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DRUGS AND ALCOHOL

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Title: DRUGS AND ALCOHOL


1
DRUGS AND ALCOHOL
2
Hard vs. Soft Drugs
  • Some drugs are considered by some to be more
    addictive than other drugs.
  • Hard are powerfully addictive, lead users to
    abandon responsibility.
  • Soft allow some users to continue to go to work
    and school and not dismiss all responsibility.
  • Legal vs. Illegal

3
Philosophical Views
  • Conservative
  • James Wilson
  • William J. Bennett
  • Moderate
  • Milton Friedman
  • Joseph DesJardins Ronald Duska
  • Bonnie Steinbock
  • Liberal
  • Ethan Nadelmann
  • Walter Block

4
James Wilson
  • Dr. Wilson was chairman of the National Advisory
    Council for Drug Abuse Prevention
  • Argues that legalizing drugs would lead to an
    exponential explosion of users!

5
Anti-legalization
  • Argues that drugs should not be legalized. He
    thinks that since we cannot know the consequences
    of legalization, we ought to leave the current
    system in place.
  • Even though we did not know the consequences of
    prohibition initially he thinks it is better to
    keep the current system than risk letting the
    cork of the pill bottle and having society
    crumble as the result of legalization.

6
Support for his view
  • In the United States there were approximately
    500,000 Heroine users in 1972. There were the
    same number, 500,000 in 1990.
  • United Kingdom, 1968 2,000 heroine Users, 1972
    20,000 in London alone.
  • Argues that how many people use a drug when it is
    illegal is no evidence for how many will use it
    if it is legal.

7
Milton Friedman
  • An Open Letter to Bill Bennett
  • Milton Friedman argues that the economic cost of
    prohibition does not justify the benefit.
  • He think our resources would be better spent on
    education and treatment, instead of on police,
    jails and court rooms.

8
In Support of his View
  • Legalization would reduce street crime.
  • Alcohol and tobacco cause more deaths than
    illicit drugs
  • Prohibition leads to powerful crime syndicates,
    including narco-trafficos such as FARC in
    Colombia.

9
William J. Bennett
  • Served as Director of the Office of National Drug
    Control Policy and US secretary of Education

10
In support of his view
  • Decriminalization of Heroine lead to a 400
    increase in Heroine users in Britain.
  • Legalizing alcohol after probation lead to a 350
    increase in alcohol consumption.
  • We dont know what would happen if we
    decriminalized drugs.

11
Joseph DesJardins Ronald Duska
  • Drug Testing in Employment
  • Argue that drug testing is only justified if the
    company has a relevant and justifiable reason for
    this knowledge.

12
Drug use lowers job performance
  • Some argue that drug use lowers job performance.
    This may be true, but how low can you go? Should
    the company have all employees working 100 all
    the time? What about 50, 80?
  • If drugs dont make you totally unproductive,
    then perhaps the company has no right to know if
    you do or do not use.

13
Can the Employee cause harm
  • They argue that there are 2 reasons to test
    employees.
  • 1) lower productivity
  • 2) danger to consumers and other employees
  • They argue for limited testing based upon 2.

14
Limited Drug Testing
  • They argue for limited drug testing, and only in
    cases where there is a legitimate reason to test,
    such a steroids in the MLB but not pot in the
    NFL- (Ricky Williams)
  • Or if your actions may have dangerous
    consequences to others because of your
    incompetence that is a result of drug use.

15
Bonnie Steinbock
  • Argues that society has reason to intercede in
    drug addiction, and that contrary to Block there
    is no natural right to get high. Further she
    employs a public health approach to drug use and
    law. She argues that the libertarian view of
    people quietly getting high in the privacy of
    their own homes is unrealistic.

16
Reality check
  • The reality of drug use is that it plays a
    significant factor in 40 of all murders in the
    US, 70 of all cases of infant neglect.

17
Ethan Nadelmann
  • Executive Director of Drug Policy Alliance.
  • Pro legalization and decriminalization of drugs.

18
In support of his View
  • Domestic law enforcement blame international law
    enforcement, international blame local law
    enforcement.
  • Increased spending has done little to stem the
    supply or number of drug users.
  • In fact cocaine purity has gone up 50 in the
    last 10 years.

19
Cost
  • The cost of prohibition has increased
    dramatically, without any measurable decline.
  • The cost to taxpayers
  • Drugs and crime
  • Corruption
  • Medical cost and public health

20
TYPES OF DRUGS
  • Alcohol
  • Tobacco
  • Marijuana
  • Heroine
  • LSD
  • Xtasy
  • Cocaine
  • Crack
  • Prescription Drugs/ Steroids
  • Natural Herbs

21
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22
Steroids
  • Commonly abused steroids Anadrol, Oxandrin,
    Dianobol, Winstrol, Durabolin, Depo-Testosterone,
    and Equipoise
  • What is the form of steroids?
  • There are more than 100 types of anabolic
    steroids, and each requires a prescription

23
What are the methods of usage?
  • Oral ingestion
  • Injection
  • Rubbed on the skin in the form of gels or creams

24
Who uses steroids?
  • Steroid use among young adults and high school
    students is much more prevalent among males than
    females.
  • Among 19-22 year olds surveyed in 2000, 18.9
    reported having a friend who was a current user
    of steroids.
  • 1.4 of young adults (ages 19-28) surveyed in
    2000 reported using steroids at least one time
    during their lives.

