Hallucinogen Abuse and Addiction

1
Chapter 15

• Hallucinogen Abuse and Addiction

2
What are hallucinogens?

• Hallucinogens are drugs that cause hallucinations
  - profound distortions in a person's perceptions
  of reality. Under the influence of hallucinogens,
  people see images, hear sounds, and feel
  sensations that seem real but do not exist. Some
  hallucinogens also produce rapid, intense
  emotional swings. NIDA

3
Pharmacology

• Hallucinogens cause their effects by disrupting
  the interaction of nerve cells and the
  neurotransmitter serotonin. Distributed
  throughout the brain and spinal cord, the
  serotonin system is involved in the control of
  behavioral, perceptual, and regulatory systems,
  including mood, hunger, body temperature, sexual
  behavior, muscle control, and sensory perception.
  NIDA

4
Most used

• LSD (an abbreviation of the German words for
  "lysergic acid diethylamide") is the drug most
  commonly identified with the term "hallucinogen"
  and the most widely used in this class of drugs.
  It is considered the typical hallucinogen, and
  the characteristics of its action and effects
  described in this Research Report apply to the
  other hallucinogens, including mescaline,
  psilocybin. NIDA

5
History of Hallucinogens in the US

• See video

6
Names

• LSD-acid, blotter, zen, dots, paper, sugar
• PCP-angel, angel dust, boat
• Ketamine-Kat, K, purple, bump
• Ecstacy/MDMA

7
MDMA

• http//www.drugabuse.gov/infofacts/ecstasy.html

8
Chapter 16

• Inhalants and Aerosols

9
How are inhalants used?

• Inhalants can be breathed in through the nose or
  the mouth in a variety of ways, such as
• "Sniffing" or "snorting" fumes from containers
• Spraying aerosols directly into the nose or
  mouth
• "Bagging"-sniffing or inhaling fumes from
  substances sprayed or deposited inside a plastic
  or paper bag
• "Huffing" from an inhalant-soaked rag stuffed in
  the mouth and
• Inhaling from balloons filled with nitrous oxide.
  

10
What are they?

• Inhalants are volatile substances that produce
  chemical vapors that can be inhaled to induce a
  psychoactive, or mind-altering, effect. Although
  other abused substances can be inhaled, the term
  "inhalants" is used to describe a variety of
  substances whose main common characteristic is
  that they are rarely, if ever, taken by any route
  other than inhalation. NIDA

11
Volatile solvents

• liquids that vaporize at room temperatures. They
  are found in a multitude of inexpensive, easily
  available products used for common household and
  industrial purposes. These include paint thinners
  and removers, dry-cleaning fluids, degreasers,
  gasoline, glues, correction fluids, and felt-tip
  marker fluids. NIDA

12
Aerosols

• sprays that contain propellants and solvents.
  They include spray paints, deodorant and hair
  sprays, vegetable oil sprays for cooking, and
  fabric protector sprays.

13
Gases

• include medical anesthetics as well as gases used
  in household or commercial products. Medical
  anesthetic gases include ether, chloroform,
  halothane, and nitrous oxide, commonly called
  "laughing gas." Nitrous oxide is the most abused
  of these gases and can be found in whipped cream
  dispensers and products that boost octane levels
  in racing cars. Household or commercial products
  containing gases include butane lighters, propane
  tanks, whipped cream dispensers, and
  refrigerants. NIDA

14
Nitrites

• often are considered a special class of
  inhalants. Unlike most other inhalants, which act
  directly on the central nervous system (CNS),
  nitrites act primarily to dilate blood vessels
  and relax the muscles. While other inhalants are
  used to alter mood, nitrites are used primarily
  as sexual enhancers. Nitrites include cyclohexyl
  nitrite, isoamyl (amyl) nitrite, and isobutyl
  (butyl) nitrite, and are commonly known as
  "poppers" or "snappers." NIDA

