1. 藥物濫用 Tobacco, Hallucinogens and marijuana 賴滄海 教授 12-01-2008

2. Learning Objectives History of Tobacco use History of Tobacco use (Nicotiana tabacum) (Nicotiana tabacum) Statistics of Tobacco use and regulations Statistics of Tobacco use and regulations Pharmacological effects of nicotine Pharmacological effects of nicotine Disease states caused by cigarettes smoking Disease states caused by cigarettes smoking Strategies that aid in smoking cessation Strategies that aid in smoking cessation

3. Nicotiana tabacum 菸草

4. Spittoons 芝加哥法庭場面, 中間 1910s 。1910s spittoon 被看見在地板在底層右邊。

6. Government Regulation of Tobacco Use in the USA 1964 Report of the Advisory Committee to the Surgeon 1964 Report of the Advisory Committee to the Surgeon General General 1965 Required warning label on all cigarettes ” Caution: 1965 Required warning label on all cigarettes ” Caution: Cigarette smoking may be hazardous to your health.” Cigarette smoking may be hazardous to your health.” 1967 FTC rules that “Fairness Doctrine” applies to 1967 FTC rules that “Fairness Doctrine” applies to cigarette advertising. cigarette advertising. 1967 National Association of Broadcasters endoses 1967 National Association of Broadcasters endoses phasing out cigarette ads on TV and radio phasing out cigarette ads on TV and radio 1971 Cigarette advertising ends on TV and radio 1971 Cigarette advertising ends on TV and radio 1973 CAB requires “no smoking” section on all commercial 1973 CAB requires “no smoking” section on all commercial airline flights airline flights

7. 1975 Cigarettes are discontinued in rations to soldiers. 1975 Cigarettes are discontinued in rations to soldiers. 1979 Twin city ban the distribution of free cigarette samples 1979 Twin city ban the distribution of free cigarette samples 1988 No Smoking on domestic airline flights scheduled for 2 1988 No Smoking on domestic airline flights scheduled for 2 hours or less. hours or less. 1993 Postal service eliminates smoking in all of its facilities. 1993 Postal service eliminates smoking in all of its facilities. 1994 Mississippi sue the tobacco in dustry to recover 1994 Mississippi sue the tobacco in dustry to recover Medicaid cost for tobacco related illnesses. Medicaid cost for tobacco related illnesses. 1998 California ban Smoking in bars 1998 California ban Smoking in bars 1999 Texas settles its Medicaid lawsuit for more than 14 1999 Texas settles its Medicaid lawsuit for more than 14 billion billion Master Settlement (46 states and 5 territories) sign a 206 Master Settlement (46 states and 5 territories) sign a 206 billion agreement to settle Medicaid lawsuits billion agreement to settle Medicaid lawsuits

8. Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health Nov.1 1970

11. 吸煙之危害 全世界人口每 10 秒鐘就有一人死於吸菸 全世界人口每 10 秒鐘就有一人死於吸菸 台灣每年有超過 18000 人因吸煙引發相 關疾病死亡 台灣每年有超過 18000 人因吸煙引發相 關疾病死亡 台灣每年因吸煙相關疾病之醫療花費超 過新台幣 300 億元 台灣每年因吸煙相關疾病之醫療花費超 過新台幣 300 億元 所耗費的整體經濟損失超過新台幣 500 億元 所耗費的整體經濟損失超過新台幣 500 億元

16. 菸害防制法 中華民國八十六年十月十六日衛署保字第 86062999 號 第八條第二項 第八條第二項 明定菸品之尼古丁（ Nicotine ）及焦油 (Tar ） 明定菸品之尼古丁（ Nicotine ）及焦油 (Tar ） 不得超過最高容許含量。 不得超過最高容許含量。 公告之最高許可含量 公告之最高許可含量 2001 年 尼古丁 1.5mg/ 支 焦油 15mg/ 支 2001 年 尼古丁 1.5mg/ 支 焦油 15mg/ 支 2007 年 尼古丁 1.2mg/ 支 焦油 12mg/ 支 2007 年 尼古丁 1.2mg/ 支 焦油 12mg/ 支

21. 95 年進口菸生產國家別數量表 單位：紙菸 / 千支

23. Pharmacology of Nicotine Administration (Smoking, chewing,Snuff dipping) Administration (Smoking, chewing,Snuff dipping) Effect on the CNS Effect on the CNS release of dopamine in the reward pathways release of dopamine in the reward pathways Other effects Other effects Increase the respiration rate Increase the respiration rate Stimulate the Cardiovascular system Stimulate the Cardiovascular system ( increase blood flow, heart rate, blood pressure) ( increase blood flow, heart rate, blood pressure) Inhibite hunger contractions in the stomach, deaden the taste buds Inhibite hunger contractions in the stomach, deaden the taste buds Insecticide Insecticide

