Thursday Mar 15

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Thursday Mar 15 Methamphetamine and Cocaine
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D. Research on amphetamine 1. 10 mg oral dose to
naïve users 2. Withdrawal following prolonged
use in 10-30 mg range 3. 15-30 mg range for
naïve users NE DA and SE 4. 60 mg/day for at
least 2-3 days (seen in users) clear Amphetamine
toxicity lasting about a week after
discontinuation 5. After stimulant phase
crash Fatigue severe depression increased
appetite Cardiovascular effects headache
chills flushed appearance (look pale) heart
arrhythmias hyper or hypotension Anorexia
nausea vomiting diarrhea abdominal cramps
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• D. Research on amphetamine
• 5. After stimulant phase crash
• 6. Pattern of use several day run of use (4-6
  day binge), then crash and may sleep for 2 days
  cycles. In crash, person is lethargic for days
  then symptoms gone in about a week.
• 7. Lethal dose in naïve users 120 mg/kg d
  amphetamine - overdose reaction stroke
  convulsions coma
• But cardiovascular and mental effects show
  marked tolerance in regular users
• 400-2000 mg can be taken by regular user
• One reported case had 17000 mg intake in 24
  hours without acute illness

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D. Research on amphetamine 8. Nature of
tolerance Fast for effects on heart and appetite
suppression. Fast for euphoria Slowest for
effects on attention and narcolepsy when used at
recommended doses) Receptors for NE, DA, SE down
regulate by reducing sensitivity Then when usage
stopped, more receptors are formed Normal
production of neurotransmitters is inadequate to
stimulate causes craving and anhedonia
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D. Research on amphetamine 9. Pre 80s - Usage
escalation of d amphetamine often at a
1000mg/day level of pill use, users want more
effects and switch to methamphetamine and to
other routes - smoking or IV use Methamphetamine
speed of old days IV methamphetamine
effects felt immediately and last about 5 min.
Rush described as orgasmic and euphoric. May
inject 10x/day (2 g/day) for 4-6 days then crash.
Sleep 2 days then start again. Get Malnourished.
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• D. Research on amphetamine
• 9. Todays use Methamphetamine (crystal crank
  chalk Ice glass)
• Still snort or take orally, but more commonly
  smoked or injected by abusers
• Ingestion 15-20 minutes for effects high, no
  intense rush last 6-8 hours.
• Snorting high, but no intense rush. Feel
  effects in 3-5 minutes. Lasts 6-8 hours.
• Smoking or IV injection immediate intense rush
  that lasts a few minutes
• Rush attributed to dopamine release in reward
  centers

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D. Research on amphetamine 9. Todays use
(crystal crank chalk Ice glass) 12 year olds
and up 10.4 million have tried it 3-4 of 8th
graders 4.5 of H.S. seniors Popularity growing
since 1995
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Ice (glass) heated in glass pipe and smoked or
melted and vaporized and inhaled Rush in
seconds, lasting 12 hrs
Ice abusers may smoke 1 gram/day about 500/day
habit
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• 10. Long term consequences of abuse
• Paranoid psychosis homicidal and suicidal
  thoughts rage violence hallucinations.
  Typically lasts 1 week, but for some, some
  psychosis remains as a problem.
• damage to dopamine-producing neurons
• damage to serotonin neurons
• long term effects on cognition and affect
  (depression)
• damage to heart and blood vessels
• skin abscesses
• increased risk for hepatitis B and C HIV among
  IV users
• (acute lead poisoning due to contamination)

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D. Research on amphetamine 10. Long term
consequences of abuse 11. Fetal effects
increased miscarriage increased prematurity
withdrawal seen in infants long term behavioral
effects suggested in animal studies
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• II. Cocaine
• stimulant with similar action as methamphetamine
• unlike man-made amphetamine, cocaine comes from
  the coca plant (native to Peru, Bolivia, and
  Columbia)
• use for strength and stamina dates back 5000
  yrs cultivated since A.D. 1000
• medical uses today short-acting local
  anesthetic (related to longer acting Novacaine
  and Lidocaine) cocaine used to deaden nose,
  mouth, or throat during quick procedures (putting
  tube in)

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• II. Cocaine
• effects are similar to that of methamphetamine
  with 2 exceptions
• Effects last only 20-30 minutes (half-life of 1
  hour)
• Less neurotoxic following chronic use does not
  destroy DA and SE neurons full recovery is
  possible following high levels of abuse

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• II. Cocaine
• History
• Spanish Conquistadors (16th century) arrived in
  South America and recruited Incas for labor via
  coca leaf payments
• Took coca leaves back to Europe, but lost potency
  along the way and had no effect. Europeans
  accused Incans of imagining the effects.
• Mid 1800s active alkaloids were identified by
  scientist, Albert Niemann named it cocaine

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• II. Cocaine
• History
• Soon after a French chemist, Mariani, put it in
  teas, lozenges, then wine sold in Europe
• Vin Mariani wine and cocaine very popular
  president McKinley, Thomas Edison, Pope Leo XIII
• The Pope gave Mariani a gold medal as a
  benefactor of humanity

