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SUSAN L. DALTERIO PHD
I.
DRUGS
A.
B.
II.
AND BRAIN CHEMISTRY
SOCIAL
A.
B.
C.
V.
THE PUBLIC HEALTH EPIDEMIC
THE MAJOR DRUG PLAYERS
1.
2.
PAIN MEDICATIONS
STIMULANTS
3. MARIJUANA
THE “NEW” DRUGS ON THE STREET
A.
B.
IV.
DRUG EFFECT
RX DRUG ABUSE
A.
B.
III.
BRAIN CHEMICALS THAT MEDIATE
THE ADDICTION PROCESS
BATH SALTS
SYNTHETIC MARIJUANA
IMPACT
DRUG AVAILABILITY
IMPACT OF MIND-ALTERING DRUGS ON THE USER
IMPLICATIONS FOR HEALTH CARE, WORKPLACE AND
EDUCATIONAL SYSTEMS
CONCLUSIONS

DRUGS ACT THROUGH EFFECTS ON
NATURAL BRAIN CHEMICALS

DRUG EFFECTS LAST LONGER THAN
THOSE PRODUCED NATURALLY


DRUGS OFTEN RELEASE MUCH MORE
BRAIN CHEMICAL THAN FATIGUE, FEAR,
EXCITEMENT
DRUGS CAN DISRUPT PROCESSES THAT
RECYCLE THESE BRAIN CHEMICALS
LEADING TO THEIR DEPLETION IN
NEURONS




SATIATION OCCURS WITH FOOD, WATER,
SEX BUT NOT WITH DRUGS
DRUGS PRODUCE EFFECTS ON DOPAMINE
VERY RAPIDLY
THE MORE OFTEN DRUGS ARE USED THE
MORE REINFORCING THEY BECOME
EVENTUALLY DRUGS CAN CONTROL LARGE
AREAS OF BEHAVIOR


DRUGS ACTIVATE THE REWARD SYSTEM
PRODUCING POWERFUL FEELINGS OF
PLEASURE & AN INCREASED DESIRE TO
REPEAT DRUG USING BEHAVIOR
DRUGS EXERT POWERFUL CONTROL
OVER BEHAVIOR BY ACTING DIRECTLY
ON THE MORE PRIMITIVE SURVIVAL
AREAS IN BRAIN




ACTIVATION of BRAIN REWARD
PROCESSES
ULTIMATELY REDUCES ACTIVITY IN
THESE PATHWAYS
LONG LASTING CHANGES IN BRAIN
STRUCTURES THAT UNDERLIE LEARNING
“MEMORIES” OF DRUG EXPERIENCE AS A
FORM OF LEARNING




DEVELOP INTO LATE ADOLESENCE
DRUGS CAUSE RELEASE OF
DOPAMINE
TRIGGERS MEMORY ENCODING
LINKED TO THE DRUG EXPERIENCES
LINKED TO DRUG CRAVING


PREFRONTAL CORTEX -ROLE IN PLANNING
MOTIVATING ACTION, MODULATED BY
DOPAMINE (DA)
VTA - PRIMITIVE BRAIN, SYNTHESIZES DA,
INFLUENCED BY ENDORPHINS & TARGETED
BY OPIATE DRUGS SUCH AS HEROIN

&
NUCLEUS ACCUMBENS - ROLE IN REWARD,
PLEASURE, LAUGHTER, ADDICTION,
AGGRESSION, FEAR
“GRABBING A HANDFUL OF
PRESCRIPTION DRUGS AND
SWALLOWING THEM, A COMMON
PRACTICE AMONG ADOLESCENTS AND
TEENS”
RX DRUG ABUSE

CHEWING TABLETS

SNORTING CRUSHED TABLETS


DISSOLVING TABLETS IN WATER &
INJECTING
THESE METHODS CAUSE A FASTER,
HIGHLY DANGEROUS RELEASE OF
ACTIVE INGREDIENTS

OVERDOSES
NEARLY
OF RX PAIN MEDS KILLED
15,000

IN 2010

NEARLY

NON-MEDICAL
PEOPLE IN THE
US
IN
2008.
OVER 12 MILLION AMERICANS AGE 12
OR OLDER REPORTED NON-MEDICAL USE OF RX
PAIN MEDS
HALF A MILLION EMERGENCY
DEPARTMENT VISITS IN 2009 WERE DUE TO
PEOPLE MISUSING OR ABUSING RX PAIN MEDS.
USE OF RX PAIN MEDS COSTS
HEALTH INSURERS UP TO $72.5 BILLION
ANNUALLY IN DIRECT HEALTH CARE COSTS

MANY

MIDDLE-AGED

PEOPLE

WHITES

MORE MEN THAN WOMEN DIE OF OVERDOSES FROM
PRESCRIPTION PAINKILLERS.
ADULTS HAVE THE HIGHEST
OVERDOSE RATES.
RX
PAINKILLER
IN RURAL COUNTIES ARE ABOUT 2X AS LIKELY TO
OVERDOSE ON RX PAINKILLERS AS PEOPLE IN BIG CITIES.
AND NATIVE AMERICANS ARE MORE LIKELY TO
OVERDOSE ON RX PAINKILLERS.
ABOUT 1 IN 10 NATIVE AMERICANS AGE 12 OR OLDER USED
RX PAINKILLERS FOR NONMEDICAL REASONS IN THE PAST
YEAR, COMPARED TO 1 IN 20 WHITES AND 1 IN 30 BLACKS.

