Understanding Drug Abuse and Addiction. Steve Hanson - Associate Commissioner NYS OASAS

Transcription

1 Understanding Drug Abuse and Addiction Steve Hanson - Associate Commissioner NYS OASAS

2 Basic Questions Why do people do drugs? Why can t/ won t some people stop?

3 Realities 1. People like Drugs. 2. We all like things faster and easier.

4 Drive to Get High Some people will seek any means to alter their state of consciousness

5 Neurotransmitter Action Release of NT Reuptake Receptor

6 How Drugs Work Interact with neurochemistry Results: Feel Good Euphoria/reward Feel Better reduce negative feelings

7 Addiction is a Brain Disease Prolonged Use Changes the brain in Fundamental and Long Lasting Ways

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9 Brain Changes

10 methamphetamine marijuana ecstasy opium etc.

11 Food % of Basal DA Output Empty Box FOOD Feeding NAc shell Time (min) Source: Di Chiara et al.

12 Sex DA Concentration (% Baseline) SEX 0 ScrScr Scr Scr BasFemale 1 Present Female 2 Present Sample Number Mounts Intromissions Ejaculations Source: Fiorino and Phillips Copulation Frequency

13 Nicotine % of Basal Release NICOTINE Accumbens Caudate hr Time After Nicotine

14 Alcohol 250 Accumbens Alcohol 200 Dose (g/kg ip) % of Basal Release hr Time After Ethanol

15 Cocaine 400 Accumbens COCAINE % of Basal Release DA DOPAC HVA hr Time After Cocaine

16 Morphine % of Basal Release Accumbens Heroin MORPHINE Dose (mg/kg) hr Time After Morphine Source: Di Chiara and Imperato

17 Methamphetamine 1100 Accumbens METHAMPHETAMINE % of Basal Release DA DOPAC HVA hr Time After Amphetamine Source: Di Chiara and Imperato

18 Behavior Pathways Rewarding behaviors can become routine Subconscious control of the behavior Difficult to extinguish behaviors because people are not always aware when they are initiated. Resistant to change

19 Circuits Involved In Drug Abuse and Addiction STOP GO

20 Go & Stop Craving elicits Go!! Powerful Activity in limbic system not frontal cortex Feeling/reacting vs. thinking/planning Thinking initiates Stop!! Addicts have bad brakes Stop! Hard to stop this fast moving car.

21 AMYGDALAR CONNECTIVITY during brief.5 sec Cocaine Cues Placebo Drug 2 amyg conx (n=7) Baclofen blunts AMYGDALAR CONNECTIVITY Baclofen Source: Childress et al

22 Chemical Dependency Chronic Disease Prone to Relapse Requires significant behavior changes Similar to Heart Disease, Diabetes, Asthma, Gingivitis,etc. Similar treatment success

23 Drug Types Stimulants: Cocaine, Caffeine, Methamphetamine Depressants: Alcohol, Barbiturates, Anti Anxietals Pain Relief: Opioids, Aspirin, Ibuprofen Hallucinogens: LSD, Ecstasy, Bath Salts Cannibinoids: Marijuana, Synthetics

24 Cocaine Natural Stimulant from South America Main Effects: Euphoria Fight/Flight Snorted, Smoked, Injected, Other Mucosal Absorption

25 5 mins Smoked - onset 5-12 seconds mins Snorted - onset 2 mins. 15 mins 1 hour

26 Dose Response EFFECTS Energized Euphoria Metabolic Crisis Psychosis Paranoia Anxiety DOSE

27 Animal Studies Primates will ignore food and water in order to get cocaine to the point of death by starvation/dehydration Given unlimited access to cocaine, animals will quickly die from cocaine related deaths.

28 Stopping Cocaine Use Anhedonia Dopamine depletion Craving intense craving for drug

29 Methamphetamine Synthetic stimulant Amphetamine family Main Effects 8 12 hours from single dose: Euphoria Energy Snorted, smoked, injected

30 Methamphetamine DOPAMINE DOPAMINE

31 Meth Signs of Abuse Rapid weight loss Nervous energy No need for sleep Aggressive Excited talk Meth mouth

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33 Meth Signs of Withdrawal long crash apathy depression fatigue anxiety suicidal ideation cravings

34 Alcohol Most popular drug of abuse Probably the most physically toxic of drugs Damages almost every organ in the body Easy access, adults use, advertising, relatively inexpensive. THE DRUG for Youth

35 Action Dopamine excitement & reward Serotonin feel normal GABA lowers anxiety Endorphins pain relief, reward, craving

36 Benzodiazepine Family Anti Anxiety: Valium, Xanax Sleeping Aids: Ambien, Lunesta Can produce dependency Long withdrawal periods.

