1. Drugs of Abuse
DR. Sazan Dakheel Saeed

2. Performance enhancing drugs
DRUGS OF ABUSE
Opioids
CNS depressants
CNS stimulants
Hallucinogens
Mind altering drugs
Performance enhancing drugs

3. What are the commonly abused prescription
drugs?
Although many medications can be abused, the following three classes are most commonly abused:
• Opioids—usually prescribed to treat pain
• Central nervous system (CNS) depressants—used to treat
anxiety and sleep disorders
• Stimulants—most often prescribed to treat attention deficit
hyperactivity disorder

4. All Abused Substances Enhance Dopamine (neurotransmitter) Activity
(particularly related to pleasure,
motor, and cognitive function
Other pathways also involved!

5. Dopamine Pathways Serotonin Pathways Functions mood memory processing
nucleus
accumbens
hippocampus
striatum
frontal
cortex
substantia
nigra/VTA
raphe
Functions
reward (motivation)
pleasure,euphoria
motor function
(fine tuning)
compulsion
perserveration
decision making
Serotonin Pathways
Functions
mood
memory
processing
sleep
cognition

6. Neuronal structure
(receiving)
(sending)

9. /serotonin Neuronal terminal Drug : cocaine ritalin transporter
vesicle
Neuronal terminal
Drug :
cocaine
ritalin
stimulation
transporter
How some drugs of abuse cause dopamine release:
opioids narcotics (activate opioid receptors)
nicotine (activate nicotine receptors)
marijuana (activate cannabinoid receptors)
caffeine
alcohol (activate GABA receptors; an inhibitory transmitter)
Vmat
/serotonin
DA/5HT

10. transporter
Vmat
serotonin/
Release DA from vesicles and reverse
transporter
DA/5HT
Drug Types:
Amphetamines
Methamphetamine
MDMA (Ecstasy)
methylenedioxy-methamphetamine

11. OPIATES medications that relieve pain. The most common opiates are:
Opiates are drugs that are derived from the Poppy Plant and are
medications that relieve pain.
The most common opiates are:
Opium
Heroin
Morphine
Codeine
Opiates are known by several different names:
Soapium
Smack
Poppy

12. codeine—it is a very effective to relieve coughs
Not an analgesic unless metabolized to morphine
Ceiling dose: 360mg/da
codeine—it is a very effective to relieve coughs
2. Morphine
natural opioid”
Widely available in multiple forms: oral pill and liquid, parenteral

13. HOW ARE OPIATES CONSUMED?
Snorted – Because of the high potency of heroin today, more and more users are snorting the drug.
Injected – Injecting opiates, specifically heroin, is still the choice ingestion method. Many addicts choose to inject the drug because of the quick and powerful onset of the effects. Users can inject the drug directly into the blood stream or the muscle tissue.
Smoked – The method of choice for opium is smoking the tar like substance. Other opiates are often smoked on top of marijuana. This is known as “snow capping”.
Eaten – All opiates can be consumed orally. Many prescription pain killers on the market today are opiates.

14. Opioids 1. Hydromorphone 2. Oxycodone
Opioids are synthetic or partly-synthetic drugs that are manufactured to work in a similar way to opiates for pain relieving.
Opioid receptors are :Mu, Delta, Kappa
1. Hydromorphone
2. Oxycodone
Oxycontin is an extremely potent pain killer that comes in time release tablets that last for up to twelve hours.
Oxycontin is prescribed to cancer patients and chronic pain suffers to help in managing pain.
3. Fentanyl
4. Sufentanil Tramadol
5. Methadone

15. What are the possible consequences of opioid
use and abuse?
Taken as prescribed, opioids can be used to manage pain safely and effectively.
However, when abused, even a single large dose
can cause severe respiratory depression and death.
Properly managed, short-term medical use of opioid analgesics rarely causes addiction
Regular (e.g., several times a day, for several weeks or more) or longer term use or abuse of opioids can lead to physical dependence and, in some cases, addiction.

