Cannabis dependence as a primary drug use-related problem: the case for harm reduction-oriented treatment options.

Few studies have focused on cannabis dependence as compared to other drugs more commonly acknowledged as presenting a substantial need for treatment. This paper presents findings from a 2004-2005 study of drug user treatment clients in Southern Ontario, Canada. Clients with cannabis (n = 128) or cocaine (n = 300) as their primary drug problem were compared on psychosocial and demographic characteristics, drug effects, and clinical impairment. There are more similarities than differences between groups, with DAST and DSM scores showing high rates of "dependence" and reported symptoms of "abuse." However, cannabis consistently scored lower on these items, supporting the idea of a continuum of risk on which its rank compared with other potentially misused drugs holds across a wide range of symptoms of impairment. The less disruptive nature of cannabis use-related problems poses greater challenges for drug user treatment providers guided by strict abstinence agendas. The authors call for the expansion of harm reduction treatment options and educational initiatives beyond primary prevention that acknowledge benefits of moderate controlled use when addressing cannabis misuse.

Driving behavior under the influence of cannabis or cocaine.

OBJECTIVE: The purpose of this study is first to describe perceptions of driving under the influence of cannabis or cocaine among clients in treatment and, second, to assess whether these perceptions are related to the frequency of driving under the influence of cannabis or cocaine. METHODS: A questionnaire was administered to clients in treatment for abuse of either cocaine or cannabis, many of whom also had a problem with alcohol; additional groups of clients consisted of those in smoking cessation and gambling programs (N = 1021). Open-ended and close-ended questions were used to assess self-reported effects of cannabis or cocaine on driving and frequency of driving under the influence of cannabis, cocaine, or alcohol. RESULTS: Two dimensions of driving behavior under the influence of cocaine or cannabis were found in both qualitative and quantitative analyses: 1) physical effects and 2) reckless styles of driving. Common physical effects for both drugs were heightened nervousness, greater alertness, and poorer concentration. In terms of driving behavior, cautious or normal driving was commonly reported for cannabis, whereas reckless or reduced driving ability was frequently reported for cocaine. When comparing negative physical effects and reckless style of driving with frequency of driving under the influence of cannabis or cocaine, increased negative physical effects from cannabis were inversely related to frequency of driving under the influence of cannabis (p = .001), but other relationships were not significant. CONCLUSIONS: The findings indicate that both cannabis and cocaine have detrimental but different effects on driving. The negative physical effects of cannabis may reduce the likelihood of driving under the influence of cannabis.

Predicting violence among cocaine, cannabis, and alcohol treatment clients.

In this study, the relationship between the use of various substances, selected psychosocial characteristics, and violence was examined. Groups of subjects in treatment for a primary problem with cocaine (n=300), cannabis (n=128), alcohol (n=110), other drugs (33), tobacco (n=249) or gambling (n=199) completed a self-administered questionnaire. The questionnaire included questions on various psychosocial scales (i.e., aggressive personality, chronic stress, sleep problems, impulsivity, disrespect for the law and social supports), frequency of drug and alcohol use, and violence in the past year. For the univariate analyses, all of the drug and psychosocial variables were significantly related to violence. In the multivariate analyses, frequency of cocaine and alcohol use, disrespect for the law, aggressive personality, age and sex were significantly related to violence. The findings point to multi-causal explanations; however, both alcohol and cocaine use appear to play a significant role in explaining violence.

Barriers to access to medical cannabis for Canadians living with HIV/AIDS.

North American studies suggest that as many as one-third of people living with HIV/AIDS self-medicate with cannabis for relief of physical and stress-related symptoms. Although cannabis remains a controlled substance in Canada, legal access has been granted to people with HIV/AIDS and other serious illness under the Marihuana Medical Access Regulations (MMAR) since 2001. Several years into the programme, however, few Canadians ( approximately 1400) have obtained MMAR approval, suggesting that substantial obstacles remain. This paper reports findings from a 2005 survey (n=197) and focus groups conducted to identify barriers to access to medical cannabis among people living with HIV/AIDS. Most (86%) respondents who reported using cannabis as medicine continue to rely on illegal sources for their supply. They cited lack of information, product quality concerns, and an onerous, confusing application process among other problems mentioned with the MMAR. The findings are discussed in terms of policy suggestions for facilitating access to a legal source of cannabis for medical users.

Shortcomings of harm reduction: toward a morally invested drug reform strategy.

After a decade of steady diffusion in the drugs field, the harm reduction movement, posing pragmatic public health solutions based on empirical analysis, is still hindered by dissension and general confusion as to its underlying ideals. Despite having short-term political advantages, its 'value-neutral' style of discourse undercuts deeper moral foundations by attempts to forge the common ground in drug debates. Drawing on key statements in the literature and insights from interviews with leading Canadian drug policy observers, this commentary looks at rhetorical shortcomings that may act to encumber longer term harm reduction adoption and promotion.

