Heroin cocaine dependence

Several CM studies have explored interactions between medication and psychosocial treatments for substance use disorders. In a 12-week randomized, double-blind study of buprenorphine-maintained opioid- and cocaine-dependent patients, Kosten et al. (2003a) found that desipramine and CM together led to greater abstinence from cocaine and heroin and more consecutive weeks of abstinence than either treatment individually or placebo. A later... 

Kleber HD. Pharmacologic treatments for heroin and cocaine dependence. Am J Addict. 2003 12(suppl 2) S5-S18. 

In an interview study (Robson and Bruce 1997), the dependence potential of various street drugs was assessed in 201 problem and 380 social users of heroin, cocaine or amphetamine using the well-validated Severity of Dependence Scale (SDS). Scores (maximum = 15) in the problem group were 12.9 for heroin, 9.6 for other opioids, 6.1 for amphetamine and 5.5 for crack cocaine. All of these scores were consistent with findings in other studies. Cannabis SDS score was 2.6 and comparable with those of LSD (3.1) and ecstasy (1.3), two drugs that are generally not associated with physical or psychological dependence. In the parallel sample of social users, the cannabis SDS was similar at 3.4. 

Seecof R, Tennant FS Subjective perceptions to the intravenous rush of heroin and cocaine in opioid addicts. Am J Drug Alcohol Abuse 12 79—87, 1987 Sees KL, Delucci KL, Masson C, et al Methadone maintenance vs. 180-day psycho-socially enriched detoxification for treatment of opioid dependence a randomized controlled trial. JAMA 283 1303-1310, 2000 Sells SB Treatment effectiveness, in Handbook on Drug Abuse. Edited by Dupont RE, Goldstein A, O Donnell J. Washington, DC, U.S. Government Printing Office, 1979, pp 105-118... 

A formal diagnosis of substance dependence requires a maladaptive pattern of abuse that leads to clinically significant impairment or distress. More detailed criteria revolve around the development of tolerance, the experience of withdrawal when abstinence is required, the inability to stop using the drug, and continued use over a protracted period of time. The question is whether or not these criteria, clearly applicable to cocaine, heroin, and other drugs, are met by caffeine. 

Sizemore G.M., Davies H M., Martin T.J., Smith J.E. Effects of 2beta-propanoyl-3beta-(4-tolyl)-tropane (PTT) on the self-administration of cocaine, heroin, and cocaine/heroin combinations in rats. Drug Alcohol Depend. 73 259, 2004. 

Cannabis carries some potential for dependence and addiction. Compared to cocaine, heroin, alcohol, and nicotine, cannabis has lesser addictive potential and withdrawal effects, but some users do develop compulsive and maladaptive use patterns that require treatment (Taylor 1998). Individuals with underlying psychopathology or tendencies for substance abuse should be particularly leery of using cannabis in the interests of avoiding compulsive use patterns. 

In contrast, some drugs of abnse prodnce intense craving and are highly addictive bnt do not prodnce physical dependence. The absence of physical dependence indicates the relative lack of physiological withdrawal. This is not synonymous with meaning that discontinuation of these componnds may not be psychologically nncomfortable. Two examples are marijnana and cocaine. One need only look to the recent crack epidemic to see evidence of the way these substances can destroy lives, bnt they do not produce tolerance or risk of withdrawal to the same extent as alcohol or heroin. As a result, we would say that the daily crack or marijuana user meets the dehnition of substance dependence bnt does not exhibit true physical (or physiological) dependence. 

Pula G, Mundell SJ, Roberts PJ, Kelly E (2004) Agonist-independent internalization of metabotropic glutamate receptor la is arrestin- and clathrin-dependent and is suppressed by receptor inverse agonists. J Neurochem 89 1009-1020 Pulvirenti L, Maldonadolopez R, Koob GF (1992) NMDA receptors in the nucleus accimibens modulate intravenous cocaine but not heroin self-administration in the rat. Brain Res 594 327-330... 

An alkaloid is a complex organic chemical substance found in plants, which characteristically combines nitrogen with other elements, has a bitter taste, and typically has some toxic, stimulant, analgesic effects. There are many different alkaloids, 30 of which are found in the opium plant. While morphine is the most important alkaloid in opium—for its natural narcotic qualities as well as providing the chemical structure for heroin—another alkaloid, codeine, is also sought after for its medicinal attributes. Other alkaloids include papaverine, narcotine, nicotine, atropine, cocaine, and mescaline. While the concentration of morphine in opium varies depending on where and how the plant is cultivated, it typically ranges from 3 percent to 20 percent. 

---