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PS268 drugs.docx

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Bruce Mc Kay

Ch 1. Drug: something your body doesn’t naturally produce, modifies brain chemistry, modifies brain function (psycho active) food is not as it includes nutrients related to normal functioning -drug effects depend on amount individual has taken as well as history and expectation, every drug has multiple effects -a truly drug free society probably never existed Psychoactive drug: influences functioning of brain via behavior and experience Polypharmacy: using multiple medications Licit drug- legal Illicit drug- illegal Instrumental use: a socially accepted goal in mind Recreational use: for sole purpose of getting intoxicated Deviant drug use: a drug that very few people approve of (ex. Meth) Drug misuse: use of drugs or chemicals in greater use than prescribed by doctor or for purposes other than intended by manufacturer Drug abuse: recurrent substance use in a manner, amount or situation such that it causes social, occupational, psychological or physical problems, over 30% of university students qualifies for substance abuse Drug dependence: less loaded than the word addiction but with the same meaning, uses a drug so frequently it would be difficult to stop, tolerance, withdrawal, often taking more of substance for longer than intended, unable to cut down, great deal of time spent obtaining substance, continue taking it despite knowing its having bad effects, important social, occupational, recreational activities given up due to substance use, has to disrupt your life clinically (16% of university students) Harm reduction: Canada’s Drug Strategy includes public education, safe injection sites, syringe exchange programs, methadone maintenance therapy, and designated driver/ alternative transportation programs -Surveys can be inaccurate as they are often door to door or by phone -changes in rates and patterns of illicit drug use probably reflect changes over time in a range of attitudes and behaviours as social trends -males are more likely to drink, smoke and use illicit drugs than females -drugs and education level are related -personality factors play a role in whether someone who tries drugs becomes dependent -antecedents: things that predict later behavior -Tobacco generally the gateway drug, gateway substances may not be caused by the drug but show a risk taking personality Ch2. -problems in society due to drugs are either related to the drug or behavior of people on the drug, arrests fines, jailings No control on drugs until 1900s onward, people began being able to synthesize stronger chemicals, as well as the existence of pharmaceutical companies Laws on drugs driven by concerns of: Toxicity Dependence Crime Drug toxicity: Physiological: has the capacity to kill you (ex stop the heart) Behavioural: dangerous behavior while using Acute toxicity: amphetamines can cause the heart to stop, alcohol can cause breathing to stop Chronic effects: heart disease, lung cancer, meth mouth DAWN- drug abuse warning network, reports number of drug related visits to ER, about half due to prescription drugs leass than a third due to recreational drugs CIH Canadian institute for health information keeps track of deaths IDU (intravenous drug users) are at risk for HIV/AIDS, and Hep C Tolerance: reduced effect after prolonged use, typically precedes physical dependence Physical dependence: body gets accustomed to compensating for the drug and becomes imbalanced without it leading to withdrawal Psychological dependence: behavioural dependence, craving and a high rate of relapse, may be due to the reinforcement of taking the drug, more important than physical dependence in addiction. Biological: Any drug use that has pleasurable r rewarding properties spurs dopamine activity in the brain Personality: may be sue to sensation-seeking or impulsive personality Family: family adapts to the addiction of a member maybe making it hard to stop without disrupting the family, also runs in the family Most addictive: heroin, tobacco Medium: cocaine Least: hallucinogens, marijuana Most addictive: snorting, injecting Medium: smoking Least: eating -alcohol: combines horribly with most drugs, most alcohol poisoning due to benzodiazepines, makes them toxic -heroin second most toxic -tobacco also at the high end Crime: heroin and cocaine are inexpensive from legal retailers but illegally people may have to resort to crime to afford the habit, maybe a connection between personalities that chose drugs and deviant behavior. Also inherently a criminal by using drugs. -legal drugs such as tobacco and alcohol kill more people than illegal drugs Ch 3 - In 1900s there was a fear of Chinese immigrants taking jobs which lead to first legislation of drugs in the Opium Act - Proprietary medicine act: required documentation and approval of medicines prescribed by doctors - 1950’s media produces highly sensational accounts of evil drug users - 1996 Controlled drugs and substances act in Canada o Prohibits importation, sale possession etc of illegal drugs and drugs without a prescription o Not all offences result in a