Transcript Commonly Abused Drugs - Isfahan University of Medical Sciences

Commonly Abused
Drugs
and
Addictive Substances
‫دکتر فردین مردانی‬
‫سازمان پزشکی قانونی کشور‬
[email protected]
Addictive Substances
Addictive substances can affect the brain in
different ways.
• Stimulants: make a person feel more
energetic
• Depressants: bring a feeling of relaxation.
• Hallucinogens: change the way someone
experiences reality.
• Some drugs fall into more than one
classification.
Legal Addictive Substances
• Caffeine: Coffee, tea, soda, sports drinks. Coffee has roughly twice as
much caffeine as other sources. Moderate consumption is three cups or
less of coffee per day. Ten cups is considered excessive and results in
nervousness, sleeping difficulty, increased heartbeat, headaches, anxiety
and nausea.
• Nicotine: Cigarettes, cigars, nicotine patches. Both coffee and nicotine
are stimulants that not only increase dopamine levels, but boost
adrenaline. Increased adrenaline raises the user's heart rate and blood
pressure, and interferes with the release of insulin by the pancreas,
leading to elevated blood sugar. Nicotine can also act as a depressant.
• Alcohol: Wine, beer, liquor. Alcohol is a depressant that affect neurons in
the central nervous system which leads to relaxation, drowsiness, lack of
inhibition, sleep, coma and even death. Addiction to alcohol is called
alcoholism.
• Inhalants: Aerosols, solvents, gases and nitrates. Products range from
paint thinners to hair spray to propane tanks, and inhalation results in a
high similar to that of alcohol. Even one-time use of inhalants can kill or
cause heart failure.
Controlled Addictive Substances
• available by prescription only.
• Amphetamines: Stimulants that boost alertness and concentration.
Adderall, dexedrene and other drugs are normally prescribed for
treatment of ADHD. Abuse occurs when they're taken in quantities other
than those prescribed or by someone other than the intended patient.
• Sedative-hypnotic drugs: Benzodiazepines, Xanax, Valium,
barbiturates, Seconol, phenobarbital. Benzodiazepines are also known as
depressant because they depress brain activity. These drugs are
prescribed for insomnia, anxiety, seizures and symptoms of bipolar and
manic depressive disorder. Even a small overdose of barbiturates used for
anesthesia can result in coma, respiratory distress or death.
• Opioids: Heroin, morphine, oxycodone, codeine and other narcotic pain
relievers are very useful when prescribed. They interfere with the way
pain messages are sent to the brain and how they brain receives them.
Heroin, an illegal drug processed from the poppy-plant product, morphine,
is highly addictive. Can be injected, smoked or snorted.
Illegal Addictive Substances
• Illegal in all cases, but can still be widely available.
• Cannabis: marijuana, grass, pot, hashish. The most commonly used illegal drug
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in the U.S., it relaxes the user and concentrated doses may bring euphoria,
hallucinations or paranoia. Long-term use can be addictive for some people.
Prescribed legally in some states for medical use because it curbs nausea.
Cocaine: Coke, crack. Brings users a strong sense of euphoria and energy before
leading to agitation, depression and paranoia. A white powder, cocaine comes
from the coco plant and is the second most-used illegal drug in America. Can be
snorted, sniffed, injected or smoked (crack).
Hallucinogens: LSD, ecstasy. Changes the way users perceive time, motion,
colors, sound and their own thoughts. Disruption of normal thinking can lead to
dangerous behavior.
Phencyclidine(PCP):Angel dust. Anesthetic approved only for animal use. A
hallucinogen that has sedative qualities producing a dissociative state, or out-ofbody experience, along with a euphoric rush. Can be sprinkled on marijuana or
other substances and smoked, snorted or taken in pill form. Users can become
violent or suicidal, and experience muscle contractions so severe they can lead to
bone fractures.
Cannabis & Hashish
Cannabis & Hashish
 Cannabis is a collective term referring to the bioactive
substances from Cannabis sativa.
 The C. sativa plant contains a group of more than 60
chemicals called cannabinoids.
 The major cannabinoids are cannabinol, cannabidiol,
and tetrahydrocannabinol. The principal psychoactive
cannabinoid is ~9-tetrahydrocannabinol (THC).
 Marijuana is the common name for a mixture of dried
leaves and flowers of the C. sativa plant.
