Popular Drugs: Impact Brain Behavior & Society

SUSAN L. DALTERIO PHD

I. BACKGROUND: HOW DRUGS AFFECT THE BRAIN

A. BRAIN CHEMICALS

B. ADDICTION PROCESS

C. ADOLESCENT BRAIN DEVELOPMENT

II. ABUSE OF Rx & RELATED PRODUCTS

A. STIMULANTS- AMPHETAMINES & RELATED ADD AGENTS

B. OPIOIDS

1. EFFECTS OF ABUSE

2. EPIDEMIC OF ABUSE – FDA RESPONSE

III. MARIJUANA

A. PHARMACOLOGY

B. MEDICAL USE

C. SYNTHETIC CANNABINOIDS- “SPICE” OR K2

IV. CLUB DRUGS & NOVEL DESIGNER PSYCHEDELICS

A. ECSTASY – MDMA OR ‘MOLLY”

B. BATH SALTS- MEPHIDRONE & RELATED AGENTS

C. THE “ALPHABET SOUP” OF DESIGNER AGENTS

V. CONCLUSIONS & QUESTIONS

SOCIAL IMPACT

HOW DO DRUGS AFFECT

THE BRAIN ?

MIMIC NATURAL BRAIN CHEMICALS

BLOCK ACTIONS OF BRAIN CHEMICALS

ALTER RECYCLING OF BRAIN CHEMICALS

AFFECT BRAIN CHEMICALS RELEASE

ALTER BRAIN CHEMICAL BREAKDOWN

MAJOR BRAIN CHEMICALS

DOPAMINE —

PRODUCES PLEASURE THROUGH THE

“ REWARD SYSTEM “

IMPORTANT IN COGNITION & EMOTION

ACETYLCHOLINE —

REGULATES MEMORY

ALSO AFFECTS DREAMING

SEROTONIN —

INVOLVED IN SENSORY PERCEPTION

HALLUCINATIONS

CONTROL OF EMOTIONAL STATES SUCH AS

ANXIETY & DEPRESSION

NOREPINEPHRINE

FIGHT OR FLIGHT

AROUSAL

FOCUS

FEAR

ENDORPHINS –

PAIN MODULATION

APPETITE & MOOD

GLUTAMATE –

SENSATIONS

LEARNING

THE ADDICTION PROCESS

ACTIVATION OF BRAIN REWARD PATHS

LONG LASTING CHANGES IN BRAIN

STRUCTURES INVOLVED IN LEARNING

REINFORCES BEHAVIORS

“MEMORIES” OF THE DRUG EXPERIENCE

CREATE A POWERFUL FORM OF

LEARNING

REWARD SYSTEM

DRUGS ACTIVATE REWARD PATHS

PRODUCE POWERFUL FEELINGS OF

PLEASURE & AN INCREASED DESIRE

TO REPEAT DRUG USING BEHAVIOR

DRUGS ACT ON THE MORE PRIMITIVE

CHILD-LIKE SURVIVAL AREAS IN

BRAIN

A REMINDER

THE INTERNET MAKES Rx DRUGS OTC !

TEXAS DUI TRENDS

PROPORTION REPORTING A PRIMARY PROBLEM

WITH ALCOHOL DECREASED FROM 75% IN 1990

TO 21% IN 2008

THE PROPORTION WITH A PRIMARY PROBLEM

OF MARIJUANA INCREASED FROM 19 TO 63 %

THE PROPORTION WITH A PRIMARY PROBLEM

WITH COCAINE INCREASED FROM 5 TO 7 %

“PHARMING ”

TRADING OF RX/OTC MEDICATIONS

INGESTING THE MIX OF PILLS, OFTEN

WITH ALCOHOL TO GET “HIGH ”

INGESTING HANDFULS, SOMETIMES

SEVERAL BOTTLES OF PILLS & COUGH

SYRUP A DAY OR “PARTYING”

SIGNS & SYMPTOMS

PHYSICALFATIGUE, REPEATED HEALTH COMPLAINTS, RED AND GLAZED

EYES, AND A LASTING COUGH

EMOTIONAL

PERSONALITY CHANGE, SUDDEN MOOD CHANGES, LOW SELF-

ESTEEM, IRRITABILITY, IRRESPONSIBLE BEHAVIOR, POOR

JUDGMENT, DEPRESSION, GENERAL LACK OF INTEREST

FAMILY

STARTING ARGUMENTS, BREAKING RULES, WITHDRAWING

FROM THE FAMILY

SCHOOL

DECREASED INTEREST, NEGATIVE ATTITUDE, DROP IN

GRADES, MANY ABSENCES, TRUANCY, DISCIPLINE PROBLEMS

SOCIAL PROBLEMS

NEW ANTI-SOCIAL FRIENDS, PROBLEMS WITH THE LAW,

CHANGES TO LESS CONVENTIONAL STYLES IN DRESS &

MUSIC

THE “UPPERS”

