Download Drug Abuse and Misuse

Drug Abuse and Misuse
Carl B. Goodman, Ph.D.
Professor of Pharmacology
College of Pharmacy & Pharmaceutical Sciences
Florida A&M University
308E FSH-SRC
Tallahassee, FL 32307
850-599-3128
[email protected]
The Drug Problem
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60 million people in the USA alone are addicted
to alcohol, nicotine or both; 5.5 million are
addicted to illegal drugs and millions to legal
pharmaceuticals.
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It is important to note at the outset that the legal
status of a drug says nothing about its safety or
the health risks associated with it…for the most
part, a drug's legal status was determined before
we knew much about the risks associated with it.
If You Never Have Then You Know
Someone
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Family Acceptance
Peer Pressure
Life Circumstances/Environment
Violence – Wall Street
Society Acceptance
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Movies and TV Shows
Sports and Money
Movies/Sports/Music
ABUSED DRUGS
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alcohol
nicotine
caffeine and other OTC stimulants
cocaine
amphetamine and related legend stimulants
opioids
sedative hypnotics
cannabis, entactogens, phencyclidine
solvents and inhalants
anabolic steroids
street drugs administered intravenously; common diluents, fillers,
contaminants.
What Is Drug Addiction?
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Drug addiction is a complex brain disease.
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It is characterized by compulsive, at times
uncontrollable, drug craving, seeking, and use that
persist even in the face of extremely negative
consequences.
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Drug seeking becomes compulsive, in large part as a
result of the effects of prolonged drug use on brain
functioning and on behavior.
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For many people, drug addiction becomes chronic, with
relapses possible even after long periods of abstinence.
The Brain
Key Drug Abuse Terms
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Withdrawal: Presence and severity of characteristic withdrawal symptoms.
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Reinforcement: A measure of the substance's ability, in human and animal
tests, to get users to take it again and again, and in preference to other
substances.
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Tolerance: How much of the substance is needed to satisfy increasing
cravings for it, and the level of stable need that is eventually reached.
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Dependence: How difficult it is for the user to quit, the relapse rate, the
percentage of people who eventually become dependent, the rating users
give their own need for the substance and the degree to which the
substance will be used in the face of evidence that it causes harm.
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Intoxication: Though not usually counted as a measure of addiction in itself,
the level of intoxication is associated with addiction and increases the
personal and social damage a substance may do.
Routes of Drug Administration
Routes of Drug Administration
Drugs are consumed by people in the following ways:
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Ingestion: swallowing drugs is convenient but a major drawback is that the timing
and magnitude of the drug effects are greatly influenced by food in the stomach;
some drugs are deactivated before they can be absorbed from the digestive tract and
thus cannot be administered by this route; most drugs are absorbed from the small
intestine, but those with small molecules (e.g., alcohol) can be absorbed through the
stomach wall, and thus they act more rapidly
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Inhalation: many inhaled chemicals are absorbed directly into the bloodstream from
the lungs (e.g., chemicals in tobacco and marijuana smoke); lung damage is a
serious risk from the repeated inhalation of chemicals
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Mucous membranes: some drugs (e.g., cocaine) are readily absorbed through the
mucous membranes of the nose, mouth, or rectum; this method of administration is
problematic as these membranes can be easily damaged
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Injection; SC, IM, or IV: addicts typically favor the IV route, which is particularly
dangerous; because it is fast and direct, there is a risk of death from overdose,
impure drugs, or allergic reactions; there are only a few sites on the body appropriate
for IV injection, thus addicts frequently develop infections and scar tissue at these
sites
Mechanisms of Psychoactive
Drug Action
1.
In order to produce psychoactive effects, drugs must enter the
nervous system; fortunately, many drugs that are potentially
dangerous neurotoxins do not readily penetrate the neurons of the
CNS due to the blood-brain barrier; it is mediated by the
particularly small pores in the walls of CNS blood vessels
2.
Once a psychoactive drug has penetrated the CNS, it can
influence neural activity in numerous ways; e.g., it can act
diffusely on neural membranes or interact specifically with
particular classes of neurotransmitters and receptors
3.
