To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Drugs and addiction are relevant to the present study: (1) by analogy with drug-taking, the term ‘addiction’ can be applied to serial killing even where drugs are not involved and (2) drugs play an important role in the lives of some serial lust killers. The discussion first turns to two killers where the term ‘addiction’ has been applied but where it appears that drugs were not used. It then looks at two examples of drug-associated killing. Serial lust killer Michael Ross described feeling assailed by intrusive thoughts urging the rape and murder of women. He published an account of his experience in an academic journal concerned with addiction. Joel Rifkin was adopted and seriously bullied by his peers. He described his sexual behaviour as addictive and gave evidence of ambivalence in his killings. Anthony Sowell appears to have been influenced in his sexual addiction by extensive use of crack cocaine.
This chapter begins with an analysis of the Colombian state’s efforts to transform the Caguán frontier region of Caquetá into a site of land colonization, settlement, and agrarian development in the 1960s. It demonstrates that these state-directed agrarian development initiatives lacked the political and economic support of Colombian elites, which resulted in the transformation of the region into a site of large-scale cattle ranching under the despotic rule of Colombia’s cattle rancher association, Fedegán. It then shows how the movement of the FARC guerrillas into the region, followed by their involvement in taxing and regulating the region’s emerging coca economy, helped generated a counter-hegemonic coca-producing labor regime that was effective in protecting local migrants from the displacement and marginalization they had experienced under the auspices of Fedegán. It ends with a discussion of the similarities and differences between the FARC’s counter-hegemonic regulatory interventions in the coca regime with Fedecafé’s hegemonic interventions in the coffee regime.
This chapter begins by analyzing how the adoption of neoliberal agrarian policies in the 1990s intensified land struggles in the region by generating new waves of displaced migrants who became incorporated into the coca economy of the FARC while also transforming the cattle industry from a domestic meat and hide supplier into an exporter of dairy products for the world market. It shows how FARC control of the region remained strong until the late 1990s and early 2000s, when the region became a geographic focal point of the state’s new neoliberal development strategies. I then demonstrate how and why previous efforts to dislodge the guerrilla threat through US-backed Cold War containment strategies failed, but that the balance of power shifted to the Colombian military in the late 1990s and early 2000s, following a massive influx of US military aid that was appropriated under the aegis of the US War on Drugs and War on Terror. I conclude this chapter with a discussion of the future economic prospects of the region’s cocalero farmers and workers in the absence of FARC protection or a developmental alternative to capitalist accumulation through dispossession.
Contemporary scholars debate the factors driving despotic labour conditions across the world economy. Some emphasize the dominance of global market imperatives and others highlight the market's reliance upon extra-economic coercion and state violence. At the Margins of the Global Market engages in this debate through a comparative and world-historical analysis of the labour regimes of three global commodity-producing subregions of rural Colombia: the coffee region of Viejo Caldas, the banana region of Urabá, and the coca/cocaine region of the Caguán. By drawing upon insights from labour regimes, global commodity chains, and world historical sociology, this book offers a novel understanding of the broad range of factors - local, national, global, and interregional - that shape labour conditions on the ground in Colombia. In doing so, it offers a critical new framework for analysing labour and development dynamics that exist at the margins of the global market.
This introduces the topic of multilateral drug control, its contemporary relevance and the areas under examination within the book. It highlights the key themes grouped by three overarching focuses: historical, contemporary-legal and international relations theory. It examines the major debates under way in UN drug control and their direct relation to the historical-legal regulatory discussion encapsulated within the book. It outline existing historiography on international drug control and examines more recent developments. It points to continuing gaps in historiography, international relations, legal and policy literature which this book will fill. In particular it highlights the extensive literature on international legal fragmentation and its relevance for drug control debates. It offers an overview of regime theory and international relations approaches, suggesting a new and emerging framework based on evaluating drug control as a ‘regime complex’ in a similar lineage to climate change and intellectual property regimes, which will be covered in a more breadth in the Conclusion.
