Individual Drug InfoWinter 2015

Similar Properties Across Drugs

DifferencesFormsAvailabilityDEA ScheduleEffects

◦Acute◦Chronic◦Overdose

Photo, originally taken by Thoric, available to use in the public domain

Cannabis - marijuana

Cannabis• Cannabis sativa

• Different subspecies/varietals used for clothing vs drug use

• Active ingredient: THC• THC is a cannabinoid

• Interacts with cannabinoid receptors in brain

• Many other cannabinoids exist, but not thought to cause psychoactive reactions

• DEA: Schedule I• Despite state

regulations, marijuana still federally illegal

Medical cannabis (2/26/15), source: procon.org)

Alaska (98) Maine (99) New Jersey (10)

Arizona (10) Maryland (14) New Mexico (07)

California (96) Massachusetts (12) New York (14)

Colorado (00) Michigan (08) Oregon (98)

Connecticut (12) Minnesota (14) Rhode Island (06)

Delaware (11) Montana (04) Vermont (04)

Hawaii (00) Nevada (00) Washington (98)

Illinois (13) New Hampshire (13)

Washington, DC (10)

Recreational Cannabis

Cannabis

Alcohol vs Cannabis• More research on alcohol• Age dependent• Amount of alcohol/amount of cannabis• Mixing substances• Alcohol interferes with neurogenesis of brain cells

(Gary L. Wenk, Psychology Today, 2010)

• Cannabis: 2014 study showing regular use impacted decision-making and judgment (Published online before print November 10, 2014, doi: 10.1073/pnas.1415297111. PNAS November 10, 2014)

Depression and Anxiety

• Many use marijuana to ease mood• Regular use may trigger, or worsen, either

condition, especially in younger people• 2013 Imperial College study showed lower

dopamine levels in regular users, which may lead to more anxiety

• Marijuana, conversely, may help those with Post-Traumatic Stress Disorder• Memory inhibition• CBSNews June 2014 (3:58)

Chronic effectsRespiratory distressMood swingsImpaired memory (potential hippocampus damage)Earlier research2011 NIMH/NIDA study

◦ Daily use may reduce brain receptor number◦ Receptors regenerated with cessation◦ Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry, molecular imaging

shows." ScienceDaily. ScienceDaily, 13 June 2011. <www.sciencedaily.com/releases/2011/06/110606131705.htm>.

Marijuana & Respiratory Function During Exercise

Acute effect: any smoke can interfere with oxygen binding to red blood cells

Acute: marijuana can disrupt coordination, balance, reaction time

Acute: increase heart rate and blood pressure

Acute: stored THC in fat could be released into bloodstream during exercise

Chronic: depends on how frequently one smokes, type of exercise

LSD

Learn the effects of acidAre there different types?

LSD• Albert Hoffman: “Last Friday,

April 16,1943, I was forced to interrupt my work in the laboratory in the middle of the afternoon and proceed home, being affected by a remarkable restlessness, combined with a slight dizziness. At home I lay down and sank into a not unpleasant intoxicated-like condition, characterized by an extremely stimulated imagination. In a dreamlike state, with eyes closed (I found the daylight to be unpleasantly glaring), I perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors. After some two hours this condition faded away.”

LSD

• Schedule I hallucinogen synthesized in 1930s

• Manufacturing secretive: Nick Sand (National Geographic, 3:39)

• “Types”

• Same basic chemical structure

• Illegal, so cannot guarantee contents, care of product

• Light and air may degrade drug• Dosage measured in micrograms (very small)

LSD Forms• Crystal can be crushed,

mixed with other materials into tablets: microdots

• Gelatin squares• Converted to liquid paper

• Dosed onto sugar cubes• Placed on candy (gummy

bears - Lake Tahoe, 2011, e.g.)

