Transcript here

Individual Drug Info
Winter 2016
Similar Properties Across Drugs
• Withdrawal (physical dependence)
• Psychological dependence
Which drug is the most addictive?
• Depends on who you ask
• Depends on the individual and that person’s reasons for taking the
drug
• Depends on what substance(s) is/are readily available
• Tolerance
Differences
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Forms
Availability
DEA Schedule
Effects
◦ Acute
◦ Chronic
◦ Overdose
◦ Emergency Department
visits:
◦ All ages
◦ Aged 18-25
(Substance Abuse and Mental Health Services
Administration, 2014, Figure 3)
Photo, originally taken by Thoric, available to use in the
public domain
How does marijuana affect anxiety and depression?
Does marijuana affect respiratory function? Especially during
exercise?
Is marijuana more destructive to your brain than alcohol?
CANNABIS - MARIJUANA
Cannabis
• Cannabis sativa & indica
• Different subspecies/varietals used
for clothing vs drug use
• Canadian study – differences are
questionable
• Cannabinoids are active ingredients
• THC is a cannabinoid
• Interacts with cannabinoid receptors in brain
• Many other cannabinoids exist, but they are
less understood regarding psychoactive effects
• DEA: Schedule I
• Despite state regulations, marijuana still
federally illegal
Medical cannabis
(1/7/2016),source:procon.org)
Alaska (98)
Maine (99)
New Jersey (10)
Arizona (10)
Maryland (14)
New Mexico (07)
California (96)
Massachusetts (12)
New York (14)
Colorado (00)
Michigan (08)
Oregon (98)
Connecticut (12)
Minnesota (14)
Rhode Island (06)
Delaware (11)
Montana (04)
Vermont (04)
Hawaii (00)
Nevada (00)
Washington (98)
Illinois (13)
New Hampshire
(13)
Washington, DC
(10)
Recreational Cannabis
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Washington (2013)
Colorado (2013)
Washington, DC (2014)
Oregon (2014)
Alaska (2014)
• Although above states have legalized recreational marijuana, others
have decriminalized use (lowered policing efforts, fines instead of
other penalties)
If weed can be used for medical purposes, then
why is it illegal in different states?
• Good question
• Long-standing influences from culture, government
Cannabis
Acute effects
 THC acts on cannabinoid receptors, increases dopamine, serotonin
 Increases appetite
 ASAP Science: Your Brain on Marijuana (via YouTube, 2:26)
Are blunts much worse for health than bongs, joints,
and other forms of smoking?
 Possibly (more smoke since more product; depends on inhalation, frequency,
amount of time passing when one smokes
for health?
Are wraps like Swisher Sweets or White Owls bad
 Some wraps are made with tobacco
 Overdose generally doesn’t occur
◦ Large amount required
◦ Smoking a lot may induce sleepiness
◦ Eating too much may trigger nausea, vomiting
◦ Q13 News story, Michigan
 Mixing any chemical substances can potentially cause a problem
Alcohol vs Cannabis
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More research on alcohol
Age dependent
Amount of alcohol/amount of cannabis
Mixing substances
Alcohol interferes with neurogenesis of brain cells (Gary L.Wenk,
Psychology Today, 2010)
• Cannabis: 2014 study showing regular use impacted decisionmaking and judgment (Published online before print November 10, 2014, doi:
10.1073/pnas.1415297111. PNAS November 10, 2014; found online here)
Depression and Anxiety
• Many use marijuana to ease mood
• Regular use may trigger, or worsen, either condition,
especially in younger people
• 2013 Imperial College study showed lower dopamine
levels in regular users, which may lead to more anxiety
• Marijuana, conversely, may help those with PostTraumatic Stress Disorder
• Memory inhibition
What are the negative side effects of smoking weed
other than it being bad for your lungs?
Chronic effects
 Respiratory distress
 Mood swings
 Impaired memory (potential hippocampus damage)
 Earlier research
 2011 NIMH/NIDA study
◦ Daily use may reduce brain receptor number
◦ Receptors regenerated with cessation
◦
Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry, molecular imaging
shows." ScienceDaily. ScienceDaily, 13 June 2011.
<www.sciencedaily.com/releases/2011/06/110606131705.htm>.
Marijuana & Respiratory Function
During Exercise
 Acute effect: any smoke
can interfere with oxygen
binding to red blood cells
 Acute: marijuana can
disrupt coordination,
balance, reaction time
 Acute: increase heart rate
and blood pressure
 Acute: stored THC in fat
could be released into
bloodstream during
exercise
 Chronic: depends on how
frequently one smokes,
type of exercise
LSD
•
LSD
Albert Hoffman: “Last Friday,
April 16,1943, I was forced to
interrupt my work in the
laboratory in the middle of the
afternoon and proceed home,
being affected by a remarkable
restlessness, combined with a
slight dizziness. At home I lay
down and sank into a not
unpleasant intoxicated-like
condition, characterized by an
extremely stimulated imagination.
