Forest S. Tennant

Subjective perceptions to the intravenous "rush" of heroin and cocaine in opioid addicts.

Subjective responses to intravenous heroin and cocaine administration were investigated by questionnaire in a population of 40 male and 29 female confirmed heroin addicts. Responses of males and females were very similar for the heroin rush, ranking pleasure, relaxation, satisfaction, warmth, and thirst highest among 20 feelings surveyed and ranking feelings like sexual orgasm low, only fifteenth out of 20. Responses of males and females for the cocaine rush were similar in that both ranked excitement, pleasure, thirst, strength, and anxiety very high, in the top six responses, and both rated feelings like sexual orgasm relatively low, rank 9 for males and 15 for females. However, male and female responses for cocaine differed in that males ranked power very high, rank 2; and females ranked power relatively low, rank 10; but ranked satisfaction, rank 5; warmth, rank 5; and relaxation, rank 12; much higher than males who ranked them 15, 16, and 17, respectively. Despite the fact that sexual feelings were infrequently identified with rushes, the results best supported an interpretation that the population was largely inorgasmic without drugs, but found attractive orgasmic pleasure in heroin and cocaine. Males and females perceived the cocaine rush differently, but the reason of these differences is uncertain.

Clinical experiences with 959 opiod-dependent patients treated with levo-alpha-acetymethadol (LAAM)

Levo-alpha-acetylmethadol (LAAM) is an orphan drug that will soon be generally available to treatment facilities. We have recently treated 959 opioid addicts with LAAM for periods up to 36 consecutive months. Three times per week dosing of LAAM proved to be a safe and effective treatment agent for the majority of subjects. During LAAM induction there is a delay in opioid activity as LAAM forms its long-acting metabolites, therefore, symptomatic withdrawal medication must usually be administered during the first 96 hours of treatment to adequately suppress opioid withdrawal symptoms and prevent self-administration of drugs by the patient. No long-term hepatic toxicity or tumor formation could be demonstrated by liver function studies and liver-spleen imaging in a subgroup of patients. Some opioid addicts report that they prefer LAAM over methadone, but the reverse was reported by about 40% of our patients which suggests that both drugs are needed for adequate maintenance treatment of the opioid-addicted population.

Hepatitis C, B, D, and A: contrasting features and liver function abnormalities in heroin addicts.

Abstract Over 90% of intravenous heroin addicts (IVHAs) carry the hepatitis C virus (HCV). The other hepatitis viruses, A, B, D, and G are relatively unimportant in IVHAs compared to HCV although active hepatitis B may demonstrate a chronic, degenerative course identical to that of HCV. The clinical course of HCV and active hepatitis B may span three or more decades. It is helpful to classify patients as in the active, cirrhosis, or liver failure stages. Only in the active, early stage are the liver enzymes, ALT and AST, likely to be elevated. It is this stage that will most likely respond to antiviral therapy. HCV has so many extra-hepatic manifestations including immune suppression, collagen diseases, and possibly lymphoma and leukemia that the disease is best termed HCV syndrome rather than simple hepatitis.

Abnormal Adrenal Gland Metabolism in Opioid Addicts: Implications for Clinical Treatment

Adrenal gland metabolism is markedly altered in heroin addicts. During daytime hours, the addict may suffer corticoid deficiency of the addisonian type, and in the evening, an excess of the cushingoid type. The high plasma levels of cortisol that are found in the evening in addicts antagonize endogenous opioids in a manner similar to naloxone. In the present study, 72% of the heroin addicts who sought treatment demonstrated reduced adrenal cortisol reserve. Effective immune and stress responses are dependent on adrenal cortisol reserve. This finding provides an explanation for the heroin addicts vulnerability to AIDS and other infectious diseases. One of methadones greatest attributes is that it helps normalize adrenal metabolism. Clinical methods to at least partially correct adrenal metabolism may enhance current opioid addiction treatment modalities.

Characteristics of 68 chronic phencyclidine abusers who sought treatment

Abstract An analysis of 68 phencyclidine (PCP) users who sought treatment reveals that chronic compulsive, daily use occurs and that intravenous use is relatively common. Twenty-five (37%) subjects considered themselves to be addicted to PCP and 19 (28%) desired medication to assist withdrawal. Unwanted behaviors under the influence of PCP were common and primarily related to memory loss, or acts which resulted from loss of impulse control.

