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Transcript
Welcome to the Acción Mutua web-seminar: Substances, Use, and Users Overview Before we begin, a little about our format… Presentation by seminar speaker (approx. 40 min.) Followed by question and answer session (approx. 20 min.) Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention Substances, Use, and Users Overview Paul Simons APLA Web Seminar November 20, 2008 [1] Acknowledgements Mark Kinzly, Yale School of Public Health & Epidemiology [1] Learning Objectives Understand the general classes of drugs Describe the physical and psychological effects of illicit substances Identify characteristics of substance using populations Substance Use Overview The Substances Definition of Psychoactive Drugs “A drug is any chemical put into the body that changes mental state or bodily functions.” Drug actions: Pharmacokinetics: How the body acts on the drug; absorption, distribution, metabolism, excretion Pharmacodynamics: The drug’s direct influence on the brain (CNS). Effects of Psychoactive Drugs Desired effect (Therapeutic) Side effect Withdrawal effect Expectancy (“Placebo effect”) Paradoxical effect Synergistic effect Classifications of Psychoactive Drugs Stimulants Narcotics/Opiates Sedative-Hypnotics Depressants Hallucinogens Enactogens (XTC) “Club Drugs” (GHB; Special K) Inhalants Other designer drugs Heroin Heroin Schedule I Classified as a semi-synthetic narcotic Affects the central nervous system and acts as both a depressant and an analgesic (pain killer) Heroin History Heroin was isolated from morphine in 1874 It was thought to be the cure for morphine addiction Quickly addicted its users and became a problem drug In 1914 the Harrison Narcotic Act banned the importation of heroin into the United States Heroin Methods of Ingestion/Onset of Effects Duration of the Effects Inhaled – 1 to 3 minutes Smoked – 20 to 30 seconds Injected – 10 to 20 seconds Orally – Varies 3 to 6 hours Detection in Urine From 1 to 4 days Physical and Psychological Effects Moderate doses • • • • • Euphoria Dreamy Warm “rush” sensation Constricted pupils Nausea High doses/overdose • • • • • • Restlessness Constipation Droopy eyelids Slow breathing Depressed Death Heroin Withdrawal Symptoms Insomnia Hot and cold flashes Nausea Vomiting Weakness Abdominal cramps Diarrhea Heroin Signs of Heroin Abuse Reduced energy level Lack of motivation Low sex drive Nodding out (falling asleep) Pinpointed pupils Long sleeve shirts worn during hot weather Blood stains on shirt sleeves Dry skin Watery eyes Cigarette burns on clothing, hands, and furniture Heroin Slang Terms and Street Names Smack Junk Bindles Bags Black tar Manteca Horse Bundles Tar OxyContin OxyContin is a brand name for an opioid analgesic drug for severe pain Psychoactive prescription drug Approved by the Food and Drug Administration in late 1995 Manufactured by Purdue Pharma 10 mg to 160 mg Classified as a Schedule II drug, meaning it has a high potential for abuse. Only available by prescription by a licensed physician. Percodan, Percocet also contain Oxycodone OxyContin People are “short circuiting” the time release form of medication by chewing, crushing, or dissolving the pills. Chewing or crushing this drug corrupts or foils its timerelease protection, enabling the users to experience a rapid and intense euphoria that does not occur when taken as designed and prescribed Once having crushed the pills, the individuals are injecting, inhaling, or taking them orally, often with other pills, pot, or alcohol. OxyContin It is the active ingredient oxycodone, a synthetic opiate similar to morphine, that appears to be particularly attractive to the user and what is being used increasingly in suburban, and rural areas. 89% increase in abuse from 1993 to 1999 recently showing an increase by another 68%, with 10,825 emergency room mentions in the year 2000. It is the euphoric effect and the fact that many people perceive prescription pain killers as “safe” that are likely the reasons why this drug is being abused in such alarming numbers. Cocaine Cocaine Schedule II Central nervous system stimulant Most potent stimulant of natural origin Cocaine History Initially used as an anesthetic in the late 1800s Aided in the treatment of asthma Previously an active ingredient in many soft drinks and teas Due to its abuse and adverse effects on addicts, its use was restricted in 1906 Cocaine Production of Crack Cocaine Produced from cocaine hydrochloride through a heating and cooling process Cocaine Methods of Ingestion/Onset of Effects Inhaled – 1 to 5 minutes Injected – 20 to 30 seconds Orally – 3 to 5 minutes Smoked – 20 to 30 seconds Duration of Effects From 1 to 2 hours Detection in Urine From 2 to 4 days Cocaine Physical and Psychological Effects Moderate doses • • • • • • • Increased alertness Euphoria