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Lesson Notes 1-4 First Test

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Bruce Mc Kay

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Drugs and Behaviour Test1lesson 1-4; chapters 1-5 & 9 Lesson 1 Notes: Understanding Drug Use, Chapter 1 & 2 1.1. “The Drug Problem” -desirable outcomes and problems - drug “problem” is poorly defined - lack of information and stereotyping - need to use rigorous techniques to answer questions and generate conclusions - who uses drugs? why- self medicate vs. recreational? what makes it a “problem” (dose and # of times) and type of drug - caffeine vs heroin - neither good nor bad, has multiple effects - size of effect depends on individual history, expectation for drug effects and environmental setting (especially true of hallucinogens) DiscussionBox:whatdoesitmeanthatdrugsareneithergoodnorbad? I believe that drugs are not inherently good or bad because drugs modify ligand signalling. Abnormal neurotransmission can cause great distress to a person not seeking medical treatment. For example, abnormal levels of dopaminergic and/or serotinergic activity is related to schizophrenia, multiple schlerosis and many mood disorders such as depression and bipolar I and II. Untreated individuals may turn to drug use in order to 'balance out' neurotransmitter signalling in attempts to self medicate. In these situations, the behavioural effects are "rewarding", however, the actual change in neurotransmission is neither "good" nor "bad" as the outcome is only a modification of receptor binding, yet it serves a temporary fix for the problem. Over use of drugs in healthy individuals can cause a down regulation in endogenous ligands activating the receptors effected by the drug use, which in turn, may cause problems in mood, concentration etc. In both cases, these modifications in neurotransmission are accompanied by other side effects that can be labelled as good or bad depending on the users subjective experience, but drugs are not inherently good or bad. Another example involves morphine, a drug that is used both in a clinical setting as an analgesic and abused by others to get "high". Morphine itself, is neither good nor bad, but can cause rewarding subjective experiences yet can also modify normal neurotransmission when abused, resulting in adversive effects related to mood. 1.2 How did we get here? Terms: dependence tolerance withdrawal harm reduction safe injection facility (SIF) --> controversial 1.3 Understanding Drug Use data collection - surveys (Canadian Addiction Survey, Drug Use Among Ontario Students etc.) - sewage waste (check urine for percentage of population using drugs), drugs stuck to money etc. - to understand drug use we need a comparison group 1.4 “correlates of drug use” Alcohol and Marijuana use -male - low stress (non-academically) - made lots of friends since starting university** (only true for alcohol) - dont care much about being successful in school/career - grew up in wealthy area - impulsive and thrill seeking - positive attitude about drugs in general - friends that use illicit drugs - got intoxicated earlier in age - had sex earlier - received formal drug education in elementary or high school correlates of marijuana use only liberal political views por neighbourhood or wealthy neighbourhood (either end of spectrum) parents have little interest in daily activities number of friends did not contribute ** gateway drug (gateway to hard drug use--> heroin, meth)-- marijuana often mislabeled as such (evidence suggests alcohol, inhalents and tobacco are gateways) ReviewQuestions: 1.Define the term “drug”. 2.Be able to describe, using the terms of journalism (who, what, where, when, why, how and how much) what is meant by “drug use” or “drug problem”. 3.Describe the four principles of psychoactive drugs. 4.Distinguish between licit and illicit drugs and provide examples of each. 5.Define and describe drug use, drug misuse, drug abuse, drug dependence, physical dependence, psychological dependence, drug addiction, tolerance and withdrawal. 6.Describe how we learn about drug use in the population. What are the pros and cons of different kinds of assessment devices (school surveys, phone interviews, one-on-one interviews, etc)? What kind of information can we learn from these assessments? 7.Define the terms “risk factors” and “protective factors” and provide examples of each. 8.Define “gateway drug” and provide examples of drugs that are thought to be gateway drugs. Describe evidence for and against the “gateway drug theory”. Lesson2: Drugsandsocietyandcanadiandruglaws - ch. 3 include table3.1,first4.5pages,naturalhealthproducts(pg.56) - ignore - pg 46-51, 51-52, 52-56, 57-61 (regulation of pharmaceuticals, pharmaceutical industry in canada, canadian marihuana medical access regulations, drug regulations in the united states” 2.1 “laissez faire” - non-intervention government approach to drug regulation - in the early days, people were free to use drugs if they pleased - stephen harper -- manditory minimum prison sentences for serious drug crimes -toxicity: potential harms associated with a drug acute: immediate harmful effects (ie