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Pharmacology Update 2008

Pharmacology Update 2008. Kevin Scheel MS, MAC, LADC. Kevin Scheel Director of Educational Services, Distance Learning Center for Addiction Studies http://www.DLCAS.com kscheel@dlcllc.org 866 431-4240. Pharmacology.

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Pharmacology Update 2008

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  1. Pharmacology Update 2008 Kevin Scheel MS, MAC, LADC

  2. Kevin Scheel Director of Educational Services, Distance Learning Center for Addiction Studies • http://www.DLCAS.com • kscheel@dlcllc.org • 866 431-4240

  3. Pharmacology The broad science concerned with drugs, their sources, their physical and chemical properties, their actions in the body, and their use in the treatment of disease.

  4. Pharmacotherapeutics • The study of the use of drugs in the treatment of disease.

  5. Agonists • These drugs can be substituted for the drug of abuse to provide a more controllable form of addiction. The properties and actions of these drugs are similar to those of particular abused drugs.

  6. Antagonists • These drugs occupy the same receptor sites in the brain as specific drugs of abuse. However, they do not produce the same effects as the abused drugs, and they are non‑addicting.

  7. Tolerance • Reduction in the effects of a drug with repeated use. This often leads the user to increase the dose if possible in order to regain the original effects.

  8. The Most Dangerous Drug • Instructions: Following will be an alphabetical listing of various drugs of abuse. For the next 5 minutes, please think about each drug and it's "dangerous" potential. Then do the following:

  9. First, list what criteria you use to determine a drugs dangerousness • Next, rank the drugs from the most dangerous (1) to the least dangerous(10)

  10. Alcohol Cocaine Ecstasy Inhalants LSD Marijuana Methamphetamine Oxycontin Salvia Xanax

  11. THE FOLLOWING VARIABLES EFFECT THE ONSET AND CONTINUATION OF DRUG ABUSE AND ADDICTION

  12. The User • Heredity • Innate Tolerance • genetically determined sensitivity (or lack of sensitivity) to a drug that is observed on first exposure before there is any experience with the drug.

  13. Speed of developing Acquired Tolerance • Pharmacokinetic (homeostasis) • Pharmacodynamic (neurochemical) • Behavioral • Cross-tolerance

  14. Likelihood of experiencing Intoxication as Pleasure • Psychiatric Symptoms • Prior Experiences/Expectations • Propensity for Risk Taking Behavior

  15. The Environment • Social Setting • Community Attitudes • Peer Influence; Role Models • Availability (or Lack) of other Reinforcers (sources of pleasure or recreation)

  16. Employment or Educational Opportunities • Conditioned Stimuli: Environmental cues become associated with drugs after repeated use in the same environment

  17. The Psychoactive Substance • Availability • Cost • Purity/Potency • Pharmacokinetics • how the body absorbs, distributes, transforms or metabolizes, and excretes the drug.

  18. The Psychoactive Substance, continued • Mode of Administration • Chewing (absorption via oral mucous membranes) • Gastrointestinal • Intranasal

  19. Intravenous • Sub-cutaneous • Intra-muscular • Inhalation

  20. Today’s Schedule • Review current statistics on drug use/abuse • Discuss drugs of abuse that are creating new problems/concerns for addiction professionals • Identify resources for staying current

  21. Current Use Statistics • 2007 MONITORING THE FUTURE SURVEY • http://www.monitoringthefuture.org/ • 2006 NATIONAL SURVEY ON DRUG USE AND HEALTH • http://www.oas.samhsa.gov/nhsda.htm

  22. 2007 MTF Overview – The Good News • Overall, the results are very positive - • From 2006 to 2007, the percentage of 8th graders reporting lifetime use of any illicit drug declined from 20.9% to 19.0%. • Reported past year use among 8th graders declined from 14.8% to 13.2%. • Past year prevalence has fallen by 44% among 8th graders since the peak year of 1996. • Past year prevalence has fallen 27% among 10th graders and 15% among 12th graders since the peak year of 1997.

  23. Cigarette smoking continues to fall to the lowest rate in the survey's history. Between 2006 and 2007, declines were observed in lifetime, past month, and daily cigarette use among 8th graders. Although there were no 1-year declines for 10th and 12th graders, all grades have continued a longer term trend of declining cigarette use. 1 • Past year use of marijuana by 8th graders declined from 11.7% in 2006 to 10.3% in 2007. Between 2001 and 2007, past month marijuana use declined by nearly 25% for 8th, 10th, and 12th graders combined.

  24. Since 2006, past year steroid use decreased in 8th, 10th, and 12th graders combined from 1.3% to 1.1%. • Methamphetamine abuse continues to decline - between 2006 and 2007, lifetime and past year use among 8th and 12th graders decreased.

  25. A substantial long-term decline was observed in past year alcohol use among 8th graders, down to 31.8% from its peak of 46.8% in 1994. Additionally, past year use of flavored alcoholic beverages among 10th graders decreased from 48.8% in 2006 to 45.9% in 2007.

  26. 2007 MTF Overview – Areas of Concern • In 2007, 15.4% of 12th graders reported using a prescription drug nonmedically within the past year2. Vicodin continues to be abused at unacceptably high levels. • Attitudes toward substance abuse, often seen as harbingers of change in abuse rates, were mostly stable. However, among 8th graders, perceived risk of harm associated with MDMA decreased for the third year in a row. Attitudes towards using LSD also softened among 10th graders this year.