criminal record o Summary conviction offences (less severe): police must see you do it, 6 months in prison o Indictable offence: must have warrants for arrest, over 6 months in prison or over $5000 in fines, hybrid offence (sentence to be determined) o Trafficking will result in criminal record, not expunged in US ever o Illegal for someone to attempt to obtain medication from a doctor without disclosing all other controlled substances obtained from other doctors in the last 30 days - Compulsory licensing for production of generic drugs, this keeps the price of medication down - Schedules: no relevance between harm and the punishment o If a drug is not in the act but has effects similar to one in the act it is illegal o 1: MDMA, Rohypnol, Adderal, Cocaine, “hard drugs”, can have life imprisonment for anything other than possession) o 2: Cannabis and derivatives o 7, 8: hash and marijuana quantities o 3: Medical sedatives, hallucinogens, max 3 years for possession, 10 for trafficking, production, importing o 4: prescriptions, steroids, sedatives, legal with prescriptions o 5: laws, in transport over the border should be declared o 6: precursors- suspicious for making drugs, acetone, ethyl ether, lysergic acid, isosafrole, ephedrine, pseudoephedrine, toluene, sulfuric acid - Clinical trial phases: o 1- initial safety, first administration to humans in healthy volunteers o 2- side effects and drug interaction studies o 3- usefulness of drug on patients o 4- trials after the drug has already received patent - 2001 Canada implements Marijuana regulation for those in category 1: painful medical conditions (MS, cancer, seizures, HIV/AIDS, arthritis, spinal cord injury) and category 2: when conventional treatments have failed - Natural health Products regulations: vitamins, supplements, herbal remedies, traditional medicines, probiotics, must state ingredients, storage conditions, dosage, any side effects, be licensed and keep up to standards of manufacturing Drug relations in the US - Morphine synthesized as much stronger than opium and danger is recognized, 1800’s tax on opium - Patent medicines spread - 1905 Roosevelt decides to regulate drugs - Dietary supplements not regulated and treated more as foods, don’t need to be proven effective, permitted to make general statements about overall health - Narcotic relates to opiates and in the McCarthy era it spread that communists were using narcotics to demoralize the US, leading in a very strict law that had to result in jail term with no suspension, probation or parole, and included the death penalty - 1960s the drug use shifted to amphetamines and hallucinogens - 1970 a major reform gave funding to prevention and education programs, began the DEA, mandatory minimum penalties were removed as well as the death penalty, five schedules of substances established, evidence for decisions was to be based on opinions from medical professionals - 1980s introduction of crack, laws stiffened penalties, brought back mandatory minimum, sentences without parole, requiring banks to report suspicious activities and death penalty for drug-related murders Ch4 - Psychoactive drugs influence homeostasis - Neural system has glia cells (create blood-brain barrier that protects the brain from potentially toxic chemicals, a drug must be able to pass through this layer, to do this it must be lipophilic meaning dissolvable in oils and fats) and nerve cells, astrocytes (large cells that support and maintain tissue, supply glucose and modulate neuron activities). Dendrites, at the end of the neuron, have receptors that can activate or inhibit the action potential of a neuron. Axon extends from this conducting electrical signal to presynaptic terminals where chemical messengers are stored. - Action potential is the electrical signal initiating the chain of events to release neurotransmitters. At rest the neuron is polarized, it becomes hyperpolarized when inhibited and depolarized when activated. - Peripheral nervous system: nerves outside the brain and spinal cord consisting of somatic and autonomic nervous system - Somatic: nerves carry sensory information - Acetylcholine: neurotransmitter in the somatic system to excite the muscle - Autonomic nervous system: controls involuntary functions such as heart rate o Parasympathetic: relaxed, has acetylcholine o Sympathetic: fight or flight, norepinephrine is the neurotransmitter - CNS Central Nervous System, brain and spinal cord o Cerebral cortex, tissue that covers the top and sides of upper parts of brain o Basal ganglia, maintenance of proper muscle tone, includes caudate nucleus, putamen, globus pallidus o Hypothalamus: controls hormones for primal urges, eat, sleep, sex o Limbic system involved in emotion, memory, contains amygdala, nucleus accumbens and hippocampus o Dopaminergenic pathway, plays a large role in reward and reinforcement, compulsion, pleasure o Mid brain, pons, medulla play roles in sensory and motor reflexes, they also include most of the manufacture of neurotransmitters dopamine, norepinephrine and serotonin o Norepinephrine: arousal, attentiveness, food intake, body weight o Serotonin: mood, memory processing, sleep, cognition, link