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Individual Drug Info Winter 2016 Similar Properties Across Drugs •  Withdrawal (physical dependence)
•  Psychological dependence
Which drug is the most addictive?
•  Depends on who you ask
•  Depends on the individual and that person’s reasons for taking the
drug
•  Depends on what substance(s) is/are readily available
•  Tolerance
Differences Forms Availability DEA Schedule Effects ◦  Acute ◦  Chronic ◦  Overdose ◦  Emergency Department visits: — 
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◦  All ages ◦  Aged 18-­‐25 (Substance Abuse and Mental Health Services AdministraIon, 2014, Figure 3) Photo, originally taken by Thoric, available to use in the public domain How does marijuana affect anxiety and depression? Does marijuana affect respiratory funcIon? Especially during exercise? Is marijuana more destrucIve to your brain than alcohol? CANNABIS -­‐ MARIJUANA Cannabis •  Cannabis sativa & indica
•  Different subspecies/varietals used
for clothing vs drug use
•  Canadian study – differences are
questionable
•  Cannabinoids are active ingredients
•  THC is a cannabinoid
•  Interacts with cannabinoid receptors in brain
•  Many other cannabinoids exist, but they are
less understood regarding psychoactive effects
•  DEA: Schedule I
•  Despite state regulations, marijuana still
federally illegal
Medical cannabis (1/7/2016), source: procon.org) Alaska (98) Maine (99) New Jersey (10) Arizona (10) Maryland (14) New Mexico (07) California (96) MassachuseZs (12) New York (14) Colorado (00) Michigan (08) Oregon (98) ConnecIcut (12) Minnesota (14) Rhode Island (06) Delaware (11) Montana (04) Vermont (04) Hawaii (00) Nevada (00) Washington (98) Illinois (13) New Hampshire (13) Washington, DC (10) Recreational Cannabis • 
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Washington (2013)
Colorado (2013)
Washington, DC (2014)
Oregon (2014)
Alaska (2014)
•  Although above states have legalized recreaIonal marijuana, others have decriminalized use (lowered policing efforts, fines instead of other penalIes) If weed can be used for medical purposes, then
why is it illegal in different states?
•  Good question
•  Long-standing influences from culture, government
Cannabis Acute effects —  THC acts on cannabinoid receptors, increases dopamine, serotonin —  Increases appeIte —  ASAP Science: Your Brain on Marijuana (via YouTube, 2:26) Are blunts much worse for health than bongs, joints, and other forms of smoking? —  Possibly (more smoke since more product; depends on inhalaIon, frequency, amount of Ime passing when one smokes for health? Are wraps like Swisher Sweets or White Owls bad —  Some wraps are made with tobacco —  Overdose generally doesn’t occur ◦  Large amount required ◦  Smoking a lot may induce sleepiness ◦  EaIng too much may trigger nausea, vomiIng ◦  Q13 News story, Michigan —  Mixing any chemical substances can potenIally cause a problem Alcohol vs Cannabis • 
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More research on alcohol
Age dependent
Amount of alcohol/amount of cannabis
Mixing substances
Alcohol interferes with neurogenesis of brain cells
(Gary L.Wenk, Psychology Today, 2010)
•  Cannabis: 2014 study showing regular use impacted decisionmaking and judgment (Published online before print November 10, 2014, doi: 10.1073/pnas.