15
What is thescope ofinhalant abuse?

• Inhalant abuse was up significantly for the
  second year in a row among 8th-graders, according
  to the latest MTF (Monitoring the Future study,
  an annual NIDA-supported survey of the Nation's
  secondary school students) while use among 10th-
  and 12th-graders continued to decline.
• The rate of high school seniors who abused
  inhalants in the past year was 4.2 percent in
  2004, down from the peak of 8.0 percent in 1995.
• Annual abuse of inhalants among 10th-graders was
  5.9 percent in 2004, also down from a high in
  1995 (9.6 percent).
• Among 8th-graders, 2004 abuse figures, at 9.6
  percent, were down overall from the 1995 peak of
  12.8 percent, but were up from the 2002 rate of
  7.7 percent. NIDA

16
How can inhalant abuse be recognized?

• Chemical odors
• Paint on face, hands, clothing
• Hidden spray or solvent cans and rags
• Slurred speech
• Acting drunk but no smell of alcohol detected

17
Complicatins of use

• Asphyxiation - from repeated inhalations, which
  lead to high concentrations of inhaled fumes
  displacing the available oxygen in the lungs
• Suffocation - from blocking air from entering the
  lungs when inhaling fumes from a plastic bag
  placed over the head
• Convulsions or seizures - caused by abnormal
  electrical discharges in the brain
• Coma - the brain shuts down all but the most
  vital functions
• Choking - from inhalation of vomit after inhalant
  use or
• Fatal injury - from accidents, including motor
  vehicle fatalities, suffered while intoxicated.

18
Pharmacology

• A recent study indicates that toluene, a solvent
  found in many commonly abused inhalants,
  including model airplane glue, paint sprays, and
  paint and nail polish removers, activates the
  brain's dopamine system. The dopamine system has
  been shown to play a role in the rewarding
  effects of many drugs of abuse. Nitrites, in
  contrast, dilate and relax blood vessels rather
  than acting as anesthetic agents. NIDA

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Chapter 17

• Steroids

20
Steroids

• Refer to your text for
• Scope of problem
• Medical uses
• Legal status
• Problems with use/abuse
• Complications

21
Chapter 18

• OVER THE COUNTER ANALGESICS

22
OTC

• Refer to your text
• Medical uses
• Uses
• Overdoses

23
Chapter 19

• TOBACCO PRODUCTS
• NICOTINE ADDICTION

24
Why Is It So Hard to Quit Smoking?

• Mark Twain said, "Quitting smoking is easy. I've
  done it a thousand times." Maybe you've tried to
  quit too. Why is quitting and staying quit hard
  for so many people? The answer is nicotine.

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SCOPE OF THE PROBLEM

• It wasnt until 1964 that the Surgeon General
  stated that cigerette smoking was dangerous
• Estimate is 1 billion smokers worldwide
• Estimate that 1 in 3 who smoke that first smoke
  will become addicted
• Estimate 46.5 million out of 265 million in US
  smoke cigerettes

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Substance Abusers Nicotine

• Prevalance rate is between 71-100
• Why?
• Some research indicates that a recovering addict
  will have a 4x greater chance at recovery if they
  stop nicotine. Why?

27
How does tobacco deliver its effects?

• There are more than 4,000 chemicals found in the
  smoke of tobacco products. The cigarette is a
  very efficient and highly engineered drug
  delivery system. By inhaling tobacco smoke, the
  average smoker takes in 1 to 2 mg of nicotine per
  cigarette8. When tobacco is smoked, nicotine
  rapidly reaches peak levels in the bloodstream
  and enters the brain. A typical smoker will take
  10 puffs on a cigarette over a period of 5
  minutes that the cigarette is lit. Thus, a person
  who smokes about 1-1/2 packs (30 cigarettes)
  daily gets 300 hits of nicotine to the brain
  each day. In those who typically do not inhale
  the smokesuch as cigar and pipe smokers and
  smokeless tobacco usersnicotine is absorbed
  through the mucosal membranes and reaches peak
  blood levels and the brain more slowly.NIDA

