Psychoactive Drugs the Updated Story

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Psychoactive Drugs the Updated Story

• David Scratchley, Ph.D.
• Clinical Director
• Matt Talbot Center

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(No Transcript)
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The Impact of Addictive Drugs on Neural
Functioning
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Stimulants Crank Crack

• Stimulant use, especially, Methamphetamine is
  epidemic is region.
• Methamphetamine is 6th leading cause of
  drug-related death nationally
• Lab seizures have increased several-fold

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Images of Methamphetamine
Methamphetamine
Ice or Glass
CH3
CH2
NH
CH2
CH3
NH2
CH3
Amphetamine
Methamphetamine
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Physical Effects of Stimulant Use

• Physical Effects Associated with Stimulant Use
• Addiction
• Death
• Brain Damage
• High Blood Pressure
• Seizures
• Skin Ulcers
• Chronic Fatigue
• Extreme Anorexia
• Cardiac Arrest
• Bad Teeth

Lung Disease
Skin Ulcers
Tooth Abscesses
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Methamphetamine Summary of Effects
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Stimulant Toxicity

• Signs of toxicity
• Movement disorder
• Hyperfocused attentional state
• Stereotypic behavior
• Paranoid thought
• Hallucinations

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Long-Term Neurological Damage

• Potential damage to Basal Ganglia and Right
  Frontal Cortex.
• Both areas are rich in dopamine activity.
• Imaging studies have demonstrated a reduction of
  N-acetyl-aspartate of 5 in the frontal white
  matter and 6 in the basal ganglia in 26 users of
  methamphetamine.
• A corresponding increase in glial cells was also
  found.

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Anxiety

• Most frequent reason for admission of
  methamphetamine user to mental health hospital
• May appear as a reactive attitude (jumpy,
  agitated state) following prolonged use.
• Commonly develops as panic anxiety following
  periods of extended use.

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Prolonged Depression Following Cessation of Use

• Use of methamphetamine has been found to produce
  a reduction in serotonin.
• This reduction in serotonin has been found to
  continue for several months following the last
  use of the drug.
• A consequence of this depression in serotonin is
  that mood remains anhedonic for several months
  following abstinence.

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Cocaine Different Preparations But Same Active
Ingrediant

• Cocaine can be snorted, smoked, or injected.
• Crack is a form of cocaine modified to withstand
  heat so it allows for smoking essentially
  free-base.
• Powder forms of cocaine can be injected or
  snorted or used as follies all forms are
  potentially deadly.

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An Overview of Cocaines Behavioral Actions

• When Cocaine is used in conjunction with Alcohol
  it Forms Deadly Compound Cocaethylene
• Cocaine can cause the heart to misfire causing an
  arrhythmiathis can be fatal.
• Adrenaline increases heart rate and blood
  pressure.
• Crack smoking releases Methylecgonidine which
  effects the heart, lungs, and liver
• High is short-lived, as short as fifteen minutes
  with Crack leaving the user depressed and craving
  more.
• Heart failure, Cerebral Hemorrhage,
  Hallucinations, and Paranoid Delusions are all
  potential health risks associated with the use of
  cocaine in any form

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Cocaine
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Marijuana The Other Sedative
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Marijuana - Pharmacology

• Active Ingredient Delta - 9 Tetrahydrocannabinol.
  
• Introduces 60 unique chemicals into the body.
• New techniques have increased the amount of THC
  in typical plant product
• Frequently mixed with Formaldehyde

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Marijuana

• Wide spectrum of physical effects, many of which
  are poorly understood
• Dose-dependent effect in traffic accidents
• Rates of addiction are frequently underestimated
• Potency of marijuana is significantly higher than
  in the recent past

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Marijuana Behavioral Action

• Drug Detected for 250 Hours (one time use)
• Increases Distractability
• Decreases attention span
• Impairs short-term memory
• Alters perception of time
• Creates false perception of richness of thought
• Reduces Anxiety
• Impacts motivation

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Prescription Medications and Abuse...the Updated
Story

• David Scratchley, Ph.D.
• Washington State Prevention Summit
• October 17th 2008

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Medications, Like Street Drugs,Act in the
BrainBut Differences Exist in Dose, Schedule and
Route Used
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Incorrectly Used, Prescription Medications are as
Dangerous as Street Drugs - or More So
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Faces of Prescription Drug Abuse

