1. Classes/Types of Depressants b b 1. Anesthetics b b 2. Barbiturates b b 3. Benzodiazepines (anxiolytics - _____ ) b b Many labels have been used to describe them, which can be confusing: -tranquilizers-anti-anxiety pills -sleeping pills -sedatives

2. Depressants b Mechanism of action: GABA: acts mainly on inhibitory receptorsGABA: acts mainly on inhibitory receptors –taking off the brakes – e.g. GHB (gamma hydroxy butyrate) Separate receptors identified for barbiturates and benzosSeparate receptors identified for barbiturates and benzos

3. Etherdome

4. History / Development of Depressants b b Nitrous oxide (1776) (laughing gas) development of ether, (MGH-etherdome) a flammable liquid which vaporizes at room temperature b b Chloral hydrate, bromides, paraldehyde b b Barbiturates came next in 1860s ___________________________

5. Barbiturates b USES: some used as anesthetics if they work quickly and then wear offsome used as anesthetics if they work quickly and then wear off others used to prevent seizures because their sedating effects lasted longerothers used to prevent seizures because their sedating effects lasted longer often used as sleeping pills and anxiolyticsoften used as sleeping pills and anxiolytics

6. Barbiturate Use 2002-2003 Total12-1718-2526+ 20021.4%.1%.4%1.8% 20031.4%.2%.3%1.7% For example, Nembutal®, Pentobarbital, Seconal®, Secobarbital, or Butalbital. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health.

7. BARBITURATE USE declined due to their unwanted effects: - ____________________________ ____________________________ withdrawal SX similar to alcohol: ____________________________

8. Quaaludes (Methaqualone) came next in the 50s and 60s and were developed as alternatives to barbs for sleep/anxiety disorders   they became a street drug;   now a schedule I drug   no longer produced for medical reasons

9. Depressants (con’t) b b Benzodiazepines classic anti-anxiety drugs synthesized initially in 1950s more potent in 1960s with the advent of ______________________ similar to barbs but less dangerous in that: – – ____________________________________ _____________________________________

10. Depressants b b Benzodiazepines Withdrawal symptoms: increased anxiety, insomnia, tremors, sweating Dangers: ___________________ ___________________ b b what are the clinical implications of treating anxiety with drugs? b b difficult to estimate non-medical misuse or abuse of sedatives and tranquilizers

11. Benzodiazepine Misuse? Total12-1718-2526+ 2006 __% __% % % % 2007 % % % Includes Klonopin® or clonazepam, Xanax®, or alprazolam, Ativan®, or lorazepam, Valium® or diazepam, Librium®, Limbitrol®, Rohypnol®, Serax®, and Tranxene®. Patterns in Non-medical Use of Specific RX Drugs http://www.oas.samhsa.gov/prescription/Ch3.htm#3.2.2

12. The case of Rohypnol (flunitrazepam) b b a.k.a. roofies, rib, circles, wolfies, rope, ropies, ruffies, roach-2, “roaches” after drug company Hoffman-La Roche a Benzodiazepine used in the short-term treatment of insomnia and as a pre- anesthetic medication similar to valium in effect but 10 times stronger effects begin within 30 minutes, may last for 8 hours or more

13. Rohypnol made in Europe and Latin America and sold by prescription there, not in U.S. so it is usually smuggled via mail into country, or comes across Mexican border b b distribution and abuse especially in southwest & south b b low cost < $5 per tab b b popularity among young people; “Said to be south Florida’s fastest growing drug problem”

14. Rohypnol b b 2 COMMON MISPERCEPTIONS: ________________________________

15. Adverse Effects of Rohypnol b b memory impairment, drowsiness, dizziness, confusion; can induce excitability or aggressiveness in some users b b can cause dependence: tolerance may develop; withdrawal symptoms include - headaches, anxiety, muscle pain, confusion, restlessness, numbness, tingling of extremities, convulsions and cardiac problems

16. Rohypnol b b used in date rape situations….WHY? ___________________________________ __________________________________ b b used to augment an alcohol high without elevating BAL b b used as a “parachute” or remedy for depression that follows a stimulant high

17. Inhalants b USES: varied as products “huffed” include gasoline, glues, solvents, paint.. b Mostly young kids, adolescents b highly destructive to brain with OD potential