HLTH 237 wk 6 - stimulants & hallucinogens

Stimulants (list)

• cocaine

• amphetamines

• methamphetamine

• methylphenidate

• anorexiants

• decongestants

• khat

• bath salts

• betel

• nicotine

• caffeine

Stimulants

• increase activity in the CNS and ANS

• Mood changes: euphoria, excitement, agitation, feelings of power

• enhanced concentration and increased vigilance

• reduced fatigue and appetite

• higher doses: irritability, violent behaviour, spasms and convulsions, infrequently death

Cocaine: background

• originates in coca plant, primarily grown in south american andes mountains

• coca leaves used for centuries by indigenous people

  • stimulant for heavy labour

  • medicinal purposes

• cocaine hydrochloride isolated in 1860

  • originally seen as a therapeutic wonder-drug cure-all

  • also used as anaesthetic

  • now mostly used recreationally

• extraction to powder involves toxic chemicals

• huge increases in value from source to street

• production and trafficking associated with hundreds of thousands of deaths in South America, Central America, and Mexico

• Profits:

  • 1% at source

  • 10% in transit

  • 66% at point of final distribution

cocaine: details

• local anaesthetic and stimulant

• dopamine reuptake inhibitor, increasing dopamine in synapses

• short length of effect, leading to repeated administration

• continued use reduces ability to experience pleasure from other basic rewards (ie. food, sex)

• withdrawal associated with fatigue, mood depression, lethargy, and irritability

• has among the strongest behaviourally reinforcing qualities of all psychoactive drugs

Cocaine: forms

• two types:

  • powder: usually snorted, can be injected or rubbed into gums

  • crack: usually smoked, causing rapid absorption

• powder and crack cocaine are identical substances

• crack is powdered cocaine mixed with water and a weak base ie. baking soda

• large differences in societal views on legality based on demographics of people who use

Cocaine: effects with infrequent use

• enhanced mood, self confidence, and self esteem

• increased energy, concentration, and sex drive

• talkativeness and alertness

• decreased appetite

• increased anxiety, respiration, heart rate, blood pressure

Cocaine: effects with high doses

• bizarre, erratic, violent behaviour

• cardiac arrhythmia, hypothermia, seizures

• respiratory depression

  • unique among stimulants

  • dangerous if mixed with depressants ie. alcohol

Cocaine: long term effects with chronic use

• tissue damage in nasal passage

• damage to lungs

• damage to pleasure perceiving portions of the brain

• memory loss

• renal failure

• anorexia and weight loss

• GI disturbances

• impotence

• high blood pressure

• aneurysms, strokes, seizures, hemorrhaging surrounding brain

• early aging and mortality

Amphetamines

• act on body similar to adrenaline

• chemically related to norepinephrine and dopamine

• effects

  • raised energy levels

  • reduced appetite

  • reduced need for sleep

  • feelings of clear-headedness and power

• used in WWII to combat fatigue

• used to treat various conditions including overeating, depression, narcolepsy, and hyperactivity

• chronic use leads to physical and psychological dependence

• withdrawal associated with:

  • depression

  • fatigue

  • disrupted REM sleep

  • irritability

  • hunger

  • violence

Methamphetamine

• “poor man’s cocaine” that can be manufactured with chemicals available locally

• popular recreationally because of powerful rush and euphoria

• can lead to memory loss, aggressive behaviour, and violence

• users remain awake for extended periods of time, leading to paranoid and psychotic thoughts and behaviour

• regular use: psychological and physical dependence

• long term use:

  • organ damage, malnutrition, premature death

  • anxiety, depression, insomnia

  • meth mouth

  • violence and homicidal or suicidal thoughts

• crystal meth

  • synthesized form of meth that is smoked

  • releases enormous amount of dopamine

  • duration of effects is 6-12 hours

  • intensifies sex drive and sexual pleasure

  • significant health, social, and economic harms for users and communities

  • relatively higher rates among:

    • street youth

    • gay and bisexual men, men who have sex with men

ADHD

• attention deficit/hyperactivity disorder

  • most commonly diagnosed mental health disorder among children globally

  • characterized by inattention, hyperactivity, impulsivity

  • interferes with child and adolescent development

  • disrupts home, school, and peer interactions

  • estimated prevalence in school aged children:

    • 8-10% of boys

    • 3-4% of girls

  • condition continues for most through adolescence into adulthood

methylphenidate

• treats ADHD in children and adults

• common brand names:

