SPECIFIC DRUGS

SPECIFIC DRUGS

The Major (vs. minor) Stimulants

Cocaine and Amphetamine

Major Stimulants - Cocaine

* Free association

COCAINE

* What is coke and where does it come from?

coca leaf / coca bush Incas and Spanish Freud American history (VIP usage)

Major Stimulants - Cocaine

street cocaine: coca paste and hydrochloric acid =

type of salt--powder sniffed or snorted

more addictive uses:

can inject it if mix with water--IV quicker smoking: freebase - powder and ether crack - dissolve cocaine salt in baking soda solution, boil off water, left with rock

Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of cocaine, which may be more cardiotoxic via increased half-life of cocaine

Dependence Potential of Psychoactive DrugsVery High: Heroin (IV)

Crack cocaineHigh: Morphine

Opium (smoked)Moderate/High: Cocaine powder

Tobacco cigarettesPCP (smoked)

Moderate: Diazedpam (Valium)AlcoholAmphetamines (oral)

Moderate/Low: CaffeineMDMA(Ecstasy”)Marijuana

Low: KetamineVery Low: LSD, Mescaline

Psilocybin

Major Stimulants - CocainePrevalence

1998 2003Cocaine (Crack) Cocaine (Crack)

Past month .8% (.2%) 1.0% (.3%)

Past year 1.7% (.4%) 2.5% (.6%)

Lifetime 10.6% (2.0%) 14.7% (3.3%)

cheapness of crack--national crisis

shift of users from college educated to high school dropouts

smoking cocaine becoming more popular, especially among young users

Major Stimulants - SpeedAmphetamines• ephedrine, principal chemical in these drugs, has been known for thousands of years; used as Chinese medicinal herb

• ephedrine first isolated in late 1800's, and synthesized in 1920s when it was named “amphetamine”

• first medically used in 1920's for treating obesity, narcolepsy, colds, and much later ADHD

• used to enhance performance, decrease fatigue – sport & military applications (e.g., go and no-go pills)

Major Stimulants - SpeedPrevalence – 2003

Stimulants (Methamphetamine)

Lifetime 8.8% 5.2%

Past year 1.2% 0.6%

Past month 0.5% 0.3%

*ages 12 and older, from NSDUH

Major Stimulants

• Neurotransmitters and behavioral pharmacology

• Effects of the Major Stimulants

– Desired effects– Negative effects– Overdose

• Withdrawal SXs

Major Stimulants

•Medical Effects

• Fetal Exposure during Pregnancy

• Other Co-morbid Diagnoses

• Factors in Initiation of use leading to

dependence

Major Stimulants Treatment of Cocaine Dependence

A. Drug TX

B. Psychological TX

• Community reinforcement

• Payment for abstinence• Relapse prevention (triggers, cravings…)

• Lifestyle modification• Self-help Groups (CA - cocaine anonymous)

U.S. Banned Ephedra in 2004

• used primarily for weight loss and body building in the U.S.

• linked to 155 deaths and dozens of heart attacks and strokes.

• Derived from a plant (powdered and then put in pills)

• Contains ephedrine & pseudoephedrine

ephedra ban, cont…

• side effects can be life threatening even for a health individual (constricts blood vessels, raises blood pressure).

• FDA was aware of a problem for 8 years, however the high profile death of Baltimore Orioles pitcher, Steve Bechler stimulated concern from the FDA as well as many others.

• 1st government ban on a dietary supplement