PSB Test 3

most common species of cannabis plant

Cannabis Sativa and Indica

Delta-9-tetrahydrocannabinol (THC)

the active psychoactive ingredient in marijuana, though cannabis plants also contain CBD and many other cannabinoids

Where are CB1 receptors primarily located in the brain?

Throughout the brain, with high densities in the prefrontal cortex, basal ganglia, striatum, and hippocampus.

What is anandamide?

A naturally occurring chemical in the brain that stimulates THC receptors and produces similar effects to THC.

What type of receptors does THC act on?

CB1 receptors in the brain.

How does THC contribute to abuse-related effects?

By inhibiting GABA-releasing neurons that project onto dopamine neurons.

What is the result of THC inhibiting GABA neurons in the mesolimbic reward circuit?

Increased dopamine activity, which contributes to rewarding and abuse-related effects.

How is THC metabolized in the body?

It is broken down by the liver.

What is the absorption and timing of smoked marijuana?

Rapid absorption; peak effects in 30–60 minutes; effects last 2–4 hours.

How is THC metabolized and eliminated?

Broken down by the liver; most eliminated in ~7 days (30+ days in chronic users).

How do oral marijuana preparations compare to smoked?

Slower onset and less potent at similar doses.

What are the primary acute effects of cannabis?

Euphoria, relaxation, and altered perception.

What are common low-dose effects of cannabis?

Well-being, enhanced senses, mild thought changes, talkativeness, giggling, increased appetite, appreciation of music, mild visuals.

What are common high-dose effects of cannabis?

Stronger visuals, altered time perception, impaired attention and memory, altered thinking.

What are negative acute effects of cannabis?

Paranoia, dry mouth, respiratory issues, nervousness, and increased heart rate.

What functional impairments can cannabis cause?

Reduced concentration, impaired memory, tiredness, and confusion.

How do cannabis effects change with long-term use?

Increased anxiety/uncomfortable effects and decreased euphoria over time.

Who is most impacted by cannabis addiction

not very addictive overall, more men, 18-29 age group

long term health effects of cannabis use

lung and throat problems including: coughing, increased frequency of throat and lung infections, and reduced lung capacity.

Long Term Cognitive Effects of cannabis

Long term marijuana use probably does not lead to sustained changes in IQ, general cognitive functioning, or memory, though there is evidence for acute and subacute effects on cognition.

What is the earliest recorded use of cannabis?

2727 B.C. in Chinese medical literature.

When did marijuana become illegal across the U.S.?

By 1940, it was illegal in every state.

What happened with cannabis laws in the 1970s–1980s?

1970s: some decriminalization and federal reform support; 1980s: stricter laws and nationwide illegality.

When was medical marijuana first legalized in the U.S.?

1996 in California.

When did recreational marijuana first become legal in the U.S.?

2012 in Colorado and Washington.

What was the status of cannabis legalization by 2022?

18 states had recreational legalization; 20 had medical legalization.

What is the relationship between heavy THC use and psychotic disorders?

Strong evidence it increases risk and worsens/exacerbates psychosis.

What is the relationship between cannabis and mood disorders?

Associated with worse symptoms and course; abstinence can improve depressive symptoms; causal link unclear.

How does cannabis relate to anxiety disorders?

Heavy use is associated with anxiety/CUD; causal link unclear. Mixed evidence for PTSD treatment; dose and chronicity matter.

Withdrawal of cannabis

Irritability, Anxiety, Insomnia, Decreased appetite, Depressed mood, Physical symptoms (headaches, sweating, nausea)

How was heroin initially marketed?

As a treatment for respiratory ailments; widely exported by 1898.

When was heroin synthesized and by whom?

1897 by Felix Hoffmann at Bayer.

When was heroin recognized as highly addictive?

1911, British Pharmaceutical Codex noted it was as addictive as morphine

When was heroin made illegal in the U.S.?

1924, with the Heroin Act.

What is heroin?

An opiate (diacetylmorphine) chemically similar to morphine, codeine, oxycodone, and others.

How is heroin produced?

Processed from morphine, which is extracted from poppy plants. usually white or brownish

What is the fastest and most intense route of heroin administration?

Intravenous injection (effects in ~7–8 seconds).

How does intramuscular heroin use differ from IV use?

Slower onset, with effects in ~5–8 minutes.

How long does sniffed heroin take to peak?

