Transcript Recruitment

Welcome to the Acción Mutua web-seminar:
Substances, Use, and Users Overview
Before we begin, a little about our format…
Presentation
by seminar speaker (approx. 40 min.)
Followed by question and answer session (approx. 20 min.)
Acción Mutua is a capacity building
assistance (CBA) program of AIDS
Project Los Angeles in collaboration
with the César E. Chávez Institute of
San Francisco State University
Funded by the Centers for Disease Control
and Prevention
Substances, Use, and
Users Overview
Paul Simons
APLA Web Seminar November 20, 2008
[1]
Acknowledgements

Mark Kinzly, Yale School of
Public Health & Epidemiology
[1]
Learning Objectives



Understand the general classes of drugs
Describe the physical and psychological effects
of illicit substances
Identify characteristics of substance using
populations
Substance Use Overview
The Substances
Definition of Psychoactive Drugs
“A drug is any chemical put into the body that
changes mental state or bodily functions.”
 Drug actions:



Pharmacokinetics: How the body acts on the drug;
absorption, distribution, metabolism, excretion
Pharmacodynamics: The drug’s direct influence on
the brain (CNS).
Effects of Psychoactive Drugs
 Desired
effect (Therapeutic)
 Side effect
 Withdrawal effect
 Expectancy (“Placebo effect”)
 Paradoxical effect
 Synergistic effect
Classifications of Psychoactive Drugs









Stimulants
Narcotics/Opiates
Sedative-Hypnotics
Depressants
Hallucinogens
Enactogens (XTC)
“Club Drugs” (GHB; Special K)
Inhalants
Other designer drugs
Heroin
 Heroin



Schedule I
Classified as a semi-synthetic narcotic
Affects the central nervous system
and acts as both a depressant and an
analgesic (pain killer)
Heroin

History




Heroin was isolated from morphine in 1874
It was thought to be the cure for morphine
addiction
Quickly addicted its users and became a
problem drug
In 1914 the Harrison Narcotic Act banned the
importation of heroin into the United States
Heroin

Methods of Ingestion/Onset of Effects





Duration of the Effects


Inhaled – 1 to 3 minutes
Smoked – 20 to 30 seconds
Injected – 10 to 20 seconds
Orally – Varies
3 to 6 hours
Detection in Urine

From 1 to 4 days
Physical and Psychological Effects
Moderate doses
•
•
•
•
•
Euphoria
Dreamy
Warm “rush” sensation
Constricted pupils
Nausea
High doses/overdose
•
•
•
•
•
•
Restlessness
Constipation
Droopy eyelids
Slow breathing
Depressed
Death
Heroin

Withdrawal Symptoms







Insomnia
Hot and cold flashes
Nausea
Vomiting
Weakness
Abdominal cramps
Diarrhea
Heroin
 Signs










of Heroin Abuse
Reduced energy level
Lack of motivation
Low sex drive
Nodding out (falling asleep)
Pinpointed pupils
Long sleeve shirts worn during hot weather
Blood stains on shirt sleeves
Dry skin
Watery eyes
Cigarette burns on clothing, hands, and furniture
Heroin
 Slang





Terms and Street Names
Smack
Junk
Bindles
Bags
Black tar




Manteca
Horse
Bundles
Tar
OxyContin








OxyContin is a brand name for an opioid analgesic drug for
severe pain
Psychoactive prescription drug
Approved by the Food and Drug Administration in late 1995
Manufactured by Purdue Pharma
10 mg to 160 mg
Classified as a Schedule II drug, meaning it has a high
potential for abuse.
Only available by prescription by a licensed physician.
Percodan, Percocet also contain Oxycodone
OxyContin



People are “short circuiting” the time release form of
medication by chewing, crushing, or dissolving the pills.
Chewing or crushing this drug corrupts or foils its timerelease protection, enabling the users to experience a
rapid and intense euphoria that does not occur when
taken as designed and prescribed
Once having crushed the pills, the individuals are
injecting, inhaling, or taking them orally, often with other
pills, pot, or alcohol.
OxyContin



