Marijuana Abuse and Addiction

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Chapter 13

• Marijuana Abuse and Addiction

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What do you think? T or F

• The marijuana smoked in the US today is more
  potent than 20 years ago.
• Marijuana use often causes long-term damage to
  the cardiovascular system.
• Drug effects following oral ingestion last longer
  than after the drug is smoked.

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Answers

• The marijuana smoked in the US today is more
  potent than 20 years ago. T
• Marijuana use often causes long-term damage to
  the cardiovascular system. F
• Drug effects following oral ingestion last longer
  than after the drug is smoked. F

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Intro

• Most controversial substance of abuse.
• Cannabis sativa is Latin for cultivated hemp

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History

• 5,000 years ago used by Chinese physicians
• Used to treat malaria, pain, and as an
  anticonvulsant
• In the 1800s was used as an all purpose
  medication
• Is thought that Mexican laborers brought it north
  when looking for work
• Increase in use due to alcohol prohibition

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Medicinal Marijuana

• Decrease nausea with chemotherapy
• Synthetic Marinol a version of one of the
  chemicals found in marijuana
• 60-65 of glaucoma patients experience a
  decrease in fluid pressure in the eye
• Relieves symptoms of ALS, MS, RA and chronic pain
  conditions

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Some evidence that marijuana helps with

• Weight loss in AIDS patients or cancer pts
• Limit damage of strokes
• Asthma
• Crohns disease
• Anorexia
• Emphysema
• Epilepsy
• Tumor growth

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DEA

• Does not view marijuana as having medical value
• Any attempts to classify the drug as such has
  been blocked. P.495
• In late 1990s California approved the medical use
  of marijuana but the gov. continues to block
  efforts

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Potency

• Since 1960 growing strains that have a more
  pleasurable effect
• Marijuana is said to be the biggest cash crop
  in the US

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Concentration

• Highest concentration in small upper leaves and
  flowering tops
• Term marijuana is used to identify the plant that
  is used for eating or smoking
• Term hashish is used to identify the dark thick
  resin that is obtained from the flowers
• Hash oil is a liquid that is extracted from the
  plant
• The book uses the generic term marijuana to refer
  to any part of the plant that is used to be
  smoked or ingested

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Scope of the Problem

• World users-200-300 million
• 30 of users live in Asia, US and Canada, and
  Africa each have about 24 of the worlds users.
  Another 20 in Europe
• In Us the most frequently abused illegal drug.
  Estimates are that 50 of the entire population
  have used it at least once.

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Scope of Problem (cont.)

• No evidence of increase of marijuana abuse since
  1991
• Use peaks in early adulthood and usually
  discontinues by age 30
• 10 who use is do so daily, 20-30 use it once a
  week
• Estimates are 17 of users smoke more that 5x a
  week and are considered addicted

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Criminalization

• Varies from state to state, then some states will
  change the laws again
• In some states a small amt. is like a traffic
  ticket

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Pharmacology

• The principal psychoactive agent in cannabis has
  been labeled delta-9-tetrahydrocannabinol or THC.
• Is thought to bind to receptor sites which
  involves neurotransmitters that are involved in
  mood, memory, cognition, perception,
  coordination, sleep, appetite.

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Pharmacology (cont)

• THC rapidly reaches heart, lungs and brain then
  fat tissues
• Repeated use over a short time will cause THC to
  be stored in fat tissues
• Drug screens of heavy users will continue to test
  positive for weeks or months
• Tolerance develops rapidly

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Administration

• Orally-user does not feel effects for 1 hour.
  Cookies and Brownies
• Smoked-typical cigarette 500 mg-750 mg
• Blunts-filling empty cigar with marijuana mixed
  with chopped cigar tobacco
• Smoking tech. different than cigs. Must inhale
  smoke deeply into lungs and hold. Why?
• Effects begin in seconds or minutes and reach a
  peak within 30 min.
• Avg. person would need to smoke 100 s of pot for
  15 min. to OD-least toxic drug known

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Subjective effects

• 2 phase reaction-mild anxiety at first followed
  by relaxation
• Release of dopamine
• Many users report altered sense of time and mood
  swings
• Feeling of wellbeing, happiness, splitting of
  consciousness

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Adverse effects of occasional use

• 2,000 metabolites of the 400 chemicals of the
  plant found in the body
• Blood shot eyes
• Drug induced anxiety/panic attacks
• Impaired reflexes
• Drug induced psychosis-p.169
• Sexual dysfunction
• depression

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Consequences of chronic use

• Precancerous cells
• Decrease in immune system
• Pot has 10 20 times the tar as cigs
• Pot smoker will absorb 5x as much carbon monoxide
  as cig. Smoker
• 4 joints has the same negative impact on the
  lungs as 20 cigs.
• Pot smoke 5-15x amt. of carcinogens as tobacco
  smoke-cancer

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Consequences (cont.)

