Drugs of abuse

Drugs of abuse

def. drugs or chemicals which are taken repeatedly in a pattern & amount that interferes with one’s health or normal function

used for a variety of reasons; they have multiple effects, usually producing a feeling of well-being in the user repeated use higher & higher dose needed to replicate the feeling emotional dependence, & in some, true physical dependence

Classification of dsoa

Opiates & Opioids: morphine, codeine, heroin, meperidine (Demerol), hydromorphone

Sympathomimetic stimulants: cocaine, amphetamines, metamphetamines, MDMA

Depressants: barbiturates, benzodiazepines, ethyl alcohol

Hallucinogens: LSD, mescaline, MDMA,

Others: PCP, marijuana, nicotine

Classification of drugs of abuse

CNS actionsStimulants: amphetamine, caffeine,

nicotine, cocaine - Depressants : barbiturates,

benzodiazepines, ETOHAnalgesics: narcotics (opiates & opioids)Sedative–Hypnotics: relaxants, induce

sleep: alcohol; anti-anxiety agents-tranquilizers; nonbarbiturates- Halcion, Quaalude; long-acting barbiturates – Phenobarbital; short-acting barbiturates - Seconal

Drugs of abuse

Legal classification

Schedule 1: high abuse, no recognized medical use, lack of safety

Schedule 2: high abuse, medical utility, high dependency risk

Schedule 3: lower abuse, medical utility, moderate dependency risk

Schedule 4: limited abuse, high medical utility, limited dependency risk

Schedule 5: minor problems

Drugs of abuseSchedule 1:

Heroin LSD MDMA Marijuana Methaqualone

Schedule 2: Opium Morphine Coca Cocaine Methadone Methampethamine

Schedule 3: Amphetamine Barbiturates Valium Xanax Anabolic steroids Codeine

Schedule 4: Chloral hydrate Meprobamate Paraldehyde phenobarbital

Schedule 5: limited amts

DEFINITIONSPositive reinforcement: release of positive

reinforcement neurotransmitters e.g. dopamine, endorphins

Tolerance: reduced effect with repeated use of the drug need for progressively higher doses to produce the same effect; due to down-regulation of receptors, changes in receptors, exhaustion of neurotransmitters, increased metabolic degradation, physiological adaptation

Cross-tolerance: for drugs of the same class

DEFINITIONSDependence- compulsion to take the drug

repeatedly Psychological dependence – positive

reinforcement causes a compulsion to take the drug

Physical dependence – negative reinforcement – distress upon stopping the drug (withdrawal) is the main reason for continuing to take it

Cross-dependence – different drugs within a pharmacological class can generally maintain physical dependence produced by another member

DEFINITIONS

Sensitization – craving for the drug

Withdrawal – symptoms are opposite to the acute effects of a drug

Detoxification – used to treat physical dependence “cold turkey” – abrupt stoppage of the drug “warm turkey” – gradual reduction in drug dosage

Psychomotor stimulants

Drugs: Cocaine Amphetamine(s) Methylpenidate Ephedrine Cathinone

Effects Mood elevation Wakefulness; increased

alertness, restlessness Heightened energy Mild to moderate

anorexia Sleep disturbance

Psychomotor stimulants

mechanism of action: indirect agonists – increase synaptic activity of the monoamines

withdrawal syndrome: lethargy. Depression, hypersomnia, craving

Cocaine – available as leaves, paste, salt, smokeable base – can be chewed, inhaled, snorted, rubbed on mucosa (e.g. gums) metabolized in plasma, Liver “crack baby”

Amphetamines

shabu (Metamphetamine) & ecstasy (MethyleneDioxyMetAmphetamine)

metabolized by Liver or excreted unchanged

effects: increased wakefulness, anorexia, Sympathomimetic: mydriasis, vasoconstriction, tachycardia,

hypertension, hyperthermia, hyperventilation, Vivid hallucinations & paranoid ideation Euphoria, sense of well-being, self-confidence

opiates

Opium – papaver (poppy plant)Opiate alkaloids – morphine &

CodeineSemi-synthetic opioids – Heroin

(diacetylmorphine)Synthetic opioids –

phenylheptamines (Methadone), phenylpiperidines (Fentanyl, Meperidine), morphinans (Levorphanol), benzomorphans ( Pentazocine)

Opium creates a psychic screen between the mind and the body of the smoker, so that pain becomes an abstraction, without the sharpness of physical sensation...The anesthesia produced by opium may be described as a sort of cerebral intoxication, a psychic fog between oneself and external reality that diminishes the outer world. The smoker forgets he has a body. His mind escapes the prison of the flesh and the material world, and is removed to the periphery of reality by the centrifugal force of opium. He escapes not only his own body, but also the physical world in which his body exists. Opium plays a siren's tune on the piano off his nerves, and as he listens, the smoker forgets about the passage of time, and he also forgets about hunger, thirst, fatigue and sleep."Nguyen Te Duc, (Le Livre de l'opium)

opiates

opioid receptors: mu, delta, kappa

Endogenous opioids: endorphins, enkephalins, dynorphins, endomorphins

opiates

Opioid antagonists: naloxone, naltrexone

physiologic effects – analgesia, miosis, constipation, cough suppression

opiates

Chronic use: Tolerance Sensitizations

Physical dependencePharmacological Tx of Opioid

abuse: Substitution: Methadone, Buprenorphine Opioid antagonist: Naltrexone

marijuana

delta-9-tetrahydrocannabinol (THC)in the resin of Cannabis sativa

Cannabinoid receptorsEndogenous cannabinoids Acute effects: euphoria & exhiliration;

relief of anxiety, disinhibition, time distortion, hunger/thirst, bloodshot eyes, attention & memory impairment, motor impairment

marijuana

Therapeutic uses: Dronabinol (Marinol)Antiemetic/antinausea – esp. in CA

chemoTxAppetite stimulantAntispasmodicReduction of intraocular Pressure - in

GlaucomaAnalgesia – in tic doloreauxBronchodilation – in asthmaNeuroprotective – in seizures

