SUBSTANCE ABUSE PHARMACOLOGY

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SUBSTANCE ABUSE PHARMACOLOGY

• David R. Turpin
• MA, LCAS, CCS,

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SLANG TERMS

• Lovers Speed Blunt
• Smack Rock
• Sinse Zig-Zag
• 8-Ball O.C.
• Roach Uppers
• Shrooms Oz.
  Roofies Downers

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Addiction is a BIO-PSYCHO-SOCIAL process.

• BIOLOGICAL Alcohol and other drugs alter the
  chemistry of the brain and body functioning.
  Continued use can cause damage or injury to vital
  organs. (?)
• PSYCHOLOGICAL Altered brain chemistry affects
  the brains ability to think, alters feeling
  states, and impacts the personality of the user.
  (?)
• SOCIOLOGICAL Behavioral interactions with
  family and social contacts are altered and/or
  misinterpreted by the user and those observing
  the behavior. (?)
• There has been some debate re which type of
  addiction is worse
  Whatcha think?

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BIOCHEMICAL

• Biologically Alcohol other Drugs (interfere
  with/alter neurotransmitters), transmitters that
  allow neurons to communicate with each other,
  tell us/body what to do, how to react, what to
  experience etc.
• These things all happen in the primitive
  brain (survival section)
• The four major neurons addressed in
  addictions/abuse are
• 1. DOPAMINE (governs- reward stimulation)
  (Cocaine, Methamphetamines)
• 2. SEROTONIN (governs- mood sleep, appetite,
  perceptions etc. (THC, Hallucinogens)
• 3. GABA ( governs- sedative anti-anxiety)
  (Benzodiazepines)
• 4. ENDORPHINS (governs pain) (Opiates/Opioids)
• When most addictive drugs enter they brain they
  give corresponding messages (more of this less of
  that)

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Defining Terminology

• Psychoactive substances that can pass the
  Blood Brain Barrier and become active in the
  brain central nervous system, with effects on
  mood, cognition, psychomotor movement, and
  personality.
• Drug any chemical entity or mixture of
  entities that alters biological (body brain)
  function or structure when administered.
• (We often say alcohol drugs which suggests a
  difference. It is
• more correct to say alcohol and other drugs
  as alcohol is also a drug.)

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Four Principles of Psychoactive Drug Use

• Drugs, per se, are not good or bad. It is the
  resulting behavior associated with the use /abuse
  that causes judgment by the observer about the
  user. Good Bad
• Every drug has multiple effects. Not just the
  subjective effect but effects on the brain/body
  functions.
• Both the extent and the quality of a drugs
  effects depend on the amount taken (dosage), and
  potency. examples
• The effect of any psychoactive drug depends on
  the users history and expectations. examples
• (Ray Kiser, 2002)

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How Drugs Enter the Body

• Orally /Sublingual (drinking, swallowing , etc.)
• When someone swallows a drug, it passes
  through the esophagus and stomach to the small
  intestine where it is absorbed into the tiny
  blood vessels lining the walls. It usually takes
  approx. 20-30 minutes for full reaction time.
• Snorting (sniffing)
• When drugs are taken this way they are absorbed
  by the tiny blood vessels in the mucous membranes
  lining the nasal passages. It takes approx. 3-5
  minutes for full reaction

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How Drugs Enter The Body

• Inhaling (smoking, huffing)
• Smokes a joint or inhales heroin/crack,
  the vaporized drug enters the lungs and is
  rapidly absorbed thru tiny blood vessels lining
  the air sacs of the bronchi. From the lungs, the
  drug laden blood is pumped back to the heart
  and then directly to the body and brain thus
  acting more quickly than any other methods of
  use. (7-10 seconds for full reaction time).
• Injection (IV or IM- mainlining or skin popping)
• Injecting with needles, either into the
  bloodstream, or under the skin.
• IV takes approx. 15-30 seconds, where IM takes
  approx. 3-5 minutes for full reaction time.
• Anally (suppositories)

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How Long Drug Use/Abuse

• 100 yrs ?
• 500 yrs ?
• 1000 yrs?
• 2000 yrs ?
• Ever since the beginning of written history
• Cave Walls, Hieroglyphics, Bible, Torah, Koran,
  Dead Sea Scrolls
• All indicated the use/abuse of mind altering
• mood altering substances

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CATEGORIES OF DRUGS OF ABUSE

• 
  
  
  
  
  

STIMULANTS
Depressants
Hallucinogens
Narcotics
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NARCOTICS