The effects of psychoactive drugs are terminated by their
metabolism, i.e., by their conversion to nonactive metabolites;
most drugs are metabolized by liver enzymes; only small
amounts of unmetabolized active drugs are eliminated in sweat,
breath, urine, etc.
Drug Tolerance
Drug tolerance is any diminution of a drug's effect that results from prior
exposure to the drug
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Tolerance can be measured in two ways: (1) by measuring the decrease
in the response elicited by the same dose of the drug, or (2) by measuring
the increase in the amount of drug required to produce the same effect; in
effect, drug tolerance is a shift in the dose-response curve to the right
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It is common to think of tolerance effects as being of two different types:
1.
Metabolic tolerance (any tolerance effect that results from a decrease in
the amount of the drug reaching the target cells) or
Functional tolerance (any tolerance that results from a decrease in the
ability of the drug to influence the target cells)
2.
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Tolerance to most psychoactive drugs is primarily functional; an important
thing to remember about functional tolerance is that it often develops for
some effects of a drug but not others
Addiction
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Physical Dependence: Biochemical level
changes
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Patterns of addictive behavior:
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Eliminating physical dependence on a
substance does not "cure" the addiction.
Psychological Addiction
Analogy of your first love to explain how addicts feel.
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Remember the first time they fell in love- and
1)
Whole life began to focus on, and revolve around…….
2)
“Broking the rules" ….. And perhaps exercised less than
perfect judgement in the matter.
This is compared with the addict's attitude towards their drug of
choice- they are "in love" with the drug, and use of the drug and
obtaining more becomes the center of their existence, very much
like that person became the center of their lives.
Scheduled Drug Lists
Schedule I
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The drug or other substance has a high potential for abuse.
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The drug or other substance has no currently accepted medical use in treatment in
the United States.
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There is a lack of accepted safety for use of the drug or other substance under
medical supervision.
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Examples of Schedule I substances include heroin, lysergic acid diethylamide (LSD),
marijuana, and methaqualone.
Schedule II
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The drug or other substance has a high potential for abuse.
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The drug or other substance has a currently accepted medical use in treatment in the
United States or a currently accepted medical use with severe restrictions.
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Abuse of the drug or other substance may lead to severe psychological or physical
dependence.
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Examples of Schedule II substances include morphine, phencyclidine (PCP), cocaine,
methadone, and methamphetamine.
Scheduled Drug Lists
Schedule III
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The drug or other substance has less potential for abuse than the drugs or other
substances in schedules I and II.
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The drug or other substance has a currently accepted medical use in treatment in the
United States.
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Abuse of the drug or other substance may lead to moderate or low physical
dependence or high psychological dependence.
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Anabolic steroids, codeine and hydrocodone with aspirin or Tylenol®, and some
barbiturates are examples of Schedule III substances.
Schedule IV
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The drug or other substance has a low potential for abuse relative to the drugs or
other substances in Schedule III.
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The drug or other substance has a currently accepted medical use in treatment in the
United States.
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Abuse of the drug or other substance may lead to limited physical dependence or
psychological dependence relative to the drugs or other substances in Schedule III.
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Examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®,
Valium®, and Xanax®.
Scheduled Drug Lists
Schedule V
 The drug or other substance has a low potential for
abuse relative to the drugs or other substances in
Schedule IV.
 The drug or other substance has a currently accepted
medical use in treatment in the United States.
 Abuse of the drug or other substances may lead to
limited
physical
dependence
or
psychological
dependence relative to the drugs or other substances in
Schedule IV.
 Cough
medicines with codeine are examples of
Schedule V drugs.
Commonly Abused Drugs
CNS Stimulants
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Nicotine
Caffeine
Cocaine
Amphetamines
Methcathinone
Methylphenidate
Anorecitc Drugs
Khat
CNS STIMULANTS
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Cocaine: Made from the leaf of the coca plant, this drug
often comes in the form of a white powder that some
people inhale through their nose.
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Crack: A form of cocaine that can be smoked.
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Amphetamines: Often called "speed," these pills are
sometimes prescribed by doctors for medical problems.
