Transcript Uppers Downers & All Arounders

Uppers Downers & All
Arounders
Uppers/Stimulants
Chapter 3
Uppers/Stimulants
• In 1999 about
• 1.7 million Americans used amphetamines
for nonmedical reasons,
• 4.2 million used cocaine,
• 68 million smoked cigarettes,
• 200 million drank coffee, tea, caffeinated
soft drinks or an over-the-counter
medication containing caffeine. (p. 83).
General Classification
• Most people use stimulants in the form of:
– Diet aids
– Drugs to control hyperactivity
– Coffee & Tea
– Cigarettes
– Caffeinated solf drinks
• Stimulants are found in plants and in
synthetic form
General Effects
• Stimulants force the release of the energy
chemicals (epinephrine and norepinephrine
along with dopamine and serotonin)
• Infuses the body with large amounts of extra
energy before the body needs it
• With heavy use the body’s energy supply is
depleted leading to crash, withdrawal and
depression
• Crash and withdrawal occurs when energy
supplies become depleted and body is left
without reserves
General Effects
• All Stimulants activate chemical and electrical
activity in central nervous system
– Increases
• Heart rate
• Blood pressure
• Respiration
– Effects include
• Activeness
• Restlessness
– Medical uses include treatment of obesity, narcolepsy
and Attention-deficit/hyperactivity Disorder
General Effects
• Reward/reinforcement center is artificially overstimulated
– Rush of pleasure and strong sense of wellbeing
– Often accompanied by no basic need for hunger,
thirst or sex
• Weight loss: stimulants fool the body into
thinking it has satisfied hunger without eating
• Cardiovascular side effects include constricted
blood vessels, high blood pressure and
sometimes arrhythmia
– Chronic use weakens blood vessels and risk of stroke
General Effects
• Emotional & mental effects:
– Initial release causes increase of confidence
and euphoria
– As use continues feeling of euphoria turn to
irritability, paranoia, aggressiveness,
depression
• Tolerance & Addiction liability
– Increases as body loses its ability to
synthesize drugs
– Can also develop with methamphetamine
congeners, caffeine, nicotine and other mild
stimulants
COCAINE
• Cocaine epidemics seem to occur every
few generations
• Hardcore use still strong in 2000’s
• Cocaine is extracted from coca plant
– 97% grown in South America
– Colombian drug Cartels control cultivation and
production
– 2/3 of smuggling handled by drug artels in
Mexico
– U.S. consumes 70% of world’s cocaine trade
COCAINE: Routes of Administration
• Chewing Leaf: Historically Native cultures
• Drinking: Started in 1880’s in wine, coca cola,
and patent medicine. Widely prescribed to
womem
• Injecting: Started after the invention of
hypodermic needle in 1853
– Intravenous use takes 15-30 seconds
– Subcutaneous/intramuscular takes 3-5 minutes
• Snorting: Self-limiting method
– The more snorted, the less absorption due to
constriction of capillaries in the nose
– Destructive to nasal passages
COCAINE: Routes of Administration
• Mucosal & contact absorption
– Can be absorbed through mucosal tissue in
nose, mouth, rectum & vagina
– Delivery method is also used for dental work,
minor surgeries
• Smoking:
– First introduced in 1914, but high temperature
was needed to keep cocaine cigarettes going
– Mid-1970’s, cocaine hydrochloride was
chemically altered into freebase
– Fastest form to reach brain… Highly addictive
COCAINE: Physical and Mental Effects
• Metabolism: Quickly metabolized and
disappears faster than methamphetamine
• Medical Use: Only naturally occurring local
anesthetic
– Used to numb nasal passages, eyes, throat, and
chronic sores
• Neurochemistry & Central Nervous System
– Forces relase of norepinephrine, epinephrine and
dopamine
– Blocks re-absorption so more intense stimulation
– Blocks 60-70% of dopamine reuptake
– Too much dopamine can over stimulate brain’s fright
center causing paranoia.
COCAINE: Physical and Mental Effects
• Sexual Effects:
– At low doses cocaine increases desire for sex
and delay ejaculation
– As use continues sexual dysfunction occurs
• Aggression, violence & cocaethylene
– Increases aggression & violence by disrupting
inhibitory and fright centers of the brain
– Cocathylene (metabolite when cocaine &
alcohol is combined) induces greater
agitation, euphoria and violence
• Can also induce cardiac conduction abnormalities
COCAINE: Physical and Mental Effects
• Cardiovascular Effects
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Can damage circulatory system
Raise blood pressure
Cause stroke (bursting of blood vessels in brain)
Cause heart damage
• Neonatal Effects:
– Transmitted within seconds to fetus
– Increases chances for miscarriage, stroke, SIDS,
respiratory ailments, mental delays & other
abnormalities
– Proper pre-natal and post natal treatment can hel
cocaine babies
COCAINE: Physical and Mental Effects
• Tolerance: To the euphoric effect can
begin to develop after first injection or
smoking session
• Withdrawal, Craving & relapse:
– Major effects include anhedonia, lack of
energy and intense craving
– Typical cycle of compulsive use:
• Bingeing to crashing to detox to resolutions of
abstinence or treatment and relapsing 2-4 weeks
later.