24. Nicotine poisoning Nicotine poisoning sweating, vomiting, mental confusion, diarrhea, breathing difficulty (fatal dose 60mg) sweating, vomiting, mental confusion, diarrhea, breathing difficulty (fatal dose 60mg)

25. Disease states caused by cigarette smoking Mortality rates Mortality rates Chronic illnesses Chronic illnesses Cardiovascular disease Cardiovascular disease Cancer Cancer Bronchopulmonary disease Bronchopulmonary disease Effects on the fetus Effects on the fetus

26. 資料來源： 2008 年 5 月 1 日 自由時報

27. Reasons For Smoking 1. It is relaxing 2. Decreases tension, anxiety and anger 3. Satisfies the craving 4. It is a habit 5. Stimulation 6. To lose weight 7. Parents/ Sibling smoke 8. Close friends smokes

28. Alternative activities for Successful Quitting 1. Nibble on fruit. Celery or carrots 2. Chew gum 3. Use smoking cessation aids 4. Exercise 5. Stay in non-smoking places as much time as possible 6. Associate with nonsmokers for long periods of time

29. Smoking Cessation Aids Nicotine gum Nicotine gum Nicotine patches Nicotine patches Nicotine nasal spray Nicotine nasal spray Nicotine inhalers Nicotine inhalers Bupropion Bupropion

30. Learning Objectives--Hallucinogens How hallucinogens alter the senses How hallucinogens alter the senses Describe the major types of hallucinogens Describe the major types of hallucinogens Describe the effects that environment and personality have on the individuals response to hallucinogens Describe the effects that environment and personality have on the individuals response to hallucinogens Describe the effects of halllucinogens Describe the effects of halllucinogens

31. Sensory and Psychological effects Altered senses (Synesthesia) Altered senses (Synesthesia) Loss of control Loss of control Self-reflection Self-reflection Loss of identity and cosmic merging Loss of identity and cosmic merging

32. Mechanism of action Serotonin Serotonin norepinephrine, dopamine, acetylcholine and others norepinephrine, dopamine, acetylcholine and others

33. Synesthesia a subjective sensation or image of a sense other than the one being stimulated, such as an auditory sensation caused by a visual stimulus a subjective sensation or image of a sense other than the one being stimulated, such as an auditory sensation caused by a visual stimulusFlashbacks Recurrences of earlier drug-induced sensory experiences in the absence of the drug Recurrences of earlier drug-induced sensory experiences in the absence of the drug

34. Hallucinogens (Psychedelics) LSD (Lysergic Acid Diethylamide) LSD (Lysergic Acid Diethylamide) Mescaline （ Peyote ） Mescaline （ Peyote ） Psilocybin Psilocybin Tryptamines Tryptamines Dimethyltryptamine (DMT) Dimethyltryptamine (DMT) Foxy(5-methoxy-N,N- diisopropyltryptamine) Foxy(5-methoxy-N,N- diisopropyltryptamine) Nutmeg Nutmeg

35. Physiological Effects of LSD Concentrated in the Hypothalamus, the limbic system, the auditory and visual reflex area. Concentrated in the Hypothalamus, the limbic system, the auditory and visual reflex area. Activates the sympathetic nervous system.( Increase body temperature, heart rate, blood pressure, sweats, dilated pupils). Activates the sympathetic nervous system.( Increase body temperature, heart rate, blood pressure, sweats, dilated pupils). Affect the parasympathetic nervous system (salivation and nausea). Affect the parasympathetic nervous system (salivation and nausea).

