Thesis Submitted for the Degree of Doctor of Philosophy University of Bath Department of Pharmacy and Pharmacology 2014

University of Bath PHD Designing An Educational Intervention For Crack Users Depending On Pharmaceutical Analysis Results Shehab, Mohammad Zaher Award date: 2014 Awarding institution: University of Bath Link to publication Alternative formats If you require this document in an alternative format, please contact: [email protected] General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 08. Oct. 2021 Designing An Educational Intervention For Crack Users Depending On Pharmaceutical Analysis Results Mohammad Zaher Shehab A thesis submitted for the degree of Doctor of Philosophy University of Bath Department of Pharmacy and Pharmacology 2014 COPYRIGHT Attention is drawn to the fact that copyright of this thesis rests with the author. A copy of this thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that they must not copy it or use material from it except as permitted by law or with the consent of the author. This thesis may be made available for consultation within the University Library and may be photocopied or lent to other libraries for the purposes of consultation with effect from September 2014. Signed on behalf of the Faculty/School of Science. Signed: …………………………….……… Date: ……………..………………….. Mohammad Zaher Shehab 1 Summary/Abstract Street-seized crack cocaine samples are cut with diverse impurities which may be very harmful to health. Harm reduction experts say that interventions are urgently needed to reduce the harmful behaviours associated with drug abuse. In this multidisciplinary approach, a successful intervention, Promoting Inhaled Pleasure Easily and Safely (PIPES), has been designed and tested in pilot studies. PIPES informs crack smokers about the crack sample content, efficiency of crack delivery, and the harms associated with different home-made smoking tools and cutting agents. Crack samples were profiled by spectroscopic and chromatographic methods. In an attempt to track crack sources, PCA of the 1H NMR spectroscopic data clustered samples of similar contents together. A laboratory crack smoking model was optimised to measure the emitted and recovered doses of cocaine and cutting agents from common crack smoking devices. Seized samples contained 24% cocaine base and 32% phenacetin. A medical inhaler delivered the highest dose of cocaine and phenacetin into the apparatus, then a glass pipe (shooter), and then tin cans. The analytical results and the harms associated with each smoking device and toxic phenacetin were used to design PIPES, an educational intervention that was delivered by harm reduction workers to crack smokers. Users showed: a lack of knowledge of cutting agents and the harms associated with different pipes and cutting agents, their reasons for sharing pipes, and their attitudes to share knowledge and receive more information about cutting agents and pipes. The results of this applied research should be more widely known and used. 2 Acknowledgements Completing my PhD degree may be the most challenging experience of the first 31 years of my life. The best and hardest memories of my doctoral journey are shared with many dear people. First of all, I dedicate my thesis to my mother’s soul who was waiting for me to come back with my degree and also to my brother’s soul. I missed our last farewell … to my family martyrs and to free Syrians martyrs. I express my sincere thanks to my dear father who has given me his life for me to be what I am now. I would like to be able to compensate him at least a little bit compared with what he has done for me and my brothers and sisters. I thank my brother and sisters who supported me and encouraged me to keep going in the hard times during my PhD. Also, I cannot thank my beloved wife enough for encouraging me throughout this experience, and to her family for their caring and support. In my home country, I would like to thank all my teachers, staff, and friends who helped and supported me. In the UK, I express my special appreciation and thanks to my advisors, Dr Ian S. Blagbrough, Dr Michael G. Rowan, and Dr Jenny Scott for their support during my PhD research studies, for their patience, motivation, enthusiasm, and immense knowledge. Their guidance helped me in all the times of research and in the writing of this thesis. I could not have imagined having a better advising and supporting team for my PhD studies. I thank the Academics, the Technical staff, and friends at the University of Bath, and those in the UK who are my family here. Of course, these studies would not have been possible without the generous financial support, in dire straits, from The Said Foundation, The Wellcome Trust, and the University of Bath who in different ways allowed me to complete my work in Bath. Finally, I thank my God for getting me through all the difficulties. 