About 10–15 minutes.

How does heroin act in the brain?

It is an opiate agonist that stimulates opioid receptors. It crosses the blood-brain barrier and is converted into morphine, which binds opioid receptors.

Where are opioid receptors found and what do they do?

Distributed throughout the brain; involved in pain, reward, and other functions.

What are medical uses of opiates?

Pain relief, cough suppression, and slowing digestion (e.g., for dysentery).

What is the initial effects of heroin use?

A “rush” of intense pleasure influenced by dose and route of administration. Physically: Warm skin flushing, dry mouth, heavy limbs, nausea, vomiting, and itching.

What happens after the initial rush of heroin?

Drowsiness (“nodding”) for several hours with clouded mental function.

How does heroin affect vital body functions?

Slows heart rate and severely depresses breathing

What are common heroin withdrawal symptoms?

Restlessness, muscle/bone pain, insomnia, diarrhea, vomiting, cold flashes, goosebumps, and leg movements. Begins a few hours after last use, Peaks at 24–48 hours; subsides in about one week.

medical consequences of heroin use

scarred and/or collapsed veins, bacterial infections of the blood vessels and heart valves, abscesses (boils) and other soft-tissue infections, and liver or kidney disease. Lung complications, clogged the blood vessels → cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems. sharing needles → blood borne virus

What is the main strategy for medically assisted heroin withdrawal?

Substitute with a similar opioid to reduce withdrawal, then gradually taper.

What medications are commonly used for heroin use disorder treatment?

Methadone (full agonist) and buprenorphine (partial agonist). buprenorphine preferred because it’s a partial agonist and has higher receptor affinity compared to heroin. both long-acting mu-opioids agonists while heroin is short acting.

How do opioids produce analgesia?

By activating descending inhibitory systems and blocking pain transmission.

Where do opioids act to reduce pain signals?

They inhibit C-fiber terminals in the spinal cord and peripheral nociceptors.

Why do opioid responses vary between patients?

Due to MOR gene polymorphisms and differences in metabolism (pharmacokinetics).

What additional brain system do opioids activate?

The reward pathway

Opioid risks

Nausea, sedation, constipation, urinary retention, sweating, Respiratory depression – sleep apnea, Suppression of hypothalamic-pituitary-gonadal axis, Immunosuppression, Increased risk of invasive pneumonia, Worsening pain (hyperalgesia in some patients), Addiction (Opioid Use Disorder), Overdose when combined w/ other sedatives and at higher doses

Opioid misuse and addiction rates

Misuse rates: 21% - 29%, Addiction rates: 8% - 12%

What are key principles of opioid prescribing and risk management?

Use lowest effective dose (avoid >90 MME), avoid benzodiazepines, and start with immediate-release opioids if needed.

How is opioid misuse monitored and prevented?

PPAs, frequent visits, UDT, pill counts, PDMP checks, and naloxone co-prescribing.

Tapering opioids

CDC guideline recommends decrease of 10% per month if patient on opioids for years and decrease of 10% per week if patient on opioids for weeks to months. Annual percentage undergoing tapering increased from 13% in 2008 to 23% in 2017. Tapering was significantly more likely among women and patients with higher baseline opioid doses. 27% of tapers had a maximum dose reduction rate exceeding 10% per week

Opioid Discontinuation Risks

Opioid discontinuation was associated with an increased risk of death from overdose or suicide regardless of the length of opioid treatment. Patients with SUD (HR, 2.48) and mental health diagnoses (HR, 1.54) were at most risk for overdose or suicide

Cocaine history

The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years

Cocaine medical label.

Schedule 2, it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for some eye, ear, and throat surgeries.

crack v cocaine

freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride. Because crack is smoked, the user experiences a high in less than 10 seconds.

How does cocaine work in the brain?

Cocaine blocks the reuptake of dopamine (as well as norepinephrine and serotonin) by inhibiting their transporters, leading to increased neurotransmitter levels in the synapse and overstimulation of reward and arousal pathways.

Short term effects of cocaine

feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep.

short term physiological effects of coke

physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.

