ILLICIT SUBSTANCES ADDICTION COCAINE •stimulant drug extracted from coca plants (growing in Ands) •Usually powder (of very bitter taste) that is snorted or pills that are eaten. Less commonly administered via injection. Cocaine is not smoked. •Crack cocaine – smoked substance made of cocaine and other chemicals (e.g. baking soda) that forms wax like block •After cannabis the most frequently used illicit drug •In brain, cocaine blocks reuptake of dopamine, noradrenaline, serotonin and even helps their release. Dopamine is causing feelings of pleasure, noradrenaline increases physical energy (increased blood pressure, body temperature, heart rate,…), serotonin is causing higher confidence effect •If eaten (chew coca leaves, drink as tea), effect comes slowly and is less potent (most of cocaine degrade by stomach acid) •If snorted (most common), effect comes in couple of minutes, plateaus in 20 minutes and comes down in 60 minutes. Party drug – often it is taken several times during night or as multidose •If smoked (crack cocaine) the effect comes in a dozen of seconds. Effect is short (2-3 minutes) but powerful •Injection, although the fastest, it is less common •Smoked and injected is not only faster, but also stronger and more addictive (general rule – the faster the effect comes, the more addictive) effect •Positive and desired •Euphoria, mood lift •Physical and mental boost •Increased sexual stimulation •Appetite suppression •Neutral •Increased blood pressure, heat rate and body temperature, significant weight loss over time •Negative and undesired •Dry mouth, sensation of throat closing •Insomnia •Rapid mood swings and emotional instability •Anxiety, panic, paranoia •Sensation of insect crawling (and consequent skin damage from scratching) •Strong psychological need to take more •Destroyed nose mucosa in long term use of powder; burn lips and destroyed lungs in crack cocaine • effect - overdose •Heart arrhythmia, heart attack (and consequent death) •Overheating (and consequent death) •Acute psychosis- anxiety, paranoia, fear •Extreme aggression •Rhabdomyolysis – muscle fibre degradation and consequent kidney failure (and consequent death) • •Overdose often happen when cocaine is taken together with other stimulants and alcohol (creates cocaethylene that lasts longer in body plus synergic effect) •If one is overdosed – keep cooling the body, sedatives like diazepam may help too • addiction •Highly addictive •There is no physical dependency and physical withdrawal •Psychological withdrawal does exist (excessive appetite, anxiety, excessive sleepiness, tiredness. Worst withdrawal so called “crash” – suicidal tendencies •Tolerance is built quickly, but is levelled also rather quickly •Treatment can be almost only psychological (therapy) • •About 5% of European population ever tried cocaine, about 1% used cocaine in the last year (2% in population under 35) and between 0.3-0.6% are risk users. •Males prefer cocaine much more (about 3 times more likely to try compared to females) •Rather expensive and thus more used in rich places like London or party cities like Barcelona •Usage is currently on the raise (after decade of lower use) •Rich risk group reports powder cocaine usage with alcohol and cannabis, poorer risk group reports usage of crack cocaine (often injected) with use of heroin • European Drug Report. Trends and Developments. 2018 - 20181816_TDAT18001ENN_PDF.pdf - Mozilla Firefox AMPHETAMINES •Meth – crystal, ice, pervitin. Usually injeckted, smoked (vaporized) and inhaled. Only pure material can grow crystals • • • • •Speed – street name for various amphetamines and methamphetamines. Usually in form of tablets or powder • •MDMA – ecstasy. Usually in form of tablets • • • • • •Various prescription drugs (e.g. Ephedrine, Adderall) https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQYBJjvOh87Kx9Abr_sfhQAq70ngCuQuqTJPpYS7cI5t1u 2fSgX http://www.emcdda.europa.eu/userfiles/image/pods/2014/methPanel4.jpg http://www.minddisorders.com/photos/amphetamines-984.jpg