Uppers Downers & All Arounders Uppers/Stimulants Chapter 3.

Uppers Downers & All Arounders

Uppers/Stimulants

Chapter 3

Uppers/Stimulants

• In 1999 about

• 1.7 million Americans used amphetamines for nonmedical reasons,

• 4.2 million used cocaine,

• 68 million smoked cigarettes,

• 200 million drank coffee, tea, caffeinated soft drinks or an over-the-counter medication containing caffeine. (p. 83).

General Classification

• Most people use stimulants in the form of:– Diet aids– Drugs to control hyperactivity– Coffee & Tea– Cigarettes– Caffeinated solf drinks

• Stimulants are found in plants and in synthetic form

General Effects

• Stimulants force the release of the energy chemicals (epinephrine and norepinephrine along with dopamine and serotonin)

• Infuses the body with large amounts of extra energy before the body needs it

• With heavy use the body’s energy supply is depleted leading to crash, withdrawal and depression

• Crash and withdrawal occurs when energy supplies become depleted and body is left without reserves

General Effects

• All Stimulants activate chemical and electrical activity in central nervous system– Increases

• Heart rate• Blood pressure• Respiration

– Effects include• Activeness• Restlessness

– Medical uses include treatment of obesity, narcolepsy and Attention-deficit/hyperactivity Disorder

General Effects

• Reward/reinforcement center is artificially over-stimulated– Rush of pleasure and strong sense of wellbeing– Often accompanied by no basic need for hunger,

thirst or sex

• Weight loss: stimulants fool the body into thinking it has satisfied hunger without eating

• Cardiovascular side effects include constricted blood vessels, high blood pressure and sometimes arrhythmia– Chronic use weakens blood vessels and risk of stroke

General Effects

• Emotional & mental effects:– Initial release causes increase of confidence and

euphoria– As use continues feeling of euphoria turn to

irritability, paranoia, aggressiveness, depression

• Tolerance & Addiction liability– Increases as body loses its ability to synthesize

drugs– Can also develop with methamphetamine

congeners, caffeine, nicotine and other mild stimulants

COCAINE

• Cocaine epidemics seem to occur every few generations

• Hardcore use still strong in 2000’s

• Cocaine is extracted from coca plant– 97% grown in South America– Colombian drug Cartels control cultivation and

production – 2/3 of smuggling handled by drug artels in

Mexico– U.S. consumes 70% of world’s cocaine trade

COCAINE: Routes of Administration

• Chewing Leaf: Historically Native cultures• Drinking: Started in 1880’s in wine, coca cola,

and patent medicine. Widely prescribed to womem

• Injecting: Started after the invention of hypodermic needle in 1853– Intravenous use takes 15-30 seconds– Subcutaneous/intramuscular takes 3-5 minutes

• Snorting: Self-limiting method– The more snorted, the less absorption due to

constriction of capillaries in the nose– Destructive to nasal passages

COCAINE: Routes of Administration

• Mucosal & contact absorption– Can be absorbed through mucosal tissue in

nose, mouth, rectum & vagina– Delivery method is also used for dental work,

minor surgeries

• Smoking: – First introduced in 1914, but high temperature

was needed to keep cocaine cigarettes going– Mid-1970’s, cocaine hydrochloride was

chemically altered into freebase– Fastest form to reach brain… Highly addictive

COCAINE: Physical and Mental Effects

• Metabolism: Quickly metabolized and disappears faster than methamphetamine

• Medical Use: Only naturally occurring local anesthetic– Used to numb nasal passages, eyes, throat, and chronic

sores

• Neurochemistry & Central Nervous System– Forces relase of norepinephrine, epinephrine and dopamine– Blocks re-absorption so more intense stimulation– Blocks 60-70% of dopamine reuptake– Too much dopamine can over stimulate brain’s fright center

causing paranoia.– Excessive use causes insomnia, agitation and severe

depression

COCAINE: Physical and Mental Effects

• Sexual Effects: – At low doses cocaine increases desire for sex

and delay ejaculation– As use continues sexual dysfunction occurs

• Aggression, violence & cocaethylene– Increases aggression & violence by disrupting

inhibitory and fright centers of the brain– Cocathylene (metabolite when cocaine &

alcohol is combined) induces greater agitation, euphoria and violence

• Can also induce cardiac conduction abnormalities

COCAINE: Physical and Mental Effects

• Cardiovascular Effects– Can damage circulatory system– Raise blood pressure– Cause stroke (bursting of blood vessels in brain)– Cause heart damage

• Neonatal Effects:– Transmitted within seconds to fetus– Increases chances for miscarriage, stroke, SIDS,

respiratory ailments, mental delays & other abnormalities

– Proper pre-natal and post natal treatment can hel cocaine babies

COCAINE: Physical and Mental Effects

• Tolerance: To the euphoric effect can begin to develop after first injection or smoking session

• Withdrawal, Craving & relapse:– Major effects include anhedonia, lack of

energy and intense craving– Typical cycle of compulsive use:

• Bingeing to crashing to detox to resolutions of abstinence or treatment and relapsing 2-4 weeks later.