25
How do steroids get to the United States?
  • Illicit anabolic steroids are often sold at gyms,
    competitions, and through mail operations.
  • Steroids are also illegally diverted from U.S.
    pharmacies or synthesized in clandestine
    laboratories.
  • Anabolic steroids are illicitly smuggled from
    Mexico and European countries to the United
    States.
  • Recent DEA reporting indicates that Russian,
    Romanian, and Greek nationals are significant
    traffickers of steroids.

26
What are some consequences of steroid use?
  • Effects associated with anabolic steroid abuse
    range from acne and breast development in men,
    increased irritability and aggression, to liver
    cancer, heart attacks, and high cholesterol.
  • People who inject steroids run the risk of
    contracting or transmitting hepatitis or HIV.
  • Withdrawal symptoms include mood swings, fatigue,
    restlessness, loss of appetite, insomnia, reduced
    sex drive, and depression.
  • This depression can lead to suicide attempts and
    can persist for a year or more after the abuser
    stops taking the drugs.

27
GHB (gamma hydroxybutyric acid)
  • Street Names Liquid Ecstasy, Scoop, Easy Lay,
    Georgia Home Boy, Grievous Bodily Harm, Liquid X,
    and Goop.
  • What are the different forms of GHB?
  • An odorless, colorless liquid form
  • White powder material.

28
How is GHB used?
  • Usually ingested in a liquid mixture most
    commonly mixed with alcohol

29
Who uses GHB?
  • GHB has become popular among teens and young
    adults at dance clubs and "raves."
  • Body builders sometimes use GHB for its alleged
    anabolic effects.
  • How does GHB get to the United States?
  • Because the drug is easy to synthesize and
    manufacture, local operators usually handle
    distribution.

30
How much does GHB cost?
  • GHB is usually sold by the capful, and sells for
    5 to 25 per cap.

31
What are some consequences of GHB use?
  • In lower doses, GHB causes drowsiness, dizziness,
    nausea, and visual disturbances.
  • At higher dosages, unconsciousness, seizures,
    severe respiratory depression, and coma can
    occur.
  • Overdoses usually require emergency room
    treatment, including intensive care for
    respiratory depression and coma.
  • GHB has been used in the commission of sexual
    assaults because it renders the victim incapable
    of resisting, and may cause memory problems that
    could complicate case prosecution.

32
Emergency Department Drug Mentions - GHB
33
Ketamine
  • Street terms for Ketamine jet, super acid,
    Special "K", green, K, cat Valium1

34
What does Ketamine look like?
  • Ketamine comes in a clear liquid and a white or
    off-white powder form.

35
How is Ketamine used?
  • Ketamine is a tranquilizer most commonly used on
    animals.
  • The liquid form can be injected, consumed in
    drinks, or added to smokable materials.
  • The powder form can be used for injection when
    dissolved.
  • In certain areas, Ketamine is being injected
    intramuscularly.

36
Who uses Ketamine?
  • Ketamine, along with the other "club drugs," has
    become popular among teens and young adults at
    dance clubs and "raves."

37
How does Ketamine get into the United States?
  • Marketed as a dissociative general anesthetic for
    human and veterinary use, the only known source
    of Ketamine is via diversion of pharmaceutical
    products.
  • Recent press reports indicate that a significant
    number of veterinary clinics are being robbed
    specifically for their Ketamine stock.
  • DEA reporting indicates that a major source of
    Ketamine in the United States is product diverted
    from pharmacies in Mexico

38
OxyContin
  • What is OxyContin?
  • OxyContin is the brand name of a time-release
    formula of the analgesic chemical oxycodone.
    OxyContin, which is produced by the
    pharmaceutical company Purdue Pharma, is
    prescribed as a pain medication.
  • Instances of abuse of this drug have increased in
    recent years.
  • Street terms for OxyContin Hillbilly heroin,
    Oxy, Oxycotton
  • What does OxyContin look like?
  • OxyContin comes in tablet form.

39
What are the methods of usage?
  • Chewing the tablets
  • Snorting crushed tablets
  • Dissolving tablets in water and injecting
  • These methods cause a faster, highly dangerous
    release of medication.

40
Who abuses OxyContin?
  • An increase in illegal use has been especially
    apparent on the East Coast.
  • 9 or 19.9 million Americans have used pain
    relievers illegally in their lifetime.

41
How much does OxyContin cost?
  • When legally sold, a 10-mg tablet of OxyContin
    will cost 1.25 and an 80-mg tablet will cost 6.
  • When illegally sold, a 10-mg tablet of OxyContin
    can cost between 5 and 10. An 80-mg tablet can
    cost between 65 and 80.

42
What are some consequences of illicit OxyContin
use?
  • Long-term usage can lead to physical dependence.
  • A large dosage can cause severe respiratory
    depression that can lead to death.
  • Withdrawal symptoms include restlessness, muscle
    and bone pain, insomnia, diarrhea, vomiting, cold
    flashes with goose bumps, and involuntary leg
    movements.

