Downers

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Downers

• Opiates/Opioids
• Sedative-Hypnotics

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General Classification

• Downers Slow down activity in the Center Nervous
  System
• Sedation, muscle relaxation, drowsiness
• Extreme cases coma by depressing the Central
  Nervous System
• Downers work on many more receptor
• sites than in the body than uppers.

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Major Depressants

• Opiates/Opioids
• Developed to treat acute pain, diarrhea, coughs,
  other illnesses
• Abused for euphoric effects, pain relief,
  suppression of withdrawal symptoms

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Major Depressants

• Sedative- reduce anxiety
• Hypnotics- induce sleep
• Synthesized drugs, devised to treat nervousness
  insomnia
• All have toxic side effects, can cause dependence

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Sedative-Hypnotics Benzodiazepines Xanax ?,
Valium ?, Halcion ?, Librium ?, Rohypnol ?,
Klonopin ?, Restoril ?, Ativan ? Barbiturates Sec
onal ?, Nembutal ?, Amytal ?, phenobarbital Other
s Chloral hydrate, GHB, GBL, Placidyl ?, etc.
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Minor Depressants

• Skeletal Muscle Relaxants
• Synthetically developed to depress areas
• of the brain responsible for muscle coordination
  activity
• Prescribed for muscle tension pain
• Antihistamines
• Synthetic drugs used to treat allergies, ulcers,
  shock, rashes, motion sickness, produce
  drowsiness, block the release of histamine, can
  induce depression/drowsiness

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Minor Depressants

• Over-The-Counter Downers
• Nytol Sominex, Calm,
• Many new products on the market
• Promoted as sleep aids sedatives

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Opiates/Opioids

• Classification
• Some of the most widely used drugs
• Have been the source of worldwide problems,
  political, economic, health
• History of Use
• Opium was used by the ancient Sumerians,
  Egyptians, Chinese
• Used as medicine, pleasure inducing substance,
  poison

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Legal Changes

• 20th Century
• 1914 Harrison Narcotic Act passed
• Non-medical use of opiates cocaine made illegal
  in US
• Required all distributors to pay a tax on the
  drugs used for medical purposes
• Legal prescriptions diverted to illegal markets

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Methods of Ingestion

• Oral
• Opium was originally chewed, eaten, or drunk
• Used in medications from Middle Ages to present
• 30-20 minutes to reach brain
• Smoking
• Non-medical use increased the intensity
• multiplied abuse potential
• 710 seconds to reach brain

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Opium Changes

• Refinement of Opium
• Morphine made from opium, increased the
  strength 10X
• Heroin refined from morphine, made it even
  stronger
• Codeine 1/5 the strength of morphine

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Methods of Ingestion

• IV Use
• 1858 The invention of hypodermic needles
• Morphine/Heroin began to be injected
• Increased intensity/addictive potential
  (especially with heroin
• 15-30 seconds to reach brain
• Snorting
• Popular methods of taking heroin
• Requires more drug to produce highs
• 5-8 minutes to reach brain

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Effects of Opioids

• Pain
• Prevent transmission of neurotransmitters that
  transmit pain
• Painkilling effects lowered anxiety, serenity,
  drowsiness, deadening of unwanted emotions
• Pleasure
• Artificially activate reward/pleasure center
• Pain relief euphoria main reasons for addiction

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Natural Pain Suppression
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Artificial Pain Suppression
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Effects of Opioids

• Satiation
• Disrupts the pleasure-regulating control in the
  brain, causes craving of pleasurable effects
• Receptor Sites
• Opioids slot into the receptors causing more
  intense reactions than normal
• Cough Suppression Diarrhea Control
• Opioids suppress coughs by controlling the cough
  center in the brain stem
• Inhibit gastric secretions depress intestinal
  muscles

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Effects Opiates/Opioids Pain suppression Pinpoint
pupils Lowered heart rate, blood pressure,
respiration Constipation Cough suppression Lax
muscle tone Dryness of mouth Euphoria
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Side Effects of Heroin Opioids

• Physical Effects
• Felt in almost every part of the body
• Includes Drooping eyelids, nodding,
  slowed/slurred speech, slowed muscle reactions
• More severe in digestive/hormonal systems
• Tolerance
• Tolerance Body builds up a resistance to the
  drug requires user to increase usage to
  maintain usual effects. Occurs rapidly with
  opioids

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Side Effects of Heroin Opioids

