Studies conducted with nonhuman laboratory animals have consistently shown that atypical antipsychotics that are mixed dopamine and serotonin antagonists attenuate the discriminative-stimulus effects of amphetamine. In the present experiment, eight healthy humans learned to discriminate 15 mg of oral d-amphetamine. After acquiring the discrimination (i.e., Ն80% correct responding on four consecutive days), the effects of a range of doses of d-amphetamine (0, 2.5, 5, 10, and 15 mg), alone and after pretreatment with risperidone (0 and 1 mg), a D 2 dopamine and 5-hydroxytryptamine (5-HT) 2 serotonin antagonist, were assessed. d-Amphetamine alone functioned as a discriminative stimulus and produced stimulant-like selfreported drug effects (e.g., increased ratings of "like drug"). These effects were generally a function of dose. Risperidone alone did not occasion d-amphetamine-appropriate responding, but impaired performance. Risperidone pretreatment significantly attenuated the discriminative-stimulus effects of damphetamine, and some of the self-reported drug effects. The results of the present experiment suggest that combining drugdiscrimination and self-reported drug-effect questionnaires may be an effective strategy for assessing the behavioral effects of agonist-antagonist interactions. Future studies should compare the behavioral effects of d-amphetamine after pretreatment with a selective D 2 dopamine (e.g., haloperidol) or 5-HT 2 serotonin (e.g., ritanserin) antagonist to determine the relative contribution of dopamine and serotonin systems in mediating the behavioral effects of stimulants in humans. The results of these studies might guide the development of a pharmacotherapy for the treatment of amphetamine abuse/ dependence. The results of preclinical behavioral pharmacology experiments suggest that atypical antipsychotics such as risperidone, olanzapine, and clozapine consistently attenuate the discriminative-stimulus effects of amphetamine (Kilbey and Ellinwood, 1979;Nielsen and Jepsen, 1985;Meert, 1991Meert, , 1996Arnt, 1992Arnt, , 1996Mechanic et al., 2002). The discriminative-stimulus effects of drugs in animals are thought to be a model of the self-reported effects of drugs in humans. In one experiment, the discriminative-stimulus effects of d-amphetamine (1.0 mg/kg) were tested alone and after pretreatment with risperidone (0.04 -2.5 mg/kg), olanzapine (0.0025-2.5 mg/kg), and clozapine (0.08 -2.5 mg/kg) in rats trained to discriminate 1.0 mg/kg d-amphetamine (Arnt, 1996). Risperidone, olanzapine, and clozapine dose dependently decreased

OxyContin is a controlled-released form of oxycodone indicated for the management of moderate to severe pain. OxyContin diversion and abuse has become a major problem in certain areas of the United States, particularly rural areas and Appalachia. This study undertakes an 18-month retrospective chart review at a private freestanding psychiatric facility to develop a profile of OxyContin addicts seeking treatment. There were 579 admissions to the Addictive Disease Unit of this facility from October 2000 to March 2002, with 298 of these admissions being for the treatment of opioid abuse or dependence. One hundred and eighty seven of these individuals were dependent on OxyContin, using an average dose of 184 milligrams of OxyContin per day. The OxyContin dependent individuals tended to show a progression from p.o. use to either snorting or i.v. use. The author concludes that a sociocultural understanding is needed to better treat these addicts as is improved communication between the pain treatment community and the addiction treatment community.

The evidence suggests a two-phasic dose-response in which facilitating effects of stimulant drugs on inhibitory control might be limited to a range of intermediate doses, above which improvement is no longer evident and impairing effects could possibly emerge.

There has been intense interest in the problem of prescription drug abuse on the parts of health professionals, law enforcement, the media, and the general public. Clinicians not only need to know how to assess risk but also what drugs are being diverted most in their region. We conducted a prospective survey of prescription drug abusers entering a treatment facility in central Kentucky. Participants (n = 109) were enrolled and completed a structured clinical interview and prescription drug abuse survey. The prescription drug abusers assessed in the study had a mean age of 30.95 years (SD = 10.21), were comprised of 75 men (69%) and 34 women (31%), and were mostly Caucasian (98%). The majority (84%) stated that they had legitimately been given a prescription for opioids for pain at some point from a physician and 61% reported chronic pain concerns. The most commonly abused drugs were hydrocodone-containing formulations (78%) and oxycodone-containing products (69%), while products containing methadone (23%) or fentanyl (7%) were abused much less frequently. Most respondents (91%) stated that they had purchased prescription opioids from a street dealer at least once and the majority (80%) had altered the delivery system of the prescription drug by chewing, snorting, or using i.v. administration. Implications for pain management are discussed, focusing on the need for clinicians treating chronic pain to more thoroughly assess patients for their risk of abuse and addiction before starting an opioid regimen.

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