In a dreamlike state, with eyes
closed (I found the daylight to be
unpleasantly glaring), I perceived
an uninterrupted stream of
fantastic pictures, extraordinary
shapes with intense,
kaleidoscopic play of colors. After
some two hours this condition
faded away.”
LSD
• Schedule I hallucinogen synthesized in 1930s
• Dosage measured in micrograms (very small)
• Manufacturing secretive: Nick Sand (National Geographic, 3:39)
• Same basic chemical structure
• Illegal, so cannot guarantee contents, care of
product
• Light and air may degrade drug
LSD Forms
• Crystal can be crushed,
mixed with other materials
into tablets: microdots
• Gelatin squares
• Converted to liquid paper
• Dosed onto sugar cubes
• Placed on candy (gummy
bears - Lake Tahoe, 2011,
e.g.)
• Usually taken orally
• Can be inhaled, injected,
applied transdermally
LSD Acute Effects
• Duration of “trip” = several hours in length
• Visual hallucinations (images, color, light)
• Altered perception of senses
• “Seeing sounds, hearing colors”
• Color, size of objects
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Altered perception of time, depth
Potential anxiety/panic
Experiences can vary widely
Serotonin receptors may be excited or inhibited
LSD experimentation on British soldiers (YouTube.com)
Overdose thought to be rare, but some individuals may not
respond well, or may experience problems if drug is different
than LSD
LSD
• Chronic effects may involve flashbacks, usually among those
who continue taking the substance
• Sudden onset of abnormal perceptions
• Hallucinogen Persisting Perception Disorder
• Visual images remain longer than in consciousness
• Dr. Henry Abraham (Tufts University) blog
• A 2013 PLOS One open access data study article
• National Survey on Drug Use and Health respondents
• 130,000+ subjects
• No relationship between lifetime hallucinogen use and mental
health issues
LSD Research
• US Food and Drug Administration allowed
LSD research
• Recent study sponsored by Multidisciplinary
Association for Psychedelic Studies, carried
out by Swiss physician Peter Gasser
• Information published 2014
• 12 patients with terminal illness, end-of-life anxiety
• Took one of two doses of LSD with talk therapy,
across eight weeks
• Those with larger dose reported improvement
What is DMT?
How does DMT work as a psychoactive drug?
DIMETHYLTRYPTAMINE (DMT)
Dimethyltryptamine
• Chemical structure
• Hallucinogenic ingredient
• Present in a variety of
plants
• Occurs naturally in the
body
• Schedule I substance
Image source: Wikimedia Commons
Dimethyltryptamine
• Often consumed via
beverage: ayahuasca tea
• Requires MAO-I (specific
vine)
• Ceremonial purposes
• Ashland, OR Brazilian church
lawsuit
• Ashland, OR Brazilian church
lawsuit
• Daime Church (DenizenTV)
• Can be injected, inhaled,
smoked
Dimethyltryptamine Effects
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Hallucinogenic visualizations
Mood change
Time distortion
Dissociation
Muscle twitching, coordination difficulties
Nausea, vomiting
Shorter-lasting effects than other hallucinogens
◦ “businessman’s trip” per DEA
◦ 30-60 minutes
 Video Clip - The Spirit Molecule, Part 1 (YouTube)
 Video Clip – London Real (34:00+ = trip described)
Source: Arch Gen Pesychiatry. 1994 Feb;51(2):98-108.
Heroin
Heroin
• Narcotic
• Synthesized from morphine in late 1800’s
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Morphine synthesized from opium poppy
Heroin 10x more powerful than morphine
Was thought to be less addictive
After many people became addicted, heroin was
outlawed in 1920’s
• Drug Ads (wings.buffalo.edu)
• Schedule I
Heroin
• Narcotic
• Synthesized from morphine in late 1800’s
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Morphine synthesized from opium poppy
Heroin 10x more powerful than morphine
Was thought to be less addictive
After many people became addicted, heroin was
outlawed in 1920’s
• Drug Ads (wings.buffalo.edu)
• Schedule I
Heroin Availability
• Increasing use in recent years
(DEA, 2015, via Business Insider)
• Across world, Afghanistan still
considered #1 opium
cultivator (United Nations)
• DEA reports, through 2015
National Drug Threat
Assessment, that most heroin
in US comes from Mexico
(DEA, 11/4/15)
• At left, estimates of heroin
production in Mexico, metric
tons (USDOJ)
Heroin Availability
• Change in heroin
trafficking – customs
border patrol areas,
2014 (DEA, via Business Insider,
Map 5)
Heroin
Acute effects
• Euphoria
• Slow, shallow respiration
• Analgesia (pain relief)
• Skin flushing/redness
• Stupor
• Dry mouth
• Nausea/vomiting
Overdose
• Frequently occurs when mixing with other substances
• DAWN: 258,482 emergency department visits, 2011
Heroin: Chronic Effects
• Respiratory
problems
• Collapsed veins from
injection
• High rate of injection
use leads to
increased disease
transmission risk
• From Mexico to the
Midwest (The Washington Post, 9/24/15,
~9:00)
Drug Preferences Ebb & Flow with Time
(DEA, National Drug Threat Survey, via Business Insider)
What to Do: Different Approaches
• Syringe exchanges (in
King County, United
States)
• Syringe vending
machines (right,
Puerto Rico)
• Supervised injection
clinics (e.g. Insite,
Vancouver, B.C.)
