Popular Drugs: Impact Brain Behavior & Society SUSAN L. DALTERIO PHD

Transcription

1 Popular Drugs: Impact Brain Behavior & Society SUSAN L. DALTERIO PHD

2 I. BACKGROUND: HOW DRUGS AFFECT THE BRAIN A. BRAIN CHEMICALS B. ADDICTION PROCESS C. ADOLESCENT BRAIN DEVELOPMENT II. ABUSE OF Rx & RELATED PRODUCTS A. STIMULANTS- AMPHETAMINES & RELATED ADD AGENTS B. OPIOIDS 1. EFFECTS OF ABUSE 2. EPIDEMIC OF ABUSE FDA RESPONSE III. MARIJUANA A. PHARMACOLOGY B. MEDICAL USE C. SYNTHETIC CANNABINOIDS- SPICE OR K2 IV. CLUB DRUGS & NOVEL DESIGNER PSYCHEDELICS A. ECSTASY MDMA OR MOLLY B. BATH SALTS- MEPHIDRONE & RELATED AGENTS C. THE ALPHABET SOUP OF DESIGNER AGENTS V. CONCLUSIONS & QUESTIONS SOCIAL IMPACT

3 HOW DO DRUGS AFFECT THE BRAIN? MIMIC NATURAL BRAIN CHEMICALS BLOCK ACTIONS OF BRAIN CHEMICALS ALTER RECYCLING OF BRAIN CHEMICALS AFFECT BRAIN CHEMICALS RELEASE ALTER BRAIN CHEMICAL BREAKDOWN

4 MAJOR BRAIN CHEMICALS DOPAMINE PRODUCES PLEASURE THROUGH THE REWARD SYSTEM IMPORTANT IN COGNITION & EMOTION ACETYLCHOLINE REGULATES MEMORY ALSO AFFECTS DREAMING SEROTONIN INVOLVED IN SENSORY PERCEPTION HALLUCINATIONS CONTROL OF EMOTIONAL STATES SUCH AS ANXIETY & DEPRESSION

5 NOREPINEPHRINE FIGHT OR FLIGHT AROUSAL FOCUS FEAR ENDORPHINS PAIN MODULATION APPETITE & MOOD GLUTAMATE SENSATIONS LEARNING

6 THE ADDICTION PROCESS ACTIVATION OF BRAIN REWARD PATHS LONG LASTING CHANGES IN BRAIN STRUCTURES INVOLVED IN LEARNING REINFORCES BEHAVIORS MEMORIES OF THE DRUG EXPERIENCE CREATE A POWERFUL FORM OF LEARNING

7 REWARD SYSTEM DRUGS ACTIVATE REWARD PATHS PRODUCE POWERFUL FEELINGS OF PLEASURE & AN INCREASED DESIRE TO REPEAT DRUG USING BEHAVIOR DRUGS ACT ON THE MORE PRIMITIVE CHILD-LIKE SURVIVAL AREAS IN BRAIN

8 A REMINDER THE INTERNET MAKES Rx DRUGS OTC!

9 TEXAS DUI TRENDS PROPORTION REPORTING A PRIMARY PROBLEM WITH ALCOHOL DECREASED FROM 75% IN 1990 TO 21% IN 2008 THE PROPORTION WITH A PRIMARY PROBLEM OF MARIJUANA INCREASED FROM 19 TO 63 % THE PROPORTION WITH A PRIMARY PROBLEM WITH COCAINE INCREASED FROM 5 TO 7 %

10 PHARMING TRADING OF RX/OTC MEDICATIONS INGESTING THE MIX OF PILLS, OFTEN WITH ALCOHOL TO GET HIGH INGESTING HANDFULS, SOMETIMES SEVERAL BOTTLES OF PILLS & COUGH SYRUP A DAY OR PARTYING

11 SIGNS & SYMPTOMS PHYSICAL FATIGUE, REPEATED HEALTH COMPLAINTS, RED AND GLAZED EYES, AND A LASTING COUGH EMOTIONAL PERSONALITY CHANGE, SUDDEN MOOD CHANGES, LOW SELF- ESTEEM, IRRITABILITY, IRRESPONSIBLE BEHAVIOR, POOR JUDGMENT, DEPRESSION, GENERAL LACK OF INTEREST FAMILY STARTING ARGUMENTS, BREAKING RULES, WITHDRAWING FROM THE FAMILY SCHOOL DECREASED INTEREST, NEGATIVE ATTITUDE, DROP IN GRADES, MANY ABSENCES, TRUANCY, DISCIPLINE PROBLEMS SOCIAL PROBLEMS NEW ANTI-SOCIAL FRIENDS, PROBLEMS WITH THE LAW, CHANGES TO LESS CONVENTIONAL STYLES IN DRESS & MUSIC

