Transcript SUBSTANCE ABUSE PHARMACOLOGY

SUBSTANCE ABUSE
PHARMACOLOGY
David R. Turpin
MA, LCAS, CCS,
SLANG TERMS
u Lovers
Speed
u Smack
Sinse
u 8-Ball
u Roach
u Shrooms
Roofies
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Blunt
Rock
Zig-Zag
O.C.
Uppers
Oz.
Downers
Addiction is a “BIO-PSYCHO-SOCIAL”
process.
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BIOLOGICAL – Alcohol and other drugs alter the chemistry of the
brain and body functioning. Continued use can cause damage or injury
to vital organs. (?)
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PSYCHOLOGICAL – Altered brain chemistry affects the brain’s
ability to think, alters feeling states, and impacts the personality of the
user. (?)
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SOCIOLOGICAL – Behavioral interactions with family and social
contacts are altered and/or misinterpreted by the user and those
observing the behavior. (?)
There has been some “debate” re: “which type of addiction is worse”
Whatcha think?
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BIOCHEMICAL
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Biologically Alcohol & other Drugs (interfere with/alter
neurotransmitters), transmitters that allow neurons to communicate
with each other, tell us/body what to do, how to react, what to
experience etc.
These things all happen in the “primitive brain (survival section)
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The four major neurons addressed in addictions/abuse are:
1. DOPAMINE (governs- reward; stimulation) (Cocaine, Methamphetamines)
u 2. SEROTONIN (governs- mood; sleep, appetite, perceptions etc. (THC,
Hallucinogens)
u 3. GABA ( governs- sedative; anti-anxiety) (Benzodiazepines)
u 4. ENDORPHINS (governs pain) (Opiates/Opioids)
When most addictive drugs enter they brain they give corresponding messages (more
of this less of that)
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Defining Terminology
“Psychoactive” – substances that can pass the Blood Brain Barrier and
become active in the brain & central nervous system, with effects on
mood, cognition, psychomotor movement, and personality.
“Drug” – any chemical entity or mixture of entities that alters biological
(body & brain) function or structure when administered.
(We often say “alcohol & drugs” which suggests a difference. It is
more correct to say “alcohol and other drugs” as alcohol is also a
“drug”.)
Four Principles of Psychoactive Drug Use
1.
Drugs, per se, are not good or bad. It is the resulting behavior
associated with the use /abuse that causes judgment by the observer
about the user. “Good & Bad”
2.
Every drug has multiple effects. Not just the subjective effect but
effects on the brain/body functions.
3.
4.
Both the extent and the quality of a drug’s effects depend on the
amount taken (dosage), and potency. examples:
The effect of any psychoactive drug depends on the user’s history and
expectations. examples:
(Ray & Kiser, 2002)
How Drugs Enter the Body
Orally /Sublingual (drinking, swallowing , etc.)
When someone swallows a drug, it passes through the esophagus and
stomach to the small intestine where it is absorbed into the tiny blood
vessels lining the walls. It usually takes approx. 20-30 minutes for full
reaction time.
Snorting (sniffing)
When drugs are taken this way they are absorbed by the tiny blood
vessels in the mucous membranes lining the nasal passages. It takes
approx. 3-5 minutes for full reaction
How Drugs Enter The Body
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Inhaling (smoking, huffing)
Smokes a “joint” or inhales “ heroin/crack”, the vaporized drug enters
the lungs and is “rapidly” absorbed thru tiny blood vessels lining the
air sacs of the bronchi. From the lungs, the “drug laden” blood is
pumped back to the heart and then directly to the body and brain thus
acting more quickly than any other methods of use. (7-10 seconds for
full reaction time).
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Injection (IV or IM- mainlining or skin popping)
Injecting with needles, either into the bloodstream, or under the skin.
IV takes approx. 15-30 seconds, where IM takes approx. 3-5 minutes
for full reaction time.
Anally (suppositories)
How Long Drug Use/Abuse
100 yrs ?
500 yrs ?
1000 yrs?
2000 yrs ?
Ever since the beginning of written history:
Cave Walls, Hieroglyphics, Bible, Torah, Koran, Dead Sea
Scrolls:
All indicated the use/abuse of mind altering
mood altering substances
CATEGORIES OF DRUGS
OF ABUSE
STIMULANTS
Depressants
Hallucinogens
Narcotics
NARCOTICS
OPIUM
OPIATES
OPIOIDS
MORPHINE
HEROIN
CODEINE
DILAUDID
VICODIN
METHADONE
OXYCODONE
(oxycontin)
Primarily Physically Addicting
NARCOTICS/OPIUM
Has been around since the beginning of time, the first written account
of it’s use dates back to approx. 4,000 B.C.
