Human testing will begin later this year on an inexpensive drug, used in the treatment of epilepsy, that may have the ability to block cocaine highs and cravings. Researchers at the Brookhaven National Laboratory have been conducting tests, on rodents and primates, of the medication called gamma vinyl GABA, or GVG. GVG has been used outside the United States to treat epilepsy for almost 15 years and is in the final stages of prescription approval in our Country.

In a press release earlier this month Brookhaven brain scientist Stephen Dewey , commenting on GVG, said "if this can do for humans what it did for animals, we may have opened the door for addicts around the world to kick their habit." Dewey further stated "there is no other drug that looked as promising" when questioned about cocaine treatment.

Cocaine addicts experience a "high" that is precipitated by blocking the normal flow of the chemical messenger dopamine in the brain. Dopamine has many diverse functions within the brain, including the ability to modulate pleasure and reward. This brain substance is often described as the "feel-good" transmitter. Researchers at Brookhaven became interested in GVG because it reduces the level of dopamine released in the brain.

GVG also increases the amount of the brain's most common neurotransmitter, GABA. The increased GABA allows brain cells to communicate more effectively.

In the difficult-to-treat world of drug use, and abuse, GVG is being seen as a prospective breakthrough drug, with the potential to reduce cocaine addiction. It will be interesting to see the results of human testing which will begin soon. If the data are positive, it is a certainty that GVG will be looked at as a possible treatment of other related stimulant addictions.

Information for the following article was provided by Dr. Robert Yolton, PhD, OD, and Professor of Optometry at Pacific University College. Dr. Yolton has published over 100 papers in scientific and professional literature and has testified as an expert witness on HGN and DRE cases.

Consider the position of the two eyes relative to each other. If you look at an object and both eyes look exactly at the object, this would be referred to as a "ortho" (straight) posture. If you try to look at the object and one eye looks too far outward, or too far inward, while the other eye looks at the object, this is called strabismus (stra-bis-mis), also called tropia (trop-e-ah). About 3-5% of the population has this. Exotropia means that one eye looks outward, and esotropia means that one eye looks inward.

These conditions can complicate HGN testing somewhat. I recommend having the strabismic suspect cover one eye at a time with their hand and then testing the other eye alone. This is a non-standard procedure which should be noted in the records but the one-eye-at-a-time technique should work well because HGN testing does not require binocular vision. Determining the near point of convergence is not possible to do meaningfully with these persons.

A related concept is lazy eye, often called amblyopia (am-ble-oh-pee-a). During development, the brain expects the inputs from the two eyes to about equal and for these inputs to fight with each other for connections on the brain cells. If one eye is disadvantaged during development and cannot fight for connections as hard as the other eye, the brain pays less attention to the signals from the eye and the result is a reduction in visual acuity (the 20/20 thing). This can occur only up to about 12 years of age when the brain's wiring is pretty much complete. A person with amblyopia will have reduced acuity in one eye only but it would be very unusual for the acuity reduction to affect the HGN test results significantly. If the suspect claims lazy eye, have him cover the good eye and ask if he can see your stimulus. If he can, you should be OK to continue testing, but note this in your record.

Another term that gets used in regard to eye positions is phoria (for-e-ah). Phorias can be thought of (sort of) as resting positions of the eyes. If you ask a person to look at a stimulus with both eyes and then cover one eye, the covered eye will go to its position of rest. If it stays pointed right at the target, the person has ortho phoria (straight ahead vision). If the eye that is covered swings outward behind the cover so that its resting position is pointed outward, this is called exophoria, and if the covered eye turns inward, it is esophoria. Phorias are only detectable with one eye covered or with the images seen by the two eyes separated in some way, and since HGN testing is done with both eyes open, it should not confuse the test results.

An essential point is that strabismus occurs with both eyes open and trying to look straight ahead. Phorias can only be measured when one eye is covered. Patients with high phorias will often have problems with reading, and high phorias (the eyes turn in or out a long way) can convert to temporary strabismus with intoxication.

High phorias will not have a significant effect on HGN testing because they are manifest only when one eye is covered. They can affect near point of convergence testing however because the exophorias can make it difficult for persons to converge. It is possible that phorias can be accompanied by poor eye movement skills which might show up as jerky eye movements. However, I know of no association between phorias or strabismus and the type of nystagmus that would be seen in HGN testing. If you have distinct and sustained end point nystagmus, nystagmus at 45 degrees, and possibly vertical nystagmus, it is extremely unlikely that these are caused by strabismus or phorias. What you might have is a drunk with a high phoria or strabismus. When in doubt, send the subject to an eye doctor and ask that the EXACT, COMPLETE HGN series be done with the subject. If in a sober state they can demonstrate the entire pattern of HGN findings (e.g., get 6 points), then the test was invalid. If they cannot, then the test is likely to have been valid.

All opinions expressed are personal ones and should not be taken as professional advice or recommendations.

The following advice was copied from an informational handout provided at the National DRE Conference, conducted in Portland, Oregon. The breakout session was entitled "What's New in DRE/HGN Court Cases". Patricia Gould of the National Traffic Law Center moderated the discussion. The panel included Mary Anderson, Deschutes OR District Attorney, Barbara Bailey, City Attorney Tacoma WA, Karen Herland, Minneapolis City Attorney, and local Defense Attorney John Henry Hingson.

In last months edition of The Nebraska DRE the subjects of report writing and courtroom testimony were covered. This issue will continue with points for case preparation.

1. Practical Tips

1. Maintain a complete, up-to-date and accurate Rolling Log and Resume.
2. Track the disposition of your court cases through your prosecutor's office or the clerk of the court.
3. Wait until the toxicology results are back before presenting DRE cases for prosecution.
4. Track the results of the toxicological testing in your cases.
5. Establish a partnership with your prosecutor's office.
1. Identify your prosecutors and introduce yourself as a DRE.
2. Hand deliver your DRE cases to them if possible and offer to discuss the case with them. An uneducated prosecutor is more likely to plea bargain a case dealing with an unfamiliar subject matter. Let them know that you care about these cases.
3. Invite your prosecutor's to attend SFST and/or DRE school, on a ride-a-long, or to an alcohol workshop where SFST's and DRE evaluations are demonstrated.
4. Send your prosecutor copies of the PDR pages for the drug involved in your cases.
6. Opinions:
1. Say only what you know.
2. If you are unable to form an opinion due to an incomplete evaluation but still have an opinion, write "incomplete evaluation" in the opinion section and document whatever opinion you have, along with a detailed explanation for it, in the miscellaneous section of your narrative.

During the first week of April The Nebraska DRE sent out a request, via the National DRE e-mail service, asking Drug Recognition Experts from around the country what drugs they are seeing most frequently in their evaluations. In the May and June editions of the newsletter several DRE's responses were printed. The following edited replies have been received since then. The random sample is not scientific, and is intended to provide readers information on drug trends around the nation.

Methamphetamine and Marijuana are the two most prevalent drugs encountered in El Dorado County, California. We see a little bit of prescription medications and only encounter LSD (acid) and Heroin on rare occasions.

In Maryland the drug of choice on a state wide basis continues to be marijuana. However, depending upon location we also have a big problem with cocaine, heroin, and PCP. Cocaine and Heroin appears to be very prominent in the cities and adjoining suburbs. PCP has always been a major drug in Maryland, but is found more frequently in the central and southern parts of the State in the corridor that stretches from Baltimore south to Washington D.C.