PSYCHOSTIMULANT DRUGS

CLINICAL USES:

ANOREXIANTS (WEIGHT LOSS)

ATTENTION DEFICIT DISORDER

DECONGESTANTS

ENHANCE THE ACTIVITY OF NE & DA

INCREASE HEART RATE, BP

AMPHETAMINES, RITALIN®, METHAMPHETAMINE

ADVERSE EFFECTS

SLEEPLESSNESS

RESTLESSNESS & IRRITABILITY

HEADACHE

INCREASED RISK OF STROKE

NAUSEA & VOMITING

INCREASED BODY TEMPERATURE

RAPID HEARTBEAT & ALTERED HEART RHYTHM

SEIZURES & PSYCHOSIS

CHRONIC USE CAN CAUSE TOLERANCE &

DEPENDENCE

OPIOIDS & BRAIN CHEMISTRY

INCREASE RELEASE OF DOPAMINE

PARTICIPATES IN “REWARD”

MIMICS THE EFFECTS OF

ENDORPHINS @ OPIOID RECEPTOR

DECREASES ACTIVITY OF PAIN

PRODUCING BRAIN CHEMICALS

ABUSED OPIOIDS

• HEROIN

• VICODIN

• OXYCONTIN

• MEPERIDINE (DEMEROL)