Cocaine deaths

often a result of cardiac arrest or seizures followed by respiratory arrest.

cocaine addiction gen effects

Tolerance to cocaine develops fairly rapidly. Discontinuing regular use can lead to a wide varieties of unpleasant withdrawal and craving symptoms, including: intense cravings for more cocaine, hunger, irritability, apathy, depression, paranoia, suicidal ideation, loss of sex drive, insomnia or excessive sleep. Often, individuals simply take more cocaine to reduce these effects, leading to a pattern of addiction and habituation

Medical complications in cocaine use

Medical Complication of Cocaine Use, Disturbances in heart rhythm and heart attacks, Respiratory effects as chest pain and respiratory failure, Neurological effects, including strokes, seizure, and headaches, Gastrointestinal complications, including abdominal pain and nausea. Other symptoms include blurred vision, fever, convulsions and coma. many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.

Choice Behavior in Rhesus Monkeys: Cocaine Versus Food, Aigner & Balster

In animals given a choice between food and cocaine, the drug was almost exclusively chosen. Periods of low drug intake did not coincide with increased food intake. The animals either chose the drug or they did not complete the schedule requirements

What is methamphetamine?

powerfully addictive stimulant that is easily made in home labs with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.

What are common street names for methamphetamine?

“Meth,” “speed,” “chalk,” and in smoked form “ice,” “crystal,” “crank,” or “glass.

Meth similarities to amphetamine

chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. added ch3 group.

Short term effects of meth

Increased Attention, Decreased Fatigue, Increased Activity, Decreased Appetite, Euphoria and Rush, Increased Respiration, Hyperthermia

long term effects of meth

Dependence and addiction psychosis, Paranoia, Hallucinations, Mood Disturbances, Repetitive Motor Activity, Stroke, Weight loss

Oxycodone v oxycodone CR

Oxycodone CR (OxyContin) v Oxycodone (Roxicodone)

• Controlled/extended-release v immediate

• Used for chronic pain (often opioid-tolerant patients) v acute pain

• Duration: ~12 hours (typically BID dosing) v 4-6 hours

• Forms: extended-release tablets (e.g., 80, 160 mg) v tablets eg 30 mg

• Long-acting; delayed absorption, designed to be more abuse-deterrent

Weed use trends among 8-12th population

highest in 1980, decrease to lowest by 1990, increasing through 2000s and staying steady since then

Recreational weed law trends

those with RML have higher rates of use than non RML states. Usage increased in all states after legalization. Non RML stayed stable.

Weed use disorder associations

Worse mental health, social functioning, role-emotional functioning, and overall mental health functioning. The more severe the disorder, the greater the symptoms/decline

Life cycle study for weed use results

cognitive deficits and smaller hippocampal volume

What makes weed withdrawal worse

psychiatric diagnoses

Weed abstaining effects

increase in: agitation, anxiety, physical symptoms, irritability, and ability to concentrate. Decrease in: appetite, mood, and sleep. Overall increase then leveling out/consistency in reports.

Hamilton score for weed

Depression and anxiety Hamilton score increased from 0-7 days, then decreed back to original scores by day 28

Fent compared to other opiates

Way lower amount for equal effects, immediate effects compared to others wait times. Morphine next quickest w/5 min wait time through IV.

Vicodin and Oxycontin use 8-12

Use peaks around 2005, decline since then

Opioid prescription trends

peak in 2011, decreasing since then (43% by 2018)

Source of opioid misuse

Biggest source from friends or family, then from doctor prescriptions

Addiction and Overdose risks of opioids

daily dose over 100 MME, long term use over 3 mo, mental health disorders, substance use disorder

Overdose risks of opioids

extended release, 2 weeks or less on ER opioids, combination of opioids and benzos, age > 65, sleep-disordered breathing, history of overdose

Misuse risks of opioids

family history of substance use disorders, legal history (DUI), history of sexual trauma

Addiction risks of opioids

adolescence

Heroin use trends among 8-12th

peaks in 2000s, decreases steadily since then

Heroin use prevalence & increase data

men more likely, non-Hispanic white more likely, married less likely, college educated less likely, higher poverty level less likely

Heroin treatment success

Stepped treatment and methadone maintenance treatment similar levels of success. about .8 stayed in treatment over 180 days. About .8 tested negative after 6 months. Down from 17 to 13 on addiction score index at 6 months.

Cocaine and crack use prevalence among 8-12th pop

peaked around 2000s, big decrease since then

When was meth made illegal

1970

Meth use prevalence among 8-12th pop

Peak in 2000s, sharp decline since then

Survival rates of meth addicts

decrease from 1 to 20% in 72 months