Uppers Downers & All Arounders

1. Uppers Downers & All Arounders Uppers/Stimulants Chapter 3

2. Uppers/Stimulants • In 1999 about • 1.7 million Americans used amphetamines for nonmedical reasons, • 4.2 million used cocaine, • 68 million smoked cigarettes, • 200 million drank coffee, tea, caffeinated soft drinks or an over-the-counter medication containing caffeine. (p. 83).

3. General Classification • Most people use stimulants in the form of: • Diet aids • Drugs to control hyperactivity • Coffee & Tea • Cigarettes • Caffeinated solf drinks • Stimulants are found in plants and in synthetic form

4. General Effects • Stimulants force the release of the energy chemicals (epinephrine and norepinephrine along with dopamine and serotonin) • Infuses the body with large amounts of extra energy before the body needs it • With heavy use the body’s energy supply is depleted leading to crash, withdrawal and depression • Crash and withdrawal occurs when energy supplies become depleted and body is left without reserves

5. General Effects • All Stimulants activate chemical and electrical activity in central nervous system • Increases • Heart rate • Blood pressure • Respiration • Effects include • Activeness • Restlessness • Medical uses include treatment of obesity, narcolepsy and Attention-deficit/hyperactivity Disorder

6. General Effects • Reward/reinforcement center is artificially over-stimulated • Rush of pleasure and strong sense of wellbeing • Often accompanied by no basic need for hunger, thirst or sex • Weight loss: stimulants fool the body into thinking it has satisfied hunger without eating • Cardiovascular side effects include constricted blood vessels, high blood pressure and sometimes arrhythmia • Chronic use weakens blood vessels and risk of stroke

7. General Effects • Emotional & mental effects: • Initial release causes increase of confidence and euphoria • As use continues feeling of euphoria turn to irritability, paranoia, aggressiveness, depression • Tolerance & Addiction liability • Increases as body loses its ability to synthesize drugs • Can also develop with methamphetamine congeners, caffeine, nicotine and other mild stimulants

8. COCAINE • Cocaine epidemics seem to occur every few generations • Hardcore use still strong in 2000’s • Cocaine is extracted from coca plant • 97% grown in South America • Colombian drug Cartels control cultivation and production • 2/3 of smuggling handled by drug artels in Mexico • U.S. consumes 70% of world’s cocaine trade

9. COCAINE: Routes of Administration • Chewing Leaf: Historically Native cultures • Drinking: Started in 1880’s in wine, coca cola, and patent medicine. Widely prescribed to womem • Injecting: Started after the invention of hypodermic needle in 1853 • Intravenous use takes 15-30 seconds • Subcutaneous/intramuscular takes 3-5 minutes • Snorting: Self-limiting method • The more snorted, the less absorption due to constriction of capillaries in the nose • Destructive to nasal passages

10. COCAINE: Routes of Administration • Mucosal & contact absorption • Can be absorbed through mucosal tissue in nose, mouth, rectum & vagina • Delivery method is also used for dental work, minor surgeries • Smoking: • First introduced in 1914, but high temperature was needed to keep cocaine cigarettes going • Mid-1970’s, cocaine hydrochloride was chemically altered into freebase • Fastest form to reach brain… Highly addictive

11. COCAINE: Physical and Mental Effects • Metabolism: Quickly metabolized and disappears faster than methamphetamine • Medical Use: Only naturally occurring local anesthetic • Used to numb nasal passages, eyes, throat, and chronic sores • Neurochemistry & Central Nervous System • Forces relase of norepinephrine, epinephrine and dopamine • Blocks re-absorption so more intense stimulation • Blocks 60-70% of dopamine reuptake • Too much dopamine can over stimulate brain’s fright center causing paranoia. • Excessive use causes insomnia, agitation and severe depression

12. COCAINE: Physical and Mental Effects • Sexual Effects: • At low doses cocaine increases desire for sex and delay ejaculation • As use continues sexual dysfunction occurs • Aggression, violence & cocaethylene • Increases aggression & violence by disrupting inhibitory and fright centers of the brain • Cocathylene (metabolite when cocaine & alcohol is combined) induces greater agitation, euphoria and violence • Can also induce cardiac conduction abnormalities

13. COCAINE: Physical and Mental Effects • Cardiovascular Effects • Can damage circulatory system • Raise blood pressure • Cause stroke (bursting of blood vessels in brain) • Cause heart damage • Neonatal Effects: • Transmitted within seconds to fetus • Increases chances for miscarriage, stroke, SIDS, respiratory ailments, mental delays & other abnormalities • Proper pre-natal and post natal treatment can hel cocaine babies

14. COCAINE: Physical and Mental Effects • Tolerance: To the euphoric effect can begin to develop after first injection or smoking session • Withdrawal, Craving & relapse: • Major effects include anhedonia, lack of energy and intense craving • Typical cycle of compulsive use: • Bingeing to crashing to detox to resolutions of abstinence or treatment and relapsing 2-4 weeks later.