• Heroin prescription
Cocaine
Cocaine
• Extracted from coca
plant
• Meeting Cocaine
Farmers (BBC)
• Stimulant
• Schedule II drug
About Cocaine: Some History
• In late 1800’s was
prescribed by US
physicians
• Coca-Cola had
cocaine removed in
early 1900’s
• Cocaine wine was
available
Image is in the public domain
Cocaine Forms
• Powdered form
• Snorted
• Dissolved in water,
injected
• Processed in rock form
• Generally, the faster a drug
can enter the brain, the more
it will be abused
Pathways Into Brain
Cocaine Availability
• According to DEA, second most commonly used illegal
substance
• In WA, 604 kg of cocaine were seized in 2005
• Marijuana: 9873kg, heroin 8.2kg, meth 74.4kg
• South America is primary production source
• Other countries involved with transportation
• UNODC: Global Cocaine Production (Figure 21; p. 66)
• UNODC: Map 6; page 70
• Most cocaine enters US via Mexico
Cocaine Availability - Price
• Price depends on purity (50-70%), form of cocaine,
amount purchased, region, $10-200 (crack vs
cocaine, wholesale vs retail)
• UNODC: Table 9, page 71
Cocaine Effects
 Increased heart rate, blood pressure, temperature
 Improved mood, well-being
 Short-lived (few minutes to few hours)
 Increased sensation of energy
 Chronic users may experience bloody noses (damage to septum), brain
adaptations to cocaine-induced dopamine effects, compromised immunity
 Brain changes, even after halting use (Univ. of Utah; scroll to mouse)
 Lesions and clots in brain blood vessels
 Relationship between cognition & therapy dropout
Cocaine Overdose
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Seizures
Heart attack
Stroke
Kidney failure
Death
In 2010, cocaine-mentioned ER cases: 488,101 Source: DAWN
Cocaine Withdrawal
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Apathy
Fatigue
Depression/mood swings
Cravings for drug
Not as intense as withdrawal from heroin, alcohol
Post acute withdrawal syndrome (PAWS)
Cocaine Tolerance,
Dependence
• Tolerance may occur quickly
• Emphasis appears to be on psychological rather than physical
dependence
• Rats and self-administration (reinforcement)
How does Ecstasy prove to help people with PTSD?
What exactly is Molly?
How do you overdose Ecstasy? Molly?
MDMA
3,4-METHYLENEDIOXY-N-METHYLAMPHETAMINE
MDMA
• Molly, Ecstasy, Thizz
• Synthetic drug
• Stimulant and
hallucinogenic
properties
MDMA
• Acute effects on the brain
• Increased serotonin release
• Increased dopamine release
• Increased norepinephrine release
• Effects will vary since formula is not standardized or regulated
• Effects will vary based on the synthetic nature of substance
• MDMA-assisted therapy (Multidisciplinary Association for
Psychedelic Studies, video; 2:30-3:50, 14 subjects, per website)
• More on MDMA therapy for PTSD (The Verge via YouTube, MAPS
research through 7:00)
MDMA
• Chronic effects are controversial, per Carl Hart, Columbia
University (YouTube)
• Well-circulated animal studies showing neuron damage
Emergency Department Visits
Synthetics are currently
popular
• MDMA, bath salts, 2C-I, synthetic cannabis
• Lower price (think about economy’s influence)
• Drug popularity changes with time (synthetics were popular in
1970s)
• Health-related issues will subsequently ebb and flow as drugs move
in and out of favor
• That acknowledged, some can be devastating: Krokodil (CBS, 2013)
Which drugs are the most popular? (by
country here)
MUSHROOMS
Mushrooms
 Psilocybin/psilocin are two
active psyhoacticve
substances found in “magic
mushrooms”
Most from psilocybe genus,
couple dozen species
 Taken orally
 Recognized for centuries
Probably used in religious
rites
 Hallucinogen
 Schedule I
Mushrooms
• Dose
• Varies
• Fresh vs dried
• Dried mushrooms
typically less potent,
but most don’t know
how old product is
• User
• Trip desired
• ~1 mushroom or less
for new user
Mushrooms
• Acute effects:
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Relaxation
Altered perception of reality
Altered perception of time
Sense of connection to others/universe
Visual hallucinations (images, color, light)
Potential for anxiety and subsequent panic, heart rate & blood
pressure increase
 Chronic effects:
◦ A “bad trip” may trigger fear
◦ Hallucinogens may exacerbate mental illness
Mushrooms
How do they interact with antidepressants?
