Individual Drug Info

1. Individual Drug Info Winter 2015

2. Similar Properties Across Drugs • Withdrawal (physical dependence) • Psychological dependence • Student Question: Which drug is the most addictive? • Depends on who you ask • Depends on the individual and that person’s reasons for taking the drug • Depends on what substance(s) is/are readily available • Tolerance

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

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

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 (2/26/15), source: procon.org)

7. Recreational Cannabis • Washington (2013) • Colorado (2013) • Washington, DC (2014) • Oregon (2014) • Alaska (2014) • Student Question: If weed can be used for medical purposes, then why is it illegal in different states? • Good question • Long-standing influences from culture, government

8. Cannabis Acute effects • THC acts on cannabinoid receptors, increases dopamine, serotonin • Increases appetite • ASAP Science: Your Brain on Marijuana (via YouTube) • Student Question: Are blunts much worse for health than bongs, joints, and other forms of smoking? • Possibly (more smoke since more product; depends on inhalation, frequency, amount of time passing when one smokes • Student Question: Are wraps like Swisher Sweets or White Owls bad for health? • Some wraps are made with tobacco • Overdose generally doesn’t occur • Large amount required • Smoking a lot may induce sleepiness • Eating too much may trigger nausea, vomiting • Q13 News story, Michigan • 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) • 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 anxiety • Marijuana, conversely, may help those with Post-Traumatic Stress Disorder • Memory inhibition • CBSNews June 2014 (3:58)

11. Student Question: What are the negative side effects of smoking weed other than it being bad for your lungs? Chronic effects • Respiratory distress • Mood swings • Impaired memory (potential hippocampus damage) • Earlier research • 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. <www.sciencedaily.com/releases/2011/06/110606131705.htm>.

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

14. 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.”

15. LSD • Schedule I hallucinogen synthesized in 1930s • Manufacturing secretive: Nick Sand (National Geographic, 3:39) • “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)

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

17. 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) • Overdose thought to be rare, but some individuals may not respond well, or may experience problems if drug is different than LSD

18. 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) blog

19. 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 Gasser • 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

20. Mushrooms

21. Mushrooms • Psilocybin/psilocin are two active psyhoacticve substances found in “magic mushrooms” Most from psilocybe genus, couple dozen species • Taken orally • Recognized for centuries Probably used in religious rites • Hallucinogen • Schedule I

22. Mushrooms • Dose • Varies • Fresh vs dried • User • Trip desired • ~1 mushroom or less for new user

23. 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

24. Mushrooms • Student Question: How do they interact with antidepressants? • According to 2006 publication of Australian Pharmacist: • Information on LSD only (hallucinogens impact serotonin) • Taking anti-depressants may increase or decrease hallucinogen’s effects • Avoid stopping SSRI medications • Flu-like symptoms • Headache • Mood changes • Irony? Treatment investigations: OCD, depression, smoking cessation • In depression, psilocybin may “turn off” parts of the brain that are overactive among individuals who are depressed (Discovery, 1/2012) • Johns Hopkins Psilocybin Cancer Project (via YouTube, 0:30-4:03)

25. Student Question: Which Drugs are Most Dangerous? • Largely depends on availability • Carl Hart, Columbia University, on drug abuse (0-2:40) • Most emergency department (ED) visits: alcohol (DAWN, 2011) • Half + of 2.5 million ED visits: illicit substances

26. Student Question: Is Heroin or Meth More Addictive? • Depends on availability, mode, reasons for use • 2008 study by Hser et. Al.: • Researchers examined data from five studies • Assessed 10-year drug behaviors among 629 heroin users, 694 cocaine users, 474 meth users • Heroin users: used 13-18 days per month • Cocaine: used 8-11 days per month • Meth: 12 days per month • Groups – “consistently high use,”“increasing use,”“decreasing use,”“moderate use,”“low use” • Heroin over-represented in “consistently high use,” under-represented in “low use” • 2011 study by Novak et. Al. – injection users were more likely to abuse and become dependent

27. Student Questions • “Why do we focus more on jailing addicts than recovery options? What helps people quit these substances? Are there any positive uses that have been proven and could be used under a doctor’s watch?” • History, government, culture • Cocaine, opium available in 1800s, early 1900s • Harrison Act in early 1900s regulated these substances – taxing • Those who did not pay the tax were in legal trouble (tax evasion) • Alcohol prohibited (prohibition later appealed) • Heroin Act, Narcotic Drug Import & Export Act • 1970 Drug Abuse Prevention & Control Act • NIDA Principles of Effective Treatment

28. Student Question (continued) • WHO ATLAS on Substance Abuse (2010) • Alcohol main problem • Other drug issue is cocaine • 39 deaths per 100,000 (35 due to alcohol) • Not enough government resources • Africa – out of pocket treatment costs • Beds: 1.7 per 100,000 • Many other issues

29. 4-iodo-2,5-dimethoxyphenethylamine 2C-I

30. 2C-I • “Smiles” • Synthetic substance • Usually inhaled or taken orally; may also be taken via blotter paper • Stimulant & hallucinogenic properties • Schedule I

31. 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 • CNN 2014 report about 2C-I deaths in North Dakota • Synthetics often a problem • Who can you trust? • Illegality = no regulation

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

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

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

35. 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 – London Real (34:00+ = trip described) Source: Arch Gen Pesychiatry. 1994 Feb;51(2):98-108.

36. How does Ecstasy prove to help people with PTSD? What exactly is Molly & why does it kill people? How do you overdose Ecstasy? Molly? MDMA3,4-methylenedioxy-N-methylamphetamine

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

38. 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) • More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)

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

40. Emergency Department Visits

41. Synthetics are currently popular • MDMA, bath salts, 2C-I, 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)

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

43. Dextroamphetamine (Adderall)

44. 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

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

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

47. 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

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

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

50. Methamphetamine