COCAINE: Physical and Mental Effects• Overdose:

– Can be caused by as little as 1/50 gram– Overwhelmingly intense stimulation– Injury to heart and blood vessels– More often not fatal…just feels that way– Severe reaction through in verse tolerance or kindling

• Miscellaneous Effects:– Formication (itching from imaginary bugs)– Dental erosion– Seizures– Gastrointestinal complications

• Cocaine Psychosis: – Paranoid psychosis/schizophrenia caused by excess

dopamine– Can also activate genetic predisposition to

schizophrenia

COCAINE: Other Problems with Use

• Polydrug Use– Alcohol, valium, heroin to take the edge off

• Adulteration & Contamination– Cocaine at street level is almost always cut– When injected, bacteria and viruses

contaminate drugs and needles– Hepatitis C rate for IV drug users is between

50% and 90%

• Compulsion – Use for euphoria, boredom, peer pressure,

curiosity, self-medication, escape from personal problems

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Smokable cocaine (freebase, crack, paste)Smokable cocaine (freebase, crack, paste)

SMOKABLE COCAINE (CRACK & FREEBASE)• Pharmacology of smokable Cocaine

– Began around 1981– Crack epidemic in 1986– Chemically crack is the same as freebase– Delivered to the brain faster– Ether converts cocaine to freebase– Baking soda converts cocaine to crack

• Effects and Side Effects– More intense than snorting or injecting– Rush or euphoria last 5 – 20 minutes– Replaced by the feeling of irritability and other

negative emotions– Always used in a binge pattern– Chronic use include paranoia, intense cravings,

depression, cocaine psychosis, high-risk sexual activity

SMOKABLE COCAINE (CRACK & FREEBASE)

• Respiratory Effects– Breathing problems– Severe fever– Chest pains– Coughs– Crack lung– Hemorrhage– Respiratory failure & death– Aggravated by cigarette smoking

• Polydrug use – Increases the potential for abuse of

depressants

SMOKABLE COCAINE (CRACK & FREEBASE)• Overdose

– Mild-rapid heart beat– Hyperventilation– Fear of dying– Kills several thousand a year due to

• Cardiac arrest• Seizure• Stroke• Respiratory failure• Severe hypothermia

• Consequences of Crack use– Economic– Social: abuse, family, legal, formation of sex trade

• Cocaine vs Amphetamines– Cocaine’s duration is 40 minutes/ Meth is 4-6 hours– Meth is cheaper

Amphetamines

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MethamphetaminesCopyright 2004, CNS Productions

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““Ice”Ice”

Amphetamines

• Classification: “Sympathomimetic agent”– Stimulate the release of sympathic neurotransmitters– Activates the sympathetic nervous system that

controls the fight or flight response– Stimulates the reward/information center– Street names: crank, ice, shabu, glass, clear

• History of Use– First synthesized in 1887– Medically used in 1930s– Treats narcolepsy & depression– Used by students and truck drivers to stay awake– Widely used in pill form during WW II

Amphetamines

• History of Use– Japanese epidemic continued after WW II– 1970 6-8% of American population used

prescribed amphetamines for weight loss– Street speed chemists increased production

of crank and crystal in late 1980s– Ice highly potent smokable form used in

1990’s and common use in Hawaii– Recent development of “ya ba” in Thailand

Amphetamines (Effects)

• Routes of Administration– Snorting– Intravenous– Smoking– Oral

• Neurochemistry– Like cocaine, amphetamines increase levels of

catecholamines by stimulating their release and blocking reuptake

– Unlike cocaine, amphetamines block metabolism– Long term use alters the ability to produce vital

neurotransmitters causing depression and taking mor to stay normal

Amphetamines (Effects)• Physical Effects

– Small to moderate doses cause • Increased heart rate• Raised body temperature• Rapid respiration• Higher blood pressure• Extra energy• Dilation of bronchial vessels• Appetite suppression

– Meth users go on binges for 3, 4 or 10 days• Long term use can cause sleep deprivation• Heart & blood toxicity• Severe malnutrition• Bad or rotten teeth• Tolerance is more pronounced

Amphetamines (Effects)

• Mental & Emotional Effects– Mild to intense euphoria / sense of wellbeing– Prolong use leads to

• Irritability• Paranoia• Anxiety• Confusion• Poor judgement• Hallucinations• Delusions• Can result in violent, suicidal & homicidal thoughts• Antisocial behaviors

Amphetamines (Effects)

– With abstinence, disturbed mental states such as amphetamine psychosis or depression can stop for some people

– Amphetamines release neurotransmitter that mimics sexual gratification

• Effects of Ice is greater on the brain than the respiratory and pulmonary system– Results in more overdoses– Greater mental side effects– Longer detoxification

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Lookalike StimulantsLookalike Stimulants

