POPULAR DRUGS:IMPACT BRAIN BEHAVIOR AND

SOCIETY

SUSAN L. DALTERIO PHD

POPULAR DRUGS:IMPACT BRAIN BEHAVIOR AND SOCIETY

I. DRUGS AND BRAIN CHEMISTRYA. BRAIN CHEMICALS THAT MEDIATE DRUG EFFECTB. THE ADDICTION PROCESS

II. RX DRUG ABUSEA. THE PUBLIC HEALTH EPIDEMICB. THE MAJOR DRUG PLAYERS

1. PAIN MEDICATIONS2. STIMULANTS

3. MARIJUANA

III. THE “NEW” DRUGS ON THE STREETA. BATH SALTSB. SYNTHETIC MARIJUANA

IV. SOCIAL IMPACTA. DRUG AVAILABILITYB. IMPACT OF MIND-ALTERING DRUGS ON THE USERC. IMPLICATIONS FOR HEALTH CARE, WORKPLACE AND

EDUCATIONAL SYSTEMS

V. CONCLUSIONS

DRUGS & BRAIN CHEMSITRY

DRUGS ACT THROUGH EFFECTS ON NATURAL BRAIN CHEMICALS

DRUG EFFECTS LAST LONGER THAN THOSE PRODUCED NATURALLY

DRUGS OFTEN RELEASE MUCH MORE BRAIN CHEMICAL THAN FATIGUE, FEAR, EXCITEMENT

DRUGS CAN DISRUPT PROCESSES THAT RECYCLE THESE BRAIN CHEMICALS LEADING TO THEIR DEPLETION IN NEURONS

DRUGS VS NATURAL REINFORCERS

SATIATION OCCURS WITH FOOD, WATER, SEX BUT NOT WITH DRUGS

DRUGS PRODUCE EFFECTS ON DOPAMINE VERY RAPIDLY

THE MORE OFTEN DRUGS ARE USED THE MORE REINFORCING THEY BECOME

EVENTUALLY DRUGS CAN CONTROL LARGE AREAS OF BEHAVIOR

REWARD SYSTEM

DRUGS ACTIVATE THE REWARD SYSTEM PRODUCING POWERFUL FEELINGS OF PLEASURE & AN INCREASED DESIRE TO REPEAT DRUG USING BEHAVIOR

DRUGS EXERT POWERFUL CONTROL OVER

BEHAVIOR BY ACTING DIRECTLY ON THE MORE PRIMITIVE SURVIVAL AREAS IN BRAIN

DOPAMINERGIC NEURON

THE ADDICTION PROCESS

ACTIVATION of BRAIN REWARD PROCESSES

ULTIMATELY REDUCES ACTIVITY IN THESE PATHWAYS

LONG LASTING CHANGES IN BRAIN STRUCTURES THAT UNDERLIE LEARNING

“MEMORIES” OF DRUG EXPERIENCE AS A FORM OF LEARNING

BRAIN REWARD PATHWAYS

DEVELOP INTO LATE ADOLESENCE DRUGS CAUSE RELEASE OF DOPAMINE TRIGGERS MEMORY ENCODING LINKED

TO THE DRUG EXPERIENCES LINKED TO DRUG CRAVING

BRAIN PLEASURE MECHANISMS

PREFRONTAL CORTEX -ROLE IN PLANNING & MOTIVATING ACTION, MODULATED BY DOPAMINE (DA)

VTA - PRIMITIVE BRAIN, SYNTHESIZES DA, INFLUENCED BY ENDORPHINS & TARGETED BY OPIATE DRUGS SUCH AS HEROIN

NUCLEUS ACCUMBENS - ROLE IN REWARD, PLEASURE, LAUGHTER, ADDICTION, AGGRESSION, FEAR

“PHARMING”

“GRABBING A HANDFUL OF PRESCRIPTION DRUGS AND SWALLOWING THEM, A COMMON PRACTICE AMONG ADOLESCENTS AND TEENS”

RX DRUG ABUSE

ABUSE ISSUES

CHEWING TABLETS SNORTING CRUSHED TABLETS DISSOLVING TABLETS IN WATER & INJECTING THESE METHODS CAUSE A FASTER, HIGHLY

DANGEROUS RELEASE OF ACTIVE INGREDIENTS

A PUBLIC HEALTH EPIDEMIC

OVERDOSES OF RX PAIN MEDS KILLED NEARLY 15,000 PEOPLE IN THE US IN 2008.

IN 2010 OVER 12 MILLION AMERICANS AGE 12 OR OLDER REPORTED NON-MEDICAL USE OF RX PAIN MEDS

NEARLY HALF A MILLION EMERGENCY DEPARTMENT VISITS IN 2009 WERE DUE TO PEOPLE MISUSING OR ABUSING RX PAIN MEDS.

