Drugs of Abuse: Clinical Signs and symptoms Sir Christian Kreipke, PhD, FRSC Drugs of Abuse: Clinical Signs and symptoms

What is a drug of abuse A substance which is chronically used without consultation with a trained professional A non-controlled substance A controlled substance which is utilized outside of the recommendation of a trained professional A substance, either controlled or non-controlled, which causes a deviation from normal behavior ETC, ETC, ETC

Why use a “Drug of abuse” Peer pressure Feels good Looks cool Necessary to begin and then gets out of hand Accessible Cheap escape to an otherwise contrary existence

Age of onset Up to 50% of highschool-aged children have experimented with drugs of abuse Up to 35% of middle-schoolers have gotten drunk Up to 35% of those under the age of 18 are addicted to some drug of abuse Up to 40% of adults over the age of 18 chronically abuse prescription drugs

Method of delivery Oral Snorting Injecting Topical application

consequences Legal troubles Interactions with non-drugs of abuse Chronic physiological effects Addiction Comorbidity due to concentration deviations, poor quality control, etc Financial ruin Stigma

Common drugs of abuse Amphetamines Barbituates Cocaine Heroin Methamphetamine MDMA (ecstasy) LSD PCP Alcohol Marijuana Prescription drugs Etc.

Amphetamines Mode of delivery: oral or injection Benefits: high without extreme low, apparent low addictive quality Risks: potential for addiction; drug quality problems Biology: selectively releases DA into the synaptic cleft

Barbituates Mode of delivery: oral Benefits: calming low; apparent metabolism booster Risk: temperature regulation imbalance; chronic fatigue; addiction; severe dehydration; depression Biology: catch-all for DA, 5HT, and endocrine system

Cocaine Method of delivery: oral, snorting, injection Benefits: great high Risks: great low, highly addictive; quick sensitization requiring repetitive and frequent use; drug quality issues Biology: selectively releases DA and reverses DA transporter (DAT)

Heroin Mode of delivery: most common is injection Benefits: extreme initial high Risks: “benefit” is transient and unpredictable; highly addictive; live destroyer; extreme low; very difficult to break the habit; expensive Biology: causes neuronal death

Methamphetamine Mode of delivery: injected, oral, snorted Benefits: mellow high; cheap Risks: phenotypic signs (meth mouth); highly addictive; difficult to kick the habit; brain death Biology: kills dopamine cells in VTA and SNc; cleaves DA terminals in STR

MDMA (ecstasy) Common mode of delivery: oral Benefits: transient increase in sensory perception, particularly with pleasurable sensations Risks: drug quality and concentration variability; effects are addictive; difficult to detect Biology: selectively releases 5HT and blocks reuptake

LSD Mode of delivery: oral, topical Benefits: creative high Risks: highly addictive; individual tolerance highly variable; negative flashbacks; overdose Biology: initially releases 5HT, with delays GLU release and eventual GLU cell death

PCP Mode of delivery: oral or snorted Benefits: extreme high; escape from reality Risks: highly addictive; irreversible modification of brain physiology Biology: inhibits NMDA receptors which initially shuts down GLU system then leads to increased mGLUr activation

Alcohol Mode of delivery: oral Benefits: socially accepted; buzz risks: readily available, yet legally tightly controlled; individual tolerance hard to determine; false sense of security and confidence; impaired brain processing; addiction possible with varying genetics Biology: blocks muscarinic receptors; selectively inhibits GLU in cerebellum and PFC; neural death

Marijuana Mode of delivery: oral Benefits: mellow high Risks: unpredictable paranoia; possible addiction Biology: binds cannabanoid receptors

Prescription drugs Mode of delivery: various Benefits: readily available; potential various benefits Risks: overdose; obtuse effects Biology: varied

ETC. Many other drugs that are household products or “home chemistry set made” that vary in quality, effect, danger, etc.