3 Contents Page Title 1 Summary/Abstract 2 Acknowledgements 3 List of Abbreviations 8 Chapter 1. General Introduction and Aims 10 1.1. Introduction 1.1.1. Cocaine around the world 1.1.1.1. Coca leaf and cocaine 1.1.1.2. Production of cocaine 1.1.1.3. Cocaine use/market changes during the last 10 years 1.1.2. Cocaine pharmacology 1.1.3. Cocaine metabolism 1.1.4. Adulterants identified in cocaine 1.1.5. Harm reduction 1.1.5.1. Harm reduction principles 1.2. Aims Chapter 2. Literature Review - Analytical part 27 Chapter 3. Experimental 35 3.1. Materials 3.1.1. Cocaine free base preparation 3.1.2. Description of seized crack samples 3.2. Experimental 3.2.1. Methods of profiling crack samples 3.2.2. Calibration curves by HPLC 3.2.3. Calibration curves by GC-FID 3.2.4. Multivariate statistical analysis 4 3.2.5. Differential Scanning Calorimetry (DSC) 3.2.6. Crack cocaine pipe smoking model Chapter 4. Results and Discussion of Profiling Street Crack Samples 45 4.1. Introduction about profiling 4.2. Qualitative analysis 4.2.1. High Performance Thin Layer Chromatography (HPTLC) 4.2.2. NMR spectroscopic analysis 4.2.3. Infra-Red spectrometry (FT-IR) 4.2.4. Mass Spectrometry (MS) 4.3. Quantitative analysis 4.3.1. High Performance Liquid Chromatography (HPLC) 4.3.2. GC-FID optimisation 4.4. Conclusions Chapter 5. Multivariate statistical analysis of 1H NMR data of street crack samples 88 5.1. Introduction 5.2. Results and Discussion 5.2.1. Protocol A 5.2.2. Protocol B 5.3. Conclusions Chapter 6. DSC of Street Samples of Crack Cocaine 110 6.1. Introduction 6.2. Results and Discussion 6.2.1. Concentration effect on thermal peaks shift of the components in the mixture 6.3. Conclusions Chapter 7. Crack smoking model 124 7.1. Introduction 7.2. Results and Discussion 7.2.1. Optimisation of crack smoking carried out 7.2.2. Behaviour of pure cocaine in crack smoking model 5 7.2.3. Behaviour of street crack cocaine in crack smoking model 7.2.4. Comparison between different tools used to smoke crack cocaine by drug users 7.3. Conclusions Chapter 8. Literature Review - Pharmacy Practice aspect 135 8.1 Harm reduction (HR) 8.1.1 HR theory 8.1.2 Practice and history of HR 8.1.3 An HR Framework and Approach 8.1.4 A focused overview of HR evidence 8.1.5 Crack literature review 8.2 Theories of behaviour change and the Information Motivation Behaviour model (with evidence) 8.2.1 Introduction to theories of behaviour change 8.2.2 Health Belief Model (HBM) 8.2.3 Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB) 8.2.4 Social Cognitive Theory (SCT), Social Learning Theory (SLT) 8.2.5 Information Motivation Behavioural skills (IMB) model Chapter 9. Methodology and Methods 153 9.1 Methodology 9.2 Methods 9.2.1 Mixed methods 9.2.1.1 Quantitative methods 9.2.1.2 Qualitative methods Chapter 10. Results and Discussion of Quantitative and Qualitative results 164 10.1 Results and Discussion of Quantitative part 10.1.1 Results of Quantitative part (baseline and follow up, two group) 10.1.1.1 Demographics 10.1.1.2 Crack use 10.1.1.3 Advantages and disadvantages of smoking versus injecting crack cocaine 10.1.1.4 The first experience of using crack cocaine 10.1.1.5 Use of Crack Pipes 6 10.1.1.6 Sharing pipes 10.1.1.7 Cutting agents 10.1.1.8 Source of Information 10.1.1.9 Drug Services 10.1.1.10 Follow up stage 10.1.2 Discussion of Quantitative part 10.2 Qualitative data analysis (Results and Discussion) 10.2.1 Results of Qualitative study 10.2.1.1 Knowledge 10.2.1.2 Motivation 10.2.1.2.1 Motivation about smoking model pipes- health problems 10.2.1.2.2 Motivation about phenacetin and cutting agents 10.2.1.2.3 Motivation about availability 10.2.1.2.4 Motivation to share knowledge 10.2.1.2.5 Future investment 10.2.1.3 Behavioural skills 10.2.1.3.1 Sharing pipes 10.2.2 Discussion of Qualitative study Chapter 11.

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