Sticky business: patterns of procurement and misuse of prescription cough syrup in Houston.

Reports of recreational codeine cough syrup use have increased in Houston and in the state of Texas. Occasional and polydrug users increasingly have consumed codeine cough syrup (with or without alcohol or other drugs) over the past three years, accounting for a $40 increase in the price of an eight-ounce bottle on the underground economy. News stories regarding syrup abuse and reports of deaths by codeine overdoses suggested the need to explore this emerging drug trend. The investigator conducted a literature search of scientific journals and news media, interviews with community authorities, and guided interviews with 25 adults who reported using codeine cough syrup in the 30 days preceding their interviews. Participants were recruited through snowball sampling; interview transcripts were coded and content analyzed. Polydrug users reported a penchant for codeine syrup because it carries fewer legal consequences, is perceived as "safer" than illegal drugs, and is either free or inexpensive for users with Medicaid or private insurance. Participants reported methods for procuring syrup from physicians and hospital emergency rooms which they consumed or traded for money, goods, or services. Consumption patterns for chronic and occasional users are described. Reported side effects include a drowsy relaxed high, fatigue, loss of coordination, constipation, and urinary retention.

Treating substance-using women and their children in public housing: preliminary evaluation findings.

The Key West Housing Authority created SafePort, a residential substance abuse treatment program within public housing to provide drug treatment to parenting women. All family members-women, children, and significant others-receive comprehensive assessments to determine appropriate therapeutic interventions to resolve their problems. Preliminary evaluation findings suggest that women who participate with their children are more likely to remain drug free than are those who participated without their children.

A comparison of the reliability of self-reported drug use and sexual behaviors using computer-assisted versus face-to-face interviewing.

The purpose of this study was to assess the reliability of responses to HIV risk behavior questions obtained using a voice-enhanced, computer-administered self-interview (audio-CASI) system with touch-screen response compared with those obtained via face-to-face interviews administered by trained and experienced interviewers. Additionally, the study assessed bias that may be attributable to an audio-CASI data collection format. The design of the study was a four-group crossover design with random assignment to one of four study conditions: (a) audio-CASI interview at both intake and retest, (b) face-to-face interview at both intake and retest, (c) audio-CASI interview at intake and face-to-face interview at retest, and (d) face-to-face interview at intake and audio-CASI interview at retest. The study was conducted with a sample of drug users at risk for HIV infection interviewed in nonclinical settings. Data were collected at intake and 48 hours after intake. Analyses show that data obtained using voice-enhanced computer interviewing with touch-screen response are reliable and are comparable to data obtained using interviewer administered face-to-face interviews. However, bias was found to be associated with data collection format and may be partially attributable to the complexity of the questionnaire.

Perceived compliance with AZT dosing among a sample of African-American drug users.

The purpose of this report was to present findings from a pilot study conducted to explore the associations between sociodemographic, drug use, and health belief factors and perceived compliance with zidovudine (AZT) among African-American drug users. Data were collected in Washington, DC, USA from individuals who were African-American; were recent or current drug injectors or crack smokers; were HIV-seropositive, and were receiving treatment for HIV infection. Participants were recruited through local organizations that provide services to HIV-infected persons. Participants were interviewed using a questionnaire that solicited sociodemographic, lifetime and current drug use, current sexual behaviours, health status, HIV and drug treatment history, and health belief data. Analyses were limited to individuals currently using an illicit substance and who had received AZT during their medical treatment. Parametric (Pearson's r) and nonparametric (Spearman's rho) statistics were used to assess correlations between perceived compliance with AZT dosing and independent variables. As the study was intended to be both descriptive and exploratory, the level of statistical significance was set at 0.10, rather than the customary 0.05. Antiretroviral medications recognized and recalled by participants are presented. The most commonly recalled medication was AZT. Slightly less than one-third of participants reported being completely compliant with an AZT regimen. Perceived compliance was found to be negatively associated with 5 variables: age, homelessness, number of injections in the previous 30 days, trading sex for drugs, and the perception that AIDS is no longer a serious disease since the development of new antiretroviral medications. Intensity of feelings of joy, fear, and the belief that taking more anti-HIV medications would result in better health were found to be positively correlated. Bivariate associations between perceived compliance and sociodemographic, drug use, sexual behaviour, and health belief variables suggest further avenues of study and potential points for intervention to increase compliance with antiretroviral medications among racial/ethnic minority drug users receiving treatment for HIV infection.