1415297111. PNAS November 10, 2014; found online here)
Depression and Anxiety •  Many use marijuana to ease mood
•  Regular use may trigger, or worsen, either condition,
especially in younger people
•  2013 Imperial College study showed lower dopamine
levels in regular users, which may lead to more anxiety
•  Marijuana, conversely, may help those with PostTraumatic Stress Disorder
•  Memory inhibition
What are the negative side effects of smoking weed other than it being bad for your lungs? Chronic effects —  Respiratory distress —  Mood swings —  Impaired memory (potenIal hippocampus damage) —  Earlier research —  2011 NIMH/NIDA study ◦  Daily use may reduce brain receptor number ◦  Receptors regenerated with cessaIon ◦  Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry, molecular imaging shows." ScienceDaily. ScienceDaily, 13 June 2011. <www.sciencedaily.com/releases/
2011/06/110606131705.htm>. Marijuana & Respiratory Function During Exercise —  Acute effect: any smoke can interfere with oxygen binding to red blood cells —  Acute: marijuana can disrupt coordinaIon, balance, reacIon Ime —  Acute: increase heart rate and blood pressure —  Acute: stored THC in fat could be released into bloodstream during exercise —  Chronic: depends on how frequently one smokes, type of exercise LSD • 
LSD Albert Hoffman: “Last Friday,
April 16,1943, I was forced to
interrupt my work in the laboratory
in the middle of the afternoon and
proceed home, being affected by a
remarkable restlessness, combined
with a slight dizziness. At home I lay
down and sank into a not unpleasant
intoxicated-like condition,
characterized by an extremely
stimulated imagination. In a
dreamlike state, with eyes closed (I
found the daylight to be unpleasantly
glaring), I perceived an
uninterrupted stream of fantastic
pictures, extraordinary shapes with
intense, kaleidoscopic play of colors.
After some two hours this condition
faded away.”
LSD •  Schedule I hallucinogen synthesized in 1930s
•  Dosage measured in micrograms (very small)
•  Manufacturing secretive: Nick Sand (National Geographic, 3:39) •  Same basic chemical structure •  Illegal, so cannot guarantee contents, care of product •  Light and air may degrade drug LSD Forms •  Crystal can be crushed,
mixed with other materials
into tablets: microdots
•  Gelatin squares
•  Converted to liquid paper
•  Dosed onto sugar cubes
•  Placed on candy (gummy
bears - Lake Tahoe, 2011,
e.g.)
•  Usually taken orally
•  Can be inhaled, injected,
applied transdermally
LSD Acute Effects •  DuraIon of “trip” = several hours in length •  Visual hallucinaIons (images, color, light) •  Altered percepIon of senses •  “Seeing sounds, hearing colors” •  Color, size of objects • 
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Altered percepIon of Ime, depth PotenIal anxiety/panic Experiences can vary widely Serotonin receptors may be excited or inhibited LSD experimentaIon on BriIsh soldiers (YouTube.com) Overdose thought to be rare, but some individuals may not respond well, or may experience problems if drug is different than LSD LSD •  Chronic effects may involve flashbacks, usually among those
who continue taking the substance
•  Sudden onset of abnormal perceptions
•  Hallucinogen Persisting Perception Disorder
•  Visual images remain longer than in consciousness
•  Dr. Henry Abraham (Tufts University) blog
•  A 2013 PLOS One open access data study article
•  National Survey on Drug Use and Health respondents
•  130,000+ subjects
•  No relationship between lifetime hallucinogen use and mental
health issues
LSD Research •  US Food and Drug Administration allowed
LSD research
•  Recent study sponsored by Multidisciplinary
Association for Psychedelic Studies, carried
out by Swiss physician Peter Gasser
•  Information published 2014
