PCP abuse in New Orleans: a six-year study.

Methods for determination of PCP in body fluids are presented and a rapid screening method is suggested. The demographics, psychiatric profiles, forensic aspects, and diagnostic problems of PCP abuse are discussed.

Extended EMIT-DAU phencyclidine screen.

In a public hospital emergency room, 580 urines were screened for phencyclidine (PCP) with the routine EMIT-DAU PCP screen, the extended EMIT-DAU PCP screen, and a gas chromatograph/mass spectrometer/computer (GC/MS/COMP) in selected ion mode, which was chosen as the reference method. The extended method produced a 38.5% increase in positives detected over the routine EMIT-DAU PCP screen and allowed 66.4% of the specimens to be signed out as negative without confirmation by GC/MS/COMP. This ability to provide a rapid, relatively inexpensive screen for PCP in urine and, in particular, to eliminate those patients whose specimens are negative, is important in a psychiatric population that contains many acutely psychotic individuals with grossly abnormal behavior.

4-Bromo-2,5-dimethoxyphenethylamine: identification of a new street drug.

The identification of 4-bromo-2,5-dimethoxyphenethylamine as a street drug is described. NMR, UV, and mass spectral data used in the identification of the compound are presented.

Contaminated street heroin. Relationship to clinical infections.

Thirty-one samples of street heroin were analyzed bacteriologically and chemically as to their microbial burden and chemical adulterants (fillers). Sixty-one percent of the samples were positive for microbial growth. Many species were isolated from the positive samples with Bacillus sp (79%) and Aspergillus sp (10%) predominating. The level of contamination ranged from 1.6 X 10(2) to 3.7 X 10(4) organisms per gram. We obtained cultures from 16 addicts from the Chicago area and 21 from the New Orleans area who had soft-tissue infections related to their habit. Infections in this group of patients were usually polymicrobial; however, there was no correlation between the organisms recovered from street heroin and the addicts' infections. Most drug-related infections appear to be related to the addicts' own oral and dermal microflora. No correlation was observed between the chemical fillers and the bacteria recovered from the heroin.

Medical and sociological aspects of T's and Blues abuse in New Orleans.

The medical and sociological aspects of T's and Blues abuse in New Orleans were studied to determine the effect of abuse on the medical and psychological status of the individuals involved and the sociological effects on the community in general. Sociologically, the most pertinent findings were an increase in the number of (1) deaths related to the use of T's and Blues, (2) arrests and revocation of parole for possession and/or sale of Talwin, and (3) a decrease in the number of arrests for the possession and sale of heroin. In the medical and psychiatric context of this study, three distinct groups of addicts were found of which the T's and Blues users were the largest. Psychiatrically, the most pertinent observation was the high (30-35%) incidence of paranoid, violence prone life-styles seen among T's and Blues users. This finding certainly is in accord with the increased homicide rate and T's and Blues related deaths noted in other aspects of this study.

Cannabis sativa: effects on brain function and ultrastructure in rhesus monkeys.

Two studies, designed to control for as many variables as possible, were conducted in 21 rhesus monkeys, some with brain electrodes and some unoperated, to determine the effects of marijuana on brain function and ultrastructure. Some monkeys were exposed to smoke of active marijuana (using different dose schedules), some were administered delta-9-THC (0.69 mg/kg iv), and others were exposed to smoke of inactive marijuana (from which all cannabinols had been removed). To deliver smoke to the monkeys, two different apparatuses were used. Dose schedules comparable to those of human marijuana smokers were established, as determined by plasma levels of delta-9-THC. After 2- to 3-months' exposure, the monkeys that were heavy- and moderate-smokers of active marijuana, and those administered delta-9-THC iv, developed chronic recording changes at deep brain sites, most marked in the septal region, hippocampus, and amygdala. These changes persisted throughout the exposure period (6 or 8 months) and during the postexposure observation period (1 to 8 months). Brains of these electrode-implanted monkeys, as well as those without electrodes that were exposed to delta-9-THC, showed ultrastructural alterations characterized by changes at the synapse, destruction of rough endoplasmic reticulum, and development of nuclear inclusion bodies. In contrast, brains of monkeys exposed to smoke of inactive marijuana and of unexposed controls showed no ultrastructural changes. The findings indicate that exposure to delta-9-THC, the psychoactive ingredient of marijuana, at doses commensurate with those used by human marijuana smokers can produce permanent alterations in brain function and structure of monkeys.

Treatment of heroin addicts: is the client--therapist relationship important?

The purpose of this paper is to examine one variable in the treatment of heroin addiction, ther therapist-client relationship. Eighty-six individuals who were discharged from the Tulane NARA Drug Abuse Program were examined on 20 social and personality variables. The variable of the counselor--patient relationship was found important in the final outcome of treatment. Clients who had a single counselor throughout the entire course of treatment did significantly better (p less than .002) than their peers who were transferred from one counselor to another, suggesting that a stable client--therapist relationship greatly enhances the chances of the patient reaching drug abstinence and being rehabilitated.