Embalming fluid-soaked marijuana: new high or new guise for PCP?

A growing trend of smoking marijuana soaked in what is purported to be embalming fluid has been reported in the literature since the mid-1980s. This article describes several cases of intoxication, gives regional epidemiological data on this phenomenon, and includes current nomenclature. The authors also analyze a sample of fluid said to be embalming fluid and discover PCP (phencyclidine) and multiple congeners and by-products of PCP manufacture. The implications of this finding are discussed, and the hypothesis that most embalming fluid-soaked marijuana likely contains PCP is considered.

A cluster analysis of not-in-treatment drug users at risk for HIV infection.

The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several "homogeneous" HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.

Introduction of HIV into drug injector networks outside AIDS epicentres.

Injection drug users (IDUs) continue to be at risk for HIV infection despite high levels of knowledge about how human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is transmitted. Yet, among not-in-treatment injection drug users, the chances of becoming infected with HIV vary substantially. Information regarding the factors that facilitate the introduction of HIV into networks of drug injectors in low HIV seroprevalence cities is urgently needed. This study examines the factors related to HIV seroprevalence in a large (n=9492), multi-site sample of IDUs recruited in 11 low seroprevalence cities. Univariate and multivariate associations between drug injection and sexual behaviours and travel to an AIDS epicentre were examined. Results show that, next to male-to-male sexual contact, having sex at least twice in an AIDS epicentre was the strongest predictor of HIV infection. Also associated with higher odds of being HIV-positive were racial/ethnic characteristics, daily drug injection, and injecting drugs in an AIDS epicentre. These results confirm that travelling to an AIDS epicentre and having sex or injecting drugs play a large role in the introduction of HIV into drug injector networks in low seroprevalence cities.

Powerlessness and HIV prevention among people who trade sex for drugs ('strawberries').

Researchers and members of the drug culture have employed the term 'strawberries' to describe African American women who trade sex for drugs. Data from six US cities participating in a community-based drug research project were analysed to examine the determinants of trading sex for drugs. As shown by our data, some African American women match the street description commonly attributed to 'strawberries'. However, our results also show that trading sexual favours for drugs is not limited to African American women, nor solely to women. Rather, trading sex for drugs is an economic behaviour that occurs among women and men of any race/ethnicity who use crack cocaine. Trading sex for drugs is closely related to conditions of poverty and homelessness, conditions that especially affect many crack smokers. The discussion urges educators and researchers to be alert for 'strawberry behaviours' exhibited by drug-users of any racial/ethnic background or gender.

Influence of interpersonal and mass-mediated interventions on injection drug and crack users: diffusion of innovations and HIV risk behaviors.

Evaluation research of public health media campaigns to influence behavior change often bemoans the lack of relevance to target audience and an absence of integrated interpersonal and mass-mediated communication channels. The assumption that illegal drug users are disconnected from mass-mediated communication may account for this absence of media interventions. The authors used cross-tabulation, chi-square, and regression analyses to demonstrate that many out-of-treatment drug users in an HIV-prevention research project are media consumers and that participants who recalled seeing or hearing media interventions reported greater levels of positive behavior change than participants who did not recall such messages. Results suggest coordination of human and mass-mediated public health messages relevant to this population to facilitate behavior changes.

An assessment of the risks of syphilis and HIV infection among a sample of not-in-treatment drug users in Houston, Texas.

The research presented in this paper details the results of an assessment of the risk factors associated with having a positive syphilis or HIV serology. The study was conducted using a sample of not-in-treatment drug users volunteering to participate in an HIV risk reduction intervention. The sample was composed of individuals who had injected drugs within 30 days or smoked crack cocaine 48 hours prior to participation in the study. Study participants were approximately 75% male and 66% African-American. All participants provided a blood sample to be tested for HIV and syphilis. Analysis of risk was conducted using univariate and multivariate statistical methods. Multivariate analysis of blood results showed that women, African-Americans, and those having a positive blood test for HIV were at higher odds of having a positive syphilis test. Analysis also showed that being a gay or bisexual male, having a history of drug injection, having less than a high-school education, having a history of trading sex for money, being African-American, and having a positive blood test for syphilis significantly increased the odds of a positive HIV test. Implications for HIV and STD prevention are discussed.

