Crack cocaine treatment

Gawin F., Allen D., Humblestone B. Outpatient treatment of crack cocaine smoking with flupentixol decanoate. Arch. Gen. Psychiatry. 46 322, 1989. 

Residential treatment appeared the most likely way of making an impact on Carl s crack cocaine use, and plans were made for an admission. This could not happen immediately, and in the meantime Carl was prescribed fluoxetine 20mg per day, and diazepam 20-30mg per day. He was keen to try to withdraw himself from crack without going into hospital, and he and his mother were instructed about his use of the two medications. They were advised that diazepam would reduce anxiety and agitation, and might help relieve craving for crack. 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Gossop M, Marsden J, Stewart D Kidd T (2002a). Changes in use of crack cocaine after drug misuse treatment 4-5 year follow-up results from the National Treatment Outcome Research Study (NTORS). Drug and Alcohol Dependence, 66, 21-8... 

A 27-year-old man twice developed inflammatory lung disease (with a predominance of eosinophils) after inhaling crack cocaine (104). Glucocorticoid treatment led to prompt resolution on both occasions. 

The rate of co-morbidity has been studied in 208 female African-American crack cocaine users 148 were in treatment, 54 were active crack users, and 61% reported a history of sexual abuse (174). Many had co-morbid depression (48%) and eating disorders (11%). 

Henderson and co-workers demonstrated an even more pronounced effect on the retention of cocaine after a permanent wave solution was applied. The amounts of cocaine incorporated from crack cocaine smoke prior to treatment were as follows Asian, 52.6ng/mg hair Caucasian brown, 22.7 ng/mg hair and Caucasian blond, 14.9ng/mg hair. After treatment, these concentrations drop to Asian, 8.2 ng/mg hair Caucasian brown, 2.2 ng/mg hair and Caucasian blond, 0.8 ng/mg hair. The percentage decreases from the untreated hair were similar Asian, 84% Caucasian... 

Like any other drug, common methods of cocaine intake are snuffing or snorting and subcutaneous or intravenous injection. Also, free-base cocaine may be smoked in a water pipe. Cocaine hydrochloride is converted to a more potent free-base cocaine (also known as crack ) by treatment with a mild base, such as ammonia or sodium carbonate. 

Pavenski K, Vandenberghe H, Jakubovic H, Adam DN, Garvey B, Streutker CJ. Plasmapheresis and steroid treatment of levamisole-induced vasculopathy and associated skin necrosis in crack/cocaine users. J Cutan Med Surg 2013 17(2) 123-8. 

Cocaine is a widely abused, addicting drug. Cocaine is usually obtained as its hydrochloride salt (cocaine hydrochloride) but can be converted to crack (the neutral molecule) by treatment with base. Which of the two compounds here has a higher boiling point Which is more soluble in water How does the relative solubility explain why crack is usually smoked but cocaine hydrochloride is injected directly into the bloodstream ... 

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