NON-MEDICAL USE OF RX PAIN MEDS COSTS HEALTH INSURERS UP TO $72.5 BILLION ANNUALLY IN DIRECT HEALTH CARE COSTS

WHO IS AT RISK?

MANY MORE MEN THAN WOMEN DIE OF OVERDOSES FROM PRESCRIPTION PAINKILLERS.

MIDDLE-AGED ADULTS HAVE THE HIGHEST RX PAINKILLER OVERDOSE RATES.

PEOPLE IN RURAL COUNTIES ARE ABOUT 2X AS LIKELY TO OVERDOSE ON RX PAINKILLERS AS PEOPLE IN BIG CITIES.

WHITES AND NATIVE AMERICANS ARE MORE LIKELY TO OVERDOSE ON RX PAINKILLERS.

ABOUT 1 IN 10 NATIVE AMERICANS AGE 12 OR OLDER USED RX PAINKILLERS FOR NONMEDICAL REASONS IN THE PAST YEAR, COMPARED TO 1 IN 20 WHITES AND 1 IN 30 BLACKS.

MAJOR OPIOID DRUGS

HEROIN (SCHEDULE I)

OXYCODONE (PERCODAN®, OXYCONTIN®)

OXYMORPHONE (OPANA®)

MORPHINE

CODEINE

THOSE DUE PRIMARILY FROM ADULTERANTS FOUND IN STREET DRUGS & IN THE NON-STERILE PRACTICES OF INJECTING

SKIN, LUNG, AND BRAIN ABSCESSESBACTERIAL INFECTION E.G. FLESH-EATING STREP C &

STAPH AENDOCARDITIS (INFLAMMATION OF THE HEART LINING)HEPATITIS B,CHIV/AIDS

THOSE DUE TO THE PHARMACOLOGICAL ACTIONS OF THE DRUGS EVEN WITH MEDICALLY APPROPRIATE USE

NAUSEITCHINGBOWEL OBSTRUCTIONRESPIRATORY DEPRESSION

MEDICAL COMPLICATIONS OF OPIOID ABUSE

XANAX AND RELATED DRUGS

BENZODIAZEPINES

PHARMACEUTICAL NAMESATIVAN ®- LORAZEPAM

KLONOPIN® - CLONAZEPAM VALIUM ® - DIAZEPAM XANAX ® - ALPRAZOLAM

STREET NAMES CANDY; Z-BARS; ZANNIES DOWNERS; SLEEPING PILLS; TRANKS

BENZODIAZAPINE BASICS CLINICAL USES:

INSOMNIAANXIETYANESTHESIAMUSCLE RELAXANTS

INTERACT WITH GABA RECEPTORS TO PRODUCE CALM, SLEEP, & AMNESIA

CAUSES REDUCED INHIBITIONS & IMPAIRED JUDGEMENT

CONCURRENT ALCOHOL OR OTHER DEPRESSANT USE CAN

BE FATAL

HIGH ABUSE AMONG HEROIN & COCAINE ABUSERS

ALPRAZOLAM & DIAZEPAM ARE THE TWO MOST FREQUENTLY ENCOUNTERED BENZODIAZEPINES ON THE ILLICIT MARKET

BENZODIAZEPINE ABUSE

PSYCHOSTIMULANTSPROVIGIL ®, METH, AMPHETAMINES,

RITALIN®

PSYCHOSTIMULANT DRUGS

CLINICAL USES:ANOREXIANTS (WEIGHT LOSS)ATTENTION DEFICIT DISORDERDECONGESTANTS

ENHANCE THE ACTIVITY OF NOREPINEPHRINE & DOPAMINE

HEART RATE & BLOOD PRESSURE OFTEN USED/ABUSED TO BOOST COGNITIVE

FUNCTIONS

AMPHETAMINES

FIRST USED IN GERMANY & JAPAN DURING WWII

WIDELY USED AS DIET PILLS DURING 1950s “SPEED” IN 1960s CHEAPER & MORE LONG LASTING THAN

COCAINE

METHAMPHETAMINE

“SPEED”, “CRYSTAL”, “CRANK” Rx – METHEDRINE; DOSOXYN USE: ORAL; IV; SMOKING; SNORTING MORE POTENT BRAIN ACTIONS THAN

AMPHETAMINE GREATER NEUROTOXICITY THAN

AMPHETAMINE

BEHAVIORAL EFFECTSMETHAMPHETAMINE

IRRITABLE; WIRED; JITTERY

MAY FEEL SUPER PRODUCTIVE

STEREOTYPY – STRINGING/UNSTRINGING

BEADS, FLOOR PACING; CLEANING; SHINING

SHOES HOUR AFTER HOUR

METHYLPHENIDATE (RITALIN®, METHYLIN®, CONCERTA®)

STREET SLANG – PINEAPPLE; KIBBLES & BITS

TREATMENT OF EXCESSIVE DAYTIME SLEEPINESS

ASSOCIATED WITH NARCOLEPSY

TREAT ATTENTION DEFICIT HYPERACTIVITY DISORDER

(ADHD) IN CHILDREN.