between serotonin system dysfunction in depression and suicide, also may be related to hallucinogenic drugs o GABA: found in most areas of CNS, generalized inhibitory functions may be affected by sedative drugs o Glutamate: found throughout the brain, nearly all neurons have receptors activated by it, makes cells more excitable o Endorphins: play a role in pain relief, found in several places in the brain and circulating in the blood - Dosage is most important in side effects of drugs not how many you’ve taken - Not linear curve, goes from low- to high, can be more dangerous for concentrated drugs such as cocaine - Comparing potency: o ED effective dose, minimal dose of a particular drug to have effect in a given percentage of population o LD lethal dose, minimal dose of a particular drug capable of causing death in a given percentage of population - Higher the difference between ED and LD the safer it is TI (therapeutic index) the ratio of LD to ED, difference between doses called safety margin - Oral ingestion: slow absorption, reject poisons, stomach pump opportunity, (disadvantage, no immediate effect) - Injection: rapid effects, high concentration can be delivered, must have I.V. antidote if there is a mistake, damaged veins, blood borne disease transmission - Subcutaneous injection (under the skin) - Intramuscular: easier to do, absorption is more rapid, absorbed into capillaries, slower to act than IV but faster to administer - Inhalation: vaporous injection, burn the drug and inhale, fast absorption time, shorter duration of a drug, lung/throat irritation with chronic use, risk of cancers from tars/hydrocarbons - Topical application transdermal (across skin, slowly but stably), Intranasal (absorbs across mucous membranes rapidly) - Suppository/enema good for patients who can’t swallow or are vomiting - Neurotransmitters made from precursors in the blood supply, the cell already has more of this than outside the cell but must increase the concentration further - Most neurtransmitters have more than one type of receptor in the brain Agonist: mimicks action of neurotransmitter and activates receptor Antagonist: occupies the receptor and prevents the neurotransmitter from activating it Ch 5. - Chemical name of a drug gives complete chemical description of the molecule - Generic names are official legal names - Brand name specifies particular formula and trademark - Canadian laws protect brand names for 20 years - Before a drug can cease to have an effect it must be excreted unchanged from the body via urine or chemically changed so that it no longer has the same effect on the body, most common way is to be deactivated by enzymes in the liver - Many drugs shown to increase the enzyme hat metabolizes them - Prodrugs: only active after metabolized by liver, lasts longer - Pharmacodynamic tolerance: neuron’s sensitivity to drugs changes Ch 9 - Many prehistoric cultures used fermented honey to preserve magic mushrooms, beer in ancient Egypt, alcohol first distilled in middle ages (brandy) - Mid 1800s gin epidemic, average 5 drinks a day - The percentage of alcohol by volume is one half the proof number - Largest fully owned Canadian brewer is Moosehead - Late 1700’s North Americans drank alcoholic beverages and most favoured them to water which was likely to be contaminated - Until demonization of alcohol, the concept of addiction ensues - Begins the temperance movement - Second half of 1800s refrigeration and immigration made the sale of beer easier - 1851 US prohibition begins - 1864 Dunkin act in Ontario any country may vote to be dry by majority - 1901 Canadian prohibition begins, Ontario had numerous exceptions - Organized crime begins and Canada realizes that prohibition laws are unenforceable, repealed by 1948, as well as loss of income for the government without alcohol sales - Majority of alcohol is in tax dollars: domestic 77% spirits, 55% wine, 51% beer (without costs $7, $14, $15) - Today we drink over $100 billion beer>wine> spirits - Average person drinks 2.2 gallons of ethanol a year - At Laurier 90% drink at least once a month, most drink 2/3 times per week - Average person drinks about 80 days per year - Male more than female - BA more than BSc - More frequent users linear relation to lower grades - - Wine o Fermentation: a biological process by which sugars such as glucose are converter by yeast to ethanol and carbon dioxide o Organic material with sugar content, add yeast, creates ethyl alcohol and Carbon dioxide - Beer, similar to wine with barley and hops o Malt: germinated and kiln dried o Grist - Liquor: o Starts similar to wines but yeast dies at a certain percentage so it must be distilled, boiled off and collect vapour o Can be distilled to 95% ethanol - One drink has about 0.6 ounces of ethanol - Canada per person 7.8L of alcohol per year, Russia 18 - 20% of the population drinks 80% of the alcohol - Under 16 drinks a week is healthy according to health Canada - Binge drinking for men: 5+ drinks in a row, female 4+ drinks in a row - When someone passes out, stay with them at all times, regularily ask questions, name, have them open their eyes, if they fall asleep with a huge