Drugs Of Abuse

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Drugs Of Abuse

• Dr. Jacqueline E. Campbell
• January 2007

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DRUG ABUSE

• Refers to the use , usually by self
  administration of any drug in a manner that
  deviates from the approved medical or social
  patterns within a given culture ( Jerome Jaffe ,
  1980 )

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Criteria for drug abuse

• Use of any prohibited drug
• Intentional taking of any therapeutic drug in
  amounts greater than prescribed / or self
  administration of any drug by routes other than
  medically approved

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Criteria for drug abuse

• Excessive use of licit social drugs
• Taking of two or more intoxicating substances in
  combination in order to obtain a more pleasurable
  or intense high

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Abuse potential

• Intrinsic dependence liability - drugs
  fundamental propensity to produce physiological
  or psychological dependence
• Availability of drug within society
• Inherent harmfulness of drug wrt direct
  physical psychological effects it produces in
  user

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Abuse potential

• of any given drug will depend on the degree to
  which these various factors interact to promote
  or limit widespread abuse

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Dependence liability

• Varies from one drug to another
• Depends on 3 factors
• Pharmacological activity of the drug molecule
• Route by which it is administered
• Amount of drug used

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Drugs with abuse potential

• Socially acceptable alcohol , caffeine
  nicotine
• Opioid analgesics- morphine , heroin
• Sedative / hypnotics
• Hallucinogens
• Inhalants
• Club drugs / designer drugs

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Drugs with abuse potential

• Stimulants cocaine amphetamines
• Cannabis
• Anabolic steroids
• antihistamines

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Cocaine

• Powerful CNS stimulant
• Effects noted are generally a result of the
  drugs stimulant properties

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Patterns of cocaine use

• Cocaine hydrochloride snorting (intranasal),
  smoking, intravenous (including being mixed with
  heroin (speedball or snowball)), ingestion,
  application to genitalia
• Crack cocaine inhalation of vapour from heated
  foil or pipe
• Freebasing
• Coca leaves chewed/ ingested  

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Crack cocaine

• Crack cocaine - produced when cocaine
  hydrochloride mixed with sodium bicarbonate
  (baking soda) and water, then heated. On cooling,
  rocks precipitated, can be smoked in crack
  pipes, or heated on foil vapour inhaled.

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Freebase cocaine

• Changes cocaine hydrochloride into smokeable
  more potent form
• Make cocaine hydrochloride alkaline by adding a
  base , then extracting cocaine base from mixture
  using organic solvent
• Solvent must be evaporated before being smoked

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Effects

• Short term use low doses
• CNS, behavioural , subjective
• CVS
• Respiratory
• GI

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Effects -SHORT TERM USE HIGHER DOSES-

• INTENSIFICATION OF COCAINES LOW DOSE EFFECTS

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EFFECTS OF LONG TERM USE

• BINGES FOLLOWED BY CRASHES
• INFECTIONS
• SLEEP DISORDERS
• FORMICATION
• MISCARRIAGES
• PREMATURE DELIVERY
• LOW BIRTH WEIGHT BABIES

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TOLERANCE DEPENDENCE

• To euphoric effects can develop over course of
  months or years or even within a few days during
  a binge

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Cannabis sativa

• Main psychoactive ingredient is delta 9 THC (
  tetrahydrocannabinol )

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Cannabis

• Effects of short term use low to moderate doses
• CNS , behavioural , subjective
• Cardiovascular
• Respiratory
• GI
• other

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Cannabis

• Effects of short term use higher doses
• CNS , behavioural , subjective
• Synesthesias
• Pseudohallucinations
• Impaired judgement
• Reaction time slowed

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Cannabis

• Effects of short term use higher doses
• True hallucinations
• Delusions
• Depersonalization

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Cannabis

• _at_ very high doses --- acute toxic psychosis
  characterized by hallucinations , paranoid
  delusions, disorientation , intense feelings of
  depersonalization, severe agitation , loss of
  insight