HEROIN (SCHEDULE I)

OXYCODONE (PERCODAN®, OXYCONTIN®)

OXYMORPHONE (OPANA®)

MORPHINE

CODEINE
THOSE DUE PRIMARILY FROM ADULTERANTS FOUND IN
STREET DRUGS & IN THE NON-STERILE PRACTICES OF
INJECTING
SKIN, LUNG, AND BRAIN ABSCESSES
BACTERIAL INFECTION E.G. FLESH-EATING STREP C &
STAPH A
ENDOCARDITIS (INFLAMMATION OF THE HEART LINING)
HEPATITIS B,C
HIV/AIDS
THOSE DUE TO THE PHARMACOLOGICAL ACTIONS OF THE
DRUGS EVEN WITH MEDICALLY APPROPRIATE USE
NAUSE
ITCHING
BOWEL OBSTRUCTION
RESPIRATORY DEPRESSION
XANAX AND RELATED
DRUGS

PHARMACEUTICAL NAMES
ATIVAN ®- LORAZEPAM
KLONOPIN® VALIUM ®
XANAX ®

CLONAZEPAM
- DIAZEPAM
- ALPRAZOLAM
STREET NAMES
CANDY; Z-BARS; ZANNIES
DOWNERS; SLEEPING PILLS; TRANKS

CLINICAL USES:
INSOMNIA
ANXIETY
ANESTHESIA
MUSCLE RELAXANTS

INTERACT WITH GABA RECEPTORS TO
PRODUCE CALM, SLEEP, & AMNESIA
CAUSES REDUCED INHIBITIONS & IMPAIRED JUDGEMENT
CONCURRENT ALCOHOL OR OTHER DEPRESSANT USE CAN
BE FATAL
HIGH ABUSE AMONG HEROIN & COCAINE ABUSERS
ALPRAZOLAM & DIAZEPAM ARE THE TWO MOST
FREQUENTLY ENCOUNTERED BENZODIAZEPINES ON THE
ILLICIT MARKET
PROVIGIL ®, METH,
AMPHETAMINES, RITALIN®

CLINICAL USES:
ANOREXIANTS (WEIGHT LOSS)
ATTENTION DEFICIT DISORDER
DECONGESTANTS



ENHANCE THE ACTIVITY OF
NOREPINEPHRINE & DOPAMINE
 HEART RATE & BLOOD PRESSURE
OFTEN USED/ABUSED TO BOOST
COGNITIVE FUNCTIONS




FIRST USED IN GERMANY & JAPAN
DURING WWII
WIDELY USED AS DIET PILLS DURING
1950s
“SPEED” IN 1960s
CHEAPER & MORE LONG LASTING
THAN COCAINE

“SPEED”, “CRYSTAL”, “CRANK”

Rx – METHEDRINE; DOSOXYN

USE: ORAL; IV; SMOKING; SNORTING


MORE POTENT BRAIN ACTIONS THAN
AMPHETAMINE
GREATER NEUROTOXICITY THAN
AMPHETAMINE

IRRITABLE; WIRED; JITTERY

MAY FEEL SUPER PRODUCTIVE

STEREOTYPY – STRINGING/UNSTRINGING
BEADS, FLOOR PACING; CLEANING;
SHINING SHOES HOUR AFTER HOUR
METHYLPHENIDATE (RITALIN®, METHYLIN®, CONCERTA®)
STREET SLANG – PINEAPPLE; KIBBLES & BITS
TREATMENT OF EXCESSIVE DAYTIME SLEEPINESS
ASSOCIATED WITH NARCOLEPSY
TREAT ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD) IN CHILDREN.
DISSOLVE TABLETS IN WATER & INJECT THE MIXTURE
COMPLICATIONS DUE TO INJECTION OF THE INSOLUBLE
FILLERS USED IN THE TABLETS; THESE MATERIALS BLOCK
SMALL BLOOD VESSELS CAUSING SERIOUS DAMAGE TO THE
LUNGS AND RETINA OF THE EYE
BINGE USE CAUSE PSYCHOTIC EPISODES, CARDIOVASCULAR
COMPLICATIONS, & SEVERE PSYCHOLOGICAL ADDICTION
9 - TETRAHYDROCANNABINOL