It is the active ingredient oxycodone, a synthetic
opiate similar to morphine, that appears to be
particularly attractive to the user and what is being
used increasingly in suburban, and rural areas.
89% increase in abuse from 1993 to 1999 recently
showing an increase by another 68%, with 10,825
emergency room mentions in the year 2000.
It is the euphoric effect and the fact that many people
perceive prescription pain killers as “safe” that are
likely the reasons why this drug is being abused in
such alarming numbers.
Cocaine
 Cocaine



Schedule II
Central nervous system stimulant
Most potent stimulant of natural origin
Cocaine
 History




Initially used as an anesthetic in the late
1800s
Aided in the treatment of asthma
Previously an active ingredient in many
soft drinks and teas
Due to its abuse and adverse effects on
addicts, its use was restricted in 1906
Cocaine
 Production

of Crack Cocaine
Produced from cocaine hydrochloride
through a heating and cooling process
Cocaine

Methods of
Ingestion/Onset of
Effects




Inhaled – 1 to 5
minutes
Injected – 20 to 30
seconds
Orally – 3 to 5 minutes
Smoked – 20 to 30
seconds

Duration of Effects


From 1 to 2 hours
Detection in Urine

From 2 to 4 days
Cocaine
Physical and Psychological Effects
Moderate doses
•
•
•
•
•
•
•
Increased alertness
Euphoria
Loss of appetite
High blood pressure
Increased heart rate
Dilated pupils
Increased sociability
High doses/overdoses
•
•
•
•
•
•
•
Agitation
Confusion
Hallucinations
Cardiac arrest
Panic attacks
Paranoia
Convulsions
Cocaine
 Withdrawal





Symptoms
Irritability
Sluggishness
Prolonged periods of sleep
Depression
Nausea
Cocaine
 Slang
Terms and Street Names
Blow
Flake
Base
Powder
Rock
Hard
Coke
White
Dime
Perico
Modes of Ingestion
 Injection
 Inhale
 Snort
 Ingest
 Smoke
 Transdermal
absorption
Methamphetamine
 Methamphetamine





Schedule II
An amphetamine analog
Central nervous system stimulant
Triggers the release of large amounts of
dopamine & norepinephrine in the brain
High potential for abuse
Methamphetamine
 History

1930s - 1950s
• Treatment for narcolepsy
• Used to keep soldiers alert during
combat
• Anti-depressant
Methamphetamine
 History

1960s - Present
•
•
•
•
Produced in clandestine laboratories
Used as a party drug
Abused throughout the United States
Presently a national problem affecting both
large cities and rural America
Methamphetamine

Methods of
Ingestion/Onset of
Effects




Inhaled – 3 to 5
minutes
Injected – 20 to 50
seconds
Swallowed – 15 to 20
minutes
Smoked – 20 to 50
seconds

Duration of the High


From 4 to 8 hours
Detection in Urine

A soon as 1 hour after
initial dose
and up to 48 hours
afterwards

1500
METHAMPHETAMINE
Neuroxmission
Dopamine

% of Basal Release

1000

500

0


0
1
2
3hr
Time After Methamphetamine


500


% of Basal Release


400

300

200

100
0

0

1


2
COCAINE
3

4

Time After Cocaine

5 hr

Methamphetamine
Physical and Psychological Effects

Moderate doses
•
•
•
•
•
Euphoria
Alertness
Dilated pupils
Loss of appetite
Enhanced
concentration
• Elevated blood
pressure

High doses
•
•
•
•
•
•
•
•
Malnutrition
Physical burnout
Aggressive behavior
Stroke
Rapid weight loss
Paranoia
Convulsion
Death
Methamphetamine
 Withdrawal






Symptoms
Depression
Nausea
Severe craving for drugs
Shaking
Desire to sleep
Loss of energy
Methamphetamine
 Slang





Terms and Street Names
Batu
Speed
Meth
Crack meth
Go Fast





Crank
L.A. glass
Crystal
Poor man’s coke
Tina
Methamphetamine
 Paraphernalia





Glass pipes
Cut-off straws
Hypodermic needles
Lighters
Razor blades
MSM and methamphetamine
The MSM Users
Why Do People Use Crystal Meth?