This chapter examines the legal legal of the Single Convention and its successor treaties. The passage of the Single Convention represented a high-water mark in the international regulatory system. While it contained little in terms of innovation, it streamlined the complex array of drug treaties, while moving the terrain of control forward marginally. It essentially solidified an economic regulatory framework for a global licit commodity market in certain essential medicines. To enforce this market it mandated certain action around controlling and prohibiting non-medical production and manufacturing. Key questions around dealing with ‘addiction’ and suppressing non-medical consumption were left largely unanswered. The US may have lost the battle around the Single Convention and control of the system in the 1960s but they would enter the 1970s ready to refight many of these battles, beginning with the declaration of the ‘war of drugs’ and an aggressive new round of bilateral drug diplomacy. Ultimately the ‘war on drugs’ was not an inevitable outgrowth of these documents, but instead represented a specific set of interpretations, bureaucratic and normative trajectories and member state implementations.
This chapter argues that whereas much of the past century was geared towards a legal and institutional homogenisation of international drug control, the coming decades appear underpinned by recourse to ‘policy pluralism’ as a mechanism to enable policy evolution. It is precisely these endogenous processes of pluralism, devolution and increasing diversity of global drug policies that provide the most promising avenues for various actors to influence policies at local, national, regional and international levels. It further argues that the international drug control system is undergoing a long-term process of fragmentation and evolution towards what international relations scholars in other spheres would term a ‘regime complex’. It concludes by suggesting that these endogenous regime changes likely provide the greatest opportunity to draw exogenous actors and regimes into the system’s orbit and thereby modernise and adapt drug policies to new global realities.
This chapter examines the role of the Opium Wars and great power conflict between Britain and China within the context of drug control. Within the Opium Wars, the foundational elements for the coming global drug control system were laid. These included straining bilateral relations between great powers as well as the emergence of nationalist and moralist coalitions of diplomats and missionaries driving ‘reformist’ agendas globally. The first international treaty, the 1912 International Opium Convention, aimed to create reciprocal state responsibilities for limiting the flow of mind-altering drugs. After World War I, the new multilateral drug control system was quickly absorbed by the League of Nations. However, the US’ simultaneous interest in the issue and unwillingness to join the League of Nations proved complicating. Throughout the 1920s and 1930s a whole series of treaties and institutional changes gave the system regulatory shape. The League Opium Advisory Committee, precursor to the UN Commission on Narcotic Drugs (CND) ultimately sank. The enforcement and monitoring bodies, survived and fled Geneva for the safety of Washington DC. The chapter concludes with a brief introduction to the main diplomats of the wartime era, most prominently, Harry J. Anslinger.
Where did the regulatory underpinnings for the global drug wars come from? This book is the first fully-focused history of the 1961 UN Single Convention on Narcotic Drugs, the bedrock of the modern multilateral drug control system and the focal point of global drug regulations and prohibitions. Although far from the propagator of the drug wars, the UN enabled the creation of a uniform global legal framework to effectively legalise, or regulate, their pursuit. This book thereby answers the question of where the international legal framework for drug control came from, what state interests informed its development and how complex diplomatic negotiations resulted in the current regulatory system, binding states into an element of global policy uniformity.
Excited delirium, which has been defined as combativeness, agitation, and altered sensorium, requires immediate treatment in prehospital or emergency department (ED) settings for the safety of both patients and caregivers. Prehospital ketamine use is prevalent, although the evidence on safety and efficacy is limited. Many patients with excited delirium are intoxicated with illicit substances. This investigation explores whether patients treated with prehospital ketamine for excited delirium with concomitant substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage.
Over 28 months at two large community hospitals, all medical records were retrospectively searched for all patients age 18 years or greater with prehospital ketamine intramuscular (IM) administration for excited delirium and identified illicit and prescription substance co-ingestions. Trained abstractors collected demographic characteristics, history of present illness (HPI), urine drug screens (UDS), alcohol levels, and noted additional sedative administrations. Substance intoxication was determined by UDS and alcohol positivity or negativity, as well as physician HPI. Patients without toxicological testing or documentation of substance intoxication, or who may have tested positive due to ED sedation, were excluded from relevant analyses. Subsequent ED intubation was the primary pre-specified outcome. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare variables.
Among 86 patients given prehospital ketamine IM for excited delirium, baseline characteristics including age, ketamine dose, and body mass index were similar between those who did or did not undergo intubation. Men had higher intubation rates. Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates, and synthetic cathinones, both bath salts and flakka, had similar rates of intubation compared to those negative for these substances. Of 27 patients with excited delirium and concomitant cocaine intoxication, nine (33%) were intubated compared with four of 50 (8%) without cocaine intoxication, yielding a 5.75 OR (95%, CI 1.57 to 21.05; P = .009).