16. CNS depressants
CNS depressants, sometimes referred to as sedatives and tranquilizers, are substances that can slow brain activity. This property makes them useful for treating anxiety and sleep disorders.
1. Benzodiazepines:
Diazepam and Alprazolam.
The more sedating benzodiazepines are Triazolam (Halcion) and Estazolam (ProSom) are prescribed for short-term treatment of sleep disorders.
Usually, benzodiazepines are not prescribed for long term use because of tolerance, dependence, or addiction.

17. Non-benzodiazepine sleep
The medications:
zolpidem, eszopiclone and zalepon
They have a different chemical structure, but act on some of the same brain receptors as benzodiazepines.
They are thought to have fewer side effects and less risk of dependence than benzodiazepines.
2. Barbiturates
Mephobarbital (Mebaral), Phenobarbital (Luminal Sodium), and Pentobarbital sodium (Nembutal) are still used in surgical procedures and for seizure disorders.
Mechanism of Action
Barb:Site of action:
Brain stem (reticular formation)
Cerebral cortex
By inhibiting GABA, nerve impulses traveling in the cerebral cortex are also inhibited

18. KETAMINE
Ketamine, or ketamine hydrochloride, is a Central Nervous System (CNS) Depressant and a dissociative anesthetic.
Ketamine is used primarily as an anesthetic in veterinary medicine, but is also sometimes used with small children and elderly.
Ketamine can be found as a clear white liquid or as a white powder.

19. KETAMINE Ketamine can be ingested several different ways:
Injected
Snorted
Smoked
Orally – In a pill or liquid form
Ketamine is also called: K
Kit Kat
Special K

20. GHB
GHB, or Gamma Hydroxylbuteric acid, is a central nervous system (CNS) depressant that sometimes causes hallucinations.
GHB is usually found as a clear liquid with a slightly salty taste, but can also be found as a small tablet or capsule, all of which dissolve quickly in liquid.
GHB usually is sold by capful or teaspoon, also known as a “dose”.

21. ROHYPNOL
Rohypnol (chemical name – fluritrazepam) is a CNS Depressant that is more than ten times as strong as Valium.
Rohypnol belongs to the benzodiazepines family, which also includes drugs such as Valium, Librium, and Xanax.
Rohypnol is known as a “Date Rape Drug” due
to its association with sexual assaults.
Rohypnol is almost always ingested orally in either the pill form or dissolved in a beverage, but is sometimes ground up and snorted.

22. depressants with other
Is it safe to use CNS
depressants with other
medications?
Typically, they should not be combined with any other
medication or substance that causes CNS depression, including prescription pain medicines, some OTC cold and allergy medications, and alcohol. Using CNS depressants with these other substances—particularly alcohol— can affect heart rhythm, slow respiration, and even lead to death.

23. Stimulants What are stimulants?
As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulants historically were used to treat asthma and other respiratory problems, obesity, neurological disorders
But as their potential for abuse and addiction became apparent, the medical use of stimulants began to wane. Now, stimulants are prescribed to treat only a few health conditions, including ADHD, narcolepsy, and occasionally depression—in those who have not responded to other treatments.
Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness

24. CNS Stimulants Amphetamines Methamphetamines Cocaine
Nicotine, caffeine, energy drinks
Other stimulants such as:
dextroamphetamine (Dexedrine )
Methylphenidate (Ritalin ).

25. How do stimulants affect
the brain and body?
Stimulants enhance the effects of norepinephrine and dopamine in the brain.
The associated increase in dopamine can induce a feeling of euphoria when stimulants are
taken non medically.
Stimulants also increase blood pressure and
heart rate, constrict blood vessels, and open up breathing passages.

26. AMPHETAMINES
Amphetamines are generally a white or off-white powder that can be ingested orally, snorted, or injected.
Amphetamines are powerful stimulants that increase activity in the Central Nervous System (CNS), or speed up the way the human body works.
Amphetamines are drugs that induce false feelings of power, strength, self-assertion and enhanced motivation.

27. METHAMPHETAMINE
Methamphetamine is a powerful, synthetic Central Nervous System (CNS) Stimulant.
Methamphetamine is generally a white or off-white powder that can be ingested several different ways:
Orally – In a pill form
Snorted – This can cause severe damage to the interior and exterior of the nose.
Intravenously - The methamphetamine can be injected into either the blood stream or the muscle tissue
Smoked – Methamphetamine is sometimes smoked by itself or on top of marijuana.
because it has been methylated twice, is significantly faster acting, more potent, and more addictive, and thus quite a bit more dangerous.