• "Mr. Heath Ledger died as the result of acute
  intoxication by the combined effects of
  oxycodone, hydrocodone, diazepam, temazepam,
  alprazolam, and doxylamine," the office said in a
  short statement.
• "We have concluded that the manner of death is
  accident, resulting from the abuse of
  prescription medications.
• - CNN February 6th 2008
• Susie Hall's 18-year-old son, Jordan, was found
  dead of an apparent overdose July 4 after months
  of prowling emergency rooms begging for
  prescriptions for Xanax, Valium or OxyContin -
  The Dallas Morning News July 20th 2007

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Prescription Medications

• Present a significant overdose risk, including
  harmful physical and psychological effects,
  including the possible lethal overdose
• Present a significant risk of addiction
• A often similar to Street drugs in actions of
  their active ingredients
• Differ from Street drugs, when used as
  prescribed, in terms of Dose, Schedule, and Route
  of Use.
• Classes of Abused Prescription Medications
  Include Painkillers, Stimulants, and Depressants

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Prescription Painkillers, Opiates and Heroin
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Analgesics

• Opiate painkillers may contain a wide range of
  drugs
• Drugs found in these medications include
  morphine, methadone, meperidine, opium,
  propoxyphene, oxycodone, and buprenorponine
• Non-steroidal anti-inflammatory agents
  (inbuprofen etc.) may provide an alternative

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OxyContin (Oxycodone)

• Powerful opiate agonist
• Intended route of administration Oral
• Misused by chewing or inhaling
• When chewed or inhaled, drug is much more rapidly
  absorbed
• Result Significant increase in number of
  overdose deaths and ER visits

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Vicodin (Hydrocodone)

• From 1990 the average consumption nationwide has
  increased by 300. In the same period there has
  been a 500 increase in the number of Emergency
  Department visits attributed to Vicodin abuse
  with 19,221 visits estimated in 2000.
• Vicodin is structurally related to codeine and is
  approximately equal in strength to morphine in
  producing opiate-like effects.

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Methadone and Other Prescription Painkillers

• Methadone is responsible for over 4000 overdose
  deaths a year.
• Methadone is a synthetic form of morphine which
  remains in the body for approximately 24 hours

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Heroin

• Powerful Opiate Agonist
• Short-acting 6 Hours Until Withdrawal Starts
• Can Be Smoked, Snorted, or Injected
• Seattle Has the Second Highest Population of
  Heroin Users in US San Francisco is First
• Heroin Can Come in the Form of Black Tar or White
• Often is Used in Combination with Cocaine

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Examples of Analgesics Containing Opiates and
Opioids

• Lortab
• Luline
• MSIR
• Mepergan
• Methadone
• Morphine
• Nubain
• Nubain
• Numorphan
• Oramorph
• Oxycodone
• Pantopon
• Pentazocine
• Percocet
• Percodan
• Phenaphen/Codeine
• Phrenilin
• Propoxyphene

• Alfenta
• Anexsia
• Astrmorph
• Codeine
• Dalgan
• Darvocet
• Darvon
• Demerol
• Dilaudid
• Duragesic
• Durmorph
• Esgic
• Firoicet
• Fiorinal
• Hydrocet
• Hydrocodone
• Hydromorphone
• Levo-Dromoran

• Roxanol
• Roxicodone
• Sedapa
• Stadol
• Sublimaze
• Synalgos
• Talacen
• Talwin
• Tylenol/codeine
• Tylox Vicodin
• Wygesic
• Zydone

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Stimulant Drugs and Medications
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Stimulants Medications Use and Abuse

• Stimulants, including Ritalin (methylphenidate),
  and Adderall (Biphetamine and other analogs) have
  widespread utility in the treatment of several
  types of disorders
• Frequently, stimulant drugs may be sold or used
  by those without a prescription in an attempt to
  increase energy or work while tired.

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Stimulants Medications

• Often given for ADD or ADHD, for nacroleptic
  conditions, or for head injury.
• Drugs in this class have been, and, infrequently
  are, still given for obesity.
• Many of the drugs in this class share
  similarities to amphetamine or cocaine
• Drugs in this class are frequently diverted for
  illicit use.

