Transcript 'Rave' drugs / OTCs / Drugs in Sport

“Rave” Drugs
OTCs
Drugs in Sport
Pearl Isaac & Anne Kalvik
Learning Objectives
• To become aware of some substances used
on the rave/club scene and their risks
• To recognize OTC products that are abused
and their effects
• To develop an understanding of substances
abused in sports and their consequences
“Rave” Scene
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is it over?
PLUR
clubs, parties
younger users
older users & different patterns of use
raves & alcohol, cannabis use (why not?)
Ontario School Drug Use Survey
2003
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alcohol 66.2%
cannabis 29.6%
tobacco 19.2%
hallucinogens 10%
stimulants 5.8%
solvents 6.1%
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LSD 2.9%
methamphetamine 3.3%
methylphenidate 2.9%
MDMA 4.1%
cocaine 4.8%
ketamine 2.2%
heroin 1.4%
GHB 0.7%
Drugs Used on the “Rave” Scene
(or by adolescents)
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LSD
Ecstasy (MDMA)
Herbal Ecstasy
Ketamine (“Special K”)
Methamphetamine (“Crystal Meth”)
Psilocybin (Magic Mushrooms)
GHB
Rohypnol?
MDMA (Ecstasy)
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Ecstasy, e, XTC, X , Adam, MDM, hug drug
branding (logos)
price
doses
purity & strength
amphetamine derivative with hallucinogenic
properties, but...
MDMA: Effects
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euphoria, energy
increased self-esteem, confidence
increased sociability, benevolence
visual distortions (minimal)
some anxiety, panic, confusion
paranoia
“hangover”
seizures, death
MDMA: Acute Effects
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grinding of teeth (jaw pain)
sweating, hyperthermia (rhabdomyolysis possible)
high BP, increased heart rate
decreased appetite
insomnia
headache, stiffness of back and legs
arrhythmias, stroke, MI
MDMA: Long-term Effects
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weight loss
psychiatric issues: depression, memory loss
flashbacks
hepatotoxicity
neurotoxicity
• MDMA plus Viagra =
MDMA and Harm Reduction
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venues
volunteers, police
fluids
loose clothing
DI questions
other? SSRI’s??
useful?
Ketamine “Special K”
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anesthetic related to PCP
diverted from hospitals and vetrinarians
antagonist at NMDA receptor
“dissociation”
impaired thought processes & memory
confusion, dizziness, slurred speech
hallucinations, flashbacks
aspiration, respiratory depression
“Date-Rape” Drugs
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GHB
Rohypnol
Ketamine
Benzodiazepines
Alcohol
GHB
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Looks like water
Liquid X, Liquid Ecstasy, GBH, Easy Lay
Narrow therapeutic window
CNS depressant
date rape context
euphoria
dizziness, drowsiness, sedation
GHB: Overdose
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nausea & vomiting
loss of consciousness
amnesia
coma
seizures
respiratory arrest
GHB
• dependence
• withdrawal
GHB
Precursors
(GBL, Blue Nitro)
Rohypnol (flunitrazepam)
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“roofies”
availability
how abused
change in formulation
police seizures?
other benzodiazepines
alcohol
Jessica
• 16 years old
• goes to raves when she can
• at raves, she uses “e”, “k” and “crystal
meth”
• reports feeling depressed over past 6
months
• denies suicidal ideation or intent
Jessica
issues?
OTCs
• why abused?
• patterns of abuse (chronic vs. recreational)
OTCs that are Abused
• codeine preparations (e.g. Tylenol #1)
• dimenhydrinate (e.g. Gravol)
• sleep aids with diphenhydramine
(e.g. Sleep-Eze D, Nytol)
• dextromethorphan
• caffeine
OTCs that are Abused
• cold preparations
– with antihistamines
– with stimulants/decongestants: ephedrine,
pseudoephedrine (e.g. Sudafed)
– with alcohol (Nyquil “all of the above” plus
dextromethorphan)
OTCs that are Abused
• alcohol-containing preparations
(including mouthwashes, aftershaves)
• herbals
• solvents
• laxatives
• ipecac
Dimenhydrinate / Diphenhydramine
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antinauseants, sleep aids
teenagers for high
hallucinations
toxicity –seizures, psychosis, arrhythmias
chronic use of high doses
psychiatric patients
tolerance, dependence, withdrawal
Dextromethorphan
• In 50% of cough and cold products (e.g.
