Drug abuse

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Drug abuse addiction

T. Pálenícek Psychiatrické centrum Praha 3.
Lékarská fakulta Univerzity Karlovy
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History

• Primitive cultures Egypt, indians, chinese
  ..
• Medical indications, raw material, shamanic use
• Old continent canabis, opiats, mushrooms,
• New continent mushrooms, coca, peyotl, ayahuasca

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Today

• Illicit substances (most of them) in most
  countries arround the world
• Many new drugs chemistry
• Purity
• Lost of the traditional consequences of use
  misuse
• New ways of application

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Definitions

• Affects the perception of the reality
  psychotropic effect addictive Potential (Presl)
• Any substance, that if gets into the organism,
  affects one or more of its function
  (pharmacological def.)
• Drug (substance) abuse psychological or
  physical state of servility vis-a-vis the drug

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Terms

• Use
• Abuse
• Tolerance
• Dependence - physical psychic
• Whitdrawal syndrom

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Addiction

• First experience
• Recreational use
• Abuse
• Dependece
• Based on the reward
• drug seeking aplication of the drug
  effect(reward) reinforcing effect
• Neurobiological substrate DA system (NAC)

Pálenícek,2002
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General risks of drug use

• Toxic effects
• Form of application i.v. - infections
• Loss of control addiction
• Social consequences - loss of work, living place,
  friends
• Changes in mood, personality

Pálenícek,2002
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Classification

• Natural versus synthetic
• Through the effect
• Sedatives, tranqulisers, hypnotics
• Stimulants
• Halucinogens
• Entactogens
• Inhallants
• Legal versus illegal

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Opiats

• Morfin, heroin, kodein, buprenorfin
• Acts through own receptors (µ, ?, s)
• Analgesic effect, euphoria, sedation
• Vagotonic effect
• Supression of breathing
• High addictive potential physical and
  psychological
• Tolerance overdose

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Opiats
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Other sedatives, tranqulisers, hypnotics

• Benzodiazepines
• Barbiturates
• Toluen
• Alcohol
• High addictive potential, physical dependence
  (often mixed with others), live threatening
  withdrawal

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Stimulants

• Kokain, crack
• inhibitor of DA and NA reuptake
• euphoria, state of high, increased speach,
  feeling I am the best
• increased locomotion
• elevates heart rate, blood presure
• snorted, smoked, injected, on genitals
• psychological dependece
• heart attack, stroke

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Stimulants

• Amphetamine, methamphetamine (speed, ice, meth)
• Release of DA
• Speed feeling, insomnia, anorexia, increased
  speach, stereotyped behaviour
• Increased heart rate, blood presure
• Snorted, injected, smoked, per os
• Psychological dependence
• Heart attack, stroke, toxic hepatitis,
  neurotoxic, toxic psychosis

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Halucinogens

• Natural (cannabis), psylocin, mezcal,
  ayahuasca, ibogain, muscarin
• Synthetic LSD, DOB, DOM (STP), TMA, DMT,
  Ketamine (Special K), PCP (Angel dust)
• Most affect 5-HT system - 5HT2a receptors
• Cannabis CB1 CB2 receptors
• Ketamine, PCP NMDA antagonists

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Halucinogens

• Halucinations - tripping
• Most are not addictive
• Bad trip, flashbacks, risk of injury, psychosis
• LSD (acid, trip) trips, crystal, liquid
• DOM, DOB trips, pills
• Ketamine, PCP white powder

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Cannabis

• Marijuana, hashish
• many states of being, often upside-down
  stimulation, sedation, anxiosity, anxiolytic
  effect, laugh, halucinations, euforia, taste to
  eat
• anxiety disorders, memory deficits, insulted
  spermatogenesis
• a lot of terapeutical indications (CB recptor
  agonists, antagonists, natural medicine)

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Entactogens

• MDMA, MDEA, MDA
• PMA, PMMA, 4-MTA, 2C-B, 2C-T-7, MBDB
• Entactogen the touch within
• producing state of well being, empathy, belonging
  to others, feeling of love, peace

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Ecstasy
E, madam, eve, pill, xtc

1. Ecstasy - MDMA (MDA, MDEA)
2. Ecstasy - tablet (capsule)

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Use of MDMA

• Young people (15 30 yrs)
• All social groups
• Connection with parties
• polydrug users
• recreational users
• Per os, snorted

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effects

• Metabolised by (CYP2D6) (cytochrom P450)
• 5-9 white population is defficient
• Poor metabolisers
• Increased risk of acute toxicity
• Drug-drug interactions (virostatics - ritonavir)
• Acute effects release of 5-HT and DA
• Chronic effects toxic effects

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effects

• Chronic neurotoxicity - cognitive defficit,
  sleep disorders, parkinsonism???, toxic
  hepatitis, teratogenic, imune dysfunction,
  flashbacks, psychosis
• Risks serotonin syndrom, stroke, rhabdomyolysis,
  acute liver failure
• Neurotoxicity selective degeneration of 5-HT and
  DA axons

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Treatment of addiction

• Motivation
• Decission to stop
• First contact with proffesionals (K-centre,
  hospital )
• Again motivation and testing the decision to stop
• Detoxification
• Therapy ambulant, in hospital, in community
• Susequent care getting back to society
• Relaps

Pálenícek,2002
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Prevence

• Primární vzdelávání cílové populace
• Sekundární práce s vylécenými (abstinujícími)
  závislými
• Terciární minimalizace rizik (harm reduction,
  substitucní lécba, testování drog)

Pálenícek,2002
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Dekuji vám za pozornost
Pálenícek,2002
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Serotonergní dráhy
Pálenícek,2002