43
Emergency Department Drug Mentions - OxyCodone
                                                  
                                                  
                                   
44
LSD
  • LSD, aka "acid," is odorless, colorless, and has
    a slightly bitter taste and is usually taken by
    mouth. Often LSD is added to absorbent paper,
    such as blotter paper, and divided into small,
    decorated squares, with each square representing
    one dose.

45
Physical Psychological short-term effects
  • The effects of LSD are unpredictable. They depend
    on the amount taken the user's personality,
    mood, and expectations and the surroundings in
    which the drug is used
  • Usually, the user feels the first effects of the
    drug 30 to 90 minutes after taking it. The
    physical effects include dilated pupils, higher
    body temperature, increased heart rate and blood
    pressure, sweating, loss of appetite,
    sleeplessness, dry mouth, and tremors.

46
Health Hazards of LSD
  • LSD trips are long - typically they begin to
    clear after about 12 hours. Some users experience
    severe, terrifying thoughts and feelings, fear of
    losing control, fear of insanity and death, and
    despair while using LSD. In some cases, fatal
    accidents have occurred during states of LSD
    intoxication.

47
Flashbacks
  • Many LSD users experience flashbacks, recurrence
    of certain aspects of a person's experience,
    without the user having taken the drug again
  • A flashback occurs suddenly, often without
    warning, and may occur within a few days or more
    than a year after LSD use
  • Flashbacks usually occur in people who use
    hallucinogens chronically or have an underlying
    personality problem however, otherwise healthy
    people who use LSD occasionally may also have
    flashbacks
  • . Bad trips and flashbacks are only part of the
    risks of LSD use
  • LSD users may manifest relatively long-lasting
    psychoses, such as schizophrenia or severe
    depression

48
Physical Psychological short-term effects
(continued)
  • Sensations and feelings change much more
  • dramatically than the physical signs. The user
    may feel
  • several different emotions at once or swing
    rapidly from
  • one emotion to another. If taken in a large
    enough
  • dose, the drug produces delusions and visual
  • hallucinations. The user's sense of time and self
  • changes. Sensations may seem to "cross over,"
    giving
  • the user the feeling of hearing colors and
    seeing
  • sounds. These changes can be frightening and can
  • cause panic attacks.

49
MDMA (Ecstasy)
  • Street terms for MDMA
  • Ecstasy
  • XTC,
  • Go,
  • X,
  • Hug Drug

50
What does Ecstasy look like?
  • Ecstasy is distributed in tablet form. Individual
    tablets are often imprinted with graphic designs
    or commercial logos, and typically contain 100 mg
    of MDMA.

51
Ecstasy Facts
  • How is Ecstasy used?
  • Ecstasy is usually ingested in tablet form, but
    can also be crushed and snorted, injected, or
    used in suppository form.
  • Who uses Ecstasy?
  • In 2000, more than 6.4 million people age 12 and
    older reported that they have used Ecstasy at
    least once in their lives.

52
How does Ecstasy get to the United States?
  • The vast majority of Ecstasy consumed
    domestically is produced in Europe.
  • A limited number of Ecstasy laboratories operate
    in the United States.
  • Law enforcement seized 17 clandestine Ecstasy
    laboratories in the United States in 2001
    compared to 7 seized in 2000

53
How much does Ecstasy cost?
  • It costs as little as 25 to 50 cents to
    manufacture an Ecstasy tablet in Europe.
  • Street value of that same Ecstasy tablet can be
    as high as 40, with a tablet typically selling
    for between 20 and 30.

54
What are some of the consequences of using
Ecstasy?
  • In addition to chemical stimulation, the drug
    reportedly suppresses the need to eat, drink, or
    sleep.
  • When taken at raves, where all-night dancing
    usually occurs, the drug often leads to severe
    dehydration and heat stroke in the user since it
    has the effect of "short-circuiting" the body's
    temperature signals to the brain.

55
Overdose
  • An Ecstasy overdose is characterized by a rapid
    heartbeat, high blood pressure, faintness, muscle
    cramping, panic attacks, and, in more severe
    cases, loss of consciousness or seizures. One of
    the side effects of the drug is jaw muscle
    tension and teeth grinding. As a consequence,
    Ecstasy users will often suck on pacifiers to
    help relieve the tension.
  • Ecstasy may cause hyperthermia, muscle breakdown,
    seizures, stroke, kidney and cardiovascular
    system failure, possible permanent damage to
    sections of brain critical to thought and memory,
    and death

56
Death
  • Ecstasy may cause hyperthermia, muscle breakdown,
    seizures, stroke, kidney and cardiovascular
    system failure, possible permanent damage to
    sections of brain critical to thought and memory,
    and death!

57
Emergency Department Drug Mentions - MDMA
(Ecstasy)
58
Club Drugs Operation X-Out
  • DEA Administrator Asa Hutchinson believes that
    Operation X-Out is important because "the use of
    Ecstasy and predatory drugs among our youth is
    fast reaching epidemic levels.
  • Unscrupulous dealers and promoters are marketing
    Ecstasy, Rohypnol, GHB, Ketamine and other lesser
    known drugs to individuals who, all too often, do
    not truly understand their potentially
    devastating effects,"
  • "Not only is the DEA targeting these traffickers,
    we're also reaching out to communities in an
    unprecedented way to get them involved."