15. COCAINE: Physical and Mental Effects • Overdose: • Can be caused by as little as 1/50 gram • Overwhelmingly intense stimulation • Injury to heart and blood vessels • More often not fatal…just feels that way • Severe reaction through in verse tolerance or kindling • Miscellaneous Effects: • Formication (itching from imaginary bugs) • Dental erosion • Seizures • Gastrointestinal complications • Cocaine Psychosis: • Paranoid psychosis/schizophrenia caused by excess dopamine • Can also activate genetic predisposition to schizophrenia

16. COCAINE: Other Problems with Use • Polydrug Use • Alcohol, valium, heroin to take the edge off • Adulteration & Contamination • Cocaine at street level is almost always cut • When injected, bacteria and viruses contaminate drugs and needles • Hepatitis C rate for IV drug users is between 50% and 90% • Compulsion • Use for euphoria, boredom, peer pressure, curiosity, self-medication, escape from personal problems

18. SMOKABLE COCAINE (CRACK & FREEBASE) • Pharmacology of smokable Cocaine • Began around 1981 • Crack epidemic in 1986 • Chemically crack is the same as freebase • Delivered to the brain faster • Ether converts cocaine to freebase • Baking soda converts cocaine to crack • Effects and Side Effects • More intense than snorting or injecting • Rush or euphoria last 5 – 20 minutes • Replaced by the feeling of irritability and other negative emotions • Always used in a binge pattern • Chronic use include paranoia, intense cravings, depression, cocaine psychosis, high-risk sexual activity

19. SMOKABLE COCAINE (CRACK & FREEBASE) • Respiratory Effects • Breathing problems • Severe fever • Chest pains • Coughs • Crack lung • Hemorrhage • Respiratory failure & death • Aggravated by cigarette smoking • Polydrug use • Increases the potential for abuse of depressants

20. SMOKABLE COCAINE (CRACK & FREEBASE) • Overdose • Mild-rapid heart beat • Hyperventilation • Fear of dying • Kills several thousand a year due to • Cardiac arrest • Seizure • Stroke • Respiratory failure • Severe hypothermia • Consequences of Crack use • Economic • Social: abuse, family, legal, formation of sex trade • Cocaine vs Amphetamines • Cocaine’s duration is 40 minutes/ Meth is 4-6 hours • Meth is cheaper

21. Amphetamines

22. Amphetamines • Classification: “Sympathomimetic agent” • Stimulate the release of sympathic neurotransmitters • Activates the sympathetic nervous system that controls the fight or flight response • Stimulates the reward/information center • Street names: crank, ice, shabu, glass, clear • History of Use • First synthesized in 1887 • Medically used in 1930s • Treats narcolepsy & depression • Used by students and truck drivers to stay awake • Widely used in pill form during WW II

23. Amphetamines • History of Use • Japanese epidemic continued after WW II • 1970 6-8% of American population used prescribed amphetamines for weight loss • Street speed chemists increased production of crank and crystal in late 1980s • Ice highly potent smokable form used in 1990’s and common use in Hawaii • Recent development of “ya ba” in Thailand

24. Amphetamines (Effects) • Routes of Administration • Snorting • Intravenous • Smoking • Oral • Neurochemistry • Like cocaine, amphetamines increase levels of catecholamines by stimulating their release and blocking reuptake • Unlike cocaine, amphetamines block metabolism • Long term use alters the ability to produce vital neurotransmitters causing depression and taking mor to stay normal

25. Amphetamines (Effects) • Physical Effects • Small to moderate doses cause • Increased heart rate • Raised body temperature • Rapid respiration • Higher blood pressure • Extra energy • Dilation of bronchial vessels • Appetite suppression • Meth users go on binges for 3, 4 or 10 days • Long term use can cause sleep deprivation • Heart & blood toxicity • Severe malnutrition • Bad or rotten teeth • Tolerance is more pronounced

26. Amphetamines (Effects) • Mental & Emotional Effects • Mild to intense euphoria / sense of wellbeing • Prolong use leads to • Irritability • Paranoia • Anxiety • Confusion • Poor judgement • Hallucinations • Delusions • Can result in violent, suicidal & homicidal thoughts • Antisocial behaviors