• Reduced sperm count
• Men have 50 lower testosterone
• Failure to ovulate
• flashbacks if used hallucinogens
• Minor reduction in users ability to learn new
  info. while using
• Memory deficits of chronic users usually reverse
  after 2 weeks of abstinence

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Amotivational Syndrome

• Conflicting evidence
• Consist of decreased drive, ambition, attention
  span, distractibility and tendency not to make
  plans beyond the present day
• Study cited on p.171
• A.S. challenged-even chronic abusers are
  successful

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Cause of Death

• Slows cells renewal
• Users experience 30-50 increase in heart rate
• Causes reduction in the strength of the heart
  contractions and oxygen which is serious for
  people with heart disease

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Addiction potential

• W/D- irritability, aggressive, anxiety, insomnia,
  loss of appetite, sweating and vomiting.
• W/D begins 1-3 days, peaks between 2nd and 10th
  day lasting up to 28 days
• Tolerance does develop

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Other issues

• gateway drug
• lifestyle

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Chapter 14

• Opiate Abuse and Addiction
• Intro-phenomenon of pain
• pain meds viewed with distrust
• Historically abused
• Dr.s are hesitant to prescribe
• Under prescribed
• DEA diversion of prescribed narcotics

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History

• Evidence that opium was used in religious rituals
  10,000 years ago
• Opium is from the poppy plant and is juice a
  resin
• Widespread use around 7,000 B.C.E.
• Gift from the Gods, relieve every form of pain
• Early 1800s scientist isolated a pure alkaloid
  base from opium-morphine
• Morphius-greek God of dreams
• 1857, Alexander Wood invented hypodermic needle

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Smoking opium

• Chinese Immigrants
• By 1900 ¼ of the opium imported to the US was
  used for smoking
• 2/3 to ¾ addicted were women
• Harrison Act of 1914, prohibited use of narcotics
  without a prescription

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Classification

• Page 176-177
• Where produced
• 75 of all opium is produced in Afghanistan
• Most of the morphine still comes from the poppy

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Opiates as Drugs of Abuse

• Why use?
• Feels good
• Activates the brains reward system
• Drug euphoria
• Rush like a orgasm
• Nodding
• Narcotics mimic the action of brains naturally
  occurring neurotransmitters-the nucleus accumbens
  and ventral tegmentum, pleasure response
• Opoids trigger massive amts. of dopamine

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Heroin

• Widespread abuse of synthetic narcotics-Vicodin
  and Oxycontin
• Globally 9 million people addicted to heroin and
  maybe up to 1 million in US addicted
• Heroin deaths account for about ½ of all illicit
  drug use deaths in US

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History

• Dev. By chemist at Bayer
• Introduced in 1898
• Obtained from raw opium
• Drug made people feel heroic
• Civil war men were given heroin to w/d from
  morphine, thought non-addictive, cure
• During 1920s term junkie

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Pharmacology

• Once in the body it is Biotransformed into
  morphine
• Lipid soluble so crosses blood-brain barrier 100x
  faster than morphine
• ½ life2 min. to 36 minutes
• Opiates mimic endorphins in brain-natural pain
  killer

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Narcane

• Blocks the effects of opiates
• Opoids antagonist
• Reverses the effects of OD
• Naltrexon

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Endorphins

• Brain has its own morphine/pain relief system
• Opiates stimulate the endorphin receptor sites
• Injury, battlefield-feel no pain

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Subjective effects

• IV use
• Rush
• Flash
• Feeling of warmth
• Dry mouth
• Nausea
• Nasal congestion
• Itchy skin
• Sense of floating or light sleep
• Clouded mental function

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Today

• Avg. age at first use dropped from 27 in 1988 to
  19 by mid 90s
• 12-17 yr olds make up 22 of users
• Oversupply of heroin
• High purity and low cost

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Brand names

• Vicodin
• Dilaudid
• Percodan
• Oxycontin
• Demerol
• Darvon
• Talwin
• Codeine
• Hydrocodone
• Methadone
• fentanyl

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Explosion of Oxy

• Illicit use of prescribed opiates triple from
  1990 to 2001
• Into in mid 90s
• Synthetic opiate found in Percodan
• Designed to treat server chronic pain contains
  higher dose of oxycodone
• Percodan 5 mg. of oxy, oxycontin 20-160 mg. time
  released to last up to 12 hours
• Crush and inject
• DEA forced pharm. Co. to discontinue high
  dose-160 mg.

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Methods of use

• Skin popping
• Mainlining
• Smoking
• Snorting
• Chasing the dragon
• speedball

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Scope of problem

• Est user will use for 2 yrs to develop dependence
• Chippers
• Est. heroin addict spends 250 week to support
  habit
• Males make up ¾ of those addicted

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Scope of the problem

• Est. 1.6 million abuse prescribed narcotic for
  the first time in U.S.
• People share prescriptions
• Many abusers go from clinic to clinic
• 1 in 4 who abuse opiates will become addicted
• Half of those who repeatedly abuse heroin will go
  on to become addicted
• Est. 3 million people in U.S. have used heroin at
  least once, 1.4 million addicted

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How addicts obtain opiates

• Doctor shopping/manipulating
• Relationships with terminally ill
• Dealers
• Health care professionals who steal the drugs

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Complications

• Withdrawal-peak at 72 hours and lasts about a
  week
• Signs of w/d
• Extended w/d lasting months-restlessness,
  fatigue, anxiety
• Lifestyle health risks
• Strokes, liver problems, sexual dysfunction,
  hypertension, organ failure, infections
• Cotton fever