Loss of appetite High blood pressure Increased heart rate Dilated pupils Increased sociability High doses/overdoses • • • • • • • Agitation Confusion Hallucinations Cardiac arrest Panic attacks Paranoia Convulsions Cocaine Withdrawal Symptoms Irritability Sluggishness Prolonged periods of sleep Depression Nausea Cocaine Slang Terms and Street Names Blow Flake Base Powder Rock Hard Coke White Dime Perico Modes of Ingestion Injection Inhale Snort Ingest Smoke Transdermal absorption Methamphetamine Methamphetamine Schedule II An amphetamine analog Central nervous system stimulant Triggers the release of large amounts of dopamine & norepinephrine in the brain High potential for abuse Methamphetamine History 1930s - 1950s • Treatment for narcolepsy • Used to keep soldiers alert during combat • Anti-depressant Methamphetamine History 1960s - Present • • • • Produced in clandestine laboratories Used as a party drug Abused throughout the United States Presently a national problem affecting both large cities and rural America Methamphetamine Methods of Ingestion/Onset of Effects Inhaled – 3 to 5 minutes Injected – 20 to 50 seconds Swallowed – 15 to 20 minutes Smoked – 20 to 50 seconds Duration of the High From 4 to 8 hours Detection in Urine A soon as 1 hour after initial dose and up to 48 hours afterwards 1500 METHAMPHETAMINE Neuroxmission Dopamine % of Basal Release 1000 500 0 0 1 2 3hr Time After Methamphetamine 500 % of Basal Release 400 300 200 100 0 0 1 2 COCAINE 3 4 Time After Cocaine 5 hr Methamphetamine Physical and Psychological Effects Moderate doses • • • • • Euphoria Alertness Dilated pupils Loss of appetite Enhanced concentration • Elevated blood pressure High doses • • • • • • • • Malnutrition Physical burnout Aggressive behavior Stroke Rapid weight loss Paranoia Convulsion Death Methamphetamine Withdrawal Symptoms Depression Nausea Severe craving for drugs Shaking Desire to sleep Loss of energy Methamphetamine Slang Terms and Street Names Batu Speed Meth Crack meth Go Fast Crank L.A. glass Crystal Poor man’s coke Tina Methamphetamine Paraphernalia Glass pipes Cut-off straws Hypodermic needles Lighters Razor blades MSM and methamphetamine The MSM Users Why Do People Use Crystal Meth? Perceived desirable effects (Subjective benefits): Provides energy; increases alertness Lessens desire and ability to sleep Increases sexual arousal Increases stamina and enhances endurance Reduces appetite Induces sense of self-confidence; productivity Focuses thinking; increases concentration Distorts perceptions of time Form of escape (from ‘hassles of daily living’) Desired Effects Cited Among Studies of Gay Men Enhances and/or prolongs intensity and frequency of sexual encounters Keeps you active for weekend-long parties Helps you escape from unpleasant emotions In several studies this was linked to avoidance of dealing with one’s HIV status/risk Crystal use cited as a method of coping with “specter of death” National HIV Behavioral Surveillance System • Adults at high risk in the United States • MSM Cycle: Venue-based sampling • Venues were randomly selected • Participants in venues are systematically recruited and interviewed Inclusion criteria Eligibility 18+ years • Resident of city • Analytic criteria • 1+ male sex partners during past 12 months Cities in MSM Cycle, 2003-2005 Boston New York City San Francisco Chicago Newark Denver Philadelphia Baltimore Los Angeles Atlanta San Diego Houston Ft. Lauderdale n = 11,331 Miami San Juan Methamphetamine use in 12 months, by self-reported HIV status Meth use Total Self-reported HIV status No. % Positive 1422 331 23.3 Negative/untested 9909 1147 11.6 High risk sex behavior at last sex by self-reported HIV status High risk behavior at last sex Self-reported HIV status Total No. % Positive 1422 107 7.5 Negative/untested 9909 402 4.1 Psychoactive Substances and Sexual Behaviors My sexual drive is increased by the use of the following substance(s) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 57% l o h o c l A 42% 16% O Rawson R; Matrix Instit., CA te a pi in a c o C e A M Psychoactive Substances and Sexual Behaviors My use of the following substance(s) has made me become obsessed with sex and/or made my sex drive abnormally high. