Transcript DRUGS OF ABUSE

‫المنشطات و أضرارها‬
PERFORMANCE ENHANCING DRUGS
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Athletic or Performance-Related
Fitness
Agility
Balance or equilibrium
Coordination
Power
Reaction time
Speed or velocity
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PERFORMANCE ENHANCING
DRUGS
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Performance-Enhancing Drugs
Anabolic Steroids
Description
Drugs derived from testosterone and approved for
medical use, but often used by athletes to increase
musculature and weight.
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Performance-Enhancing Drugs
Anabolic Steroids
Claims  May enhance performance and improves physical
appearance.
 Reported to increase lean muscle mass, strength, and
the ability to train longer and harder.
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Performance-Enhancing Drugs
Anabolic Steroids
Risks  Liver tumors, jaundice, fluid retention, high blood
pressure, severe acne, aggression and other
psychiatric side effects.
 Men: Shrinking testicles, reduced sperm count,
infertility, baldness, and development of breasts.
 Women: growth of facial hair, changes in or
cessation of the menstrual cycle, enlargement of the
clitoris, and deepened voice.
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Table 5-3, p.126
Androstenedione
produced by:
1- the ovary, testes, and the adrenal cortex,
2-is a prohormone for both estrogen and testosterone..
3- Androstenedione supplementation has become popular
with male athletes because they believe they will be more
powerful.
4-Research shows no measureable effect on free or total
testosterone,
5-but HDL levels dropped and plasma estrogens rose.
6- No measurable effect has been noted on athletic
performance.
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GYNECOMASTIA
These pictures are the “BEFORE” (left) and “AFTER” (right)
pictures of a man that had surgery to correct his case of
gynecomastia. I’m sure he thought “It won’t happen to me.”
as well! Think about it before you choose to take P.E.D.!
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Performance-Enhancing Drugs
Androstenodione
Claims
Improves testosterone concentration, increases
muscular strength and mass, helps reduce body
fat, enhances mood, and improves sexual
performance.
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Performance-Enhancing Drugs
Androstenodione
Risks  Breast enlargement, increased risk of
cardiovascular disease and pancreatic cancer
in men, acne, male pattern baldness, and a
decrease in “good” (HDL) cholesterol.
 In women, high testosterone levels can cause
increased body hair, deepening of the voice,
and other male characteristics.
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RISKS OF P.E.D.
 Steroid induced acne
 Anti-hypertensive behaviors
 Hypertension or fatigue
 Chronic gonadotrophin
 Increased level of female hormones in a man’s body
 Testicular atrophy
 Induced gynecomastia
 Presence of abnormally large breasts in men
 Increased use of other drugs to mask symptoms
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SYMPTOMS OF P.E.D. USE
 Rapid weight gain with larger muscle
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mass
Aggressiveness
Jaundice/Skin color change
Purple or red spots on body
Swelling of feet and legs
Shaking and/or trembling
Persistent body odors
Severe acne breakouts with
abnormally oily skin
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DOES THIS LOOK APPEALING TO
YOU?
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CNS Stimulants
COCAINE
CRACK
METHAMPHETAMINE
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Stimulants
Description: A group of synthetic or plant-derived drugs
that increase alertness and arousal by stimulating the
central nervous system.
Medical Uses:
Short-term treatment of obesity,
narcolepsy, and hyperactivity in children No medical use
for methamphetamine
Method of Use: Intravenous, intranasal, oral, smoking
Types of Stimulant Drugs
1- Cocaine Products
 Cocaine Powder (Generally sniffed, injected, smoked on foil)
 “Crack” (smoked)
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Types of Stimulant Drugs
2- Amphetamine Type Stimulants (ATS)
 Amphetamine
 Dexamphetamine
 Methylphenidate
 Methamphetamine
“Speed”
“Ice”
“Crank”
“Go Fast”
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Methamphetamine vs. Cocaine
 Cocaine half-life: 1-2 hours
 Methamphetamine half-life: 8-12 hours
Cocaine and the amphetamines have very similar effects on
mood, patterns of abuse, the type of dependence produced,
and their toxic effects.
 Cocaine paranoia: 4 -8 hours following drug cessation
 Methamphetamine paranoia: 7-14 days
 Methamphetamine psychosis - May require medication/hospitalization
and may not be reversible
 Neurotoxicity: Appears to be more profound with amphetamine-like
substances, rapid formation of lesions
Acute Stimulant Effects
Psychological
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Increased energy
Increased clarity
Increased competence
Feelings of sexuality
Increased sociability
Improved mood
Powerful rush of euphoria intravenous only
freebase and
Acute Stimulant Effects
Physical
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Increased heart rate
Increased pupil size
Increased body temperature
Increased respiration
Constriction of small blood vessels
Decreased appetite
Decreased need for sleep
Numbness of nasal mucosa - intranasal only
Chronic Stimulant Effects
Physical
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Weight loss/anorexia
Sleep deprivation
Respiratory system disease
Cardiovascular disease
Headaches
Severe Dental disease
Needle marks and abscesses - intravenous only
Seizure
Agitation and violence
Cocaine Hydrochloride
 Crystalline white powder
 Snorted in “lines” of 10-35 mg each
 Adulterated w cheap local anesthetics,
stimulants, and inert white powders
 Yields moderate to high blood levels
 Gradual onset of effects at 15-20 min with peak at
30-60 min
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Cocaine Hydrochloride:
Intravenous Administration
 Soluble in water
 Peak blood levels achieved instantaneously
 Rapid onset, brief duration, intense “crash”
 Rapid development of compulsive use pattern
 “Speedball” when mixed with heroin to cushion the
“crash”
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Cocaine: Mechanism of
CNS Action
 Increases the synaptic concentration of dopamine and
Norepinephrine by preventing its reuptake
 Dopamine agonists/replacements have not proved
therapeutically useful in addicts
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Because…
Their Brains
have been
Re-Wired
by Drug Use
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Partial Recovery of Brain Dopamine
Transporters in Methamphetamine
(METH)
Abuser After Protracted Abstinence
3
0
ml/gm
Normal Control
Hint: Ask about free radicals!