  • Ritalin

  • Concerta

  • Adderall

• prevents reuptake of dopamine, increasing amount in synaptic cleft

• allows brain to carry on typical cognitive control

• shown to increase attention span among those with and without ADHD

• shown to increase academic performance for those with ADHD

  • no evidence of increased performance for those without ADHD

• some controversy over if these drugs are overprescribed

• huge increase in prescriptions over past 20-30 years

• negative side effects:

  • loss of appetite, nervousness, tics, Tourette’s syndrome, cardiac arrhythmia, increased blood pressure, rash, dry mouth, abdominal pain

• evidence of:

  • delayed physical growth and development

  • increased risk of cardiovascular death

  • increased risk of suicidal ideation

anorexiants

• diethylpropion (Tenuate), fenfluramine (Ponderal), phentermine (Ionamin)

• prescribed over short periods for weight reduction and clinical obesity

• fenfluramine associated with cardiovascular problems, especially in combination with phentermine (AKA Fen-Phen)

• low relative potency means not used illicitly

decongestants

• Phenylpropanolamine, Propylhexedrine, Pseudoephedrine

• similar to amphetamines but low dependency

• constrict blood vessels, relieving nasal and sinus congestion

• historically found in cold and allergy medications

• availability over the counter restricted since 2000

  • direct health risks

  • athletic performance enhancing abilities

  • use in methamphetamine production

• therapeutic doses relatively safe

Khat

• use dates back to ancient egypt

• fundamental part of social and cultural traditions in parts of Yemen and East Africa

• plant’s leaves contain substances chemically similar to amphetamine

• usually chewed or brewed in tea, also smoked

• reduces fatigue and hunger, enhances concentration, produces euphoric feeling and energy

• criminalized in canada since 1997

bath salts

• recently emerged “designer drug”

• pharmacologically related synthetic version of active substance in khat

• some similarities to MDMA/ecstasy

• administered orally, across mucous membrane, via inhalation, or through injection

• increases dopamine, leading to euphoria, increased physical activity, heightened sexual interest

• also sleeplessness, erratic behaviour, panic attacks, anxiety, agitation, paranoia, psychosis, suicidal ideation and action

Betel

• mild stimulant

• used regularly by over ½ billion people, mainly in southeast asia and the indian subcontinent

• fourth most commonly used psychoactive drug after caffeine, alcohol, and tobacco

• betel quid: combination of betel leaf, areca nut, slaked lime, and sometimes spices or tobacco

• placed between gum and cheek

• increases capacity to work, causes hot sensations in the body, heightens alertness, suppresses hunger

• long term use associated with precancerous lesions and oral cancer

Nicotine: get ready for a fuck ton of information cuz I don’t feel like making multiple slides :)

• psychoactive agent found naturally in tobacco

• stimulates, the reduces, brain and nervous system activity

• dopamine, opioid receptors, GABA B and cannabinoid C all create dependence

• rapid absorption with quick decrease

• rapid tolerance

• highly addictive physically and psychologically

• initiation of habit and addiction psychologically dependent

• users of other drugs report that quitting smoking most difficult

• tobacco originated in Ecuadorean and Peruvian Andes

• by 1st century BCE, widespread cultural use in South and North ameirca

• smoke from ceremonial tobacco used in healing ceremonies

• tobacco taken to europe by early colonists, eventually spread throughout the world

• Effects:

  • increased heart rate and blood pressure

  • depressed spinal reflex

  • reduced muscle tone

  • decreased skin temperature

  • increased stomach acid

  • reduced urine formation

  • loss of appetite

  • in non smokers: coughing, nausea, vomiting, dizziness, abdominal discomfort, weakness, flushing

• nicotine and tobacco:

  • leading cause of premature death attributable to psychoactive agents

  • 7 million deaths globally each year

• tobacco smoke includes 500 compounds including tar, ammonia, benzene, carbon monoxide, and carbon dioxide

• smokeless consumption:

  • oral cancer risk

  • gum disease

  • heart attacks and stroke

• smoking outcomes: reduces life expectancy by 5-10 years

  • heart attack and stroke

  • respiratory infections including pneumonia

  • chronic bronchitis

  • 16 forms of cancer including lung, mouth, larynx, and esophagus

  • stomach ulcers

  • impotence

  • brain hemorrhages and damage

  • cognitive decline and memory loss

  • chronic obstructive pulmonary disease

  • emphysema

  • low birth weight, stillbirth, sudden infant death syndrome, birth defects

• second hand smoke:

  • increased mortality: 1 million deaths annually

  • stillbirths

  • coronary heart disease

  • asthma

  • dementia

  • breast cancer

• third hand smoke

  • pollutants settled on surfaces that is later re-emitted

• good news: body rapidly recovers after cessation of use

• E cigarettes

  • have been promoted as harm reduction

    • does it lead to initiation of cigarette use?

