1. Individual Drug Info Fall 2014

2. Similar Properties Across Drugs Withdrawal (physical dependence) Psychological dependence Tolerance

3. Differences Forms Availability DEA Schedule Effects ◦ Acute ◦ Chronic ◦ Overdose Photo, originally taken by Thoric, available to use in the public domainThoric

4. Cannabis - marijuana How does marijuana affect anxiety and depression? Does marijuana affect respiratory function? Especially during exercise? Is marijuana more destructive to your brain than alcohol?

5. Cannabis Cannabis sativa ◦ Different subspecies/varietals used for clothing vs drug use Active ingredient: THC THC is a cannabinoid ◦ Interacts with cannabinoid receptors in brain ◦ Many other cannabinoids exist, but not thought to cause psychoactive reactions DEA: Schedule I Despite state regulations, marijuana still federally illegal

6. Medical cannabis (10/30/14), source: procon.org) procon.org) Alaska (98)Maine (99)New Jersey (10) Arizona (10)Maryland (14)New Mexico (07) California (96)Massachusetts (12)New York (14) Colorado (00)Michigan (08)Oregon (98) Connecticut (12)Minnesota (14)Rhode Island (06) Delaware (11)Montana (04)Vermont (04) Hawaii (00)Nevada (00)Washington (98) Illinois (13)New Hampshire (13) Washington, DC (10)

7. Recreational Cannabis Washington (2013) Colorado (2013) Washington, DC (2014) Alaska (2014)

8. Cannabis Acute effects THC acts on cannabinoid receptors, increases dopamine, serotonin Increases appetite ASAP Science: Your Brain on Marijuana (via YouTube)Your Brain on Marijuana Overdose generally doesn’t occur ◦ Large amount required ◦ Smoking a lot may induce sleepiness ◦ Eating too much may trigger nausea, vomiting ◦ Q13 News story, Michiganstory Mixing any chemical substances can potentially cause a problem

9. Alcohol vs Cannabis More research on alcohol Age dependent Amount of alcohol/amount of cannabis Mixing substances Alcohol interferes with neurogenesis of brain cells (Gary L. Wenk, Psychology Today, 2010) (Gary L. Wenk, Psychology Today, 2010) Cannabis: 2014 study showing regular use impacted decision-making and judgment (Published online before print November 10, 2014, doi: 10.1073/pnas.1415297111. PNAS November 10, 2014)

10. Depression and Anxiety Many use marijuana to ease mood Regular use may trigger, or worsen, either condition, especially in younger people 2013 Imperial College study showed lower dopamine levels in regular users, which may lead to more anxietyImperial College Marijuana, conversely, may help those with Post- Traumatic Stress Disorder ◦ Memory inhibition

11. Cannabis Chronic effects Respiratory distress Mood swings Impaired memory (potential hippocampus damage) Earlier researchresearch 2011 NIMH/NIDA study ◦ Daily use may reduce brain receptor number ◦ Receptors regenerated with cessation ◦ Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry, molecular imaging shows." ScienceDaily. ScienceDaily, 13 June 2011..

12. Marijuana & Respiratory Function During Exercise Acute effect: any smoke can interfere with oxygen binding to red blood cells Acute: marijuana can disrupt coordination, balance, reaction time Acute: increase heart rate and blood pressure Acute: stored THC in fat could be released into bloodstream during exercise Chronic: depends on how frequently one smokes, type of exercise

13. Dimethyltryptamine (DMT) Dimethyltryptamine (DMT) What is DMT? How does DMT work as a psychoactive drug?

14. Dimethyltryptamine Chemical structure Hallucinogenic ingredient Present in a variety of plants plants Occurs naturally in the body Schedule I substance Image source: Wikimedia Commons

15. Dimethyltryptamine Often consumed via beverage: ayahuasca tea ◦ Requires MAO-I (specific vine) ◦ Ceremonial purposes ◦ Ashland, OR Brazilian church lawsuit Can be injected, inhaled, smoked

