Hallucinogens Hallucinogens Hallucinogens are substances that alter sensory processing in the brain, causing perceptual disturbances, changes in thought processing, and depersonalization Hallucinogens Organic and synthetic agents that induce visual, auditory, and tactile hallucinations. Disrupt cognition and perception. Use has decreased with the onset of the cocaine/crack epidemic. Taken orally, in the form of pills, tablets, capsules, or blotter papers. The intoxication is a typical example of an acute psychotic state. 1
LSD class drugs LSD, mescaline, Psilocybin, DMT, bufotenine Primarily act on Serotonin receptors Frontal cortex and limbic system Also act on raphe nucleus which functions to filter incoming sensory stimuli Disrupts the sorting process Flood of sensations and perceptions LSD Physical Effects Physiological effects: Massive increase in neural activity in some brain regions Activates sympathetic nervous system (rise in body temperature, heart rate, and blood pressure) Parasympathetic nervous system (increase in salivation and nausea) Psilocybin Psilocybin its principal source is the Psilocybe mexicana mushroom. It is not very common on the street. Hallucinogenic effects produced are quite similar to LSD. Cross-tolerance among psilocybin, LSD, mescaline. Stimulates the autonomic nervous system, dilates the pupils, increases the body temperature 2
Psilocybin Mushrooms Small brown mushrooms that stain blue to the touch Illicit cultivation but also searched from countries with temperate climates Continues use in religious rituals Amphetamine Hallucinogens Drugs are chemically related to amphetamines. They have varying degrees of hallucinogenic and CNS stimulant effects. Released serotonin explains their hallucinogenic action Released dopamine explains their stimulant effects Amphetamine Class Hallucinogenes Mescaline Synthetic amphetamine derivatives (DOM, MDA, MDMA) Act on dopamine and serotonin 3
Amphetamine Hallucinogens Mescaline Designer amphetamines 3,4 Methylenedioxyamphetamine (MDA) Methylenedioxymethamphetamine (MDMA, Ecstasy) Mescaline Mescaline is the most active drug in peyote cactus; it induces intensified perception of colors and euphoria Effects include dilation of the pupils, increase in body temperature, anxiety, visual hallucinations, and alteration of body image, vomiting, muscular relaxation. Very high doses may cause death. Street samples are rarely authentic. Peyote Lophophoria williamsii contains 1.5% mescaline (b-3,4,5trimethoxyphenethylamine) 3mg/kg potent intoxication Up to 8 to 10 hour duration Continued religious use in North America Other cacti used in South America 4
The Peyote Ceremony Stewart OC. Peyote Religion. Norman, OK: University of Oklahoma Press, 1987. Aberle DF. The Peyote Religion Among the Navaho. Chicago, IL: Aldine Publishing Co., 1966. Dissociative Drugs PCP (phencyclidine) Ketamine Dextromethorphan Phencyclidine (PCP) It was developed as an intravenous anesthetic, but found to have serious adverse side effects. It differs from the other traditional hallucinogens. It is a general anesthetic in high doses. It causes incredible strength and extreme violent behavior. Fat solvable, can store in organs for a long time Management of the severe psychological reactions requires drug therapy. 5
PCP physiological effects Hallucinogenic effects, stimulation, depression, anesthesia, analgesia Large doses can cause coma, convulsions, and death. PCP psychological effects: Feelings of strength, power, invulnerability; perceptual distortions, paranoia, violence, Potential for psychotic break. Ketamine ( Special K ) Anesthetic developed to replace PCP, manufactured by Pfizer Used in human and veterinary medicine Injected or dried and snorted Feelings of floating, or sometimes terrifying bad trip called K hole Vitamin K K Bump DXM (dextromethorphan) Cough suppressant Also used to boost effects of analgesics for severe pain) Typical dose 15-30 mg. for cough 4 or more ounces may cause distorted visual perceptions, similar effects to PCP and Ketamine Internet groups to discuss Robo-ing 6
Inhalants What is inhalant use? Inhalant use refers to the intentional breathing of gas or vapors with the purpose of reaching a high. Inhalants are legal, everyday products which have a useful purpose, but can be misused - paint, glue and others. There are more than 1,000 products that are very dangerous when inhaled (typewriter correction fluid, airconditioning refrigerant, felt tip markers, spray paint, air freshener, butane and even cooking spray). Categories of Inhalants Volatile solvents Include items such as nail polish remover, lighter fluids, paint thinner, cleaning products, correction fluid, felt-tip markers and gasoline. Aerosols hair spray, spray paint, computer duster and anything that comes from an aerosol can. Gases Include helium, nitrous oxide (laughing gas), freon, ether, butane and chloroform. Nitrites The nitrites are sealed in capsules and are "popped" to release the vapors and are referred to as "poppers" in street lingo. 7
