Individual Drug Info

1. Individual Drug Info Winter 2016

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 • Emergency Department visits: • All ages • Aged 18-25 (Substance Abuse and Mental Health Services Administration, 2014, Figure 3) 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 & indica • Different subspecies/varietals used for clothing vs drug use • Canadian study – differences are questionable • Cannabinoids are active ingredients • THC is a cannabinoid • Interacts with cannabinoid receptors in brain • Many other cannabinoids exist, but they are less understood regarding psychoactive effects • DEA: Schedule I • Despite state regulations, marijuana still federally illegal

6. Medical cannabis (1/7/2016), source: procon.org)

7. Recreational Cannabis • Washington (2013) • Colorado (2013) • Washington, DC (2014) • Oregon (2014) • Alaska (2014) • Although above states have legalized recreational marijuana, others have decriminalized use (lowered policing efforts, fines instead of other penalties) • 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, 2:26) • 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; found online here)

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

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. 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 • Dosage measured in micrograms (very small) • Manufacturing secretive: Nick Sand (National Geographic, 3:39) • Student Question: Are There Different Types of LSD? • Same basic chemical structure • Illegal, so cannot guarantee contents, care of product • Light and air may degrade drug

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 • Student Question: Are there long-term effects of LSD? • Chronic effects may involve flashbacks, usually among those who continue taking the substance • Sudden onset of abnormal perceptions • Hallucinogen Persisting Perception Disorder • Visual images remain longer than in consciousness • Dr. Henry Abraham (Tufts University) blog • A 2013 PLOS One open access data study article • National Survey on Drug Use and Health respondents • 130,000+ subjects • No relationship between lifetime hallucinogen use and mental health issues

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 one of two doses of LSD with talk therapy, across eight weeks • Those with larger dose reported improvement

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

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

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

23. 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.

24. Heroin

25. Heroin • Narcotic • Synthesized from morphine in late 1800’s • Morphine synthesized from opium poppy • Heroin 10x more powerful than morphine • Was thought to be less addictive • After many people became addicted, heroin was outlawed in 1920’s • Drug Ads (wings.buffalo.edu) • Schedule I

26. Heroin • Narcotic • Synthesized from morphine in late 1800’s • Morphine synthesized from opium poppy • Heroin 10x more powerful than morphine • Was thought to be less addictive • After many people became addicted, heroin was outlawed in 1920’s • Drug Ads (wings.buffalo.edu) • Schedule I

27. Heroin Availability • Increasing use in recent years (DEA, 2015, via Business Insider) • Across world, Afghanistan still considered #1 opium cultivator (United Nations) • DEA reports, through 2015 National Drug Threat Assessment, that most heroin in US comes from Mexico (DEA, 11/4/15) • At left, estimates of heroin production in Mexico, metric tons (USDOJ)

28. Heroin Availability • Change in heroin trafficking – customs border patrol areas, 2014 (DEA, via Business Insider, Map 5)

29. Heroin Acute effects • Euphoria • Slow, shallow respiration • Analgesia (pain relief) • Skin flushing/redness • Stupor • Dry mouth • Nausea/vomiting Overdose • Frequently occurs when mixing with other substances • DAWN: 258,482 emergency department visits, 2011

30. Heroin: Chronic Effects • Respiratory problems • Collapsed veins from injection • High rate of injection use leads to increased disease transmission risk • From Mexico to the Midwest (The Washington Post, 9/24/15, ~9:00)

31. Drug Preferences Ebb & Flow with Time (DEA, National Drug Threat Survey, via Business Insider)

32. What to Do: Different Approaches • Syringe exchanges (in King County, United States) • Syringe vending machines (right, Puerto Rico) • Supervised injection clinics (e.g. Insite, Vancouver, B.C.) • Heroin prescription

33. Cocaine

34. Cocaine Extracted from coca plant Meeting Cocaine Farmers (BBC) Stimulant Schedule II drug

35. About Cocaine: Some History • In late 1800’s was prescribed by US physicians • Coca-Cola had cocaine removed in early 1900’s • Cocaine wine was available Image is in the public domain

36. Cocaine Forms Powdered form Snorted Dissolved in water, injected Processed in rock form Generally, the faster a drug can enter the brain, the more it will be abused

37. Pathways Into Brain

38. Cocaine Availability According to DEA, second most commonly used illegal substance In WA, 604 kg of cocaine were seized in 2005 Marijuana: 9873kg, heroin 8.2kg, meth 74.4kg South America is primary production source Other countries involved with transportation UNODC: Global Cocaine Production (Figure 21; p. 66) UNODC: Map 6; page 70 Most cocaine enters US via Mexico

39. Cocaine Availability - Price • Price depends on purity (50-70%), form of cocaine, amount purchased, region, $10-200 (crack vs cocaine, wholesale vs retail) • UNODC: Table 9, page 71

40. Cocaine Effects Increased heart rate, blood pressure, temperature Improved mood, well-being Short-lived (few minutes to few hours) Increased sensation of energy Chronic users may experience bloody noses (damage to septum), brain adaptations to cocaine-induced dopamine effects, compromised immunity Brain changes, even after halting use (Univ. of Utah; scroll to mouse) Lesions and clots in brain blood vessels Relationship between cognition & therapy dropout

41. Cocaine Overdose Seizures Heart attack Stroke Kidney failure Death In 2010, cocaine-mentioned ER cases: 488,101 Source: DAWN

42. Cocaine Withdrawal Apathy Fatigue Depression/mood swings Cravings for drug Not as intense as withdrawal from heroin, alcohol Post acute withdrawal syndrome (PAWS)

43. Cocaine Tolerance, Dependence Tolerance may occur quickly Emphasis appears to be on psychological rather than physical dependence Rats and self-administration (reinforcement)

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

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

46. 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; 2:30-3:50, 14 subjects, per website) • More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)

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

48. Emergency Department Visits

49. 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)

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