Uppers Downers

1
Uppers Downers All Arounders

• Uppers/Stimulants
• Chapter 3

2
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).

3
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

4
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 bodys 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

5
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

6
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

7
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

8
COCAINE

• Cocaine epidemics seem to occur every few
  generations
• Hardcore use still strong in 2000s
• 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 worlds cocaine trade

9
COCAINE Routes of Administration

• Chewing Leaf Historically Native cultures
• Drinking Started in 1880s 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

10
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-1970s, cocaine hydrochloride was chemically
  altered into freebase
• Fastest form to reach brain Highly addictive

11
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 brains
  fright center causing paranoia.
• Excessive use causes insomnia, agitation and
  severe depression

12
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

13
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

14
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.

15
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 fataljust 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

16
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

17
(No Transcript)
18
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

19
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

20
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
• Cocaines duration is 40 minutes/ Meth is 4-6
  hours
• Meth is cheaper

21
Amphetamines
22
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

23
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 1990s
  and common use in Hawaii
• Recent development of ya ba in Thailand

24
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

25
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

26
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

27
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

28
(No Transcript)
29
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

30
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

31
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

32
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

33
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

34
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)

35
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

36
(No Transcript)
37
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

38
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

39
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

40
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 xs more chance of cancer
• Women 12 xs more chance of cancer