1. Psychoactive Substances Student Interests/Questions

2. General Organization About Forms Availability Effects Overdose Withdrawal Tolerance Dependence

3. Methamphetamine

4. About Methamphetamine Stimulant Limited medical use: narcolepsy, weight control DEA: Schedule II drug

5. Methamphetamine Availability Historically existed as independent laboratories DEA: In 2001, 12,715 labs reported; in 2007, 5,910 labs Reduction due to 2005 U.S. restrictions on OTC cold medications, Mexico restrictions in 2007Mexico  Production thought to be increasing as cooks find ways around the regulations (smurfing), some Mexico operations moving to U.S. ~$30-60/gram, depending on purity (“pure gram” price significantly higher)price Purity has been reduced, perhaps due to regulation

6. Methamphetamine Forms Snorted, smoked, orally ingested, injected

7. Methamphetamine Effects Intense high/euphoria  May last up to 12 hours (longer than cocaine)  Meth known for its dopamine-related effects (Meth Inside and Out clip)effects Increased blood pressure Increased sensation of energy, alertness Higher dopamine levels than cocaine Effects of those near a meth lab (KING TV, November 2009)meth lab

8. Methamphetamine Effects Chronic users may experience hallucinations, rage, paranoia, heart inflammation, sores from “crank bugs”; body wasting, “meth mouth;” brain cell death; damage to dopamine-, serotonin-containing nerve cells“crank bugs”; body wastingmeth mouthbrain cell death  Dopamine damage may result in similar symptoms seen in Parkinson’s disease  Damage may at least partially return to normal, when meth use halted

9. Methamphetamine Effects Before & After Photos

10. Before and After Photos 3 Years and 5 months after starting meth Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

11. Before and After 17 months after starting meth Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

12. Before and After 3 months later Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

13. More Before and After Photos http://www.mappsd.org/Faces%20of%20Meth-2.htm http://www.mappsd.org/Faces%20of%20Meth-2.htm

14. Methamphetamine Overdose Dangerous increase in blood pressure Sweating Seeing spots (increased pressure in eye) Convulsions Heart attack Stroke In 2008, hospitals reporting “stimulant”-mentioned (meth, amphetamine) ER cases: 107,575 Source: DAWN

15. Methamphetamine Hospitalizations, 2002 Rates per 100,000 population: Boston: 15 Atlanta: 23 St. Louis: 24 Denver: 29 Los Angeles: 39 Seattle: 46 Phoenix: 65 San Francisco: 91 Source: Drug Abuse Warning Network

16. Methamphetamine Tolerance, Dependence Tolerance: A need to increase the dosage of a substance to obtain the same effects  With chronic use, tolerance develops  Higher dose  Up to several 100 times greater than original dose (Source: Merck) (Source: Merck)  Increased frequency  Different administration Dependence: Compulsion to take a substance despite adverse consequences  Dependence typically develops

17. Methamphetamine Withdrawal Withdrawal: Symptoms experienced by user when substance is not used Depression Fatigue Anxiety Paranoia Craving Process takes ~48 hours, extremely uncomfortable

18. PBS: Frontline - The Meth Epidemic (2006) Uncovering Meth’s History and Spread  Portland, OR  Effects seen in law enforcement  Familial effects  Use trends

19. Which Substance is the Most Addictive? Depends on who you ask In 1990’s three researchers identified substance addictiveness ratingsthree researchers  Dr. Jack E. Henningfield  Dr. Neal L. Benowitz  Dr. Daniel M. Perrine Chart of Findings Source: druglibrary.org Chart of Findings

20. Cocaine Extracted from coca plant Meeting Cocaine Farmers (BBC) Meeting Cocaine Farmers Stimulant Schedule II drug

21. About Cocaine: Some History In late 1800’s was prescribed by US physicians  Cough drops Cough drops Coca-Cola had cocaine removed in early 1900’s Coca-Cola Cocaine wine was availablewine

22. Cocaine Forms Powdered form  Snorted  Dissolved in water, injected Processed in rock form Generally, the faster a drug can enter the brain, the more it will be abused Generally, the faster a drug can enter the brain, the more it will be abused

23. Cocaine Availability According to DEA, second most commonly used illegal substance  In WA, 604 kg of cocaine were seized in 2005  Marijuana: 9873kg, heroin 8.2kg, meth 74.4kg South America is primary source  Other countries involved with transportation  Generally supervised via Colombia Most cocaine enters US via Mexico Price depends on purity (50-70%), form of cocaine, amount purchased, region, $10-200 (crack vs cocaine, wholesale vs retail)