•  12 patients with terminal illness, end-of-life anxiety
•  Took one of two doses of LSD with talk therapy,
across eight weeks
•  Those with larger dose reported improvement
What is DMT? How does DMT work as a psychoacIve drug? DIMETHYLTRYPTAMINE (DMT) Dimethyltryptamine •  Chemical structure
•  Hallucinogenic ingredient
•  Present in a variety of
plants
•  Occurs naturally in the
body
•  Schedule I substance
Image source:Wikimedia Commons
Dimethyltryptamine •  Often consumed via
beverage: ayahuasca tea
•  Requires MAO-I (specific
vine)
•  Ceremonial purposes
•  Ashland, OR Brazilian church
lawsuit
•  Ashland, OR Brazilian church
lawsuit
•  Daime Church (DenizenTV)
•  Can be injected, inhaled,
smoked
Dimethyltryptamine Effects —  Hallucinogenic visualizaIons —  Mood change —  Time distorIon —  DissociaIon —  Muscle twitching, coordinaIon difficulIes —  Nausea, vomiIng —  Shorter-­‐lasIng effects than other hallucinogens ◦  “businessman’s trip” per DEA ◦  30-­‐60 minutes —  Video Clip -­‐ The Spirit Molecule, Part 1 (YouTube) —  Video Clip – London Real (34:00+ = trip described) Source: Arch Gen Pesychiatry. 1994 Feb;51(2):98-­‐108. Heroin Heroin •  Narcotic
•  Synthesized from morphine in late
1800’s
•  Morphine synthesized from opium poppy
•  Heroin 10x more powerful than morphine
•  Was thought to be less addictive
•  After many people became addicted, heroin
was outlawed in 1920’s
•  Drug Ads (wings.buffalo.edu)
•  Schedule I
Heroin •  Narcotic
•  Synthesized from morphine in late
1800’s
•  Morphine synthesized from opium poppy
•  Heroin 10x more powerful than morphine
•  Was thought to be less addictive
•  After many people became addicted, heroin
was outlawed in 1920’s
•  Drug Ads (wings.buffalo.edu)
•  Schedule I
Heroin Availability •  Increasing use in recent years
(DEA, 2015, via Business Insider)
•  Across world, Afghanistan still
considered #1 opium
cultivator (United Nations)
•  DEA reports, through 2015
National Drug Threat
Assessment, that most heroin
in US comes from Mexico
(DEA, 11/4/15)
•  At left, estimates of heroin
production in Mexico, metric
tons (USDOJ)
Heroin Availability •  Change in heroin trafficking – customs border patrol areas, 2014 (DEA, via Business Insider, Map 5) Heroin Acute effects •  Euphoria •  Slow, shallow respiraIon •  Analgesia (pain relief) •  Skin flushing/redness •  Stupor •  Dry mouth •  Nausea/vomiIng Overdose •  Frequently occurs when mixing with other substances •  DAWN: 258,482 emergency department visits, 2011 Heroin: Chronic Effects •  Respiratory problems
•  Collapsed veins from
injection
•  High rate of injection
use leads to
increased disease
transmission risk
•  From Mexico to the
Midwest (The Washington Post, 9/24/15,
~9:00)
Drug Preferences Ebb & Flow with Time (DEA, National Drug Threat Survey, via Business Insider) What to Do: Different Approaches •  Syringe exchanges (in King County, United States) •  Syringe vending machines (right, Puerto Rico) •  Supervised injecIon clinics (e.g. Insite, Vancouver, B.C.) •  Heroin prescripIon Cocaine Cocaine
•  Extracted from
coca plant
•  Meeting Cocaine
Farmers (BBC)
•  Stimulant
•  Schedule II drug
About Cocaine: Some
History
•  In late 1800’s was
prescribed by US
physicians
•  Coca-Cola had
cocaine removed in
early 1900’s
•  Cocaine wine was
available
Image is in the public domain
Cocaine Forms
•  Powdered form
•  Snorted
•  Dissolved in water,
injected
•  Processed in rock form
•  Generally, the faster a drug
can enter the brain, the
more it will be abused
Pathways Into Brain
Cocaine Availability
•  According to DEA, second most commonly used
illegal substance
•  In WA, 604 kg of cocaine were seized in 2005
•  Marijuana: 9873kg, heroin 8.2kg, meth 74.4kg
•  South America is primary production source
•  Other countries involved with transportation