• Tissue Dependence
• Tissue Dependence Adaptation to effects of a
  drug alters brain chemistry. Body begins to
  rely on drug to feel normal. Intensifying the
  desire to use the drug again
• Withdrawal occurs after 2-3 weeks of continuous
  use followed by abstinence
• Heroin/morphine cause severe physical withdrawal
  peak at 48 hours lasts 5-7 days
• Methadone milder, but longer lasting up to 14 days

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Additional Problems

• Neonatal Effects crosses the placental barrier
  giving large doses to unborn fetus
• Overdose occurs when so much of the drug enters
  the brain the nervous system shuts down. Blood
  pressure drops, heart becomes to weak to pump
  blood, lungs labor fill with fluid
• Dirty Shared Needles Hepatitis B C, HIV,
  flesh eating bacteria, gangrene, endocarditic,
  malaria, syphilis

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Polydrug Use

• Mixing Opioid users often mix cocaine or
• amphetamine, speedball. Combine heroin
• marijuana to give it more kick.
• Alcohol benzodiazepines create synergistic
  effects increase potential for overdose,
  respiratory depression death
• Cycling Addicts go on off their drug of choice
  
• Lowers tolerance tissue dependence so
  the body can attempt to return to normal. Switch
  to alcohol, marijuana,
• barbiturates, benzodiazepines

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Other Opioids

• Codeine
• Used for relief of moderate pain control cough
• Hydrocodine- Vicodin
• One of the most widely abused prescription drug
• Methodone- longer acting synthetic opioid
• Reduces drug craving blocks withdrawal symptoms
• Oxycodone Percodan, Oxycontin
• Both extremely addictive

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Barbiturates

• Sedative hypnotic over 2,500 different types of
  the drug
• Many medical uses Phenobarbital, seizures
• Seconal, Nembutal induce sleep
• Pentothal used in anesthesia
• Temporary stimulation then sedation
• Immediate Unconsciousness

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Tolerance Tissue Dependence

• Develop very quickly with sedative-hypnotics
• Liver becomes very efficient in processing
• Age dependences occurs
• Tissue Dependence occurs when 8-10 times
• the normal dosage is taken for 30 days
• Withdrawal can be severe, seizures,
  convulsions, death
• Must have professional intervention for
  successful withdrawal

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Benzodiazepines

• Widely prescribed legal sedatives
• Zanax,Valuim, Ativan
• Medical Uses
• Anxiety, panic disorders
• Calm down before surgical procedures
• Sleep problems
• Muscular spasms
• Help with acute alcohol withdrawal

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Benzodiazepines Very Long Acting Short
Acting Halazepam (Paxipam?) Alprazolam (Xanax
?) Prazepam (Centrax ?) Temazepam (Restoril ?)
Flurazepam (Dalmane ?) Oxazepam (Serax
?) Lorazepam (Ativan ?) Intermediate
Acting Very Short Acting Clonazepam (Klonipin ?)
Triazolam (Halcion ?) Chlordiazepoxide (Librium
?) Diazepam (Valium ?)
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Effects of Benzodiazepines Anxiety control (e.g.,
panic attack) Relaxation Drowsiness
sleep Control seizures Reduced muscular
coordination Dulled physical sensations Tolerance
to effects develops
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Other Sedative-Hypnotics

• GHB (gammahydroxybutyrate)
• Odorless, tasteless, colorless powder
• Popular among bodybuilders
• Has an effect similar to alcohol intoxication
• Also popular in rave clubs
• Two CSU, Chico student deaths due to
• GHB Alcohol
• Female Butte College student Spring 2002

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Drug Interactions

• Synergism
• Combined effects of drugs are greater than the
  individual effects
• Results in 4,000 deaths 50,000 ER visits/year
• Cross-Tolerance Cross Dependence
• Development of tolerance to other drugs because
  of exposure to a drug
• Addiction to one drug increases liability to
  addiction to other drugs in the same family

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Economics

• 2002 Americans spent 91 billion on prescription
  medications
• Three times the amount 10 years ago
• 15 billion on over- the- counter drugs
• 50-60 billion on illegal drugs
• 75 billion on tobacco
• 140 billion on alcohol WOW!!

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United States 33
Australia 1
Africa 1
Japan 18
Europe 29
Middle East 2
Latin America 7
Canada 1
Southeast Asia China 8
World Prescription Drug Market