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Methamphetamine: A powerful form of amphetamine that
comes in clear crystals (called "ice") or powder (called
"crank") that is smoked or injected.
Cocaine
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Cocaine and other stimulants have the same general effect, but differ
greatly in their potency
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May be inhaled, absorbed across mucosal membranes, or ingested orally
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Cocaine is very addictive; it acts by blocking catecholamine reuptake
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It is a general stimulant, producing a feeling of energy, well-being, and selfconfidence; extremely high doses can lead to cocaine psychosis
characterized by sleeplessness, nausea, restlessness and psychotic
behavior.
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Very high doses can produce stroke, seizures, and respiratory arrest;
withdrawal symptoms are mild. Clinically, cocaine derivatives are effective
as local anesthetics
Some Effects of Cocaine Use
Tobacco
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It is used more than any other drug except caffeine; usually inhaled
or absorbed through oral mucosa
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Nicotine is the major psychoactive ingredient; 4,000 other known
chemicals are in tobacco
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Tobacco is highly addictive (e.g., patients with Buerger's disease
will still smoke, even after their limbs are amputated)
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Effects ranging from nausea to relaxation
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Consequences of smoking range from coughing to failure of the
cardiorespiratory system to cancer
CNS Depressants
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Barbiturates
Benzodiazepines
Flunitrazepam
Gamma Hydroxybutyric Acid
Paraldehyde
Chloral Hydrate
Glutethimide and Methaqualone
Meprobamate
Alcohol
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It is consumed by 66% of the US population and 15 million are addicted
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Orally ingested; at most doses it is a depressant resulting in impaired
function and is implicated in almost 50% of traffic fatalities
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It is believed to act primarily at the GABA-A receptor complex
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Alcohol is a small molecule and thus crosses the blood-brain barrier
resulting in brain damage such as seen in Korsakoff's syndrome
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Alcohol also crosses the placenta and can result in birth defects such as
Fetal Alcohol Syndrome.
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Very severe withdrawal effects; delerium tremens represent the 3rd stage
of withdrawal, and may be lethal.
Opiates
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Opiates include morphine and heroin; these are unmatched as analgesics
and are very addictive
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Act at receptors for endogenous opiate neurotransmitters that are
located throughout the brain
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Elicits moderately severe withdrawal symptoms but these are not lethal
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Over 2 million Americans use heroin to experience a rush of pleasure and
drowsy euphoria
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Tolerance leads to an ever greater use of the drug which has many crime
implications
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Common IV transmitted diseases and opiate side effects= Respiratory
Depression can be seen with lethal doses
Cannabis
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Marijuana
Hashish
Hashish Oil
Synthetic THC Dentification
Marijuana & Hashish
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It elicits psychoactive responses largely due to its active ingredient is
tetrahydrocannabinol –THC; Hashish is more potent resin of marijuana
plant - 7-14% THC content.
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Hallucinogen - distorts perceptions of time and space
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Little physical dependence or physical withdrawal
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May be inhaled or ingested orally (usually baked into an oil-rich substrate to
aid absorption)
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Act at THC receptors throughout the brain
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Effects range from increases appetite, craving sweets to very relaxed states
to periods of impaired judgement and short-term memory impairment
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A possible negative consequence is lung damage due to inhaling the drug
Marijuana & Hashish
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Acts like depressant
Clinically, marijuana has been shown to block the nausea of
cancer and AIDS drugs, stimulate appetite, and decrease the
severity of Glaucoma
Stimulates dopamine and serotonin, influences GABA, and
acetylcholine
High doses - toxic psychosis
Max effect - 30 minutes
Effects last up to 3 hrs.
Half-life - 19 hrs
May be found in blood up to 50 hrs
THC stored in fat cells
Some Effects of Long-Term Use with Marijuana
Use
Hallucinogens
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Disrupt serotonin functioning
Elevation of some bodily functions
Altered sense of reality - sight and sound
Enhanced emotionality
Indoles & Catechols
Hallucinogens
Indoles
 LSD and psilocybin
 Similar chemical structure as
indolin (serotonin NT)
 Ingestion - orally
 Max. effect - 1 hr. Half-life - 3
hrs
 Tolerance develops quickly
 Cross tolerance
 Little physical dependence or
withdrawal
 Not generally toxic
Catechols
 Hallucinogenic effects similar
to indoles
 Similar to structure of
dopamine & norepinephrine
NT
 Peyote, mescaline, PCP
 Max effect - 1/2 - 2 hrs. Halflife - 6 hrs.
