Drugs and Behavior Exam 4

Development of Heroin

→ Heroin was developed in 1898 and is 3 times stronger than morphine. It was initially marketed as a medical drug but quickly led to widespread dependence.

Opiates vs Opioids

→ Opiates are naturally occurring compounds from the opium poppy (e.g., morphine, codeine).
→ Opioids include opiates plus synthetic and semi-synthetic drugs that act on the same receptors.

By 1900: Opiate Dependence in the U.S.

→ By 1900, about 1% of the U.S. population (~1 million people) was dependent on opiates, largely due to medical use and lack of regulation.

Early Prescription Laws

→ Laws required doctors to list ingredients in prescriptions, leading to a shift in public opinion and decreased opiate use in the early 1900s.

Gender Differences in Opiate Use (Early 1900s)

→ Women were more likely to use oral forms (drinking).
→ Men were more likely to use injection (IV).

Vietnam War and Heroin Use

→ Heroin use rose during the Vietnam War due to stress, availability, and trafficking routes. Many soldiers were exposed overseas.

Rise of New Heroin Suppliers

→ Mexican cartels produced Mexican Black Tar heroin, often smoked.
→ China White heroin came from Afghanistan and was typically snorted.

Black Tar vs China White Heroin

→ Black Tar: cheaper, lower purity, often smoked or injected.
→ China White: higher purity, snorted, considered “cleaner.”

Media Glorification of Heroin

→ Heroin use was glamorized in movies and fashion (e.g., Pulp Fiction, “heroin chic” look—thin body, dark circles).

Rise of Prescription Painkiller Abuse

→ Abuse of oxycodone (OxyContin) led many users to transition to heroin.
→ Media falsely claimed <1% addiction risk.

Common Prescription Opioids

→ Oxycodone = OxyContin (“Appalachian Heroin”)
→ Oxycodone + acetaminophen = Percocet
→ Hydrocodone + acetaminophen = Vicodin

War on Drugs vs Treatment

→ The War on Drugs focused on punishment.
→ Treatment approaches emphasize compassion, harm reduction, and public health.

The “Fly Effect”

→ The idea that drug use starts small and gradually escalates into more severe substance use.

Routes of Opiate Administration

→ Injection (IV)
→ Inhalation (smoking/snorting)
→ Oral ingestion
→ Faster absorption = stronger effect and higher addiction risk.

CNS Effects of Opiates

→ Opiates act on the endogenous opioid system in the CNS, reducing pain and producing euphoria.

PNS Effects of Opiates

→ Histamine release causes itching.
→ Inhibition of peristalsis leads to constipation.

Signs of Opiate Intoxication

→ Euphoria
→ Impaired cognition and social functioning
→ Pinpoint pupils
→ Slurred speech
→ Drowsiness or unconsciousness

Opiate Withdrawal Symptoms

→ Begin within 6–12 hours, peak around 36–72 hours, last 6–10 days
→ Dysphoria
→ Diarrhea
→ Nausea and fever
→ Muscle aches
→ Insomnia
→ Pupil dilation

Positive Effects of Opiates

→ Pain relief
→ Anti-diarrheal
→ Cough suppression

Negative Effects of Opiates

→ Few direct long-term effects
→ Exception: smoking heroin linked to neurological disorders
→ High risk due to ancillary factors (HIV, hepatitis, violence)

Opiate Treatment: Detoxification

→ Medical detox helps manage withdrawal safely.

Naloxone (Narcan)

→ An opioid antagonist used to reverse overdoses.

Naltrexone (ReVia)

→ Blocks opioid receptors to prevent relapse.

Maintenance Therapy

→ Uses long-acting opioids to prevent withdrawal without producing a high.

Methadone

→ Synthetic opioid used for maintenance treatment; taken daily.

Buprenorphine (Subutex/Suboxone)

→ Partial agonist; safer than methadone and doesn’t require daily clinic visits.

Harm Reduction Strategies

→ Needle exchange programs
→ Supervised injection sites
→ Focus on reducing harm rather than eliminating use.

Primary Routes of Cocaine Use

→ Inhalation (snorting)
→ Injection
→ Absorption through mucous membranes

CNS Effects of Cocaine

→ Increases dopamine activity in the mesolimbic-cortical pathway, leading to intense reward.

SANS Effects of Cocaine

→ Heightens fight-or-flight response
→ Increased heart rate, alertness, and arousal

Cocaine-Induced Psychosis

→ Includes paranoia and hallucinations.

Formication

→ A tactile hallucination where users feel bugs crawling under their skin.

Chronic Effects of Cocaine Use

→ Kindling (increased sensitivity to seizures)
→ Nasal septum damage
→ Suicidal ideation

Examples of Amphetamines

→ d-amphetamines (more addictive)
→ l-amphetamines
→ Methamphetamine
→ Methylphenidate
→ MDMA (Ecstasy)

Routes of Amphetamine Use

→ Oral ingestion
→ Inhalation (crystal meth)
→ Absorption

History of Amphetamines

→ Ma Huang used in 5000 BC
→ Ephedrine isolated in 1887
→ First synthetic amphetamines in 1932

Amphetamines in WWII

→ Used by soldiers to increase alertness and stamina.

Peak Use of Amphetamines

→ Late 1960s (“speed freaks”).

