A Handbook on Drug and Alcohol Abuse THE BIOMEDICAL ASPECTS THIRD EDITION Gail Winger Frederick G. Hofmann James H. Woods New York Oxford OXFORD UNIVERSITY PRESS 1992
1. Introduction 3 The Problem of Drug Abuse 3 Why People Abuse Drugs 4 Theories of Drug Abuse 4 Dopamine Theory of Reward 8 Factors that Affect Reinforcing Effects of Drugs 9 Patterns and Development of Drug Use 10 Polydrug Abuse 12 Non-Drug Related Medical Problems 12 Infectious Diseases 13 Terminology 16 Terms to Be Used in This Book 18 References 20 2. Tobacco and Nicotine 22 Tobacco Culture 22 Epidemiology and Patterns of Use 24 Pharmacokinetics and Pharmacodynamics 27 Effects of Nicotine 28 Subjective Effects 28 Physiologic Dependence and Tolerance 29 Physiologic Effects 30 Mechanism of Action 31 Morbidity and Mortality 32 Coronary Heart Disease 33 Cancer 33 Morbidity 34 Smoking and Fetal Development 34
Passive Smoking 35 Contribution of Nicotine to Cigarette Smoking Toxicity 36 References 37 3. Opioid Drugs 39 Sources of Opioid Drugs 40 Patterns of Use 44 Effects of Opioid Drugs 46 Subjective Effects 46 Analgesia 47 Gastrointestinal System 48 Respiration 48 Physiologic Dependence 48 Tolerance 49 Mechanism of Action 50 Absorption and Fate 52 Toxicity 53 References 54 4. Depressants of the Central Nervous System: Alcohol, Barbiturates, and Benzodiazepines 56 Alcohol 57 Diagnosis and Epidemiology of Use 58 Genetics and Alcoholism 60 Pattern of Use 60 Central Nervous System Effects of Alcohol 61 Alcohol and the Digestive System 66 In Utero Effects of Alcohol 68 Beneficial Effects of Alcohol 69 Morbidity 69 Mortality 73 Barbiturate and Nonbarbiturate Sedative-Hypnotics 73 Patterns of Use 74 Effects of Sedative-Hypnotics 75 Absorption, Distribution, and Metabolism 76 Tolerance 77 Physiologic Dependence and the Withdrawal Syndrome 78 Benzodiazepines and Other Minor Tranquilizers 78 Effects of Benzodiazepines 79 Patterns of Use 79
Tolerance and Physiologic Dependence 80 Other Minor Tranquilizers 81 References 82 5. Depressants of the Central Nervous System: Volatile Solvent and Aerosol Inhalation 85 Preparations Used 87 Patterns of Use 88 Effects of Volatile Solvents 90 Habitual Use of Volatile Solvents 91 Psychologic Dependence 91 Tolerance 91 Physiologic Dependence 91 Toxic Effects of Volatile Solvents: Morbidity and Mortality 92 Aliphatic Hydrocarbons 92 Aromatic Hydrocarbons 92 Halogenated Hydrocarbons 93 Ketones 94 Esters 94 Alcohols 94 Glycols 94 Nitrites 95 References 95 6. Hallucinogens: Phencyclidine, LSD, and Agents Having Similar Effects 98 Phencyclidine 98 Patterns of Use 100 Effects 100 Tolerance and Physiologic Dependence 101 PCP Toxicity; Overdose 101 Mechanism of Action 102 LSD 103 Patterns of Use 104 Effects of LSD 105 Mechanism 106 Absorption, Fate, and Excretion 107 Tolerance and Physiologic Dependence 107 Mortality and Morbidity 108 Peyote and Mescaline 110 DOM(STP) 111
xii Contents Psilocybin 113 DMT 114 References 115 7. Marihuana and Hashish 117 Chemistry 118 Absorption, Biotransformation, and Excretion 120 Patterns of Use 122 Physiologic Effects 122 Psychologic (Subjective) Effects 123 Mechanism of Action 125 Physiologic Dependence and Tolerance 126 Adverse Effects 127 Acute Adverse Effects 127 Persistent Adverse Effects 128 Potential Therapeutic Uses of THC 130 References 130 8. Central Nervous System Stimulants: Amphetamines, Caffeine, and Related Drugs 132 The Amphetamines 134 Patterns of Use 134 Effects of Stimulants 136 Mechanism of Action 139 Absorption and Fate 139 Stimulant Toxicity 140 Khat Chewing and Cathinone 141 Caffeine and Theophylline 142 Patterns of Use 142 Effects 143 Methylenedioxymethamphetamine (MDMA) 145 Drugs Used to Treat Hyperactivity and Obesity 147 References 148 9. Central Nervous System Stimulants: Cocaine 150 Cocaine Production 151 Pharmacology and Behavior 154 Patterns of Use 154 Effects of Cocaine 155 Mechanism of Action 159
xiii Absorption and Fate 160 Legalization of Cocaine? 160 References 162 10. The Medical Diagnosis of Drug Abuse 164 History 165 Physical Examination 166 Appearance 166 Sensorium 166 Vital and Other Signs 167 Blood Pressure 168 Pulmonary Ventilation 168 Pulse Rate 168 Temperature 169 Integument 169 Lymph Nodes 171 Eyes 171 Nose 172 Mouth and Throat 172 CYies/ 173 Heart 173 Abdomen \1A Kidney 175 Endocrine System 175 Nervous System 176 Summary 176 Laboratory Detection 177 References 177 11. Management of Selected Clinical Problems: Pharmacologic Aspects 179 Overdose 179 Opioids 179 Barbiturate and Other Central Nervous System Depressants 181 Stimulants 182 Drug Withdrawal 182 Opioids 182 Central Nervous System Depressants 184 Stimulants 184 Treating Infants Born of Drug-Abusing Mothers 185 Opioids 185
xiv Contents Alcohol 186 Stimulants 186 Pharmacologic Management of Drug Abuse 187 Opioids 187 Alcohol 189 Stimulants 190 Nicotine 191 References 192 12. Drug Abuse and the Law 194 Drug Abuse and the American Federal Law 194 The English "System" 204 References 207 Index 209