 Ingestion - smoke, snorted,
oral or injection
 Adverse affects
Anabolic Steroids
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Steroids are synthetic substances similar to the
male sex hormone testosterone. They do have
legitimate medical uses. Sometimes doctors
prescribe anabolic steroids to help people with
certain kinds of anemia and men who don't
produce enough testosterone on their own.
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Most common anabolic steroids taken today:
anadrol, oxandrin, dianabol, winstrol, decadurabolin, and equipoise.
Anabolic Steroids Side Effects
Side Effects:
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Baldness can be caused by steroid abuse.
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Because of how steroids act on the limbic system in the brain, mood swings,
including homicidal rage can occur.
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Taking roids can cause pimples to pop up.
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Females who take steroids can become more masculine. Their voices can deepen.
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A condition called atherosclerosis can be caused by steroid use. This condition can
lead to a heart attack or stroke.
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When hormone production is disrupted, males can develop breasts, a condition called
gynecomastia.
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Tumors and blood-filled cysts can develop on the liver of steroid users.
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Increased levels of hormones signal bones to stop growing.
Anabolic Steroids
Inhalants
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Most inhalants are common household products that, when inhaled, cause
a psychoactive (mind-altering) effect.
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There are literally hundreds of inhalants, including everyday products such
as nail polish remover, glue, gasoline, household cleaners, and nitrous
oxide ("laughing gas," which can be found in whipped cream dispensers
and is often inhaled via a balloon).
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Inhalants also include fluorinated hydrocarbons found in aerosols such as
hairspray, spray paint, and household cleaners.
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Although the wide range of chemicals found in different products can have
different effects, inhalants generally fall into three categories:
1) Solvents
2) Gases
3) Nitrites
Types of Inhalants
Solvents include:
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Certain industrial or household products, such as paint thinner, nail polish remover,
degreaser, dry-cleaning fluid, gasoline, and glue
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Some art or office supplies, such as correction fluid, felt-tip marker fluid, and
electronic contact cleaner
Gases include:
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Some household or commercial products, such as butane lighters, propane tanks,
whipped cream dispensers, and refrigerant gases
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Certain household aerosol propellants, such as those found in spray paint, hair spray,
deodorant spray, and fabric protector spray.
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Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide
Nitrites include:
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Cyclohexyl nitrite (found in substances marketed as room deodorizers)
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Amyl nitrite (used for medical purposes)
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Butyl nitrite (previously used in perfumes and antifreeze, but now an illegal
substance)
Inhalants
How Are They Used?
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Inhalants can be breathed in
through the nose or mouth in a
variety of ways:
"Sniffing" or "snorting" fumes from
containers
Spraying aerosols directly into the
nose or mouth
Sniffing or inhaling fumes from
substances sprayed or placed into
a plastic or paper bag ("bagging")
"Huffing" from an inhalant-soaked
rag stuffed in the mouth
Inhaling from balloons filled with
nitrous oxide
What Are the Common Street
Names?
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Laughing gas (nitrous oxide)
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Snappers (amyl nitrite)
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Poppers (amyl nitrite and butyl
nitrite)
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Whippets (fluorinated
hydrocarbons, found in whipped
cream dispensers)
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Bold or Rush (nitrites)
Club Drugs
Effects:
Chronic use of MDMA may lead to changes in brain
function. GHB abuse can cause coma and seizures.
High doses of ketamine can cause delirium, amnesia,
and other problems. Mixed with alcohol, Rohypnol can
incapacitate users and cause amnesia.
Statistics and Trends:
According to the 2004 National Survey on Drug Use and
Health, more than 11 million people have tried MDMA,
more than 11 million have tried methamphetamine, and
more than 23 million have tried LSD at least once.