36. Tolerance to LSD developed very quickly due to changes in sensitivity of target cells Tolerance to LSD developed very quickly due to changes in sensitivity of target cells No withdrawal symptoms after stop use No withdrawal symptoms after stop use Had no effect on creativity Had no effect on creativity

37. Adverse Psychedelic Effects of LSD-”Freak out” Intense nightmarish experience Intense nightmarish experience Complete loss of emotional control Complete loss of emotional control Paranoid delusion Paranoid delusion Hallucinations, panic attacks Hallucinations, panic attacks Psychosis Psychosis No carcinogenic or mutagenic effects in human No carcinogenic or mutagenic effects in human

38. Non psychotic adverse reaction of LSD Tension anxiety Tension anxiety Fear Fear Depression Depression Despair Despair Altered perception Altered perception

39. Nutmeg--( 肉豆蔻 )

40. Phenethylamines Dimethoxy methylamphetamine ( DOM,STP ） MDA （ methylenedioxy amphetamine ） MDA （ methylenedioxy amphetamine ） MDMA MDMA （ methylenedioxy methamphetamine, Ecstasy, 搖頭丸） Ecstasy, 搖頭丸）

41. entactogens drugs that enhance the sensation and pleasure of touching drugs that enhance the sensation and pleasure of touching

42. Anticholinergic Hallucinogens Atropa belladonna 顛茄 Atropa belladonna 顛茄 The deadly nightshade plant ( Atropine) The deadly nightshade plant ( Atropine) Mandragora officinarum 毒参茄 Mandragora officinarum 毒参茄 The mandrake （ hyocyamine, scopolamine, atropine and mandragorine ） The mandrake （ hyocyamine, scopolamine, atropine and mandragorine ） “And Shrieks like mandrakes torn out of the earth, that living mortals hearning them run mad.” Romeo and Juliet “And Shrieks like mandrakes torn out of the earth, that living mortals hearning them run mad.” Romeo and Juliet Hyoscyamus niger 茛菪（ ㄍㄣˋ ㄉㄤˋ ） Henbane （ hyocyamine and scopolamine ） Hyoscyamus niger 茛菪（ ㄍㄣˋ ㄉㄤˋ ） Henbane （ hyocyamine and scopolamine ） Datura stramonium 曼陀羅 Datura stramonium 曼陀羅 Jimson weed （ scopolamine ） Jimson weed （ scopolamine ）

43. Atropa belladonna -- 顛茄 The deadly nightshade plant

44. Mandragora officinarum- 毒参茄 The mandrake

45. Hyocyamus niger 茛菪 （ ㄍㄣˋ ㄉㄤˋ ） Henbane Hyocyamus niger 茛菪 （ ㄍㄣˋ ㄉㄤˋ ） Henbane

46. Datura stramonium – 曼陀羅 Jimson weed

47. Other Hallucinogens PCP （ Angel dust ） PCP （ Angel dust ） Ketamine Ketamine Dextromethophan Dextromethophan Marijuana Marijuana Salvia divinorum Salvia divinorum

48. Salvia divinorum

49. Marijuana Learning objectives Statistics of Marijuana use Statistics of Marijuana use Effects of Marijuana use Effects of Marijuana use Medical use of Marijuana Medical use of Marijuana

50. Contradictory views Assassin of youth (USA) Assassin of youth (USA) Holy Plant (Jamaica) Holy Plant (Jamaica)

52. Major factors Affecting Marijuana Use 1. Perceived risk 2. Parental role model 3. Mass media 4. availability

53. Major Factors Affecting Marijuana Use 5. Peers 6. Structural factors-Ages gender 7. Social factors 8. Settings 9. Attitudinal factors

54. Effects of marijuana use The High Subjective Euphoric Effects Driving performance Critical thinking skills Amotivational Syndrome

55. Medical use of marijuana Reduction in intraocular （ eye ） pressure Anti asthmatic Muscle relaxant Anti depressant Analgesic Appetite stimulant

56. Physiological effects of Marijuana use Damage to the lung Damage to the lung CNS （ Altered perceptions ） CNS （ Altered perceptions ） Respiratory System Respiratory System laryngitis, pharyngitis, bronchitis asthma-like conditions, cough, hoarseness,dry mouth laryngitis, pharyngitis, bronchitis asthma-like conditions, cough, hoarseness,dry mouth

57. Physiological effects of Marijuana use Cardiovascular System Cardiovascular System vasodilation vasodilation binding to hemoglobin binding to hemoglobin Reproduction decreased amount of testosterone Reproduction decreased amount of testosterone decreased number of sperm decreased number of sperm blocks ovulation blocks ovulation

58. Inhalants Types of Inhalants Types of Inhalants Gasoline, freon, butane, propane, aerosol Gasoline, freon, butane, propane, aerosol toluene, Nitrous oxide, nitrites toluene, Nitrous oxide, nitrites

59. Danger of Inhalant Abuse 1. Direct physical damage to the heart, lung, liver and the brain 2. Choking on vomitus, asphyxiation, suffocation 3. Falls or accidents involving impaired driving under the influence of inhalants