suffocation from alcohol overdose) chronic: harmful effects after repeated use (ie. cirrhosis of the liver from excessive alcohol over time) - toxicity can also be - physiological (effects on body processes essential to support life) - behavioural(effects persons ability to response to their surroundings/ poor decision making) - ex. cocaine -- hr acceleration (physiological), hallucinations (behavioural) - intraveneous (i.v.) injections = potential to be highly toxic --> blood borned diseases - more than 99% of university students would not use a needle to administer a psychoactive drug Comparing Drug Toxicity 430,000 deaths from tobacco 125,000 dealth from alcohol 8100 deaths from cocaine 6500 deaths from opiate drugs ( heroin, morphine etc.) *its toxicity also depends on how many people do the drugs versus how many deaths *alcohol: 70% of people consume alcohol each year *1/1680 users die from alcohol each year *cocaine 1/370 users die each year *tobacco: 20% of the population in north america smoke tobacco *1/138 users die each year *heroin: 1/28 users die each year 2.2 substancedependence:whatisit?andBroadviewofsubstancedependence - dependence:uncontrolled drug use resulting in potential consequences at work, social situations, problems with the law, dysfunction in family etc. - drug dependence/ abuse not defined by quantity of drug used - drugabuse - criteria: maladaptive pattern of substance use leading to clinically significant impairment/ distress: - one or more of the following occurances at any time during 12 month period: - failure to fulfill obligations at work school or home - recurrent substance use in physically hazardous situations - substance -related legal problems - recurrent substance use despite persistent social/ interpersonal problems ** about 30% of the student population might meet the DSM-IV definition of drug abuse substancedependencecriteria 3 or more of the following; occurring at any time in same 12 month period: 1. tolerance 2. withdrawal 3. substance taken in larger amounts over a period longer than intended 4. persistent desire/ unsuccessful efforts to cut down/ control substance use 5. a lot of time spent obtaining substance 6. social, occupational, recreational activities given up/ reduced because of substance use 7. substance use continues despite knowing they cause recurrent problems ** about 15% of students meet DSM-IV definition of drug dependency “theaddictivepersonality”-no evidence supporting it - people wiht DSM personality disorders more likely to have substance abuse/ dependence, but no single “addictive personality” - about 1/2 of all males with substance abuse diagnosis have antisocial personality disorder, highly impulsive tend to be more thrill seeking -- higher rates of substance dependence - these traits do not “doom you to a life of drug abuse” 2.4 Crime and violence: does drug use cause crime? - specific drugs cause long-term changes in decision- making areas of the brain - may result in maladaptive brain changes - can impair decision making circuitry in brain over the long-term - most drugs = inacapable of committing crimes against others (ie. violent offenses while smoking weed) - - alcohol most likely to be associated with violent crime - violent people sober = very violent drunk -drug TRADE has very high rates of violence -- not necessarily because of intoxication but primarily because of profit, territory etc. in sober individuals 2.5 “ why we try to regulate drugs” and “the history of drug regulations” - laws governing penalties for drugs regulated by the Controlled Drugs and Substances Act (1996) - divided into 8 schedules -- named by Bruce (not real names of schedules) schedule I “hard drugs” schedule II “cannabis” --> see also schedule VII and VIII schedule III “amphetamines, medical sedatives and hallucinogens” schedule IV “prescriptions: steroids and sedatives” schedule V “cough and cold medicines” schedule VI “precursors” schedule VII schedule VIII summaryconvictionoffense - less serious crimes - police must see you do it - max 6 months in prison - $5000 fine max indictableoffenses - more serious crimes - police do not need to see you do it - must have warrants for arrest - greater than 6 months in prison - greater than $5000 dollar fine scheduleI Drugs - opium poppy derivatives (opium, heroin, morphine, codeine) - coca and derivatives (coca leaves, cocaine) - PCP - Ketamine - Fentanyls - Methamphetamine - others PenaltiesforscheduleIdrugs possession - indictable offense - max 7 years in prison - summary conviction offense - first offense: $1000 fine and/ or 6 months max - subsequent offense: max $2000 fine and/ or 1 year max trafficking - maximum life imprisonment exportation - max life production - max life ScheduleIIdrugs -dependentonweight(governmentsayingsomeisacceptablewhereasscheduleIarenot acceptableatall?) cannabis and derivatives excludes hemp schedule VII 3 kg hashish 3 kg marijuana schedule VIII 1 g hashish 30 g marijuana penaltiesforscheduleIIdrugs - possession - greater than amounts in schedule VIII - indictable offense - max 5 years - summary conviction offense -first offense: $1000 and/ or max 6 months -second offense: $2000 fine and/ or max 1 year less