Nicholas E. Goeders

The emergency department (ED) at Louisiana State University-Health Science Center in Shreveport (LSUHSC-S) serves an urban population with a large rural catchment area. This study focuses on demographic variables in substance abuse trends in this region based on urine drug screen (UDS) results. A database of de-identified UDSs ordered in the ED at LSUHSC-S between 1998 and 2011 was analyzed. Samples were tested for the presence of amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, 3,4-methylenedioxymethamphetamine (MDMA), methadone, methamphetamine, opiates, phencyclidine, and propoxyphene. The patient population was categorized by age group, gender, and race. The majority of tests were performed on African-American and Caucasian patients aged 18–54 followed by the 0–11-year-old group. Of the drugs tested, cannabinoids represented the highest percentage of positive results in both the African-American and Caucasian populations. Opiates returned the highest percent of positive results among all prescription drugs. The Caucasian population predominated in positive tests for prescription drugs (opiates and benzodiazepines), while the African-American population predominated in results positive for illicit drugs (cannabinoids and cocaine). The increasing presence of opiates and cannabinoids, particularly in very young patients, should prompt policy-makers and health care providers to develop intervention strategies to protect the most vulnerable populations.

Rationale Despite increased education regarding its dangers, cigarette smoking remains a significant public health concern due to serious associated health consequences such as cancer and respiratory and cardiovascular diseases. Most smokers fail in their attempts to quit smoking, and current pharmacological interventions have relatively low levels of efficacy and are associated with significant adverse events. We have previously reported that combinations of metyrapone and oxazepam, administered at doses that were ineffective when delivered singly, resulted in dose-related decreases in cocaine self-administration in rats while not affecting food-maintained responding during the same sessions. Objectives The current study was designed to test the effects of the administration of a metyrapone:oxazepam combination on nicotine self-administration in rats. Methods Several dose combinations of metyrapone (12.5, 25 or 50 mg/kg) and oxazepam (5 or 10 mg/kg) were tested in rats trained to intravenously (IV) self-administer nicotine (0.03 mg/kg/infusion) during 1-h self-administration sessions using both fixed-ratio and progressive-ratio (PR) schedules of reinforcement. Results The administration of low doses of metyrapone and oxazepam in combination significantly decreased IV nicotine self-administration in rats. At the lowest doses of 12.5 mg/kg of metyrapone and 5 mg/kg of oxazepam, the drugs alone did not decrease IV nicotine self-administration, but the combination was effective. Varenicline was also tested using the fixed-ratio schedule, and reductions in nicotine intake were similar to those seen with the moderate dose of the combination. Conclusions The results of this study suggest a potential utility of the combination of metyrapone and oxazepam for smoking cessation in humans.

We have previously reported that pretreatment with benzodiazepines reduces intravenous cocaine self-administration in rats.

Recent evidence suggests an important role for corticotropin-releasing hormone (CRH) and CRH receptors in cocaine reinforcement. CRH receptor antagonists reduce cocaine self-administration and attenuate the reinstatement of extinguished cocaine-seeking behavior, but little is known about the mechanisms involved. One possible mechanism for these effects may involve the cocaine-induced activation of CRH located in brain regions outside of the hypothalamus. CRH has been shown to increase dopaminergic transmission in regions relevant for cocaine reinforcement, such as the medial prefrontal cortex and the nucleus accumbens. Here, we report that CP-154,526, a CRH1-receptor antagonist, actually enhances cocaine-induced increases in dopamine overflow in the medial prefrontal cortex, measured using in vivo microdialysis. In contrast, the receptor antagonist did not alter cocaine-induced increases in dopamine in most of the nucleus accumbens, except for the most rostral part. These data suggest a surprising role for prefrontal cortex dopamine in the ability of CRH-receptor antagonists to attenuate cocaine seeking in rats. Synapse 57:202–212, 2005.