59
Methamphetamine
60
Methamphetamine
  • Amphetamine, Dextroamphetamine, Methamphetamine,
    and their various salts are collectively referred
    to as amphetamines.
  • Their chemical properties and actions are so
    similar that even experienced users have
    difficulty knowing which drug they have taken.
    Methamphetamine is the most commonly abused.
  • Street terms for methamphetamine Meth, poor
    man's cocaine, crystal meth, ice, glass, speed.

61
What Does Methamphetamine Look Like?
  • Typically meth is a white powder that easily
    dissolves in water.
  • Another form of meth, in clear chunky crystals,
    called crystal meth, or ice.
  • Meth can also be in the form of small, brightly
    colored tablets. The pills are often called by
    their Thai name, yaba.

62
What are the methods of usage?
  • Injecting
  • Snorting
  • Smoking
  • Oral ingestion

63
Who uses methamphetamine and amphetamines?
  • During 2000, 4 of the U.S. population reported
    trying methamphetamine at least once in their
    lifetime.
  • Abuse is concentrated in the western,
    southwestern, and mid-western United States.

64
How do methamphetamine get to the United States?
  • Clandestine laboratories in California and Mexico
    are the primary sources of supply for
    methamphetamine available in the United States.
  • Domestic labs that produce methamphetamine are
    dependent on supplies of the precursor chemical
    pseudo ephedrine, which is sometimes diverted
    from legitimate sources. It is smuggled from
    Canada, and to a lesser extent from Mexico.

65
How much do methamphetamine and amphetamines cost?
  • Prices for methamphetamine vary throughout
    different regions of the United States.
  • At the distribution level, prices range from
    3,500 per pound in parts of California and Texas
    to 21,000 per pound in southeastern and
    northeastern regions of the country. Retail
    prices range from 400 to 3,000 per ounce

66
What are some consequences of methamphetamine use?
  • Effects of usage include addiction, psychotic
    behavior, and brain damage .
  • Withdrawal symptoms include depression, anxiety,
    fatigue, paranoia, aggression, and intense
    cravings.
  • Chronic use can cause violent behavior, anxiety,
    confusion, insomnia, auditory hallucinations,
    mood disturbances, delusions, and paranoia.
  • Damage to the brain cause by meth usage is
    similar to Alzheimer's disease, stroke, and
    epilepsy!

67
Emergency Department Drug Mentions -
Methamphetamine
68
Heroin
  • Street terms for heroin smack, thunder, hell
    dust, big H, nose drops.
  • What does heroin look like?
  • Pure heroin is a white powder with a bitter
    taste.
  • Most illicit heroin varies in color from white to
    dark brown.
  • "Black tar" heroin is sticky like roofing tar or
    hard like coal, and its color may vary from dark
    brown to black.

69
How is heroin used?
  • Injecting
  • Smoking
  • Snorting

70
Who uses heroin?
  • In the United States in 1999 there were 104,000
    new heroin users.
  • In 2000, approximately 1.2 of the population
    reported heroin use at least once in their
    lifetime.

71
How does heroin get to the United States?
  • The U.S. heroin market is supplied entirely from
    foreign sources of opium.
  • Production occurs in South America, Mexico,
    Southeast Asia, and Southwest Asia

72
How much does heroin cost?
  • Nationwide, in 2000, South American heroin ranged
    from 50,000 to 200,000 per kilogram. Southeast
    and Southwest Asian heroin ranged in price from
    40,000 to 190,000 per kilogram. Wholesale-level
    prices for Mexican heroin were the lowest of any
    type, ranging from 13,200 to 175,000 per
    kilogram.
  • The wide range in kilogram prices reflects
    variables such as buyer/seller relationships,
    quantities purchased, purchase frequencies,
    purity, and transportation costs

73
What are some consequences of heroin use?
  • One of the most significant effects of heroin use
    is addiction. Once tolerance happens, higher does
    become necessary to achieve the desired effect,
    and physical dependence develops.
  • Chronic use may cause collapsed veins, infection
    of heart lining and valves, abscesses, liver
    disease, pulmonary complications, and various
    types of pneumonia.
  • May cause depression of central nervous system,
    cloudy mental functioning, and slowed breathing
    to the point of respiratory failure.
  • Heroin overdose may cause slow and shallow
    breathing, convulsions, coma, and possibly death.

74
Emergency Department Drug Mentions - Heroin
75
Cocaine
  • Street terms for cocaine
  • Blow, nose candy, coke
  • What are the different forms of cocaine?
  • White crystalline powder
  • "Crack" or "rock" cocaine is an off-white chunky
    material.

76
How is cocaine used?
  • Powder cocaine is generally snorted or dissolved
    in water and injected.
  • Crack cocaine is usually smoked

77
Who uses cocaine?
  • Cocaine is the second most commonly used illicit
    drug in the United States.
  • About 10 percent of Americans over the age of 12
    have tried cocaine at least once in their
    lifetime, about 2 percent have tried crack, and
    nearly one percent is currently using cocaine

78
How does cocaine get to the United States?
  • The United States-Mexico border is the primary
    point of entry for cocaine shipments being
    smuggled into the United States.