http://edmchicago.com/wp-content/uploads/2016/12/Ecstasy-pills-inquirer-file-photo.jpg http://www.theplaidzebra.com/wp-content/uploads/2015/09/4_Nazis-on-crystal-meth.jpg METHAMPHETAMINE •First synthesized 1887 and used as prescript drug since 1930s, largely used during ww2 •Stimulant that is often used for treatment (ADHD, narcolepsy, obesity, depression) e.g. Adderall •Mimic the sympathetic system (“psycho-motor stimulant” - similar to cocaine, but even more powerful) – huge presynaptic release of dopamine and noradrenaline. Methamphetamine has the highest potential for dopamine release of all drugs (up to 20 times higher that the highest possible via natural way). • effects •Positive •increased alertness and motivation •increased sociability / talkativeness •positive mood shift, sense of well-being and euphoria •increased sex drive •reduced appetite • effects •Negative •Dry mouth, headaches •Increased heartrate, blood pressure, sweating, temperature •Increased body movements, convulsion •Impaired speech •Insomnia (person can stay awake for days) •Anxiety, fear, panic – psychotic episodes •Overdose – convulsion and coma. Extremely influenced by tolerance – poisoning and death can happen after administration between 2-500mg long-term effects •Methamphetamine psychosis (lasts for weeks after last usage) •Aggression and violent behaviour •Crime •Sexual transmitted diseases •Hepatitis B &C •Malnutrition •Skin problems •Sleep deprivation •Bizarre manners •Dental problems •Cognitive deterioration – permanent brain • addiction •Both physical and psychological withdrawal exist – confusion, extreme hunger, depression, anxiety, fatigue •High tolerance •Dependency develops slowly and within years – amphetamines (especially meth – smoked and injected) are usually not the drugs of first choice. Develops in about 20% people who used it •Males are much more vulnerable •Social environment plays very strong influence – challenge for treatment (as e.g. peer pressure to stop is needed). Sedatives, antidepressants and antipsychotic are sometimes used to help from withdrawal •Widely popular in West and North Europe. Meth is popular in USA (drug of motorbike gangs), Central Europe, Australia and Asia European Drug Report. Trends and Developments. 2018 - 20181816_TDAT18001ENN_PDF.pdf - Mozilla Firefox •https://www.youtube.com/watch?v=PB5bsFzl98Q •https://www.youtube.com/watch?v=CVp9rKF3hag • http://images.amcnetworks.com/amc.com/wp-content/uploads/2010/12/breaking-bad-S5-400x600-compressed V1.jpg MDMA •“psychedelic amphetamine” •Party drug, however, heavily unreliable on street market content wise - can consist basically of anything from ephedrine, caffeine, methamphetamine to fertilizer •Effect starts after 20 minutes and lasts 3-5 hours •Apart from general amphetamine effects, positive special effects include: •Ego softening •Feelings of love and empathy •Spiritual feelings and inner peace •Appreciation of sensation (music,…) •Negative special effects include •Inappropriate social bonding •Erectile and orgasm dysfunction •Confusion and memory loss •Sadness on coming down effect •Hangover may last up to a week! – inability to focus, depression (even up to 2 weeks) • mdma •Taking mdma during parties can be associated with various health risks: •Overheating •Excessive drinking and loss of salt •Overreaction to impurities •Overreaction with combination with other stimulants •Dangerous combination with Viagra (penis injuries, heart attacks – mdma users often need more than one Viagra pill) •Animal studies showed permanent brain damage - not confirmed for humans yet but it prevent to use in psychotherapy (promising therapy results in PTSD patience) • •Addiction: •For most users mdma lose its magic after 10-25 pills •It is probably not addictive as it dominantly works through serotonin OPIATES •Group of chemicals derived from poppy •Includes opium, morphine, methadone, heroin •Morphine - natural opioid used for treatment of pain e.g. in palliative treatment •Heroin – semi-natural