METHYLPHENIDATE USE

DISSOLVE TABLETS IN WATER & INJECT THE MIXTURE

COMPLICATIONS DUE TO INJECTION OF THE INSOLUBLE

FILLERS USED IN THE TABLETS; THESE MATERIALS BLOCK

SMALL BLOOD VESSELS CAUSING SERIOUS DAMAGE TO THE

LUNGS AND RETINA OF THE EYE

BINGE USE CAUSE PSYCHOTIC EPISODES, CARDIOVASCULAR

COMPLICATIONS, & SEVERE PSYCHOLOGICAL ADDICTION

METHYLPHENIDATE ABUSE

MARIJUANA

THC

9 - TETRAHYDROCANNABINOL

MAJOR PSYCHOACTIVE INGREDIENT

PRODUCES THE “HIGH” FEELING

CHANGES BEHAVIOR & PERCEPTION

ACUTE EFFECTS

PHYSICAL RELAXATION

SEDATION

GIDDINESS

TIME SLOWS DOWN

SHORTENS ATTENTION SPAN

SHORT TERM MEMORY DEFICIT

ANXIETY/PARANOIA

MARIJUANA & BRAIN CHEMISTRY BINDS TO CB1&2 RECEPTORS; SAME AS

ANANDAMIDE, AN ENDOCANNABINOID

DECREASES GABA RELEASE

REDUCES ACETYLCHOLINE ACTIVITY IN HIPPOCAMPUS, AFFECTING MEMORY & COGNITIVE FUNCTIONING

INCREASES DOPAMINE RELEASE

MARIJUANA & HEART ATTACK RISK

A STUDY @ BETH ISRAEL DEACONESS MEDICAL CENTER FOCUSED ON 4,000 PEOPLE WHO HAD SUFFERED A HEART ATTACK

A PERSON'S CHANCE OF HAVING A HEART ATTACK, ESPECIALLY FOR THOSE WHO ARE ALREADY AT RISK FOR HEART DISEASE, NEARLY 5 FOLD DURING THE 1ST HOUR AFTER SMOKING MARIJUANA

HEART ATTACK MAY BE DUE TO THE RUPTURE OF CORONARY PLAQUES CAUSING A CLOT, WHICH RESTRICTS BLOOD FLOW TO THE HEART

MARIJUANA & MENTAL ILLNESS

INCREASED RISK OF SCHIZOPHRENIA INCREASED RISK OF DEPRESSION INCREASED RISK OF SUICIDAL IDEATION INCREASED RISK OF PSYCHOSIS ESPECIALLY

IN THOSE GENETICALLY PREDISPOSED ABOUT 1 OUT OF 4 ARE PREDISPOSED TO

MARIJUANA-RELATED MENTAL HEALTH CONSEQUENCES

© DALTERIO 2009

MARIJUANA & THE IMMUNE SYSTEM

T CELLS VIRAL RESISTANCE RESPIRATORY DISEASES IMMUNOSUPPRESSIVE EFFECTS MEDIATED

BY CB2 RECEPTORS

© DALTERIO 2009

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 POSTNATALLY WERE SIGNIFICANTLY ASSOCIATED WITH 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 2009

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 2009

CONCLUSIONS:Rx CANNABINOIDS

CAN BE EFFECTIVE TREATMENT FOR SEVERAL CONDITIONS IN WHICH PATIENTS DO NOT REPOND TO OTHER THERAPIES

LIKE ANY Rx PRODUCT CANNABINOIDS ARE ASSOCIATED WITH ADVERSE EFFECTS WHICH MUST BE CONSIDERED AS A BENEFIT V RISK MEDICAL DECISION

© DALTERIO 2009

Synthetic cannabinoidsK2 “spice”