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Cannabis - long term use

• Psychological effects - occasional , low dose
  use does not appear to produce harmful
  psychological effects in healthy adults
• Risk of pronounced psychological dependence high
  among users w emotional problems who turn to
  cannabis to relieve psychological stress

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Cannabis - long term use

• Amotivational syndrome ???? Manifestation of
  chronic intoxication
• Other effects respiratory system bronchitis ,
  asthma , lung cancer

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Detection periods

• Span 4 6 days in acute users 20 50 days in
  chronic users

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Heroin or diacetylmorphine

• semi-synthetic opioid.
• is the 3,6-diacetyl derivative of morphine
• synthesised from morphine by acetylation
• white crystalline form is commonly the
  hydrochloride salt, diacetylmorphine
  hydrochloride

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Heroin- physical dependence / withdrawal

• Can develop v rapidly for regular high dose user
• Early symptoms
• Onset typically occurring 6 12 hrs after last
  dose

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Heroin- physical dependence / withdrawal

• Symptoms include
• Watery eyes
• Runny nose
• Yawning
• Sweating
• Above stage followed by phase called yen
  agitated sleep that may last several hrs

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Heroin- physical dependence / withdrawal

• On awakening agitation continues accompanied by
  depression , loss of appetite , dilated pupils,
  tremors

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Heroin- physical dependence / withdrawal

• Peak intensity
• Usu 36 72 hrs after last dose of heroin
• Bouts of chills , shivering alternating w bouts
  of flushing excessive sweating
• Goose flesh highly prominent
• Insomnia
• Violent yawning , sneezing

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Heroin- physical dependence / withdrawal

• NV , intestinal spasm , diarrhoea , pain in bones
  , muscles
• Uncontrolled kicking movements
• Severity of symptoms grad ? , most symptoms not
  present 5 10 days after onset of withdrawal
  sickness

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Heroin psychological dependence

• Can persist long after signs of withdrawal
  sickness have disappeared
• Chronic depression
• Anxiety
• Insomnia
• Loss of appetite
• Periods of agitation continued craving for drug
  may last for periods of months / even years

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Designer club drugs

• Manufactured by chemically altering controlled
  substances

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Designer club drugs

• Hallucinogens - MDMA methylenedioxymethamphetam
  ine- ecstasy
• methamphetamine
• Ketamine
• Date rape drugs gamma hydroxybutyrate ( GHB )
  Flunitrazepam ( Rohypnol )
• inhalants

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Hallucinogens - MDMA ecstasy

• Hallucinogenic stimulant properties
• _at_ low doses hallucinogenic effects predominate
• _at_ higher doses amphetamine like effects
  experienced

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Methamphetamine

• ? release of dopamine
• Weak inhibitor of monoamine oxidase
• Available in several forms smoked , injected ,
  snorted , orally
• Powder is hydrophilic so methamphetamine salt (
  ice ) recrystallized to form chunks which can
  be smoked

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Methamphetamine

• Smoking produces immediate bioavailability of
  drug ---- equivalent to i.v injection
• Acute intoxication ? ? alertness NRG, HTN ,
  arrthythmias, hyperthermia , ? respiratory rate
• Effects last for several hrs , persist longer
  than those of cocaine

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Methamphetamine

• Long term neurological effects stereotypical
  movements , psychotic behaviour , long term CVS
  effects

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Hallucinogens

• Cannabis
• LSD ( lysergic acid diethylamide )
• Mescaline
• Psilocybin
• DMT ( dimethyltryptamine )
• LSA ( d lysergic acid amide )

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Hallucinogens

• MDA ( methylenedioxyamphetamine )
• MDMA ( methylenedioxymethamphetamine ) ecstasy
• PMA ( paramethoxyamphetamine )
• STP
• harmaline , harmine
• TMA

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Hallucinogens- Dissociative anesthetics

• PCP ( phencyclidine )
• Ketamine
• PCE ( cyclohexamine )

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Hallucinogens- The atropinic family

• Atropine
• scopolamine

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Hallucinogens

• Amanita muscaria ( fly agaric mushroom )
• Nutmeg
• Peyote
• Angels trumpet
• Bufotenin
• Catnip
• Ibogaine