Psychedelics / hallucinogensSerotonin-like: LSDCatecholamine-like:

Mescaline Methoxyamphetamines: MDMA

Anticholinergic Atropa belladona Datura stramonium Mandragora officinarum Scopolamine, Hyoscyamine, Atropine

Dissociatives Phencyclidine (PCP, angel dust) Ketamine

CAFFEINE & XANTHINES

Coffee : Coffea arabica & C. robusta

Tea: Camellia (Thea) sinensis

Chocolate: Theobroma cacao

Cola: Cola acuminata

Effects: Bronchodilation Increased HR, BP Arousal

High dose: caffeinism, panic attacks; tremors

nicotine

Nicotiana tabacum (Tobacco)Receptors: nicotonic ACh

receptorsEffects

Psycomotor activity Alertness attention Cognitive function Sensorimotor performance Fluid retention Tremors Increased respiration

nicotine

Withdrawal: craving, dysphoria, anxiety, irritability, restlessness, impatience, anger, increased appetite, insomnia

Toxicity: cigarette smokeCancer: mouth, throat, larynx,

lungs, bladder, pancreas, uterus,

Cns depressants & alcoholEthyl Alcohol: Acetaldehyde

10 gm in 12 oz beer, 4 oz unfortified wine, or 1.5 oz 80-proof liquor

rapidly absorbed in the stomach & small intestines Metabolized by the liver at the rate of 10gm/hr

• Acute intoxication: mainly affects the CNS & Stomach • 20-30mg/dL= powerful depressant effect on cortical inhibitory

centers= loss of inhibitions= “party” syndrome; Euphoria; disordered cognitive & motor functions

• 100mg/dL= legal level of intoxication= Ataxia• 200-250mg/dL= narcosis= drowsiness

• 300-400mg/dL= coma; profound anesthesia; death

Chronic Alcoholism: induces injuries in all tissues Liver - most commonly & severely affected= fatty change, acute

hepatitis--- Cirrhosis CNS – Wernicke’s encephalopathy- ataxia, global confusion,

ophthalmoplegia, loss of neuropil & demyelination (vit B1 def) & Korsakoff syndrome- profound memory deficit both recent & remote; cerebellar degeneration; cerebral atrophy

Fetal Alcohol Syndrome: microcephaly, cardiac defects, mental deficiency, facial malformations

Misc.: neuropathies; congestive cardiomyopathy; ↑frequency of cancer in the larynx, oropharynx, esophagus, rectum, lung

Cns depressants

Drugs: Bromide, Chloral hydrate Barbiturates Methaqualone Benzodiazepines

sedative effect toxicity: respiratory

depression

Dangerous drugs act

Republic Act 6425: DANGEROUS DRUGS ACT OF 1972

RA 9165: an act instituting the COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002, repealing RA 6425, as amended, providing funds therefor, and for other purposes

Declaration of policy It is the policy of the State to safeguard the

integrity of its territory and the well-being of its citizenry particularly the youth, from the harmful effects of dangerous drugs on their physical and mental well-being, and to defend the same against acts or omissions detrimental to their development and preservation. In view of the foregoing, the State needs to enhance further the efficacy of the law against dangerous drugs, it being one of today's more serious social ills.

Toward this end, the government shall pursue an intensive and unrelenting campaign against the trafficking and use of dangerous drugs and other similar substances through an integrated system of planning, implementation and enforcement of anti-drug abuse policies, programs, and projects.

Declaration of policyThe government shall however aim to

achieve a balance in the national drug control program so that people with legitimate medical needs are not prevented from being treated with adequate amounts of appropriate medications, which include the use of dangerous drugs.

It is further declared the policy of the State to provide effective mechanisms or measures to re-integrate into society individuals who have fallen victims to drug abuse or dangerous drug dependence through sustainable programs of treatment and rehabilitation.

Drug testing

random urine sample other fluids: blood, sweat, saliva,

milk; other tissue: hair ‘screen’ : opiates,

benzodiazepines, barbiturates, cannabinoids, amphetamines, cocaine, methadone, buprenorphine

Length of time drugs are detected in urine

Alcohol – up to 1 dayAmphetamines (incl. Ecstasy) – 1 to 3

daysBarbiturates – 1 to 3 daysBenzodiazepines – 1 to 3 daysCannabis – up to 2 weeksCocaine – 1 to 3 daysCodeine; Dihydrocodeine – 1 to 2

daysHeroine, Morphine – up to 1 dayMethadone – 1 to 3 days

Thank you !