Sys Manage Copyright2 EXCLUSIVE Crack Cocaine

Sys Manage Copyright2 EXCLUSIVE Crack Cocaine

Download File --->>> https://blltly.com/2t861k

Mortality is a significant outcome among Brazilian crack/cocaine-dependent patients yet not well understood and is under investigated. This study examined a range of mortality indicators within a cohort of 131 crack/cocaine-dependent patients admitted into treatment and meeting criteria for dependence of crack (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). After 12 years of treatment discharge, 107 individuals were reassessed and 27 death cases were confirmed by official records, wherein in its majority were caused by homicide (n = 16). In this group, survival rate was 0.77 (95% confidence interval [CI] = 0.74-0.81) and previous history of IV cocaine use was identified as a predictor of mortality (2.5, 95% CI = 1.08-5.79). High mortality rates among Brazilian crack/cocaine-dependent patients, exposure to violence, and HIV/AIDS were topics discussed in this study. This research highlights the importance of ongoing programs to manage crack/cocaine use along with other treatment features within this population.

Cocaine abuse is a major worldwide health problem. Patients with acute cocaine toxicity may require urgent treatment for tachycardia, dysrhythmia, hypertension, and coronary vasospasm in order to prevent pathological sequelae such as acute coronary syndrome, stroke, and death. This activity reviews the evaluation and management of cocaine toxicity and highlights the role of the interprofessional team in caring for affected patients.

Objectives:Describe the toxicokinetics of cocaine toxicity.Describe the typical history and physical exam findings for a patient with cocaine toxicity.Summarize the management options for cocaine toxicity.Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with cocaine toxicity.Access free multiple choice questions on this topic.

Over the past few decades, body packers have also presented to the emergency department following bag ruptures. The other problem is that many patients have also ingested other illicit agents, including alcohol, which makes management difficult. While cocaine can adversely affect every organ in the body, its most lethal effects are on the cardiovascular system.

Patients with cocaine toxicity need to be stabilized, and attention should be paid to the ABCDEs. The patient's fever should be managed, and one should rule out hypoglycemia as a cause of the neuropsychiatric symptoms. A pregnancy test should be ruled in women of childbearing age. The treatment should be based on clinical symptoms, and one should avoid physical restraints.

The "War on Drugs" reached new heights in the 1980s. Nancy Reagan's "Just Say No" campaign flooded the schools and media outlets. In this environment, a new drug emerged that horrified and mobilized people: crack cocaine. The media screeched that crack was more addictive, concentrated and destructive than any other drug, fueling the drug-war blaze.

Already, the existence of crack cocaine shows the naivete inherent in the deterrence rationale of prohibition. Instead of deterring cocaine use, prohibition spurred the black market to adapt to prohibition by producing stronger, cheaper and more highly addictive versions of existing drugs. Prohibition and the resulting black markets have been co-evolving.

In response, Congress united in support of new federal mandatory minimum sentences meant to crack down on high-level traffickers under the 1986 Anti-Drug Abuse Act (ADAA). The law imposed a five year mandatory minimum sentence for distribution of five grams of crack cocaine, enough to fill a sugar packet, while imposing the same sentence for 500 grams of powder cocaine.

Rather than deterring drug trafficking, this "get tough" posture led to utter disaster in the African American community. By the early 1990s, nearly 90 percent of crack cocaine defendants in federal court were black, even though nearly two-thirds of crack cocaine users were white or Hispanic. Imprisonment rates and sentence lengths skyrocketed. Many black communities were ravaged as enforcement disproportionately affected the young and their families. Yet harsh sentences have only partly been mitigated by the Fair Sentencing Act of 2010.

Class-based policing was aggravated by several features unique to crack cocaine. The triggering thresholds for the mandatory minimums were so low that it facilitated police focus on small-time crack users, who were easier to catch and subdue than dangerous high-level dealers. The nature of crack cocaine, which is usually cooked from powder cocaine by users, further ensured that street-level dealers and users would be targeted. In other words, there were rarely high-level dealers with crack cocaine.

