Effects of drugs PSYCH 630 January, 2015 Team B week 6 presentation

introduction Identifying drug and its primary use Rate of use and populations affected Region of brain affected and altered brain chemistry High versus low doses on behavior, mood, and cognition Implications on physiology of brain, behavior, mood, and cognition Therapeutic interventions to treat addiction In this presentation Team B will discuss a common street drug that is also a brain altering drug. We will begin by identifying the drug and list it’s primary use. The rate of use and the particular populations affected will be reviewed. Because the drug we will identify is also a brain altering drug we will discuss the regions of the brain the drug affects and how this drug alters brain chemistry. The relevance of high and low doses of the drug will be compared in reference to behavior, mood, and cognition. The team will discuss the implications of one-time, casual, or long-term use on the brain, behavior, mood, and cognition. Finally the team will discuss therapeutic interventions that may be utilized for those that become addicted to the identified drug.

Identify drug Heroin Heroin is a highly addictive, illegal drug (Drugfreeworld.org, 2014). Heroin is made from the resin of poppy plants. The milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine and then further refined into different forms of heroin. Heroin was first manufactured in 1898 by the Bayer pharmaceutical company of Germany and marketed as a treatment for tuberculosis as well as a remedy for morphine addiction (Drugfreeworld.org, 2014). Heroin is classified as a Schedule I drug under the Controlled Substances Act of 1970 and as such has no acceptable medical use in the United States (Drugs.com, 2014). Clip Art Bing

Recreational Use Medical Use Primary use Recreational Use Medical Use Heroin is a Drug that is well known in the United States, there are many different street name for this drug and is one of the most high addicting drugs in the united states. This drug is used by many Americans from all ages and ways of life. Heroin has many medical uses also and due to this reason many countries such as UK; heroin is available as controlled prescription drug. Heroin is used medical practice, where help for addiction to heroin is easily available. Heroin or diacetylmorphine is a strong analgesic (commonly known as pain killer medicine, as they are used in treatment of pain) medication (Healthyone.org, 2011). In some countries such as the United Kingdom it is a strong analgesic and available strictly as a controlled prescription medication and is commonly used for palliative care pain management. It is also used in the UK as maintenance drug for long-term heroin addicts when all treatment modalities for de-addiction fail, as a last resort (Healthyone.org, 2011). Recreational use is the most prevalent form of use for those using heroin. Initially used as a pain killer in the 1800s it quickly took on another highly addictive use, as it users found it readily available and affordable. It is an extremely powerful painkiller and users experience exhilaration, euphoria and a sense of well being. The individual use heroin with the intention to alter the state of consciousness (through disruption of the CNS) in order to recreate positive emotions and feelings. Recreational use of heroin has been associated with such things as curiosity, boredom, low self-esteem, desire for risk, for meditation, desire to escape from or cope with difficulties, to relax, to increase energy, and to improve focus or concentration.

Single Use Daily Full Blown Addiction Percentage of Use Rate of use Single Use Daily Full Blown Addiction Percentage of Use The DEA states that 1.2 % of our population has reported using heroin or tried heroin at least once in their life time. In 2011, 4.2 Million Americans ranging from the age of 12 and older have used heroin. There is a 23 percent rate of individuals who become dependent of this drug (NIH,2024). An estimated 13.5 Million people in the world take opioids (opium-like substances), including 9.2 million who use heroin (Drugfreeworld.org, 2014). In 2007, 93% of the world’s opium supply came from Afghanistan. Opiates, mainly heroin, were involved in four of every five drug-related deaths in Europe, and it accounts for 18% of the admissions for drug and alcohol treatment in the United States (Drugfreeworld.org, 2014).