Fostering a drug-free workplace.

Drug abuse costs American industry and the public an estimated $100 billion a year. As a result, workplace drug testing programs have become a serious option for many companies. Federal guidelines regarding testing and laboratories are in place. An overview of the current components necessary in designing a corporate drug testing program that complies with these guidelines is presented. Essential features of a corporate workplace drug testing program, that is, the policy, the testing process, and the laboratory contracted to test employees, are detailed from designs suggested in the current literature and in compliance with federal guidelines. Developing a cost-effective corporate program that meets federal guidelines, stands up to court scrutiny, and is universally accepted by employees is the objective of a drug testing program. The challenge can be met by building consensus, spelling out policy, maintaining high testing standards, and above all making rehabilitation of employees who test positive the ultimate goal of a drug-free workforce/workplace.

To hang in the 'hood: description and analysis of outreach activities.

The unique, influential, and successful characteristics of outreach as a risk behavior reduction intervention among active drug users is examined. The history of outreach is posited as a delineation of roles, and the outreach process as one of communication and role enactment. The premise is that the outreach worker's juxtaposition of multiple communicative roles facilitates success with HIV outreach interventions. The word "outreach" implies a desired object that eludes one's ready grasp. In the attempt to educate the active drug user about HIV risk behavior, it is the addict that often eludes the educator's ready grasp; a small dilemma for the creative outreach worker. An ethnographic description is provided of four different outreach workers' abilities to penetrate social networks, locate and recruit hidden populations, contextualize client behavior, respond to client needs, and build trust necessary to engage them in risk reduction interventions, while still adhering to program recruitment guidelines. Investigative, study, and outreach limitations are discussed.

Inhibition of allergen-induced lung eosinophilia by type-III and combined type III- and IV-selective phosphodiesterase inhibitors in brown-Norway rats.

We examined the effect of a type IV (rolipram) and a combined type III and IV (Org 20421) isoenzyme-selective phosphodiesterase inhibitor upon allergen-induced pulmonary eosinophil recruitment in sensitised Brown Norway rats. Rats were sensitised with ovalbumin intraperitoneally and later challenged with ovalbumin aerosol which induced a significant increase in the total eosinophil and neutrophil count in bronchovalveolar lavage fluid at 24 hours (from 0.38 +/- 0.12 to 1.36 +/- 0.18 x 10(6), p < 0.01 and from 0.06 +/- 0.01 to 0.33 +/- 0.07 x 10(6), p < 0.01) respectively. Pretreatment with rolipram (30 mumol/kg) and Org 20421 (30 mumol/kg) abolished the eosinophilia and neutrophilia evoked by ovalbumin. We conclude that type IV and possibly type III isozyme phosphodiesterase inhibitors may regulate, directly or indirectly, eosinophil and neutrophil activity and/or those cells responsible for attracting them into the lung.

Effects of prolonged repeated exposure to ovalbumin in sensitized brown Norway rats.

The effects of chronic exposure to ovalbumin (OA) aerosol were studied in Brown Norway rats following intraperitoneal injections with OA and AI(OH)3 and exposure to OA or saline aerosols, once or every third day for 3 to 8 wk. Measurements of airway responsiveness to acetylcholine (ACh) aerosol at 18 to 24 h after allergen exposure showed a significant increase in -logPC150, the concentration of ACh needed to cause a 150% increase in baseline lung resistance, in animals single-exposed or chronic OA-exposed for 3 wk, compared with saline-exposed control animals. The group receiving 8 wk of OA exposure demonstrated no difference from the control animals with -logPC150 lower than that of the two previous groups (p < 0.001). In all three groups, BAL fluid showed a significant increase in neutrophils, but a significant increase in eosinophils (p < 0.01) was only observed in the single-exposed group when compared with saline-exposed control animals. In the 8-wk exposed rats, there was a higher recovery of macrophages and lymphocytes (p < 0.01) compared with control animals and the other two groups. AHR, present after single or 3-wk repeated exposure, disappears by 8 wk of continuous allergen exposure. Both the enhancement and suppression of AHR may be linked to OA-induced immune and inflammatory mechanisms.

Contribution of intercellular-adhesion molecule-1 in allergen-induced airway hyperresponsiveness and inflammation in sensitised brown-Norway rats.