derivate of morphine (often in form of white to dark brown powder that is either smoked, snorted or taken intravenously) •Body has natural opioid receptors (in CNS, spinal cord, GI tract) and produces own opioids like endorphin (endogenous morphine). The are active on inhibitory neurons – when they bind to receptors of inhibitoryneurons so their neurotransmitters are blocked. As a result they block pain or cause more dopamine in the system. Exogenous opioids cause massive release of dopamine in reward pathway that has euphoric and calming effect •https://www.youtube.com/watch?v=29Z0qLB8sEc Heroin effects •Intravenous injection can produce strong effects in 3-5 seconds; smoking produces milder effects in 5-15 seconds. Intramuscular and subcutaneous injection produce a more gradual onset in 5-10 minutes. Insufflate heroin produces effects within 2-10 minutes, similar to suppository distribution (anus or vaginal insertion). Oral use can take 60-90 minutes to produce effects. •Intravenous injection, smoked, or insufflate - euphoria followed by a sedation lasting for 2-4 hours. Intramuscular and subcutaneous injection lack the wave of intense euphoria, and cause only feelings of sedation •Overdose causes death by lack of oxygen (person has very shallow breath and gradually stops breathing). Typical sign are pinpoint pupils. Naloxone (opioid antagonist) is used as immediate treatment – it binds to opioid receptors with higher priority • • health risks •Connected to injection way of distribution: hepatitis C, HIV, superficial veins deterioration, emboli •Financial issues •Drug purity issues •Overdose risks • •Heroin is popular in south and west Europe (Turkey, Greece, Spain, France, UK) •Usage of heroin is not growing, but its purity in – increasing number of overdose and deaths • addiction •Rapid tolerance and physical dependency - high addictive potential •Withdrawal symptoms are very unpleasant but not life threatening – vomiting, sweating, hallucination, anxiety, oversensitive genitals (e.g. permanent painful erection in males), body shaking and shivering •Tolerance is rapidly fluctuating – even a short break may lead to overdose. Overdose may be also caused by break in daily habits and by higher purity of substance or when in combination with other sedatives. •Treatment is usually combination of psychotherapy and help of substitute treatment (methadone – opioid agonist that binds to receptors but does not produce euphoria) • European Drug Report. Trends and Developments. 2018 - 20181816_TDAT18001ENN_PDF.pdf - Mozilla Firefox Current opioid overdose crisis (USA) •In 2017, 47000 Americans died on opioid overdose •Increase from 2016 is 30% overall, 70% in Midwest area, 50% in large cities •25% of patients prescribed opioids for chronic pain misuse them •Between 8 and 12 % develop an opioid use disorder •An estimated 4 to 6 % who misuse prescription opioids transition to heroin •About 80 % of people who use heroin first misused prescription opioids •https://www.youtube.com/watch?v=BG70kTLfS7w •Cause of the problem: massive increase in prescription of opioid painkillers since 90s – believe that every pain should be avoided/treated, believe that prescript opioids are not addictive •Solution? Change our attitude towards pain, other pain management strategies (e.g. psychological), more accessible anti-overdose drugs (e.g. Naloxone in form of spray in emergency and police cars). Study Links Drug Maker Gifts for Doctors to More Overdose Deaths - The New York Times - Mozilla Firefox Sacklers Directed Efforts to Mislead Public About OxyContin, Court Filing Claims - The New York Times - Mozilla Firefox Sacklers Directed Efforts to Mislead Public About OxyContin, Court Filing Claims - The New York Times - Mozilla Firefox •Heroin attempt to quit and relaps effect •https://www.youtube.com/watch?v=pm4fsi6OvFI •https://www.youtube.com/watch?v=7RoMaS1pzOE •Heroin overdose •https://www.youtube.com/watch?v=v6uBkJSbQO0 •Heroin withdrawal •https://www.youtube.com/watch?v=KYAmt9WRoNo •