MAJOR PSYCHOACTIVE INGREDIENT

PRODUCES THE “HIGH” FEELING

CHANGES BEHAVIOR & PERCEPTION

PHYSICAL RELAXATION

SEDATION

GIDDINESS

TIME SLOWS DOWN

SHORTENS ATTENTION SPAN

SHORT TERM MEMORY DEFICIT

ANXIETY/PARANOIA



BINDS TO CB1&2 RECEPTORS; SAME AS
ANANDAMIDE, AN ENDOCANNABINOID
DECREASES GABA RELEASE
REDUCES ACETYLCHOLINE ACTIVITY IN
HIPPOCAMPUS, AFFECTING MEMORY &
COGNITIVE FUNCTIONING

INCREASES DOPAMINE RELEASE



A STUDY @ BETH ISRAEL DEACONESS MEDICAL
CENTER FOCUSED ON 4,000 PEOPLE WHO HAD
SUFFERED A HEART ATTACK
A PERSON'S CHANCE OF HAVING A HEART
ATTACK, ESPECIALLY FOR THOSE WHO ARE
ALREADY AT RISK FOR HEART DISEASE, 
NEARLY 5 FOLD DURING THE 1ST HOUR AFTER
SMOKING MARIJUANA
HEART ATTACK MAY BE DUE TO THE RUPTURE
OF CORONARY PLAQUES CAUSING A CLOT,
WHICH RESTRICTS BLOOD FLOW TO THE HEART

INCREASED RISK OF SCHIZOPHRENIA

INCREASED RISK OF DEPRESSION

INCREASED RISK OF SUICIDAL
IDEATION


INCREASED RISK OF PSYCHOSIS
ESPECIALLY IN THOSE GENETICALLY
PREDISPOSED
ABOUT 1 OUT OF 4 ARE PREDISPOSED
TO MARIJUANA-RELATED MENTAL
HEALTH CONSEQUENCES
© DALTERIO 2009

 T CELLS

 VIRAL RESISTANCE

 RESPIRATORY DISEASES

IMMUNOSUPPRESSIVE EFFECTS
MEDIATED BY CB2 RECEPTORS
© DALTERIO 2009



MARIJUANA IS THE MOST WIDELY USED DRUG BY
WOMEN AT REPRODUCTIVE AGE
STUDIES REPORT EITHER LOWER BIRTH WEIGHT OR
SHORTER LENGTH AT BIRTH FOR INFANTS EXPOSED
PRENATALLY
PATERNAL MARIJUANA USE DURING THE PERIODS
OF CONCEPTION & PREGNANCY & ALSO
POSTNATALLY WERE SIGNIFICANTLY ASSOCIATED
WITH INCREASED RISK OF SIDS
 EXPOSURE VIA BREAST MILK DURING THE FIRST
MONTH POSTPARTUM APPEARS TO BE ASSOCIATED
WITH A DECREASE IN INFANT MOTOR DEVELOPMENT
AT ONE YEAR OF AGE
© DALTERIO 2009

NOT FDA APPROVED FOR SAFETY & EFFECTIVENESS

CANNOT PROVIDE CONSISTENT DRUG DOSE OR DELIVERY
GUIDELINES

CONTAMINATION ISSUES

SMOKING & PLANTS ARE NO LONGER ACCEPTED IN ANY
CURRENT TREATMENT SCENARIO IN THE US

ADVERSE EFFECTS OF SMOKING

SMOKING PRODUCES A QUICK”HIGH” MAKING THE PATIENT FEEL
“BETTER”

AN EXAMPLE OF THE PLACEBO EFFECT; IF PEOPLE “BELIEVE”
MARIJUANA IS A MEDICINE FOR THEM IT MAY WORK
© DALTERIO 2009


CAN BE EFFECTIVE TREATMENT FOR
SEVERAL CONDITIONS IN WHICH
PATIENTS DO NOT REPOND TO
OTHER THERAPIES
LIKE ANY Rx PRODUCT
CANNABINOIDS ARE ASSOCIATED
WITH ADVERSE EFFECTS WHICH
MUST BE CONSIDERED AS A BENEFIT
V RISK MEDICAL DECISION
© DALTERIO 2009

BLISS

BLACK MAMBA

BOMBAY BLUE

FAKE WEED

GENIE

SPICE

DEVELOPED BY JW HUFFMAN
THE MID 90’S

SPRAYING A SYNTHETIC THC LIKE COMPOUND
JWH-018 ONTO HERBAL PRODUCTS OR INCENSE

EASY

LEGAL

SOLD AS
KOREA
A PLANT GROWTH STIMULANT IN

BANNED
IN SOME LOCALITIES,

BANNED
AT
CLEMSON U
IN
TO GET ON THE INTERNET OR IN HEAD SHOPS,
SOME GAS STATIONS ETC.
STATUS IN QUESTION
BY US MILITARY
DRUG SCREENING TESTS
&
CHINA &
EUROPE & RUSSIA
DETECTED BY THEIR