Studies on enteric campylobacteriosis in Tikur Anbessa and Ethio-Swedish children's hospital, Addis Ababa, Ethiopia.

Between February 1992 and January 1993 different Campylobacter spp. were isolated from 86 (13.7%) of 630 patients with diarrhoea at Tikur Anbessa and Ethio-Swedish Children's Hospital, Addis Ababa, Ethiopia. In the same study population, Shigella spp. were found in 11.7% and Salmonella spp. in 3.8%. Campylobacter spp. were found in all age groups, but the majority were isolated from children less than five years of age (68.6%). Only 2 (0.9%) of 220 controls had campylobacter in their stools. Of the campylobacters that were differentiated at species level, Campylobacter jejuni accounted for 82.4% and Campylobacter coli for 17.6% of the isolates. Yersinia enterocolitica was not isolated from any tested stool specimen. More patients (53.1%) presented for investigation of diarrhoea during the months of April through July than during other parts of the year but there was no significant difference in the frequency of isolation of the three enteric pathogens studied during this period as compared to other months of the year. In 12 of the patients infected with Campylobacter spp., Shigella spp. or Salmonella spp. was concomitantly isolated from their stools. The most common symptoms and signs in both adults and children were watery diarrhoea in 82.4%, low grade fever in 78.4% and frequent vomiting in 45.9%. Dehydration ranging from mild to severe was observed in 25.4% of the 55 children with campylobacter infections. Of the 55 children 67.2% had signs of malnutrition and most of them (47.2%) were underweight. This study indicates that Campylobacter spp. are an important cause of diarrhoea both in adults and children in Addis Ababa, and should be considered routinely in the diagnosis of patients with diarrhoea.

Macroamylasemia in HIV infection.

A case of macroamylasemia was seen in a 40-year-old HIV-positive bisexual male treated at the Fort Worth-Tarrant County Health Department (Ryan White Clinic). Macroamylasemia is a rare condition encountered sometimes in persons with HIV infection. Apart from the setting of HIV infection and acquired immunodeficiency syndrome, macroamylasemia is seen also in various conditions including liver disease, diabetes, cancer, malabsorption, and autoimmune disorders. Although this biochemical phenomenon requires no therapy, it should be considered in the differential diagnosis of patients who have persistently high levels of serum amylase and yet do not exhibit any clinical symptoms of pancreatitis or salivary gland inflammation.

The serotype distribution of Campylobacter jejuni and C. coli isolated from patients with diarrhoea and controls at Tikur Anbassa Hospital, Addis Ababa, Ethiopia.

Sixty-eight isolates of Campylobacter jejuni and C. coli isolated from patients with diarrhoea (n = 630) and controls (n = 220) at Tikur Anbassa Hospital, Addis Ababa, Ethiopia were serotyped on the basis of the heat-labile (HL) and the heat-stable (HS) antigens, by using 16 and 34 antisera, respectively, for the two methods. With the antisera against heat labile antigens, 89.3% of the C. jejuni and 75% of the C. coli were typable. The HL serotypes 1, 2, 3, 4, 5, 6 and 7 were the most common among the C. jejuni while HL serotypes 1 and 2 were dominant among the C. coli isolates. These serotypes accounted for 63.2% of all isolates. For the heat-stable antigens, 60% of the C. jejuni and 83.3% of the C. coli isolates were typable. The HS serotypes 1, 3, 8, 26 and 34 were most common among the C. jejuni, while serotypes 3 and 8 were dominant among C. coli isolates. This study shows that the most common HL and HS antigens among campylobacter isolates from Ethiopia correspond to the most frequent antigenic types from other parts of the world. A limited number of antisera were sufficient to identify the majority of the isolates.

The epidemiology of AIDS in Tarrant County from 1982 through 1992.

From 1982 through 1992, the Fort Worth-Tarrant County Health Departments monitored the AIDS epidemic in 1080 cases. Vital records and surveillance data were used to describe the epidemiological characteristics of AIDS in Tarrant County by age, risk, racial/ethnic, sex, and geographic factors. The study found that the male-to-female ratio of cases was 12:1, that incidence among blacks was nearly twice that in whites and Hispanics, that the incidence rate was highest in the group aged 30 through 39 years, and that transmission patterns differed dramatically among zip codes, particularly affecting the poorest and the affluent in Fort Worth. Distribution of AIDS was influenced by demographic characteristics, risk-associated behaviors, and viral seroprevalence. The epidemiological information gleaned by active and passive surveillance enables the county health department to enhance its community-wide efforts to provide programs for prevention and education and to support AIDS-related services.

HIV-1 inhibits Leishmania-induced cell proliferation but not production of interleukin-6 and tumour necrosis factor alpha.