 Hashish and hashish oil are the pressed resin and the
oil expressed from the pressed resin, respectively.
History
• Cannabis has been used for more than 4000
years. The earliest documentation of the
therapeutic use of marijuana is the 4t century
BC in China.
• Cannabis use spread from China to India to
North Africa, reaching Europe around AD 500.
Medical Conditions Proposed for
Cannabinoid Use
dronabinol and nabilone
• Anorexia-cachexia
syndrome secondary to HIV
infection'
• Anxiety
• Asthma
• Depression
• Epilepsy
• Glaucoma
• Head injury
• Insomnia
• Migraine headaches
• Multiple sclerosis
• Muscle spasticity and
spasms
• Nausea and vomiting
(resistant)
• Neurologic disorders
• Pain
• Parkinson disease
• Tourette syndrome
Cannabinoids pharmacodynamics
• Before the 1980s, it was often speculated that
cannabinoids produced their physiological and
behavioral effects via nonspecific interaction
with cell membranes, instead of interacting
with specific membrane-bound receptors. The
discovery of the first cannabinoid receptors in
the 1980s helped to resolve this debate. At
present, there are two known types of
cannabinoid receptors, termed CB1 and
CB2,with mounting evidence of more.
DEA Schedule
Schedule I Controlled Substances: Substances in
this schedule have no currently accepted medical
use in the United States, a lack of accepted safety
for use under medical supervision, and a high
potential for abuse.
• Examples: heroin, lysergic acid diethylamide
(LSD), marijuana (cannabis), peyote,
methaqualone, and
3,4methylenedioxymethamphetamine
("Ecstasy").
DEA Schedule
 Schedule II/IIN Controlled Substances (2/2N): Substances
in this schedule have a high potential for abuse which may
lead to severe psychological or physical dependence.
• Examples of Schedule II narcotics: hydromorphone
(Dilaudid®), methadone (Dolophine®), meperidine
(Demerol®), oxycodone (OxyContin®, Percocet®), and
fentanyl (Sublimaze®, Duragesic®). Other Schedule II
narcotics include: morphine, opium, and codeine.
• Examples of Schedule IIN stimulants: amphetamine
(Dexedrine®, Adderall®), methamphetamine (Desoxyn®),
and methylphenidate (Ritalin®).
• Other Schedule II substances: amobarbital, glutethimide,
and pentobarbital.
DEA Schedule
 Schedule III/IIIN Controlled Substances (3/3N): Substances
in this schedule have a potential for abuse less than
substances in Schedules I or II and abuse may lead to
moderate or low physical dependence or high
psychological dependence.
• Examples of Schedule III narcotics: combination products
containing less than 15 milligrams of hydrocodone per
dosage unit (Vicodin®), products containing not more than
90 milligrams of codeine per dosage unit (Tylenol with
Codeine®), and buprenorphine (Suboxone®).
• Examples of Schedule IIIN non-narcotics: benzphetamine
(Didrex®), phendimetrazine, ketamine, and anabolic
steroids such as Depo®-Testosterone.
DEA Schedule
Schedule IV Controlled Substances
• Substances in this schedule have a low potential
for abuse relative to substances in Schedule III.
• Examples of Schedule IV substances: alprazolam
(Xanax®), carisoprodol (Soma®), clonazepam
(Klonopin®), clorazepate (Tranxene®), diazepam
(Valium®), lorazepam (Ativan®), midazolam
(Versed®), temazepam (Restoril®), and triazolam
(Halcion®).
DEA Schedule
Schedule V Controlled Substances
• Substances in this schedule have a low potential
for abuse relative to substances listed in Schedule
IV and consist primarily of preparations
containing limited quantities of certain narcotics.
• Examples of Schedule V substances: cough
preparations containing not more than 200
milligrams of codeine per 100 milliliters or per
100 grams (Robitussin AC®, Phenergan with
Codeine®), and ezogabine.
Cannabinoids
Acute Toxicity
 decreases in coordination, muscle strength, and hand
steadiness. Lethargy, sedation, postural hypotension,
inability to concentrate, decreased psychomotor
activity, slurred speech, and slow reaction time.
- Life-threatening ventricular tachycardia (200 beats/min)
has been reported.
- acute cardiovascular deaths(?)