79
Narco-traffico FARC
  • Organized crime groups based in Colombia control
    the worldwide supply of cocaine.4

80
Coca
  • Erythroxylum coca (Erythroxylaceae). Tree native
    to South America.

81
Cocaine History
  • Active Drug. Cocaine an alkaloid, was isolated
    by Germans in 1850.
  • Used medicinally as a local analgesic, it is now
    replaced in part by synthetic derivatives such as
    novacain (procaine) and xylocaine (lidocaine).
    Obtained from leaves that are harvested dried and
    extracted using organic solvents.

82
History
  • Has been used for at least 3500 years by South
    American people (Incas) living at high elevations
    - Incan artifact showing coca use.
  • They chew the leaves with lime alkali (taken by
    poporo stick)
  • Helps reduce fatigue.
  • Traditionally only used by ruling class (plant
    was sacred).

83
Conquistadors
  • Spanish explorers introduced idea of adding lime
    (calcium carbonate) which releases the cocaine
    from the leaves when chewed. Increased
    productivity and endurance of enslaved Indians.

84
Original Formula Coke
  • 1886 in Atlanta Georgia, Coca Cola was invented
    by J. S. Pemberton.
  • At that time it did contain cocaine which was
    removed in 1903.
  • The Harrison Act of 1914 first regulated the use
    of cocaine (as well as opium, morphine and
    heroin).

85
Freudian Slip?
  • 1884, Sigmund Freud was an enthusiastic advocate
    of cocaine use.
  • Coca-wine was widely used, e.g. by Jules Verne,
    Thomas Edison, John Philip Sousa.
  • Sir Arthur Conan Doyle's "Sherlock Holmes" was
    written under influence of cocaine.

86
How much does cocaine cost?
  • Cocaine prices depend upon the purity of the
    product.
  • Cocaine remained low and stable, which suggests a
    steady supply to the United States.
  • Nationwide, prices ranged from 12,000 to 35,000
    per kilogram

87
What are some consequences of cocaine use?
  • Cocaine is powerfully addictive.
  • Smoking crack can cause severe chest pains with
    lung trauma and bleeding.
  • The mixing of cocaine and alcohol create
    cocaethylene while increasing risk of sudden
    death.
  • Cocaine-related deaths are often a result of
    cardiac arrest or seizures followed by
    respiratory arrest.

88
Emergency Department Drug Mentions - Cocaine
89
Marijuana
  • Marijuana
  • Street Terms grass, pot, weed, bud, Mary Jane,
    dope, indo, hydro ganga.

90
  • What does marijuana look like?
  • A green, brown, or gray mixture of dried,
    shredded leaves, stems, seeds, and flowers of the
    hemp plant.
  • Other forms, less common in the United States,
    are hashish and hashish oil.

91
What are the methods of usage?
  • Marijuana is usually smoked as a cigarette
    (called a joint) or in a pipe or bong.

92
Who uses marijuana?
  • Marijuana is the most commonly used illicit drug.
  • At least one-third of Americans have used
    marijuana sometime in their lives.

93
Others, Never Have.
94
GROW IN WILD OR HOME!
95
Indoor labs
96
Marijuana Alternatives
  • Hawaiian Gold Bud
  • http//www.herbalsmokeshops.com/hawaiian-herbal-hy
    brid.html

97
Emergency Department Drug Mentions - Marijuana
98
FDA and Prescription Drugs
  • There are two issues in this section,
  • 1) How the FDA APPROVES DRUGS
  • 2) PEOPLE ARE ABUSING PERSCRITION AND OVER THE
    COUNTER DRUGS.

99
Drug approval Process
  • How a drug is placed on the market.
  • Drug companies run tests on their own drugs. The
    results of these tests are given to the Center
    for Drug Evaluation and Research. The CDER never
    tests the drugs themselves. In the 1990s CDER
    reformed the review process to speed the
    acceptance of new drugs. Now CDER can review new
    drugs in less than a year before they are
    approved.

100
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101
Changing evolution
  • Are drugs wrong?
  • Survival of the wealthy vs. Survival of the Fit
  • Dick Cheney
  • Magic Johnson
  • Insulin and Myopia
  • Effectiveness of drugs.
  • Meningococcal Meningitis Vaccine is only
    affective against 70 of the disease.

102
Strange diseases
  • Drugs for Public Speaking...
  • Is that even a disease?
  • Paxil CR a drug for social phobia
  • Situations that can trigger the social phobia
    that in an earlier era might have been deemed
    severe shyness include public speaking,
    performing in public, eating in front of others
    or using public bathrooms. (Forbes Magazine)

103
Misdiagnosis
  • 7,000 Americans die from
  • mistakes involving prescription
  • medications, while thousands
  • more suffer serious or
  • uncomfortable side effects.

104
Death by Medicine
  • A Book by Gary Null PhD, Carolyn Dean MD ND,
    Martin Feldman MD, Debora Rasio MD, Dorothy Smith
    PhD
  • Over the next ten years, 1.06 million people
    will die because of an Adverse Drug Reaction and
    7.8 million people will suffer iatrogenic deaths.
  • Approximately 56 of the population of America
    has been treated unnecessarily by the medical
    industry.