We investigated the potential role of intercellular-adhesion molecule-1 (ICAM-1) in allergen-induced bronchial hyperresponsiveness (BHR) and inflammation in sensitised Brown-Norway rats. Rats were sensitised with ovalbumin (OA) intraperitoneally and 21 days later they were either exposed to 0.9% NaCl or 1% OA aerosol for 15 min. Rats exposed to OA aerosol were pretreated either with ICAM-1 antibody (3 mg/kg i.p. and i.v., 45 min prior to OA exposure) or with the diluent for the antibody. Eighteen to twenty-four hours after OA or 0.9% NaCl exposure, rats were anaesthetised, tracheostomised and mechanically ventilated, and airway responsiveness to acetylcholine (ACh) aerosol was measured as the provocative concentration of ACh needed to increase pulmorary resistance by 100% (PC100). Mean -log PC100 was increased in rats exposed to OA but pretreated with diluent (2.75 +/- 0.06) compared to rats treated with ICAM-1 antibody (2.51 +/- 0.08; < 0.05). However, only the former group showed significantly higher mean -log PC100 compared to the sensitised group exposed to 0.9% NaCl alone (2.22 +/- 0.12; p < 0.01). There was a significant increase in eosinophil and lymphocyte counts in bronchoalveolar lavage fluid at 24 h in rats pretreated with diluent compared to saline exposed rats. However, in ICAM-1 antibody-pretreated rats, eosinophil and lymphocyte counts were significantly different from diluent-treated ones. We conclude that ICAM-1 antibody inhibits BHR without reducing the influx of inflammatory cells.

Role of cyclooxygenase and 5-lipoxygenase metabolites, platelet-activating factor and 5-hydroxytryptamine in allergen-induced airway responses in the brown Norway rat.

We determined the effects of selective inhibition of arachidonic acid metabolism via the cyclooxygenase and 5'-lipoxygenase pathways using flurbiprofen and BWA4C, respectively, of 5-hydroxytryptamine (5-HT) using methysergide and of platelet-activating factor (PAF) using WEB 2086 on the airway responses to ovalbumin (OA) aerosol in OA-sensitized Brown Norway rats. Twenty-one days after intraperitoneal injection of OA, rats were exposed to a 1% OA or saline aerosol. Only methysergide (10 mg/kg i.p.; 3 doses over 24 h) provided significant protection of the immediate response to OA. The increase in airway responsiveness to acetylcholine after OA exposure was not significantly altered by methysergide, flurbiprofen (10 mg/kg i.p.), BWA4C (50 mg/kg i.p.) and WEB 2086 (50 mg/kg i.p.) all given over 24 h prior to OA challenge. In addition, there was no effect on the increased recovery of eosinophils and lymphocytes in bronchoalveolar lavage fluid at 24 h. We conclude that 5-HT is an important mediator of the acute response to OA, but that 5-HT, lipoxygenase and cyclooxygenase products and PAF are unlikely to be involved in OA-induced airway hyperresponsiveness and inflammation in the Brown Norway rat.

Effect of thiazide diuretics against neurally mediated contraction of guinea pig airways. Contribution of carbonic anhydrase.

The effect of thiazide diuretics on neurally and agonist-induced contractile responses of guinea pig airways in vitro were investigated. Tracheal or bronchial strips were suspended in organ baths and isometric tension recorded. Chlorothiazide (CTZ, 10(-4) to 3 x 10(-3) M), hydrochlorothiazide (HCTZ, 10(-3) M), and dichlorphenamide (DCPM, 10(-3) M) significantly potentiated contraction of tracheal strips induced by electrical field stimulation (EFS). They also increased acetylcholine (ACh)- but not carbachol-induced tracheal contraction. In the presence of atropine and propranolol, on the other hand, CTZ and DCPM but not HCTZ significantly inhibited EFS-induced contraction in bronchial strips. We determined whether carbonic anhydrase inhibition could mimic the effects of CTZ and DCPM. Acetazolamide (ATZ), an inhibitor of carbonic anhydrase, had no effect on either EFS- or ACh-induced contraction in tracheal strips but significantly inhibited nonadrenergic, noncholinergic (NANC) contractile responses induced by EFS in bronchial strips. CTZ, DCPM, and ATZ did not affect substance P-induced contractile responses in the bronchi. We conclude that CTZ, DCPM, and ATZ attenuate NANC neurally mediated bronchial contraction by preventing the release of contractile neuropeptides from sensory nerve endings. This effect may occur through inhibition of carbonic anhydrase activity. In addition, thiazide diuretics potentiate contractile responses to ACh in the trachea, probably through inhibition of acetylcholinesterase activity.

