Medical Effects of Drugs of Abuse Pierre Rouzier, M.D.

Medical Effects of

Drugs of Abuse

Pierre Rouzier, M.D.

Goals and Objectives

• Learn how drugs work

• How you get high

• How you OD

• How you die fast

• How you die slow

• Understand drug dependence/addiction/withdrawal

Classes of Drugs

• Depressants • Stimulants• Opiates• Cannabis• Hallucinogens• “Designer/Club Drugs”

Basic principles

• Receptors - part of nervous system where drugs bind

• Neurotransmitters - “messengers” send signals ex: serotonin

• Tolerance - need for “more” to get the same effect

• Addiction - receptors “need and want” drug to feel normal

UMass survey-664 random students polled spring 2003

• Alcohol use: Average # drinks/week: males-15 females-7

• “Binge drinking” - # of drinks in a “sitting” (males-5 females-4)

72% of all students in past 2 weeks.

SurveyWhy do students drink...

• 89% gives people something to do

• 82% facilitates a connection with peers

• 80% allows people to have more fun

• 55% makes it easier to deal with stress

• 65% facilitates sexual opportunities

• 26% makes them sexier

Survey - Drug use

• Marijuana - 61% smoked in past year, 31% smoke once a week

• 10% used designer drugs, hallucinogens, cocaine, sedatives

Depressants

• Examples: alcohol, benzodiazepines (valium), barbituates (secobarbital), etc.

• Tolerance - all

• Addiction - physiologic, psychologic

Depressants, cont.

• Effects - slurred speech, decreased inhibition, disorientation, staggering, drunken behavior

• Overdose - decreased respirations, loss of consciousness, coma, death

• Withdrawal - anxiety, insomnia, elevated BP/pulse, tremor, hallucinations, seizures, death

Alcohol levels

• 0.08 legally drunk• 0.1 “delightfully dizzy”• 0.2 “drunk and disorderly”• 0.3 “death’s doorstep”• 0.4 “dead drunk”

What’s your alcohol level?1 drink = 12 oz. beer, 4 oz. wine, 1 oz. Liquor

# drinks/time (hours 1-2-3)

Weight (lbs) 2 4 6 8 100 .07/.04/.02 .14/.12/.10 .22/.12/.18 .27/.25/.23 120 .06/.03/.01 .12/.09/.08 .18/.16/.14 .26/.24/.22 140 .05/.02/- .10/.07/.05 .15/.13/.11 .20/.18/.16 160 .045/.02/- .09/.06/.04 .13/.10/.09 .18/.15/.13 180 .04/.02/- .08/.05/.03 .115/.09/.07 .16/.14/.12 200 .035/-/- .07/.04/.02 .10/.08/.06 .14/.12/.10

The problem drinker

• Family, friends, you?• CAGE• Cut down• Annoy anyone• Guilty• Eye-opener• Repeatedly do stupid things• Bring out the demons?

Alcohol - how to die slowly

• Liver disease• Stomach and esophagus• Pancreas• Brain atrophy• Bleeding problems• Trauma, injuries• Making bad choices

Stimulants

• Examples - caffeine (oral), ephedrine (oral), cocaine (snorted, smoked, IV), amphetamine, (oral, SS,IV), methylphenidate (Ritalin)

• Tolerance - all

• Addiction - physiologic and psychologic

Stimulants, cont.

• Effects - increased alertness, excitation, euphoria, increased pulse and BP, decreased appetite

• Overdose - agitation, fever, hallucinations, seizures, heart attack, death

• Withdrawal - severely depressed mood, prolonged sleep, apathy, irritability, disorientation

Opiates• Examples - heroin (IV, smoked), opium

(oral, smoked), morphine (oral, IV), codeine, etc. (oral), methadone (oral, IV)

• Tolerance - all

• Addiction - physiologic and psychologic

Opiates, cont.

• Effects - euphoria, drowsiness, nausea, decreased respirations

• Overdose - clammy skin, constricted pupils, respiratory arrest, coma, death

• Withdrawal - watery eyes, runny nose, goose bumps, yawning, decreased appetite, nausea, chills and sweats, panic, tremor, cramps (“COLD TURKEY”)

Cannabis

• Examples - marijuana (smoked, oral), THC (oral), hashish (smoked)

• Tolerance - all

• Addiction - psychologic, minimal physiologic

Cannabis, cont.

• Effects - Euphoria, relaxation, loss of inhibition, increased appetite, decreased memory and attention.

• Overdose - can get panic attacks, hallucinations, paranoia

• Chronic effects - problems with short term memory, cognitive skills

• Withdrawal - rare, insomnia, hyperactivity

Hallucinogens

• Examples - LSD, psilocybin, peyote, mescaline• Tolerance - all• Addiction - psychologic, minimal physiologic• Effects - altered perception of body,

hallucinations, visual illusions, increased emotions• Overdose - prolonged episodes, psychotic states• Withdrawal - none

Ecstasy• MDMA - “methylenedioxymethamphetamine”

• Early 1900’s used in psychotherapy

• Hallucinogenic stimulant

• Euphoria, enhanced mental or emotional clarity, “tingling” sensation, “love to be touched”

• Tablet, pill, powder $10-$30

• High 3 -4 hours (longer?)

Ecstasy side effects• nausea, vomiting, loss of

appetite

• blurred vision

• anxiety, paranoia

• seizures

• dehydration

• hyperthermia

• coma and death

• dumping of serotonin depression

Ketamine• aka “special K”

• Veterinary anesthetic

• Effects - Relaxation, loss of sense of time and identity, hallucinations, visual distortion

• Adverse effects - delirium, amnesia, depression, tachycardia, respiratory depression

PCP (Phencyclidine)

• aka angel dust, to be “dusted”

• Veterinary anesthetic

• dissociative effects

• Adverse effects - aggression, violence, panic, loss of appetite, decrease BP/HR

Rohypnol

• Date Rape drug (“roofies”, “roache”, etc.)

• Benzodiazepine - 10 times stronger than Valium

• Oral - “slipped in to a drink”, colorless, odorless, tasteless

• Effects - intoxicated, sleepy, sedated, blackouts, amnesia

• Adverse effects - rape, memory loss, respiratory depression, hallucinations

GHB• Gamma-hydroxybutyrate. Depressant.

• Initially a weight lifting supplement.

• Date rape

• Oral - tablet, powder ,dissolved in liquid @$5.00 per dose

• Effects - start within 1 hr, lasts 1 to 3 hrs, euphoria, intoxication, disinhibition, sedation

• Adverse effects - nausea, vomiting, seizures, respiratory depression, coma

Inhalants• Aerosols - paint, hair

spray, whippets• Solvents - gasoline, glue,

paint thinner, nail polish remover, white out

• Gases - nitrous oxide, butane lighters

• Nitrites - air fresheners, video head cleaners

• Sniffing, bagging, huffing

• euphoria, intoxication

• Bad for you!! Dizzy, headache, irregular heartbeat, sudden death

• Can attach to fatty tissues causing brain and nerve damage