 According to 2006 publication of Australian Pharmacist:
 Information on LSD only (hallucinogens impact serotonin)
 Taking anti-depressants may increase or decrease hallucinogen’s effects
 Avoid stopping SSRI medications
 Flu-like symptoms
 Headache
 Mood changes
 Irony? Treatment investigations: OCD, depression, smoking
cessation
 In depression, psilocybin may “turn off” parts of the brain that are
overactive among individuals who are depressed (Discovery, 1/2012)
◦ Johns Hopkins Psilocybin Cancer Project (via YouTube, 0:30-4:03)
• Largely depends on availability
• Carl Hart, Columbia University, on drug abuse (0-2:40)
• Most emergency department (ED) visits: alcohol (DAWN, 2011)
• Half + of 2.5 million ED visits: illicit substances
Cocaine – 505,224
Combinations – 10,388
Marijuana – 455,668
Inhalants – 10,032
Heroin – 258,482
Unclassified hallucinogens – 8,043
Amphetamine/meth. – 159,840
LSD – 4,819
PCP – 75,538
GHB – 2,406
Synthetic cannabinoids – 28,531
Ketamine – 1,550
MDMA – 22,498
• “Why do we focus more on jailing addicts than recovery
options? What helps people quit these substances? Are there
any positive uses that have been proven and could be used
under a doctor’s watch?”
• History, government, culture
• Cocaine, opium available in 1800s, early 1900s
• Harrison Act in early 1900s regulated these substances – taxing
• Those who did not pay the tax were in legal trouble (tax evasion)
• Physicians were unable to prescribe narcotics to dependent patients
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Alcohol prohibited (prohibition later appealed)
Heroin Act, Narcotic Drug Import & Export Act
1970 Drug Abuse Prevention & Control Act
NIDA Principles of Effective Treatment
Student Question (continued)
• WHO ATLAS on
Substance Abuse (2010;
147 countries)
• Alcohol main problem
• Other drug issue is
cocaine
• 39 deaths per 100,000 (35
due to alcohol)
• Not enough government
resources
• Africa – treatment mainly
funded by out of pocket $
• Beds: 1.7 per 100,000
• Many other issues
METHAMPHETAMINE
Methamphetamine
• Famous/notorious for laboratory production, short-term dopamine
effects & long-term effects
• Stimulant (blood pressure, heart rate, alertness)
• DEA: Schedule II substance (Desoxyn: ADD, narcolepsy, weight
control)
Methamphetamine acute
effects
 Intense high/euphoria
◦ May last up to 12 hours (longer than cocaine)
◦ Meth Inside and Out video describing effects
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Energetic, talkative, excitable
Insomnia
Increased heart rate, blood pressure
Sweating
Dry mouth
Jaw clenching
Nausea, vomiting
Comparison: meth vs cocaine,Brookhaven National
Laboratory, 2008
Methamphetamine chronic effects
 Chronic users may experience hallucinations, rage, paranoia, heart
“meth mouth;” damage to dopamine-, serotonin-containing nerve cells
◦ Crank Bugs (Meth Project)
◦ Meth Mouth (Meth Project)
◦ Ashley’s Story (Meth Project)
◦ Research supports both brain damage as well as lack of brain damage
Methamphetamine Chronic
Effects
Before & After Photos
Before and After Photos
3 Years and 5 months after starting meth
Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm
Before and After
17 months after starting meth
Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm
Before and After
3 months later
Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm
• Depends on availability, mode, reasons for use
• 2008 study by Hser et. Al.:
• Researchers examined data from five studies
• Assessed 10-year drug behaviors among 629 heroin users, 694
cocaine users, 474 meth users
• Heroin users: used 13-18 days per month
• Cocaine: used 8-11 days per month
• Meth: 12 days per month
• Groups – “consistently high use,” “increasing use,” “decreasing
use,” “moderate use,” “low use”
• Heroin over-represented in “consistently high use,” underrepresented in “low use”
• 2011 study by Novak et. Al. – injection users were more likely
to abuse and become dependent