Goldberg Chapter 11

Albia Dugger • Miami Dade College

Chapter 11Stimulants

Types of Stimulants

• Stimulants modify a person’s activity level, mood, and central nervous system

• Some stimulants, such as cocaine and methamphetamines, are illegal

• Others, such as amphetamines, require a prescription

• Legal stimulants such as caffeine and nicotine are among the most widely used drugs in the world

Cocaine

• Cocaine comes from the leaves of the coca plant, Erythroxylon coca

• Natives of the Andes Mountains chew coca leaves to relieve fatigue, for spiritual reasons, or to enhance well-being

• Colombia is the largest producer of cocaine

Sources of Cocaine

• Bolivia and Peru account for a small percentage of cocaine production

Properties of Cocaine

• Cocaine is an odorless, crystalline, white powder that produces intense euphoria, alertness, and energy

• Cocaine may be used in a Brompton’s cocktail, which is used to manage cancer pain

• Cocaine is used in surgical procedures on the facial area

Mode of Intake

• Injected cocaine reaches the brain the fastest, and euphoria is rapid and intense

• Snorted cocaine is absorbed into the bloodstream through the nasal mucous membranes

• Crack cocaine is made by heating cocaine after mixing it with baking soda and water

• Freebase cocaine is separated from its hydrochloride salt by heating, using a volatile chemical such as ether

Crack Cocaine

Cocaine Paraphernalia

Forms of Cocaine

Historical Use of Cocaine

• Cocaine was isolated from coca leaves by the German scientist Niemann around 1859

• Freud recommended cocaine to alleviate opiate addiction, depression, and fatigue

• Cocaine was originally included in Coca-Cola

• The Harrison Narcotic Act of 1914 designated cocaine as a narcotic

Early Products Containing Cocaine

Current Use of Cocaine

• Cocaine use increased again in the 1970s, accompanied by an increase in cocaine-related deaths

• In the 1980s celebrity users made cocaine glamorous

• In 2010, an estimated 1.5 million Americans aged 12 and older were cocaine users

2010 Drug Use

Crack

• Crack is usually smoked, but it can also be injected

• Because it comes in small units, the cost is low

• The euphoria is brief (about 10 to 20 minutes), and the desire to repeat usage is high

• Crack use is a problem among impoverished, inner-city adolescents

Crack

• Many addicts exchange sex for crack

• Rates of AIDS are high

Crack Law

• In 1984, laws mandated harsher penalties for individuals arrested for crack cocaine than for powder cocaine

• In 2010, the United States Sentencing Commission reversed that law

• The law was viewed as racially discriminating – 85% of offenders are African American, only 5% are White

Crack Arrests

Cocaine and the Media

• Drugs and musicians:• Jazz musicians commonly used cocaine during the 1930s

and 1940s• Starting in the 1960s, references to drugs in music were

conspicuous• In the early 1990s, rap musicians promoted cocaine use

• The media offer a paradoxical view of cocaine – the drug is connected with high status, yet the messages often carry a negative connotation

Physical Effects of Cocaine

• Elevated blood pressure• Excessive perspiration• Nausea, vomiting,

abdominal pain• Headache• Tightened muscles • Slower digestion• Anorexia• Nutritional deficiencies• Rapid pulse• Faster breathing rate

• Increased body temp• Urge to urinate,

defecate, belch• Inflammation of trachea

and bronchi• Hoarseness or laryngitis• Wheezing and coughing• Coughing up pus,

mucus, blood• Seizures• Hallucinations

Physical Effects of Cocaine

• Physical effects of cocaine depend on how the drug enters the body

• The speedball, an injected mixture of cocaine and heroin, carries a higher risk of dependency and overdose

• Smoked cocaine can affect the heart to the point of congestive heart failure and death

• Injected cocaine has been linked to inflammation of the heart lining and liver

Psychological Effects of Cocaine

• Talkativeness• Mood swings• Hallucinations• Repetitive behaviors• Extreme depression• Neglect of personal

hygiene

• Rage and violent behavior

• Delusions• Distorted perceptions• Depersonalization• Suicidal ideation• Paranoia

Rates of Emergency Room Visits

Cocaine Dependence

• Cocaine users build up tolerance to the drug, but not to the health risks

• Withdrawal symptoms include depression, lack of energy, poor appetite, restlessness, and agitation