All lifestyles All ages All cultures Populations affected All lifestyles All ages All cultures There is no “cookie-cutter” heroin user (Alcoholism.about.com, 2014). Individuals of all ages, cultures and lifestyles have and can use heroin. Addiction has been described as an ‘equal opportunity’ disease, affecting individual across racial, ethic, geographic and class lines (Bernstein et al., 2005). There has been an increase in initiation among young adults ages 18 to 25 and adults 26 and older using heroin (Drugs.com, 2014). “The Centers for Disease Control (CDC) reports that teenagers reporting heroin use in their lifetime is declining. Amongst 12th graders, the number has come down from 3.0 percent in 2001 to 2.0 percent. The total number of teenagers that report using heroin in their lifetimes has dropped from 3.1 percent to 2.4 percent since 2001” (Bernstein et al., 2005). Amongst young adults and college students, heroin use is not seeing the decline it has in teenagers. Among the users a high percent were African American (82%), Hispanic (54%), and White (57%) (Bernstein et al., 2005).

The Limbic System is affected by Heroin (Bing, 2015) Region affected The Limbic System is affected by Heroin (Bing, 2015) The region of the brain affected by Heroin is the limbic system (NIH, 2014). The limbic system controls a person’s emotions, eating, socializing, mood, feeling of pleasure, and repeated behaviors (NIH, 2014). The limbic system is located in the center of the brain, this area controls many functions for the person. Heroin affects the limbic system by giving the brain a different type of pleasure, emotions, behaviors, and moods (NIH, 2014). Heroin affects the memory, motivation, and other functions of a person. Many areas of the brain are affected by Heroin.

Alter brain chemistry Heroin affects the neurons in the brain. This disrupts the normal brain chemistry. (Bing, 2015) Heroin alters brain chemistry by triggering “the release of dopamine in the nucleus accumbens (NAC), as measured by microdialysis (Di Chiara, 1995)” (Carlson, 2013, p. 617). Heroin affects the brain by activating the neurons (NIH, 2014). Heroin acts like natural neurotransmitter (NIH, 2014). According to NIH (2014) “Although these drugs mimic the brains own chemicals, they don’t activate neurons in the same way as a natural neurotransmitter, and they had through the network” (p. 1). Heroin tricks the neurons, this allows the drug to enter into the brain but does not do the same function as the brains own chemicals. “A person taking an addictive drug seeks a sudden “rush "produced by a fast-acting drug” (Carlson, 2013, p. 617). Heroin produces a fast-acting rush because it is used many times as a liquid injected into the blood stream. This gives the drug an easier access to the blood stream and brain.

Effects of Heroin use is different for each person. (Bing, 2015) High versus low doses Effects of Heroin use is different for each person. (Bing, 2015) [“Not everyone will respond the same way to a given drug dose-many factors can influence this, including those mentioned above, as well as age, gender, and the person’s history of using that drug or other related drugs”] (Kandel, Schwartz, & Jessell, 1991, p. 69-70). The effects of Heroin depends on the person (Personal Interview, Ed Grey, January 17, 2015). A lower dose may affect a person the same as a person taking a higher dose, depending on the person (Personal Interview, Ed Grey, January 17, 2015). The higher the dose of Heroin, the increased chances for the person to have more behavior, mood swings, and cognitive behaviors. Ed Grey (Personal Interview, January 17, 2015) states “some people (as myself) experienced blue lips, labored breathing, and incoherence; with an extremely high dose of Heroin.” A person may become moodier, more agitated, mild tempered, or more. The high versus low doses depends on the person and how his or her brain reacts to the drug.

