep, and decreased appetite (Budney, Moore, Vandrey, & Hughes, 2003). This syndrome is not as painful as that with heroin, as dangerous as that The clinician is confronted with a wider range of marijuana users. At one end is the individual who uses the drug only rarely, but whose use is detected on a routine drug screen and brought to the clinician's attention, perhaps for an evaluation. Brief assessment, to make sure the problem is not more serious than it appears, is always necessary in this case. Subsequent follow-up, to ensure that the initial impression was correct, is part of a thorough assessment. In this instance, the user is usually embarrassed and repentant, and has no objection to future monitoring. Users who do not have a problem with...

Treatment Method

Marijuana is available in several forms. The main active constituent in marijuana, a chemical known as delta-9-tetrahydrocannabinol or THC, is available by prescription as a pill (dronabinol or Marinol). Sativex, an oral spray that contains THC and another marijuana constituent, cannabidiol, is available by prescription in Canada. A synthetic form of THC (nabilone or Cesamet) also is available as a pill in Canada, Europe, and Australia. Most simply, the leaf may be smoked or eaten. The resin of the plant, hashish, also may be smoked.

Journal Articles

Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature 2000 404 84-87. Baker D, Pryce G, Giovannoni G, et al. The therapeutic potential of cannabis. Lancet Neurol 2003 2 291-298. Bowling AC. Worthless weed or pot of gold Int J MS Care 2004 5 138,166. Clark AJ, Ware MA, Yazer E, et al. Patterns of cannabis use among patients with multiple sclerosis. Neurol 2004 62 2098-2100. Fox P, Bain PG, Glickman S, et al. The effect of cannabis on tremor in patients with profile in multiple sclerosis. Clin Exp Immunol 2005 140 580-585. Killestein J, Hoogervorst ELJ, Reif M, et al. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. J Neuroimmunol 2003 137 140-143. Vaney C, Heinzel-Gutenbrunner M, Jobin P, et al. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis a randomized, double-blind, placebo-controlled,...


Treatment Episode Data Set (TEDS Substance Abuse and Mental Health Services Administration, 2002) data also reveal the use of cocaine in combination with other illegal drugs. Marijuana, methamphetamine, and heroin were the secondary drugs of abuse most often mentioned in 1999 TEDS admissions for which cocaine was identified as the primary substance of abuse. Admissions for cocaine taken by routes other than smoking were more likely to be white males (29 ), followed by black males (23 ), white females (18 ), and black females (12 ). Admissions for smoked cocaine were more likely to be black


Significant psychiatric comorbidity has been observed depression and personality disorder are the most frequent diagnoses. Polysubstance abuse is common in opioid addicts. Many are nicotine addicted, and many have serious alcohol-related problems as well. Benzodiazepine use is common and probably underestimated, because it may not be specifically assayed in urine specimens. Sporadic use of cocaine and other stimulants is common, as is the use of marijuana. A few opioid addicts also use hallucinogens or inhalants. der with water, heat it, and use cotton or a cigarette filter to block the entry of undissolved particles as the solution is drawn into the syringe. As a result, fibers enter the venous bloodstream and lodge in the lungs, where conditions become favorable for the development over time of pulmonary thrombosis (emboli arise at distant sites), pulmonary hypertension, and right-side heart failure. Opioid abusers are at further risk of compromised pulmonary function if they use...

Clinical Samples

Comorbidity of various substance use and other mental disorders tends to cluster among certain subsets of the general population, such that more than half of the lifetime alcohol, drug, and mental disorders diagnoses can be found among about 14 of the population (Kessler et al., 1994). In any year, almost 59 of the community sample with an alcohol, drug, or other mental (ADM) disorder meet criteria for three or more lifetime ADM disorders (Kessler et al., 1994). Therefore, compared to the community, treatment settings that aggregate those with SUDs are also most likely to cohort people at the highest risk for multiple SUDs. This is borne out in large-scale family genetics studies. For example, in the Collaborative Study on the Genetics of Alcoholism (COGA), among 1,212 subjects with definite alcohol dependence, recruited from addiction treatment centers, 62 had an additional diagnosis of cannabis and or cocaine dependence (Bierut et al., 1998). Treatment Episode Data Set (TEDS) data...

Typologic Approaches

Alcohol, cocaine, marijuana, or opiate abuse or dependence. The authors found a consistent 60 40 ratio of Type A to Type B for each of the drug groups, suggesting clusters of personality characteristics that are independent of drug of choice. Similarly, in 370 patients attending treatment for alcoholism, cocaine, or opiate dependence, Ball and colleagues (1998) replicated the A-B classification and also found a 60 40 Type A to Type B ratio. Type A substance abusers had less multiple drug use, as well as an older age of onset, fewer years of heavy use, less family history of substance abuse, less impulsivity, and less severe substance abuse. Type B substance abusers tended to be more severe than type A abusers, scoring higher on the personality dimensions of neuroticism, novelty seeking, and harm avoidance. They also had a higher prevalence of multiple substance abuse, an earlier age of onset, more childhood psychiatric symptoms, higher incidence of all Cluster B personality disorders,...

Survivor Education

Their consumption to problem levels following traumatization. Some research does suggest that trauma survivors will respond to brief interventions targeting their drinking. Working with patients admitted to a hospital trauma center for treatment of injury, who screened positive for excessive alcohol use, Gentilello et al. (1999) demonstrated that a single 30-minute interview can reduce alcohol consumption in those with existing alcohol problems. Another study, of an intervention based on motivational enhancement (Miller & Rollnick, 1992), which addressed substance use problems in patients seeking emergency medical care, suggested that more than one contact may be important. Longabaugh et al. (2001) found that a 40- to 60-min-ute intervention, plus booster session, reduced consumption and was more effective in reducing alcohol-related negative consequences than standard care or a single-session intervention. In addition to these brief one-to-one interventions, it is possible that...

Toxicology Screens

Less used is the screen for higher volatiles, a gas chromatographic method used to detect toluene, the most commonly abused inhalant benzene trichlo-rethane and trichlorethylene. Another screen now being performed routinely is for cannabis components. Blood from the test tube containing sodium fluoride and potassium oxalate should be used, because some of the active components of cannabis will otherwise deteriorate with time. We generally use an immunoassay screen on the urine for metabolites of delta-9-tetrahy-drocannabinol. If positive, then we analyze the blood by GC-MS. Rarely, we use a heavy-metal screen. Depending on the metal, one can use either ICP or a specific chemical test. In all homicides, accidents, and suicides, the authors recommend the lower alcohol screen the acidic and neutral screen and the basic screen. In stranger-to-stranger homicides and those in which the use of narcotics is suspected, the narcotic screen is also recommended. In natural deaths, the authors...


After alcohol and marijuana, the most commonly abused drugs are probably heroin and cocaine. There are numerous other drugs of abuse the synthetic narcotics, phencyclidine, amphetamine and methamphetamine, propoxyphene, inhalants, and so on. These drugs, however, come and go on the drug scene, but the three curses always remain. In the next section, we will discuss the three main drugs of abuse, a number of other drugs of abuse, and some drugs that cause deaths because their lethal potential is not appreciated or because they fall into the hands of a child.

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