28
Impact

• Tobacco use is the leading preventable cause of
  death in the United States. The impact of tobacco
  use in terms of morbidity and mortality costs to
  society is staggering. Economically, more than
  75 billion of total U.S. healthcare costs each
  year is attributable directly to smoking7.
  However, this cost is well below the total cost
  to society because it does not include burn care
  from smoking-related fires, perinatal care for
  low birth-weight infants of mothers who smoke,
  and medical care costs associated with disease
  caused by secondhand smoke. In addition to
  healthcare costs, the costs of lost productivity
  due to smoking effects are estimated at 82
  billion per year, bringing a conservative
  estimate of the economic burden of smoking to
  more than 150 billion per year7.NIDA

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Brain Reward System

• Research has shown how nicotine acts on the brain
  to produce a number of effects. Of primary
  importance to its addictive nature are findings
  that nicotine activates reward pathwaysthe brain
  circuitry that regulates feelings of pleasure. A
  key brain chemical involved in mediating the
  desire to consume drugs is the neurotransmitter
  dopamine, and research has shown that nicotine
  increases levels of dopamine in the reward
  circuits. This reaction is similar to that seen
  with other drugs of abuse, and is thought to
  underlie the pleasurable sensations experienced
  by many smokers9. Nicotines pharmacokinetic
  properties also enhance its abuse potential.
  Cigarette smoking produces a rapid distribution
  of nicotine to the brain, with drug levels
  peaking within 10 seconds of inhalation9.
  However, the acute effects of nicotine dissipate
  in a few minutes, as do the associated feelings
  of reward, which causes the smoker to continue
  dosing to maintain the drugs pleasurable effects
  and prevent withdrawal.NIDA

30
Medical Consequences

• Cigarette smoking harms every organ in the body.
  It has been conclusively linked to leukemia,
  cataracts, and pneumonia, and accounts for about
  one-third of all cancer deaths14. The overall
  rates of death from cancer are twice as high
  among smokers as nonsmokers, with heavy smokers
  having rates that are four times greater than
  those of nonsmokers17. Foremost among the cancers
  caused by tobacco use is lung cancercigarette
  smoking has been linked to about 90 percent of
  all lung cancer cases, the number-one cancer
  killer of both men and women18. Smoking is also
  associated with cancers of the mouth, pharynx,
  larynx, esophagus, stomach, pancreas, cervix,
  kidney, ureter, and bladder7.NIDA

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Medical Consequences

• In addition to cancer, smoking causes lung
  diseases such as chronic bronchitis and
  emphysema, and it has been found to exacerbate
  asthma symptoms in adults and children. More than
  90 percent of all deaths from chronic obstructive
  pulmonary diseases are attributable to cigarette
  smoking. It has also been well documented that
  smoking substantially increases the risk of heart
  disease, including stroke, heart attack, vascular
  disease, and aneurysm7. It is estimated that
  smoking accounts for approximately 21 percent of
  deaths from coronary heart disease each
  year16.NIDA

32
Second hand smoke

• Environmental tobacco smoke is a major source of
  indoor air contaminants secondhand smoke is
  estimated to cause approximately 3,000 lung
  cancer deaths per year among nonsmokers and
  contributes to more than 35,000 deaths related to
  cardiovascular disease7. Exposure to tobacco
  smoke in the home is also a risk factor for new
  cases and increased severity of childhood asthma
  and has been associated with sudden infant death
  syndrome. Additionally, dropped cigarettes are
  the leading cause of residential fire fatalities,
  leading to more than 1,000 deaths each
  year20.NIDA

33
Pregnancy Nicotine

• In the United States, it is estimated that 18
  percent of pregnant women smoke during their
  pregnancies1. Carbon monoxide and nicotine from
  tobacco smoke may interfere with the oxygen
  supply to the fetus. Nicotine also readily
  crosses the placenta, with concentrations in the
  fetus reaching as much as 15 percent higher than
  maternal levels24. Nicotine concentrates in fetal
  blood, amniotic fluid, and breast milk. Combined,
  these factors can have severe consequences for
  the fetuses and infants of smoking mothers.
  Smoking during pregnancy caused an estimated 910
  infant deaths annually from 1997 through 200115,
  and neonatal care costs related to smoking are
  estimated to be more than 350 million per
  year7,25.NIDA