Perceived desirable effects (Subjective benefits):









Provides energy; increases alertness
Lessens desire and ability to sleep
Increases sexual arousal
Increases stamina and enhances endurance
Reduces appetite
Induces sense of self-confidence; productivity
Focuses thinking; increases concentration
Distorts perceptions of time
Form of escape (from ‘hassles of daily living’)
Desired Effects Cited Among
Studies of Gay Men

Enhances and/or prolongs intensity and
frequency of sexual encounters
 Keeps you active for weekend-long parties
 Helps you escape from unpleasant emotions


In several studies this was linked to avoidance of
dealing with one’s HIV status/risk
Crystal use cited as a method of coping with “specter
of death”
National HIV Behavioral Surveillance System
•
Adults at high risk in the United States
•
MSM Cycle: Venue-based sampling
• Venues were randomly selected
• Participants in venues are systematically recruited
and interviewed
Inclusion criteria
Eligibility
18+ years
• Resident of city
•
Analytic criteria
•
1+ male sex partners during past 12
months
Cities in MSM Cycle, 2003-2005
Boston

New York City

San Francisco
Chicago


Newark

Denver

Philadelphia

Baltimore

Los Angeles

Atlanta

San Diego

Houston

Ft. Lauderdale


n = 11,331
Miami

San Juan

Methamphetamine use in 12 months, by
self-reported HIV status
Meth use
Total
Self-reported HIV status
No.
%
Positive
1422
331
23.3
Negative/untested
9909
1147
11.6
High risk sex behavior at last sex by
self-reported HIV status
High risk
behavior at last
sex
Self-reported HIV
status
Total
No.
%
Positive
1422
107
7.5
Negative/untested
9909
402
4.1
Psychoactive Substances and
Sexual Behaviors

My sexual drive is
increased by the use
of the following
substance(s)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
73%
57%
l
o
h
o
c
l
A

42%
16%
O
Rawson R; Matrix Instit., CA
te
a
pi
in
a
c
o
C
e
A
M
Psychoactive Substances and
Sexual Behaviors

My use of the
following
substance(s) has
made me become
obsessed with sex
and/or made my sex
drive abnormally
high.
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
A

67%
40%
16%
0%
lco
l
o
h
Rawson R; Matrix Instit., CA
O
te
a
pi
C
oc
ne
i
a
M
A
Psychoactive Substances and Sexual
Behaviors

My sexual behavior
under the influence
of the following
substance(s) caused
me to feel sexually
perverted or
abnormal

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
55%
34%
12%
l
o
h
o
c
Al
O
4%
te
a
pi
Rawson R; Matrix Instit., CA
in
a
c
o
C
e
A
M
US TX Admissions by Primary Drug
300000
250000
200000
Amphetamine
150000
100000
Heroin
50000
0
C ocaine
2000
2003
2006
Sexual HIV Risk Behavior
•
Changing sexual roles
(insertive/receptive anal intercourse)


Because of “crystal dick,” men who previously were
“tops” may engage in receptive anal intercourse.
“Bottoms” are at statistically higher risk of
being/becoming HIV infected
“Bottoms” who use sexual performance enhancing
drugs may “top” (become insertive partners). If they are
HIV positive and don’t consistently practice safer sex
while high, they may be infecting others.
US Reported HIV Cases by Year of
Diagnosis and Transmission Category
1000
900
800
700
600
500
400
300
200
100
0
1997
2001
MSM/IDU
2005
Substance Users
Demographics
Monthly Heroin Use by Employment
1:Full-time job 28%
2.Part-time job 14%
3: Job, no work last week
5%
4: Did not work 53%
Demographics
Monthly Cocaine Use by Employment
Full-Time 42%
Part-Time 18%
Has Job not
working 7%
Not Working 33%
Demographics
Monthly Crack Use by Employment
Full-Time 33%
Part-Time 15%
Has Job not
working 7%
Not Working 45%
Demographics
Monthly Methamphetamine Use by Employment
1:Full-time job 37%
2.Part-time job 11%
3: Job, no work last week
7%
4: Did not work 44%
Current Drug Use and Age
Percent Reporting Past Month Use of an Illicit Drug
25
19.6
20
16.4
15
13.2
9.8
10
7.8
7
5.3
5
6.5
3
4.8
2.4
0.3
0
12-13 14-15 16-17 18-20 21-25 26-29 30-34 35-39 40-44 45-49 50-64
Years
of age
Source: 2000 National Household Survey on Drug Abuse
65+
U.S. Tx Admissions 2006
80
70
60
50
40
30
20
10
0
Male
Female
U.S. Tx Admissions 2006
80
70
60
50
40
30
20
10
0
White
Black or AfricanAmerican
American Indian
or Alaska Native
U.S. Tx Admissions 2006
100
90
80
70
60
50
40
30
20
10
0
Hispanic or Latino
Not Hispanic or
Latino
Types of Substance Use
Approaches in the U.S. to Address
Alcohol/Drug Use