12 THE UPPERS

13 PSYCHOSTIMULANT DRUGS CLINICAL USES: ANOREXIANTS (WEIGHT LOSS) ATTENTION DEFICIT DISORDER DECONGESTANTS ENHANCE THE ACTIVITY OF NE & DA INCREASE HEART RATE, BP AMPHETAMINES, RITALIN, METHAMPHETAMINE

14 SLEEPLESSNESS ADVERSE EFFECTS RESTLESSNESS & IRRITABILITY HEADACHE INCREASED RISK OF STROKE NAUSEA & VOMITING INCREASED BODY TEMPERATURE RAPID HEARTBEAT & ALTERED HEART RHYTHM SEIZURES & PSYCHOSIS CHRONIC USE CAN CAUSE TOLERANCE & DEPENDENCE

15 OPIOIDS & BRAIN CHEMISTRY INCREASE RELEASE OF DOPAMINE PARTICIPATES IN REWARD MIMICS THE EFFECTS OF OPIOID RECEPTOR DECREASES ACTIVITY OF PAIN PRODUCING BRAIN CHEMICALS

16 ABUSED OPIOIDS HEROIN VICODIN OXYCONTIN MEPERIDINE (DEMEROL) CODEINE METHADONE BUPRENORPHINE

17 ADVERSE EFFECTS BOWEL OBSTRUCTION POTENTIALLY FATAL RESPIRATORY DEPRESSION POTENTIAL LIVER TOXICITY FROM COMBINATION PRODUCTS CONTAINING ACETAMINOPHEN ADDICTION

18 FDA RESPONSE OXYCONTIN REFORMULATION TO DISCOURAGE ABUSE BY INJECTION REDUCTION OF ACETAMINOPHEN DOSES IN MANY COMBINATION PRODUCTS NEW GUIDELINES THAT WILL REQUIRE DOCTOR REVISITS EVERY THREE MONTHS FOR CERTAIN SCH II & III OPIOID AGENTS

19 SEDATIVE HYPNOTICS XANAX ALPRAZOLAM SEDATIVE-HYPNOTIC USED TO HEIGHTEN/PROLONG HEROIN EFFECTS MOST POPULAR TEXAS STREET BZ ANTEROGRADE AMNESIA SEIZURE SUDDEN WITHDRAWAL

20 MARIJUANA TRENDS 1960s 2% U.S. USE ILLICIT DRUGS MILLION TRIED MARIJUANA MILLION USED ONCE/MONTH 3.2 MILLION USED DAILY HALF ARE DEPENDENT 374,000 VISITS TO THE EMERGENCY DEPARTMENT 33-50% OF ARRESTEES TESTED POSITIVE FOR MARIJUANA MARIJUANA WAS THE PRIMARY PROBLEM FOR 23% OF ADMISSIONS TO TREATMENT PROGRAMS IN 2012 MEDICAL MARIJUANA HAS INCREASED POTENCY; VARIETY & PRICE

21 THC 9 - TETRAHYDROCANNABINOL MAJOR PSYCHOACTIVE INGREDIENT PRODUCES THE HIGH FEELING CHANGES BEHAVIOR & PERCEPTION

22 MARIJUANA & BRAIN CHEMISTRY BINDS TO ANANDAMIDE RECEPTOR AFFECTS ACETYLCHOLINE ACTIVITY INCREASES DOPAMINE RELEASE

23 ACUTE EFFECTS PHYSICAL RELAXATION SEDATION GIDDINESS TIME SLOWS DOWN SHORTENS ATTENTION SPAN SHORT TERM MEMORY DEFICIT ANXIETY/PARANOIA

24 EFFECTS ON BODILY FUNCTIONS SUPPRESSED IMMUNITY DAMAGE TO LUNG TISSUE CARDIOVASCULAR DAMAGE DECREASED TESTOSTERONE INCREASED APPETITE