Club Drugs
Brief Description:
Typically used by teenagers and young adults at bars,
clubs, concerts, and parties. The most common club
drugs include Ecstasy (MDMA), GHB, Rohypnol,
ketamine, methamphetamine, and acid (LSD).
Street Names:
XTC, X (MDMA)
Special K, Vitamin K (ketamine)
Liquid ecstasy, soap (GHB)
Roofies (Rohypnol)
MDMA (Ecstasy)
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MDMA (3-4 methylenedioxymethamphetamine) is a synthetic, psychoactive
drug chemically similar to the stimulant methamphetamine and the
hallucinogen mescaline.
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Street names for MDMA include "ecstasy," "XTC," and "hug drug."
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MDMA produces both amphetamine-like stimulation and mild mescaline-like
hallucinations.
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After oral administration at doses ranging from 50 to 200 mg, effects are felt
within 30 to 45 minutes, peak at 60 to 90 minutes, and last for 4 to 6 hours.
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In high doses, MDMA can interfere with the body's ability to regulate
temperature. On rare but unpredictable occasions, this can lead to a sharp
increase in body temperature (hyperthermia), resulting in liver, kidney, and
cardiovascular system failure, and death. Because MDMA can interfere with
its own metabolism (breakdown within the body), potentially harmful levels
can be reached by repeated drug use within short intervals.
GHB, Ketamine, and Rohypnol
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GHB and Rohypnol are predominantly central nervous
system depressants. Because they are often colorless,
tasteless, and odorless, they can be added to beverages
and ingested unknowingly.
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These drugs emerged several years ago as "date rape"
drugs.***** Because of concern about their abuse,
Congress passed the "Drug-Induced Rape Prevention
and Punishment Act of 1996" in October 1996. This
legislation increased Federal penalties for use of any
controlled substance to aid in sexual assault.
GHB
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Since about 1990, GHB (gamma hydroxybutyrate) has been used in
the U.S. for its euphoric, sedative, and anabolic (body building)
effects. It is a central nervous system depressant that was widely
available over-the-counter in health food stores during the 1980s
and until 1992. It was purchased largely by body builders to aid in fat
reduction and muscle building. Street names include "liquid
ecstasy," "soap," "easy lay," "vita-G," and "Georgia home boy."
Coma and seizures can occur following use of GHB. Combining use
with other drugs such as alcohol can result in nausea and breathing
difficulties. GHB may also produce withdrawal effects, including
insomnia, anxiety, tremors, and sweating. GHB and two of its
precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD),
have been involved in poisonings, overdoses, date rapes, and
deaths.
Ketamine
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Ketamine is an anesthetic that has been approved for
both human and animal use in medical settings since
1970; about 90 percent of the ketamine legally sold is
intended for veterinary use. It can be injected or snorted.
Ketamine is also known as "special K" or "vitamin K."
Certain doses of ketamine can cause dream-like states
and hallucinations. In high doses, ketamine can cause
delirium, amnesia, impaired motor function, high blood
pressure, depression, and potentially fatal respiratory
problems.
Rohypnol
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Rohypnol, a trade name for flunitrazepam, belongs to a class of
drugs known as benzodiazepines. When mixed with alcohol,
Rohypnol can incapacitate victims and prevent them from resisting
sexual assault. It can produce "anterograde amnesia," which means
individuals may not remember events they experienced while under
the effects of the drug. Also, Rohypnol may be lethal when mixed
with
alcohol
and/or
other
depressants.
Rohypnol is not approved for use in the United States, and its
importation is banned. Illicit use of Rohypnol started appearing in the
United States in the early 1990s, where it became known as
"rophies,"
"roofies,"
"roach,"
and
"rope."
Abuse of two other similar drugs appears to have replaced Rohypnol
abuse in some regions of the country. These are clonazepam,
marketed in the U.S. as Klonopin and in Mexico as Rivotril, and
alprazolam,
marketed
as
Xanax.
Drugs Used to Treat
Dependence and Addiction
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Naloxone
Naltrexone
Buprenorphine
Varenicline/Cytisine
Rimonabant
Acamprosate
Oxazepam/Lorazepam