Cocaine additive

Substance abuse has been the subject of several lOM studies, which have covered a whole host of issues related to the topic, including federal regulation of methadone treatment, the development of medications for the treatment of opiate and cocaine additions, and community-based research to find better ways to treat people who abuse drugs. 

Other Substances. Driving under the influence of alcohol cases are compHcated because people sometimes consume alcohol with other substances (11—13). The most common iUicit substances taken with alcohol are marijuana and cocaine (see Table 1) (14). In combination with alcohol, some dmgs have an additive effect. When a blood or urine alcohol sample is tested for alcohol and the result is well below the legal concentration threshold yet the test results are not consistent with the arresting officers observation that the subject was stuporous, further toxicological tests for the possible presence of dmgs are indicated. 

Amines occur widely in all living organisms. Trimethylamine, for instance, occurs in animal tissues and is partially responsible for the distinctive odor of fish, nicotine is found in tobacco, and cocaine is a stimulant found in the South American coca bush. In addition, amino acids are the buildingblocks from which all proteins are made, and cyclic amine bases are constituents of nucleic acids. 

Increased oxygen demand secondary to increased heart rates and blood pressure has been hypothesized to lead to myocardial infarction (especially in patients with fixed coronary disease) and/or ventricular arrhythmias. In patients with no history of cardiac disease, cocaine is thought to induce acute isehemie complications via vasospasm of the coronaries (Ascher et al. 1988). In addition, Virmani et al. (1988) have reported a 20 percent incidence of myocarditis thought to be secondary to accumulated microvascular injuries. 

For all 12 mother-infant pairs, either the mother or the infant s toxicology report was subsequently positive for PCP. In nine cases, the screens for both mother and infant were positive. In two cases, the mother s results were positive and the infant s were negative. In one case, the infant had a positive result while the mother s test was negative. Test sensitivity, specimen handling procedures, and delays in obtaining specimens undoubtedly contributed to the inconsistency in paired results. Cocaine, codeine, and glutethemide, in addition to phencyclidine, were identified in the urine toxicology screens of two mothers and their neonates. 

In the vertebrate CNS monoamines have been associated with a number of physiological functions (reviewed in Kandel et al., 1991). Serotonin has functions associated with mood, pain, sleep, learning, and memory. Dopamine has functions associated with schizophrenia, Parkinson s disease, and cocaine addiction. In vertebrates, dopamine is further metabolized into two additional neurotransmitters, norepinephrine and epinephrine. Norepinephrine increases the excitability of cells in response to sudden sensory input such as fear. Epinephrine has been identified in specific neurons of the brain, but the function of these cells is unknown. In addition, AADC has also been found in a class of neurons that do not have any of the four neurotransmitters discussed above (Jaeger et al., 1983). These neurons may use one of the trace amines, tyramine, tryptamine, or phenylethylamine, as a neurotransmitter. 

Krapcho and Vivelo have described a new formal total synthesis of tropinone (124) and ( )-cocaine (98) (94). Cycloaddition of IV-methylpyrrole (182) and acetylenedicarboxylic acid leads to 183, which is hydrogenated to 184. The diacid mixture 184 is refluxed in MeOH/HCl to yield the diester mixture 185. Addition of this to an excess of metallic sodium in liquid ammonia at — 78°C leads to the N-methylpyrrolidine derivative 186 (cf. 95), whose diethyl analog 147 has earlier been converted to tropinone (124) and (+)-cocaine (98) (78-80) (Scheme 13). 

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