Patients treated with ketamine IM for excited delirium with concomitant cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the ED. Amongst other substances, no other trends with intubation were noted, but further study is warranted.
Today cocaine use is very frequently associated with adolescents with maladaptive personality traits and impulse control disorder. It requires a multidisciplinary approach and individualized treatments to improve the clinic and achieve the abandonment of consumption.
1. To assess the efficacy of monthly injectable paliperidone palmitate treatment in controlling impulsivity. 2. Determine the consumption of toxins after treatment.
Sample: Adolescents, 14-17 years old, with a diagnosis of Personality Limit T and cocaine consumption who start treatment with Paliperidone Palmitate LD IM (50-100mg / month) in monotherapy, with Diazepam 5mg if significant anxiety. Retrospective data collection. Plutchik impulsivity scale (IE) before starting treatment and at 3 months. Statistical analysis SPSS 20.0
Twelve adolescents who met the inclusion criteria were included and 12 adolescents, 83% male, 16% female, completed the questionnaires. After its application and correction through non-parametric tests (N <30), scores in the EI questionnaire of a mean of 37.42 points in the pretest were observed, corresponding to a severe level of impulsivity; and a mean of 26.28 points in the post-test, compatible with a mild-moderate degree of impulsive symptoms. A decrease in the consumption of toxins was observed in 65% of the cases.
In our experience, the management of toxic consumption in adolescent population with severe impulsivity symptoms has great limitations due to the scarce resources available. The Palpitate of Paliperidone long-term treatment has been useful in the approach of serious registered cases, being associated with symptomatic improvement and decrease in consumption.
This chapter looks at examples of how psychoactive substances affect experience and behaviour. It reviews the pharmacological, behavioural and phenomenological effects of cannabis, amphetamine and other stimulants, cocaine, and opiates and opioids, particularly morphine and heroin. There is a particular emphasis on hallucinogenic drugs, including naturally occurring hallucinogens such as mescaline and psilocybin, and especially LSD. The chapter examines the history of LSD manufacture and use, and its wider effects on society in the 1960s. It looks at the religious and spiritual use of entheogens. The chapter attempts to relate pharmacological effects to the phenomenology of the user. The chapter concludes with an examination of the dangers of drug use, and of cultural differences in the way naturally occurring psychoactive drugs are used.
Books focusing on Sigmund Freud are voluminous; dedicated scholars have spent their lives combing through every detail of his life and contributions, and controversies surrounding his relationships with his followers, colleagues, and patients. However, there has been very little focus on his addiction to cocaine. Even less attention has been paid to his dependence to cigars, which persisted despite the development of oral cancer and numerous surgeries. This chapter focuses on his life vis-à-vis these highly addictive and dangerous substances, discussing their significance in the context of his personality, childhood experiences, and career trajectories. The main purpose of the chapter is to use this dimension of his life to highlight his remarkable strength as well as his vulnerability, and to demonstrate that suffering (childhood adversities and career disappointments) often go hand in hand with unyielding striving leading to remarkable achievements.
Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
All drugs abused by humans increase dopamine in the shell of nucleus accumbens, which implicate the neurons of this structure in their hedonic and reinforcing properties. Among the various dopamine receptor subtypes, the D1 (D1R) and D3 (D3R) receptors co-localise in accumbal shell neurons. Synergistic D1R/D3R interactions at this level were found on gene expression and during induction and expression of behavioral sensitisation to levodopa in rats bearing unilateral lesions of dopamine neurons. Behavioral sensitisation to abused drugs is a component of their long-term effects. Converging pharmacologic, human postmortem and genetic studies suggest the involvement of the D3R in reinforcing effects of drugs; D3R agonists reduced cocaine self-administration in rats, without disrupting the maintenance of self-administration. These data suggest the use of D3R agonists as partial substitutes to treat cocaine dependence, by affecting its reward component. However, substitution therapies maintain dependence and may be inefficient on drug craving and relapse, which are the unsolved and critical problems in the treatment of drug addiction. Recently, a highly selective and partial D3R agonist was shown to reduce cocaine-associated cue-controlled behaviour in rats, without having any primary intrinsic effects. As drug-associated cues maintain drug-seeking in animals and elicit craving and relapse in humans, such D3R agents have potential therapeutic applications.