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% A 67% 40% 16% 0% lco l o h Rawson R; Matrix Instit., CA O te a pi C oc ne i a M A Psychoactive Substances and Sexual Behaviors My sexual behavior under the influence of the following substance(s) caused me to feel sexually perverted or abnormal 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 55% 34% 12% l o h o c Al O 4% te a pi Rawson R; Matrix Instit., CA in a c o C e A M US TX Admissions by Primary Drug 300000 250000 200000 Amphetamine 150000 100000 Heroin 50000 0 C ocaine 2000 2003 2006 Sexual HIV Risk Behavior • Changing sexual roles (insertive/receptive anal intercourse) Because of “crystal dick,” men who previously were “tops” may engage in receptive anal intercourse. “Bottoms” are at statistically higher risk of being/becoming HIV infected “Bottoms” who use sexual performance enhancing drugs may “top” (become insertive partners). If they are HIV positive and don’t consistently practice safer sex while high, they may be infecting others. US Reported HIV Cases by Year of Diagnosis and Transmission Category 1000 900 800 700 600 500 400 300 200 100 0 1997 2001 MSM/IDU 2005 Substance Users Demographics Monthly Heroin Use by Employment 1:Full-time job 28% 2.Part-time job 14% 3: Job, no work last week 5% 4: Did not work 53% Demographics Monthly Cocaine Use by Employment Full-Time 42% Part-Time 18% Has Job not working 7% Not Working 33% Demographics Monthly Crack Use by Employment Full-Time 33% Part-Time 15% Has Job not working 7% Not Working 45% Demographics Monthly Methamphetamine Use by Employment 1:Full-time job 37% 2.Part-time job 11% 3: Job, no work last week 7% 4: Did not work 44% Current Drug Use and Age Percent Reporting Past Month Use of an Illicit Drug 25 19.6 20 16.4 15 13.2 9.8 10 7.8 7 5.3 5 6.5 3 4.8 2.4 0.3 0 12-13 14-15 16-17 18-20 21-25 26-29 30-34 35-39 40-44 45-49 50-64 Years of age Source: 2000 National Household Survey on Drug Abuse 65+ U.S. Tx Admissions 2006 80 70 60 50 40 30 20 10 0 Male Female U.S. Tx Admissions 2006 80 70 60 50 40 30 20 10 0 White Black or AfricanAmerican American Indian or Alaska Native U.S. Tx Admissions 2006 100 90 80 70 60 50 40 30 20 10 0 Hispanic or Latino Not Hispanic or Latino Types of Substance Use Approaches in the U.S. to Address Alcohol/Drug Use Creating categories of ‘licit’ and ‘illicit’ Most substances that are now illicit were legal at one time: morphine, cocaine, marijuana/cannabis; LSD; Ecstasy Locating the problem in the person, not the substance (Solution: Demand reduction; moral theory) Locating the problem in the substance, not the person (Solution: Prohibition; Criminal justice model: ‘War on drugs’; Supply reduction) Harm reduction movement: Locates the problem in the relationship between the person and the substance (drug, set, and setting), which may change over time Current Understanding of Addiction Variables correlated with increased risk of addiction: Psychological vulnerability (prior history of problems with other drugs or prior treatment) Family history of addiction History of trauma Substance Abuse Dependence (DSM-IV) A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. Substance is often taken in larger amounts or over longer period than intended 2. Persistent desire or unsuccessful efforts to cut down or control substance use 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects 4. Important social, occupational, or recreational activities given up or reduced because of substance abuse Substance Abuse Dependence (DSM-IV) continued 5. 6. Continued substance use despite knowledge of having a persistent or recurrent psychological, or physical problem that is caused or exacerbated by use of the substance Tolerance, as defined by either: a. b. 7. need for greater amounts of the substance in order to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount Withdrawal, as manifested by either: a. b. characteristic withdrawal syndrome for the substance; or the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms The Addictive Personality Making impulsive choices. Constantly seeking excitement and new sensations. Feeling alienated from mainstream society. Valuing deviant or nonconformist behavior. Lacking patience, for example having trouble waiting for delayed gratification. Continuum of Substance Use Experimental Ritual use Intermittent use Social use Binge use (operationalized as conscious, planned ‘heavy’ drug use for 5 or more days, or 5 drinks for a man, 4 for a woman in rapid succession; potentially distinct from a “slip” for someone in recovery) Abuse DSM-IV-TR criteria Dependence DSM-IV-TR criteria Severely and Persistently Chemically Dependent (numerous attempts to abstain; chronic relapse) Drug, Set and Setting The dose or amount of a drug taken The mind set, or what one expects to “feel” The context and the environment in which drugs are taken All of the above are primary factors in the overall effect Cultures of Substance Use Culture as blueprint for living Language, ritual, economics, family, justice, structure and legacy Varies as regards dominant culture, ethnic culture, economic class, region and drug(s) used iGracias ~ Thank You! Questions & Comments Thanks for Your Participation Future Acción Mutua web seminars: December 3, 2008 11am (PT) HIV DISCLOSURE & Latino MSM , Dr. Maria Cecilia Zea Please register at: [email protected] For more information or to learn how to receive CBA services, contact us at: 213.201.1345 www.accionmutua.org