Signs include the following: paint or stains on body or clothing spots or sores around the mouth red or runny eyes or nose chemical breath odor drunk, dazed or dizzy appearance nausea, loss of appetite anxiety, excitability, irritability Sudden Sniffing Death Syndrome Nearly all used products produce effects similar to anesthetics, which slow down the body's function. The user can experience slight stimulation, feeling of less inhibition or loss of consciousness. The user can also suffer from Sudden Sniffing Death Syndrome. The user can die the 1st, 10th or 100th time he or she uses an inhalant. DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN BRAIN: Many inhalants dissolve the protective myelin sheath that surrounds neurons - brain cells - resulting in cell death. CEREBRAL CORTEX: Cellular death causes permanent personality changes, memory impairment, hallucinations and learning disabilities. 8
DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN CEREBELLUM: This is the center that controls balance and coordination. Inhalant-related damage results in loss of coordination and slurred speech. Chronic abusers experience tremors and uncontrollable shaking. OPHTHALMIC NERVE: Toluene may affect this nerve causing sight disorders. DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN BLOOD: Some substances like paint thinner chemically block the oxygen carrying capacity of the blood. LUNGS: Repeated use of spray paint as an inhalant can cause lung damage. DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN HEART: "sudden sniffing death syndrome - a sudden disturbance of the heart's rhythm. All inhalants can produce sudden sniffing death syndrome. LIVER: a component of aerosol paints and correction fluid have been linked to damage of this organ. 9
DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN KIDNEY: Toluene impair the kidney's ability to control the amount of acid in the blood. This is reversible when toluene leaves the body but, in the long-term, kidney stones may develop MUSCLE: Muscle wasting, reduced muscle tone and strength. DAMAGE INHALANTS CAN DO TO THE BODY & BRAIN PERIPHERAL NERVOUS SYSTEM: Inhalation of nitrous oxide (whipped cream propellant) and hexane (glues and camp stove fuels) results in damage to the peripheral nerves. Symptoms can include numbness, a tingling sensation or total paralysis. ACOUSTIC NERVE AND MUSCLE: Toluene inhalation destroys cells that relay sound to the brain. Chronic users can become deaf. Can inhalant use be treated? Treatment facilities for inhalant users are rare and difficult to find. Users suffer a high rate of relapse, and require thirty to forty days or more of detoxification. Users suffer withdrawal symptoms which can include hallucinations, nausea, excessive sweating, hand tremors, muscle cramps, headaches, chills and delirium tremens. 10
Steroids Chemicals that are similar to the male sex hormone testosterone Used by an increasing number of young people to enhance their muscle size Trigger dependence in users, particularly when taken in the large doses that have been known to be used by many bodybuilders and athletes What are Steroids? Androgenic Anabolic Steroids Synthetically produced testosterone The Major Issues Steroids have adverse side effects Steroids have severe health risks Steroid use by elite athletes influences the children who look up to them as hero s. 11
Why do people abuse steroids? To improve physical performance To gain a competitive edge To become stronger To improve self-esteem To lose weight, burn fat and increase muscle Dangers of Steroid Use Dangers for Men: Even though anabolic steroids are derived from a male sex hormone, men who take them may actually experience a "feminization" effect along with a decrease in normal male sexual function. Some possible effects include: Reduced sperm count Impotence Development of breasts Shrinking of the testicles Difficulty or pain while urinating Erectile dysfunction Steroid Use High correlation with aggressive behavior and violence 12
New Synthetic Drugs Designer Psychoactive Substances SOURCE: http://www.drugs-forum.com, updated 2013. Designer Psychoactive Substances Two classes: Stimulants: mephedrone, MPDV, piperazines, bath salts Psychedelics: 2C-B, mescaline, DMT, etc. Differences in users: Stimulant users similar to other ecstasy users; (shifting to mephedrone and MPDV due to shortage of Ecstasy?) Psychedelic users started ecstasy use earlier; were more frequent users; used multiple substances; had more legal, mental health, and social problems. SOURCE: Bruno et al. (2012). Drug and Alcohol Dependence, 124(1-2), 19-25. 13