•  UNODC: Global Cocaine Production (Figure 21; p. 66)
•  UNODC: Map 6; page 70
•  Most cocaine enters US via Mexico
Cocaine Availability - Price
•  Price depends on purity (50-70%), form of
cocaine, amount purchased, region, $10-200
(crack vs cocaine, wholesale vs retail)
•  UNODC: Table 9, page 71
Cocaine Effects
§  Increased heart rate, blood pressure, temperature §  Improved mood, well-­‐being §  Short-­‐lived (few minutes to few hours) §  Increased sensaIon of energy §  Chronic users may experience bloody noses (damage to septum), brain adaptaIons to cocaine-­‐induced dopamine effects, compromised immunity §  Brain changes, even arer halIng use (Univ. of Utah; scroll to mouse) §  Lesions and clots in brain blood vessels §  RelaIonship between cogniIon & therapy dropout Cocaine Overdose
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Seizures
Heart attack
Stroke
Kidney failure
Death
In 2010, cocaine-mentioned ER cases: 488,101 Source:
DAWN
Cocaine Withdrawal
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Apathy
Fatigue
Depression/mood swings
Cravings for drug
Not as intense as withdrawal from heroin, alcohol
Post acute withdrawal syndrome (PAWS)
Cocaine Tolerance,
Dependence
•  Tolerance may occur quickly
•  Emphasis appears to be on psychological rather than
physical dependence
•  Rats and self-administration (reinforcement)
How does Ecstasy prove to help people with PTSD? What exactly is Molly? How do you overdose Ecstasy? Molly? MDMA 3,4-­‐METHYLENEDIOXY-­‐N-­‐METHYLAMPHETAMINE MDMA •  Molly, Ecstasy, Thizz
•  Synthetic drug
•  Stimulant and
hallucinogenic
properties
MDMA •  Acute effects on the brain
•  Increased serotonin release
•  Increased dopamine release
•  Increased norepinephrine release
•  Effects will vary since formula is not standardized or regulated
•  Effects will vary based on the synthetic nature of substance
•  MDMA-assisted therapy (Multidisciplinary Association for
Psychedelic Studies, video; 2:30-3:50, 14 subjects, per website)
•  More on MDMA therapy for PTSD (The Verge via YouTube, MAPS
research through 7:00)
MDMA •  Chronic effects are controversial, per Carl Hart, Columbia
University (YouTube)
•  Well-circulated animal studies showing neuron damage
Emergency Department Visits Synthetics are currently popular •  MDMA, bath salts, 2C-I, synthetic cannabis
•  Lower price (think about economy’s influence)
•  Drug popularity changes with time (synthetics were popular in
1970s)
•  Health-related issues will subsequently ebb and flow as drugs move
in and out of favor
•  That acknowledged, some can be devastating: Krokodil (CBS, 2013)
Which drugs are the most popular? (by country here) MUSHROOMS Mushrooms —  Psilocybin/psilocin are two active psyhoacticve substances found in “magic mushrooms” Most from psilocybe genus, couple dozen species —  Taken orally —  Recognized for centuries Probably used in religious rites —  Hallucinogen —  Schedule I Mushrooms •  Dose •  Varies •  Fresh vs dried •  Dried mushrooms typically less potent, but most don’t know how old product is •  User •  Trip desired •  ~1 mushroom or less for new user Mushrooms •  Acute effects: ◦ 
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RelaxaIon Altered percepIon of reality Altered percepIon of Ime Sense of connecIon to others/universe Visual hallucinaIons (images, color, light) PotenIal for anxiety and subsequent panic, heart rate & blood pressure increase —  Chronic effects: ◦  A “bad trip” may trigger fear ◦  Hallucinogens may exacerbate mental illness Mushrooms How do they interact with anIdepressants? —  According to 2006 publicaIon of Australian Pharmacist: —  InformaIon on LSD only (hallucinogens impact serotonin) —  Taking anI-­‐depressants may increase or decrease hallucinogen’s effects —  Avoid stopping SSRI medicaIons —  Flu-­‐like symptoms —  Headache —  