The immune response of normal human peripheral blood mononuclear cells (PBMC) after stimulation with human immunodeficiency virus-1 (HIV-1) antigens plus Leishmania donovani promastigotes in vitro was investigated. HIV-1-antigen stimulation of PBMC did not induce the intracellular accumulation of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), or interferon-gamma (IFN-gamma). However, cells stimulated with L. donovani antigens exhibited the production of IL-6 and TNF-alpha, but not IFN-gamma. Furthermore, co-stimulation of PBMC with HIV-1 antigen plus L. donovani resulted in the intracellular accumulation of IL-6 and TNF-alpha comparable to that of cells that were activated with L. donovani antigen alone. Heat-inactivated HIV-1 antigen did not appear to induce or suppress cytokine production by PBMC. However, the same HIV antigens did suppress L. donovani-induced proliferation as well as PPD-induced proliferation in a dose-dependent fashion. Elevated levels of serum cytokines have been demonstrated in patients with HIV infection indicating their role in the pathogenesis of HIV-associated immunosuppression. The results may partially support the idea that the abnormally increased cytokine levels in the sera of HIV-infected subjects is due to the various opportunistic pathogens that these patients contract, rather than a response to HIV antigens. As cytokines have been shown to up-regulate HIV replication, the data suggest a role for opportunistic infections in cytokine-induced transactivation of HIV-1 and disease progression.

Prevalence of potential respiratory disease bacteria in children in Ethiopia. Antimicrobial susceptibility of the pathogens and use of antibiotics among the children.

Acute respiratory infections are primary causes of morbidity and mortality in children in developing countries. This project was designed to investigate antimicrobial susceptibility of respiratory tract pathogens isolated from children in rural and city areas, and to contribute to the rational choice of antibiotics for respiratory tract infections in children in Ethiopia. Nasopharynx and throat cultures were taken from all children under five years of age in three study areas representing different levels of contact with health care and accessibility to modern drugs, such as antibiotics. In all, 1126 children were cultured. Haemophilus influenzae and Streptococcus pneumoniae were both found in 85-90% of the children, and beta-haemolytic streptococci group A in 12%. The level of antimicrobial resistance was low. None of the 954 strains of H. influenzae were beta-lactamase producers. Pneumococci were susceptible to penicillin. The use of antibiotics was also low; 11 of 1126 children had antibiotics on the day of culture or the day before. The choice of antibiotics was not limited by resistance, and emphasis could be put on low cost, minimizing adverse drug reactions and ecological impact.

The effect of a relaxation technique on coronary risk factors.

This study examined the effect of a relaxation technique on plasma lipids, weight, blood pressure, and blood glucose. Sixteen outpatient males were randomly assigned to control or experimental groups. The experimental group was taught a relaxation technique that they used throughout the study. The control group was started in a reading program. Subjects were followed by a nurse practitioner and dietitian for eight weeks. Results revealed a significant reduction in systolic blood pressure and a marginally significant reduction in low density lipoprotein (LDL) cholesterol in the experimental group. Both control and experimental groups self-reported high compliance with diet and adherence to prescribed intervention. State anxiety was found to be inversely related to changes in total cholesterol and LDL cholesterol.

Intelligence and non-intelligence factors contributing to scores on the Rorschach Prognostic Rating Scale.

The relationship between the Rorschach Prognostic Rating Scale (RPRS) and the Wechsler Adult Intelligence Scale (WAIS) was investigated to identify the factors, intelligence and others, which contribute to the RPRS. Correlation between the RPRS total and WAIS FSIQ showed that approximately 43% of the variance in the RPRS total can be accounted for by the variance in the FSIQ. Verbal IQ is not significantly more highly correlated with the RPRS total than the Performance IQ (p less than .10). Factor analysis of the six RPRS subscores resulted in two factors. Subsequent factor analysis of the six RPRS subscores plus FSIQ and the factor analysis of the six RPRS subscores plus PIQ and VIQ showed the first factor to be an intelligence factor accounting for 85% of the common variance. The RPRS variables FL, FM, M and Sh loaded most heavily on this factor. The second factor was a non-intelligence factor accounting for 15% of the common variance. Small m is clearly the main determinant of this factor, followed by Sh.

Hepatitis-associated antigen in sporadic cases of acute viral hepatitis.

Serum specimens collected during the period from September 1970 to April 1971 from hospitalized patients and apparently healthy staff members at risk were tested for the presence of hepatitis-associated antigen (HAA) by the parallel use of three techniques: the complement fixation test, crossover-electrophoresis and immuno-electronmicroscopy.Out of a total of 204 persons investigated 63 (30.9%) were found to harbour the antigen. The HAA-positive sera originated almost exclusively from sporadic cases of acute viral hepatitis (clinically diagnosed as "infectious hepatitis" or "serum hepatitis"). The great majority of the hepatitis cases studied had a history of drug addiction.