Phencyclidine abuse in New Orleans: medical, forensic, and laboratory aspects.

A one year study of phencyclidine abuse in New Orleans showed that 90% of the cases cannot be detected by routine laboratory methods. Fifty percent of all cases showed evidence of police intervention. Initial impressions covered a wide range of psychiatric and clinical diagnoses. Recurring psychiatric problems due to the presence of the drug would indicate observation for a period of at least 72 hours. Patterns of PCP abuse cross racial and ethnic boundaries and are found uniformly in all population groups.

PCP (phencyclidine): an update.

The steady rise in the promiscuous use of phencyclidine (PCP) as a "recreational" drug has recently gained nationwide attention because of the numerous violent and/or bizarre incidents caused by the use of this drug. Because the media often exaggerate reports of bizarre and violent behavior to make a "good" story, the potential PCP user may be tempted to ignore the media warnings. In the case of PCP, however exaggerated the story, a real danger does exist. So, despite numerous newspaper, radio and television warnings about the possible consequences of PCP use and abuse, the incidence of toxic reactions continues to climb. In many cases PCP is sold as other drugs, particularly THC, and in various colored capsules, tablets, liquids and crystals which may explain the increased usage despite the numerous warnings against its use. The advances in laboratory techniques and chemical processess have enabled the clandestine chemist to prepare relatively pure PCP and thus eliminate many of the toxic side effects due to impurities in the drug. In addition, 30 or more psychoactive PCP analogues have been developed and are starting to make an appearance on the street. PCP is perhaps the most potent psychotomimetic compound known at the present time and is capable of inducing a psychosis which is clinically indistinguishable from schizophrenia. The psychosis-producing effects of PCP are the most common toxic effects seen in hospital emergency rooms; but as the amount of PCP taken and/or the simultaneous involvement of other drugs, particularly barbiturates, occurs, severe medical problems (e.g., coma, seizures, respiratory arrest) begin to appear. Death from high doses of PCP or PCP plus other drugs does occur, but the principal cause of death from PCP abuse is due to trauma, homicide or suicide (usually of the bizarre or violent form). Young adult males, persons predisposed to mental illness and naive drug users appear to be the most susceptible to the adverse effects of PCP. The fact that chronic PCP users are starting to increase in number is mute testimony that not all users experience "bad trips" with PCP. Unfortunately for the user, however, this does not guarantee that the next trip will not be a bad one. The effects of chronic use seem to be twofold: severe depression with suicidal thoughts and numerous violent, agitated behavioral patterns. Neither seems to be a suitable alternative. At the present time there is not specific antidote for toxic PCP reactions and the prolonged psychosis induced in some cases does not appear to respond to the standard antipsychotic medications as quickly as do the functional psychoses. The major improvement from a medical standpoint is the development of more sensitive laboratory techniques to confirm the presence of PCP in body fluids. This advance has undoubtedly led to the apparent increase in the number of PCP cases reported by hospitals and to the accuracy of clinical diagnosis by medical, drug or law enforcement communities...

Effects of 6-hydroxydopa on noradrenergic neurons in developing rat brain.

The temporal sequence of changes in norepinephrine (NE) levels in various regions of brains of control and 6-hydroxydopa (6-OHDOPA)-treated rats was determined. It was found that 6-OHDOPA (60 mug/g i.p., three doses, 48-hour intervals), when administered from birth, markedly altered the NE content of various brain regions during the following 8-week period. In telencephalic regions, such as the neocortex and hippocampus, NE levels (micrograms per tissue) increased dramatically from birth in saline-treated rats, while NE was depressed by 55 to 85% in 6-OHDOPA animals. Studies for measuring the uptake of 3H-NE (2 X 10(-7) M) by synaptosomes isolated from the neocortex showed that uptake, was reduced by approximately 40% at 2, 5 and 52 weeks of age. Therefore, it appears that 6-OHDOPA is able to permanently impair the ontogenetic development of noradrenergic neurons in regions supplied by the dorsal noradrenergic bundle. In contrast to these effects, NE levels in the cerebellum were elevated 2-fold in 6-OHDOPA-treated rats of 8 weeks, postnatal age. Uptake was not similarly increased, indicating that the elevation in NE was not due to an increase in the number of nerve endings, but rather to an increase in the intraneuronal storage depots of NE. In the hypothalamus NE levels were not dramatically altered, while uptake was reduced by about 40% up to 1 year of age. Application of Michaelis-Menten kinetics indicated a decrease in the Vmax for 3H-NE uptake in the hypothalamus of 6-OHDOPA (60 mug/g i.p., two doses, 48-hour intervals from birth)-treated rats, sacrificed at 6 months of age. The pons-medulla and midbrain regions showed moderate increases in NE levels at 5 and 8 weeks. Uptake 1 was not increased in the pons-medulla at any time, and the Vmax remained unchanged when measured in rats at 6 months of age. It is apparent that 6-OHDOPA is capable of altering the ontogenesis of noradrenergic neurons and that the effects on development are different in different areas of the brain.