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• II. Cocaine
• History
• In 1884, Freud wrote Song of Praise singing
  praises of cocaine as lifter of spirits
  treatment for depression inducing exhiliration
  and lasting euphoria which in no way differs from
  the normal euphoria of the healthy person
• 1885 advertised by Parke-Davis as a wonder drug
• Marketed in medicine, soda, and wine prescribed
  for opium, morphine, and alcohol addiction
• 1885-1905 Great Cocaine Explosion

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• II. Cocaine
• History
• 1885-1905 Great Cocaine Explosion
• 1885 Pemberton introduced French Wine Cola in
  Georgia became CocaCola the intellectual
  beverage and temperance drink
• This carbonated beverage is one reason why soda
  fountains became associated with drug stores
• Then addictive potential became clear
• Freud and others retracted original statements
• 1906 Pure Food and Drug Law forced to remove
  cocaine from the coca leaves used in CocaCola

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• II. Cocaine
• History
• Then addictive potential became clear
• Freud and others retracted original statements
• 1906 Pure Food and Drug Law forced to remove
  cocaine from the coca leaves used in CocaCola
• In 1906 there were as many cocaine users as in
  1976, with only half the population Palfai and
  Jankowicz 1991 (Cocaine was 10 cents a gram)
• 1914 Harrison Act regulated sales
• 1920s 30/ounce
• By 1930s, replaced by cheaper amphetamines

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• II. Cocaine
• By 1930s, replaced by cheaper amphetamines
• Then in late 60s and 70s,law enforcement and
  education reduced amphetamine use and increased
  its costs cocaine rose again
• 1970s cocaine viewed as an expensive and
  glamorous upscale treat
• Demand reduced prices and increased purity in
  1980s much increased use
• In 80s, yuppies were the main users
• 1985 average user was a 30 year old white male
  earning 25000

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• II. Cocaine
• 1986 big change introduction of crack
• Crack smokable cocaine
• small white chunks of cocaine that have been
  freed from the base (cocaine hydrochloride) and
  crack when smoked
• Sold in 1-2 rock quantities for 10-20 (compared
  to 100 minimums for cocaine by the gram)
• 5-10x more powerful effect when smoked than when
  cocaine is snorted
• Those who would snort but not inject, now would
  smoke
• Those who could not afford cocaine before, now
  could

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• B. Cocaine Pharmacokinetics
• Routes
• Chewing coca leaves absorbed through mouth. In
  past, ashes (contain lime) added to leaves to
  improve absorption.
• Now South American people still add lime.
• Cocaine poorly absorbed by oral route to gut.
  Mostly snorted, smoked, or injected IV.
• Snorting 25-100 mg dose effects in 3-4
  minutes, peak in 15 min, last maybe an hour. Not
  an intense rush no clear crash, but anxiety,
  fatigue, depression
• IV use 10-25 mg dose onset in less than 2
  minutes peaks in 5-10 min. Euphoric rush, then
  intense crash fatigue, depression, craving.
• Crack or freebase inhalation intense rush in 10
  sec sharp letdown in a few minutes

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• B. Cocaine Pharmacokinetics
• Routes
• abusers normally escalate from snorting to
  smoking to injecting
• 2. Metabolism
• Rapidly metabolized by enzymes in blood and liver
• Moderate dose only active for 15 minutes before
  breakdown
• Half-life is 1 hour
• Excreted in urine and metabolites found for 24-36
  hours

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• B. Cocaine Pharmacokinetics
• Routes
• 2. Metabolism
• 3. Mechanisms of action
• Potentiates release of NE, DA, SE
• Blocks DA reuptake appears responsible for rush
  and reinforcement
• In PNS, actions on norepinephrine receptors
  similar to amphetamines
• As a local anesthetic, it blocks action
  potentials in neurons by interference with
  incoming Na

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4. Acute effects similar to methamphetamine
(coke bugs a cocaine psychosis stroke) 5.
Chronic effects Tolerance and addiction On
withdrawal, fatigue, depression, craving
oversleeping overeating. After 2 weeks, feel
great about being clean, then anhedonia
(inability to feel pleasure or reward) sets
in. Snorting constricts blood vessels in nose,
then a rebound stuffiness. Constriction reduces
oxygen delivery and damages tissues, ultimately
causes tender, bleeding membranes. Lung damage
from smoking. All routes challenge cardiovascular
system - can damage the heart.
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• 4. Acute effects similar to methamphetamine
  (coke bugs a cocaine psychosis stroke)
• 5. Chronic effects
• Effects on the fetus initially quite overblown
  and more showing alcohol than cocaine effects
  over long term cocaine withdrawal effects in
  neonatal period
• Increased miscarriage rate
• Increased prematurity
• Increased birth complications
• Withdrawal symptoms in infants irritability
  poor suck sleep disturbances
• Long term behavioral effects seen in animals
  still unclear in humans, but growing concern.

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7. Drug combinations 60-90 of cocaine abusers
are also alcohol abusers Co-use prolongs euphoria
and shortens dysphoria on withdrawal. Combo
causes an active metabolite to be formed
cocaethylene. Cocaethylene is active blocks
dopamine reuptake transporter. Has 3-5x longer
half-life than cocaine. Cocaine and alcohol combo
increases cardiac effects and associated risk for
death. Death rate is 18x higher from combo than
for cocaine alone.