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Effects of Stimulant Abuse

• Toxicity
• Movement disorder
• Hyperfocused attentional state
• Stereotypic behavior
• Paranoid thought
• Hallucinations

• Physical Effects
• Death
• Brain Damage
• High Blood Pressure
• Seizures
• Chronic Fatigue
• Extreme Anorexia
• Cardiac Arrest

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Stimulants

• Benzphetamine
• Biphetamine
• Desoxyn
• Dexadrine
• Didex
• Methylphenidate
• Obertrol
• Pemoline
• Tenuate Dospan
• Tepanil
• Ephedrine

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Sedatives and Hypnotics
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CNS Depressants

• CNS Depressants are Drugs with a Sedating Effect
  Used to Treat Anxiety, Sleeplessness, or Seizures
• Commonly Prescribed Drugs in this Group include
  Benzodiazepine Compounds like Valium, Xanax, and
  some barbiturates
• These drugs present a significant overdose risk
  when taken in excess or when combined with
  alcohol or opiates.

• Depressant Overdose
• Difficulty remaining conscious or passing out
• Decrease in judgment
• Lack of motor coordination
• Behavioral disinhibition
• Depressant Withdrawal
• rapid heartbeat
• shaky hands
• insomnia or disturbed sleep
• sweating
• irritability
• anxiety and agitation

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Sedatives

• Sedatives produce actions in the nervous system
  similar to those of ethyl alcohol and can be used
  to induce sleep or relaxation
• Tolerance can develop rapidly to these compounds
• Tolerance, in combination with the Iatrogenic use
  of drugs in this class, can lead to the ingestion
  of large quantities of drug
• Withdrawal can be life-threatening.

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Anxiolytic Compounds

• Like the sedative compounds, these drugs share
  some features in common with ethyl alcohol.
• Anxiolytic compounds are designed to reduce
  anxiety and can be used to initiate sleep
• Tolerance and use with alcohol commonly are
  reported
• Withdrawal is significant and complex

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Xanax A Commonly Abused CNS Depressant

• Nearly 5 million people have at one point taken
  Xanax or a similar anti-anxiety medication for
  nonmedicinal reasons, according to a 2000 survey
  conducted by the federal Substance Abuse and
  Mental
• More than 22,000 Xanax-related emergency-room
  visits were reported in the United States in
  2000, up from 16,000 seven years before,
  according to the Substance Abuse and Mental
  Health Services Administration.

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Anxiolytics (Tranquilizers)

• Benzodiazepines
• Ativan
• Centrax
• Librium
• Limbitrol
• Klonopin
• Serax
• Tranxene
• Valium
• Xanax

• Non-Benzodiazepine
• Atarax
• Deprol
• Equanil
• Hydroxyzine
• Meprobamate
• Milpath
• Miltown
• Vistaril

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Examples of Drugs Containing Barbiturate and
Other Sedatives

• Barbiturate
• Amytal
• Alurate elixir
• Butisol
• Fiorinal
• Fioricet
• Mebaral
• Nembutal
• Phenobarbital

• Non-Barbiturates
• Benadrul
• Chloral hydrate
• Dalmane
• Doral
• Halcion
• ProSom
• Restoril

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Muscle Relaxants

• Dantrium
• Flexeril
• Norflex
• Norgesic
• Robaxin
• Soma
• Valium

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Club Drugs, Hallucinogens and OTC Medications
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Organic Solvents (including Alcohol

• High degree of solubility
• Act to transport chemicals into body tissues -
  especially the brain.
• Exposes body to cancer activating agents
• Exposes brain to agents normally excluded from
  the nervous system.
• Solvent alters the activity of nerve cells
• Reduces anxiety in the user.

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Glues and Solvents

• Easily available alternative to ethanol with
  severe physical consequences.
• Produces a drunk state similar to ethanol
  intoxication.

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PCP, Ketamine (Special K)

• Initially used in anesthesiology
• Addictive Risk High
• Causes Profound Dissociation
• Physiological
• Elevated vital signs
• Toxic psychotic state

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Gamma Hydroxy Butyrate (GHB) (Liquid X)

• Initially used experimentally
• Sold as dietary supplement
• Addictive Risk High
• Physiological Risk
• Cardiovascular
• Drug interaction
• Neuropsychiatric

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Ecstasy (XTC, Adam, X)

• Derivative of Meth-amphetamine
• Addictive Risk High
• Physiological Risk
• Cardiovascular
• Neurological
• Psychiatric

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LSD (Acid) Mushrooms

• Wide variety of hallucinogenic substances in use
• Addictive Risk Moderate
• Physiological
• Accidental Overdose
• Toxic Psychosis

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Over-the-Counter Drugs

• Dextromethorphan
• Diphenhydramine
• Alcohol containing mouthwash
• Asthma medications containing ephedrine
• Nasal decongestant sprays with ephedrine
• Anti-emetic