  • e liquids include propylene glycol, vegetable glycerin, nicotine, ethanol, acetol, propylene oxide, may be cancer causing

  • nicotine, aerosol propellants are harmful

  • lack of research regarding long term effects

Caffeine

• world’s most used psychoactive drug

• 80% of canadians consume regularly

• found in coffee, tea, soda, chocolate, and energy drinks

• stimulates nervous system similar to amphetamines

• potential for dependence and withdrawal

• often not seen as a drug

• tolerance, physical dependence, mild psychological dependence, withdrawal syndrome (headaches)

• tea used in China starting for centuries

• coffee plants evolved in Ethiopia and well established in Arab world by 7th century

• effects of moderate amounts:

  • mood elevation

  • increased wakefulness

  • enhanced energy and alertness

  • diminished sleep time and depth of sleep

  • increased respiration, blood pressure, and metabolism

• high use can lead to irritability, anxiety, restlessness, headache, lightheadedness, GI upset, rapid and irregular heartbeat

• chronic long term high use:

  • ulcers

  • persistent anxiety

  • increased cholesterol

  • depression

  • bone loss

  • fetal arrhythmia

Hallucinogens (list)

• LSD like hallucinogens

• Mescaline like substances

• dissociative anaesthetics

• novel psychoactive substances

• cannabis

Hallucinogens

• produce disconnect between physical world and how people perceive the physical world

• can be synthetic but also include 100 plants

• most act on serotonin

• administered orally, inhaled, injected, and transdermally

• psychoactive effects:

  • separation from self and reality

  • loss or confusion of body image

  • altered perceptions of colours, distance, and shape

  • distortion, blending, or synthesis of sense ie. seeing sounds and smelling colours

  • vivid recall of past events

  • greater insight into self and creativity

• physical effects:

  • most are similar to amphetamine, can include nausea and vomiting

  • cannabis and dissociative anaesthetics: similar to depressants

• do not produce physical dependency or withdrawal

• generally not addictive, with the exception of cannabis

• regular use leads to tachyphylaxis, development of rapid tolerance

• effects not always consistent

• can produce sever anxiety and panic (“bad trip”)

• hallucinogen persisting perception disorder (HPPD; aka flashbacks)

• studies in late 1950s-1970s:

  • anxiety among critically ill patients

  • addiction, primarily alcohol dependence

  • promising results but research ended with the advent of the war on drugs

• current promising studies:

  • psilocybin, ketamine, LSD, MDMA

  • treatment for anxiety, depression, PTSD, addiction

LSD-like hallucinogens: LSD/acid

• semi synthetic drug derived from fungus on rye and other grains

• profound effect on serotonin

• most powerful of all known hallucinogens

• effects last 8-12 hours

• microdosing has become popular recently

LSD-like hallucinogens: psilocybin/shrooms

• historically used in religious ceremonies in indigenous communities in mexico

• 100 times less potent than LSD, shorter duration of effects

• least likely substance to produce drug poisoning

• no physical dependence

• negligible misuse potential

• promising results treating anxiety and depression among people with life threatening cancer diagnoses

• microdosing for creativity

LSD-like hallucinogens: Dimethyltryptamine (DMT)

• similar to psilocybin

• historically used by indigenous people living along amazon river

• can be brewed into tea known as ayahuasca

LSD-like hallucinogens: morning glory seeds

• active ingredient is chemically related to LSD

• can be chewed and ingested but also extracted and injected

Phenylethylamines: mescaline-like hallucinogens

• weaker than LSD but produce similar effects

• act on norepinephrine

• majority are produced in illicit laboratories for street use

• simple molecular structure

Mescaline-like hallucinogens: mescaline

• natural substance though can be synthesized

• prepared from mexican peyote cactus and cactus found in south america

• historically and currently used in religious ceremonies by Indigenous communities in south and north america