content of alcohol in their stomach their BAC will continue to rise, can they open their eyes, can they answer your question, can they move on command, can they localize a painful stimulus - Decrease in memory due to disrupted sleep - Some alcohol absorbed by stomach but most by small intestine - Alcohol is removed by the liver 7-9g per hour - Alcohol increases the activity of one or two enzymes related to its oxidation, women have less of this enzyme, most Asians don’t have the enzyme that breaks down what alcohol turns into, causing it to have a worse effect - Increase in GABA, decrease in glutamate, widespread neuronal inhibition - Increased behavioral output related to decrease in inhibition - BAC number of grams of alcohol in 100 mLs of blood - Blackout- a sign of danger of excessive use - Dilation of peripheral blood vessels making loss of body heat but making the user feel warmer - Hangover thirst- due to body excreting more fluid than taken in in alcoholic beverages as well as alcohol causes fluid inside cells to move outside them - Alcohol contains acetaldehyde quite toxic in small quantities and could be cause of nausea and headache in the morning - Heavy alcohol use affects every organ system in the body - Damage to brain tissue, heart disease (protective effect of moderate consumption), immune deficits - Fetal alcohol syndrome: o Growth retardation before or after birth o Abnormal features on face and head , small head, face and eyes o Evidence of brain abnormality - Withdrawal includes (can last several weeks) o Stage 1. Tremors, loss of appetite, insomnia, sweating rapid heartbeat o Stage 2. Hallucinations, auditory, visual, tactile: sensation of snakes or bugs crawling may be due to nervous system rebounding from constant inhibition by becoming overly excitable o Stage3. Delusions, disorientation usually followed by amnesia o Stage 4. Seizure activity - Pricing and taxation of alcoholic beverages are important in health and safety Ch 10. - Originally north American aboriginal peoples used tobacco in rituals - Chris Columbus “discovered” tobacco - Cigars are made of tightly rolled leaves - Cigarettes are made of shredded tobacco - Chewing increased in the US because of fire concerns - 1908 NYC makes it illegal for a women to smoke in public - 1930’s and 40’s began seeing cigarettes as a health problem, marketing of filter cigarettes begins - 1964 US surgeon general saw cigarettes as causing cancer, 1965 companies began having to include the warning on lables and television and radio ads were banned in 1971 - 1908 tobacco restraint Act in Canada banned sales of cigarettes to those under 16 years of age but never enforced - 1983 tobacco tax doubled but not much changes - 1989 cigarette manufacturers began needing to list amounts in each brand and warnings on packages as well as restriction on promotion - 1993 legal age for buying tobacco becomes 18 - 1994 tobacco companies attest to US congress that tobacco is not addictive: correlation doesn’t equal causation, don’t spend a lot of time obtaining and doesn’t force them to give up activities such as employment or social ties - Almost perfect inverse linear relationship between cigarette smoking and number of years of education - Since 1985 smoking prevalence has significantly dropped - 2000- 50% of packaging must be a warning (in Canada), 2011 75% - 2006: smoke-free Ontario act, cigarettes must be out of sight in stores - Chewing tobacco causes leukoplakia a whitening, thickening and hardening of tissue in the mouth considered a precancerous lesion, irritation of gums can cause them to recede and expose teeth to disease, overall prevalence in Canada is low - Tobacco damages DNA - Passive/second hand smoking: inhaling cigarette smoke from the environment by nonsmokers, contains more chemicals but is less concentrated - Sidestream smoke (from ash) - Most provinces now have laws prohibiting smoking in public places - Recent years cigarette promotions in other countries have increased the export of cigarettes from the US, developing countries smoke a lot as there is no regulation - For effect on fetuses there is a dose-response relationship, the more a woman smokes during pregnancy the lower the baby’s birth weight will be, babies become shorter and smaller, and born earlier, have neurological problems with reading and mathematical skills, miscarriages are also common,(similar to “crack babies”), SIDS increased risk of facial mal-formations when the father smokes - Birth control increases likelihood of sticky platelets causing blood clots - Nicotine is one of the most toxic drugs, deactivated in the liver, overdose causes seizures - Nicotine mimics acetylcholine, also causes a release of adrenaline, passes blood brain barrier in 58 sec - Nicotine used as insecticide, stimulates CNS - Smoking ruins cilliary escalator that clears toxins from lungs - May be mild cognitive enhancer - CO attaches to hemoglobin better than O so pre2ents the body from getting enough oxygen, slow asphyxiation th th - Peak age to start is 6 to 7 grade - 80-90% start before age 18 - 1 in 4 smoke - Smoking increases metabolism rate, may cause weight gain after quitting - Smokers show