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
