Michael Prinzleve

Cocaine Use in Europe – A Multi-Centre Study: Patterns of Use in Different Groups

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

Cocaine Use in Europe – A Multi-Centre Study

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Cocaine Use and the Utilisation of Drug Help Services by Consumers of the Open Drug Scene in Hamburg

In order to describe the patterns of use in the open drug scene in Hamburg, a study was carried out among 616 drug users in the drug scene and in or in the vicinity of low-threshold institutions close to the drug scene in summer 2000. The special focus was on the prevalence of cocaine and crack use as well as on the utilisation of help services for drug users. 80% of the interviewed persons were male, the average age was 32.6 years. They had been using drugs such as heroin or cocaine for an average of 11 years. 84% had used heroin and 74% cocaine within the last 24 h. Use was intravenous for 66%. 57% used cocaine intravenously, the percentage of crack smokers was 22%. Compared to previous studies, an increase in cocaine use can be noted among the scene users in Hamburg, mainly related to intravenous cocaine use. Crack smoking has only increased slightly over the past few years. Based on cluster analysis, four consumption pattern groups can be established. The largest group (38%) mainly uses cocaine and heroin. The second group (26%) consists of polyvalent drug consumers using methadone in addition to heroin and cocaine, as well as, partially, benzodiazepines, cannabis or alcohol. Group 3 (19%) mainly uses heroin only, some of them also using methadone and/or cannabis. The fourth group (17%) is mainly related to alcohol, the greater part of them additionally using heroin. On the whole, it appears that those users who currently do not use cocaine (or crack) are in a better health and social situation. The group using only heroin (cluster 3) also compares favourably with the other three consumption pattern groups with regard to the intensity of use, consumption in public and risk behaviour. Almost all the interviewed persons are in contact with general practitioners. However, the increasing cocaine use has not been met by sufficient intervention and treatment programmes so far.

Cocaine and crack use and dependence in Europe – experts view on an increasing public health problem

Background: The spread of cocaine and crack use in Europe poses a challenge to the European health-care systems. The assessment of the extent of the problem as well as the support needs of the users require involving all relevant parties in research and future planning. Method: Within the framework of a European multi-center and multi-modal research project, experts of nine European cities were interviewed according to a standardised structural interview protocol. Results: Cocaine use is considered to be on the increase in Europe. The prevalence rates vary substantially between countries and the problem emerges in different target groups in distinct patterns of use. Although cocaine and crack specific risks can be diagnosed, health risks follow basically the general risks of illicit drug use. Proposals for future planning include the broadening of the existing services and the implementation of evidence-based approaches to the problem. Conclusion: In dealing with the cocaine problem in Europe, a comprehensive public health approach is appropriate. An overall strategy should include preventive, harm reductive as well as rehabilitative measures. Consequently, cross-national guidelines should be established and their implementation as well as evaluation should be monitored.

Smoking Cocarettes: A Less Harmful Alternative of Cocaine Use?

Smoking cocaine hydrochloride in the form of cocarettes is a method of cocaine use that has not been described in the scientific literature so far. Nonetheless it seems to be a somewhat common method of cocaine use in order to avoid the nasal irritation. Three case reports are presented in order to discuss the possibility.

Treatment of Opiate Addicts With Buprenorphine: A Prospective Naturalistic Trial

Aims:In a nationwide German post-marketing surveillance, the acceptance, efficacy, and tolerability of buprenorphine in opiate dependent patients were tested. Design:The study was conceived as a prospective naturalistic approach over a period of 12 weeks. Data were collected from doctors and patients at the start of treatment and after 1, 5, 9 and 12 weeks. Setting:The study was conducted with general practitioners. The patients were recruited between February 2000 and April 2001. Participants:Inclusion criteria according to Summary of Product Information (SPC) were a minimum age of 18 years and an established opiate dependency. Three hundred ninety patients participated in the study; valid data were available from 314 patients at the time of inclusion. Measurements:The descriptive analysis focused on duration of participation, buprenorphine dosage, drug use behavior, and withdrawal symptoms. Findings:Sixty-eight percent of the patients regularly completed the study. Positive effects concerning the reduction of drug use and the improvement of withdrawal symptoms can be observed in patients who continued buprenorphine treatment. Conclusions:Buprenorphine treatment proves to be a good supplement or alternative (for methadone maintenance treatment) in the medication assisted treatment of opiate dependency.

Is Forgetting of Dreams due to Repression? Experimental Investigations Using Free Associations

This study investigated whether forgetting of dream material is due to repression. Under this assumption, free associations starting from forgotten elements are expected to encounter successively growing resistance. In Experiment 1, 25 participants brought along notes of dreams and were asked to freely associate to five elements from their own dreams and five stimuli from someone else’s dreams. One week later, they were tested for recognition of sequences of their dreams. Afterwards they produced free associations to five elements they had remembered and to five elements not identified (Experiment 2). Skin conductance responses (SCR) and perceived unpleasantness were recorded. Results of Experiment 1 were in line with previous findings from our laboratory: Associations starting from own dream material provoke greater SCRs. Results of Experiment 2 were: In comparison to recognised dream material, unrecognised elements elicited associations accompanied by greater activation. During associations to the latte...