reduction in MAO oxidase that breaks down dopamine. This may enhance the pleasurable effects of a dose of nicotine - 1 hookah session may equal 100 cigarettes in tar and CO - Filtered cigarettes must have more chemicals and so have worse second hand smoke - Ch 15 - 3 kinds of cannabis: sativa, indica, ruderalis - 3 forms, hashish (concentrated, made of resin), ganja (dried flowering tops of female plants) and bhang (remainder of the plant such as leaves, stems) - Sinsemilla: without seeds, more potent or high-grade marijuana - Indica: 2-3’ high, historically had THC, potency varies on genetics and environmental conditions - Sativa 18’ high, less THC, hybridized with indica to increase THC, originated in Asian, historically grown for fibres for rope, up to 2lbs of bud - Up to 66 compounds in marijuana that are psychoactive - Growing: seedling 16hrs of sunlight per day 2-5 months, transition to flowering state has to change photoperiod to 12hrs for 1-4 months, must remove male plants otherwise plants start to produce seeds, outdoor plants THC 5-15% - “autoflowering strains” no need to adjust photoperiod, small, low yield, 7-13 weeks - Hash up to 20% THC, Hash oil up to 60% THC (trichomes ground, mixed with ethanol to separate THC and then evaporated to leave only oil) - How to tell a grow op: o Exterior appearance untidy, only home sometimes, only go in through garage, electricity meters show signs of tampering, skunk like odour detected from outside o Thermal image (hot) o Helicopter spectral reflectance, shine wavelength of light and measure what comes back, marijuana somewhat similar to trees and ground cover species as well as no consistant wavelength between species o Usually busted due to confession - Illegal form the last 90 years - Full of anti carcinogens - BC pot industry larger than mining and forestry th - May 27 2002 Canadian government began a bill to decriminalize marijuana but it didn’t go through - 1970’s people began seeing that regular people were using marijuana and a more lax position was taken until Reagen admin in 1981 took a “get tough” attitude - Most marijuana smuggled into Canada comes from Middle East, Morocco, Afghanistan, Pakistan, Jamaica - Prevalence higher in males and age of initiation at average 15.6 years - Most widely consumed illicit drug in the world (about 50% of Canadians), typical WLU student 40 times/year, peak starting age 16 - Frequency of marijuana smoking in university is strongly predicted by age of fist alcohol intoxication - People who don’t believe in God smoke the most pot as a linear function - When smoked THC is rapidly absorbed into the blood and distributed first to the brain then to the rest of the body, peaking within 5-10 mins, metabolized by the liver, complete elimination may take 2 or 3 weeks - 1992 Anandamide- natural substance produced in the body with marijuana-like effects - In the brain works mostly on cerebellum (fine body movements), hippocampus (memory storage), cerebral cortex (higher cognitive functions), nucleus accumbens (involved in reward) - THC’s abuse potential is small - Cannabis self-administration influenced by social factors - Acute administration to infrequent marijuana speakers shows: o Slowed cognitive processing o Impaired short-term memory o Impaired inhibitory control o Loss of sustained concentration or vigilance o Impaired visuospatial processing o Fragmented speech o Impairment in attention - This is less dramatic in habitual users - Following a significant period of abstinence cognitive functioning is entirely normal: thought for a long time but actually persistent users lose about 6 IQ points or persistent users since age 18 about 9 IQ points, loss in executive function and processing speed - Dronabinol: oral form of synthetic THC - Medicinal uses: o Improve spasticity in MS patients o Delay disease progression in ALS o Management of glaucoma o Increases in airway conductance in asthma - Marijuana may decrease immune system - May cause amotivational syndrome: diminished motivation in habitual users - Lung cancer, higher correlation with anxiety, depression and schizophrenia, abuse potential as quitting causes irritability, anxiety, loss of appetite Ch 6 - Inca empire in Peru used coca plants, holding a ball in the mouth almost continually - Earlier use primarily in religious ceremonies, treated as money by the time conquistadors arrived - 1800’s as local anaesthetic, Canada banned coca additive in 1908 - 14% of males, 7% of females have tried cocaine - Ontario high school seniors 5% have tried, recently females 2x as likely to use - 2% of WLU once a month - Cocaine use is regionalized, either no one is doing it or many people - Freud touted as cure for many psychiatric ails including depression, morphine dependence until he saw his friend in the throws of withdrawal - Absorbs so well into mucous membranes still used as local anesthetic for surgery in nose, larynx or esophagus - 1960’s amphetamines become harder to obtain and cocaine use begins to increase - Before 1985 cocaine was a symbol of wealth and fame, majority of users snorted - “Free Base” no acid content, different chemical preparation - Late 1980’s crack was