34
Pregnancy Nicotine

• The adverse effects of smoking during pregnancy
  can include fetal growth retardation and
  decreased birth weights. The decreased birth
  weights seen in infants of mothers who smoke
  reflect a dosedependent relationshipthe more
  the woman smokes during pregnancy, the greater
  the reduction of infant birth weight26,27. These
  newborns also display signs of stress and drug
  withdrawal consistent with what has been reported
  in infants exposed to other drugs28. In some
  cases, smoking during pregnancy may be associated
  with spontaneous abortions, sudden infant death
  syndrome, as well as learning and behavioral
  problems in children. In addition, smoking more
  than a pack a day during pregnancy nearly doubles
  the risk that the affected child will become
  addicted to tobacco if that child starts
  smoking29.NIDA

35
Gender Differences

• women smoke fewer cigarettes per day, tend to use
  cigarettes with lower nicotine content, and do
  not inhale as deeply as men. However, it is
  unclear whether this is due to differences in
  sensitivity to nicotine or other factors that
  affect women differently, such as social factors
  or the sensory aspects of smoking.
• The number of smokers in the United States
  declined in the 1970s and 1980s, remained
  relatively stable throughout the 1990s, and
  declined further through the early 2000s. Because
  this decline in smoking was greater among men
  than women, the prevalence of smoking is only
  slightly higher for men today than it is for
  women30. Several factors appear to be
  contributing to this narrowing gender gap,
  including increased initiation of smoking among
  female teens and women being less likely than men
  to quit31.

36
Why do women quit less?

• Although postcessation weight gain is typically
  modest (about 510 pounds), concerns about this
  may be an obstacle to treatment success. In fact,
  NIDA research has found that when womens weight
  concerns were addressed during cognitive-behaviora
  l therapy, they were more successful at quitting
  than women who were in a program designed only to
  attenuate postcessation weight gain32. Other NIDA
  researchers have found that medications used for
  smoking cessation, such as bupropion and
  naltrexone, can also attenuate postcessation
  weight gain and could become an additional
  strategy for enhancing treatment
  success33,34.NIDA

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Numerous forms of treatment

• Nicotine replacement therapies (NRTs), such as
  nicotine gum and the transdermal nicotine patch,
  were the first pharmacological treatments
  approved by the Food and Drug Administration
  (FDA) for use in smoking cessation therapy.
• NRTs are used (in conjunction with behavioral
  support) to relieve withdrawal symptomsthey
  produce less severe physiological alterations
  than tobacco-based systems and generally provide
  users with lower overall nicotine levels than
  they receive with tobacco12. An added benefit is
  that these forms of nicotine have little abuse
  potential since they do not produce the
  pleasurable effects of tobacco productsnor do
  they contain the carcinogens and gases associated
  with tobacco smoke. Behavioral treatments, even
  beyond what is recommended on packaging labels,
  have been shown to enhance the effectiveness of
  NRTs and improve long-term outcomes.

38
The Patch

• The nicotine patch is a small, self-adhesive
  patch that slowly releases nicotine into the
  bloodstream through the outer layer of skin. It
  can be applied anywhere between the waist and
  neck often the upper arm or shoulder. Patches
  must be replaced every 24 hours.
• Brand names include Nicoderm CQ and Habitrol.
  Generic patches also are available.
• Pros The patch is easy to use and provides a
  steady release of nicotine. It's available
  without a prescription and in various doses. This
  flexibility allows you to manage your withdrawal
  symptoms and cravings, as well as to taper the
  amount of nicotine you receive gradually.
• Cons You can't quickly adjust the amount of
  nicotine in the patch in response to cravings.
  The patch may cause itching and irritation where
  it's applied. Other side effects may include
  headache, dizziness, upset stomach and blurred
  vision. Occasionally, patches may cause sleep
  disturbances and vivid, colorful dreams. Removing
  the patch at night may help.
• Timelines The patch is often used for eight
  weeks or longer.
• Caution The patch may not be appropriate if you
  have certain skin conditions, such as eczema or
  psoriasis. Don't smoke while using the patch.
  Rarely, you may get too much nicotine and
  experience nausea or dizziness.