• CODEINE

• METHADONE

• BUPRENORPHINE

ADVERSE EFFECTS

• BOWEL OBSTRUCTION

• POTENTIALLY FATAL RESPIRATORY DEPRESSION

• POTENTIAL LIVER TOXICITY FROM COMBINATION

PRODUCTS CONTAINING ACETAMINOPHEN

• ADDICTION

FDA RESPONSE

• OXYCONTIN REFORMULATION TO DISCOURAGE

ABUSE BY INJECTION

• REDUCTION OF ACETAMINOPHEN DOSES IN MANY

COMBINATION PRODUCTS

• NEW GUIDELINES THAT WILL REQUIRE DOCTOR

REVISITS EVERY THREE MONTHS FOR CERTAIN

SCH II & III OPIOID AGENTS

SEDATIVE HYPNOTICS XANAX

ALPRAZOLAM

SEDATIVE-HYPNOTIC

USED TO HEIGHTEN/PROLONG HEROIN

EFFECTS

MOST POPULAR TEXAS “STREET” BZ

ANTEROGRADE AMNESIA

SEIZURE RISK @ SUDDEN WITHDRAWAL

MARIJUANA TRENDS

1960s – 2% U.S. USE ILLICIT DRUGS

1979 – 68 MILLION TRIED MARIJUANA

2008-15.2 MILLION USED ONCE/MONTH

3.2 MILLION USED DAILY

HALF ARE DEPENDENT

374,000 VISITS TO THE EMERGENCY DEPARTMENT

33-50% OF ARRESTEES TESTED POSITIVE FOR MARIJUANA

MARIJUANA WAS THE PRIMARY PROBLEM FOR 23% OF

ADMISSIONS TO TREATMENT PROGRAMS IN 2012

MEDICAL MARIJUANA HAS INCREASED POTENCY; VARIETY & PRICE

THC

9 - TETRAHYDROCANNABINOL

• MAJOR PSYCHOACTIVE INGREDIENT

• PRODUCES THE “HIGH” FEELING

• CHANGES BEHAVIOR & PERCEPTION

MARIJUANA & BRAIN

CHEMISTRY

•BINDS TO ANANDAMIDE RECEPTOR

•AFFECTS ACETYLCHOLINE ACTIVITY

• INCREASES DOPAMINE RELEASE

ACUTE EFFECTS

• PHYSICAL RELAXATION

• SEDATION

• GIDDINESS

• TIME SLOWS DOWN

• SHORTENS ATTENTION SPAN

• SHORT TERM MEMORY DEFICIT

• ANXIETY/PARANOIA

EFFECTS ON BODILY FUNCTIONS

• SUPPRESSED IMMUNITY

• DAMAGE TO LUNG TISSUE

• CARDIOVASCULAR DAMAGE

• DECREASED TESTOSTERONE

• INCREASED APPETITE

MARIJUANA & THE IMMUNE

SYSTEM

T CELLS

VIRAL RESISTANCE

RESPIRATORY DISEASES

IMMUNOSUPPRESSIVE EFFECTS MEDIATED BY CB2

RECEPTORS

© DALTERIO 2013

RESPIRATORY SYSTEM

AIRWAY DAMAGE

CHRONIC BRONCHITIS

LUNG INFLAMMATION

TAR DEPOSITS

HEAD & NECK CANCERS

CARDIOVASCULAR EFFECTS

• PALPITATIONS

• TACHYCARDIA

• ACUTE IN BP

• PROLONGED HYPOTENSION

• RISK OF HEART ATTACK

• RISK OF STROKE

MARIJUANA USE LINKED TO

• INCREASED RISK OF HEART ATTACK

• INCREASED RISK OF STROKE EVEN IN YOUNG

USER

• INCREASED RISK FOR PSYCHIATRIC ILLNESS

• LOSS OF IQ POINTS AFTER CHRONIC USE

CHRONIC MARIJUANA USE

THERE IS EVIDENCE OF PSYCHIATRIC, RESPIRATORY, CARDIOVASCULAR, &

BONE TOXICITY ASSOCIATED WITH CHRONIC USE.

ASSOCIATED WITH MANY MAJOR LONG-TERM PSYCHIATRIC CONDITIONS

INCLUDING DEPRESSION, ANXIETY, PSYCHOSIS, BIPOLAR DISORDER, & AN

AMOTIVATIONAL STATE.

RESPIRATORY CONDITIONS INCLUDE REDUCED LUNG DENSITY, LUNG CYSTS,

AND CHRONIC BRONCHITIS.

DOSE-DEPENDENT ELEVATED RATES OF MYOCARDIAL INFARCTION &

CARDIAC ARRHYTHMIAS.

IT IS KNOWN TO AFFECT BONE METABOLISM & ALSO HAS TERATOGENIC

EFFECTS ON THE DEVELOPING BRAIN FOLLOWING PERINATAL EXPOSURE.

LINK TO CANCERS AT EIGHT SITES, INCLUDING CHILDREN AFTER IN UTERO

MATERNAL EXPOSURE

REPRODUCTIVE ISSUES

MARIJUANA IS THE MOST WIDELY USED DRUG BY

WOMEN AT REPRODUCTIVE AGE

STUDIES REPORT EITHER LOWER BIRTH WEIGHT OR

SHORTER LENGTH AT BIRTH FOR INFANTS EXPOSED

PRENATALLY

PATERNAL MARIJUANA USE DURING THE PERIODS OF

CONCEPTION & PREGNANCY & ALSO POSTNATAL

EXPOSURE SIGNIFICANTLY INCREASED RISK OF SIDS

EXPOSURE VIA BREAST MILK DURING THE FIRST

MONTH POSTPARTUM APPEARS TO BE ASSOCIATED

WITH A DECREASE IN INFANT MOTOR DEVELOPMENT

AT ONE YEAR OF AGE

© DALTERIO 2013

PROPOSED MEDICAL USES

PAIN RELIEF

AIDS WASTING

CHEMO RELATED NAUSEA

SPASTICITY

GLAUCOMA

© DALTERIO 2013

ISSUES

PHARMACEUTICAL PRODUCTS VS. PLANT MARIJUANA

PRODUCT CONSISTENCY FOR MEDICINAL PLANTS

DOSAGE ISSUE FOR SMOKING AS A DRUG DELIVERY

SYSTEM

BENEFIT TO RISK FOR GENERAL USE

EFFECTIVENESS OF CANNABINOIDS VS OTHER

ESTABLISHED PHARMACEUTICALS

© DALTERIO 2013

HIV/AIDS PATIENTS

THE MOST COMPELLING CONCERNS REGARDING MARIJUANA

SMOKING IN HIV/AIDS PATIENTS ARE THE POSSIBLE EFFECTS

OF MARIJUANA ON IMMUNITY.

REPORTS OF OPPORTUNISTIC FUNGAL & BACTERIAL PNEUMONIA

IN AIDS PATIENTS SUGGEST THAT MARIJUANA SMOKING EITHER

SUPPRESSES THE IMMUNE SYSTEM OR EXPOSES PATIENTS TO AN

ADDED BURDEN OF PATHOGENS.

PATIENTS WITH PREEXISTING IMMUNE DEFICITS DUE TO AIDS

SHOULD BE EXPECTED TO BE VULNERABLE TO SERIOUS HARM

CAUSED BY SMOKING MARIJUANA."

