Substance abuse. Barbara Loi, Stefania Chiappini, Hugh Claridge, John Corkery, Carla Gimeno Clemente, Christine Goodair, Fabrizio Schifano

Transcription

1 10th International Training Seminar in Child and Adolescent Psychiatry, June 2013, Bocca di Magra (La Spezia), Italy Substance abuse Barbara Loi, Stefania Chiappini, Hugh Claridge, John Corkery, Carla Gimeno Clemente, Christine Goodair, Fabrizio Schifano

2 Brain reward pathways

3 Substances Amphetamine and amphetamine-like substances Cocaine Nicotine Opiates Alcohol Cannabinoids Lysergic acid dietylamide (LSD) Ecstasy Ketamine and Phencyclidine Novel Psychoactive Substances (NPS)

4 Amphetamines (4) Street names: speed, whizz, sulph, uppers, ice, crystal, glass Routes of administration: swallowing, sniffing, smoking, injecting

5 Chemical synapse

6 Mechanism of action of amphetamine

7 Cocaine (4) Street names: coke, charlie C, white, percy, snow, toot (white crystalline powder) Routes of administration: sniffing and snorting

8 Mechanism of action of cocaine

9 Nicotine (4) Main psychoactive ingredient of tobacco Routes of administration: smoking, chewing

10

11 Mechanism of action of nicotine

12 Opiates (4) Codeine, heroin, morphine, methadone Routes of administration: oral, intramuscular, intravenous Mechanism of action

13 Alcohol (4)

14 Mechanism of action of alcohol

15 Cannabis (4) delta-9-tetrahydrocannabinol, cannabidiol Street names: ganja, pot, skunk,weed Route of administration: smoking, oral

16 Mechanism of action of cannabis

17 Lysergic acid dietylamide (LSD) (4) Liquids, tablets, capsules, blotting paper Routes of administration: swallowing, sniffing, injecting, smoking

18 Activation of serotoninergic receptors stimulates glutamate release in the cortex

19 ECSTASY Street names: E, MDMA, adam, love doves (tablets, capsules, powder) Routes of administration: swallowing, snorting, injecting (4) Amphetamine-like properties Binding to 5HT2 receptors

20 Ketamine and Phencyclidine (PCP) (4) Street names of ketamine: special K, super K, green, vitamin K (powder or liquid) Routes of administration of ketamine: inhalation, injecting, drinking Street name of PCP: angel dust (tablets, capsules, powders) Routes of administration of PCP: swallowing, smoking, sniffing, injecting

21 Effects of Ketamine Effects of Phencyclidine (PCP)

22 Novel Psychoactive Substances (NPS) (1) Some may be legal to possess Easy to obtain from head shops, internet Marketed as producing similar effects to illegal drugs Labelled not for human consumption NPS commonly used: Herbal Marijuana Alternatives (HMAs) Synthetic Cathinones Salvia divinorum Methoxethamine

23 Herbal Marijuana Alternatives (HMAs) (1) Spice, K2 Marketed as incense and potpourri Sold in blends containing herbal additives and synthetic cannabinoids HMAs are not detectable by traditional screening methods Route of administration: smoking Mechanism of action: agonism of the cannabinoid receptors CB1 and CB2, non competitive NMDA glutamatergic receptor antagonism Clinical effects: agitation, anxiety, paranoia, psychosis, tachycardia, seizures

24 Synthetic Cathinones (1, 2) Marketed as legal highs, or herbal highs Bath salts, plant food, chicken feed additives Substances identified: mephedrone, Methylenedioxypyrovalerone (MDPV), methylone, butylone Routes of administration: nasal inhalating, oral ingesting, intravenous/intramuscular injecting Mechanism of action: Inhibition of monoaminergic transporters Clinical effects: Euphoria, increased energy, talkativeness, psychotic behaviours, hypertension, hyperthermia, psychomotor agitation

25 Salvia divinorum (1) Herb native to Mexico (Diviner s sage, mystic sage, Sally D, Maria Pastora) Marketed as aliquots of crushed plant leaves, or salvinorin A extract Routes of administration: chewing, swallowing, smoking Mechanism of action: kappa opioid receptor agonism, dopaminergic and noradrenergic stimulation. Clinical effects: hallucinations, visual distortions, accentuation of sensations, out of body experience, analgesia, sedation