Implications on brain http://medicalassistedtreatment.org/95142/ The majority of people do not realize the powerful effect addictive drugs have on the brain, the effects of drug use on the body are more commonly known. When someone uses heroin for the first time, it begins the roller coaster ride, setting them user up for years of heroin addiction. The user experiences a rush of euphoria, which is brought about by the opiates being sent to the brain. The user then tries to achieve this same feeling over and over, it is termed “chasing the dragon.” The brain begins to put demands on the individual to use a greater amount of the opiates for it to send the message to the body that everything is alright, making them feel normal. If the brain does not receive the extra amount of opiates, it goes into panic mode, the brain signals the body that it needs more opiates to achieve the feeling of normalcy. The addiction begins to grow and to spread, and begins to starve the brain’s opiate receptors. Long-term abuse and use of heroin actually changes the brain chemistry over time. If the drug is used for many years, the change is permanent (Effects of heroin on the brain, 2014). There is a certain amount of dopamine in a normal human brain produces regularly. The dopamine is then distributed out to the brain so the user can attempt to feel normal. An example of this is during and after exercise that is strenuous, the body begins to slowly releasing small amounts dopamine that is produced naturally, to the brain, so that the person feels a better despite working hard. This biological process is a mechanism that is used for survival (Effects of heroin on the brain, 2014). When the addict begins using heroin daily, their brain is saying “Hey wait a minute here. My body is being constantly flooded with extra opiates and dopamine, so there is no need to produce any myself naturally (Effects of heroin on the brain, 2014). I am getting all that I need and more.” If an individual keeps using heroin for an extended period of time, the body is slowly being trained to stop the production of dopamine naturally. It is very dangerous to be addicted to heroin. Long term use involves many risks, overdose is common (Effects of heroin on the brain, 2014). When the user tries to get clean, and does not use for a period of time, they lose their tolerance for the drug. The intense cravings for the drug lead them to relapse. The addict uses again, the same about being used before they stopped, and overdose, because they no longer have the tolerance built up to use that amount. Most heroin addicts do not live to reach the end stage, where their body stops producing dopamine naturally. “Addicts who do, are stuck in a stage where their body is in a constant state of being starved for opiates so they can feel normal. In these cases, drug maintenance therapy with a synthetic opiate, such as Suboxone is recommended (Effects of heroin on the brain, 2014).” This phenomenon demonstrates the power the use of heroin use has. Other effects, such as the phenomenon of cravings that can be so powerful that they are stronger than wanting to eat when one is starving. This powerful opioid literally changes the brain chemistry over time, which puts a grip on the addict, putting them even deeper into opioid addiction (Effects of heroin on the brain, 2014).

Implications on brain “The circuit in the brain that is thought to be most important to the reinforcement system that is neurological is the limbic reward system, which is known also as the brain reward system, or the dopamine reward system. This brain circuit runs the span of the nucleus accumbens and the ventral tegmental area (VTA) (Bromberg-Martin, Matsumoto, & Hikosaka, 2011).” All substance that are abused, such as heroin, cocaine, alcohol, MA, nicotine, marijuana, other illicit drugs, and synthetic substances have an effect on the limbic reward system. The nucleus accumbens are also affected, and the release of dopamine is increased, which is the neurotransmitter that helps regulate the feelings of satisfaction, euphoria and pleasure. Dopamine also plays a major role in controlling motivation, cognition, movement, and reward (Bromberg-Martin, Matsumoto, & Hikosaka, 2011). Dopamine levels that are high in the brain causes enhancement to the mood and increases body movement, such as motor activities. Levels of dopamine that are too high can produce irritability, nervousness, paranoia, and aggressiveness that are characteristics of schizophrenia (Bromberg-Martin, Matsumoto, & Hikosaka, 2011). This increase of dopamine may also cause bizarre thoughts and hallucinations that are symptoms of schizophrenia. “Dopamine levels that are too low in certain areas of the brain can result in tremors and paralysis that are symptoms of Parkinson's disease (Bromberg-Martin, Matsumoto, & Hikosaka, 2011).” Stop Heroin. http://www.stopheroin.net/heroinfacts.htm