27. Amphetamines (Effects) • With abstinence, disturbed mental states such as amphetamine psychosis or depression can stop for some people • Amphetamines release neurotransmitter that mimics sexual gratification • Effects of Ice is greater on the brain than the respiratory and pulmonary system • Results in more overdoses • Greater mental side effects • Longer detoxification

29. Amphetamine Congeners/Lookalikes • Methylphenidate (Ritalin) • Most widely used • Prescribed as mood elevator, narcolepsy and to treat Attention-deficit/hyperactivity disorder • Diet Pills • Only recommended for short-term use • Careful monitoring by physician • Long-term use associated with abuse • Lookalikes • Prescription drugs that contain ephedrine and pseudoephedrine (anti-asthmatics) • Decongestants • Caffeine • Ephedra & ephedrine

30. Miscellaneous Plant Stimulants • Khat & methcathione • Used in Arab and African countries • Produces amphetamine like highs • Insomnia, anorexia • Chronic abuse cause exhaustion, violence & depression • Methcathione: AKA ephedrone is synthesized in illegal labs in U.S. • Sold as a powerful alternative to methamphetamine

31. Miscellaneous Plant Stimulants • Betel Nuts (seed of betel palm) • Used by 200 million people in Arab world, India and Asia • Effects similar to nicotine • High doses can be toxic and produce psychological dependence • Yohimbine • Spicy extract from African yohimbe tree • Used in tea • Medicine • Aphodisiac • Produces mild euphoria and occassional hallucinations

32. Miscellaneous Plant Stimulants • Ephedra • Ephedra bush • Mild stimulant used as medicine, tea & tonic • Also used by athletes for energy boost • Banned in U.S. because of overdoses • This drug and synthetic version is main ingredients in methamphetamine & methcathione • Herbal Ecstasy and Herbal Nexus are two herbal products marketed as stimulants and as buffers for illegal drugs • Contains herbal forms of ephdrine, caffeine, herbs and vitamines

33. Miscellaneous Plant Stimulants • Caffeine • Most popular stimulant in the world • Found in teas, coffee, soft drinks, chocolate & hundreds of medications • History • Tea: drunk in China as early as 2700 B.C. • Introduced to Europe in 16th Century • Coffee: Cultivated in Ethiopia A.D. 650 and spread to Arabia then Europe • Classified as a drug and banned in many cultures • Cocoa: Mayan and Aztec royalty • Only small amount of caffeine in cocoa

34. Miscellaneous Plant Stimulants • Pharmacology • Classified as an akaloid of the chemical class called xanthines • Found in more than 60 plants • Takes 15-35 hours for 95% of the caffeine to be excrete by the body • Physical and Mental Effects • Mild stimulant • 5-7 cups of coffee can cause anxiety, insomnia, nervousness • Higher doses can cause muscle twitching, increased heart rate, palpatations • Letal at about 10 grams (100 cups of coffee)

35. Miscellaneous Plant Stimulants • Tolerance, withdrawal & addiction • Dosages vary depending on person • Symptom includes throbbing headache • Dependence can occur with 5 cups of coffee 10 cola drinks or 8 cups of tea • Nicotine • Cigarettes account for 90% of all tobacco use in U.S. • Discover in American and spread to Europe • Smokeless tobacco: moist snuff, powder snuff & loose-leaf • Absorbed by mucosal in the mouth and nise

37. Nicotine/Tobacco • Pharmacology • Nicotine is the most important ingredient • Average cigarette contains 10 mg of nicotine • Central Nervous system stimulant that disrupts the balance of neurotransmitters • Dopamine • Endorphins • epinephrine, • Acetylcholine • Constricts blood vessels • Raises heart rate • Depresses appetite • Produces mild euphoria • Deadens senses

38. Nicotine/Tobacco • Two most important reasons people smoke tobacco is: • Weight loss • Craving • One must keep a certain level in blood stream to avoid withdrawal • Tolerance develops quickly • Withdrawal causes: • Headaches • Nervousness • Fatigue • Severe irritability • Intense craving • Poor concentration • Sense of relaxation from smoking a cigarette is actually a withdrawal symptom being subdued

39. Nicotine/Tobacco • Addiction • Tobacco is pure example of addiction process • 80% want to quit & 10% want to cut down • May have a genetic predisposition to nicotine addiction • Side Effects • Tobacco & smoke contain more than 4,000 other chemicals of which 400 are classified as toxic • 43 are known as carcinogens

40. Nicotine/Tobacco • 1997: 3.5 million premature deaths • In U.S. 392,000 die prematurely • 50,000 die of second hand smoke • Cardiovascular & Respiratory effects: • Plaque formation • Hardening of the arteries • Leading cause of heart attacks • Lung cancer • Men who smoke are 22 x’s more chance of cancer • Women 12 x’s more chance of cancer