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“Rave” Drugs OTCs Drugs in Sport Pearl Isaac & Anne Kalvik Learning Objectives • To become aware of some substances used on the rave/club scene and their risks • To recognize OTC products that are abused and their effects • To develop an understanding of substances abused in sports and their consequences “Rave” Scene • • • • • • is it over? PLUR clubs, parties younger users older users & different patterns of use raves & alcohol, cannabis use (why not?) Ontario School Drug Use Survey 2003 • • • • • • alcohol 66.2% cannabis 29.6% tobacco 19.2% hallucinogens 10% stimulants 5.8% solvents 6.1% • • • • • • • • LSD 2.9% methamphetamine 3.3% methylphenidate 2.9% MDMA 4.1% cocaine 4.8% ketamine 2.2% heroin 1.4% GHB 0.7% Drugs Used on the “Rave” Scene (or by adolescents) • • • • • • • • LSD Ecstasy (MDMA) Herbal Ecstasy Ketamine (“Special K”) Methamphetamine (“Crystal Meth”) Psilocybin (Magic Mushrooms) GHB Rohypnol? MDMA (Ecstasy) • • • • • • Ecstasy, e, XTC, X , Adam, MDM, hug drug branding (logos) price doses purity & strength amphetamine derivative with hallucinogenic properties, but... MDMA: Effects • • • • • • • • euphoria, energy increased self-esteem, confidence increased sociability, benevolence visual distortions (minimal) some anxiety, panic, confusion paranoia “hangover” seizures, death MDMA: Acute Effects grinding of teeth (jaw pain) sweating, hyperthermia (rhabdomyolysis possible) high BP, increased heart rate decreased appetite insomnia headache, stiffness of back and legs arrhythmias, stroke, MI MDMA: Long-term Effects • • • • • weight loss psychiatric issues: depression, memory loss flashbacks hepatotoxicity neurotoxicity • MDMA plus Viagra = MDMA and Harm Reduction • • • • • • • venues volunteers, police fluids loose clothing DI questions other? SSRI’s?? useful? Ketamine “Special K” • • • • • • • • anesthetic related to PCP diverted from hospitals and vetrinarians antagonist at NMDA receptor “dissociation” impaired thought processes & memory confusion, dizziness, slurred speech hallucinations, flashbacks aspiration, respiratory depression “Date-Rape” Drugs • • • • • GHB Rohypnol Ketamine Benzodiazepines Alcohol GHB • • • • • • • Looks like water Liquid X, Liquid Ecstasy, GBH, Easy Lay Narrow therapeutic window CNS depressant date rape context euphoria dizziness, drowsiness, sedation GHB: Overdose • • • • • • nausea & vomiting loss of consciousness amnesia coma seizures respiratory arrest GHB • dependence • withdrawal GHB Precursors (GBL, Blue Nitro) Rohypnol (flunitrazepam) • • • • • • • “roofies” availability how abused change in formulation police seizures? other benzodiazepines alcohol Jessica • 16 years old • goes to raves when she can • at raves, she uses “e”, “k” and “crystal meth” • reports feeling depressed over past 6 months • denies suicidal ideation or intent Jessica issues? OTCs • why abused? • patterns of abuse (chronic vs. recreational) OTCs that are Abused • codeine preparations (e.g. Tylenol #1) • dimenhydrinate (e.g. Gravol) • sleep aids with diphenhydramine (e.g. Sleep-Eze D, Nytol) • dextromethorphan • caffeine OTCs that are Abused • cold preparations – with antihistamines – with stimulants/decongestants: ephedrine, pseudoephedrine (e.g. Sudafed) – with alcohol (Nyquil “all of the above” plus dextromethorphan) OTCs that are Abused • alcohol-containing preparations (including mouthwashes, aftershaves) • herbals • solvents • laxatives • ipecac Dimenhydrinate / Diphenhydramine • • • • • • • antinauseants, sleep aids teenagers for high hallucinations toxicity –seizures, psychosis, arrhythmias chronic use of high doses psychiatric patients tolerance, dependence, withdrawal Dextromethorphan • In 50% of cough and cold