-- INSTITUTE OF MEDICINE REPORT

MARIJUANA AND MEDICINE: ASSESSING THE SCIENCE BASE

MAR. 1999

STATES vs. FEDS

A GROWING NUMBER OF STATES HAVE PASSED VOTER

REFERENDA MAKING SMOKED MARIJUANA AVAILABLE FOR A

VARIETY OF MEDICAL CONDITIONS UPON A DOCTOR'S

RECOMMENDATION

THESE MEASURES ARE INCONSISTENT WITH EFFORTS TO

ENSURE THAT MEDICATIONS UNDERGO THE RIGOROUS

SCIENTIFIC SCRUTINY OF THE FDA APPROVAL PROCESS TO

ENSURE THEY ARE SAFE AND EFFECTIVE UNDER THE

STANDARDS OF THE FD&C ACT.

THE FDA, THE FEDERAL AGENCY RESPONSIBLE FOR

REVIEWING SAFETY & EFFICACY OF DRUGS, DEA AS THE

FEDERAL AGENCY CHARGED WITH ENFORCING THE CSA, AND

THE OFFICE OF NATIONAL DRUG CONTROL POLICY, AS THE

FEDERAL COORDINATOR OF DRUG CONTROL POLICY, DO NOT

SUPPORT THE USE OF SMOKED MARIJUANA FOR MEDICAL

PURPOSES.

© DALTERIO 2013

SMOKED MARIJUANA

• RESPIRATORY DISEASE

•LOSS OF BRONCHIAL CILIA

•PROGRESSION OF HIV AIDS

•2X MORTALITY IN MEN WITH AIDS

CONCLUSIONS:

PLANTS AS MEDICINE

NOT FDA APPROVED FOR SAFETY & EFFECTIVENESS

CANNOT PROVIDE CONSISTENT DRUG DOSE OR DELIVERY

GUIDELINES

CONTAMINATION ISSUES

SMOKING & PLANTS ARE NO LONGER ACCEPTED IN ANY

CURRENT TREATMENT SCENARIO IN THE US

ADVERSE EFFECTS OF SMOKING

SMOKING PRODUCES A QUICK "HIGH” MAKING THE PATIENT FEEL

“BETTER”

AN EXAMPLE OF THE PLACEBO EFFECT; IF PEOPLE “BELIEVE”

MARIJUANA IS A MEDICINE FOR THEM IT MAY WORK

© DALTERIO 2013

CONCLUSIONS

•MARIJUANA ADVERSELY AFFECTS THE

BRAIN, HEART, IMMUNE, RESPIRATORY &

REPRODUCTIVE SYSTEMS

•MARIJUANA INTERFERES WITH LEARNING,

MEMORY & PERFORMANCE OF COMPLEX

COGNITIVE TASKS

•PLANT MARIJUANA IS NOT MEDICINE

SYNTHETIC CANNABINOIDS

IN A 2012 “MONITORING THE FUTURE” SURVEY

ABOUT 11% OF US HIGH SCHOOL SENIORS 17-18 YRS.

OLD ADMITTED USING SPICE

MALE ADOLESCENTS ARE MORE LIKELY TO USE SPICE

SPICE USERS ARE

◦ 1) MARIJUANA SMOKERS,

2) OCCASIONAL DRUG USERS SEEKING TO AVOID LEGAL COMPLICATIONS (NO LONGER

LEGAL)

3) DRUG-NAÏVE EXPERIMENTERS

SYNTHETIC CANNABINOIDS

SPICE OR K2

DEVELOPED BY JW HUFFMAN AT CLEMSON U IN

THE MID 90’S

SPRAYING A SYNTHETIC THC LIKE COMPOUND

JWH-018 ONTO HERBAL PRODUCTS OR INCENSE

EASY TO GET ON THE INTERNET OR IN HEAD

SHOPS, SOME GAS STATIONS ETC.