• OPIUM
• OPIATES OPIOIDS
• MORPHINE
• HEROIN
• CODEINE
• DILAUDID
• VICODIN
• METHADONE
  
  
• OXYCODONE
• (oxycontin)
• Primarily Physically Addicting

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NARCOTICS/OPIUM

• Has been around since the beginning of time, the
  first written account of its use dates back to
  approx. 4,000 B.C.
• Homer wrote in the Odyssey When Helen said
  Into the bowl in which their wine was mixed, she
  slipped a drug that had the power of robbing
  grief and anger of their sting and banishing all
  painful memories. No one who swallowed this in
  their wine could shed a single tear that day even
  for the death of their mother or father, or if
  they put his own son to the sword

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NARCOTICS/OPIUM

• The ancient Arabs both used and organized the
  trade of Opium, (Why ?)
• The Holy Prophet had forbidden the use of
  Alcohol not Hashish or Opium.
• Some ancient descriptions of Opium
  include The Hand of GOD, The Destroyer of Grief,
  Fruit of the Gods, The Milk of Paradise!

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NARCOTICS/OPIUM

• It is easy to see why such a potentially deadly
  drug was sought after. The ancient Greek
  physicians said of OPIUM
• it resists poison and venomous bites, cures
  chronic headache, vertigo, deafness, epilepsy,
  apoplexy, dimness of sight, loss of voice,
  asthma, coughs of all kinds, spitting of blood,
  tightness of breath, colic, jaundice, urinary
  complications, fever, dropsies , leprosies, and
  the trouble to which women are subject,
  melancholy and all pestilences.
• OPIUM is the Granddaddy of all Narcotics. All
  Narcotics come from or are chemically altered to
  mimic the properties of Opium.
• How big do you think the Opium problem is
  today? (Why)

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NARCOTICS

• Used commonly to control moderate-severe acute
  pain.
• Can cause physiological tolerance (more to get
  same effect).
• Can cause physical dependence (discomfort if
  abruptly stopped)

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QUIZ

• 1st popularized in the US, not as a
  devastating/disgusting or dangerous drug we have
  come to know, but a legitimate, researched "and
  widely dispensed medication which had the
  following attributes more powerful then any
  commonly used pain drug, cheaper to manufacture,
  will last forever and causes no lingering
  cravings.
• Introduced When, by Who and Drug Name
• 1888
• The Bayer Pharmaceutical Company
• The name of this new miracle medicine was
• Heroin

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HEROIN

• HEROIN as well as various prescription
  analgesics, all function by binding with
  naturally occurring opiate receptors in the CNS.
• HEROIN, known primarily as a street drug is
  typically snorted or injected, (IV or IM ? Where
  and how ?). The duration of sensation is
  usually 2-4 hours, this causes users to have to
  dose multiple times per day.
• It can also be smoked (which we see increasing
  due to potency). This is called (?)
• All Narcotics are cross tolerant which means
  ? (examples)

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NARCOTICS

• Pain Pills
• A number of recent patients/consumers/clien
  ts present addicted to or for use/abuse of
  prescription Narcotics. All symptoms, cautions
  and treatments previously mentioned for the
  street narcotics remain. However, patients may
  present somewhat differently (examples).
• Popular types of prescribed pain meds
  codeine, dilaudid, fentanyl,
• demerol, methadone, oxycontin, ultram, percocet,
  vicodin, darvon, darvocet, lortab, etc., etc

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NARCOTICS

• With narcotic and opioid medications, there is a
  potential for the development of tolerance and
  dependence as well as a great potential for abuse
  and severe withdrawal reactions (why).
• Are there any considerations that should be
  taken when a prescription abuser request/enters
  treatment??
• Because Narcotics are so powerful, withdrawal
  will cause DEATH
• 
  (True/False)

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NARCOTICS/METHADONE

• Methadone
• Is it villain
  or savior
• What is it (?)
• Discovered in 1937, by German Scientist as an
  alternative pain reliever (Dolophine).
  Rediscovered in 1960 by Drs. Doyle Nyswynder
  as a possible cure for Narcotic Addiction.
  Their research was supported both nationally and
  locally to address the Dreaded Scourge of
  America HEROIN Addiction. Realizing (already
  knowing), no cure for addictions they began to
  investigate the potential craving blockage
  aspects of this drug. They introduced the drug
  (Methadone) as a medication to assist in the
  tx. of narcotic addiction.

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Narcotics/Methadone

• Methadone quickly became the demon drug,
  treating addiction to one drug with another,
  its worst than heroin, they stay addicts for
  life it gets into the bones etc, etc. (True
  or False)
• Methadone can be and is an effective Medication
  Assisted Treatment in conjunction with other
  therapies. (?)
• Methadone patients can/do live productive
  healthy lives.. However, it can and is abused
  like all psychoactive drugs and has a
  potential to be lethal, particularly when mixed
  with other drugs.