COCAINE: Physical and Mental Effects
• Overdose:
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Can be caused by as little as 1/50 gram
Overwhelmingly intense stimulation
Injury to heart and blood vessels
More often not fatal…just feels that way
Severe reaction through in verse tolerance or kindling
• Miscellaneous Effects:
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Formication (itching from imaginary bugs)
Dental erosion
Seizures
Gastrointestinal complications
• Cocaine Psychosis:
– Paranoid psychosis/schizophrenia caused by excess
dopamine
– Can also activate genetic predisposition to
schizophrenia
COCAINE: Other Problems with Use
• Polydrug Use
– Alcohol, valium, heroin to take the edge off
• Adulteration & Contamination
– Cocaine at street level is almost always cut
– When injected, bacteria and viruses
contaminate drugs and needles
– Hepatitis C rate for IV drug users is between
50% and 90%
• Compulsion
– Use for euphoria, boredom, peer pressure,
curiosity, self-medication, escape from
personal problems
Smokable cocaine (freebase, crack, paste)
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SMOKABLE COCAINE (CRACK & FREEBASE)
• Pharmacology of smokable Cocaine
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Began around 1981
Crack epidemic in 1986
Chemically crack is the same as freebase
Delivered to the brain faster
Ether converts cocaine to freebase
Baking soda converts cocaine to crack
• Effects and Side Effects
– More intense than snorting or injecting
– Rush or euphoria last 5 – 20 minutes
– Replaced by the feeling of irritability and other
negative emotions
– Always used in a binge pattern
– Chronic use include paranoia, intense cravings,
depression, cocaine psychosis, high-risk sexual
activity
SMOKABLE COCAINE (CRACK & FREEBASE)
• Respiratory Effects
– Breathing problems
– Severe fever
– Chest pains
– Coughs
– Crack lung
– Hemorrhage
– Respiratory failure & death
– Aggravated by cigarette smoking
• Polydrug use
– Increases the potential for abuse of
SMOKABLE COCAINE (CRACK & FREEBASE)
• Overdose
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Mild-rapid heart beat
Hyperventilation
Fear of dying
Kills several thousand a year due to
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Cardiac arrest
Seizure
Stroke
Respiratory failure
Severe hypothermia
• Consequences of Crack use
– Economic
– Social: abuse, family, legal, formation of sex trade
• Cocaine vs Amphetamines
– Cocaine’s duration is 40 minutes/ Meth is 4-6 hours
– Meth is cheaper
Amphetamines
Methamphetamines
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“Ice”
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Amphetamines
• Classification: “Sympathomimetic agent”
– Stimulate the release of sympathic neurotransmitters
– Activates the sympathetic nervous system that
controls the fight or flight response
– Stimulates the reward/information center
– Street names: crank, ice, shabu, glass, clear
• History of Use
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First synthesized in 1887
Medically used in 1930s
Treats narcolepsy & depression
Used by students and truck drivers to stay awake
Widely used in pill form during WW II
Amphetamines
• History of Use
– Japanese epidemic continued after WW II
– 1970 6-8% of American population used
prescribed amphetamines for weight loss
– Street speed chemists increased production
of crank and crystal in late 1980s
– Ice highly potent smokable form used in
1990’s and common use in Hawaii
– Recent development of “ya ba” in Thailand
Amphetamines (Effects)
• Routes of Administration
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Snorting
Intravenous
Smoking
Oral
• Neurochemistry
– Like cocaine, amphetamines increase levels of
catecholamines by stimulating their release and
blocking reuptake
– Unlike cocaine, amphetamines block metabolism
– Long term use alters the ability to produce vital
neurotransmitters causing depression and taking mor
to stay normal
Amphetamines (Effects)
• Physical Effects
– Small to moderate doses cause
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Increased heart rate
Raised body temperature
Rapid respiration
Higher blood pressure
Extra energy
Dilation of bronchial vessels
Appetite suppression
– Meth users go on binges for 3, 4 or 10 days
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Long term use can cause sleep deprivation
Heart & blood toxicity
Severe malnutrition
Bad or rotten teeth
Tolerance is more pronounced
Amphetamines (Effects)
• Mental & Emotional Effects
– Mild to intense euphoria / sense of wellbeing
– Prolong use leads to
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Irritability
Paranoia
Anxiety
Confusion
Poor judgement
Hallucinations
Delusions
Can result in violent, suicidal & homicidal thoughts
Antisocial behaviors
Amphetamines (Effects)
– With abstinence, disturbed mental states such
as amphetamine psychosis or depression can
stop for some people
– Amphetamines release neurotransmitter that
mimics sexual gratification
• Effects of Ice is greater on the brain than
the respiratory and pulmonary system
– Results in more overdoses
– Greater mental side effects
– Longer detoxification
Lookalike Stimulants
Any combination of
Caffeine
Ephedrine
Pseudoephedrine
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Amphetamine Congeners/Lookalikes
• Methylphenidate (Ritalin)
– Most widely used
– Prescribed as mood elevator, narcolepsy and to treat
Attention-deficit/hyperactivity disorder
• Diet Pills
– Only recommended for short-term use
– Careful monitoring by physician
– Long-term use associated with abuse
• Lookalikes
– Prescription drugs that contain ephedrine and
pseudoephedrine (anti-asthmatics)
– Decongestants
– Caffeine
– Ephedra & ephedrine
Miscellaneous Plant Stimulants
• Khat & methcathione
– Used in Arab and African countries
– Produces amphetamine like highs
– Insomnia, anorexia
– Chronic abuse cause exhaustion, violence &
depression
– Methcathione: AKA ephedrone is synthesized
in illegal labs in U.S.