SYNTHETIC MARIJUANA STREET NAMES

BLISS

BLACK MAMBA

BOMBAY BLUE

FAKE WEED

GENIE

SPICE

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

American Association of Poison Control Centers

REPORTS THAT SO FAR THIS YEAR THERE HAVE BEEN 567 K2-RELATED CALLS, UP FROM 13 IN 2009

INVESTIGATORS NOT REALLY CERTAIN WHAT IS IN K2 LABELED PRODUCTS

PEOPLE ARE ARRIVING AT ERS WITH SYMPTOMS NOT NORMALLY BE ASSOCIATED WITH MARIJUANA

MECHANISM OF ACTION

K2 AFFECTS THE BRAIN IN THE SAME WAY AS MARIJUANA'S PSYCHOACTIVE THC

BOTH COMPOUNDS BIND TO THE CB1 RECEPTORS, WHICH PRIMARILY AFFECT THE CENTRAL NERVOUS SYSTEM

JWH-018 ALSO BINDS TO THE PERIPHERAL BRAIN (CB2) RECEPTORS, WHICH ARE INVOLVED IN THE IMMUNE SYSTEM

PHYSICAL SYMPTOMS

VERY RAPID IN HEART RATE

DANGEROUSLY ELEVATED BLOOD PRESSURE

PALE SKIN & VOMITING

SEVERE HALLUCINATIONS

EXTREME ANXIETY, AGITATION & SEIZURES

POISON CONTROL CENTER DATA

ALTHOUGH THE DATA IS STILL BEING UPDATED THE FOLLOWING REFLECTS CLOSED CASES FOR SYNTHETIC MARIJUANA EXPOSURES IN 2010 THERE WERE 2,906 CALLS FOR 2011 6,959 AS OF JUNE 2012 THERE WERE 3,372

“bath salts”

“BATH SALTS” BATH SALTS' FIRST BECAME POPULAR WITH

THE CLUB SCENE IN EUROPE

IN 2010 OVER 2,000 CLUBBERS REPORTED THAT 40% OR MORE HAD USED SOME FORM OF BATH SALTS, AND MORE THAN 30% HAD USED THEM WITHIN THE LAST MONTH

THEY ARE SYNTHETIC DERIVATIVES OF CATHINONE, A SUBSTANCE THAT COMES FROM AN AFRICAN PLANT CALLED “KHAT.”

CATHINONE IS A SCHEDULE I CONTROLLED SUBSTANCE UNDER THE FEDERAL CONTROLLED SUBSTANCES ACT

EMERGENCE OF BATH SALTS

THE AMERICAN ASSOCIATION OF POISON CONTROL CENTERS REPORT THAT IN 2009 U.S. POISON CONTROL CENTERS RECEIVED NO CALLS ON INGESTION OF BATH SALTS.

IN 2010, THEY RECEIVED 303 CALLS BY 2011 MORE THAN 6138 CALLS AS OF MAY 2012 THERE WERE 1302

CALLS

EFFECTS ON USERS

DELUSIONS

HALLUCINATIONS

SEIZURES

PANIC ATTACK

INCREASED HEART RATE & BLOOD PRESSURE

FY 2007 - 6,299 FEDERAL OFFENDERS SENTENCED FOR MARIJUANA-RELATED CHARGES IN U.S. COURTS.

APPROXIMATELY 96.9% OF CASES INVOLVED TRAFFICKING

2.5% OF CASES INVOLVED SIMPLE POSSESSION

MARIJUANA & THE JUSTICE SYSTEM

“THE AMBIEN EXCUSE”

Percentage of Fatally Injured Drivers With Known Test Results Testing Positive for at Least One Drug, d 2005-2009

DRUGS & BRAIN CHEMISTRY : SOCIAL IMPLICATIONS

PSYCHOACTIVE DRUGS ACT BOTH RAPIDLY & DRAMATICALLY ON NEURONS THAT RELEASE DOPAMINE

THIS CREATES STRONG & LONG-LASTING MEMORIES ACTIVATING PRIMAL SURVIVAL REWARD MECHANISMS

REWARD IS ACTIVATED BOTH BY DRUG ACQUISITION & ACTUAL DRUG EFFECTS

THE NEED FOR REACTIVATE THESE PATHWAYS ARE PERCEIVED AS NECESSARY FOR SURVIVAL

CONCLUSIONS DRUGS INTERFERE WITH LEARNING &

MEMORY ESPECIALLY IN ADOLESCENTS AGE OF FIRST USE HAS A PROFOUND

EFFECTS ON ADDICTION PROBABILITY DRUG AVAILABILITY INCREASES USE LONG-TERM MEDICAL EFFECTS OF THE

LEGAL ALCOHOL & TOBACCO COST BILLIONS PSYCHOACTIVE DRUG USE HAS PROFOUND

IMPACT ON TRAFFIC-RELATED DEATHS, WORKPLACE ACCIDENTS & ABSENTEISM, DOMESTIC VIOLENCE & CRIMINAL BEHAVIORS