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OXYCONTIN

• Oxy is a prescription painkiller used for mild to
  moderate pain control, chronic pain, and the
  treatment of cancer pain. The active ingredient
  is oxycodone. (effects similar to that of Heroin)
  Is time-released and contains much larger amounts
  of oxycodone than other painkillers (vicodin,
  percocet, percodan). Tablet form last for approx
  12 hours.
• Used by swallowing tablets, crushing and snorting
  or injection. When snorted or injected effects
  sooner. Abusers are attracted because effects are
  very similar to HEROIN, and much cheaper (40
  milligram tablet cost about 4, but often sells
  on the streets for 20-40) also obtained by
  prescription for pain.

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HALLUCINOGENS

• LSD (acid, window pane)
• PSILOCYBIN (shrooms)
• MDMA (ecstasy)
• MESCALINE (mesc, buttons)
• PCP (angel dust, blast)
• PEYOTE
• STP, MDA (love drugs)
• MARIJUANA ( grass, pot, weed, chronic, herb,)
• Primarily Psychologically
  Addicting

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Marijuana
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CLUB DRUGS

• Ecstasy (methylenedioxymethamphetamine)
• GHB (Gamma-hydroxybutyrate)
• Rohypnol (Flunitrazepam related to Valium,
  Xanax)
• Ketamine ( anesthetic for humans and animals,
  injected, smoked)
• Methamphetamine
• LSD (Lysergic Acid Diethylamide 25)

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CLUB DRUGS

• Ecstasy Deve. In 1900 as appetite suppressant.
  Has effects of Stimulant and Hallucinogen,
  effects last approx 3-6hrs. Usual side effects
  (confusion, depression, sleep problems, anxiety,
  paranoia, dehydration, hypertension and heart or
  kidney failure) can last up to 1 mo. Significant
  increase in BP, heart rate, increased sense of
  alertness and energy.
• GHB Sometimes used as Muscle Builder, and to
  enhance sexual performance. GHB is a central
  nervous system depressant that can relax or
  sedate the body.
• At higher doses it can slow breathing and heart
  rate to dangerous levels. Its intoxicating
  effects begin 10 to 20 minutes after the drug is
  taken. GHB is cleared from the body relatively
  quickly, so it is sometimes difficult to detect
  in emergency rooms and other tx. facilities.

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CLUB DRUGS

• Rohypnol In the benzodiazepine family (valium,
  xanax). Is tasteless and odorless, dissolves
  easily in carbonated beverages. Effects are
  aggravated by concurrent use of alcohol. Even
  without alcohol, a dose of Rohypnol can impair a
  victim for 8 to 12 hours.. The drug causes
  profound anterograde amnesia, individuals may
  not remember events experienced while under the
  influence. One of the street names is the
  forget-me-pill, and has/is used in many
  reported/unreported sexual assaults.
• Ketamine Actually classified as an anesthetic
  (animal). Popularized in the 1980s. High doses
  produced effects similar to PCP (dream-like
  states and hallucinations. (smoked-usually in
  marijuana, snorted, injected)

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STIMULANTS

• DEXEDRINE
• CAFFEINE
• METHEDRINE
• AMPHETAMINE
• COCAINE (CRACK)
• Both Physically Psychologically Addicting

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CLUB DRUGS

• Methamphetamines A toxic, addictive stimulant
  that affects many areas of the central nervous
  system. Smoked, snorted, injected or orally
  ingested. Easily dissolves in beverages. Serious
  health consequences, (memory loss, aggression,
  violence, psychotic behaviors, and potential
  cardiac and neurological damage. Side effects
  Signs of agitation, excited speech, decreased
  appetite, and increased physical activity levels.
• LSD LSD is classified as an Hallucinogen, it
  induces abnormal sensory perceptions. Its
  effects are unpredictable depending on the amount
  and purity, as well as the users personality,
  mood and expectations. Effects begin approx.
  30-90 minutes. Physical effects include dilated
  pupils, higher body temp., increased heart and
  blood rates, sweating, loss of appetite,
  sleeplessness, dry mouth nausea. FLASHBACKS! 1
  week to 1 year reported

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COCAINE FACTS

• 1855-1860 Cocaine isolated from other chemicals
  in the coca leaf
• 
  COCAINE HYDROCHLORIDE
• 1884 Used as a local anesthetic
• 1885 Rbt. Louis Stevenson wrote Dr. Jekyll and
  Mr. Hyde
• in 3 days under the influence of cocaine
• 1886 Dr. Sigmund Freud prescribed and used
  cocaine daily
• gave to patients for a number of ailments,
  cure for the
• disease of alcoholism and morphine addiction
• 1887 Arthur Cannon Doyle-(Sherlock Holmes), used
  cocaine
• continuously to combat fatigue depression.
  He also
• included the use of cocaine by his major
  character. In plays like The Seven
  Solution. The actor playing Holmes actually
  injected cocaine on stage.

