Drug Abuse lecture from Toxicology 30. 11. 2021 M. Chalupová Drug Abuse • improper or excessive use • psychological dependency (habituation) – drug necessary to maintain user’s sense of well-being • physical dependency – physical symptoms if intake reduced • compulsive drug use – preoccupation with obtaining drug – rituals of preparing • tolerance – increasing doses needed to obtain drug effect I. Cannabis drugs II. Opiates III. Stimulants IV. Hallucinogens and delirogens V. Psychotropic drugs/barbiturates, benzodiazepines/ Drugs Cannabis Drugs • Cannabis sativa var. indica • δ-9-tetrahydrocannabinol (THC) – mean content 1–2 % Cannabis herbal form – marijuana • dry, shredded mix of flowers, stems, seeds and leaves of the hemp plant Cannabis sativa • usually smoked as a cigarette or in a pipe • the most commonly abused illegal drug Hashish • resin • smoking in pipes with tobacco or peroral use • euphory, impairment in perception of time and reality, dyspnoea, tachycardia, hypertension • optic hallucinations, psychotic disorders, memory impairment Marijuana • abusing marijuana can result in problems with memory, learning and social behavior • interfere with family, school, work and other activities • scientific studies are underway to test the safety and usefulness of cannabis for treating certain medical conditions • glaucoma • multiple sclerosis • Alzheimer´s disease • cancer pain • neurogenic pain Opiates • depressant alkaloids from raw opium poppy plant • incising of poppy head and collecting latex from the opium poppy /Papaver somniferum album/ – Golden triangle (Barma, Thailand, Laos) – Golden crescent (Iran, Afghanistan, Pakistan) • euphory, later apathy, smooth muscle hypomotility (constipation, urine retention, sterility) • classical trias: coma, breathing inhibition, small pupils (miosis) • heroin (diacetylmorphine) – brown heroin (brown sugar) – adding of acid, smoking – white heroin (white powder) – intravenous application • braun (hydrocodone) • antidote: naloxone Painkillers Abuse • codein • oxycodone (Oxycontin) • hydrocodone (Vicodin) • meperidine (Demerol) Stimulants • sometimes prescribed to treat obesity and attentiondeficit hyperactivity disorder • cocaine • amphetamines – benzedrine (bennies) – dexedrine (dexies, copilots) – methamphetamine (ice, black beauties) • ephedrine • caffeine • methylphenidate (Ritalin) Stimulants • euphoria • hyperactivity • alertness • sense of enhanced energy • anorexia Overdose signs/symptoms • euphoria, restlessness, agitation, anxiety • paranoia, irritability, delirium, psychosis • muscle tremors, rigidity • seizures, coma • nausea, vomiting, chills, sweating, headache • elevated body temperature • tachycardia, hypertension • ventricular arrhythmias Stimulants Overdose complications • hyperthermia, heat stroke • hypertensive crisis • acute myocardial infarction • intestinal infarctions • rhabdomyolysis • acute renal failure Chronic effects • weight loss • cardiomyopathy • paranoia • psychosis • stereotypic behavior: picking at skin (“cocaine bugs”) Stimulants Cocaine • bush Coca /Erythroxylon coca/ – Peru, Bolivia, Ecuador, Columbia • crack (cocaine-hydrochloride) – snuffing, application to the mucous membranes – smoking of free base • biphasic effect: intense euphory, psychomotor activation, low appetite, aphrodisiac, later depression • heart and brain stroke, lung toxicity, rhabdomyolysis, psychotic disorders Stimulants Amphetamine Pervitin (methamphetamine) Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) – euphory, intensified sensation, tachycardia, hypertension, tremor, nystagmus – hyperthermia, hypertension, arrhythmia, sweating, trismus and bruxism, convulsions, rhabdomyolysis, acute respiratory failure, disseminated intravascular coagulation – anticonvulsive therapy, rehydration, active cooling Stimulants Khat • chewing of leaves /Catha edulis/ • smoking, powder in milk • cathinone Betel • /Piper betle/ • areca nuts /Areca catechu/ are wrapped into the leaves • arecoline Hallucinogens • produce altered/enhanced sensation • effects highly variable depending on the patient • increased dose does not intensify effect • toxic overdose virtually impossible • some patients may experience “bad trips” • depends on surroundings and emotional state • paranoia, fearfulness, combativeness • anxiety, excitement • nausea, vomiting • tachycardia, tachypnea • tearfulness • bizarre reasoning Hallucinogens Moderate Intoxication • tachycardia • mydriasis • excessive sweating • short attention span • tremor • hypertension • fever Life-threatening toxicity (rare) • seizures • severe hyperthermia • hypertension, arrhythmias • untreated hyperthermia can lead to hypotension, coagulopathy, rhabdomyolysis and multiple organ failure Hallucinogens LSD (Lysergid) • diethylamide of lysergic acid • synthesized in 1938 by Dr. A. Hoffmann • impregnated papers, round 5x5 mm, so called trips • illusions, depersonalisation, derealisation, changes in perception of time and space • excitation, high blood pressure, tachycardia Phencyclidine (PCP) • „angel dust“ • the antagonist of NMDA receptor • serious psychotic episodes with paranoid delusions and aggressive behaviour • tachycardia, convulsions, hyperthermia, coma Hallucinogens Liberty cap /Psilocybe semilanceata/ bohemica/ • psilocybin – genera Stropharria, Psilocybe, Conocybe • consumption of fresh, pickled or dried mushrooms • variable content of active substance !!! Golden toad /Bufo periglenes/ • bufotenine Harmal /Peganum harmale/ • harmine Halucinogens Fly amanita /Amanita muscaria/ – ibotenic acid, muscimol Panther cap /Amanita pantherina/ – muscarine Hallucinogens Peyote /Lophophora williamsii/ – mescaline • cactus pulp – oil Jimson weed /Datura stramonium/ Mandrake /Mandragora officinarum/ – hyoscyamine, atropine, scopolamine CNS Depressants Barbiturates • introduced in 1903 • anxiolytics, sedatives and anticonvulsants • quickly became a major health problem • in 1950’s-60’s barbiturates were implicated in overdoses; were responsible for the majority of drug-related suicides • phenobarbital (Luminal) • pentobarbital • amobarbital (Amytal) • secobarbital (Seconal) Barbiturates Initial overdose presentation • slurred speech • ataxia • lethargy • nystagmus • headache • confusion As overdose progresses • depth of coma increases • respiratory depression occurs • peripheral vasodilation occurs – hypotension, shock – hypothermia • blisters (bullae) form on skin Barbiturates Withdrawal signs/symptoms • anxiety • trembling • diarrhea • nausea • vomiting • seizures Barbiturates • early deaths – respiratory arrest – cardiovascular collapse • delayed deaths – acute renal failure – pneumonia – pulmonary edema – cerebral edema CNS Depressants Benzodiazepines • used to treat anxiety disorders • sometimes for the short-term treatment of insomnia • diazepam (Valium) • lorazepam (Ativan) • midazolam (Versed) • chlorodiazepoxide (Librium) • flunitrazepam (Rohypnol) • triazolam (Halcion) • clonazepam (Rivotril) Benzodiazepines Adverse Effects • weakness • headache • blurred vision • vertigo • nausea • diarrhea • chest pain Overdoses • relatively safe taken by themselves, even in overdose • can be lethal with other CNS depressants especially alcohol • antidote is flumazenil • produce withdrawal syndrome similar to barbiturate withdrawal