39
Gum

• Nicotine gum is made of a special material called
  polacrilex. To release nicotine from the gum,
  chew a piece until it has a peppery taste or you
  notice a tingly sensation in your mouth. Then, to
  absorb the nicotine, hold the chewed gum between
  your gum and cheek until the taste or tingly
  sensation disappears. Chew and hold again to
  release more nicotine. Repeat the cycle for about
  30 minutes, until most of the nicotine has been
  released from the gum.
• Brand names include Nicorette. Generic gum also
  is available.
• Pros Nicotine gum keeps your mouth busy. It can
  help satisfy cravings quickly. You can buy it
  over-the-counter in 2- or 4-milligram doses and
  chew it as often as needed up to 24 pieces a
  day. When nicotine gum is used alone, most people
  find it most effective to chew one piece every
  hour for the first few weeks.
• Cons Nicotine gum may cause gum, tooth or jaw
  soreness if chewed like regular gum. You may
  experience nausea or hiccups if you chew it too
  fast or swallow the nicotine rather than holding
  the gum against the side of your mouth as
  directed.
• Timelines Nicotine gum is recommended for up to
  12 weeks.
• Caution Nicotine gum may stick to dentures or
  other dental work. Don't smoke while using the
  gum. Rarely, you may get too much nicotine and
  experience nausea or dizziness.

40
Lozenges

• Nicotine lozenges can be used discreetly to
  quickly satisfy cravings.
• Nicotine lozenges are similar to hard candy. You
  place them between your gum and cheek and suck
  them slowly. Each lozenge lasts 20 to 30 minutes.
• Lozenges are sold under the brand name Commit.
• Pros Nicotine lozenges can be used discreetly to
  quickly satisfy cravings. You can use them as
  often as needed, up to 20 lozenges a day. They're
  available in 2- or 4-milligram doses without a
  prescription.
• Cons Occasionally, they may cause nausea,
  heartburn or hiccups.
• Timelines Nicotine lozenges are recommended for
  up to 12 weeks.
• Caution Nicotine lozenges may stick to dentures
  or other dental work. They're not meant to be
  chewed or swallowed whole. Don't smoke while
  using the lozenges. Rarely, you may get too much
  nicotine and experience nausea or dizziness.

41
Inhaler

• The nicotine inhaler allows you to mimic the
  hand-to-mouth motions of smoking.
• The nicotine inhaler is a device that allows you
  to receive some nicotine using the same
  hand-to-mouth motions of smoking. When you puff
  gently on the device, nicotine vapor is released
  from a cartridge inside the device. Hold the
  vapor in your mouth for a few seconds and then
  blow it out don't try to inhale it into your
  lungs. The nicotine is absorbed through the
  lining in your mouth and throat.
• The inhaler is available by prescription under
  the brand name Nicotrol.
• Pros The inhaler keeps your hands and mouth
  busy. You control the dose. You can take as few
  puffs as needed and save the rest of the
  cartridge for later in the day.
• Cons It may cause coughing and mouth or throat
  irritation.
• Timelines The inhaler is often used for six to
  12 weeks. Most people use six to 16 cartridges a
  day at first and gradually taper to nothing.
• Caution The inhaler may not be appropriate for
  people who have lung diseases, such as asthma.
  Don't smoke while using the inhaler. Rarely, you
  may get too much nicotine and experience nausea
  or dizziness.