made, it was cheaper and gave everyone access - Classified in Canada as schedule 1 - Columbia and Peru largest exporters, Mexico is a large transit country, by land is the most common smuggling method, Bolivia, Colombian cartels build submarines - Cocaine blocks the reuptake of dopamine, norepinephrine and serotonin - Metabolized by enzymes in blood and liver, rapidly removed - Acute cocaine poisoning leads to profound CNS stimulation progressing to convulsions, which can lead to respiratory or cardiac arrest - Difficult to estimate what a lethal dose will be from person to person - Combination of cocaine and alcohol creates a chemical more toxic than the cocaine (cocaethylene) - In a binge causes irritability, restlessness and paranoia which can result in full-blown psychosis with auditory hallucinations, formication hallucination (bugs under skin), depression, insomnia, decreased appetite, sneezing - Almost every 20$ bill in Canada has cocaine residue on it - Crack cocaine gives burst of energy, invincibility, well-being, prolonged wakefulness, appetite diminished, increased heart rate, pupils dilate - High addiction potential as it is powerfully reinforcing: if you raise a monkey in a loving environment with stimulus it doesn’t push cocaine lever to extent of addiction or death - No constant negative associations between cocaine use in the mother and developmental measures of their babies, although spontaneous abortion or torn placenta are increased - Amphetamines: (originally tea, 1920’s synthesized from ephedrine) o Increased energy, wakefulness, feelings of wellness o Canada 10% of males have tried at some time, 5% of females o Synthesized from ephedrine which was used to dilate bronchial passages in asthma patients o Currently used to treat hyperactive children o Used during WWII for soldiers to keep awake, 2002 Canadians given amphetamines in Afghanistan, pilots to stay awake o In 1950s-1970s used by athletes, truck drivers and students all legally manufactured and purchased o Amphetamines are a schedule 1 o Most desired street version is methamphetamine, injected in liquid form, at one time used in patients who overdosed on sleeping pills to stimulate respiration, prescribed less as it was seen as dangerous in 1970s and use declined until 1990s when illicitly manufactured forms made a crystallized form that was smoked under the names, crank, ice, glass o Canada has reputation as important methamphetamine source country as it did not control the use of precursor chemicals until after the US o Canada currently limits the access to precursor chemicals that are needed in manufacture as well as those needed in its preparation o Amphetamines are close in molecular structure to dopamine and to norepinephrine, in the methamphetamine a methyl group added seems to improve its ability to cross the blood-brain barrier o Amphetamine related effects are probably due to interactions with multiple neurotransmitters o Complete elimination occurs within two days of the last dose o Depending on the type of task, predrug performance level, and dose a person might either improve or be disrupted in performing tasks o Very slight and almost negligible effect on athletics o Abuse potential very high due to extreme feelings of euphoria o Higher doses the person is likely to panic and become suspicious to the point of paranoia o Impaired capacity to control or inhibit aggressive impulses, increased positive symptoms of psychosis, perception of the environment as a hostile and threatening place o Compulsive and repetitive action o Central effects of amphetamine: prolonged wakefulness, invincibility, increased attention, burst of energy o ADHD medication: better to cure hyperactivity than inattention, works only if parents are treated as well, 30% of meds used for non-medical purposes, causes arrhythmias, hypertension, depression, dependence, recent use 30-35% in US schools o Chronic Amphetamine use: formication hallucination, compulsive behavior (counting), psychosis- violent mood swings, bizarre delusions, paranoia, persist for weeks or months o Meth: 2-3% of Ontario high school students have used, highest relapse rate, rural drug (must be made in the country), 0% of WLU students, originally nicknamed Crank because of being transported in crank shaft of motorcycles, ephedrine source currently cold medications, molecule closely resembles dopamine Ch 11 Caffeine: Belongs to the xanthine family, more people use caffeine than any other psychoactive drug -closely related to alkaloids but are uniquely soluble in water Theophylline is most potent on cardiovascular assignment Peak blood levels reached 30 mins after ingestion, half life about 3hrs. Loss of tolerance can take more than 2 months of abstinence. Withdrawal: headache, fatigue, dysphoric mood, flu-like somatic symptoms. Blocks the brains receptors for adenosine which produces behavioural sedation by inhibiting. Caffeine also releases norepinephrine, dopamine, mesolimbic pathways involved in reward. Low doses- increased activity in CNS, short term memory and attention. Regular users of high amounts of caffeine perform tasks without caffeine they perform poorly High doses- may