25 MARIJUANA & THE IMMUNE SYSTEM T CELLS VIRAL RESISTANCE RESPIRATORY DISEASES IMMUNOSUPPRESSIVE EFFECTS MEDIATED BY CB 2 RECEPTORS DALTERIO 2013

26 RESPIRATORY SYSTEM AIRWAY DAMAGE CHRONIC BRONCHITIS LUNG INFLAMMATION TAR DEPOSITS HEAD & NECK CANCERS

27 CARDIOVASCULAR EFFECTS PALPITATIONS TACHYCARDIA ACUTE IN BP PROLONGED HYPOTENSION RISK OF HEART ATTACK RISK OF STROKE

28 MARIJUANA USE LINKED TO INCREASED RISK OF HEART ATTACK INCREASED RISK OF STROKE EVEN IN YOUNG USER INCREASED RISK FOR PSYCHIATRIC ILLNESS LOSS OF IQ POINTS AFTER CHRONIC USE

29 CHRONIC MARIJUANA USE THERE IS EVIDENCE OF PSYCHIATRIC, RESPIRATORY, CARDIOVASCULAR, & BONE TOXICITY ASSOCIATED WITH CHRONIC USE. ASSOCIATED WITH MANY MAJOR LONG-TERM PSYCHIATRIC CONDITIONS INCLUDING DEPRESSION, ANXIETY, PSYCHOSIS, BIPOLAR DISORDER, & AN AMOTIVATIONAL STATE. RESPIRATORY CONDITIONS INCLUDE REDUCED LUNG DENSITY, LUNG CYSTS, AND CHRONIC BRONCHITIS. DOSE-DEPENDENT ELEVATED RATES OF MYOCARDIAL INFARCTION & CARDIAC ARRHYTHMIAS. IT IS KNOWN TO AFFECT BONE METABOLISM & ALSO HAS TERATOGENIC EFFECTS ON THE DEVELOPING BRAIN FOLLOWING PERINATAL EXPOSURE. LINK TO CANCERS AT EIGHT SITES, INCLUDING CHILDREN AFTER IN UTERO MATERNAL EXPOSURE

30 REPRODUCTIVE ISSUES MARIJUANA IS THE MOST WIDELY USED DRUG BY WOMEN AT REPRODUCTIVE AGE STUDIES REPORT EITHER LOWER BIRTH WEIGHT OR SHORTER LENGTH AT BIRTH FOR INFANTS EXPOSED PRENATALLY PATERNAL MARIJUANA USE DURING THE PERIODS OF CONCEPTION & PREGNANCY & ALSO POSTNATAL EXPOSURE SIGNIFICANTLY INCREASED RISK OF SIDS EXPOSURE VIA BREAST MILK DURING THE FIRST MONTH POSTPARTUM APPEARS TO BE ASSOCIATED WITH A DECREASE IN INFANT MOTOR DEVELOPMENT AT ONE YEAR OF AGE DALTERIO 2013

31 PROPOSED MEDICAL USES PAIN RELIEF AIDS WASTING CHEMO RELATED NAUSEA SPASTICITY GLAUCOMA DALTERIO 2013

32 ISSUES PHARMACEUTICAL PRODUCTS VS. PLANT MARIJUANA PRODUCT CONSISTENCY FOR MEDICINAL PLANTS DOSAGE ISSUE FOR SMOKING AS A DRUG DELIVERY SYSTEM BENEFIT TO RISK FOR GENERAL USE EFFECTIVENESS OF CANNABINOIDS VS OTHER ESTABLISHED PHARMACEUTICALS DALTERIO 2013

33 HIV/AIDS PATIENTS THE MOST COMPELLING CONCERNS REGARDING MARIJUANA SMOKING IN HIV/AIDS PATIENTS ARE THE POSSIBLE EFFECTS OF MARIJUANA ON IMMUNITY. REPORTS OF OPPORTUNISTIC FUNGAL & BACTERIAL PNEUMONIA IN AIDS PATIENTS SUGGEST THAT MARIJUANA SMOKING EITHER SUPPRESSES THE IMMUNE SYSTEM OR EXPOSES PATIENTS TO AN ADDED BURDEN OF PATHOGENS. PATIENTS WITH PREEXISTING IMMUNE DEFICITS DUE TO AIDS SHOULD BE EXPECTED TO BE VULNERABLE TO SERIOUS HARM CAUSED BY SMOKING MARIJUANA." -- INSTITUTE OF MEDICINE REPORT MARIJUANA AND MEDICINE: ASSESSING THE SCIENCE BASE MAR. 1999