Any combination of Any combination of

CaffeineCaffeine

EphedrineEphedrine

PseudoephedrinePseudoephedrine

Amphetamine Congeners/Lookalikes

• Methylphenidate (Ritalin)– Most widely used– Prescribed as mood elevator, narcolepsy and to treat

Attention-deficit/hyperactivity disorder• Diet Pills

– Only recommended for short-term use– Careful monitoring by physician– Long-term use associated with abuse

• Lookalikes– Prescription drugs that contain ephedrine and

pseudoephedrine (anti-asthmatics)– Decongestants– Caffeine– Ephedra & ephedrine

Miscellaneous Plant Stimulants

• Khat & methcathione– Used in Arab and African countries– Produces amphetamine like highs– Insomnia, anorexia– Chronic abuse cause exhaustion, violence &

depression– Methcathione: AKA ephedrone is synthesized

in illegal labs in U.S.• Sold as a powerful alternative to

methamphetamine

Miscellaneous Plant Stimulants

• Betel Nuts (seed of betel palm)– Used by 200 million people in Arab world, India and

Asia– Effects similar to nicotine– High doses can be toxic and produce psychological

dependence

• Yohimbine– Spicy extract from African yohimbe tree– Used in tea– Medicine– Aphodisiac– Produces mild euphoria and occassional

hallucinations

Miscellaneous Plant Stimulants

• Ephedra– Ephedra bush– Mild stimulant used as medicine, tea & tonic– Also used by athletes for energy boost– Banned in U.S. because of overdoses– This drug and synthetic version is main

ingredients in methamphetamine & methcathione

– Herbal Ecstasy and Herbal Nexus are two herbal products marketed as stimulants and as buffers for illegal drugs

• Contains herbal forms of ephdrine, caffeine, herbs and vitamines

Miscellaneous Plant Stimulants

• Caffeine– Most popular stimulant in the world– Found in teas, coffee, soft drinks, chocolate &

hundreds of medications

• History– Tea: drunk in China as early as 2700 B.C.

• Introduced to Europe in 16th Century

– Coffee: Cultivated in Ethiopia A.D. 650 and spread to Arabia then Europe

• Classified as a drug and banned in many cultures

– Cocoa: Mayan and Aztec royalty• Only small amount of caffeine in cocoa

Miscellaneous Plant Stimulants

• Pharmacology– Classified as an akaloid of the chemical class called

xanthines– Found in more than 60 plants– Takes 15-35 hours for 95% of the caffeine to be

excrete by the body

• Physical and Mental Effects– Mild stimulant– 5-7 cups of coffee can cause anxiety, insomnia,

nervousness– Higher doses can cause muscle twitching, increased

heart rate, palpatations– Letal at about 10 grams (100 cups of coffee)

Miscellaneous Plant Stimulants

• Tolerance, withdrawal & addiction– Dosages vary depending on person– Symptom includes throbbing headache– Dependence can occur with 5 cups of coffee 10 cola drinks or 8 cups of tea

• Nicotine– Cigarettes account for 90% of all tobacco use

in U.S.– Discover in American and spread to Europe– Smokeless tobacco: moist snuff, powder snuff

& loose-leaf• Absorbed by mucosal in the mouth and nise

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U.S. Cigarette Use, 2001 U.S. Cigarette Use, 2001 (12 & older)(12 & older)

Ever usedEver used 68.9% 151.6 million68.9% 151.6 million

Used past yearUsed past year 29.5% 65.6 million29.5% 65.6 million

Used past monthUsed past month 24.9% 56.3 million24.9% 56.3 million

Nicotine/Tobacco

• Pharmacology– Nicotine is the most important ingredient– Average cigarette contains 10 mg of nicotine– Central Nervous system stimulant that

disrupts the balance of neurotransmitters• Dopamine• Endorphins• epinephrine,• Acetylcholine• Constricts blood vessels• Raises heart rate• Depresses appetite• Produces mild euphoria• Deadens senses

Nicotine/Tobacco

• Two most important reasons people smoke tobacco is:– Weight loss– Craving

• One must keep a certain level in blood stream to avoid withdrawal

• Tolerance develops quickly• Withdrawal causes:

– Headaches– Nervousness– Fatigue– Severe irritability– Intense craving– Poor concentration– Sense of relaxation from smoking a cigarette is actually

a withdrawal symptom being subdued

Nicotine/Tobacco

• Addiction– Tobacco is pure example of addiction

process• 80% want to quit & 10% want to cut down• May have a genetic predisposition to nicotine

addiction

• Side Effects– Tobacco & smoke contain more than 4,000

other chemicals of which 400 are classified as toxic

– 43 are known as carcinogens

Nicotine/Tobacco

• 1997: 3.5 million premature deaths

• In U.S. 392,000 die prematurely

• 50,000 die of second hand smoke

• Cardiovascular & Respiratory effects:– Plaque formation– Hardening of the arteries– Leading cause of heart attacks– Lung cancer– Men who smoke are 22 x’s more chance of

cancer– Women 12 x’s more chance of cancer