24. Cocaine Effects Increased heart rate, blood pressure, temperature Improved mood, well-being  Short-lived (few minutes to few hours) Increased sensation of energy Chronic users may experience bloody noses (damage to septum), brain adaptations to cocaine-induced dopamine effects, compromised immunity Lesions and clots in brain blood vessels Relationship between cognition & therapy dropout

25. Cocaine Overdose Seizures Heart attack Stroke Kidney failure Death In 2008, cocaine-mentioned ER cases: 548, 608 (2002: 199,198) Source: DAWN

26. Cocaine Withdrawal Apathy Fatigue Depression/mood swings Cravings for drug Not as intense as withdrawal from heroin, alcohol

27. Cocaine Tolerance Thought to increase with heavy use initially Tolerance may not continue to develop

28. Cocaine Dependence Emphasis appears to be on psychological rather than physical dependence Rats and self-administration (reinforcement)administration

29. LSD

30. About LSD Hallucinogen Synthesized in 1930’s; derived from a fungus Very small amounts are very potent  Dose measured in micrograms Schedule I

31. About LSD Discovered by Albert HoffmanAlbert 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.”

32. About 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.”

33. LSD Availability Available in all states  Typically, metropolitan/urban areas Produced in the US  Chemists vs independent producers  Recipes available  Infrequent production cycles (USDOJ)  Few labs are discovered and seized  Kansas, 2000 (silo) (millions of doses/month)  Distribution highly confidential

34. LSD Effects Increased heart rate, blood pressure, sweating Possible anxiety/panic Visual hallucinations (images, color, light) Altered perception of senses  “Seeing sounds, hearing colors”  Sound  Touch  Color, size of objects Altered perception of time, depth

35. LSD Effects Extreme mood changes Nausea Impaired judgment Experiences can vary widely  Expectations, surroundings, pre-existing mental conditions, presence of other substances LSD experimentation on British soldiers Source: Youtube.com LSD experimentation on British soldiers LSD mechanism  Serotonin and dopamine

36. LSD Forms Initially produced in crystal form Crystal can be crushed, mixed with other materials into tablets: microdots Gelatin squares Converted to liquid  Dosed onto blotter paperblotter paper  Dosed onto sugar cubes Usually taken orally  Can be inhaled, injected, applied transdermally

37. LSD Effects Long-term effects:  Flashbacks (days/months after dose)  Cause unknown; may be due to use of other substances  Hallucinogen Persisting Perception Disorder  Psychotic states among those with psychological disorders  Apathy

38. LSD Overdose Possible No reported deaths LSD implicated in accidental deaths, suicides, murders, self-inflicted wounds In 2006, 4,002 emergency room cases Source: https://dawninfo.samhsa.gov/files/ED2006/tables/AllMA/AllMA_Total_SDL_Visits.html

39. LSD Tolerance, Dependence, Withdrawal Tolerance  Tolerance does develop  Can abate after a few days of disuse Withdrawal: No evidence Dependence: While physical dependence is unlikely, psychological dependence can occur

40. Heroin

41. About 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 addictiveless addictive  After many people became addicted, heroin was outlawed in 1920’s Schedule I

42. Heroin Availability Produced largely in Burma, Afghanistan,Mexico  5,644 metric tons from Afghanistan in 2006 (WA Post) Routes, methods of transportation depend on origin US heroin increasingly obtained from South America, Mexico Costs vary across US (Asian vs Mexican heroin)  $15K-$250K per kilogram

43. Heroin Forms Pure heroin is white Most is darker  Additives  Impurities Injection, smoking, snorting

44. Heroin Effects Euphoria Slow, shallow respiration Analgesia Stupor Long-term effects: collapsed veins, respiratory problems

45. Heroin Overdose Frequently occurs when mixing with other substances In 2008, heroin-mentioned ER cases: 189,780 Source: DAWN

46. Heroin Tolerance, Dependence, Withdrawal With regular use, tolerance develops Dependence is both physical and psychological Withdrawal symptoms can be severe  Craving  Restlessness, insomnia  Pain  Diarrhea  Vomiting  Can be fatal among heavy users Methadone can be used to treat withdrawal