Homer wrote in the Odyssey: When Helen said; “Into the bowl in
which their wine was mixed, she slipped a drug that had the power of
robbing grief and anger of their sting and banishing all painful
memories. No one who swallowed this in their wine could shed a
single tear that day even for the death of their mother or father, or if
they put his own son to the sword…”
NARCOTICS/OPIUM
The ancient “Arabs” both used and organized the trade of Opium,
(Why ?)
“The Holy Prophet had forbidden the use of Alcohol; not Hashish or
Opium.”
Some “ancient” descriptions of Opium include: The Hand of GOD,
The Destroyer of Grief, Fruit of the Gods, The Milk of Paradise!
NARCOTICS/OPIUM
It is easy to see why such a “potentially” deadly drug was sought after.
The ancient Greek physicians said of OPIUM;
“it resists poison and venomous bites, cures chronic headache,
vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice,
asthma, coughs of all kinds, spitting of blood, tightness of breath,
colic, jaundice, urinary complications, fever, dropsies , leprosies, and
the trouble to which women are subject, melancholy and all
pestilences”.
OPIUM is the “Granddaddy” of all Narcotics. All Narcotics come
from or are chemically altered to mimic the properties of Opium.
How big do you think the “Opium” problem is today? (Why)
NARCOTICS
Used “commonly” to control moderate-severe acute pain.
Can cause physiological tolerance (more to get same effect).
Can cause physical dependence (discomfort if abruptly stopped)
QUIZ
1st popularized in the US, not as a devastating/disgusting or
dangerous drug we have come to know, but a legitimate,
“researched "and widely dispensed medication which had
the following attributes: more powerful then any
commonly used pain drug, cheaper to manufacture, will
last “forever” and causes no lingering cravings.
Introduced When, by Who and Drug Name
1888
The Bayer Pharmaceutical Company
The name of this “new” miracle medicine was
“Heroin”
HEROIN
HEROIN as well as various prescription analgesics, all function by
binding with naturally occurring opiate receptors in the CNS.
HEROIN, known primarily as a “street drug” is typically snorted or
injected, (IV or IM ? Where and how ?). The duration of “sensation”
is usually 2-4 hours, this causes users to have to dose multiple times
per day.
It can also be smoked (which we see increasing due to potency). This
is called (?)
All Narcotics are “cross tolerant ” which means ? (examples)
NARCOTICS
Pain Pills
A number of “recent” patients/consumers/clients present addicted to or
for use/abuse of prescription Narcotics. All symptoms, cautions and
treatments previously mentioned for the “street” narcotics remain.
However, patients may present somewhat “differently” (examples).
Popular types of “prescribed” pain meds: codeine, dilaudid, fentanyl,
demerol, methadone, oxycontin, ultram, percocet, vicodin, darvon,
darvocet, lortab, etc., etc
NARCOTICS
With narcotic and opioid medications, there is a potential for the
development of tolerance and dependence as well as a great potential
for abuse and “severe” withdrawal reactions (why).
Are there any “considerations” that should be taken when a
“prescription abuser” request/enters treatment??
Because Narcotics are so powerful, withdrawal will cause DEATH
(True/False)
NARCOTICS/METHADONE
Methadone
Is it “villain or savior”
What is it (?)
Discovered in 1937, by German Scientist as an “alternative” pain
reliever (Dolophine). “Rediscovered” in 1960 by Drs. Doyle &
Nyswynder as a “possible cure” for Narcotic Addiction. Their
research was supported both nationally and locally to address the
“Dreaded Scourge of America” HEROIN Addiction”. Realizing
(already knowing), no “cure” for addictions they began to investigate
the potential “craving blockage” aspects of this drug. They introduced
the drug (Methadone) as a “medication” to assist in the tx. of narcotic
addiction.
Narcotics/Methadone
Methadone “quickly” became the demon drug, “treating addiction to
one drug with another”, “it’s worst than heroin,” “they stay addicts
for life” “it gets into the bones etc, etc”. (True or False)
Methadone can be and is an effective “Medication Assisted Treatment”
in conjunction with other therapies. (?)