34 STATES vs. FEDS A GROWING NUMBER OF STATES HAVE PASSED VOTER REFERENDA MAKING SMOKED MARIJUANA AVAILABLE FOR A VARIETY OF MEDICAL CONDITIONS UPON A DOCTOR'S RECOMMENDATION THESE MEASURES ARE INCONSISTENT WITH EFFORTS TO ENSURE THAT MEDICATIONS UNDERGO THE RIGOROUS SCIENTIFIC SCRUTINY OF THE FDA APPROVAL PROCESS TO ENSURE THEY ARE SAFE AND EFFECTIVE UNDER THE STANDARDS OF THE FD&C ACT. THE FDA, THE FEDERAL AGENCY RESPONSIBLE FOR REVIEWING SAFETY & EFFICACY OF DRUGS, DEA AS THE FEDERAL AGENCY CHARGED WITH ENFORCING THE CSA, AND THE OFFICE OF NATIONAL DRUG CONTROL POLICY, AS THE FEDERAL COORDINATOR OF DRUG CONTROL POLICY, DO NOT SUPPORT THE USE OF SMOKED MARIJUANA FOR MEDICAL PURPOSES. DALTERIO 2013

35 SMOKED MARIJUANA RESPIRATORY DISEASE LOSS OF BRONCHIAL CILIA PROGRESSION OF HIV AIDS 2X MORTALITY IN MEN WITH AIDS

36 CONCLUSIONS: PLANTS AS MEDICINE NOT FDA APPROVED FOR SAFETY & EFFECTIVENESS CANNOT PROVIDE CONSISTENT DRUG DOSE OR DELIVERY GUIDELINES CONTAMINATION ISSUES SMOKING & PLANTS ARE NO LONGER ACCEPTED IN ANY CURRENT TREATMENT SCENARIO IN THE US ADVERSE EFFECTS OF SMOKING SMOKING PRODUCES A QUICK "HIGH MAKING THE PATIENT FEEL BETTER AN EXAMPLE OF THE PLACEBO EFFECT; IF PEOPLE BELIEVE MARIJUANA IS A MEDICINE FOR THEM IT MAY WORK DALTERIO 2013

37 CONCLUSIONS MARIJUANA ADVERSELY AFFECTS THE BRAIN, HEART, IMMUNE, RESPIRATORY & REPRODUCTIVE SYSTEMS MARIJUANA INTERFERES WITH LEARNING, MEMORY & PERFORMANCE OF COMPLEX COGNITIVE TASKS PLANT MARIJUANA IS NOT MEDICINE

38 SYNTHETIC CANNABINOIDS IN A 2012 MONITORING THE FUTURE SURVEY ABOUT 11% OF US HIGH SCHOOL SENIORS YRS. OLD ADMITTED USING SPICE MALE ADOLESCENTS ARE MORE LIKELY TO USE SPICE SPICE USERS ARE 1) MARIJUANA SMOKERS, 2) OCCASIONAL DRUG USERS SEEKING TO AVOID LEGAL COMPLICATIONS (NO LONGER LEGAL) 3) DRUG-NAÏVE EXPERIMENTERS

39 SYNTHETIC CANNABINOIDS SPICE OR K2 DEVELOPED BY JW HUFFMAN AT CLEMSON U IN THE MID 90 S SPRAYING A SYNTHETIC THC LIKE COMPOUND JWH-018 ONTO HERBAL PRODUCTS OR INCENSE EASY TO GET ON THE INTERNET OR IN HEAD SHOPS, SOME GAS STATIONS ETC. LEGAL STATUS IN QUESTION SOLD AS A PLANT GROWTH STIMULANT IN CHINA & KOREA BANNED IN SOME LOCALITIES, EUROPE & RUSSIA BANNED BY US MILITARY & DETECTED BY THEIR DRUG SCREENING TESTS

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42 STREET NAMES BLISS BLACK MAMBA BOMBAY BLUE FAKE WEED GENIE SPICE

43 POISON CONTROL CENTER DATA FOLLOWING REFLECTS CLOSED CASES FOR SYNTHETIC MARIJUANA EXPOSURES IN 2010 THERE WERE 2,906 CALLS FOR ,959 FOR ,406