47. Rohypnol

48. About Rohypnol Depressant ‘Low-cost’  $5/tablet “Date Rape” drug Legally available as a sedative in many countries (not US) Schedule IV

49. Rohypnol Effects Oral ingestion, snorting, injection Frequently combined with alcohol Muscle relaxation Drowsiness/loss of consciousness Memory impairment/amnesia Nightmares Confusion In 2004, Rohypnol attributed to 473 emergency room visits  http://www.whitehousedrugpolicy.gov/drugfact/club/index.html

50. Rohypnol Tolerance, Dependence, Withdrawal Tolerance: can develop, though lower levels compared to other depressants Dependence: less euphoria, so dependence is less likely; dependence, however, can happen Withdrawal: anxiety, numbness, sensitivity to bright lights; gradual reduction in dosage

51. Other “date rape” drugs…

52. GHB Depressant Manufactured in clandestine labs in US  Contents can vary dramatically Ingestion: powder dissolved in liquid Effects similar to Rohypnol; hallucinations also occur Anabolic effects (bodybuilder use) Schedule I

53. Ketamine Hallucinogen Tranquilizer used in veterinary clinics Can be mixed in drinks, smoked, injected $25 per dose Changes in perception; dissociative effects; loss of coordination; numbness; analgesic Schedule III

54. Ketamine, GHB Ketamine In 2004, ketamine attributed to 227 emergency room visits http://www.whitehousedrugpolicy.gov/ drugfact/club/index.html GHB In 2004, GHB attributed to 2,340 emergency room visits http://www.whitehousedrugpolicy.gov/ drugfact/club/index.html

55. Hallucinogenic Mushrooms

56. About Mushrooms Psilocybin/psilocin are two active psychoactive substances found in “magic mushrooms”  Couple dozen species Recognized for centuries  Probably used in religious rites Hallucinogen Schedule I

57. Availability of Mushrooms Available across US, though primarily western and central states Independent growers may cultivate mushrooms from kits

58. Mushrooms: Forms Psyilocybin/psilocyn mushrooms pictured Other hallucinogenic mushrooms Oral ingestion

59. Effects of Mushrooms Relaxation Provides an altered perception of reality (typically shorter “trip” than LSD) Altered perception of time Sense of connection to others/universe Visual hallucinations (images, color, light)

60. Effects of Mushrooms Anxiety, mild increases in heart rate, blood pressure & breathing Thought to act on serotonin receptors Experiences can vary widely  Expectations, surroundings, pre-existing mental conditions, presence of other substances The wrong mushroom can be toxicwrong mushroom  "All mushrooms are edible, but some only once."-- Croatian Proverb

61. Effects of Mushrooms Long-term effects:  Since hallucinogenic usage usually not frequent, long-term effects seldom occur  May cause anxiety/panic attacks  Paranoid delusions  Psychosis among those with pre-existing psychological disorders

62. Mushrooms: Overdose, Tolerance, Dependence, Withdrawal Overdose: No known reports  Among “miscellaneous” hallucinogen emergency room reports: 3,445  http://www.whitehousedrugpolicy.gov/drugfact/hallucinogens/index.html Tolerance:  Tolerance does develop  Can abate after a few days of disuse Dependence: physical dependence unlikely; psychological dependence can occur

63. Ecstasy

64. About Ecstasy Hallucinogen  Ecstasy also has stimulant properties  Is a methamphetamine  “Designer drug” MDMA synthesized in early 1900’s Popular at raves Schedule I

65. Ecstasy Availability Most produced outside US  Belgium, Netherlands Trafficked into US via organized crime  Shipment modes vary  Major gateways include Miami, NY, LA

66. Ecstasy Effects Changes in mood Changes in perception (music) Fosters feelings of empathy, intimacy Increased heart rate, blood pressure, temperature Anxiety

67. Ecstasy Effects Confusion Depression Sleeplessness Long-term effects:  Neural damage leading to mood disorders  Controversial  Memory impairment

68. Ecstasy Effects Source: www.eprom.pitt.edu/UL_media%5C686070483.ppt

69. Ecstasy Forms Most often available in pill form Capsule form Powdered  Dissolved in liquid, injected

70. Ecstasy Overdose May occur, especially when paired with rave environment  Physical activity  Heated room  Dehydration  Other psychoactive substances used Deaths have been reported Over 8,621 ER hospitalizations in 2004