than amounts in schedule VIII - max fine $1000 and/ or max 6 months sentence trafficking - greater than amounts in schedule VII -max. life imprisonment - less than amounts in schedule VII - max 5 years imprisonment Exportation - max. life production - max. life (excluding marijuana) - marijuana: max. 7 years ScheduleIII amphetamines (including MDA, excluding methamphetamine) - not specified but inferred: MDMA< MDEA< MDBD - some barbiturates (pentobarbital, secobarbital etc) - LSD, DMT - Mescaline but not peyote - flunitrazepam (rohypnol) - GHB - Harmaline penalties for schedule III drugs possession - max 3 years - first offense: max $1000 fine and/or 6 months prison - subsequent offense: max $2000 fine, max 1 year prison trafficking - indictable offense: - max. 10 years - summary conviction offense: - max 18 months exportation indictable offense: - max. 10 years summary conviction offense: - max 18 months production - max 10 years in prison schedule IV drugs: anabolic steroids benzodiazepines (valium, xanax) most barbiturates (phenobarbital, sodium thiopental etc.) Possession: indictable offense to acquire schedule IV substance, but possession not an offense trafficking - indictable offense: - max 3 years prison - summary conviction - max 1 year prison exportation indictable offense: max 10 years summary conviction max 18 months production max 3 years prison scheduleV propylhexedrine (cold medication) many others possession not an offense trafficking don’t traffic exportation indictable offense: - max 3 years summary conviction offense: max 1 year production -n/a *** only trafficking is a punishment ScheduleVI Class A -ephedrine (easily made into methamphetamine) - isosafrole (used for making mdma) Class B - acetone - ethyl ether - hydrochloric acid - methyl ethyl ketone - sulfuric acid - toluene possession - not an offense trafficking - n/a exportation indictable offense: max 3 years summary conviction offense max 1 year production n/a *** most severe punishment always exportation; least punishment always posession 2.7 “ relationship between objective drug harms and drug laws” - professor Nutt used to be chief drug advisor for UK government - was sacked after writing a paper suggesting that drug penalties should be in proportion to the harm associated with the drug’s use - categorized harm into 3 sections:physical harm, dependence, social harm PHYSICALHARM acuteharm - acute toxicity - drug safety : effective dose vs lethal dose - depression on respiratory/ cardiac function - contaminant - chronicharm - chronic health effects - psychoses vs organ damage - intravenousharm - how drug administered (speed of the effects) - blood borne toxins DEPENDENCYHARM intensityofpleasure - size of the “rush” or “high” or “euphoria” - how “moving” is the experience (ie. hallucinogens) psychologicaldependence -craving -how often is the drug used? physicaldependence - tolerance - physical withdrawal symptoms SOCIALHARM Intoxication - does one behave “badly” under the influence - damage to people and/or property Othersocialharms - family and community problems Healthcarecosts - emergency room visits - chronic health costs Review Questions: Based on Chapter 2: Describe how the government’s approach to regulating psychoactive drugs has changed over the past century. Distinguish between acute toxicity and chronic toxicity. Provide examples of each. Distinguish between physiological toxicity and behavioural toxicity. Provide examples of each. Describe how we evaluate the toxicity of psychoactive drugs. What is meant by “drugs- in-combination” and why are “drugs-in-combination” particularly toxic? Name the blood-borne diseases associated with intravenous drug use. How have Safe Injection Facilities and needle exchange programs contributed to the reduction of these diseases? Use the information in Chapter 2, together with Chapter 1, to formulate a more complete description of physical dependence, psychological dependence, and tolerance. Describe how the scientific / medical view of substance dependence has changed in the past few years. List the DSM-IV-TR criteria for substance abuse and substance dependence. What are the key differences between substance abuse and substance dependence? Describe various theories for the causes of substance dependence. Based on Chapter 3 and your Lesson Notes: Describe the factors that lead to the creation of Canada’s Opium Drug Act in 1908 (based on parallels in the US). Describe Schedules I through VIII in the Controlled Drugs and Substances Act, including drugs found in each schedule. Be aware of the penalties for possession in each of these categories. What is the relationship between objective drug harms and penalties for drug possession in Canada? Lesson3:BasicPrinciplesofDrugEffectsontheBrainandBody ch. 4 and 5 - ignore p 84-86 and 89-91 : sources and names of drugs and non-specific placebo effects 3.1“chemicalMessengers” - when psychoactive drugs change the way the brain is working, the brain overcompensates in the other direction (try to maintain homeostasis) - homeostasis underlies tolerance, psychological dependence, and physical dependence - ie. receptors too ove
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