26 Methoxetamine (1) Ketamine analogue Easy to obtain from head shops, internet Routes of administration: ingesting, inhalating, injecting Mechanism of action: antagonism of NMDA receptors, inhibition of dopamine reuptake Clinical effects: euphoria, perceptual distortion, hallucinations, paranoia, anxiety

27 Drug related-deaths in young people aged years This study describes information on drug related-deaths in people aged 10 to 18 years old in the UK and Islands Study s aim: to inform the general public about the serious consequences of drug abuse in young people This investigation could not have been performed without the existence of the national programme on Substance Abuse Deaths run by the International Centre for Drug Policy (

28 national programme on Substance Abuse Deaths (np-sad) (3) np-sad was established in 1997 in the UK to monitor and collect information on drug-related mortality Coroners of the UK and Islands (Channel Islands, Isle of man) report drug-related deaths voluntarily on a standardised questionnaire The questionnaires are sent to the programme where the data are collected, analysed and published in annual reports An np-sad case is defined as a death where any of the following criteria are met at a completed inquest, fatal accident inquiry or similar investigation: 1) One or more psychoactive substances directly implicated in death 2) History of dependence or abuse of psychoactive drugs 3) Presence of Controlled Drugs at post mortem (classified by the Misuse of drugs act 1971)

29 Drug-related deaths in young people aged years Results Average age of sample (n=421): years Gender and ethnicity: male (65.8%) and white (83.8%) Occupational status: unemployed (41.6%), student/pupil (21.9%), employed (16%) Living arrangements: with parents (47.5%), alone (13.3%), with friends (6.2%) Place of death: home (32.5%), hospital/infirmary (28.7%), private residential address (21.4%) Coroner s verdict: accidental/misadventure (39.7%), non-dependent abuse of drugs (13.8%), dependence on drugs (10.7%). Manner of death: accidental (91.4%), undetermined ( 7.1%) Underlying cause of death: accidental poisoning by narcotics and psychodysleptics (63.9%), and accidental poisoning by sedative-hypnotics, antidepressants, other psychotropic drugs (12.6%)

30 Drug-related deaths in young people aged years Psychoactive medications: where prescribing history was known, 27.7% of people were prescribed psychoactive drugs and 72.3% were not Drug addict status: yes (54.4%), no (19.5%), not known (26.1% ) Drugs implicated in death : Heroin/morphine alone or in combination (176/421 cases, 41.8%) Methadone alone or in combination (103/421 cases, 24.5%) Hypnotics/sedatives alone or in combination (98 /421 cases, 23.3%) Alcohol alone or in combination (82/421 cases, 19.5%) Other opiate/opioid analgesics alone or in combination (70/421 cases, 16.6%) MDMA alone or in combination (56 /421 cases, 13.3%) Antidepressants alone or in combination (46/421 cases, 10.9%) Cannabis alone or in combination (40/421 cases, 9.5%) Amphetamines alone or in combination (23/421 cases, 5.5%)

31 Conclusions The majority of fatalities in young people aged years in the UK and Islands were: predominantly males mainly due to use of narcotics drugs in alone or in combination with other drugs principally considered to be accidental Young people should be informed about risks associated with drug intake, to promote interventions regarding drug use among young people

32 References (1) Christopher D. Rosenbau, Stephanie P. Carreiro, Kavita M. Babu (2012). Here today, Gone tomorrow and back again? A review of herbal marjuana alternatives (K2, Spice), synthetic Cathinones (Bath salts), kratom, Salvia divinorum, Methoxetamine, and piperazines J. Med. Toxicol., 8:15-32 (2) Fabrizio Schifano, Antonio Albanese, Suzanne Fergus, Jackie L. Stair, Paolo Deluca, Ornella Corazza, Zoe Davey, John Corkery, Holger Siemann, Norbert Scherbaum, Magi' Farre, Marta Torrens, Zsolt Demetrovics, A. Hamid Ghodse. (2010) Mephedrone (4-methylmethcathinone; 'meow meow ): chemical, pharmacological and clinical issues. Psychopharmacology, 214: (3) Drug-related deaths in the UK, Report 2012, available at (4) G. Hussein Rassool Alcohol and Drug Misuse. A handbook for students and Health Professionals