Methadone patients can/do live productive “healthy” lives.. However,
it can and is abused like all “psychoactive” drugs and has a potential
to be lethal, particularly when “mixed” with other drugs.
OXYCONTIN
Oxy is a prescription painkiller used for mild to moderate pain control,
chronic pain, and the treatment of cancer pain. The active ingredient is
oxycodone. (effects similar to that of Heroin) Is time-released and
contains much larger amounts of oxycodone than other painkillers
(vicodin, percocet, percodan). Tablet form last for approx 12 hours.
Used by swallowing tablets, crushing and snorting or injection. When
snorted or injected effects sooner. Abusers are attracted because effects
are very similar to HEROIN, and much cheaper (40 milligram tablet
cost about $4, but often sells on the streets for $20-$40) also obtained
by prescription for pain.
LSD (acid, window pane)
PSILOCYBIN (shrooms)
MDMA (ecstasy)
MESCALINE (mesc, buttons)
PCP (angel dust, blast)
PEYOTE
STP, MDA (love drugs)
Primarily Psychologically Addicting
Marijuana
CLUB DRUGS
Ecstasy (methylenedioxymethamphetamine)
GHB (Gamma-hydroxybutyrate)
Rohypnol (Flunitrazepam – related to Valium, Xanax)
Ketamine ( anesthetic for humans and animals,
injected, smoked)
Methamphetamine
LSD (Lysergic Acid Diethylamide 25)
CLUB DRUGS
Ecstasy Deve. In 1900 as appetite suppressant. Has effects of Stimulant and
Hallucinogen, effects last approx 3-6hrs. Usual side effects (confusion,
depression, sleep problems, anxiety, paranoia, dehydration, hypertension and
heart or kidney failure) can last up to 1 mo. Significant increase in BP, heart
rate, increased sense of alertness and energy.
GHB Sometimes used as Muscle Builder, and to enhance sexual performance.
GHB is a central nervous system depressant that can relax or sedate the body.
At higher doses it can slow breathing and heart rate to dangerous levels. Its
intoxicating effects begin 10 to 20 minutes after the drug is taken. GHB is
cleared from the body relatively quickly, so it is sometimes difficult to detect
in emergency rooms and other tx. facilities.
CLUB DRUGS
Rohypnol
In the benzodiazepine family (valium, xanax). Is tasteless and
odorless, dissolves easily in carbonated beverages. Effects are aggravated by
concurrent use of alcohol. “Even without alcohol, a dose of Rohypnol can
impair a victim for 8 to 12 hours.”. The drug causes profound “anterograde
amnesia”;, individuals may not remember events experienced while under the
influence. One of the “street names” is the “forget-me-pill”, and has/is used in
many reported/unreported sexual assaults.
Ketamine
Actually classified as an anesthetic (animal). Popularized in
the 1980’s. High doses produced effects similar to PCP (dream-like states and
hallucinations. (smoked-usually in marijuana, snorted, injected)
STIMULANTS
DEXEDRINE
CAFFEINE
METHEDRINE
AMPHETAMINE
COCAINE (CRACK)
Both Physically & Psychologically Addicting
CLUB DRUGS
Methamphetamines
A toxic, addictive stimulant that affects many
areas of the central nervous system. Smoked, snorted, injected or orally
ingested. Easily dissolves in beverages. Serious health consequences, (memory
loss, aggression, violence, psychotic behaviors, and potential cardiac and
neurological damage. Side effects: Signs of agitation, excited speech,
decreased appetite, and increased physical activity levels.
LSD
LSD is classified as an Hallucinogen, it induces abnormal sensory
perceptions. It’s effects are unpredictable depending on the amount and purity,
as well as the users personality, mood and expectations. Effects begin approx.
30-90 minutes. Physical effects include dilated pupils, higher body temp.,
increased heart and blood rates, sweating, loss of appetite, sleeplessness, dry
mouth nausea. FLASHBACKS! 1 week to 1 year reported
COCAINE FACTS
1855-1860
1884
1885
1886
1887
Cocaine isolated from other chemicals in the coca leaf =
“COCAINE HYDROCHLORIDE”
Used as a local anesthetic
Rbt. Louis Stevenson wrote “Dr. Jekyll and Mr. Hyde”
in 3 days under the influence of cocaine
Dr. Sigmund Freud prescribed and used cocaine daily
gave to patients for a number of ailments, “cure for the
disease of alcoholism and morphine addiction”
Arthur Cannon Doyle-(Sherlock Holmes), used cocaine
continuously to combat “fatigue & depression”. He also
included the use of cocaine by his major character. In
plays like “The Seven % Solution”. The actor playing
Holmes actually injected cocaine on stage.