decrease hyperactivity Pregnant mice have indicated that large doses of caffeine can produce skeletal abnormalities in babies. In females can reduce her chances of becoming pregnant, increase chances of miscarriage, slows growth of fetus so it weighs less at birth 10g (100 cups of coffee) required for caffeine intoxication leading to death by convulsions and respiratory arrest. Symptoms: Irritability, anxiety, restlessness, confusion, delirium, headache, insomnia Visual flashes, ringing ears Increased skins sensitivity, irregular heatbeat Abdominal pain, nausea, vomiting, dehydration, fever Seizures, trembling, twitching, overextension, rapid breathing Theophylline- in tea Theobromine- in chocolate Coffee: Egypt and other Arabic companies in Middle East use and spread to Europe in seventeenth century Roasting beans improves falvour In Europe male-only coffee houses begin to be a place for intelligent discussion Spreads quickly in US because seen as opposition to tea and British Commercial roasting starts in NYC 1790 Latin America is world’s largest producer, Brazil leading, second is Vietnam, Colombia and Indonesia third Coffea Arabica beans: milder, more expensive Coffea robusta: stronger and bitter, used in instant coffee, higher caffeine content less expensive Decaf: 1970’s people begin to remove caffeine, unroasted beans soaked in organic solvent methylene chloride (a carcinogen) which evaporates during roasting. Also a Swiss water process but removes more flavor. Caffeine removed is put into soft drinks Tea: Camilla sinensis is evergreen Invented in China -British levied tax on tea and chocolate, this tax extended to Canadian and American colonies, US begins smuggling tea so Britain gives East India Trading company the right to sell tea without taxes, American merchants would make no profit on this tea and the Boston harbor turns brown with tea Tea is grown from a 3m bush in China, Sri Lanka, India or Indonesia, pluckers only use bud leaf or first two leaves at each growth Leaves are dried and crushed then fermented until the leaves turn copper Green tea: same leaves but non-oxidized Oolong tea: partially oxidized tea 40-60mg per cup Herbal teas: contain none of the Tea leaves Chocolate: Aztecs created, thick liquid that can be eaten with a spoon, prepared by letting pods dry in the sun, removing husks, grinding kernels to a thick liquid Dutch took this liquid and removed the fat calling it chocolate liquor, the fat was cocoa butter, mixed with sugar and chocolate powder it can easily be formed into bars. Swiss invented milk chocolate. Introduced to Europe almost a century before coffee and tea, use spread very slowly, Spanish kept preparation a secret until 1600s A large part of the crop comes from Africa 200 mg of theobromide, only 4mgof caffeine Pop: Coca-cola: originally marketed as tonic named for flavouring ingredients of coca leaves and cola nuts Coca leaves imported by pharmaceutical company in NJ, cocaine extracted for medical use Energy drinks: Guarana extract guaranine is caffeine from a different plant, Health Canada has strict regulations on caffeine but not guaranine. Jolt cola, first energy drink in 1985 Red Bull ingredients considered alone have little effect but sugar, caffeine and taurine together have positive synergistic effects on reaction time, memory and mood, including enhanced feelings of well- being and extraversion. With alcohol produces false sense of sobriety, more likely to drink and drive, drink more for longer. Ch 7 inhalants: Volatile solvents, aerosols, gaseous anesthetics, nitrites Volatile solvents: liquid state that dissolves other substances (ex nail polish remover, paint thinner, glue, gasoline, paint, white out, felt tip markers) Sniffing Huffing (soak shirtsleeve or sock in solvent and place it over nose or mouth) Bagging: filling a bag and placing over nose or mouth or head, or in small, enclosed spaces Depresses CNS similar to alcohol or benzodiazepines, activates the brain’s dopaminergenic system. Quickly absorbed into blood stream through lungs and travels to brain and organs. Almost immediate effect that only lasts a few minutes. User experiences: euphoria, light-headedness, distorted vision, impulsiveness or lack of inhibition. Physical symptoms: ataxia (inability to co-ordinate muscle movements), nausea and vomiting, dizziness and flushing. Once the high passes it becomes a depressant slowing down the CNS and user will feel drowsy and physically ill. Risks: -sudden heart failure due to rush of adrenaline -suicide and risk-taking behavior -asphyxiation or suffocation due to lack of oxygen -verdose, often when used in combination with other depressants -frostbite and burns to lips, tongue, air passages -Risks to mothers similar to Fetal alcohol syndrome Long term risks: -anxiety, irritability -bone marrow and blood damage -CNS damage -nose bleeds -damage to heart and lungs -sneezing, coughing, wheezing, salivating -hearing loss -liver and kidney damage -Nerve cell damage -short-term memory loss -sleep problems -spasms of arms and legs -throat and ear infection -weight loss, weakness and low energy Use is higher in younger grades, poor Hispanic youth and on