The rapid eye test to detect drug abuse.

Because the current epidemic of drug abuse has touched all levels of society, the primary care physician is increasingly called on to identify, monitor, and treat persons with drug abuse problems. All of the major drugs of abuse, including cocaine, marijuana, amphetamine, phencyclidine, heroin, and alcohol, may produce typical eye signs that can be easily detected by a rapid eye test. These signs include ptosis, abnormal pupil size, nonreactivity of the pupil to a light challenge, nystagmus, and non-convergence. When eye signs are detected, drug use should be confirmed by analysis of body fluids. The rapid eye test is suitable for routine use when screening adolescents, athletes, and employees with jobs where safety is essential.

Awareness of Substance Abuse and Other Health-Related Behaviors among Preschool Children.

A group of forty-six preschool children, ages five and six, who were recipients of well-child examinations, were surveyed by a trained person without parents or teacher present. Subjects were shown eight pictorial representations of drug abuse, alcohol abuse, smoking, over-eating, tooth brushing, exercising, wearing a seat belt, and violence towards others. Each child was asked to identify each health-related behavior; explain its health implication; state whether they currently practiced or planned to engage in the behavior in the future; and identify their source of knowledge. All children could identify at least some of the behaviors and relate some health benefits or hazards of the behavior. Parents and television were the primary sources of knowledge. This study suggests that preschool children may be a suitable target population for substance abuse and other health-related education, since awareness of these behaviors was very high in the group of children studied here.

Drug Use and Its Relation to Alcohol and Cigarette Consumption in the Military Community of West Germany (Drugs, Alcohol, Cigarettes in a Military Setting)

An epidemiological study of the prevalence of smoking, drinking, drunkenness, and drug usage based on the analysis of a questionnaire survey administered to 557 American High School students and 1219 military personnel during 1970 indicated that disorders of habit as manifested by cigarette smoking, excessive alcohol consumption, or drug abuse are interrelated. These data are interpreted as consistent with the hypothesis that some individuals respond to stress through these activities, with resultant consequences for health. Drug use is thus seen as a relatively new manifestation of established coping mechanisms (experimentations, habits, intoxications).Indirect evidence shows that the associations of drug users differ from those of nonusers in a way that might explain a progression from use of “soft” drugs to that of “hard” drugs. Survey data also indicate that the bulk of initial drug use by military respondents occurs prior to military service (56 %) and prior to arrival in the Federal Republic of Germ...

Hormone abnormalities in patients with severe and chronic pain who fail standard treatments

Abstract Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be severely impaired, nonfunctional, and bedridden or housebound. To help characterize these individuals and develop treatment strategies for them, a serum hormone profile consisting of adrenocorticotropin, cortisol, pregnenolone, progesterone, dehydroepiandrosterone, and testosterone was obtained on 61 chronic pain patients who failed standard treatments; 49 patients (80.3%) demonstrated ≥ 1 hormone abnormality defined as a serum concentration or level above or below the normal range, and 7 patients (11.5%) showed a severe pituitary-adrenal-gonadal deficiency as indicated by deficient serum levels of adrenocorticotropin and ≥ 2 adrenal-gonadal hormones. Hormone serum abnormalities are biomarkers of severe, uncontrolled pain, and, in a patient who has failed standard treatment, they are an indicator that enhanced analgesia is required and that hormone replacement may be indicated.

Efficacy of psychotherapeutic counselling during 21-day ambulatory heroin detoxification

Structured, psychotherapeutic counselling during 21-day heroin detoxification was evaluated by randomly assigning a group of 25 heroin addicts to a detoxification treatment regimen with mandatory counselling by a therapist and 25 to a control group who received only standard detoxification without counselling. There was no significant difference between groups in the number who successfully detoxified as measured by conversion of morphine positive urine to morphine negative urine. The counselling intervention group did, however, improve the attendance of subjects while in detoxification treatment, and significantly more patients entered long-term treatment following detoxification. Maximal use of a counselor during 21-day heroin detoxification may best be realized by directing therapy toward engaging patients in long-term care.