Therapeutic interventions Suboxone Scheduled III drug buprenorphine + naloxone The Controlled Substance Act (CSA) has five schedules that are used to classify drugs. “Schedule I drugs have a high potential for abuse, they have no medical use. Schedule II drugs also have a high potential for abuse, but currently have a use in medical treatments, and have a risk of severe physiological dependence. Schedule III drugs have a lower potential for abuse, and are currently used for medical treatment, these drugs may have moderate or low physical dependence, or high physiological dependence (CSA Schedules, 2000).” Scheduled III, IV, and V medications that are narcotic were approved for treatment via the Drug Addiction Treatment Act of 2000 (DATA 2000) (Varela, 2010). This act allows physicians who are qualified, to prescribe prescription drugs that are “specifically approved Schedule III, IV, and V narcotic medications for treating addiction to opioids in settings that are not in methadone treatment centers (Varela, 2010).” DATA 2000 reduced the burden placed on physicians by regulations, by allowing physicians who are qualified to apply for waivers regarding the special requirements for registration as stated in the Controlled Substance Act (Varela, 2010). "The Food and Drug Administration (FDA) approved Suboxone, a buprenorphine and naloxone combination for the treatment of addiction to opioids (Varela, 2010). Suboxone is currently the only Schedule III, IV, or V medication to have been approved by the FDA. Suboxone has many advantages over methadone. Suboxone can be prescribed for the addict to take home, just as they would any other medication (Varela, 2010).” “The main ingredient in Suboxone is buprenorphine, it is a partial opioid agonist, which can both block and activate opioid receptors, the opioid effects of Suboxone are limited in comparison to drugs that produce a full opioid agonist, such as heroin and oxycodone. Suboxone also contains naloxone, which is n opioid antagonist, it prevents the drug from binding to opioid receptors (Varela, 2010).” It is there to discourage individuals from injecting or snorting it. Suboxone comes in pill or film form, which is placed under the tongue to dissolve (Varela, 2010). When Suboxone is used correctly only a very small amount of naloxone goes into the bloodstream, and the patient feels only the effects of the buprenorphine. “If Suboxone tablet is ground up, injected, smoked, or snorted, the individual who is dependent on a full opioid agonist can quickly go into withdrawal (Varela, 2010).” Being able to get Suboxone from a doctor, without going into a methadone treatment center, and it may being people into treatment who would not have come, due to the social stigma associated with addiction. Suboxone aids people into staying in treatment, decreases cravings, suppresses opioid withdrawal, and has a ceiling effect, so the patient has limited euphoria (Varela, 2010). “If a Suboxone tablet is crushed and naloxone is injected, snorted or smoked, a person dependent on a full opioid agonist can be caused to quickly go into withdrawal (Varela, 2010).” Suboxone is safer because it offers less reason to abuse it. Suboxone is a useful tool for relapse prevention, it helps remove the strong urges to relapse, and allows the patient to be alert mentally (Varela, 2010). It is nearly impossible to overdose because it is a partial opioid agonist with a ceiling effect. Suboxone provides a longer half-life. It takes two days for the drug to lose half of its pharmacological activity, as compared to methadone, which takes one day, making it more useful for the purpose of detoxification. Suboxone can lead to respiratory suppression that is fatal, but this is rare. There is a higher risk of this condition if the use of heroin is continued. It has been found through evidence based treatment studies that Suboxone can be a positive alternative for individuals who are opioid addicts in recovery who chronically relapse. Control your Suboxone (2013) http://www.rxfilmcuttingguide.com/

Therapeutic Interventions Methadone Scheduled II drug Synthetic narcotic analgesic Methadone is a Schedule II medication, only dispensed in clinics that are federally regulated, in methadone maintenance programs (Methadone, 2013). These programs are often unappealing to patients. It is available in oral solution, injection, and tablet form. The active ingredient in methadone is always methadone hydrochloride (Methadone, 2013). It is a synthetic narcotic pain reliever. Methadone is often used in the treatment of heroin addiction. It is also used as an analgesic to relieve pain. Methadone shares the same characteristics of morphine, but when methadone is used there it prevents the person using it from experiencing the euphoric high (Methadone, 2013). The dosage is decided by the person’s body weight and their tolerance to heroin. “Methadone users can develop dependence, tolerance, and withdrawal (Methadone, 2013). When used as prescribed methadone can reduce cravings, suppresses the withdrawal symptoms, and blocks the feeling of euphoric high people get from using other opioids, such as heroin. http://www.pharmedium.com/compounding/service/61/Methadone/