Robitussin DM, Nyquil, Contac Cold&Fever,
Benylin DM etc.)
• DXM, Robo, DEX
• high doses for LSD-like high
• toxicity: hypertension, seizures, hallucinations,
coma
• chronic use - psychiatric issues
OTC Stimulants
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CAFFEINE
“Wake Ups”, an ingredient in many OTC’s
sold as energizer, to stay awake
herbal (Guarna, Herbal Ecstacy)
high doses associated with anxiety, mood,
sleep disorders
• dependence & withdrawal
OTC Stimulants
• Street Stimulants
– Caffeine, Ephedrine, Phenylpropanolamine
• Pseudoephedrine (e.g. Sudafed)/Ephedrine
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weight loss, sports, energy
precursor for methamphetamine
new legislation
herbals (e.g. ephedra herb, Ma Huang)
toxicity: stroke, arrhythmias, MI
OTC Abuse
What can you do in the pharmacy?
Drugs Used in Sports
Anabolic steroids
(“roids”, “juice”)
Other Drugs Used in Sports
• Stimulants
– amphetamine, caffeine,
pseudoephedrine
– clenbuterol
– modafinal
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diuretics
laxatives
beta-blockers
pain relievers
• urine tampering
– probenecid
• hormones
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HCG, HGH, EPO
thyroxine
insulin, OCs
mifespristone
• GHB
• antidepressants
Other Drugs/Techniques Used by
Athletes
• local anesthetics,
corticosteroids
• nutritional supplements
(e.g. creatine)
• acetylcholine
• Deprenyl
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cannabis
alcohol
tamoxifen
clomiphene
blood-doping
Drugs Used in Sports
• ergogenic
• therapeutic
• recreational
Anabolic Steroids
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androgenic (masculinizing)
anabolic (tissue building)
human
veterinary
Medical Uses for Anabolic Steroids
• testosterone deficiency in males (including
delayed puberty
• chronic tissue wasting conditions
• anemia
• osteoporosis
• others
Reasons Why Athletes Use
Anabolic Steroids
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more lean mass & less body fat
increased endurance & strength
decreased recovery time
increased aggression & ability to compete
faster healing time from injuries
winning “edge”
better appearance
Reasons for Others to Abuse
Anabolic Steroids
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enhance physical appearance
improve physical condition
personal enjoyment (“high”)
increased self-esteem
personality disorders
coach/parent/scholarship pressure
employment (e.g. law enforcement)
withdrawal symptoms?
Patterns of Use
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doses often 100x higher than for medical use
“cycling”
“pyramiding”
“stacking”
Some Injectable Steroids
• nandrolone (Deca-Durabolin)
• stanozolol (Winstrol V)
• testosterone (Depo-Testosterone,
Delatestryl, etc.)
Tetrahydrogestrinone
(THG)
Some Oral Steroids
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danazol (Cyclomen)
methyltestosterone (Metandren)
oxandrolone (Anavar)
stanozolol (Winstrol)
testosterone undecanoate (Andriol)
Adverse Effects of Anabolic
Steroids
• endocrine
– testicular atrophy, impotence, acne,
gynecomastia, masculinization etc.
• liver
– jaundice, hepatitis, cancer etc.
• musculoskeletal
– premature closure of long bones (adolescents)
– tendon ruptures
Adverse Effects of Anabolic
Steroids
• cardiovascular
– MI, enlarged heart, clots, increased LDL,
decreased HDL, fluid retention
• GI
– nausea, vomiting, irritation
• behavioural
– “roid rage”, mood swings, anxiety, paranoia,
insomnia, psychosis, changes in libido, etc.
Indirect Adverse Effects of Steroids
• infections (hepatitis, HIV)
– from needle sharing and improper technique
• abscesses & clots
– from improper injection technique, repeated
injections at same site, contaminants
• consequences of “roid rage”
Tolerance, Dependence & Withdrawal
• no evidence of tolerance
• physical dependence and withdrawal (may
simulate opioid withdrawal) have been
reported
• psychological dependence
? euphoria ? reward mechanism in brain
? natural opioids
• not included in DSM-IV
Treatment
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psychosocial counselling
stop smoking
nutritional counselling
? pharmacological treatment
? prevention strategies
? harm reduction