METH Abuser
(1 month deter)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of
Neuroscience 21, 9414-9418, 2001. 32
Cocaine: Acute Effects
Euphoric mood
Increased energy, alertness
Increased sexuality
Paranoia
Increased heart rate, blood pressure
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Cocaine: Chronic Effects
 Lethargy, fatigue
 Reduced attention span
 Sexual dysfunction
 Depression, irritability, anhedonia
 Paranoid psychosis
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Cocaine: Toxic Reactions
 Cardiac arrhythmias, fibrillation
 Hyperthermia- > 106º F
 Convulsions, loss of consciousness
 Respiratory & cardiac arrest
 Abruptio placentae (miscarriage)
 Fatal reactions rare, but unpredictable
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Cocaine “Crash”
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Rebound dysphoria
Agitation, restlessness
Intensifies with dosage & chronicity of use
Cravings & drug-seeking behavior
Abuse of alcohol & other drugs
Suicidal ideation, behavior
Often followed by prolonged sleep
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Cocaine/Amphetamines
“The Runs”
DRUG TAKING
CRAVING
DRUG TAKING
The Blues
FATIGUE
DEPRESSION
HYPERPHAGIA
sleep
CRASH
CRAVING
DRUG TAKING
CRAVING
DRUG TAKING
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Speed Methamphetamine powder
 ranging in color from white, yellow, orange, pink, or brown
 Color variations are due to differences in chemicals used to
produce it and the expertise of the cooker
 Other names: Crystal, Crystal Meth, Crank, Go Fast, Zoom
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Ice
 High purity
methamphetamine crystals
or coarse powder ranging
from translucent to white,
sometimes with a green, blue,
or pink tinge color
 Depends on additives and
filtering
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Cardiac Disorders and Methamphetamine
 Coronary Syndromes
 Arrhythmia
 Cardiomyopathy
 Hypertension
 Valvular Disease
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Neurologic Disorders and
Methamphetamine Use
 Headache
 Seizure
 Cerebrovascular
 Ischemic stroke
 Cerebral hemorrhage
 Cerebral vasculitis
 Cerebral edema
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Respiratory Disorders and
Methamphetamine Use
 Pulmonary edema
 Bronchitis
 Pulmonary hypertension
 COPD
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Formication
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Formication
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METH Use Leads to Severe Tooth
Decay!
“METH Mouth”
Source: The New York Times, June 11, 2005.
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Methamphetamine
Psychiatric Consequences
 Paranoid reactions
 Permanent memory loss
 Depressive reactions
 Hallucinations
 Psychotic reactions
 Panic disorders
 Rapid addiction
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Methamphetamine Psychosis
Inpatients
No. of patients having
symptoms (%)
Psychotic symptom
Lifetime
Current
Persecutory delusion
Auditory hallucinations
Strange or unusual beliefs
Thought reading
Visual hallucinations
Delusion of reference
Thought insertion or made act
Negative psychotic symptoms
Disorganized speech
Disorganized or catatonic behavior
130 (77.4)
122 (72.6)
98 (58.3)
89 (53.0)
64 (38.1)
64 (38.1)
56 (33.3)
35 (20.8)
75 (44.6)
39 (23.2)
27 (16.1)
38 (22.6)
20 (11.9)
18 (10.7)
36 (21.4)
19 (11.3)
14 (8.3)
Srisurapanont et al., 2003
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THERAPEUTIC DRUGS
 Diuretics
 Rapid weight loss
 Boxing, wrestling, judo
 Excretion or dilution of illegal substances
 Overall negative impact on performance
 Dehydration, hypotension, muscle cramps, electrolyte imbalance
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THERAPEUTIC DRUGS
 Opioids
 Prescription pain killers most common
 Allow performance while injured
 75% used after injury only
 Increased risk of further injury, dependence, drowsiness, mental
clouding; in high doses: respiratory depression, hypotension
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THERAPEUTIC DRUGS
 Beta-Blockers
 Anti-tremor, anxiolytic effect
 Shooters, ski jumpers, archery
 Negative effect on endurance
 Depression, bronchospasm, fatigue
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PERFORMANCE ENHANCING DRUGS
 Peptide hormones: HCG
 Increases testosterone
 Maintains testicular volume with anabolic steroid
use
 Ovarian cysts
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PERFORMANCE ENHANCING DRUGS
 Pituitary and synthetic gonadotropins
 Increases testosterone, anti- estrogenic
 Ovarian cysts
 Corticotropins
 Increase testosterone
 Rare and related to excess corticosteroids- pituitary
suppression,  immunity, osteoporosis,
hyperglycemia
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PERFORMANCE ENHANCING DRUGS
 Growth hormone
 Increase muscle mass & decrease fat mass
 Gigantism, acromegaly, hypothyroidism, cardiac disease,
myopathies, arthritis, diabetes mellitus, impotence,
osteoporosis
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PERFORMANCE ENHANCING DRUGS
 Erythropoietin (EPO)
 Stimulates RBC production
 Increases oxygen carrying capacity
 CVAs
 Blood doping
 RBC transfusion, artificial oxygen carriers
 Increases oxygen carrying capacity
 Allergic reactions, sludging of blood
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FOOD SUPPLEMENTS
 76-100% of athletes use vs. 50% general population
 May or may not contribute to enhanced
performance
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WHAT DO WE HAVE IN COMMON?
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Questions?
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