Mood changes —  Irony? Treatment invesIgaIons: OCD, depression, smoking cessaIon —  In depression, psilocybin may “turn off” parts of the brain that are overacIve among individuals who are depressed (Discovery, 1/2012) ◦  Johns Hopkins Psilocybin Cancer Project (via YouTube, 0:30-­‐4:03) •  Largely depends on availability •  Carl Hart, Columbia University, on drug abuse (0-­‐2:40) •  Most emergency department (ED) visits: alcohol (DAWN, 2011) •  Half + of 2.5 million ED visits: illicit substances Cocaine – 505,224 CombinaIons – 10,388 Marijuana – 455,668 Inhalants – 10,032 Heroin – 258,482 Unclassified hallucinogens – 8,043 Amphetamine/meth. – 159,840 LSD – 4,819 PCP – 75,538 GHB – 2,406 SyntheIc cannabinoids – 28,531 Ketamine – 1,550 MDMA – 22,498 •  “Why do we focus more on jailing addicts than recovery opIons? What helps people quit these substances? Are there any posiIve uses that have been proven and could be used under a doctor’s watch?” •  History, government, culture •  Cocaine, opium available in 1800s, early 1900s •  Harrison Act in early 1900s regulated these substances – taxing •  Those who did not pay the tax were in legal trouble (tax evasion) •  Physicians were unable to prescribe narcoIcs to dependent paIents • 
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Alcohol prohibited (prohibiIon later appealed) Heroin Act, NarcoIc Drug Import & Export Act 1970 Drug Abuse PrevenIon & Control Act NIDA Principles of EffecIve Treatment Student Question (continued) •  WHO ATLAS on Substance Abuse (2010; 147 countries) •  Alcohol main problem •  Other drug issue is cocaine •  39 deaths per 100,000 (35 due to alcohol) •  Not enough government resources •  Africa – treatment mainly funded by out of pocket $ •  Beds: 1.7 per 100,000 •  Many other issues METHAMPHETAMINE Methamphetamine •  Famous/notorious for laboratory production, short-term dopamine
effects & long-term effects
•  Stimulant (blood pressure, heart rate, alertness)
•  DEA: Schedule II substance (Desoxyn: ADD, narcolepsy, weight
control)
Methamphetamine acute effects §  Intense high/euphoria ◦  May last up to 12 hours (longer than cocaine) ◦  Meth Inside and Out video describing effects § 
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EnergeIc, talkaIve, excitable Insomnia Increased heart rate, blood pressure SweaIng Dry mouth Jaw clenching Nausea, vomiIng Comparison: meth vs cocaine,
Brookhaven NaIonal Laboratory, 2008 Methamphetamine chronic effects —  Chronic users may experience hallucinations, rage, paranoia, heart “meth mouth;” damage to dopamine-­‐, serotonin-­‐containing nerve cells ◦  Crank Bugs (Meth Project) ◦  Meth Mouth (Meth Project) ◦  Ashley’s Story (Meth Project) ◦  Research supports both brain damage as well as lack of brain damage Methamphetamine
Chronic Effects
Before & After Photos
Before and Arer Photos 3 Years and 5 months after starting meth
Meth Awareness Prevention Project: hZp://www.mappsd.org/Faces%20of%20Meth.htm
Before and Arer 17 months after starting meth
Meth Awareness Prevention Project: hZp://www.mappsd.org/Faces%20of%20Meth.htm Before and Arer 3 months later
Meth Awareness Prevention Project: hZp://www.mappsd.org/Faces%20of%20Meth.htm •  Depends on availability, mode, reasons for use •  2008 study by Hser et. Al.: •  Researchers examined data from five studies •  Assessed 10-­‐year drug behaviors among 629 heroin users, 694 cocaine users, 474 meth users •  Heroin users: used 13-­‐18 days per month •  Cocaine: used 8-­‐11 days per month •  Meth: 12 days per month •  Groups – “consistently high use,” “increasing use,” “decreasing use,” “moderate use,” “low use” •  Heroin over-­‐represented in “consistently high use,” under-­‐
represented in “low use” •  2011 study by Novak et. Al. – injecIon users were more likely to abuse and become dependent