Download Chapter 12 - Stimulants

Chapter 12 - Stimulants
History of Cocaine
 Shrubby plant-Erythroxylon coca-Andes Mountains
 Evidence of use in 6th century; probably much earlier
 German scientist-Albert Niemann-1860-named it cocaine
 Angelo Mariana-1869-Vin Mariani; combination of alcohol
and cocaine produces a metabolite several times longer acting
than cocaine alone; intoxicating
 Used by Pres. McKinley, Thomas Edison, Gen. Grant, Jules
Verne, Sara Bernhardt, Popes Pious X and Leo XII
 Freud-experimented on himself, family, friends
 Carl Koller-eye operations
 Coca-Cola; Today: factory in NJ; select team of employees of
Stepan Co.-remove cocaine from leaves
 Legally receives 175,000 kilograms from Peru each year;
results in 1,750 kilograms of cocaine (20 mill. Hits of crack;
street value=$200 million
 Sold for medical purposes-surgery
Scope of Use
 2008-1.9 million past month users (359,000 crack)
 18-25 highest rate
 2009-significant decline in past month use by 8th 10th and 12th
graders from peak use in 1990s
 DAWN-2008-24% of ED visits involved cocaine (482,188)
How Cocaine Produces Its Effects
 VTA (ventral tegmental area) most affected
 Nerve fibers from VTA extent to nucleus accumbens
Short-Term Effects
 Effects begin immediately; gone in a few minutes or within
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an hour
Small doses: euphoric; energetic; talkative; mentally alert;
decreases need for food and sleep
Duration: depends on route of administration-snorting: 1530 min; crack: 5-10 min
PHYSIOLOGICAL EFFECTS: constricted blood vessels;
dilated pupils; increased temp, heart rate, blood pressure;
sometimes bizarre, erratic, violent behavior
Restlessness, irritability; anxiety; panic; paranoia; tremors;
vertigo; twitches
 Disturbances in heart rhythm & heart attacks; strokes;
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seizures; headaches; coma; death (cardiac arrest or seizures
followed by respiratory arrest)
Cocaine and alcohol-the most common 2-drug combination
resulting in drug-related deaths
Cocaine + alcohol = cocaethylene
Increases: high blood pressure; elevated heart rate; abnormal
heart rhythms; labored breathing
18-25 x increased risk of immediate death
62-90% of cocaine abusers also abuse alcohol
Long-Term Effects
 Addiction
 Pharmacodynamic tolerance; at same time-increased
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sensitivity to cocaine’s toxic effects (convulsions)
Binging-increased irritability; restlessness; panic attacks;
paranoia
Regular snorting: loss of sense of smell; nosebleeds;
problems with swallowing; hoarseness; chronic inflamed
runny nose
Injected: allergic reactions
Loss of appetite; weight loss
Diminished sensitivity to rewards because of addiction (D2)
 Cocaine psychosis: formication; other hallucinations; feelings
of anxiety and paranoia
 Increased risk of contracting HIV/AIDS; Hepatitis C (HCV);
inject for 5 years-chances of HCV=50-80%
 Fetal Effects: premature delivery; low birth weight; small
head circumference; shorter
 “Crack Babies” : one time written off; predicted to have
severe, irreversible damage; reduced intelligence and social
skills
 Multiple factors have to be considered: am’t./type of all
drugs used; extent of prenatal care; maternal nutrition;
exposure to sexually trans diseases; neglect or abuse of child;
violence in environment; socioeconomic status; other health
problems
Treatments
 2007-cocaine-13% of all admissions to drug abuse treatment
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programs; majority: crack and polydrug abusers
Pharmacological Approaches: no FDA approved meds
disulfirim (Antabuse) produces the most consistent
reductions in use
Compounds being tested-imbalance produced by cocaine on
glutamate and GABA
D3 receptors-meds are being tested for safety in humans
Cocaine vaccine-prevents cocaine from entering the brain
Behavioral Interventions
 Contingency Management/Motivational Incentives (MI)-
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vouchers; prizes: gym membership, movies, dinner; useful
for achieving initial abstinence and staying in treatment
Cognitive-behavioral therapy (CBT)-learning plays a role in
development of abuse and addiction; helps patients
recognize, avoid, & cope; effective for preventing relapse
Therapeutic Communities-usually 6-12 mo. Stay; vocational
rehab; learn to function in society
Community-based recovery programs-Cocaine Anonymous12 step
Treatment should match needs
Amphetamine/Methamphetamine
 Chinese drug-mahuang-asthma
 Dr. Chen-Eli Lilly-1920s-ephedrine active ingredient in
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mahuang
Gordon Alles-synthesized amphetamine while trying to
develop a synthetic form of ephedrine; marketed; nasal
inhaler; spread through 1930s
Japanese scientist-methamphetamine; soldiers
1960s- “Speed Kills”
Ice; ER admissions increases 460% from 1985-1994 in Cal.;
2006-law enforcement listed meth as #1 drug problem
Scope of Meth Abuse
 Relationship between coke and meth
 About 10 million in U.S.-tried at lease once
 High use levels: Honolulu, San Diego, Seattle, San Francisco,
Los Angeles, Atlanta
 HS seniors-2005-4.5% lifetime use; 8th grade-3.1%; 10th
grade-4.1%; surveys show recent decline
 DAWN-50% increase in ED visits-1995-2002 (73,000); 4%
of all drug-related visits in 2004
 1992-5 states reported high rates of treatment admissions;
2002-21 states
Methamphetamine Compared to
Cocaine
 Meth-structurally similar to dopamine-different from coke
 Coke-quickly removed and almost completely metabolized in
the body
 Meth-longer duration of action-large amount stays in body
unchanged
 Meth-blocks dopamine reuptake; also increases release of
dopamine
Short-Term Effects
 Increased attention/decreased fatigue
 Increased activity and wakefulness
 Decreased appetite
 Euphoria and rush
 Increased respiration
 Rapid/irregular heartbeat
 hyperthermia
Long-Term Effects
 Addiction
 Anxiety, confusion, insomnia
 Mood disturbances; violent behavior
 Psychosis: paranoia, visual and auditory hallucinations,
delusions, formication; can last for years
 Changes in brain structure and function: alterations in
dopamine system associated with reduced motor speed and
impaired verbal learning; changes in structures associated
with emotion and memory
 Severe dental problems; weight loss
Recovery of Brain Dopamine
Transporters in Chronic Meth Abusers
Other Problems
 Risks During Pregnancy
 Knowledge is limited; a few human studies indicate increased
rates of premature delivery; placental abruption; fetal growth
retardation; heart and brain abnormalities
 Problem: sample size and use of other drugs
 Increased risk of HIV; hepatitis B and C
Treatments
 Behavior therapies seem to be most effective
 Matrix Model: combines behavior therapy, family education,
individual counseling, 12-step support, drug testing,
encouragement for non-drug activities
 No specific meds for amphetamine; Wellbutrin-reduces the
high and cravings