LEGAL STATUS IN QUESTION

SOLD AS A PLANT GROWTH STIMULANT IN CHINA

& KOREA

BANNED IN SOME LOCALITIES, EUROPE & RUSSIA

BANNED BY US MILITARY & DETECTED BY THEIR

DRUG SCREENING TESTS

STREET NAMES

BLISS

BLACK MAMBA

BOMBAY BLUE

FAKEWEED

GENIE

SPICE

POISON CONTROL CENTER DATA

FOLLOWING REFLECTS CLOSED CASES FOR

SYNTHETIC MARIJUANA EXPOSURES

IN 2010 THERE WERE 2,906 CALLS

FOR 2011 6,959

FOR 2012 11,406

PHYSICAL SYMPTOMS

VERY RAPID IN HEART RATE

DANGEROUSLY ELEVATED BLOOD PRESSURE

PALE SKIN & VOMITING

SEVERE HALLUCINATIONS

EXTREME ANXIETY, AGITATION & SEIZURES

DESIGNER PSYCHEDELICS

• MDA

• MDMA- MERCK 1914

• 2C-B- NEXUS

• PMA- MAY BE SOLD AN ECSTASY;• CHICKEN YELLOW

• 2C-T-7- BLUE MYSTIC

• 2C-T-2-

• STP - SERENITY

ECSTASY

• MDMA

•METHYLENEDIOXYMETHAMPHETAMINE

•MOLLY

•X

•E

•STACY

• LOVER’S SPEED

•EVE

COMMON

CONTAMINANTS

• CHALK

• LSD

• AMPHETAMINES

• HEROIN

• CAFFEINE

• KETAMINE

• EPHEDRINE

MDMA ACUTE EFFECTS

• TEETH CLENCHING/JAW SPASM

• NAUSEA/ANOREXIA

• HEADACHES/AGITATION

• SEIZURE ACTIVITY/STROKE/COMA

• TREMORS

• BLURRED VISION

• MUSCLE CRAMPING

• CARDIAC ARRHYTHMIAS

ECSTASYBEHAVIORAL EFFECTS

• INCREASED ENERGY

• EMPATHY TOWARD OTHERS

• INCREASED AFFECTION

• EMOTIONAL OPENNESS

• PROFOUND POSITIVE FEELINGS

• EUPHORIA

• DECREASED INHIBITIONS

• DECREASED ANXIETY

• EXTREME RELAXATION

MDMA OVERDOSE

• HIGH BLOOD PRESSURE

• FAINTNESS

• PANIC ATTACKS

• LOSS OF CONSCIOUSNESS

• SEIZURES

• HEART FAILURE

• HEAT STROKE

BATH SALTS

MEPHEDRONE

National Addiction Centre, UK

• 67% OF MEPHEDRONE USERS EXPERIENCED SWEATING

• 51% SUFFERED FROM HEADACHES

• 43% FROM HEART PALPITATIONS

• 27% FROM NAUSEA

• 15% FROM COLD OR BLUE FINGERS, INDICATING VASOCONSTRICTION

ADVERSE EFFECTS

POISON CENTERS REPORT:

HALLUCINATIONS

PARANOIA

TACHYCARDIA & HYPERTENSION

ALTERED RENAL FUNCTION

CARDIAC ARRHYTHMIAS

DEATHS HAVE BEEN REPORTED

2C-T-7 AND 2C-T-2

• INDUCE DELIRIUM

• HEIGHTEN SENSITIVITY

• INCREASED AWARENESS

• DANGEROUS CARDIAC EFFECTS OR DEATH IF TAKEN @

HIGH DOSES

• 7-UP

• BLUE MYSTIC

BROMO-DRAGON FLY

•MORE POTENT THAN 2C- DERIVATIVES

•LONGER LASTING- 6 H-4 DAYS

•POWERFUL HALLUCINOGEN

•VISUAL DISTORTIONS

•MEMORY LOSS/CONFUSION

•ACUTE ANXIETY REACTIONS

•DEPERSONALIZATION & PANIC

DMTDIMETHYLTRYPTAMINE

• PRODUCED IN BODY UNDER NATURAL CONDITIONS

• CAN PRODUCE AN TOTAL LOSS OF CONNECTION WITH THE REAL WORLD, INCLUDING CONTACT WITH “ALIENS”

• DR. RICK STRASSMAN (U OF NEW MEXICO), ADVANCED THE CONTROVERSIAL HYPOTHESIS

THAT A MASSIVE RELEASE OF DMT FROM THE PINEAL GLAND PRIOR TO DEATH OR NEAR DEATH

WAS THE CAUSE OF THE NEAR DEATH EXPERIENCE (NDE) PHENOMENON.

• SEVERAL OF HIS TEST SUBJECTS REPORTED NDE-LIKE AUDIO OR VISUAL HALLUCINATIONS AFTER

DMT

SOCIAL ISSUES

• DRUGS INTERFERE WITH LEARNING & MEMORY

ESPECIALLY IN ADOLESCENTS

• AGE OF FIRST USE HAS PROFOUND EFFECTS ON

ADDICTION PROBABILITY

• DRUG AVAILABILITY INCREASES USE

• LONG-TERM MEDICAL EFFECTS OF THE LEGAL ALCOHOL

& TOBACCO COST BILLIONS

• PSYCHOACTIVE DRUG IMPACT TRAFFIC-RELATED

DEATHS, WORKPLACE ACCIDENTS & ABSENTEEISM,

DOMESTIC VIOLENCE & CRIMINAL BEHAVIORS