MDMA Development

→ Used by therapists in the 1980s
→ Schedule I in 1985
→ Being studied for PTSD treatment

Acute Effects of Amphetamines

→ Similar to cocaine but longer lasting (8–24 hours)
→ Appetite suppression

Chronic Effects of Amphetamines

→ “Tweaking”
→ Increased Parkinson’s risk
→ Meth mouth and skin sores

Treatment for Amphetamine Use Disorder

→ Inpatient or intensive outpatient
→ Cocaine Anonymous
→ Pharmacological options: GVG, modafinil

Psychedelics

→ Alter perception and thought with minimal memory or intellectual impairment.

Dissociatives

→ Cause depersonalization and detachment from reality.

Deliriants

→ Cause extreme confusion and loss of control.

LSD (Serotonin Agonist)

→ Slang: acid
→ ED50 = 10 micrograms
→ Very high therapeutic index (TI ≈ 600)

Acute Effects of LSD

→ Sensory distortion
→ Synesthesia
→ Altered perception of time and space

Chronic Effects of LSD

→ Hallucinogen Persisting Perception Disorder (HPPD)

Myths About LSD

→ Leads to substance dependency
→ Causes schizophrenia and panic attacks
→ Damages DNA

→ Use increased deviant behavior

→ Use increases creativity

Other Serotonin Agonists

→ Psilocybin
→ LSA (morning glory seeds)
→ DMT (ayahuasca)

Norepinephrine Agonists

→ Mescaline (peyote)
→ MDMA
→ DOM

Acetylcholine Agonists (Deliriants)

→ Amanita muscaria
→ Belladonna
→ Atropine, scopolamine

Dissociatives: PCP

→ Slang: angel dust
→ Stimulant-like effects

Ketamine

→ Anesthetic used for depression
→ Causes dissociation (“k-hole”)
→ Risk of memory loss and immobilization

Psychedelic Treatment Uses

→ Depression & anxiety: ketamine, psilocybin
→ PTSD: MDMA
→ Substance abuse & eating disorders: psilocybin

Cross-Tolerance

→ Tolerance to one opioid reduces sensitivity to other opioids.

Cold Turkey

→ Sudden discontinuation of opioid use without gradually reducing the dose.

Fentanyl

→ Synthetic opioid 50–100x stronger than morphine; high overdose risk.

Iatrogenic Addiction

→ Addiction caused by medical treatment, especially prescription opioids.

Crash

→ Sudden depressive phase following cocaine use.

Binge Pattern

→ Repeated use over a short time to maintain the high.

Excited Delirium

→ Agitation, paranoia, hyperthermia; medical emergency.

Anhedonia

→ Inability to feel pleasure after chronic cocaine use.

Neurotoxicity

→ Damage to neurons caused by chronic stimulant use.

Bad Trip

→ Intense anxiety, panic, or fear during psychedelic use

Ego Dissolution

→ Loss of sense of self; common with psychedelics.

Depersonalization vs Derealization

→ Depersonalization: feeling detached from self
→ Derealization: world feels unreal

Psychotics vs Psychedelics

→ Psychotics involve loss of reality testing.
→ Psychedelics alter perception but users know it’s drug-induced.

Opiates vs Synthetic Opioids

→ Opiates: naturally derived (morphine).
→ Synthetic opioids: lab-made (fentanyl, methadone).

Stimulants vs Hallucinogens

→ Stimulants increase arousal and energy.
→ Hallucinogens primarily alter perception.

Detox vs Maintenance Treatment

→ Detox: short-term withdrawal management.
→ Maintenance: long-term stabilization.

Heroin Slang

• Smack → Common street term for heroin

• Dope → General slang for heroin (and sometimes other drugs)

• Horse → Older slang term

• Black Tar → Low-purity heroin from Mexico, sticky black substance

• China White → High-purity heroin, often white powder

• Brown Sugar → Brown heroin powder

Prescription Opioids Slang

• Oxy → Oxycodone / OxyContin

• Hillbilly Heroin / Appalachian Heroin → OxyContin in rural regions

• Percs → Percocet

• Vikes → Vicodin

Fentanyl Slang

• Fetty → Fentanyl or fentanyl-laced heroin

• Synthetic H → Indicates non-plant-based opioid

Powder Cocaine Slang

• Coke → Most common slang

• Blow → Refers to snorting

• Snow → White powder appearance

• Nose Candy → Recreational slang

• Yayo → Spanish-origin slang

Crack Cocaine Slang

• Crack → Freebase form of cocaine

• Rock → Solid crack cocaine

• Hard → Refers to crack versus powder cocaine

Methamphetamine Slang

• Meth → Most common

• Crystal / Crystal Meth → Clear crystalline form

• Ice → High-purity meth

• Glass → Refers to shard-like appearance

Amphetamines (General) Slang

• Speed → Amphetamines broadly

• Uppers → General stimulant category

• Bennies → Benzedrine (historical)

MDMA Slang

• Ecstasy → Tablet form

• Molly → Supposedly “pure” MDMA powder (often adulterated)

LSD Slang

• Acid → Most common slang

• Tabs → LSD on blotter paper

• Blotter → Paper soaked with LSD

Psilocybin Slang

• Shrooms → Psilocybin mushrooms

• Magic Mushrooms → Common informal term

DMT Slang

• Dimitri → Slang for DMT

• Ayahuasca → Brew containing DMT (also the proper name)

PCP Slang

• Angel Dust → Most common slang

• Dust → Shortened form

Ketamine Slang

• Special K → Most common slang

Salvia Divinorum Slang

• Salvia → Common slang