REPORTS THAT SO FAR THIS YEAR THERE
HAVE BEEN 567 K2-RELATED CALLS, UP
FROM 13 IN 2009
INVESTIGATORS NOT REALLY CERTAIN WHAT
IS IN K2 LABELED PRODUCTS
PEOPLE ARE ARRIVING AT ERS WITH
SYMPTOMS NOT NORMALLY BE ASSOCIATED
WITH MARIJUANA


K2 AFFECTS THE BRAIN IN THE SAME WAY
AS MARIJUANA'S PSYCHOACTIVE THC
BOTH COMPOUNDS BIND TO THE CB1
RECEPTORS, WHICH PRIMARILY AFFECT THE
CENTRAL NERVOUS SYSTEM

JWH-018 ALSO BINDS TO THE PERIPHERAL
BRAIN (CB2) RECEPTORS, WHICH ARE
INVOLVED IN THE IMMUNE SYSTEM

VERY RAPID  IN HEART RATE

DANGEROUSLY ELEVATED BLOOD PRESSURE

PALE SKIN

SEVERE HALLUCINATIONS

EXTREME ANXIETY, AGITATION & SEIZURES
& VOMITING
ALTHOUGH THE DATA IS STILL BEING
UPDATED THE FOLLOWING REFLECTS
CLOSED CASES FOR SYNTHETIC
MARIJUANA EXPOSURES
 IN 2010 THERE WERE 2,906 CALLS
 FOR 2011 6,959
 AS OF JUNE 2012 THERE WERE 3,372


BATH SALTS' FIRST BECAME POPULAR WITH
THE CLUB SCENE IN EUROPE
IN 2010 OVER 2,000 CLUBBERS REPORTED
THAT 40% OR MORE HAD USED SOME FORM
OF BATH SALTS, AND MORE THAN 30% HAD
USED THEM WITHIN THE LAST MONTH


THEY ARE SYNTHETIC DERIVATIVES OF
CATHINONE, A SUBSTANCE THAT COMES
FROM AN AFRICAN PLANT CALLED “KHAT.”
CATHINONE IS A SCHEDULE I CONTROLLED
SUBSTANCE UNDER THE FEDERAL
CONTROLLED SUBSTANCES ACT




THE AMERICAN ASSOCIATION OF POISON
CONTROL CENTERS REPORT THAT IN 2009
U.S. POISON CONTROL CENTERS RECEIVED
NO CALLS ON INGESTION OF BATH SALTS.
IN 2010, THEY RECEIVED 303 CALLS
BY 2011 MORE THAN 6138 CALLS
AS OF MAY 2012 THERE WERE 1302
CALLS

DELUSIONS

HALLUCINATIONS

SEIZURES

PANIC ATTACK

INCREASED HEART RATE & BLOOD
PRESSURE
FY 2007 - 6,299 FEDERAL OFFENDERS
SENTENCED FOR MARIJUANA-RELATED
CHARGES IN U.S. COURTS.
APPROXIMATELY 96.9%
OF CASES
INVOLVED TRAFFICKING
2.5%
OF CASES INVOLVED SIMPLE
POSSESSION
“THE AMBIEN EXCUSE”




PSYCHOACTIVE DRUGS ACT BOTH RAPIDLY
& DRAMATICALLY ON NEURONS THAT
RELEASE DOPAMINE
THIS CREATES STRONG & LONG-LASTING
MEMORIES ACTIVATING PRIMAL SURVIVAL
REWARD MECHANISMS
REWARD IS ACTIVATED BOTH BY DRUG
ACQUISITION & ACTUAL DRUG EFFECTS
THE NEED FOR REACTIVATE THESE
PATHWAYS ARE PERCEIVED AS NECESSARY
FOR SURVIVAL





DRUGS INTERFERE WITH LEARNING &
MEMORY ESPECIALLY IN ADOLESCENTS
AGE OF FIRST USE HAS A PROFOUND
EFFECTS ON ADDICTION PROBABILITY
DRUG AVAILABILITY INCREASES USE
LONG-TERM MEDICAL EFFECTS OF THE
LEGAL ALCOHOL & TOBACCO COST
BILLIONS
PSYCHOACTIVE DRUG USE HAS
PROFOUND IMPACT ON TRAFFICRELATED DEATHS, WORKPLACE
ACCIDENTS & ABSENTEISM, DOMESTIC
VIOLENCE & CRIMINAL BEHAVIORS