products (e.g. Robitussin DM, Nyquil, Contac Cold&Fever, Benylin DM etc.) • DXM, Robo, DEX • high doses for LSD-like high • toxicity: hypertension, seizures, hallucinations, coma • chronic use - psychiatric issues OTC Stimulants • • • • • CAFFEINE “Wake Ups”, an ingredient in many OTC’s sold as energizer, to stay awake herbal (Guarna, Herbal Ecstacy) high doses associated with anxiety, mood, sleep disorders • dependence & withdrawal OTC Stimulants • Street Stimulants – Caffeine, Ephedrine, Phenylpropanolamine • Pseudoephedrine (e.g. Sudafed)/Ephedrine – – – – – weight loss, sports, energy precursor for methamphetamine new legislation herbals (e.g. ephedra herb, Ma Huang) toxicity: stroke, arrhythmias, MI OTC Abuse What can you do in the pharmacy? Drugs Used in Sports Anabolic steroids (“roids”, “juice”) Other Drugs Used in Sports • Stimulants – amphetamine, caffeine, pseudoephedrine – clenbuterol – modafinal • • • • diuretics laxatives beta-blockers pain relievers • urine tampering – probenecid • hormones – – – – HCG, HGH, EPO thyroxine insulin, OCs mifespristone • GHB • antidepressants Other Drugs/Techniques Used by Athletes • local anesthetics, corticosteroids • nutritional supplements (e.g. creatine) • acetylcholine • Deprenyl • • • • • cannabis alcohol tamoxifen clomiphene blood-doping Drugs Used in Sports • ergogenic • therapeutic • recreational Anabolic Steroids • • • • androgenic (masculinizing) anabolic (tissue building) human veterinary Medical Uses for Anabolic Steroids • testosterone deficiency in males (including delayed puberty • chronic tissue wasting conditions • anemia • osteoporosis • others Reasons Why Athletes Use Anabolic Steroids • • • • • • • more lean mass & less body fat increased endurance & strength decreased recovery time increased aggression & ability to compete faster healing time from injuries winning “edge” better appearance Reasons for Others to Abuse Anabolic Steroids • • • • • • • • enhance physical appearance improve physical condition personal enjoyment (“high”) increased self-esteem personality disorders coach/parent/scholarship pressure employment (e.g. law enforcement) withdrawal symptoms? Patterns of Use • • • • doses often 100x higher than for medical use “cycling” “pyramiding” “stacking” Some Injectable Steroids • nandrolone (Deca-Durabolin) • stanozolol (Winstrol V) • testosterone (Depo-Testosterone, Delatestryl, etc.) Tetrahydrogestrinone (THG) Some Oral Steroids • • • • • danazol (Cyclomen) methyltestosterone (Metandren) oxandrolone (Anavar) stanozolol (Winstrol) testosterone undecanoate (Andriol) Adverse Effects of Anabolic Steroids • endocrine – testicular atrophy, impotence, acne, gynecomastia, masculinization etc. • liver – jaundice, hepatitis, cancer etc. • musculoskeletal – premature closure of long bones (adolescents) – tendon ruptures Adverse Effects of Anabolic Steroids • cardiovascular – MI, enlarged heart, clots, increased LDL, decreased HDL, fluid retention • GI – nausea, vomiting, irritation • behavioural – “roid rage”, mood swings, anxiety, paranoia, insomnia, psychosis, changes in libido, etc. Indirect Adverse Effects of Steroids • infections (hepatitis, HIV) – from needle sharing and improper technique • abscesses & clots – from improper injection technique, repeated injections at same site, contaminants • consequences of “roid rage” Tolerance, Dependence & Withdrawal • no evidence of tolerance • physical dependence and withdrawal (may simulate opioid withdrawal) have been reported • psychological dependence ? euphoria ? reward mechanism in brain ? natural opioids • not included in DSM-IV Treatment • • • • • • psychosocial counselling stop smoking nutritional counselling ? pharmacological treatment ? prevention strategies ? harm reduction