16. Dimethyltryptamine Effects Hallucinogenic visualizations Mood change Time distortion Dissociation Muscle twitching, coordination difficulties Nausea, vomiting Shorter-lasting effects than other hallucinogens ◦ “ businessman ’ s trip ” per DEA ◦ 30-60 minutes Video Clip - The Spirit Molecule, Part 1 (YouTube) Video Clip - The Spirit Molecule, Part 1 Video Clip – London Real (34:00+ = trip described) Video Clip – London Real Source: Arch Gen P e sychiatry. 1994 Feb;51(2):98-108. e

17. LSD Learn the effects of acid Are there different types?

18. 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.”

19. LSD Schedule I hallucinogen synthesized in 1930s Manufacturing secretive: Nick Sand (National Geographic, 3:39) Manufacturing secretive: Nick Sand “Types” Same basic chemical structure Illegal, so cannot guarantee contents, care of product Light and air may degrade drug Dosage measured in micrograms (very small)

20. LSD Forms Crystal can be crushed, mixed with other materials into tablets: microdots Gelatin squares Converted to liquid paperpaper ◦ Dosed onto sugar cubes ◦ Placed on candy (gummy bears - Lake Tahoe, 2011, e.g.) Usually taken orally ◦ Can be inhaled, injected, applied transdermally

21. LSD Acute Effects Duration of “trip” = several hours in length Visual hallucinations (images, color, light) Altered perception of senses “Seeing sounds, hearing colors” Color, size of objects Altered perception of time, depth Potential anxiety/panic Experiences can vary widely Serotonin receptors may be excited or inhibited LSD experimentation on British soldiers (YouTube.com) LSD experimentation Overdose thought to be rare, but some individuals may not respond well, or may experience problems if drug is different than LSD

22. LSD Chronic effects may involve flashbacks ◦ Sudden onset of abnormal perceptions ◦ Hallucinogen Persisting Perception Disorder  Visual images remain longer than in consciousness  Dr. Henry Abraham (Tufts University) blogblog

23. LSD Research US Food and Drug Administration allowed LSD research Recent study sponsored by Multidisciplinary Association for Psychedelic Studies, carried out by Swiss physician Peter Gasserstudy ◦ Information published 2014 ◦ 12 patients with terminal illness, end-of-life anxiety ◦ Took two doses of LSD with talk therapy, across eight weeks ◦ Those with larger dose reported improvement

24. Which Drugs are Most Dangerous? Largely depends on availability ◦ Most emergency department (ED) visits: alcohol (DAWN, 2011)DAWN, 2011 ◦ Half + of 2.5 million ED visits: illicit substances

25. Which Drugs are Most Dangerous? Cocaine – 505,224Combinations – 10,388 Marijuana – 455,668Inhalants – 10,032 Heroin – 258,482Unclassified hallucinogens – 8,043 Amphetamine/meth. – 159,840LSD – 4,819 PCP – 75,538GHB – 2,406 Synthetic cannabinoids – 28,531Ketamine – 1,550 MDMA – 22,498

26. MDMA 3,4-methylenedioxy-N-methylamphetamine How does Ecstasy prove to help people with PTSD? What exactly is Molly & why does it kill people? How do you overdose Ecstasy? Molly?

27. MDMA Molly, Ecstasy, Thizz Synthetic drug Stimulant and hallucinogenic properties

28. MDMA Acute effects on the brain ◦ Increased serotonin release ◦ Increased dopamine release ◦ Increased norepinephrine release ◦ Effects will vary since formula is not standardized or regulated ◦ Effects will vary based on the synthetic nature of substance ◦ MDMA-assisted therapy (Multidisciplinary Association for Psychedelic Studies, video; 0-2:00; 14 subjects, per website) MDMA-assisted therapy ◦ More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)YouTube

29. MDMA Chronic effects are controversial, per Carl Hart, Columbia University (YouTube)Carl Hart ◦ Well-circulated animal studies showing neuron damage