At the prosecutorial level, the targeting of poor minorities was also exacerbated. Crack cocaine penalties were representative of the increasing array of tools available for prosecutors, increasing their power relative to defendants and judges. First, the surge of crack-cocaine-dealing arrests gave prosecutors fodder for easy convictions. Second, mandatory minimums provided leverage in plea bargaining: when faced with a possible five- or 10-year sentence, many defendants would accept a plea agreement rather than risk conviction at trial. Third, federal conspiracy laws allowed prosecutors to pin the drug amount in the entire conspiracy on any given defendant, even if her involvement was minimal. This led to the infamous "girlfriend problem," where girlfriends of crack dealers became eligible for lengthy federal sentences after serving as couriers or using drug money to feed their children. Prosecutorial harshness was backed up by the Department of Justice's general stance in favor of severity in these cases.

Finally, at a macro political level, crack-cocaine-sentencing policy was at the center of political infighting between Congress and the judiciary. In the 1980s, members of Congress opposed leniency in sentencing by mandating that a commission create sentencing guidelines that would bind judges. In order to write rational and proportionate guidelines, the commission was forced to incorporate the 1986 mandatory minimums as a sentencing floor, thus skewing sentences for all crimes upwards. The "ratchet up" effect was amplified as Congress passed a flurry of directives in order to micro-manage the guidelines amendment process, and increase its own power relative to the judiciary. When the commission voted to reduce the sentencing guideline for crack cocaine in the mid-1990s, Congress rejected the amendment. Tough-on-crime rhetoric and power politics proved more important to Congress than reality.

In the U.S., crack cocaine refers to a smokable variety of cocaine which is considered to be more affordable and accessible than powder cocaine [1]. In the 1980s and 90 s, the U.S. response to crack cocaine was driven by media depictions of an urban, public health crisis primarily affecting black communities in American cities. This media depiction drove U.S. drug policy and shaped both political debate and public attitude towards crack cocaine [1, 2]. The subsequent influx of drug education messages, public service announcements, and curriculums that were created in response to crack cocaine were pervaded by the public and political fear that crack cocaine was destroying a generation of young Americans [3]. The U.S. government response at this time focused on managing the perceived crack cocaine epidemic by criminalizing rather than providing treatment facilities or healthcare services for people who use crack cocaine. In fact, the 1988 National Household Survey on Drug Abuse showed that the sharpest rise in cocaine and crack cocaine use since the inception of the survey in the early 1970s, rapidly outpaced the availability of treatment programs and efforts to expand treatment facilities in metropolitan areas such as New York City [4].

The French approach to crack cocaine shares commonalities and differences with the U.S. In France, crack cocaine is mostly smoked but more recently is also being injected intravenously and the spike of increased crack cocaine use in France did not occur until the 2000s [5, 6]. French political and media attention towards crack cocaine has also recently increased due to the presence of visible, open drug use in Paris framing the topic as a public order, health, and social problem. This attention stems from crack cocaine in France having increasing associations with socially and economically vulnerable populations when compared to powder cocaine use patterns [6]. Unlike the U.S., the aggregation of racial data is prohibited in France. And as a result, the French understanding of the current rise in crack cocaine use does not clearly analyze the issue along racial lines but rather considers low socioeconomic populations to be drivers of the recent increase in crack cocaine use [5]. Since the late 1970s, in addition to a repressive drug policy approach, France has implemented a strong, publicly funded drug treatment system with harm reduction services to better address the health needs of people who use drugs [7]. Accordingly, France is systematically more equipped to serve the healthcare needs of people who problematically use crack cocaine compared to the U.S. [5, 6].

In the U.S., crack cocaine is derived from powdered cocaine by combining it with water and another substance, usually bicarbonate soda. This substance is then heated and the newly formed solids broken into smaller pieces that are subsequently vaporized and inhaled [8]. The chemical alteration allows the end-user to purchase smaller amounts of crack cocaine at a lower cost, thereby increasing general accessibility.

The cultural framing about people who use crack cocaine have led to upholding American policies that continue to disproportionately target specific racial populations, particularly black communities. A 1993 JAMA publication confirmed that the prevalence of crack cocaine use did not depend on race-specific factors and showed that crack cocaine use did not differ significantly for African Americans or Hispanic Americans as compared to white Americans [15]. Additionally, Substance Abuse and Mental Health Administration reports data confirms there are no statistically significant differences in the rates of illicit drug use between racial and ethnic groups [16]. However, recent U.S. justice system data from the 2019 fiscal year shows an staggering 81.1% of smokable-cocaine trafficking offenders were black [17]. 2b1af7f3a8