• Sold as a powerful alternative to
methamphetamine
Miscellaneous Plant Stimulants
• Betel Nuts (seed of betel palm)
– Used by 200 million people in Arab world, India and
Asia
– Effects similar to nicotine
– High doses can be toxic and produce psychological
dependence
• Yohimbine
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Spicy extract from African yohimbe tree
Used in tea
Medicine
Aphodisiac
Produces mild euphoria and occassional
hallucinations
Miscellaneous Plant Stimulants
• Ephedra
– Ephedra bush
– Mild stimulant used as medicine, tea & tonic
– Also used by athletes for energy boost
– Banned in U.S. because of overdoses
– This drug and synthetic version is main
ingredients in methamphetamine &
methcathione
– Herbal Ecstasy and Herbal Nexus are two
herbal products marketed as stimulants and
as buffers for illegal drugs
• Contains herbal forms of ephdrine, caffeine, herbs
and vitamines
Miscellaneous Plant Stimulants
• Caffeine
– Most popular stimulant in the world
– Found in teas, coffee, soft drinks, chocolate &
hundreds of medications
• History
– Tea: drunk in China as early as 2700 B.C.
• Introduced to Europe in 16th Century
– Coffee: Cultivated in Ethiopia A.D. 650 and
spread to Arabia then Europe
• Classified as a drug and banned in many cultures
– Cocoa: Mayan and Aztec royalty
• Only small amount of caffeine in cocoa
Miscellaneous Plant Stimulants
• Pharmacology
– Classified as an akaloid of the chemical class called
xanthines
– Found in more than 60 plants
– Takes 15-35 hours for 95% of the caffeine to be
excrete by the body
• Physical and Mental Effects
– Mild stimulant
– 5-7 cups of coffee can cause anxiety, insomnia,
nervousness
– Higher doses can cause muscle twitching, increased
heart rate, palpatations
– Letal at about 10 grams (100 cups of coffee)
Miscellaneous Plant Stimulants
• Tolerance, withdrawal & addiction
– Dosages vary depending on person
– Symptom includes throbbing headache
– Dependence can occur with 5 cups of coffee
10 cola drinks or 8 cups of tea
• Nicotine
– Cigarettes account for 90% of all tobacco use
in U.S.
– Discover in American and spread to Europe
– Smokeless tobacco: moist snuff, powder snuff
& loose-leaf
• Absorbed by mucosal in the mouth and nise
U.S. Cigarette Use, 2001 (12 & older)
Ever used
68.9% 151.6 million
Used past year
29.5% 65.6 million
Used past month 24.9% 56.3 million
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Nicotine/Tobacco
• Pharmacology
– Nicotine is the most important ingredient
– Average cigarette contains 10 mg of nicotine
– Central Nervous system stimulant that
disrupts the balance of neurotransmitters
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Dopamine
Endorphins
epinephrine,
Acetylcholine
Constricts blood vessels
Raises heart rate
Depresses appetite
Produces mild euphoria
Deadens senses
Nicotine/Tobacco
• Two most important reasons people smoke
tobacco is:
– Weight loss
– Craving
• One must keep a certain level in blood stream to avoid
withdrawal
• Tolerance develops quickly
• Withdrawal causes:
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Headaches
Nervousness
Fatigue
Severe irritability
Intense craving
Poor concentration
Sense of relaxation from smoking a cigarette is
Nicotine/Tobacco
• Addiction
– Tobacco is pure example of addiction
process
• 80% want to quit & 10% want to cut down
• May have a genetic predisposition to
nicotine addiction
• Side Effects
– Tobacco & smoke contain more than
4,000 other chemicals of which 400 are
classified as toxic
Nicotine/Tobacco
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1997: 3.5 million premature deaths
In U.S. 392,000 die prematurely
50,000 die of second hand smoke
Cardiovascular & Respiratory effects:
– Plaque formation
– Hardening of the arteries
– Leading cause of heart attacks
– Lung cancer
– Men who smoke are 22 x’s more chance of
cancer