aboriginal reserves Possesion and use not currently controlled by Canadian federal Law but some provincial or municipal laws Gaseous anesthetics: used in medicine and surgery, nitrous oxide “laughing gas” has been used since 1800s, one of the safest when used properly, still used for light anesthesia and in combination with more effective inhaled anesthetics. Also found in whipping cream containers. Nitrites: rapid dilation of arteries, reduce blood pressure to brain faintness or even unconsciousness. Ch 13 Opioids -activate presynaptic receptors for inhibiting the release of GABA, extra dopamine. Enkephalins act like morphine released by adrenal gland, endorphins found in brain tissue and have potent opioid and released in times of stress Opioids don’t actually seem to reduce the pain but the awareness of the pain stimulus. Patient is readily awakened if sleeping and dreams during the sleep period are frequent (“on the nod”) -they can be used to treat dysentery and dehydration, decreases number of peristaltic contractions that move food through intestines and considereable water is absorbed through intestines -codeine used for antitussive, decreases activity in cough control centre in the medulla. Opioid analogue dextromethorpan is used over the counter and more selective in antitussive properties, in high doses produces hallucinogenic effects by blocking one type of glutamate receptor Opium (paver somniferum) has history of medical use 6000 years long. Relieves pain and reduces diarrhea due to dysentery. Only available to be collected for a few days between when petals drop and seedpod matures. They make shallow cuts into unripe seedpods and during the night a white substance oozes from cuts, oxidizes to red-brown, scraped and collected in small balls. Originated in Middle East. Used as a cure-all in Greek medicine, opium cakes and candies. Arabic world forbade alcohol so opium mixed with hashish became choice drug. Opium wars: When introduced to China it is only used by select elites. The emperor forbids tobacco smoking which leads to an increase in opium smoking or combining of tobacco and opium. 1729 China creates law against opium, smuggling opium becomes a profitable business. India has monopoly of opium where it is legal, almost everyone knew it was going on. Soon Chinese government discovers and captures a large amount of supplies, the British bargain for the return of the opium. Drunken American and British sailors kill a Chinese man and starts the opium wars in 1839. The British win the war but not until 1906 did they pass a bill ending the opium trade Morphine: Serturner synthesizes active opium ingredient ten times as potent in 1806. 1832 codeine is also isolated. Hypodermic syringe in 1853. Originally thought that injection of morphine would not produce as much craving as opium which was false. Civil war it was used as relief for soldiers and many came home with addiction. Attatches to nmorphine receptors in the brain, stimulate the receptor culminating in the discovery of endorphins. Mu agonist morphine- medial thalamus and brainstem, analgesia, respiratory depression, euphoria, sedation, decreased gastrointestinal motility, physical dependence Kappa-limbic and other diencephalic areas, spinal analgesia, sedation, dyspnea (shortness of breath), dependence, dysphoria, respiratory depression Delta- largely in the brain, phsychotomimetic (creating hallucinations or delusions), dysphonic (trouble speaking) effects Sigma- psychomimetic effects, dysphoria, stress-induced depression, target sites for PCP Heroin: 1874 two acetyl groups attatched to morphine called under brand name Heroin. It is three times as potent as morphine, the acetyl groups increase the lipid solubility of the molecule. It produces identical effects to morphine only more potent and acts faster. Originally marketed as non-habit forming substitute for codeine. Synthesized using acetyl chloride or acetic anhydride which is corrosive and requires care in handling and composes a significant portion of the cost of manufacture. Common way of smuggling is hollowed out objects. In US majority of opium used to come from Turkey but in 1970’s US pays Turkey to ban cultivation of opium. In Mexico the opium is processed differently creating brown or black heroin, called black tar. 1990’s reduce in price and increase in potency causing a return to smoking. Most common form for males is injection. Heroin is mixed with water, heated to evaporate the water, filtered through a cotton ball and injected. Use can mask early symptoms of an illness such as pneumonia or malnutrition. Dode: grinding dried seed pod and taken with tea or hot water for a sense of well-being, plant grown in US. Perscription Opiods: more common, available, increased medical use related to increased non-medical use Oxycodone: long acting dose OxyContin, contains more oxycodone per tablet and needs to be taken less often. Prescription Opiods ranked third among emergency room mentions and first among drug-associated deaths. Fentanyl: approximately a hundred times more potent than morphine, used in conjunction with surgical amn
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