30. Emergency Department Visits

31. Synthetics are currently popular 2C-I, MDMA, bath salts, synthetic cannabis Lower price (think about economy’s influence) Drug popularity changes with time (synthetics were popular in 1970s) Health-related issues will subsequently ebb and flow as drugs move in and out of favor That acknowledged, some can be devastating: Krokodil (CBS, 2013)Krokodil

32. Which drugs are the most popular? (by country here) here

33. Mushrooms

34. mushrooms Psilocybin/psilocin are two active psyhoacticve substances found in “magic mushrooms” Couple dozen species Taken orally Recognized for centuries Probably used in religious rites Hallucinogen Schedule I

35. mushrooms Acute effects: ◦ Relaxation ◦ Altered perception of reality ◦ Altered perception of time ◦ Sense of connection to others/universe ◦ Visual hallucinations (images, color, light) ◦ Potential for anxiety and subsequent panic, heart rate & blood pressure increase Chronic effects: ◦ A “bad trip” may trigger fear ◦ Hallucinogens may exacerbate mental illness Being investigated as treatment for OCD, depression, smoking cessation ◦ Johns Hopkins Psilocybin Cancer Project (via YouTube, 0:30-4:03) Johns Hopkins Psilocybin Cancer Project

36. Dextroamphetamine (Adderall)

37. About Adderall Stimulant Works on dopamine and norepinephrine Used as prescription for ADHD, narcolepsy Some abuse Adderall for its performance-related effects 60 Minutes program, April 2010 Schedule II

38. Adderall Availability Readily available across U.S. $5-10 per pill

39. Adderall Prescriptions, by Year (U.S. Department of Justice)

40. Adderall Effects Increased alertness Euphoria Self-assuredness Increased heart rate, blood pressure Emotional changes Weight loss Stomach discomfort (nausea, cramps) Long-term effects are not yet known

41. Adderall Forms Tablet (5-30mg) Time release capsule (10-25mg)

42. Adderall Overdose According to Dailymed (National Library of Medicine), traditional symptoms can develop: anxiety, confusion, restlessness

43. 2C-I 4-iodo-2,5-dimethoxyphenethylamine

44. 2C-I “Smiles” Synthetic substance Usually inhaled or taken orally; may also be taken via blotter paper Stimulant & hallucinogenic properties Schedule I

45. 2C-I Impacts dopamine & serotonin Onset of effects may not be immediate, triggering overdose Little information on brain impact Additives, chemical changes make drug unpredictable, similar to bath salts

46. Methamphetamine

47. Methamphetamine Famous/notorious for laboratory production, short-term dopamine effects & long-term effects Stimulant (blood pressure, heart rate, alertness) DEA: Schedule II substance (Desoxyn: ADD, narcolepsy, weight control)

48. Methamphetamine acute effects  Intense high/euphoria ◦ May last up to 12 hours (longer than cocaine) ◦ Meth Inside and Out video describing effectseffects  Energetic, talkative, excitable  Insomnia  Increased heart rate, blood pressure  Sweating  Dry mouth  Jaw clenching  Nausea, vomiting  Comparison: meth vs cocaine,Brookhaven National Laboratory, 2008Brookhaven National Laboratory, 2008

49. Methamphetamine chronic effects Chronic users may experience hallucinations, rage, paranoia, heart “meth mouth;” damage to dopamine-, serotonin-containing nerve cellsmeth mouthdamage to dopamine ◦ Crank Bugs (Meth Project) Crank Bugs (Meth Project) ◦ Meth Mouth (Meth Project) Meth Mouth (Meth Project) ◦ Ashley’s Story (Meth Project) Ashley’s Story ◦ Research supports both brain damage as well as lack of brain damage

50. Methamphetamine Chronic Effects Before & After Photos

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

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

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

54. Heroin

55. 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 ◦ Drug Ads (wings.buffalo.edu) Drug Ads Schedule I