Addiction

Focus on the A-Z of psychoactive substances

Effect of alcohol in different doses

Low → Activate NMDAr and glutamate → Increase pleasure, memory and thinking

High → Activate GABA → Poor coordination, memory loss, blurred vision

Very high → Vomiting, coma, death from respiratory failure (3-400 mg% blood)

Effects of alcohol

Good → Relaxing feeling, social, sleep inducer

Bad → Weak body control and coordination, blurred vision, slurred speech, disease, withdrawal, OD, death

Events that occur in alcochol withdrawal

24 hr → Tremor, anxiety, insomnia

1-3 days → Risk of seizure

3-4 days → Delirium tremens = alcohol withdrawal + delirium lasting 5-7 days

What is alkyl butyl nitrite

Poppers → Liquid chemical that you inhale → Common chemsex drug

alkyl butyl nitrite pharmacology

VasoDILATION as souce of NO → Start 15s after inhalation and last minutes

Effect of Alkyl butyl nitrite

Good → Short high/rush, enhanced sexual performance (MSM)

Bad → Headache, faint, heart problems in chronic use

What are benzodiazepines

Dormicum, Valium, Xanax, Zolam → Depressant and muscle relaxant that is swallowed or injected

BDZ pharmacology

Act on GABA A receptor gamma subunit → increase Cl channel opening

BDZ effects

Good → Relaxing feeling, induce sleep, mild euphoria

Bad → Short term memory loss, drowsiness, withdrawal

What is cannabis

Puff, weed, hemp, skunk → Can be smoked, used as oil or eaten as lead

Cannabis pharmacology

Delta 9 THC that act on CB1 and CBD that modify THC effect

Effect of cannabis

Good → Relaxing, sense of well bring, sense change, stimulate appetite

Bad → Increase pulse rate lower BP, lethargy, psychosis risk, impaired short term memory and coordination

What is the relation between cannabis and psychosis

More cannabis use exponentially increase risk of developing psychosis; high THC/CBC ratio

What is cocaine

Coke, crack (purest), speedball (mixed with heroin) → can be snorted, injected or smoked

Cocaine pharmacology

Act on catecholaminergic neurotransmitter → increased DOPA, 5-HT and NE reuptake

Effect of cocaine

Good → Euphoria, increased wakefulness, increased confidence

Bad → Anxiety, increased stroke/heart attack risk, skin picking, crash/comedown

What is ecstasy/MDMA

Stimulant + hallucinogen, empathogen and club drug; ecstasy = pill, MDMA = more potent powder

Ecstasy/MDMA pharmacology

Act on catecholaminergic neurotransmitter → INHIBIT DOPA, 5-HT and NE reuptake; NE and DOPA inhibit → stimulant; 5-HT inhibit → Hallucinogen

Effects of ecstasy/MDMA

Good → Euphoria, empathy, emotional understanding

Bad → Raised BP and BT, comedown

What is GHB and GBL

Called G → Depressant and date rape drug → GBL convert into GHB in body; can be swallowed

GHB and GBL pharmacology

GHB onset 20 mins, peak 1 hr → Act on GABA-B receptor to alter DOPA and 5-HT activity

GHB and GBL effects

Good → Relaxing, sleeping aid

Bad → Loss of body control, feeling sick, seizure/collapse, paranoid, hallucination

What is heroin

Diamorphine with depressant effect + strong pain killer → Can be smoked, injected, snorted

Heroin pharmacology

Act on mu opioid mu receptor → cross BBB to cause euphoric, anxiolytic effect

Heroin withdrawal symptoms

Severe but not fatal from high NE → Lacrimation, runny nose, severe muscle pain, stomach pain, nausea, diarrhea, piloerection

Effects of heroin

Good → Powerful euphoria, relaxing, pain killer

Bad → Withdrawal, HIV/blood borne virus, addiction, coma and death in OD

What is ketamine

Dissociative anesthetic in liquid (medical) or crystal (street) forms → can be swallowed or snorted

Ketamine pharmacology

NMDAr antagonist

Effect of ketamine

Good → Euphoria, pain relief, floating feeling

Bad → Loss of coordination, numbness, K hole, cystitis

What is kratom

Tropical plant → Stimulant active as mitragynine → can be chewed or drinked

Kratom pharmacology

Interact with opioid receptor and is partial agonist to other receptors

Effect of kratom

Good → Increased endurance while working, decrease pain and diarrhea, relaxing effect

Bad → Opioid withdrawal, dependence

What is LSD

Synthetic hallucinogen/psychedelic lasting 8-24 hrs found as tablet or blotting paper → Swallowed

LSD pharmacology

Act as 5-HT2A agonist → Hallucinogenic effect

What is magic mushroom

Natural hallucinogen from psilocybe → swallowed

Magic mushroom pharmacology

Psilocybin/psilocin → Mixed receptor agonist in 5-HT family (1A, 2A, 2C)

LSD and shrooms effect

Good → Displaced senses, change in time/space/personal meaning

Bad → Distortion can be scary (bad trip), negative effect in mental disorder

What is methamphetamine

Stimulant active as amphetamine → can be smoked, injected or snorted

Methamphetamine pharmacology

Metabolized as amphetamine → Inhibit DOPA reuptake + increase DOPA secretion + increased tyrosine hydroxylase to make more DOPA

Effects of methamphetamine

Good → Euphoria, increased wakefulness and energy, better libido

Bad → Anxiety, panic, seating, increased stroke/heart attack risk, comedown

What is nicotine

Tobacco leaf that is smoked or chewed

Nicotine use continuum

Cigarettes = combustible tobacco = most dangerous; NRT is non combustible = safest

Nicotine pharmacology

Nicotinic ACh agonist → Increase neurotransmitter sensitivity to ACh

Effect of nicotine

Good → Stress relief, improved cognition, wakeful

Bad → Cancer, COPD, physical disease, addiction, withdrawal, fire

What is nitrous oxide

Laughing gas → Used as anesthetic → inhaled

Nitrous oxide pharmacology

Similar to opioid → at high dose displace O2 and reduce B12 causing paresthesia and motor weakness

Nitrous oxide effect

Good → Relaxation, head rush, light headedness

Bad → headache, nausea, mood swing

What are solvents

Glue/sniffing → gas or aerosol in common product → Inhaled through bag/balloon

Solvent pharmacology

CNS depressant + blood dilation effect → High = low O2 reaching brain

Solvent effects

Good → Relaxation and dream like state

Bad → Aggressive behavior/hallucination, memory impairment and breathing problem

Smoking cessation drugs

NRT, varenicline (mimic cigarette effect) used in chronic smoker, bupropion

Drugs used for alcohol dependence

BDZ as detox, Relapse prevention with Naltrexone and acamprosate → First line, Topiramate and baclofen → 2nd line

Opioid dependence drugs

Detox and relapse prevention use methadone

Depressant drugs

BDZ, morphine, alcohol, kratom

Stimulant drugs

Meth, cocaine, nicotine, kratom

Hallucinogen drugs

Cannabis, ecstasy, LSD, magic mushroom, ketamine

Dissociative drugs

Ketamine, PCP, cannabis