COCAINE FACTS
One famous line from the play was “Quick Watson the
Needle”.
Remember Watson was a Medical Doctor.
1888
A new “medicine” called a “brain tonic”, was introduced in the southern USA- (?). The drink became
very, very, very popular because it tasted good and
gave you a definite “rush” due to it’s cocaine content.
1914
Classified as a “Dangerous Narcotic”, cocaine largely
went “underground “ used by affluent people.
1960-70,80
With the big “Crack Down” on the use of amphetamines
cocaine began to re-emerge as a stimulant of choice.
COCAINE FACTS
Cocaine was used mainly by the “AFFLUENT”, it
enjoyed a kind of acceptance by the in-crowd. The
drug was seen/used/abused at all the ‘fashionable’
places and glorified in novels, movies and other media.
Late 70s & 80s
The Debut of a “new” phenomena called FREE BASING- The
smoking of Cocaine, made infamous by the likes of Richard
Pryor. It’s used spread like “wild fire” further and faster than any
drug before, and went on to change the face of not only the USA
but the world. How and why did this happen – CHEAP, A
FASTER HIGH, NO NEEDLES AND YES TOUTED AS
NONADDICTING!!!!!!!!
DANGERS ?????
DEPRESSANTS
BARBITURATES
SECONAL
TUNIAL
PHENOBARBITUAL
TRANQUILIZERS
Valium
Librium
Xanax
Ativan
Primarily Physically Addicting
INHALANTS
SOLVENTS
AEROSOLS
ADHESIVES
CLEANING AGENTS
ROOM DEODORIZERS
NITROUS OXIDE
(polish & paint removers, lighter fluid, gas)
(paint sprays, hair sprays)
(airplane glue, rubber cement)
(spot removers, dry cleaning fluid)
(glade, etc)
(whipped cream, laughing gas)
Primarily Psychologically addicting “One of the most
dangerous”
Detection of Drugs in Urine Samples
Amphet/Meth
Barbiturates
Benzodiazepines
Marijuana
Cocaine/Metabolite
Methadone
Narcotics
PCP
2 days (1 use)
2 Days
2 Days (1 use)
2 Days
(1use)
7-28 Days (prolonged)
2 Days (1 use)
4 Days (daily)
2-3 Days
2 Days
7 days (1 use)
“Hair Test can detect presence for up to 90 Days “
ALCOHOL
A Central Nervous System Depressant, alcohol can truly be called, “The
Great Masquerader”. It can do what most other drugs cannot “It can
MIMIC the actions of most psychoactive drugs”
Beer
Wine
Whiskey or Distilled Liquor
ALCOHOL FACTS
The body’s ability to tolerate alcohol depends on the LIVER. Thus as we
drink over a period of time the liver adapts and changes. It creates
more enzymes to handle the POISON that is attacking the system.
Unfortunately, since alcohol destroys liver cells, the liver eventually
becomes less able to handle it. A condition called Reverse Tolerance
occurs. So a person who could handle 2 fifths of alcohol at age 30
will/can get drunk from a half pint of wine at age 50.
Alcohol is actually chemically classified as a Protoplasmic Poison. It can
kill liver, brain, kidney and other tissue on contact. It affects all
systems of the body.
Another danger of Alcohol is it’s involvement in SYNERGISM. What is
Synergism?
ALCOHOL FACTS
Alcohol in it’s various forms has been around since the earliest of times.
The “oldest psychoactive drug” known to man (probably fermented
fruit) Later discovered that the starch in potatoes, rice, corn etc. could
be “fermented”, first to sugar then alcohol. The concentration of
alcohol in each type of beverage depends on the time fermented.
Aside from being an enjoyable drink, alcoholic beverages were
credited with reducing tension, lowering risk of heart attacks, and
aiding people to “cope” etc.
Alcohol ranks third behind heart disease and cancer as greatest health
threats in USA.
Alcohol is metabolized at defined, continuous rate based on a persons
weight, amount, amount of time passed etc. We can usually determine
how much alcohol is circulating in the system (BAC)