37 Heroin/Opioids 142 Americans

38 Source: CDC 3/17/

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40 NY had 20.4% increase

41 Opioids Natural Opiates Derived from raw opium Morphine Codeine Semi synthetics Modified Natural Heroin Vicodin Synthetics Fentanyl Demerol Methadone

42 Heroin Heroin more potent 60 80% <10% in 70 s Younger age group y.o. and younger Suburban/Rural Users start with snorting IV within 12 months Withdrawal painful not deadly Lots of Relapse

43 Heroin Effects Analgesia change in pain perception Euphoria Intense Sedation on the nod Respiratory Depression Cough Suppression Nausea/vomiting Constipation Withdrawal Pain Depression Alert Rapid Breathing Coughing Nausea/Vomiting Diarrhea 3 5 days

44 Addiction/Dependency Opioids trigger reward system euphoria leads to continued use addiction Withdrawal symptoms are significant regular use to avoid withdrawal dependence

45 Heroin usage patterns Highly addictive and dependence producing Significant tolerance up to 35X Increased cost Tolerance management (Tx, jail, etc.) Mixing with other opiates and other drugs (speedballing/cocaine)

46 Prescription Opiates OxyContin Vicodin Hysingla ER

47 Overdose Reversal Kits Kits can save lives Over 90,000 trained in NY 2,900 known reversals Available Over the Counter at pharmacies

48 Two Types of Rx Drug Abusers The Drug Abuser who likes Rx drugs. Frequently use other drugs (cocaine, alcohol, heroin, other non Rx drugs) Fits the model of a drug abuser. addicted to high The Patient who becomes dependent on their medication Infrequent use of other substances unless can t get Rx. Don t fit model of drug user age, other behaviors. dependent on the drug

49 Marijuana Used since 2,700 BC More potent today (5 10X) than 70 s Kids starting younger Eliminates boredom, focus concentration, lowered anxiety, euphoric, increased appetite.

50 Butane Hash Oil Newest trend aka Dabs THC extracted from MJ with butane 30 80% THC Dangerous

51 Spice/K2 and Synthetic Cannabinoids

52 Botanicals are sprayed with liquid preparations of: HU 210 HU 211 CP 47,497 JWH 018 JWH 073 Preparation of the Incense :

53 Origins of Synthetic Cannabinoids HU 210 & HU 211 synthesized at Hebrew University, Israel in HU 210 is an anti inflammatory; HU 211 as an anesthetic CP 47,497 developed by Pfizer in 1980 as an analgesic JWH 018 & JWH 073 synthesize by a researcher at Clemson (1995) for use in THC receptor research John W. Huffman more than 100 different synthetic cannabinoids have been created

54 Similar to THC, but Psychotic episodes Herbal incense blends are harsher to inhale Increased restlessness & aggressive behavior Doesn t mix well with alcohol (hangovers)

55 Bath Salts: Ivory Wave Ivory Pure Ivory Coast Purple Wave Vanilla Sky

56 What s in Bath Salts?: Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties MDPV has four times the potency of Ritalin MDPV no history of FDA approved medical use

57 Pharmacological Effects of Bath Salts : increase heart rate & blood pressure pupil dilation hyperactivity, arousal & over stimulation increased energy & motivation euphoria agitation dizziness nausea breathing difficulties diminished perception of the requirement for food and sleep

58 MDMA/Molly/XTC Club drugs produce feelings of belongingness, warmth and affection Intense euphoric high Provide energy for dancing raves Less hallucinogenic Dangers teeth grinding (pacifiers) Hyperthermia/dehydration Hyponatremia (low salt) water intoxication can be lethal

59 Gabapentin (Neurontin) Used to treat epilepsy, nerve paint (herpes/shingles), restless leg, anxiety, alcohol withdrawal Growing misuse Large doses produce euphoria Can be fatal overdose no antidote Showing up with heroin/opioid users possible cutting agent Not tested for

60 Addiction is like A dog with a bone The dog does not want to let go of the bone (addiction/ denial). It gets excited when it thinks its going to get its bone (craving) It always wants more bones (loss of control) Dogs live in the moment no planning

61 What Boomer is Thinking They won t test me for another week. What can I get away with? Try the secondhand smoke excuse. We can talk our way out of this.

62 Treatment is like Obedience School for the Dog You teach the dog s owner to control the dog. You develop a variety of tools (relapse prevention) to help the dog be obedient. Some dogs are harder to train.

63 Early Recovery Issues Loss of lifestyle Loss of Coping Strategy Withdrawal Cognitive deficits related to early abstinence

64 Cognitive Deficits Memory problems short term loss Difficulty with abstractions Difficulty with impulse control Similar performance to those with brain damage Improves.

65 The End Thanks In Memory of Boomer