44 PHYSICAL SYMPTOMS VERY RAPID IN HEART RATE DANGEROUSLY ELEVATED BLOOD PRESSURE PALE SKIN & VOMITING SEVERE HALLUCINATIONS EXTREME ANXIETY, AGITATION & SEIZURES

45 DESIGNER PSYCHEDELICS MDA MDMA- MERCK C-B- NEXUS PMA- MAY BE SOLD AN ECSTASY; CHICKEN YELLOW 2C-T-7- BLUE MYSTIC 2C-T-2- STP - SERENITY

46 ECSTASY MDMA METHYLENEDIOXYMETHAMPHETAMINE MOLLY X E STACY LOVER S SPEED EVE

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48 COMMON CONTAMINANTS CHALK LSD AMPHETAMINES HEROIN CAFFEINE KETAMINE EPHEDRINE

49 MDMA ACUTE EFFECTS TEETH CLENCHING/JAW SPASM NAUSEA/ANOREXIA HEADACHES/AGITATION SEIZURE ACTIVITY/STROKE/COMA TREMORS BLURRED VISION MUSCLE CRAMPING CARDIAC ARRHYTHMIAS

50 ECSTASY BEHAVIORAL EFFECTS INCREASED ENERGY EMPATHY TOWARD OTHERS INCREASED AFFECTION EMOTIONAL OPENNESS PROFOUND POSITIVE FEELINGS EUPHORIA DECREASED INHIBITIONS DECREASED ANXIETY EXTREME RELAXATION

51 MDMA OVERDOSE HIGH BLOOD PRESSURE FAINTNESS PANIC ATTACKS LOSS OF CONSCIOUSNESS SEIZURES HEART FAILURE HEAT STROKE

52 BATH SALTS MEPHEDRONE

53 National Addiction Centre, UK 67% OF MEPHEDRONE USERS EXPERIENCED SWEATING 51% SUFFERED FROM HEADACHES 43% FROM HEART PALPITATIONS 27% FROM NAUSEA 15% FROM COLD OR BLUE FINGERS, INDICATING VASOCONSTRICTION

54 ADVERSE EFFECTS POISON CENTERS REPORT: HALLUCINATIONS PARANOIA TACHYCARDIA & HYPERTENSION ALTERED RENAL FUNCTION CARDIAC ARRHYTHMIAS DEATHS HAVE BEEN REPORTED

55 2C-T-7 AND 2C-T-2 INDUCE DELIRIUM HEIGHTEN SENSITIVITY INCREASED AWARENESS DANGEROUS CARDIAC EFFECTS OR DEATH IF HIGH DOSES 7-UP BLUE MYSTIC

56 BROMO-DRAGON FLY MORE POTENT THAN 2C- DERIVATIVES LONGER LASTING- 6 H-4 DAYS POWERFUL HALLUCINOGEN VISUAL DISTORTIONS MEMORY LOSS/CONFUSION ACUTE ANXIETY REACTIONS DEPERSONALIZATION & PANIC

57 DMT DIMETHYLTRYPTAMINE PRODUCED IN BODY UNDER NATURAL CONDITIONS CAN PRODUCE AN TOTAL LOSS OF CONNECTION WITH THE REAL WORLD, INCLUDING CONTACT WITH ALIENS DR. RICK STRASSMAN (U OF NEW MEXICO), ADVANCED THE CONTROVERSIAL HYPOTHESIS THAT A MASSIVE RELEASE OF DMT FROM THE PINEAL GLAND PRIOR TO DEATH OR NEAR DEATH WAS THE CAUSE OF THE NEAR DEATH EXPERIENCE (NDE) PHENOMENON. SEVERAL OF HIS TEST SUBJECTS REPORTED NDE-LIKE AUDIO OR VISUAL HALLUCINATIONS AFTER DMT

58 SOCIAL ISSUES DRUGS INTERFERE WITH LEARNING & MEMORY ESPECIALLY IN ADOLESCENTS AGE OF FIRST USE HAS PROFOUND EFFECTS ON ADDICTION PROBABILITY DRUG AVAILABILITY INCREASES USE LONG-TERM MEDICAL EFFECTS OF THE LEGAL ALCOHOL & TOBACCO COST BILLIONS PSYCHOACTIVE DRUG IMPACT TRAFFIC-RELATED DEATHS, WORKPLACE ACCIDENTS & ABSENTEEISM, DOMESTIC VIOLENCE & CRIMINAL BEHAVIORS