Wasted 101 Drug Use on the Streets of Winnipeg

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Wasted 101 Drug Use on the Streets of Winnipeg

• Dr. Morag Fisher
• 2005

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Objective

• Review current patterns of drug use in Winnipeg
  including
• Crack
• Methamphetamines
• Ecstasy
• Date Rape Drugs
• Oxycontin

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Crack

• Coca paste derived from the coca plant
• Cocaine hydrochloride is mixed with baking soda,
  water a precipitant to produce the alkaloid
  form sold as a rock of crack
• Smoking crack results in rapid onset of euphoria
  which lasts approx. 30mins increased energy
• Smoking crack is replacing IV use of cocaine
• Smoking crack is often combined with the use of
  sedative drugs to come down afterwards-
  combination with alcohol produces active
  metabolite cocaethylene

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Pharmacology

• Crack decreases reuptake of catecholamines
  peripherally
• Increases release of epinephrine
  norepinephrine from adrenergic nerve terminals
  centrally peripherally
• Blocks reuptake of serotonin dopamine centrally
• Euphoria addictive potential is associated with
  blocking reuptake of dopamine at the nucleus
  accumbans

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Adverse Effects

• Appetite suppression dehydration, weight loss
• Crack cough pneumonitis
• Cardiovascular toxicity-MI, arrhythmia,
  hypertension, stroke
• Seizures
• Paranoid delusions, hallucinations, violence,
  insomnia, anxiety depression

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Methamphetamines

• Crystal Meth or ice
• Synthetic stimulant manufactured from ephedrine
  or pseudo-ephedrine in home labs or superlabs
• Cheap
• Abused intra-nasally, smoked, IV or oral
• Highly addictive up to 1in10 of those who try
  methamphetamines will become addicted.

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Pharmacology

• Stimulent -long duration of action up to 8
  hours
• Increased presynaptic release of norepinephrine,
  dopamine serotonin
• Drug interaction of stimulents with tricyclic
  antidepressants MAOIs - increased
  cardiovascular toxicity
• Evidence of neurotoxicity affecting dopamine
  serotonin neurons PET scans show reduced density
  of dopamine transporters for up to 3 years after
  last use

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Adverse Effects

• Picking at the skin tactile hallucination
• Paranoid psychosis
• Agitated depression in withdrawal more prolonged
  than with cocaine
• Cognitive impairment memory impairment
  improve after 3 months abstinence
• Associated with high risk sexual activity

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Ecstasy

• 3,4-methylenedioxymethamphetamine
• 1914 produced as an appetite suppressant
• 1970s used in psychotherapy as it enhanced
  feelings
• 1980s onwards has become increasingly popular as
  a recreational drug
• Sold in pill form taken orally- dose variation
  per tablet 5-100mg

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Pharmacology

• Blocks reuptake of serotonin
• Weaker effect blocks reuptake of dopamine
• Physical effects due to increased release of
  nor-adrenaline
• Half-life 8hrs

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Effects

• Euphoria
• Enhanced sociability empathy sexual arousal
• Increased energy confidence

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Adverse effects

• Hyperthermia
• Dehydration
• Muscle tension, teeth grinding, restless
• Rhabdomyolisis
• Cardiovascular toxicity-hypertension,
  tachycardia, heart failure
• Deaths from liver failure ( acute hepatitis),
  renal failure, hyponatremia
• Major toxicity can occur with 12 tablets

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Adverse Psychological Effects

• During use anxiety, agitation, hyperactivity,
  insomnia, brief psychotic episodes, bizarre
  behavior
• Withdrawal reaction difficulty concentrating.
  depression, anxiety fatigue
• Long-term effects neurotoxic to serotonergic
  cells loss of axons, changes persist up to 1
  year or more, depression, memory impairment,
  impaired decision making, panic attacks,
  impulsive

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Management of Stimulant Intoxication Withdrawal

• Sedation with benzodiazepines e.g.
  Diazepam10-30mg prn
• Risperidol 1mg or Haloperidol 5mg prn for
  psychotic symptoms
• Assess for suicide risk
• Initial crash phase - Rehydration, nutrition,
  sleep
• Followed by agitated depression Trazodone 50mg
  or Seroquel 25mg for insomnia, Effexor or SSRI
  for persistent anxiety or depression.

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Date Rape Drugs

• Rohypnol flunitrazepam
• Produces intoxication, sedation, disinhibition,
  amnesia
• Joes story

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Oxycontin

• Euphoria associated with the use of this
  analgesic
• 10,20,40 80mg vs Percocet 5mg
• Easily injected
• Common presentation young males using very high
  doses
• Opiate withdrawal symptoms craving

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Management

• Recognition of escalating use, drug seeking
  behavior
• Voluntary moratorium on prescription of
  Oxycontin?
• Tapering dose 10-25 Q 2-4 weeks
• Addiction counseling
• Methadone maintenance if unable to maintain
  abstinence

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Resources

• Withdrawal- Emergency depts.
• Main Street Project 10 day detox Mainstay
• AFM
• Salvation Army
• Behavioral Health Foundation