105
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106
Side effects from poor testing
  • Thalidomide
  • Thalidomide (tha-lid-o-mide) was first marketed
    in Europe in the late 1950's. It was used as a
    sleeping pill and to treat morning sickness
    during pregnancy. At that time no one knew
    thalidomide caused birth defects. (FDA)

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Side Effects -
  • Zoloft an antidepression Medication
  • dry mouth, insomnia, sexual side effects,
    diarrhea, nausea, and sleepiness (Zoloft
    website)
  • Prozac an anti depression Medication
  • Antidepressants increased the risk of suicidal
    thinking and behavior in children and adolescents
    with depression and other psychiatric disorders.
    Patients starting therapy should be observed
    closely for worsening depression symptoms,
    suicidal thoughts or behavior, or unusual changes
    in behavior. (Prozac Website)

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Alternative Medicine
  • Millions of Americans spend billions of dollars
    on alternative remedies with unproven effects.
  • Rigorous science is starting to test those
    treatments and mostly finds them lacking.
  • Despite Tests, Many Consumers Swear by Remedies

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Just dont work
  • Major government-funded research indicated that
    two wildly popular arthritis pills, glucosamine
    and chondroitin, worked no better than a placebo
    at relieving mild arthritis pain.
  • Saw palmetto had no effect on prostate problems
  • Echinacea does not cure the common cold.
  • St. John's wort does not to treat major
    depression, causes glaucoma.
  • Shark cartilage has no effect on cancers.

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Placebo Effect
  • Placebo effect - just thinking you're taking
    something useful can make you think there's a
    benefit.
  • The placebo effect was huge in patients
    unknowingly taking dummy pills in the arthritis
    study.

111
Mind over Matter
  • Imaging tests have shown changes in the brains of
    placebo users, suggesting that the effect is not
    just "in your mind," it's also in the brain, says
    Dr. Stephen Straus, director of
    NIH's National Center for Complementary and
    Alternative Medicine.
  • "Their wishful thinking that they're going to get
    better is harnessing the body's own mechanism for
    relieving pain," said Dr. Straus, whose agency
    was formed seven years ago to stringently test
    non-conventional remedies.

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ALCOHOL
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ALCOHOL
  • ALCOHOL
  • Hard Liquor
  • Beer
  • Wine

114
Alcohol on Campus
  • College binge drinking a problem
  • Health is compromised when 5 or more drinks are
    consumed per occasion. At this point the P450
    complex in the liver, which neutralizes toxicity,
    cannot handle toxicity levels appropriately.
  • One drink ½ oz alcohol per shot, 5 oz wine, 12
    oz beer

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Academic Performance
  • 40 of poor academic performance at college has
    been linked to drinking
  • 7 of first year dropouts are related to alcohol
  • Alcohol intake is inversely related to GPA
  • 80 of campus vandalism involved alcohol
  • 70 of violent behavior on campus involved
    alcohol
  • 75 of men and 55 of women involved in
    acquaintance rape were under the influence of
    alcohol

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Drinking- Its not a Game.
  • Young Adults are prone to drink excessively

117
Alcoholism
  • AKA alcohol dependence, is a disease that
    includes the following four symptoms
  • Craving--A strong need, or urge, to drink.
  • Loss of control--Not being able to stop drinking
    once drinking has begun.
  • Physical dependence--Withdrawal symptoms, such as
    nausea, sweating, shakiness, and anxiety after
    stopping drinking.
  • Tolerance--The need to drink greater amounts of
    alcohol to get "high."

118
Is Alcoholism a Disease?
  • Yes, alcoholism is a disease. The craving that an
    alcoholic feels for alcohol can be as strong as
    the need for food or water. An alcoholic will
    continue to drink despite serious family, health,
    or legal problems.
  • Like many other diseases, alcoholism is chronic,
    meaning that it lasts a person's lifetime it
    usually follows a predictable course and it has
    symptoms. The risk for developing alcoholism is
    influenced both by a person's genes and by his or
    her lifestyle.

119
Alcoholism May Be Inherited as Brain
Overexcitability
  • For the first time, researchers have linked a
    gene that regulates a specific chemical in the
    brain to a person's risk of alcoholism.
  • Studies have identified a major brain chemical
    known as gamma-amino butyric acid (GABA) that is
    involved in many nerve pathways affecting alcohol
    abuse and dependence.

120
GABA
  • Many effects from alcohol involve GABA -- the
    difficulty walking, the lessened anxiety, the
    sleepiness, and even alcohol preference.
  • GABA is also involved in alcohol withdrawal and
    in the craving for greater amounts of alcohol to
    soothe nervousness.
  • Researchers found consistent evidence of alcohol
    dependence and one particular gene that regulates
    GABA activity -- called GABRG3.

121
Addiction
  • Nearly 1.9 million Americans 12 and older
    received treatment for alcohol problems in 1992.
  • In 1992, more than seven percent of the
    population ages 18 years and older - nearly 13.8
    million Americans had problems with drinking.