• less potent than LSD but more powerful than cannabis

• associated with mystical or religious experiences

• no reports of harmful dependence or withdrawal

Mescaline-like hallucinogens: methylenedioxyamphetamine (MDA)

• produces sense of peacefulness and emotional closeness to others

• some stimulant effects similar to amphetamine

• moderate doses pose risk of serotonin depletion, causing neurological damage

• popularity has lessened with emergence of MDMA

Mescaline-like hallucinogens: methylenedioxymethamphetamine (MDMA)

• aka e, ecstasy, molly

• semisynthetic drug derived from oil of sassafras and oil of nutmeg

• decreases activity in the amygdala, area of the brain associated with fear

• increases activity in prefrontal cortex, area of the brain where higher level processing occurs

• effects:

  • feelings of warmth, closeness, diminished anxiety, empathy, peacefulness, increased energy, positive “vibe”

  • dehydration, insomnia, blurred vision, seizures, high blood pressure

• sudden drop in serotonin with discontinuation causes anxiety, paranoia, and depression in days following use

• ongoing use results in neurological damage

• used therapeutically to treat PTSD

• overdoses occur because of other substances present in ecstasy pills

Dissociative anaesthetics

• have depressant properties along with hallucinatory effect

• wide spectrum of response, making it difficult to predict experiences

• dissociative anaesthetic state: feeling of detachment from surroundings, body, or reality

• effects:

  • reduced sensitivity to pain

  • loss of memory of events during use

  • visual or auditory hallucinaitons

Dissociative anaesthetics: Phencyclidine (PCP)

• AKA angel dust, crystal

• developed as an anaesthetic but sever side effects as it wore off precluded its use medically in humans

• inexpensive an easy to produce

• widespread throughout north america in the 1970s

• interacts with most neurotransmitters, making effects uncertain

  • stimulant, analgesic, anaesthetic, hallucinogen, combination of any and all

• higher doses induce acute toxic psychosis

• very high doses lead to seizures, coma, and death

Dissociative anaesthetics: Ketamine

• aka K, special K

• used as surgical anaesthetic in low and middle income countries, disaster situations, and conflict zones

• in canada, used primarily as an animal tranquilizer

• used recreationally for euphoria and mild dissociation

• risk of entering a" “k-hole,” intense dissociation, hallucinations, difficulty moving and feeling paralyzed

• used to spike drinks and commit sexual assault

• overdose can result in death

• studies show effectiveness treating depression, pain disorder, anxiety, suicidal ideation, and substance use disorders

Novel psychoactive substances

• synthetic substances created to cause psychoactive effects similar to illegal drugs

• eventually are made illegal because of threat to public health

• most mimic hallucinogens, some mimic stimulants or opioids

• ie. synthetic cannabis

Cannabis: buckle up it’s another hefty one

• multiple routes of administration

  • smoked, vaped, oil, resin, edibles

• rapid change from prohibition to legalization in north america and elsewhere

• effects of low to moderate dose:

  • relaxation, disinhibition, euphoria, talkativeness and laughing

  • unpleasant effects for some

  • increased heart rate, heightened appatite, impaired short term memory and logical thinking, impaired ability to operate machinery

• effects of very large dose similar to LSD

  • anxiety, confusion, restlessness, depersonalization, excitement, acute psychosis

  • flashbacks days to weeks after consumption

• effects of long term use:

  • impaired motor coordination

  • impaired ability to plan, organize, solve problems, make decisions, remember, think abstractly, control emotions, control behaviour

  • emotional flatness, apathy, learning deficits, decreased energy

  • risk of stroke, decreased ability to fight infections, cancers (head, neck, throat)

  • decreased testosterone and sperm count, inhibition of ovulation, decreased fertility

  • adverse effects on mental health

  • increased risk of schizophrenia if patients are schizophrenic

  • in utero exposure can affect child development

• can affect brain development in young people

• smoking cannabis can cause lung damage and increase risk of lung cancer even more than cigarettes

  • one joint has twice the carcinogens of a cigarette

  • usually smoked without a filter, deep inhales, holding in of smoke in the lungs

• tolerance develops fairly quickly, depending on frequency of use

• psychological and physical dependence can develop

• withdrawal

  • anger, irritability, aggression, insomnia, anxiety, sleep disturbances

• therapeutic uses:

  • documented uses include acute anxiety, acute depression, diabetes, fibromyalgia, and many others

  • potential effectiveness needs to be balanced with documented risks and harms