- risk of myocardial infarction is increased five times over
baseline in the 60 minutes after marijuana use.
- It is not known to cause death via direct drug toxicity.
Cannabinoids
Acute Toxicity
In children:
- 250 to 1000 mg of hashish resulted in
obtundation in 30 to 75 minutes.
- Less commonly:
apnea, cyanosis, bradycardia, hypotonia, and
opisthotonus.
Stimulants
Stimulants
• Health Risks - Weight loss, insomnia; cardiac
or cardiovascular complications; stroke;
seizures; addiction
• Also, for cocaine – Nasal damage from
snorting
• Also, for methamphetamine – Severe dental
problems
PHARMACOLOGY
(Cocain)
 inhibits the synaptic reuptake of epinephrine,
norepinephrine, dopamine, and serotonin
 stimulates the presynaptic release of
norepinephrine, leading to increased
sympathomimetic activity.
 is a powerful vasoconstrictor and may
enhance in situ thrombus formation and
platelet aggregation.
PHARMACOLOGY
(Cocain)
Cocaine + Ethanol = Cocaethylene
(more toxic than cocaine itself, has a longer
half-life than cocaine)
Acute Toxicity
(Cocain)
sudden death by:
- stroke
- seizure
- cardiac dysrhythmia
- acute coronary syndrome
may cause excited(agitated) delirium
PHARMACOLOGY
(Methamphetamine)
 promote increased norepinephrine release
into the synaptic cleft, which then overflows
into the circulation, resulting in
sympathomimetic effects.
 also promote the release of dopamine and
serotonin
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Amphetamine increases the concentration of dopamine in the synaptic cleft in 3 ways:
(1) bind to the pre-synaptic membrane of dopaminergic neurones and induce the release of dopamine
from the nerve terminal
(2) interact with dopamine containing synaptic vesicles, releasing free dopamine into the nerve terminal
(3) bind to the dopamine re-uptake transporter, causing it to act in reverse and transport free dopamine
out of the nerve terminal. Amphetamine can also cause an increased release of noradrenaline into the
synaptic cleft.
Acute Toxicity
(Methamphetamine)
 sudden death by
- stroke
- seizure
- cardiac dysrhythmia
 excited delirium
 hyperthermia
 tachycardia
 hypertension
 rhabdomyolysis
 disseminated intravascular
coagulation
Stimulants Pharmacokinetics
Duration of Action
• Cocaine - oral onset in 2-3 min with peak in 1520 min
– duration less than 1 hr
– IV or smoked - onset in 10 sec & peak in 510 min
• Amphetamine - oral effects after 30 min & peak
in 2-3 hrs
– duration 10-12 hrs
– IV or smoked - onset 5 min & lasts up to 7 hrs
designer amphetamine?
• The term ‘designer amphetamine’ is often
used to describe synthetic chemicals that are
derived from amphetamine or
methamphetamine. Designer amphetamines,
like other designer drugs, are often created to
avoid regulation by existing drug laws.
Methamphetamine
‫‪Amphetamine type stimulants‬‬
‫ترکیبات موسوم به «شیشه»‬
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‫سردسته آنها آمفتامین میباشد وایزومر‪ D‬آن اثرقوی داشته ایزومر‪ L‬اثر کمتری دارد‬
‫محرک قوی ‪ )psychostimulants(CNS‬بوده با ترشح دوپامین و نوراپی نفرین سبب‬
‫سرخوشی ‪ euphoria‬شده میل جنسی را باال میبرد‬
‫هشیاری ذهنی را افزایش داده انرژی زا محسوب میشود‬
‫ابتدا در سال ‪ 1887‬سنتز شد ولی تا اواخر دهه ‪ 1920‬اثرات دارویی آن مشخص نشده بود‬
‫ابتداجانشینی برای افدرین بود ودر دکونژستانت بینی استفاده میشد سپس اثرات الغر کنندگی‬
‫و سرکوب اشتها در آن مشخص شد‬
‫درجنگ جهانی دوم هم آلمانها و هم متفقین بعنوان ضدخستگی وجهت ایجاد هشیاری‬
‫استفاده میشد‬
‫در ژاپن حتی مصرف وسیعی بین کارگران ساده و نظامیان داشت‬
‫طوالنی اثرتر از کوکائین است(تا ده برابر)‬
‫مصرف آن منجر به وابستگی شده اعتیاد آور است‬