Creating categories of ‘licit’ and ‘illicit’




Most substances that are now illicit were legal at one time:
morphine, cocaine, marijuana/cannabis; LSD; Ecstasy
Locating the problem in the person, not the substance
(Solution: Demand reduction; moral theory)
Locating the problem in the substance, not the person
(Solution: Prohibition; Criminal justice model: ‘War on
drugs’; Supply reduction)
Harm reduction movement: Locates the problem in the
relationship between the person and the substance
(drug, set, and setting), which may change over time
Current Understanding of Addiction
 Variables
correlated with increased risk of
addiction:



Psychological vulnerability (prior history of
problems with other drugs or prior treatment)
Family history of addiction
History of trauma
Substance Abuse Dependence
(DSM-IV)
A maladaptive pattern of substance use leading to clinically
significant impairment or distress as manifested by
three (or more) of the following, occurring at any time
in the same 12-month period:
1.
Substance is often taken in larger amounts or over
longer period than intended
2.
Persistent desire or unsuccessful efforts to cut down or
control substance use
3.
A great deal of time is spent in activities necessary to
obtain the substance, use the substance, or recover
from its effects
4.
Important social, occupational, or recreational activities
given up or reduced because of substance abuse
Substance Abuse Dependence
(DSM-IV) continued
5.
6.
Continued substance use despite knowledge of having
a persistent or recurrent psychological, or physical
problem that is caused or exacerbated by use of the
substance
Tolerance, as defined by either:
a.
b.
7.
need for greater amounts of the substance in order to achieve
intoxication or desired effect; or
markedly diminished effect with continued use of the same
amount
Withdrawal, as manifested by either:
a.
b.
characteristic withdrawal syndrome for the substance; or
the same (or closely related) substance is taken to relieve or
avoid withdrawal symptoms
The Addictive Personality





Making impulsive choices.
Constantly seeking excitement and new
sensations.
Feeling alienated from mainstream society.
Valuing deviant or nonconformist behavior.
Lacking patience, for example having trouble
waiting for delayed gratification.
Continuum of Substance Use








Experimental
Ritual use
Intermittent use
Social use
Binge use (operationalized as conscious, planned
‘heavy’ drug use for 5 or more days, or 5 drinks for a
man, 4 for a woman in rapid succession; potentially
distinct from a “slip” for someone in recovery)
Abuse DSM-IV-TR criteria
Dependence DSM-IV-TR criteria
Severely and Persistently Chemically Dependent
(numerous attempts to abstain; chronic relapse)
Drug, Set and Setting
 The
dose or amount of a drug taken
 The mind set, or what one expects to “feel”
 The context and the environment in which
drugs are taken
 All of the above are primary factors in the
overall effect
Cultures of Substance Use
 Culture
as blueprint for living
 Language, ritual, economics, family,
justice, structure and legacy
 Varies as regards dominant culture, ethnic
culture, economic class, region and
drug(s) used
iGracias ~ Thank You!
Questions & Comments
Thanks for Your Participation
Future Acción Mutua web seminars:
December 3, 2008 11am (PT)
HIV DISCLOSURE & Latino MSM , Dr. Maria Cecilia Zea
Please register at: [email protected]
For more information or to learn how to receive
CBA services, contact us at:
213.201.1345
www.accionmutua.org