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COCAINE FACTS

• One famous line from the play was Quick
  Watson the Needle.
• Remember Watson was a Medical Doctor.
• 1888 A new medicine called a brain tonic,
  was intro-
• duced in the southern USA- (?). The drink
  became
• very, very, very popular because it tasted
  good and
• gave you a definite rush due to its
  cocaine content.
• 1914 Classified as a Dangerous Narcotic,
  cocaine largely
• went underground used by affluent people.
• 1960-70,80 With the big Crack Down on the use
  of amphetamines
• cocaine began to re-emerge as a stimulant of
  choice.

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COCAINE FACTS

• Cocaine was used mainly by the AFFLUENT, it
• enjoyed a kind of acceptance by the in-crowd.
  The
• drug was seen/used/abused at all the
  fashionable places and glorified in novels,
  movies and other media.
• Late 70s 80s
• The Debut of a new phenomena
  called FREE BASING- The
• smoking of Cocaine, made infamous by the likes
  of Richard
• Pryor. Its used spread like wild fire
  further and faster than any
• drug before, and went on to change the face of
  not only the USA but the world. How and why did
  this happen CHEAP, A
• FASTER HIGH, NO NEEDLES AND YES
  TOUTED AS NON-
• ADDICTING!!!!!!!!
• DANGERS ?????

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DEPRESSANTS

• BARBITURATES
• SECONAL
• TUNIAL
• PHENOBARBITUAL
• TRANQUILIZERS
• Valium
• Librium
• Xanax
• Ativan
• Primarily Physically Addicting

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INHALANTS

• SOLVENTS (polish paint
  removers, lighter fluid, gas)
• AEROSOLS (paint sprays, hair
  sprays)
• ADHESIVES (airplane glue,
  rubber cement)
• CLEANING AGENTS (spot removers, dry cleaning
  fluid)
• ROOM DEODORIZERS (glade, etc)
• NITROUS OXIDE (whipped cream,
  laughing gas)
• Primarily Psychologically addicting One of
  the most dangerous

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Detection of Drugs in Urine Samples

• Amphet/Meth 2 days (1 use)
• Barbiturates 2 Days
• Benzodiazepines 2 Days (1 use)
• Marijuana 2 Days (1use)
• 7-28 Days (prolonged)
• Cocaine/Metabolite 2 Days (1 use)
• 4 Days (daily)
• Methadone 2-3 Days
• Narcotics 2 Days
• PCP 7 days (1 use)
• Hair Test can detect presence for up to 90
  Days

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ALCOHOL

• A Central Nervous System Depressant, alcohol can
  truly be called, The Great Masquerader. It can
  do what most other drugs cannot It can MIMIC the
  actions of most psychoactive drugs
• Beer
• Wine
• Whiskey or Distilled Liquor

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ALCOHOL FACTS

• The bodys ability to tolerate alcohol depends on
  the LIVER. Thus as we drink over a period of
  time the liver adapts and changes. It creates
  more enzymes to handle the POISON that is
  attacking the system. Unfortunately, since
  alcohol destroys liver cells, the liver
  eventually becomes less able to handle it. A
  condition called Reverse Tolerance
• occurs. So a person who could handle 2 fifths of
  alcohol at age 30 will/can get drunk from a half
  pint of wine at age 50.
• Alcohol is actually chemically classified as a
  Protoplasmic Poison. It can kill liver, brain,
  kidney and other tissue on contact. It affects
  all systems of the body.
• Another danger of Alcohol is its involvement in
  SYNERGISM. What is Synergism?

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ALCOHOL FACTS

• Alcohol in its various forms has been around
  since the earliest of times. The oldest
  psychoactive drug known to man (probably
  fermented fruit) Later discovered that the starch
  in potatoes, rice, corn etc. could be
  fermented, first to sugar then alcohol. The
  concentration of alcohol in each type of beverage
  depends on the time fermented. Aside from being
  an enjoyable drink, alcoholic beverages were
  credited with reducing tension, lowering risk of
  heart attacks, and aiding people to cope etc.
• Alcohol ranks third behind heart disease and
  cancer as greatest health threats in USA.
• Alcohol is metabolized at defined, continuous
  rate based on a persons weight, amount, amount of
  time passed etc. We can usually determine how
  much alcohol is circulating in the system (BAC)

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