conclusion Heroin Methods of Use Effects of drug Side Effects Hazards Treatment Options Heroin is an highly addictive drug that comes from the seedpod of the opium poppy plant. Heroin in its purest form is usually a white powder. Less pure forms have varied colors ranging from white, brown, and black. Heroin can be injected in the user’s veins, smoked or snorted. Individuals of all ages and lifestyles have used heroin so there is no one particular set of individuals that may have experimented with the drug (Drugs.com, 2014). Users who inject heroin will experience a euphoric surge or rush as it is known to some. The users mouth may sudden become dry, they may start to nod in and out, and their legs may feel heavy(Drugs.com, 2014). Heroin is metabolized to morphine and other metabolites which bind to opioid receptors in the brain. Mental functioning becomes clouded due to the depression of the central nervous system (Drugs.com, 2014). Other hazards have been reported with regular heroin users. The user that is physically dependent on the drug and suddenly stop occasionally can be fetal. Withdrawal symptoms for regular users consist of restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps. There are several medical treatment options that exist for heroin addiction. These treatment consist of methadone, buprenorphine, and naltrexone are approved to treat opioid dependence. These treatment can be effective when combined with medication compliance programs and behavioral therapy (Drugs.com, 2014).

references Alcoholism.About.com (2014). What is heroin? Retrieved from http://alcoholism.about.com/od/heroin/a/heroin.htm Bernstein, E., Bernstein, J., Tassiopoulos, K., Valentine, A., Heeren, T., Levenson, S., & Hingson, R. (2005). Racial and ethic diversity among a heroin and cocaine using population: Treatment system utilization, 24(4): 43-63. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761118/ Bromberg-Martin, E. S., Matsumoto, M., & Hikosaka, O. (2011). Dopamine in motivational control: rewarding, aversive, and alerting. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032992/ Carlson, N. R., (2013). Physiology of behavior 11th ed. Upper Saddle River, NJ Pearson Education CSA (2000). Drugs.com. Retrieved from http://www.drugs.com/csa-schedule.html Drugs.com (2014). Heroin. Retrieved from http://www.drugs.com/illicit/heroin.html DrugFreeWorld.org (2014). The trust about heroin. Retrieved from http://www.drugfreeworld.org/drugfacts/heroin/the-truth-about-drugs.html Effects of heroin on the brain (2014). Heroin.net. Retrieved from http://heroin.net/heroin- effects/heroin-effects-sub-page- 1/heroin-effects-on-the-brain/ Clip Art retrieved from Bing, 2015

references Healthyone.org. (2011) Medical uses of heroin. Retrieved from http://healthyone.org/medical-uses- of-heroin Kandel, E.R., Schwartz, J.H., Jessell, T.M., (1991). Drugs change the way neurons communicate. Principles of Neural Science 3rd ed. Retrieved from http://science.education.nih.gov Methadone (2013). Cesar, Center for Substance Abuse Research. Retrieved from http://www.cesar.umd.edu/cesar/drugs/methadone.asp NIH, (2014). Drugs, brains, and behaviors: The science of Addiction. Retrieved from http://www.drugabuse.gov Varela, M. BA, CDP, CCDC III (2010). Suboxone Treatment. Managing Patients Taking Suboxone With in a Chemical Dependency Treatment Program. University of Nevada, Reno. Retrieved from http://casat.unr.edu/docs/varela.mark_ya.wa_08.pdf Clip Art retrieved from Bing, 2015