Modafinil and cocaine: a double-blind, placebo-controlled drug interaction study.

Modafinil is a novel compound that is approved for the treatment of narcolepsy. It is now being studied as a potential treatment for cocaine dependence. Cocaine withdrawal symptoms are associated with poor clinical outcome and are likely to be reversed by modafinil. In addition, the neurotransmitter actions of modafinil are opposite to cocaine-induced neuroadaptations affecting dopamine and glutamate reward circuits. Since cocaine-dependent subjects might use cocaine during a clinical trial with modafinil, this study tested the safety of intravenous cocaine (30 mg) in combination with modafinil. Each of seven subjects received a baseline (open-label) cocaine infusion. Three subsequent cocaine infusions were administered after subjects received 4 days of low dose modafinil (200 mg/day), high dose modafinil (400 mg/day), or placebo in randomized double-blind sequences. One subject received placebo prior to all infusions. Our results indicate that co-administering modafinil and a single dose of intravenous cocaine is not associated with medical risk in terms of blood pressure, pulse, temperature, or electrocardiogram measures. Furthermore, pretreatment with modafinil did not intensify cocaine euphoria or cocaine-induced craving. In fact, cocaine euphoria was significantly blunted (P=0.02) in one of our subjective measures.

Poor sensitivity of musculoskeletal history in children.

OBJECTIVES: To demonstrate the sensitivity of musculoskeletal (MSK) history taking. DESIGN: Prospective study: consecutive children attending outpatient clinics. SETTING AND PATIENTS: Paediatric rheumatology clinic (n=45; girls n=28; median age 12 years, range 3-18), acute general paediatric assessment unit (n=50; girls n=21; median age 8 years, range 3-16). INTERVENTION: Pro forma recording abnormal joint involvement from history taking and then following MSK examination completed by clinicians. MAIN OUTCOME MEASURES: Sensitivity of MSK history taking compared with clinical examination. RESULTS: Paediatric rheumatology clinic: 135 abnormal joints identified in 34 children; 53/135 (39%) by history alone, 82/135 (61%) detected on examination resulting in MSK history sensitivity 53%, specificity 98%. Acute paediatric unit: 29 abnormal joints identified in 17 children; 18/29 identified on history (sensitivity 62%). CONCLUSIONS: MSK history taking failed to identify a large number of abnormal joints which were detected on physical examination, emphasising the need for all joints to be examined as part of a screening examination as a minimum.

Characteristics of adolescents in residential treatment for heroin dependence.

A retrospective review of the clinical charts of 97 adolescents who had received residential treatment for heroin dependence was conducted to determine predictors of heroin use. The average age for the adolescent patients reviewed was 17 years. Almost half of the adolescents (48%) were female and over half of the adolescents (53.6%) used heroin intravenously. Both males and females had substantial heroin habits, but differing amounts of use. Boys used an average of six bags of heroin per day and girls used an average of four bags of heroin per day. Using gender, age, number of heroin dependence symptoms, and other substances as predictors, 64.21% of the adolescents were correctly classified as injectors or noninjectors of heroin. Heroin appears to be a significant drug of abuse among these predominately white, middle class, suburban adolescents.