• Scientists are working on a vaccine for preventing addiction to cocaine and other drugs

Three phases following abstinence

• Intense craving, agitation, anorexia, and deep depression –the desire for cocaine may increase

• Withdrawal, during which the person is incapable of feeling normal pleasure, but depression moderates and sleeping becomes easier

• Extinction, during which improvement is considerable, but periods of depression and craving can occur

Drugs to treat cocaine withdrawal

• The African hallucinogen ibogaine is a controversial drug given to cocaine addicts

• Propranolol eases withdrawal symptoms, making it easier for cocaine addicts to remain in treatment

• Disulfiram, a drug used to treat alcoholism, has also shown potential as a treatment for cocaine addicts

• Typically cocaine addicts are given antidepressants to lessen withdrawal symptoms

Death from Cocaine

• Cocaine can cause irregular heartbeat (cardiac arrhythmias), high blood pressure, chest pains and heart attacks

• Coronary artery disease leading to death is relatively common in cocaine users

• Some fatalities result from uncontrolled seizures, strokes, or paralysis of breathing muscles

• People who inject cocaine are in danger of contracting HIV and other potentially fatal infections

Cocaine and Pregnancy

• 1 out of every 25 women use an illegal drug while pregnant

• Cocaine constricts blood vessels and reduces blood flow and oxygen to the fetus

• Cocaine can cause detachment of the placenta, as well as premature labor

• Cocaine may reduce immunity in the fetus, increasing the risk of HIV infection

Cocaine and Pregnancy

• Prenatal exposure to cocaine delays growth and language development

• Some babies have neurological problems, perhaps caused by strokes before birth

• Babies have higher rates of congenital heart defects, lower birth weights, seizures, and are at risk for sudden infant death

• Babies tend to be born with smaller heads, and are more prone to urinary tract problems

Amphetamines

• Amphetamines were developed as inhalers to treat asthma, sold under the name Benzedrine

• Amphetamines were used for treating depression, for increasing work capacity, and for treating narcolepsy

• It then was used to suppress appetite and ward off fatigue

• In the late 1930s, it was given to hyperactive children

Common Amphetamines

Pharmacology of Amphetamines

• Amphetamines can be administered by ingestion, injection, snorting, or inhalation

• Tolerance develops quickly – many users increase the dosage or go on binges to maintain their high

• Amphetamines are sympathomimetic drugs – their effects are similar to those in people who are emotionally aroused

• Their chemical structure is similar to that of the neurotransmitters norepinephrine and dopamine

Pharmacology of Amphetamines

• The half-life is 10 to 12 hours, and they are not totally eliminated from the body for about two days

• Amphetamines are removed from the body in two ways:1. They are excreted through urine after being transformed

by liver enzymes2. They are deactivated and removed by adding molecules

to the amphetamine compound

Pharmacology of Amphetamines

• Psychological effects include paranoia, violence, restlessness, agitation, hallucinations, confusion, and anxiety

• Physical effects are tremors, tinnitus (ringing in ears), dry mouth, excessive perspiration, increased blood pressure, poor coordination, and convulsions

• Amphetamines are especially harmful to the cardiovascular system and can cause cardiac arrest

The Amphetamine Trade

• In the 1940s, Japan and Sweden had severe problems with amphetamine abuse

• In the 1930s, people in the US could legally obtain amphetamines

• In 1970, they represented about 8% of prescriptions

Consequences of Amphetamine Use

• Most people who are dependent on amphetamines experience withdrawal, continue using them despite problems, cannot stop, develop tolerance, and give up other activities to use amphetamines

• Stimulants can improve mental and physical performance for simple tasks – but not for tasks requiring complex thinking, such as problem-solving and decision-making

Consequences of Amphetamine Use

• High doses negatively affect judgment and decision-making skills, and can cause severe behavioral problems

• Gross motor skills improve; fine motor skills are impaired

• Amphetamine psychosis – marked by paranoia, aggressiveness, fearfulness, disordered thinking, mania, and hallucinations – is a significant problem related to chronic use

Methamphetamines

• Methamphetamines (speed) are more potent forms of amphetamine

• “Speed freaks” go on binges, shooting up every few hours over a five- or six-day period before crashing

• Many users take methamphetamines in conjunction with other drugs such as cocaine and marijuana

