Drug abuse & addiction

1. Páleníček,2002 Drug abuse & addiction T. Páleníček Psychiatrické centrum Praha 3. Lékařská fakulta Univerzity Karlovy

2. Páleníček,2002 History • „Primitive cultures“ – Egypt, indians, chinese ….. • Medical indications, raw material, shamanic use • Old continent – canabis, opiats, mushrooms, • New continent – mushrooms, coca, peyotl, ayahuasca

3. Páleníček,2002 Today • Illicit substances (most of them) in most countries arround the world • Many new drugs – chemistry • Purity • Lost of the traditional consequences of use – misuse • New ways of application

4. Páleníček,2002 Definitions • Affects the perception of the reality – psychotropic effect & addictive Potential (Presl) • Any substance, that if gets into the organism, affects one or more of its function (pharmacological def.) • Drug (substance) abuse – psychological or physical state of servility vis-a-vis the drug

5. Páleníček,2002 Terms • Use • Abuse • Tolerance • Dependence - physical & psychic • Whitdrawal syndrom

6. Addiction • First experience • Recreational use • Abuse • Dependece • Based on the reward • – drug seeking – aplication of the drug – effect(reward) – reinforcing effect – • Neurobiological substrate – DA system (NAC) Páleníček,2002

7. General risks of drug use • Toxic effects • Form of application – i.v. - infections • Loss of control – addiction • Social consequences - loss of work, living place, friends • Changes in mood, personality Páleníček,2002

8. Páleníček,2002 Classification • Natural versus synthetic • Through the effect • Sedatives, tranqulisers, hypnotics • Stimulants • Halucinogens • Entactogens • Inhallants • Legal versus illegal

9. Páleníček,2002 Opiats • Morfin, heroin, kodein, buprenorfin … • Acts through own receptors (µ, κ, σ) • Analgesic effect, euphoria, sedation • Vagotonic effect • Supression of breathing • High addictive potential – physical and psychological • Tolerance – overdose

10. Páleníček,2002 Opiats

11. Páleníček,2002 Other sedatives, tranqulisers, hypnotics • Benzodiazepines • Barbiturates • Toluen • Alcohol High addictive potential, physical dependence (often mixed with others), live threatening withdrawal

12. Páleníček,2002 Stimulants • Kokain, crack • inhibitor of DA and NA reuptake • euphoria, state of high, increased speach, feeling „ I am the best“ • increased locomotion • elevates heart rate, blood presure • snorted, smoked, injected, on genitals • psychological dependece • heart attack, stroke

13. Páleníček,2002 Stimulants • Amphetamine, methamphetamine (speed, ice, meth) • Release of DA • Speed feeling, insomnia, anorexia, increased speach, stereotyped behaviour • Increased heart rate, blood presure • Snorted, injected, smoked, per os • Psychological dependence • Heart attack, stroke, toxic hepatitis, neurotoxic, toxic psychosis

14. Páleníček,2002 Halucinogens • Natural – (cannabis), psylocin, mezcal, ayahuasca, ibogain, muscarin • Synthetic – LSD, DOB, DOM (STP), TMA, DMT, Ketamine (Special K), PCP (Angel dust) • Most affect 5-HT system - 5HT2a receptors • Cannabis – CB1 & CB2 receptors • Ketamine, PCP – NMDA antagonists

15. Páleníček,2002 Halucinogens • Halucinations - tripping • Most are not addictive • Bad trip, flashbacks, risk of injury, psychosis • LSD (acid, trip) – trips, crystal, liquid • DOM, DOB – trips, pills • Ketamine, PCP – white powder

16. Páleníček,2002 Cannabis • Marijuana, hashish… • many states of being, often upside-down – stimulation, sedation, anxiosity, anxiolytic effect, laugh, halucinations, euforia, taste to eat • anxiety disorders, memory deficits, insulted spermatogenesis • a lot of terapeutical indications (CB – recptor agonists, antagonists, natural medicine)

17. Páleníček,2002 Entactogens • MDMA, MDEA, MDA • PMA, PMMA, 4-MTA, 2C-B, 2C-T-7, MBDB Entactogen = „the touch within“ producing state of well being, empathy, belonging to others, feeling of love, peace

18. Páleníček,2002 Ecstasy E, madam, eve, pill, xtc… • Ecstasy - MDMA (MDA, MDEA) • Ecstasy - tablet (capsule)

19. Páleníček,2002 Use of MDMA • Young people (15 – 30 yrs) • All social groups • Connection with parties • polydrug users • „recreational users“ • Per os, snorted

20. Páleníček, 2002 effects • Metabolised by (CYP2D6) (cytochrom P450) • 5-9% white population is defficient • Poor metabolisers • Increased risk of acute toxicity • Drug-drug interactions (virostatics - ritonavir) • Acute effects – release of 5-HT and DA • Chronic effects – toxic effects

21. Páleníček,2002 effects • Chronic: neurotoxicity - cognitive defficit, sleep disorders, parkinsonism???, toxic hepatitis, teratogenic, imune dysfunction, flashbacks, psychosis • Risks: serotonin syndrom, stroke, rhabdomyolysis, acute liver failure • Neurotoxicity: selective degeneration of 5-HT and DA axons

22. Treatment of addiction • Motivation • Decission to stop • First contact with proffesionals (K-centre, hospital …) • Again motivation and testing the decision to stop • Detoxification • Therapy – ambulant, in hospital, in community • Susequent care – getting back to society • Relaps Páleníček,2002

23. Prevence • Primární – vzdělávání cílové populace • Sekundární – práce s vyléčenými (abstinujícími) závislými • Terciární – minimalizace rizik (harm reduction, substituční léčba, testování drog) Páleníček,2002

24. Děkuji vám za pozornost Páleníček,2002

25. 5-HT vlákna vycházejí zejména z mediálních a dorsálních rapheálních jader a projikují se do řady podkorových i korových oblastí mozku • rapheální jádra • neocortex • caudatum, putamen • thalamus • hypothalamus • amygdala, hipocampus • substantia nigra • neurovaskulární orgány komor • mozeček • mícha (upraveno podle Manter and Gatz´s essentials of clinical Neuroanathomy and Neurofysiology, 1992) Serotonergní dráhy Páleníček,2002