Addiction to Propofol: A Study of 22 Treatment Cases.

Addiction to Propofol: A Study of 22 Treatment Cases.

J Addict Med. 2013 Mar 20;
Earley PH, Finver T

OBJECTIVE:: To review and report the history and clinical presentation of a cohort of health care professionals (HCPs) who have abused the drug propofol. METHODS:: The authors queried a clinical database (the HCP Database) that contained information about HCPs treated at a large addiction center between 1990 and 2010. Patients who reported propofol use were removed from the HCP Database and placed in a second database referred to herein as the Propofol Database. The medical records of each of the cases in the Propofol Database were pulled and carefully reviewed; a clinical case history of each case was prepared. The Propofol Database was expanded by this chart review, adding demographics, drugs used, course of substance use, other clinical history, presenting signs, diagnoses, and comorbid conditions. At this point, the case histories and databases and were anonymized. When variables were present in both data sets, significance was tested between the HCP Database and the Propofol Database. When comparable data were not present in the HCP Database, the authors reported simple percentages within the Propofol Database. This study focused on gender, medical education and specialty, drugs used, course of illness, and comorbid conditions. RESULTS:: Compared with the composite treatment population of HCPs during the same time, records showed that the propofol group was more likely to work in the operating theater, be female, and have training as an anesthesiologist or certified registered nurse anesthetist. Presentation into treatment from the propofol cohort more commonly occurred soon after beginning propofol use, often presenting in a dramatic fashion such as motor vehicle accidents or other physical injuries. When such injuries occurred, it was a direct result of acute propofol intoxication. The number of cases arriving in treatment increased over the duration of the study. The propofol group frequently suffered with a depressive illness and had a history of earlier life trauma. They had a high frequency of biological relatives with substance dependence. The most common subjective response as to why they began using propofol was to induce sleep. Most of these patients identified propofol as one of their preferred drugs of abuse. CONCLUSIONS:: This study suggests the incidence and/or detection rate of propofol abuse in HCPs is increasing. Women and anesthesia personnel were overrepresented in the propofol cohort. Propofol-dependent patients commonly have a history of depression and earlier life trauma. A rapid downhill course and physical injury are common adverse effects of propofol abuse. The time from initial use to treatment entry is often contracted when compared with other drugs of abuse making the diagnosis of a true dependence disorder and disposition after treatment more difficult. HubMed – addiction


Intravenous Bupropion: A Previously Undocumented Method of Abuse of a Commonly Prescribed Antidepressant Agent.

J Addict Med. 2013 Mar 20;
Baribeau D, Araki KF

Bupropion is an antidepressant commonly prescribed as a smoking cessation aid. It has effects on dopamine and norepinephrine, and can lower seizure threshold, particularly in overdose. Several cases of recreational use of bupropion via nasal insufflation have been reported in the literature. Here we describe a first case of intravenous bupropion dependence, with no evidence of resulting seizure activity. This addiction was sustained in part under the the premise of seeking smoking cessation aid. Pharmacokinetic interactions are explored, and the literature with respect to buproprion abuse is reviewed. We propose that bupropion may have stimulant effects amenable to abuse that vary with route of administration. Health care providers may wish to exercise additional caution when prescribing bupropion to unfamiliar patients. HubMed – addiction


Reduced D-serine levels in the nucleus accumbens of cocaine-treated rats hinder the induction of NMDA receptor-dependent synaptic plasticity.

Brain. 2013 Mar 20;
Curcio L, Podda MV, Leone L, Piacentini R, Mastrodonato A, Cappelletti P, Sacchi S, Pollegioni L, Grassi C, D’Ascenzo M

Cocaine seeking behaviour and relapse have been linked to impaired potentiation and depression at excitatory synapses in the nucleus accumbens, but the mechanism underlying this process is poorly understood. We show that, in the rat nucleus accumbens core, d-serine is the endogenous coagonist of N-methyl-d-aspartate receptors, and its presence is essential for N-methyl-d-aspartate receptor-dependent potentiation and depression of synaptic transmission. Nucleus accumbens core slices obtained from cocaine-treated rats after 1 day of abstinence presented significantly reduced d-serine concentrations, increased expression of the d-serine degrading enzyme, d-amino acid oxidase, and downregulated expression of serine racemase, the enzyme responsible for d-serine synthesis. The d-serine deficit was associated with impairment of potentiation and depression of glutamatergic synaptic transmission, which was restored by slice perfusion with exogenous d-serine. Furthermore, in vivo administration of d-serine directly into the nucleus accumbens core blocked behavioural sensitization to cocaine. These results provide evidence for a critical role of d-serine signalling in synaptic plasticity relevant to cocaine addiction. HubMed – addiction


Social geographies of African American men who have sex with men (MSM): A qualitative exploration of the social, spatial and temporal context of HIV risk in Baltimore, Maryland.

Health Place. 2013 Mar 5; 22C: 1-6
Tobin KE, Cutchin M, Latkin CA, Takahashi LM

This qualitative study utilized a time-geography framework to explore the daily routines and daily paths of African American men who have sex with men (AA MSM) and how these shape HIV risk. Twenty AA MSM aged 18 years and older completed an in-depth interview. Findings revealed (1) paths and routines were differentiated by indicators of socio-economic status, namely employment and addiction, and (2) risk was situated within social and spatial processes that included dimensions of MSM disclosure and substance use. This study highlights the critical need for future research and interventions that incorporate the social and spatial dimensions of behavior to advance our ability to explain racial disparities in HIV and develop effective public health responses. HubMed – addiction