  27. Between 2005 and 2007, past year abuse of MDMA increased among 12th graders from 3.0% to 4.5%; and between 2004 and 2007, past year abuse of MDMA increased among 10th graders from 2.4% to 3.5%.

  28. 2006 NATIONAL SURVEY ON DRUGS USE AND HEALTH – Illicit Drug Use Illicit Drug Use • In 2006, an estimated 20.4 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.3 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically. • The rate of current illicit drug use among persons aged 12 or older in 2006 (8.3 percent) was similar to the rate in 2005 (8.1 percent).

  29. Marijuana was the most commonly used illicit drug (14.8 million past month users). Among persons aged 12 or older, the rate of past month marijuana use was the same in 2006 (6.0 percent) as in 2005. • In 2006, there were 2.4 million current cocaine users aged 12 or older, which was the same as in 2005 but greater than in 2002 when the number was 2.0 million. However, the rate of current cocaine use remained stable between 2002 and 2006.

  30. Hallucinogens were used in the past month by 1.0 million persons (0.4 percent) aged 12 or older in 2006, including 528,000 (0.2 percent) who had used Ecstasy. These estimates are similar to the corresponding estimates for 2005. • There were 7.0 million (2.8 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. Of these, 5.2 million used pain relievers, an increase from 4.7 million in 2005.

  31. In 2006, there were an estimated 731,000 current users of methamphetamine aged 12 or older (0.3 percent of the population). • Among youths aged 12 to 17, current illicit drug use rates remained stable from 2005 to 2006.

  32. Among persons aged 12 or older who used pain relievers nonmedically in the past 12 months, 55.7 percent reported that the source of the drug the most recent time they used was from a friend or relative for free.

  33. Alcohol Use • Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2006 survey (50.9 percent). This translates to an estimated 125 million people. • More than one fifth (23.0 percent) of persons aged 12 or older participated in binge drinking (having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey) in 2006. This translates to about 57 million people.

  34. Tobacco Use • In 2006, an estimated 72.9 million Americans aged 12 or older were current (past month) users of a tobacco product. This represents 29.6 percent of the population in that age range. In addition, 61.6 million persons (25.0 percent of the population) were current cigarette smokers; 13.7 million (5.6 percent) smoked cigars; 8.2 million (3.3 percent) used smokeless tobacco; and 2.3 million (0.9 percent) smoked tobacco in pipes.

  35. Initiation of Substance Use (Incidence, or First-Time Use) • The illicit drug use categories with the largest number of recent initiates among persons aged 12 or older were nonmedical use of pain relievers (2.2 million) and marijuana use (2.1 million). These estimates are not significantly different from the numbers in 2005. • In 2006, there were 783,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 77.2 percent were under age 18 when they first used.

  36. Substance Dependence, Abuse, and Treatment • In 2006, an estimated 22.6 million persons (9.2 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual. • 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs • 3.8 million were dependent on or abused illicit drugs but not alcohol • 15.6 million were dependent on or abused alcohol but not illicit drugs.

  37. There were 4.0 million persons aged 12 or older (1.6 percent of the population) who received some kind of treatment for a problem related to the use of alcohol or illicit drugs in 2006. • More than half (2.2 million) received treatment at a self-help group.

  38. Discuss drugs of abuse that are creating new problems/concerns for addiction professionals

  39. Alcohol - Absinthe • Absinthe is an anise-flavored liqueur distilled with oil of wormwood, a leafy herb • Absinthe also contains flavorful herbs such as hyssop, lemon balm, and angelica

  40. Active ingredient is thujone, a neurotoxin • Popular in underground circles in Europe and the United States • Linked to convulsions, madness, and death

  41. History • Wormwood used medicinally since the Middle Ages to exterminate tapeworms while leaving the human host uninjured and even rejuvenated by the experience • At the end of the 18th century, the herb became recreational as people discovered they could get high

  42. Unacceptably bitter • dark green color • mixed with water and sugar • elaborate spoons and glasses

  43. Side-Effects • Renal failure • Convulsions • Involuntary evacuations • Abnormal respiration • Foaming at the mouth

  44. Alcohol - AWOL • Alcohol without liquid (AWOL) – process introduced first in Asia and Europe that allows people to take in liquor (distilled spirits) without actually consuming liquid • machine vaporizes alcohol and mixes it with oxygen, allowing the consumer to breathe in the mixture

  45. AWOL machine produces a very fine alcohol mist • continual intake of this mist over a twenty-minute period is the equivalent of taking one shot of distilled spirits • introduced to the United States in August of 2004

  46. health and safety risks of inhaling alcohol vapors are unknown and many legislators are promoting legislation to ban alcohol inhalation machines • Michigan has made it illegal to possess, sell or use an AWOL machine, and at this time, sixteen other states have banned the device

  47. Effects • Largely unknown at this time • marketed as low-carb, no hangover, no worry for DWI • rapid delivery to brain a concern for physical effects

  48. Oxycontin • Known as the 'hillbilly heroin,' OxyContin is the brand name for a semisynthetic opioid analgesic prescribed for chronic moderate to severe pain. • Its active ingredient is oxycodone, which is also found in drugs like Percodan and Tylox.

  49. OxyContin contains between 10 and 160 milligrams of oxycodone in a timed-release tablet, which provides continuous relief for up to 12 hours • It is more potent than hydrocodone (Lortab, Vicodin) and has a greater potential for abuse

  50. Oxycodone is also found in at least 45 other drugs on the market, including Percocet • Painkillers such as Tylox contain 5 milligrams of oxycodone and often require repeated doses to bring about pain relief because they lack the timed-release formulation

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