Drug/Narcotics: What are they and what can they do to you?

Drug/Narcotics: What are they and what can they do to you? Art Wallace, M.D., Ph.D. Professor of Anesthesiology

Name that Dead Celebrity

Name that Dead Celebrity • DJ AM – Adam “DJ AM” Goldstein died of an accidental overdose on August 28, 2009 in his New York apartment. Goldstein’s autopsy revealed acute intoxication as the cause of his death due to the combined effects of cocaine, oxycodone, Vicodin, Ativan, Klonopin, Xanax, Benadryl and Levamisole. Further reports revealing the presence of nine undigested Oxycontin pills in DJ AM’s system point to suicide as a possible cause of his death.

Heath Ledger – Pronounced dead at 3:36 p.m. in his fourth-floor Manhattan apartment on January 22, 2008, actor Heath Ledger lost his life accidentally to acute intoxication from the combined effects of prescription medications including OxyContin, hydrocodone, diazepam, temazepam, alprazolam and doxylamine. Name that Dead Celebrity

Heath Ledger – Pronounced dead at 3:36 p.m. in his fourth-floor Manhattan apartment on January 22, 2008, actor Heath Ledger lost his life accidentally to acute intoxication from the combined effects of prescription medications including OxyContin, hydrocodone, diazepam, temazepam, alprazolam and doxylamine. Name that Dead Celebrity • Heath Ledger – Pronounced dead at 3:36 p.m. in his fourth-floor Manhattan apartment on January 22, 2008, actor Heath Ledger lost his life accidentally to acute intoxication from the combined effects of prescription medications including OxyContin, hydrocodone, diazepam, temazepam, alprazolam and doxylamine.

Name that Dead Celebrity • Kurt Cobain – An electrician who entered Kurt Cobain’s Lake Washington home on April 8, 1994 discovered the musician’s lifeless body along with a shotgun and a suicide note. Although he died of a gunshot wound, an autopsy administered to the deceased American songwriter later revealed a high concentration of heroin and traces of Valium in his body, a combination sources believe may have contributed to his mood and behavior that led to his suicide.

Chris Farley – On December 18, 1997, Chris Farley’s brother found the American comedian and actor dead in his apartment. An autopsy later revealed that Chris Farley had died of a heart attack, overdosing on a combination of cocaine and morphine early that morning. Name that Dead Celebrity

Name that Dead Celebrity • Chris Farley – On December 18, 1997, Chris Farley’s brother found the American comedian and actor dead in his apartment. An autopsy later revealed that Chris Farley had died of a heart attack, overdosing on a combination of cocaine and morphine early that morning.

Name that Dead Celebrity • Judy Garland – American actress and singer Judy Garland died from an overdose of barbiturates in the bathroom of her rented house in Chelsea, London. The ten 1.5-grain Seconal capsules found in Garland’s bloodstream created speculation that her overdose was a suicide, but the lack of inflammation and drug residue in her stomach indicated that she took the drugs over a long period. Judy’s death certificate states that her death had been “accidental.”

Name that Dead Celebrity • Jimi Hendrix – Although the death of American guitarist, singer and songwriter Jimi Hendrix has never been fully explained (reports are unclear as to whether his death was a suicide or an accident), an autopsy revealed the presence of nine prescribed Vesperax sleeping pills in Hendrix’s stomach at the time of his death on September 18, 1970.

Name that Dead Celebrity • Michael Jackson – Initial reports claimed that painkillers played a role in pop legend Michael Jackson’s death, which occurred at the Ronald Reagan UCLA Medical Center on June 25, 2009. However, later reports pointed to additional medications that may have contributed to his death, including the anesthetic Diprivan and medication Jackson had taken for insomnia.

Name that Dead Celebrity • Marilyn Monroe – Found dead in the bedroom of her Los Angeles home on August 5, 1962, American actress, singer and model Marilyn Monroe lost her life to acute barbiturate poisoning. Initially listed as a “probable suicide” and later thought to have been a murder, Monroe’s death is one of the most debated conspiracy theories of the twentieth and twenty-first centuries.

Name that Dead Celebrity • Anna Nicole Smith –American model, sex symbol, actress and TV personality Anna Nicole Smith died of combined drug intoxication on February 8, 2007. Smith’s autopsy revealed the presence of Chloral hydrate in her system, the major component that doctors believe caused her death. The sedative became increasingly lethal when combined with the other prescription drugs in her system including four benzodiazepines, Klonopin, Ativan, Serax and Valium, as well as Benadryl and Topamax.

Name that Dead Celebrity • John Belushi – Comedian, actor and musician John Adam Belushi, most notably recognized for his work on Saturday Night Live and for his roles in movies National Lampoon’s Animal House and The Blues Brothers, died on March 5, 1982 from a combined injection of cocaine and heroin, a shot known in the drug world as a “speedball.”

Name that Dead Celebrity • Whitney Houston - official cause of death: drowning and effects of atherosclerotic heart disease and cocaine use. • How injury occurred : found submerged in bathtub filled with water; cocaine intake.” • Houston died at the age of 48 at the Beverly Hilton Hotel on Feb. 11, a night when she was expected to appear at Clive Davis’s annual pre-Grammy party. • Cocaine and metabolites were identified and were contributory to the death • Marijuana, alprazolam (Xanax), cyclobenzaprine (Flexeril) and diphenhydramine (Benadryl) were identified but did not contribute to the death.”

Candidates for Celebrity Overdose

Name that Dead Celebrity: Graduates!