‫متامفتامین همان آمفتامین متیله شده بوده اثر تحریکی قویتری روی مغزدارد‬
‫متامفتامین در ادراربیشتربصورت آمفتامین و متابولیتها دفع میگردد‬
‫‪Amphetamine type stimulants‬‬
‫ترکیبات موسوم به «شیشه»‬
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‫این ترکیبات پس از حشیش که پرمصرفترین ماده‬
‫موردسوءمصرف درجهان است در رتبه دوم مصرف جهانی‬
‫قرار دارد‪.‬رتبه سوم ترکیبات اپیوئید وباالخره کوکائین است(‬
‫درایران به ترتیب تریاک ‪،%40‬کراک وهروئین ‪ %30‬و‬
‫سپس شیشه ‪ %20‬قراردارد)‬
‫معموال منظور از کریستال متامفتامین است ولی اسامی مختلفی‬
‫مثل آیس‪،‬شیشه و‪..‬دارد‬
‫شکل و رنگهای مختلفی داشته تزریق وریدی‪،‬استنشاقی‬
‫‪،‬ازطریق مقعد و خوراکی دارد‬
‫از احیای افدرین و پسودوافدرین بسادگی آمفتامین ساخته‬
‫میشود‪.‬‬
Street Names
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Meth
Crystal
Crystal meth
Glass
Shabu
Shaboo
Ice
Go fast
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Speed
Snap
Tina
Crank
Shabs
Shard
Batu
Locations of amphetamines manufacture and main trafficking routes
Sources: UNODC, Annual Reports Questionnaire Data, UNODC, Individual Drug Seizure Database, other government sources.
Club Drugs
effects
• Acute Effects, for MDMA - Mild hallucinogenic effects;
increased tactile sensitivity; empathic feelings; lowered
inhibition; anxiety; chills; sweating; teeth clenching; muscle
cramping
• Also, for Flunitrazepam - Sedation; muscle relaxation;
confusion; memory loss; dizziness; impaired coordination
• Also, for GHB - Drowsiness; nausea; headache;
disorientation; loss of coordination; memory loss
• Health Risks, for MDMA - Sleep disturbances; depression;
impaired memory; hyperthermia; addiction
• Also, for Flunitrazepam - Addiction
• Also, for GHB - Unconsciousness; seizures; coma
LSD decorated paper
Hallucinogens
effects
• Acute Effects - Altered states of perception and feeling;
hallucinations; nausea
• Also, for LSD - Increased body temperature, heart rate,
blood pressure; loss of appetite; sweating; sleeplessness;
numbness, dizziness, weakness, tremors; impulsive
behavior; rapid shifts in emotion
• Also, for Mescaline - Increased body temperature, heart
rate, blood pressure; loss of appetite; sweating;
sleeplessness; numbness, dizziness, weakness, tremors;
impulsive behavior; rapid shifts in emotion
• Also, for Psilocybin - Nervousness; paranoia; panic
• Health Risks, for LSD - Flashbacks, Hallucinogen Persisting
Perception Disorder
Dissociative Drugs
effects
• Acute Effects - Feelings of being separate from one’s
body and environment; impaired motor function
• Also, for ketamine - Analgesia; impaired memory;
delirium; respiratory depression and arrest; death
• Also, for PCP and analogs - Analgesia; psychosis;
aggression; violence; slurred speech; loss of
coordination; hallucinations
• Also, for DXM - Euphoria; slurred speech; confusion;
dizziness; distorted visual perceptions
• Health Risks - Anxiety; tremors; numbness; memory
loss; nausea
• Acute Effects, for Anabolic steroids - No intoxication effects
• Also, for Inhalants (varies by chemical) - Stimulation; loss of
inhibition; headache; nausea or vomiting; slurred speech; loss of
motor coordination; wheezing
• Health Risks, for Anabolic steroids - Hypertension; blood clotting
and cholesterol changes; liver cysts; hostility and aggression; acne;
in adolescents—premature stoppage of growth; in males—prostate
cancer, reduced sperm production, shrunken testicles, breast
enlargement; in females—menstrual irregularities, development of
beard and other masculine characteristics
• Also, for Inhalants - Cramps; muscle weakness; depression;
memory impairment; damage to cardiovascular and nervous
systems; unconsciousness; sudden death