Medical Effects of Drugs of Abuse Pierre Rouzier, M.D.

Goals and Objectives Learn how drugs work How you get high How you OD How you die fast How you die slow Understand drug dependence/addiction/withdrawal

Classes of Drugs Depressants Stimulants Opiates Cannabis Hallucinogens “Designer/Club Drugs”

Basic principles Receptors - part of nervous system where drugs bind Neurotransmitters - “messengers” send signals ex: serotonin Tolerance - need for “more” to get the same effect Addiction - receptors “need and want” drug to feel normal

UMass survey- 664 random students polled spring 2003 Alcohol use: Average # drinks/week: males-15 females-7 “Binge drinking” - # of drinks in a “sitting” (males-5 females-4) 72% of all students in past 2 weeks.

Survey Why do students drink... 89% gives people something to do 82% facilitates a connection with peers 80% allows people to have more fun 55% makes it easier to deal with stress 65% facilitates sexual opportunities 26% makes them sexier

Survey - Drug use Marijuana - 61% smoked in past year, 31% smoke once a week 10% used designer drugs, hallucinogens, cocaine, sedatives

Depressants Examples: alcohol, benzodiazepines (valium), barbituates (secobarbital), etc. Tolerance - all Addiction - physiologic, psychologic

Depressants, cont. Effects - slurred speech, decreased inhibition, disorientation, staggering, drunken behavior Overdose - decreased respirations, loss of consciousness, coma, death Withdrawal - anxiety, insomnia, elevated BP/pulse, tremor, hallucinations, seizures, death

Alcohol levels 0.08 legally drunk 0.1 “delightfully dizzy” 0.2 “drunk and disorderly” 0.3 “death’s doorstep” 0.4 “dead drunk”

What’s your alcohol level? 1 drink = 12 oz. beer, 4 oz. wine, 1 oz. Liquor # drinks/time (hours 1-2-3)

The problem drinker Family, friends, you? CAGE Cut down Annoy anyone Guilty Eye-opener Repeatedly do stupid things Bring out the demons?

Alcohol - how to die slowly Liver disease Stomach and esophagus Pancreas Brain atrophy Bleeding problems Trauma, injuries Making bad choices

Stimulants Examples - caffeine (oral), ephedrine (oral), cocaine (snorted, smoked, IV), amphetamine, (oral, SS,IV), methylphenidate (Ritalin) Tolerance - all Addiction - physiologic and psychologic

Stimulants, cont. Effects - increased alertness, excitation, euphoria, increased pulse and BP, decreased appetite Overdose - agitation, fever, hallucinations, seizures, heart attack, death Withdrawal - severely depressed mood, prolonged sleep, apathy, irritability, disorientation

Opiates Examples - heroin (IV, smoked), opium (oral, smoked), morphine (oral, IV), codeine, etc. (oral), methadone (oral, IV) Tolerance - all Addiction - physiologic and psychologic

Opiates, cont. Effects - euphoria, drowsiness, nausea, decreased respirations Overdose - clammy skin, constricted pupils, respiratory arrest, coma, death Withdrawal - watery eyes, runny nose, goose bumps, yawning, decreased appetite, nausea, chills and sweats, panic, tremor, cramps (“COLD TURKEY”)

Cannabis Examples - marijuana (smoked, oral), THC (oral), hashish (smoked) Tolerance - all Addiction - psychologic, minimal physiologic

Cannabis, cont. Effects - Euphoria, relaxation, loss of inhibition, increased appetite, decreased memory and attention. Overdose - can get panic attacks, hallucinations, paranoia Chronic effects - problems with short term memory, cognitive skills Withdrawal - rare, insomnia, hyperactivity

Hallucinogens Examples - LSD, psilocybin, peyote, mescaline Tolerance - all Addiction - psychologic, minimal physiologic Effects - altered perception of body, hallucinations, visual illusions, increased emotions Overdose - prolonged episodes, psychotic states Withdrawal - none

Ecstasy MDMA - “methylenedioxymethamphetamine” Early 1900’s used in psychotherapy Hallucinogenic stimulant Euphoria, enhanced mental or emotional clarity, “tingling” sensation, “love to be touched” Tablet, pill, powder $10-$30 High 3 -4 hours (longer?)

Ecstasy side effects nausea, vomiting, loss of appetite blurred vision anxiety, paranoia seizures dehydration hyperthermia coma and death dumping of serotonin depression

Ketamine aka “special K” Veterinary anesthetic Effects - Relaxation, loss of sense of time and identity, hallucinations, visual distortion Adverse effects - delirium, amnesia, depression, tachycardia, respiratory depression

PCP (Phencyclidine) aka angel dust, to be “dusted” Veterinary anesthetic dissociative effects Adverse effects - aggression, violence, panic, loss of appetite, decrease BP/HR

Rohypnol Date Rape drug (“roofies”, “roache”, etc.) Benzodiazepine - 10 times stronger than Valium Oral - “slipped in to a drink”, colorless, odorless, tasteless Effects - intoxicated, sleepy, sedated, blackouts, amnesia Adverse effects - rape, memory loss, respiratory depression, hallucinations

GHB Gamma-hydroxybutyrate. Depressant. Initially a weight lifting supplement. Date rape Oral - tablet, powder,dissolved in per dose Effects - start within 1 hr, lasts 1 to 3 hrs, euphoria, intoxication, disinhibition, sedation Adverse effects - nausea, vomiting, seizures, respiratory depression, coma

Inhalants Aerosols - paint, hair spray, whippets Solvents - gasoline, glue, paint thinner, nail polish remover, white out Gases - nitrous oxide, butane lighters Nitrites - air fresheners, video head cleaners Sniffing, bagging, huffing euphoria, intoxication Bad for you!! Dizzy, headache, irregular heartbeat, sudden death Can attach to fatty tissues causing brain and nerve damage