Nicknames for Methamphetamines

• Speed• Ice• Crystal• Meth• Chicken powder• Go-fast• Glass

• Crank• Christy• Crystal-meth• Chalk• Peanut butter-crank• Shabu-shabu• Zip

Methamphetamine Laboratories

• In the US, methamphetamines have become the number-one drug problem in rural areas

• Types of harm associated with meth labs:• Physical injury from explosions, fires, chemical burns, and

toxic fumes• Environmental hazards• Child endangerment

Methamphetamine’s Effects

• Slurred speech• Loss of appetite• Excitement• Increased blood

pressure and heart rate• Irregular heartbeat• Pounding heart• Severe chest pain• Hot flashes• Excessive perspiration• Anxiety

• Tremors• Confusion• Insomnia• Convulsions• Memory loss• Violent behavior• Elevated body temp• Paranoia• Auditory hallucinations• Death

Methamphetamine “Ice”

Ritalin and Adderall

• Ritalin (methylphenidate) and Adderall are the most prescribed drugs for ADHD

• Ritalin and other stimulants enhance the functioning of the reticular activating system, which helps children focus attention and filter out extraneous stimuli

• Side effects include insomnia, weight loss, headaches, irritability, nausea, and dizziness

Caffeine

• Caffeine is the world’s most frequently consumed stimulant

• Tea contains caffeine and theophylline, a stimulant from the same chemical family as caffeine

• Products containing caffeine include gum, mints, beer, candy, sunflower seeds, many prescription medicines, and chocolate

• Another stimulant in chocolate, theobromine, is related chemically to caffeine but is less powerful

High-Energy Caffeinated Beverages

• The FDA does not regulate caffeine in food and drinks –however, it suggests that a safe level is 72 mg per 12 ounces

• Many beverages such as Red Bull, Monster, and Rock Star exceed that level

• To counter the sedating effects of alcohol, some individuals alternate with these high-energy drinks when drinking alcohol

Caffeine Content

Pharmacology of Caffeine

• Caffeine acts as an antagonist to receptors for the inhibitory neurotransmitter adenosine

• Peak effects occur 30 to 45 minutes after consumption

• Caffeine use by well-conditioned athletes has been found to improve endurance on a short-term basis

• Extreme caffeine intake has been linked to a low blood sugar condition called hypoglycemia

Properties and Risks of Caffeine

• Caffeine is a xanthine – stimulants that improve work capacity, alertness, motor performance, and curb fatigue

• Caffeine may delay the progression of Alzheimer’s disease; help asthmatics breathe easier; and may reduce risk of type 2 diabetes in younger and middle-aged women

• Caffeine taken on an empty stomach releases stomach acids and digestive enzymes, causing an upset stomach

Properties and Risks of Caffeine

• Side effects include nervousness, anxiety, insomnia, heartburn, and symptoms of premenstrual syndrome

• Caffeine has been implicated in cardiovascular conditions from heart disease to hypertension

• Caffeine might contribute to breast lumps, breast tenderness, and cysts

• Caffeinated coffee decreases the likelihood of certain cancers

Effects of Caffeine

• At moderate levels, caffeine increases blood pressure, body temperature, blood sugar levels, metabolism, urination, and hand tremors, and decreases appetite and coordination

• In large amounts, it causes nausea, diarrhea, shaking, headache, and nervousness

• At worst, caffeine can cause convulsions, respiratory failure, and, if one drinks 70 to 100 cups of coffee, death

Effects of Caffeine

• Caffeine users need the drug to achieve alertness and to eliminate withdrawal symptoms

• Withdrawal symptoms appear in people who consume 2½ cups of coffee or more daily

• Withdrawal symptoms include headache, depression, lethargy, lower energy level, drowsiness, and irritability

Decaffeinated Coffee

• Caffeine is displaced from the coffee bean using a hot water solution – then is taken out of the water an organic solvent

• The original solvent, trichloroethylene, is potentially carcinogenic – it was replaced by methylene chloride, which also might contribute to cancer

• Decaffeinated coffee still has some caffeine: 5 mg to 32 mg per 10 to 12 ounces (compared to 100mg)

Caffeinism

• Excessive caffeine consumption resulting in caffeine dependency is called caffeinism

• More than one-half of moderate coffee drinkers who stop drinking it experience moderate to severe headaches

• Caffeinism is marked by irritability, depression, insomnia, headaches and morning lethargy

• About one-fourth of users experience withdrawal symptoms when they discontinue drinking caffeine