28. Cocaine Cocaine is a bitter, white, odorless, crystalline drug.
Cocaine is classified as a CNS stimulant.
Cocaine is extracted and refined from the Coca Plant, which is grown primarily in South America.
Cocaine is also known as:
Dust
Candy
Snow
Coke

29. consequences of stimulant
What are the possible
consequences of stimulant
use and abuse?
As with other drugs of abuse, it is possible for individuals to become dependent upon or addicted to stimulants.
Repeated abuse of some stimulants (sometimes within a short period) can lead to feelings of hostility or paranoia, even psychosis. Further, taking high doses of a stimulant may result in dangerously high body temperature and an irregular heartbeat.
There is also the potential for cardiovascular failure or seizures.

30. Is it safe to use stimulants with other medications?
Patients should be aware of the dangers associated with mixing stimulants and OTC cold medicines that contain decongestants, as combining these substances may cause blood pressure to become dangerously high or lead to irregular heart rhythms.

31. Hallucinogens
LSD
Mushrooms
PCP

32. LSD Lysergic acid diethylamide (LSD) is hallucinogenic chemical
LSD is produced as a crystal, then dissolved in alcohol prior to sale and consumption.
LSD has become known as:
Acid
Trips

33. HOW IS LSD CONSUMED?
LSD is generally taken orally, either as a pill, a piece of blotter paper, or via liquid LSD can also be absorbed through the users skin.

34. MUSHROOMS
Mushrooms that contain PSILOCYBIN are known as ‘magic mushrooms’ as they contain hallucinogenic properties.
Magic mushrooms have been used by several cultures to induce altered states of consciousness
Mushrooms can be consumed in a variety of manners:
Eaten – Either raw or cooked, much like non-hallucinogenic mushrooms.
Drank – Heated with water to make a tea or soup.
Smoked – The mushroom is ground into a fine powder and often smoked on top of marijuana.
PSILOCYIN: increase the level of serotonin

35. PCP
PCP (phencyclidine)is classified as a hallucinogen and a dissociative anesthetic,
PCP comes in several forms:
Crystalline Powder
Colored Powder
Diluted in Water
Pills
Capsules
PCP is also known as:
Angel Dust
Boat

36. PCP PCP can be ingested several ways: PCP has been known to be used
Orally – In liquid or pill form.
Smoked
Snorted
Injected
PCP has been known to be used
in combination with other substances:
LSD – “Super Tripping”
Marijuana – “Killer Weed” or “Boat”
Tobacco – “Sherms”, usually with menthol cigarettes to sooth the burning of the hot PCP smoke.
Mint/Parsley – “Green”
Tripping ;dancing/

37. Note
Cough syrups and cold medications are the most commonly
abused OTC medications
At high doses, dextromethorphan—a key ingredient found in cough syrup—can act like PCP or ketamine, producing dissociative or out-of-body experiences.

38. ANABOLIC-ANDROGENIC STEROIDS
Anabolic Steroids (male sex hormone testosterone ), effect the Human Body in Two Major Areas:
1) The anabolic effects of the drugs promote the growth of skeletal muscle.
2) The androgenic effects of the drugs promote the development of male sexual characteristics.

39. Treatment of include medications
Naltrexone,
Methadone
Buprenorphine
Behavioral counseling approaches.
opioids addiction
Naltrexone is an antagonist medication that prevents opioids from activating their receptors.
It is used to treat overdose and addiction, although its use for addiction has been limited due to poor adherence and tolerability by patients

40. Recently, an injectable, long-acting form of naltrexone (Vivitrol), originally approved for treating alcoholism, has also received FDA approval to treat opioid addiction (i.e., heroin or other opioids).
Methadone
is a synthetic opioid agonist that eliminates withdrawal symptoms
and relieves drug cravings by acting on the same brain targets as other
Opioids.

41. Buprenorphine
Is a partial opioid agonist (i.e., it has agonist and antagonist properties),
which can be prescribed by certified physicians in an office
setting. Like methadone, it can reduce cravings and is well
tolerated by patients.