Allergen-induced airway hyperresponsiveness in Brown-Norway rat: role of parasympathetic mechanisms.

Enhanced parasympathetic mechanisms may contribute to airway hyperresponsiveness. The present study examined whether the in vivo increase in airway responsiveness seen 18-24 h after either a single or chronic aerosolized allergen challenge protocol in actively sensitized Brown-Norway rats was due to altered parasympathetic mechanisms. The roles of central and reflex vagal mechanisms were studied by performing bilateral cervical vagotomy before measurement of airway responsiveness. Bilateral vagotomy failed to reduce the increase in airway responsiveness after either a single or chronic allergen challenge. The roles of increased neural release of acetylcholine (ACh) and increased end organ responsiveness were studied in vitro. The isometric responses of tracheal and bronchial strips to both electrical field stimulation and exogenously applied ACh from rats exposed both to single and chronic allergen challenges were compared with those from saline-exposed rats. The responses to electrical field stimulation and to exogenous ACh were not significantly enhanced 18-24 h after either protocol. We conclude that the airway hyperresponsiveness observed in this allergic rat model is not mediated through an enhancement of parasympathetic mechanisms.

Effect of inhaled lyso-platelet-activating factor on airway microvascular leakage in the guinea pig.

Lyso-platelet-activating factor (PAF), the precursor and metabolite of PAF, is considered inactive, although it may be converted to PAF by airway cells. We have investigated the effects of inhaled lyso-PAF on bronchoconstriction and airway microvascular leakage in anesthetized guinea pigs. Lung resistance (RL) was measured for 6 min after inhalation of lyso-PAF (0.3, 1, and 3 mM; 30 breaths) followed by measurement of extravasation of intravenous Evans blue dye into airway tissues, which was used as an index of airway microvascular leakage. Inhaled lyso-PAF caused an increase in RL and leakage of dye at all airway levels in a dose-dependent fashion, but intravenous lyso-PAF (0.25 mg/kg) had no airway effect. The maximum dose of inhaled lyso-PAF increased RL significantly by approximately 200%. The amount of extravasation of dye induced was 96 +/- 4 (SE) ng/mg of tissue in trachea, 77 +/- 8 ng/mg in main bronchi, and 65 +/- 7 and 25 +/- 1 ng/mg in proximal and distal intrapulmonary airways respectively; these values were all significantly higher (P < 0.01) than control values. These responses were completely abolished by a specific PAF-receptor antagonist WEB-2086 (2 mg/kg iv). Our results show that inhaled lyso-PAF is potent in increasing airway microvascular leakage. The effects of lyso-PAF may result from its metabolic transformation to PAF by lyso-PAF:acetyl-CoA acetyltransferase in the airway.

Airway hyperresponsiveness to acetylcholine and to tachykinins after respiratory virus infection in the guinea pig.

Upper respiratory tract virus infections may enhance airway responsiveness to histamine in normal subjects. We have studied the effects of parainfluenza Type I (Sendai) virus infection of the upper respiratory tract on the airway responsiveness to acetylcholine (ACh) and substance P administered by either the inhaled or intravenous route in the anesthetized guinea pig. Airway responses to electrical stimulation of the vagus nerves in the presence of atropine (1 mg.kg-1 i.v.) were also studied. After four to five days following virus infection, mean pulmonary insufflation pressure increased significantly in response to inhaled ACh compared to that in control animals. Responses to intravenous ACh were not enhanced. By contrast, responses to both intravenous and inhaled substance P were increased. In addition, mean pulmonary insufflation pressure after electrical stimulation of the vagus nerves for 30 seconds at 5 V, 5 msec (frequencies of 3, 10, and 30 Hz) were all enhanced after virus infection. We conclude that the increased airway responsiveness observed to the exogenous administration of the neurotransmitters ACh and substance P after viral respiratory infection may be due to different mechanisms possibly associated with an interference with the epithelium.