Examples of Major Synthetic Psychedelics DRUG NAME 2C-I DESCRIPTION Phenethylamine, via PiHKAL; stimulant and hallucinogen Slow onset (1 hr); long duration of action (810 hr.) Phenethylamine, via PiHKAL; visuals Faster onset; shorter duration than 2C-I 2C-B 5-MeO-DMT Tryptamine; naturally occurring (toad, shamantic brews) Smoked: almost immediate, very intense, short effect (<30 min) Tryptamine; naturally occurring Smoked: almost immediate, very intense, short effect (<20 min) DMT 40 SOURCE: Slide courtesy of R. Bruno et al., 2011, with revisions by James Hall, 2012. Examples of Major Synthetic Stimulants DRUG NAME DESCRIPTION Mephedrone 4-methyl-methcathinone; Miaow Similar to cocaine and MDMA (ecstasy) Methylone β-mdma: 3,4-methylenedioxymethcathinone; Explosion Similar to cocaine and MDMA (ecstasy) MDPV BZP 3,4-methylenedioxyprovalerone; MDPV; NRG-1 (Brandt, 2010); Ivory Wave Stimulant with rapid onset; 2-4 hour duration of action 1-benzyl-piperazone Similar to amphetamine 1/10 potency of d-methamphetamine SOURCE: Slide courtesy of R. Bruno et al., 2011, with revisions by James Hall, 2012. From the term Bath Salts to Synthetic Cathinones 2CPhenethylamines Tryptamines Piperazines Mephedrone, methylone, 4MEC Psychedelics related to mescaline 5-MeO-DMT & 4AcO-DMT BZP & TFMPP Stimulants related to methcathinone, MDMA, amphetamines Some were created in the past to imitate MDMA Stimulants Psychedelics related to psilocin & bufotenin And Dissociatives related to ketamine and PCP and Opioids related to morphine, fentanyl, and heroin. 14
Synthetic Drugs Not really Spice, Bath Salts, Incense, or Plant Food Chemically-based; not plant derived Complex chemistry Constantly changing to stay legal Need to prove intended to use to convict in some areas Synthetic Cannabinoids Spice vs. Spice Synthetic Cathinones Bath Salts vs. Bath Salts 15
Synthetic Cannabinoids Wide variety of herbal mixtures Marketed as safe alternatives to marijuana Brand names include: Spice, K2, fake weed, Yucatan Fire, Skunk, Moon Rocks, herbal incense, Crazy Clown, Herbal Madness Labeled not for human consumption Contain dried, shredded plant (inert) and chemical additives that are responsible for their effects. material psychoactive SOURCE: NIDA. (2012). NIDA DrugFacts: Spice (Synthetic Marijuana). Synthetic Cannabinoids Mainly abused by smoking (alone or with marijuana); may also be prepared as an herbal infusion for drinking. Many of the active chemicals most frequently found in synthetic cannabis products have been classified as Schedule I controlled substances, making them illegal to buy, sell, or possess. Multiple generations of drugs. SOURCE: NIDA. (2012). NIDA DrugFacts: Spice (Synthetic Marijuana). The Emergence of Synthetic Cannabinoids JWH-018/073 arrived early and have come and gone. JWH-250 arrived a little later and has also cycled out. JWH-081 was part of a second wave that has already completed its cycle. JWH-122 was part of the same wave but has persisted in popularity and is part of the current scene. AM-2201 was part of the same second wave and has gained in popularity, probably currently the most prevalent. JWH-022 and JWH-210 are showing signs of increasing popularity. Recent emergent drugs are the adamantoyl (AM-1248) and tetramethylcyclopropyl (XLR-11 and UR-144) indoles which are ahead of the latest attempts to schedule these drug classes. SOURCE: Logan, B.K. (2012). Testing Strategies to Monitor Novel/Emerging/Designer Drug Use in At-Risk Populations, Presented at 74th Annual CPDD. 16
Timeline of Synthetic Cannabinoid Products SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12. Factors Associated with Synthetic Cannabinoid Popularity They induce psychoactive effects They are readily available in retail stores and online The packaging is highly attractive They are perceived as safe drugs They are not easily detectable in urine and blood samples SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12. 50 Synthetic Cannabinoid Use Leads to Dangerous Symptoms in Pregnant Women Leads to symptoms similar to those caused by dangerous conditions known as preeclampsia and eclampsia Preeclampsia is marked by high blood pressure and a high level of protein in the urine Preeclampsia can lead to eclampsia, which can cause a pregnant woman to develop seizures or coma, and in rare cases is fatal SOURCE: Join Together Online, May 8, 2013. 51 17
Synthetic Cathinones Could be MDPV, 4-MMC, mephedrone, or methylone Sold on-line with little info on ingredients, dosage, etc. Advertised as legal highs, legal meth, cocaine, or ecstasy Taken orally or by inhaling Serious side effects include tachycardia, hypertension, confusion or psychosis, nausea, convulsions Labeled not for human consumption to get around laws prohibiting sales or possession SOURCE: Wood & Dargan. (2012). Therapeutic Drug Monitoring, 34, 363-367. Sources and Continuing Availability A number of synthetic marijuana and bath salt products appear to originate in multiple countries and are manufactured in the absence of quality controls and devoid of governmental regulatory oversight. The large profits from sales, plus the fact that these chemicals can be easily synthesized to stay one step ahead of control, indicate there is no incentive to discontinue retail distribution of synthetic cannabinoid products under the current statutory and regulatory scheme. New Zealand s Designer Drug Law Draws Global Interest The law, enacted in July 2013, represents a U-turn from the traditional approach of retroactively banning synthetic drugs New Zealand will attempt to regulate designer drugs, allowing their sale if they go through rigorous safety testing similar to that for pharmaceuticals SOURCE: Maxwell, J.C. (In Press). Drug and Alcohol Dependence. 54 18