42
Zyban

• Bupropion is a prescription stop-smoking aid that
  doesn't contain nicotine.
• The antidepressant drug bupropion can help
  control nicotine cravings. It's available as a
  prescription stop-smoking aid under the brand
  name Zyban.
• Pros Bupropion is a pill, so it's easy to use.
  It doesn't contain nicotine and isn't addicting.
• Cons Side effects may include insomnia and dry
  mouth. Rarely, a severe allergic reaction can
  occur.
• Timelines Bupropion is often used for seven to
  12 weeks, beginning one to two weeks before you
  plan to quit smoking. For the first three days of
  bupropion therapy, many people take a
  150-milligram tablet each morning. On the fourth
  day, they take another 150-milligram tablet about
  eight hours after the morning tablet. Bupropion
  may be used for smoking cessation maintenance for
  up to six months.
• Caution Bupropion isn't appropriate for people
  who have a seizure or eating disorder, those who
  have lost consciousness for more than an hour due
  to trauma to the head, those already taking a
  medication containing bupropion or those who take
  a type of antidepressant known as a monoamine
  oxidase inhibitor. If the second tablet is taken
  too close to bedtime, it may cause disturbed
  sleep.
• Smoking is a complex addiction with both physical
  and behavioral elements. If you aren't able to
  successfully quit smoking this time, talk with
  your doctor again. For most people, quitting for
  good takes several serious attempts. The most
  effective strategy is to combine medication with
  a more intensive behavioral program that includes
  support from professionals specially trained to
  treat tobacco dependence. It may also be helpful
  to adjust medication doses or use several smoking
  cessation products together.

43
Nasal Sprays

• The nicotine in nasal spray reaches the
  bloodstream quickly.
• Nicotine nasal spray is sprayed inside your
  nostril. The recommended dose is a spray in each
  nostril one to five times an hour.
• It's available by prescription under the brand
  name Nicotrol.
• Pros The nicotine in nasal spray reaches the
  bloodstream more quickly and begins working
  faster than other nicotine replacement products.
  You control the dose.
• Cons Side effects often include nasal, sinus and
  throat irritation. You may also develop watery
  eyes, sneezing and coughing.
• Timelines Nicotine nasal spray is often used for
  eight to 12 weeks. Most people use one to two
  mists an hour at first and gradually taper to
  nothing.
• Caution Nicotine nasal spray isn't recommended
  for people who have a nasal or sinus condition,
  allergies or asthma. Don't smoke while using the
  nasal spray. Rarely, you may get too much
  nicotine and experience nausea or dizziness.

44
Quitting

• Smoking is a complex addiction with both physical
  and behavioral elements. If you aren't able to
  successfully quit smoking this time, talk with
  your doctor again. For most people, quitting for
  good takes several serious attempts. The most
  effective strategy is to combine medication with
  a more intensive behavioral program that includes
  support from professionals specially trained to
  treat tobacco dependence. It may also be helpful
  to adjust medication doses or use several smoking
  cessation products together.

45
Thinking about Quitting Smoking?

• Before you attempt to stop, think about
  preparing. It is a bit like training for a race.
  The better trained you are, the higher the
  likelihood of success. Here are some suggestions
  for your training
• Decide positively that you want to quit
• Make a list of reasons, including personal
  reasons, medical effects, health benefits,
  financial advantages and obligations to others
• Repeat one of these reasons to yourself several
  times each morning
• Start conditioning yourself physically with a
  modest exercise routine. Get lots of rest and
  drink more fluids
• Set a target date for quitting. Do not allow
  anything to change this date
• Make a list of people who can support your
  intentions to quit, such as co-workers, family
  members and friends
• Make a list of activities, hobbies and interests
  that you can do with your support group
• Prepare yourself through knowledge of the
  withdrawal symptoms and ways to cope with them

46
Resources

• http//www.public-health.uiowa.edu/itrc/quitline/d
  efault.htm
• www.cancer.org
• www.lungusa.org
• http//www.nicotine-anonymous.org/