122
A life time addiction
  • 5-10 of people exposed to alcohol will develop
    impairment
  • It takes an adult 5-10 years to establish
    alcoholism, while it takes an adolescent only 4-5
    years
  • Children of alcoholics are more likely to
    experience a euphoric rush from consumption
  • Alcohol involved in 50 of all motor vehicle
    fatalities
  • Associated with Fetal Alcohol Syndrome and Sudden
    Infant Death Syndrome

123
Banning the ads
  • Nations banning the advertising of distilled
    spirits, compared to nations with no bans, had
    approximately 16 percent lower alcohol
    consumption.
  • Countries banning beer and wine ads had 11
    percent lower consumption.

124
3rd leading cause of Death
  • Alcohol contributes to 100,000 deaths annually,
    making it the third leading cause of preventable
    mortality, after tobacco and diet/activity
    patterns.
  • Among 8,541 deaths attributed to non-medical use
    of other drugs in1993, 40 percent also involved
    alcohol.

125
Economic Cost
  • A 1998 report by the National Institute on Drug
    Abuse (NIDA) and the National Institute on
    Alcohol Abuse and Alcoholism (NIAAA) estimated
    the economic costs of alcohol abuse in the United
    States to be 148.02 billion in 1998, 80
    (119.32 billion) of which were due to
    alcohol-related illness (including health care
    expenditures, impaired productivity and premature
    death).

126
Legalize and Tax?
  • In 1998, states collected 4.0 billion in alcohol
    and 7.4 billion in tobacco taxes for a total of
    11.4 billion.
  • For every dollar of such tax revenues, states
    spent 7.13 on substance abuse and addiction --
    6.83 to shoulder the burden on public programs,
    0.26 for prevention and treatment, and 0.04 to
    collect alcohol and tobacco taxes and run
    licensing boards."
  • Source  National Center on Addiction and
    Substance Abuse at Columbia University, Shoveling
    Up The Impact of Substance Abuse on State
    Budgets (New York, NY CASA, Jan. 2001), p. 27.

127
D.U.I.
  • 1 Million DUI arrest annually in the USA-
  • This represents less than 1 of all DUI incidents!

128
Is it safe to drink during pregnancy?
  • No, drinking during pregnancy is dangerous.
  • Alcohol can have a number of harmful effects on
    the baby.
  • The baby can be born mentally retarded or with
    learning and behavioral problems that last a
    lifetime.
  • We don't know exactly how much alcohol is
    required to cause these problems.
  • We do know, however, that these alcohol-related
    birth defects are 100-percent preventable, simply
    by not drinking alcohol during pregnancy.
  • The safest course for women who are pregnant or
    trying to become pregnant is not to drink alcohol
    at all.

129
Why legalization of alcohol?
  • Taxes
  • Important for the economy
  • Prevents crime
  • Health

130
Alcohol Tax - revenue
  • Alcohol is a main source of the tax - income for
    the government
  • And the sell of alcohol is a multi billion
  • dollar business, with imports
  • and exports all over the world
  • Total Tax Collection 2003
  • 8,470,199,000

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Who depends on the sell of alcohol?
  • Alcohol is important for the U.S. economy
  • Production companies
  • Distribution companies
  • Retailer
  • Advertisement companies

135
Legalizing prevents crime
  • Legalization of alcohol also prevents the society
    from an illegal black- market
  • It reduces corruption and crime
  • Prohibition failed (1920 1933)

136
Health issues
  • A glass of red wine a day may prevent cancer and
    heart- diseases
  • A glass of beer during dinner helps to have a
    better sleep at night
  • A shot of pure liquor after dinner supports the
    digestion
  • But only if you drink moderately.

137
'Hoppy' Beers May Fight Disease
  • Research is showing that beer could join the
    ranks of other guilt-inducing but wildly popular
    foods -- chocolate, coffee and red wine -- as a
    possible disease-fighter.
  • Beer hops contain a unique micronutrient that
    inhibits cancer-causing enzymes.

138
Xanthohumol
  • Xanthohumol has several unique effects. Along
    with inhibiting tumor growth and other enzymes
    that activate cancer cells, it also helps the
    body make unhealthy compounds more water-soluble,
    so they can be excreted.

139
Guinness Its Good for You!
  • Most beers made today are low on hops, and don't
    contain much xanthohumol.
  • But beers known for being "hoppy" usually
    porter, stout and ale types have much higher
    levels of the compound.

140
Tobacco
  • Tobacco is a tall, leafy annual plant, originally
    grown in South and Central America, but now
    cultivated throughout the world.
  • There are many species of tobacco Nicotiana
    tabacum (or common tobacco) is used to produce
    cigarettes.

141
Tobacco US History
  • 1804 mass produced hand rolled cigarettes
  • WWI issuing of cut tobacco to soldiers
  • WWII issuing of government packs of cigarettes
  • Filters introduced in the 1950s
  • 1964 1st Surgeon General announcement about
    tobacco

142
Nicotine
  • Nicotine, a powerful central nervous system
    stimulant found naturally in the tobacco leaf, is
    classified as a drug.
  • Nicotine is one of the main ingredients in
    tobacco. In higher doses, nicotine is extremely
    poisonous. It is commonly used as an insecticide.

143
How is it used?
  • Tobacco leaves can be burned and inhaled (in the
    form of cigarettes, cigars, pipes, smoke, etc.)
    or absorbed through the mouth (in the form of
    spit tobacco, chew, or snuff).
  • The membranes in the nose, mouth and lungs act as
    nicotine delivery systems - transmitting nicotine
    into the blood and to the brain.