• Usually taken orally• Can be inhaled, injected,

applied transdermally

LSD Acute Effects• Duration of “trip” = several hours in length• Visual hallucinations (images, color, light)• Altered perception of senses

• “Seeing sounds, hearing colors”• Color, size of objects

• Altered perception of time, depth• Potential anxiety/panic• Experiences can vary widely• Serotonin receptors may be excited or inhibited• LSD experimentation on British soldiers (YouTube.com)• Overdose thought to be rare, but some individuals may not

respond well, or may experience problems if drug is different than LSD

LSD• Chronic effects may involve flashbacks

• Sudden onset of abnormal perceptions• Hallucinogen Persisting Perception Disorder

• Visual images remain longer than in consciousness• Dr. Henry Abraham (Tufts University) blog

LSD Research

• US Food and Drug Administration allowed LSD research

• Recent study sponsored by Multidisciplinary Association for Psychedelic Studies, carried out by Swiss physician Peter Gasser• Information published 2014• 12 patients with terminal illness, end-of-life

anxiety• Took two doses of LSD with talk therapy, across

eight weeks• Those with larger dose reported improvement

Mushrooms

MushroomsPsilocybin/psilocin are two

active psyhoacticve substances found in “magic mushrooms”

Most from psilocybe genus, couple dozen speciesTaken orallyRecognized for centuries

Probably used in religious ritesHallucinogenSchedule I

Mushrooms• Dose

• Varies • Fresh vs dried• User• Trip desired• ~1 mushroom or less

for new user

Mushrooms• Acute effects:

◦ Relaxation◦ Altered perception of reality◦ Altered perception of time◦ Sense of connection to others/universe◦ Visual hallucinations (images, color, light)◦ Potential for anxiety and subsequent panic, heart rate & blood

pressure increase Chronic effects:

◦ A “bad trip” may trigger fear◦ Hallucinogens may exacerbate mental illness

Mushrooms

• Largely depends on availability• Carl Hart, Columbia University, on drug abuse (0-2:40)• Most emergency department (ED) visits: alcohol (DAWN, 2011)• Half + of 2.5 million ED visits: illicit substances

Cocaine – 505,224 Combinations – 10,388

Marijuana – 455,668 Inhalants – 10,032

Heroin – 258,482 Unclassified hallucinogens – 8,043

Amphetamine/meth. – 159,840 LSD – 4,819

PCP – 75,538 GHB – 2,406

Synthetic cannabinoids – 28,531 Ketamine – 1,550

MDMA – 22,498

• Depends on availability, mode, reasons for use• 2008 study by Hser et. Al.:

• Researchers examined data from five studies• Assessed 10-year drug behaviors among 629 heroin users, 694

cocaine users, 474 meth users• Heroin users: used 13-18 days per month• Cocaine: used 8-11 days per month• Meth: 12 days per month• Groups – “consistently high use,” “increasing use,” “decreasing

use,” “moderate use,” “low use”• Heroin over-represented in “consistently high use,” under-

represented in “low use”• 2011 study by Novak et. Al. – injection users were more likely to

abuse and become dependent

• “Why do we focus more on jailing addicts than recovery options? What helps people quit these substances? Are there any positive uses that have been proven and could be used under a doctor’s watch?”

• History, government, culture• Cocaine, opium available in 1800s, early 1900s• Harrison Act in early 1900s regulated these substances – taxing

• Those who did not pay the tax were in legal trouble (tax evasion)

• Alcohol prohibited (prohibition later appealed)• Heroin Act, Narcotic Drug Import & Export Act• 1970 Drug Abuse Prevention & Control Act• NIDA Principles of Effective Treatment

Student Question (continued)• WHO

ATLAS on Substance Abuse (2010)• Alcohol main problem• Other drug issue is cocaine• 39 deaths per 100,000 (35

due to alcohol)• Not enough government

resources• Africa – out of pocket

treatment costs• Beds: 1.7 per 100,000• Many other issues

2C-I4-iodo-2,5-dimethoxyphenethylamine

2C-I• “Smiles”• Synthetic

substance• Usually inhaled

or taken orally; may also be taken via blotter paper

• Stimulant & hallucinogenic properties

• Schedule I

2C-I• Impacts dopamine & serotonin• Onset of effects may not be

immediate, triggering overdose• Little information on brain impact• Additives, chemical changes make

drug unpredictable, similar to bath salts

• CNN 2014 report about 2C-I deaths in North Dakota

• Synthetics often a problem• Who can you trust?• Illegality = no regulation

Dimethyltryptamine (DMT)

What is DMT?How does DMT work as a psychoactive drug?