71. Ecstasy Tolerance, Dependence, Withdrawal Tolerance:  Research suggests tolerance quickly develops Dependence:  With increasing dose, positive effects decline  For some, MDMA may be physically addictive  Baboons and rhesus monkeys have been shown to self-administer (Drugs and Human Behavior)  Psychological dependence possible Withdrawal:  May include depression, anxiety, craving

72. Peyote

73. About Peyote A hallucinogen Peyote is a cactus containing the drug mescaline Evidence peyote was available several thousand years ago  Natives to Mexico, South America  Used in ceremonies/religious rites Schedule I

74. Peyote Availability Typically found in Mexico, southwestern United States

75. Peyote Effects Similar to LSD Visual hallucinations  Bright lights  Geometric patterns Change in perceptions  Time alteration  Detachment from surroundings Change in mood Increased heart rate, blood pressure, dilated pupils

76. Peyote Forms Peyote is ingested  Peyote buttons are eaten  Taste bitter  Peyote may be dried, soaked in a liquid to drink  Peyote may be ground and placed into capsules  Smoked  Rarely injected

77. Peyote Overdose In large doses, hallucinations of color and movement can be very vivid Nausea and vomiting  True overdose rare, especially due to likely vomiting Slowed breathing Among “miscellaneous” hallucinogens leading to 3,445 emergency room visits  http://www.whitehousedrugpolicy.gov/drugfact/hallucinogens/index.html

78. Peyote Tolerance, Dependence, Withdrawal Tolerance: May build rapidly at first, then fades with abstinence Dependence: Most sources indicate peyote does not create physical dependence, though psychological dependence may develop Withdrawal: Most sources indicate no withdrawal symptoms; “flashbacks” may occur, though may happen long after peyote has been used

79. Mescaline

80. About Mescaline Mescaline is retrieved from cactus species, usually peyote  Isolated in the late 1800’s  Named after Mescalero Apache tribe Schedule I

81. Mescaline Availability Found in peyote cactus in southwestern U.S., Mexico Also found in some Peruvian cacti

82. Mescaline Effects Effects are like those from peyote (hallucinogenic) Mescaline may also have stimulant effects  Increased heart rate, blood pressure, temperature, blood sugar

83. Mescaline Forms Usually taken orally  Powder, tablet, capsule, liquid  Bitter taste  Taken with milk, tea, juice, soft drink Rarely injected

84. Mescaline Overdose Hallucinogenic experiences can be severe Nausea, vomiting Among “miscellaneous” hallucinogens leading to 3,445 emergency room visits  http://www.whitehousedrugpolicy.gov/drugfact/hallucinogens/index.html

85. Mescaline Tolerance, Dependence, Withdrawal Tolerance: May build rapidly at first, then fades with abstinence Dependence: Most sources indicate peyote does not create physical dependence, though psychological dependence may develop Withdrawal: Most sources indicate no withdrawal symptoms; “flashbacks” may occur, though may happen long after peyote has been used

86. OxyContin

87. About OxyContin Brandname for drug oxycodone Narcotic  Pain (moderate-serious) reliever  Released over time  Tablet should not be chewed, else time release is lost, risking overdose Schedule II

88. OxyContin Availability In the last several years, availability has declined due to distribution control Prescription drug “Doctor shipping” According to 2004 federal government “Pulse Check,” Seattle among 15 of 25 cities where OxyContin has become a problem $5-12 for 10mg, $60-100 for 160mg

89. OxyContin Effects Pain relief Euphoria Drowsiness

90. OxyContin Forms OxyContin found in pill form Pill can also be crushed, snorted, injected  Increases risk for overdose

91. OxyContin Overdose Severe respiratory depression (slowing) Death In 2004, 36,559 OxyContin emergency room references  http://www.whitehousedrugpolicy.gov/drugfact/oxycontin/index.html http://www.whitehousedrugpolicy.gov/drugfact/oxycontin/index.html

92. OxyContin Tolerance, Dependence, Withdrawal Tolerance: Tolerance does develop Withdrawal: OxyContin dose needs to be reduced gradually  Restlessness  Muscle pain Dependence: Physical and psychological addiction can develop

93. Cannabis

94. About Cannabis DEA: Schedule I substance

95. Cannabis Availability

96. Cannabis Effects

97. Cannabis Forms

98. Cannabis Overdose Cannabis mentioned in ER visits, 2008: 290, 563 Source: DAWN

99. Cannabis Tolerance, Dependence, Withdrawal