144
Health Effects of Cigarette Smoking
  • The adverse health effects from cigarette smoking
    account for 440,000 deaths, or nearly 1 of every
    5 deaths, each year in the United States.
  • More deaths are caused each year by tobacco use
    than by all deaths from human immunodeficiency
    virus (HIV), illegal drug use, alcohol use, motor
    vehicle injuries, suicides, and murders combined.

145
Smoking Cancer
  • The risk of dying from lung cancer is more than
    22 times higher among men who smoke cigarettes,
    and about 12 times higher among women who smoke
    cigarettes compared with never smokers. 
  • Cigarette smoking increases the risk for many
    types of cancer, including cancers of the lip,
    oral cavity, and pharynx esophagus pancreas
    larynx (voice box) lung uterine cervix urinary
    bladder and kidney. 
  • Rates of cancers related to cigarette smoking
    vary widely among members of racial/ethnic
    groups, but are generally highest in
    African-American men.

146
Cardiovascular Disease (Heart and Circulatory
System)
  • Cigarette smokers are 24 times more likely to
    develop coronary heart disease than nonsmokers. 
  • Cigarette smoking approximately doubles a
    persons risk for stroke. 
  • Cigarette smoking causes reduced circulation by
    narrowing the blood vessels (arteries). Smokers
    are more than 10 times as likely as nonsmokers to
    develop peripheral vascular disease.

147
Respiratory Disease and Other Effects
  • Cigarette smoking is associated with a ten-fold
    increase in the risk of dying from chronic
    obstructive lung disease.
  • About 90 of all deaths from chronic obstructive
    lung diseases are attributable to cigarette
    smoking. 

148
SIDS Osteoporosis
  • Cigarette smoking has many adverse reproductive
    and early childhood effects, including an
    increased risk for infertility, preterm delivery,
    stillbirth, low birth weight, and sudden infant
    death syndrome (SIDS). 
  • Postmenopausal women who smoke have lower bone
    density than women who never smoked. Women who
    smoke have an increased risk for hip fracture
    than never smokers.

149
War on Drugs
  • http//www.drugwarfacts.org/economi.htm

150
The Cost of the War on Drugs
  • In 1969, 65 million was spent by the Nixon
    administration on the drug war
  • 1982 the Reagan administration spent 1.65
    billion
  • 2000 the Clinton administration spent more than
    17.9 billion
  • 2002, the Bush administration spent more than
    18.822 billion.

151
According to ONDCP
  • 18.822 Billion spent by the federal government
    on the drug war in 2002 breaks down as follows
  • Treatment (with Research) 3.587 Billion
  • Prevention (with Research) 2.548 Billion
  • Domestic Law Enforcement 9.513 Billion
  • Interdiction 2.074 Billion (11.0 of total)
    International 1.098 Billion (5.8 of total)

152
Supply and Demand
  • In other words, 12.686 Billion in 2002 was
    directed to supply reduction, i.e. law
    enforcement (67.4 of total),
  • 6.136 Billion to demand reduction, i.e.
    treatment, prevention and education (32.6 of
    total).

153
Economic Cost
  • illegal drug abuse cost a total of 97.66 billion
    in 1992, of which less than 40 (38.71 billion)
    was due to drug-related illness or premature
    death.
  • This figure includes 4.16 billion in HIV/AIDS
    and Hepatitis treatment costs.

154
United Nations Office on Drugs and Crime
  • Value of the global illicit drug market for the
    year 2003 was estimated
  • 13,000,000,000 at Production level,
  • 94,000,000,000 Wholesale
  • 322,000,000,000 Retail

155
Drug Crime
  • According to the FBI, 13,714,438 people in the
    United States of America were arrested in 2002.
    1,538,813 of these arrests were due to drug abuse
    violations.
  • 28.8 of all convicted inmates admitted to being
    under the influence of some kind of drug at the
    time of their offense

156
Ethical Questions
  • Are all illicit drugs the same?
  • Is there a distinction to be drawn between
    alcohol, nicotine and marijuana on the one hand
    and cocaine, heroin and other drugs on the other?
  • Some have argued that when we consider the
    effects of the drugs, then such a classification
    seems to make sense, but by the same token, then
    our prohibition on all drugs does not.

157
Questions
  • Should we stick with are current policy, simply
    because it is the one we adopted 50 years ago.
    The argument that we cant predict the
    consequences of legalization seems to be flawed.
    1) fifty years ago we could not predict the
    consequences of prohibition, did that mean we
    should not have adopted the policy that we did?
    Further, given those consequences, the war on
    drugs as a whole, does such a policy seem to make
    sense?

158
Final Thought
  • If drug use is immoral, then we should not
    legalize it, no matter how beneficial it should
    be. This follows for prostitution, abortion,
    euthanasia any of the topics we have discussed
    this semester.
  • If there are compelling arguments that show
    something to be immoral, then even if there is
    evidence that making it legal would have
    beneficial social consequences, that is not
    reason enough to make it legal.

159
Can we win?
  • Cant we just say NO?!?
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