Dimethyltryptamine

• Chemical structure• Hallucinogenic

ingredient• Present in a variety of

plants• Occurs naturally in

the body• Schedule I substance

Image source: Wikimedia Commons

Dimethyltryptamine

• Often consumed via beverage: ayahuasca tea• Requires MAO-I

(specific vine)• Ceremonial purposes• Ashland, OR Brazilian

church lawsuit

• Can be injected, inhaled, smoked

Dimethyltryptamine EffectsHallucinogenic visualizationsMood changeTime distortionDissociationMuscle twitching, coordination difficultiesNausea, vomitingShorter-lasting effects than other hallucinogens

◦ “businessman’s trip” per DEA◦ 30-60 minutes

Video Clip - The Spirit Molecule, Part 1 (YouTube)Video Clip – London Real (34:00+ = trip described)Source: Arch Gen Pesychiatry. 1994 Feb;51(2):98-108.

MDMA3,4-methylenedioxy-N-methylamphetamine

How does Ecstasy prove to help people with PTSD?What exactly is Molly & why does it kill people?How do you overdose Ecstasy? Molly?

MDMA• Molly, Ecstasy,

Thizz• Synthetic drug• Stimulant and

hallucinogenic properties

MDMA• Acute effects on the brain

• Increased serotonin release• Increased dopamine release• Increased norepinephrine release• Effects will vary since formula is not standardized or

regulated• Effects will vary based on the synthetic nature of

substance• MDMA-assisted therapy (Multidisciplinary Association

for Psychedelic Studies, video; 0-2:00; 14 subjects, per website)

• More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)

MDMA• Chronic effects are controversial, per Carl Hart,

Columbia University (YouTube)• Well-circulated animal studies showing neuron

damage

Emergency Department Visits

Synthetics are currently popular• MDMA, bath salts, 2C-I, synthetic cannabis• Lower price (think about economy’s influence)• Drug popularity changes with time (synthetics were

popular in 1970s)• Health-related issues will subsequently ebb and flow as

drugs move in and out of favor • That acknowledged, some can be devastating:

Krokodil (CBS, 2013)

Which drugs are the most popular? (by country here)

Dextroamphetamine (Adderall)

About Adderall• Stimulant• Works on dopamine

and norepinephrine• Used as prescription

for ADHD, narcolepsy• Some abuse Adderall

for its performance-related effects

• 60 Minutes program, April 2010

• Schedule II

Adderall Availability• Readily available across U.S.• $5-10 per pill

Adderall Prescriptions, by Year (U.S. Department of Justice)

Adderall Effects

• Increased alertness• Euphoria• Self-assuredness• Increased heart rate, blood pressure• Emotional changes• Weight loss• Stomach discomfort (nausea, cramps)• Long-term effects are not yet known

Adderall Forms

• Tablet (5-30mg)• Time release

capsule (10-25mg)

Adderall Overdose• According to Dailymed (National Library of Medicine),

traditional symptoms can develop: anxiety, confusion, restlessness

Methamphetamine

Methamphetamine• Famous/notorious for laboratory production, short-term

dopamine effects & long-term effects• Stimulant (blood pressure, heart rate, alertness)• DEA: Schedule II substance (Desoxyn: ADD,

narcolepsy, weight control)

Methamphetamine acute effects Intense high/euphoria

◦ May last up to 12 hours (longer than cocaine)◦ Meth Inside and Out video describing effects

Energetic, talkative, excitable Insomnia Increased heart rate, blood pressure Sweating Dry mouth Jaw clenching Nausea, vomiting Comparison: meth vs cocaine,Brookhaven National

Laboratory, 2008

Methamphetamine chronic effects Chronic users may experience hallucinations, rage, paranoia, heart

“meth mouth;” damage to dopamine-, serotonin-containing nerve cells◦ Crank Bugs (Meth Project)◦ Meth Mouth (Meth Project)◦ Ashley’s Story (Meth Project)◦ Research supports both brain damage as well as lack of brain damage

Methamphetamine Chronic Effects

Before & After Photos

Before and After Photos

3 Years and 5 months after starting methMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

Before and After

17 months after starting methMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

Before and After

3 months laterMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

Heroin

Heroin

• Narcotic• Synthesized from morphine in late

1800’s• Morphine synthesized from opium poppy• Heroin 10x more powerful than morphine• Was thought to be less addictive• After many people became addicted, heroin

was outlawed in 1920’s• Drug Ads (wings.buffalo.edu)

• Schedule I