Name that Dead Celebrity • Amy Winehouse drank herself to death. That was the ruling of a coroner's inquest into the death of the Grammy-winning soul singer, who died with empty vodka bottles in her room and lethal amounts of alcohol in her blood – more than five times the British drunk driving limit. • Coroner Suzanne Greenaway gave a verdict of "death by misadventure," saying Wednesday the singer suffered accidental alcohol poisoning when she resumed drinking after weeks of abstinence. • The level of alcohol in her blood was 416 milligrams per 100 milliliters, he said – a blood alcohol level of 0.4 percent. The British and U.S. legal drunk-driving limit is 0.08 percent.

Drugs Effect Reward System in Brain • Mimic neurotransmitters.

Neurotransmitter • Neurons are the cells that process information in the brain. Chemicals called neurotransmitters allow neurons to communicate with each other. • Neurotransmitters fill the gap, or synapse, between two neurons and bind to protein receptors, which enable various functions and allow the brain and body to be turned on and off. • Some neurons have thousands of receptors that are specific to particular neurotransmitters. • Foreign chemicals, like THC, can mimic or block actions of neurotransmitters and interfere with normal functions. • Enkephalin - narcotics • Anandamide – marijuana and THC cannabinoid • GABA – Alcholol, benzodiazepine

Neurotransmitter • Drugs Effect neurotransmitters. • Prevent reuptake – cocaine, methamphetamines • Imitate Enkephalin - narcotics • Anandamide – marijuana and THC cannabinoid • GABA - benzodiazepines

What is an anesthesiologist? • Physician who provides “anesthesia”. • Makes patient compatible with surgery • Allows the use of knives, saws, drills, lasers, power tools on patients. • Eliminates memory • I make people happy, unconscious, or pain free while something terrible happens. • Prevent death while administering poisons to patients.

Anesthesiologist • High school + four years of college + four years of medical school + year of internship + three years of anesthesia residency. • NPO, Preop work up, IV, monitors, blood pressure, heart rate, ECG, oxygen supply, airway, suction.

How to avoid death. • Chronic breathing is good. • Chronic beating of heart is good. • Avoid really bad stuff. • Gun shots, knives, cars, buses, falling, (trauma) • Jail • Infections • HIV • Hep C • Bacteria • Cancer • Drugs make all these things not work so well.

Russians Conducted an Experiment • 900 People got anesthesia without an anesthesiologist. • Fentanyl gas (narcotic) • 150 Died (15%) • So using “anesthetics” without an anesthesiologists kills 15% or 1: 8 people.

Lots of people play home anesthesiologist. • Use of alcohol • Use of narcotics: heroine, methadone, oxycodone • Use of benzodiazepines • Use of barbiturates • Use of sympathomimetics: cocaine, crack, methamphetamines, ephedrine • Use of hallucinogens: marijuana, LSD, mushrooms, Psilocybin, Lophophorawilliamsii (peyote)

Narcotics • Methadone, morphine, heroine, dilaudid, alfentanyl, fentanyl, remifentanyl, sufentanyl, oxycodone, percoset, codeine, talwin, etc. • Stops pain • Nausea, vomiting, respiratory depression, unconsciousness • Will cause death in overdose.

Synergism • Combination of two agents with increased effect over individual agent. • A little bit of two drugs is very different from a single drug. • Alcohol potentiates other drugs.

Dose Response Curve • Ten fold variability in dose response for narcotics in naïve patients. • 1000 fold in addicts. • Wrong dose – patient stops breathing. • If you stop breathing you die.

Death Highlights Growing Prescription Drug Abuse Trend • Corey Haim • Brittany Murphy, • Adam Goldstein, a.k.a. "DJ AM" • Heath Ledger • 5000 kids died last year from prescription pill abuse. • More than cars, guns, AIDS.

Permanent Neurologic Changes • Addiction • Schizophrenia • Anhedonia • Brain uses neurotransmitters to give pleasure and rewards. • If you swamp the brain in synthetic neurotransmitters (drug), you will not have the normal pleasures in life.

Cocaine or Methamphetamines • In psychology and psychiatry, anhedonia (< Greekἀν- an-, "without" + ἡδονήhēdonē, "pleasure") is an inability to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction or sexual activities. • Patients describe themselves as feeling emotionally empty • Permanent Anhedonia. • Strokes, heart attacks, death

MPTP and Parkinson’s Disease • Parkinson's Disease is a neurological illness named after Dr. James Parkinson, a London physician who was the first to describe it in 1817. Parkinson's disease (or PD) is a disorder caused by the gradual loss of cells in a small part of the brain called the substantianigra. The loss (death) of these cells produces a reduction in a vital chemical called "dopamine," which causes symptoms that may include shaking of hands, slowing down of movement, stiffness, and loss of balance. Other symptoms may include loss of facial expression, reduction in speech volume and clarity, difficulty swallowing, change in size of handwriting, dry skin, constipation, urinary difficulties, and depression. Because Parkinson's disease is a progressive disorder, these symptoms worsen with time. • MPTP can cause Parkinsons and was a contaminant in recreational drugs.

Psilocybin mushroom • Hallucinogenic • Can result in permanent neurologic changes.

Peyote - Mescaline • Hallucinogen - • Lophophorawilliamsii. also known as Mescal buttons is a spineless cactus. It is found in the southwestern United States including southwestern Texas into central Mexico. It is also found it the Chihuahuan desert. • Indigenious American peoples have used it for religious purposes for thousands of years. • Can result in permanent neurologic changes.

Benzodiazepines (Valium) • Benzodiazepines enhance the effect of the neurotransmittergamma-aminobutyric acid (GABA), which results in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, muscle relaxant and amnesic action.[2] • These properties make benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures. • Can have lethal synergism with narcotics or alcohol.

Opium • The dosage instructions say 2 drops for under three months, 4 drops for one year olds, 6 drops for a four year old, 14 for a ten year old, 25 for a twenty year old, and 30 for an adult

Drug/Narcotics: What are they and what can they do to you?