The present study was carried out in 2 successive phases. In the first, 91 inpatients admitted for opioid dependence were evaluated. All were treated with α2-agonists during the withdrawal period. Shortly after admission, a urine sample was taken and analyzed (EMIT and GC/MS). The presence of the cocaine metabolite benzoilecgonine in urine was a predictor of dropout probability during hospitalization (P < 0.01). A second study on a sample of 612 inpatients later admitted for similar reasons was carried out according to a simpler protocol (using only EMIT) in order to replicate the previous results. Again, the presence of benzoilecgonine in urine indicated dropout probability (P = 0.00004). Thus, the use of cocaine prior to admission for a treatment of opiate withdrawal syndrome with α2-agonists seems to predict therapeutic failure.
Epidemiologic studies in the general population and those based on the clinical assessment of schizophrenic populations have revealed a high degree of overlap between schizophrenia and addictive disorders. The abuse of psychoactive substances (including alcohol) throughout life is so frequent (50%) that the possibility of a specific link inevitably arises. Various hypotheses have been suggested to explain the high co-morbidity between schizophrenia and addiction: 1) The social-environmental hypothesis has been developed but studies have provided poor evidence to validate it. 2) The possible shared biological vulnerability between schizophrenia and addictions led researchers to explore common genetic determinants and study the involvement of the dopaminergic and opioid systems in the aetiology of both schizophrenia and the abuse of and dependence on psychoactive drugs. 3) Finally, the theory of self-medication suggests that schizophrenics may be attempting to counter the deficit linked to their disorders by using the substances they take or their dependency-type behaviour to cope with their emotional problems. The clinical profile of schizophrenic addicts does seem to display some distinctive features, such as the high level of depressive co-morbidity, very high nicotine and alcohol dependence, with a very poor prognosis. These patients are difficult to manage; the possibility of pharmacologic interactions between the substances they are taking and neuroleptic medication calls for prudence, and their compliance is also poor. Addictive disorders in schizophrenics are currently a topic of active research intended to lead to identifying specific treatments. The early identification of addictive disorders in schizophrenics should make it possible to limit their development and improve the prognosis.
The aim of this study is to describe the features of cocaine-dependent patients who have had cocaine-induced tactile/somatic hallucinations (CITSH), and to analyze the association with addiction-related variables and psychiatric comorbidity, comparing patients with CITSH, patients with cocaine psychotic symptoms (CIP) and no CITSH, and patients without any psychotic symptom.
A cross-sectional study was conducted in 767 cocaine-dependent patients in an outpatient treatment center for addictions. The following data were obtained: sociodemographic characteristics, CIP information, addiction-related variables and psychiatric comorbidity. A bivariate and multivariate analysis was performed.
Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom. According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine. In general, in all variables studied, patients with CITSH presented worse clinical features (addiction variables and psychiatric comorbidity) than patients with CIP without CITSH and non-CIP group.
CITSH are usually associated with other psychotic symptoms induced by cocaine. The patients who experienced CITSH are more severe cases compared both with patients with CIP without CITSH and patients without CIP. Increased risk of overdose is an important issue in this type of patients.
Stimulant drugs can cause persistent changes in the brain. Imaging studies show that these changes are most apparent in dopamine transporter (DAT) or receptor availability within the striatum.
This work focuses on influences of stimulant use on dopaminergic function assessed using nuclear-medicine imaging (PET/SPECT). Included are 39 studies on 655 cocaine, amphetamine, methamphetamine or nicotine users, as well as 690 healthy controls. Metaanalyses were conducted separately for D2/D3 receptors and dopamine transporters of the entire striatum, its subregions caudate and putamen respectively.
Meta-analyses results regarding nicotine did not show significant effects between smokers and nonsmokers. In cocaine users there was a significant decrease in dopamine receptor availability in all regions. The striatal DAT availability was significantly increased in cocaine users. Methamphetamine users showed a significantly decreased dopamine receptor and transporter density in all regions. Significant results also indicate a lower transporter availability in all regions. Amphetamine users showed reduced DAT availability in the striatum, as well as in the sub regions.
This meta-analysis provides evidence that there are ongoing changes in the dopaminergic system associated with the use of stimulants. Especially the results of cocaine, methamphetamine and amphetamine use mainly showed a downregulation. In addition, this meta-analysis is the first to include nicotine. This subset of studies showed evidence for a decreased receptor and DAT availability but no significant results were found in the metaanalyses.