UF RCS4451 Spring 2017 Public Health Aspects of Substance Abuse Final

Sativa

strain used as a stimulant

Primary agent in marijuana

THC (resin of the plant)

potency depends on the amount of resin

Indica

mainly medical uses, pain relief, and sleepiness

How man chemicals in a single cannabis plant? How many are unique to the plant?

480

60-70

How much THC in typical in marijuana and how much is absorbed?

2-8%

20% absorbed

Long Term Effects

chronic bronchitis

no research on marijuana and lung cancer

cigarette and marijuana smokers have greater respiratory issues

Amotivational syndrome

marijuana use reportedly are unmotivated, apathetic, lacking ambition, and not achievement- oriented (mainly adolescent chronic users)

chicken or the egg

Marijuana can result in ____________ dependence

psychological dependence

argument- addiction or habituation?

Marijuana tolerance

occurs quickly but not across all symptoms

Medical use of marijuana

glacoma

nausea

asthma

epilepsy

insomnia

rheumatoid arthritis

K-2/Spice

synthetic form of cannabinoids (similar to THC)

more powerful then weed

smoke, drank, vaporized

Not safe for human consumption but marketed as natural

Symptoms of Spice

anxiety

agitation

nausea

vomiting

high BP

seizures

hallucinations

paranoia

violent behavior

What is the number one health threat and primary source of morbidity and mortality among college students

Binge drinking

Initial definition of Binge Drinking

5 drinks for males, 4 for females at least on 1 occassion in the past 2 weeks

Binge drinking rate among college students

have remained the same

1998-2005 Binge drinking

overall increase in alcohol related unintentional deaths, proportion of students who drink, proportion of students who drove under the influence

Problem with the term binge

adopts a low threshold (casts a wide net) for problematic drinking

low measurement specificity (most binge sessions do not result in major negative consequences)

Prevention paradox

a large number of people at small risk contribute more cases of a negative health outcome tan a small number of people at large risk

NIAAA Recommended strategies

target individuals at risk, the student body as a whole, and the college and surrounding community

What strategies don't work for binge drinking?

education alone and providing BAC feedback to students

Who has the highest heavy use of alcohol?

Native Americans

How many people have had a drink in the past year? How many people are heavy users?

150 million

18 million

Main component of alcohol

ethyl alcohol

Ethyl alcohol

Central nervous system depressant

Why is alcohol withdrawal one of the most dangerous withdrawals?

Since alcohol is a depressant when removed the body tries to perk up causing seizures

Alcohol absorption

most is in the small intestine

What will make you more drunk?

Carbonated beverages, drinking on an empty stomach, hot beverages

Where is most of the alcohol metabolized?

Liver

Liver will metabolize alcohol over anything else then excreted by kidneys and lungs

Alcohol is metabolized at a __________ rate regardless of volume consumed

constant

Muscle mass and water mass vs. fat determines...

BAC

Alcohol is diluted by water so the more fat you have the less water you have to dilute

Who is more likely to be affected by 5 drinks: 180 lean male or 200 lean male?

180 lean m

Who is more likely to be affected by 5 drinks: 180 lean male or 180 fat male?

180 fat male

Who is more likely to be have a lower BAC: 180 lean male or 180 fat male?

180 lean male

Who is more likely to have a higher BAC: 120 lean female or 140 fat female?

Cant tell, weight is too close

Who is more likely to have a higher BAC: 145 lean female or 145 lean male?

145 lean female

National Minimum Drinking Age Act of 1984

states would have to set the MLDA to 21

Federal Aid Highway Act

any state with a MLDA under 21 would receive 10% less of their annual federal highway apportionment

Exception to MLDA 21

drink with legal guardian (child must be at least 18) and religious ceremonies

Who was heavily involved in lobbying to reduce the legal BAC from 0.10 to 0.08?

MADD

Medical consequences of alcohol

loss of brain tissue

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome

Wernicke- deficiency in thiamine which can lead to confusion ataxia, abnormal eye movements

Korsakoff- inability to remember recent events or learn new information

Fatty Liver

extra substances the liver doesn't metabolize form fat deposits

reversible

Liver Fibrosis

liver damage occurs and creates scar tissue to heal damage

recovery possible but scar tissue remains

Liver cirrhosis

connective tissue starts overtaking liver and destroys cells

irreversible, liver transplant needed

Alcohol is also linked to ________ and _____________

various cancers and heart disease

Fetal alcohol syndrome

- alcohol use during pregnancy that causes mental retardation, physical defects, behavioral problems, and reduced brain mass

How many women report consuming alcohol while pregnant? Binge drinking while pregnant?

13% consuming

4.5% binge drinking

Alcohol dependence

high both physically and psychologically

more likely to cause death than withdrawal from any other drugs (1 in 7)

Progression of withdrawal

stage 1= mild (hangover symptoms)

stage 2-4= severe (hallucinations --> delusions/delirium --> seizure)

Possible causes of hangovers

additives in alcohol, irritation of stomach, dehydration

Nothing consistently helps hangovers but time

What medication is dangerous to take for a hangover?

Acetaminophen (tylenol) can lead to liver damage

Doris Aiken

influenced by 2 local teens who had been hit by DD with a BAC of 0.19

pitbull tactics to lobby for victim's rights

Cindi Lamb

started MADD

Hit by a DD, broke 2 bones, and daughter was paralyzed from the waist down

Candy Lightner

most credited with starting MADD

daughter died by DD

MADD

anti drinking and driving not anti alcohol

Designated Driver Campaigns

based largely on diffusion theory- large scale attempts to communicate innovative ideas through mass media and social culture

Why are designated driver campaigns successful

Allows networks to do something positive about drinking without alienating the alcohol industry

message could easily integrate into tv

Narcotics

term used to describe all opiates

When did heroin use spike?

10 years ago with prescription drug use

________ have been prescribed despite people reporting the same amount of pain. Why?

4x

direct to consumer advertising and patient centered care

Speedball

heroin and cocaine aka pain reliever and stimulant

must take large quantities of both in the right proportion because the body metabolizes cocaine quicker than heroin

As your tolerance increases the amount you need to __________ increases but not at the same rate

overdose

When are people more likely to overdose and why?

coming out of prison or rehab because they try to use the same amounts as before

Natural opiates

morphine and codeine

Synthetic opiates

methadone

Semi-synthetic opiates

heroin

Opioid receptors mainly affect

enkephalins and endorphins

What are opiates used for??

cough suppressant

pain relief

Intestinal disorders (to induce constipation)

Symptoms of opiate use?

decreased pain receptors

pinpoint pupils (heavy users)

slow moving

What would a heroin users eyes look like during withdrawal?

Dilated pupils

What drug causes dilated pupils with heavy use and pinpoint pupils during withdrawal?

cocaine

There is no limit to the development of opioid __________

tolerance

tolerance develops at different rates for the different body parts

Cross dependence

all types of opiates contribute to the tolerance or dependence

How many overdoses are accidental?

57%

What is the major cause of overdose death with opiods?

Respiratory depression

What opioid was marketing as non addictive due to time release tablets?

oxycontin

Opiods

oxycodone, codeine, hydrocodone, fentanyl, methadone

Prescription drug abuse

taking some else's

taking meds in a way other than prescribed

taking meds to get high

Codeine

mainly in cough medications

directly from opium or refined from morphine

used to be the most prescribed opioid

Methadone

used to treat heroin addiction but just as addictive

Hydrocodone

Vicodin and lortab

Oxycodone

oxycotin and percodan

time released mechanism destroyed to allow drug to get into blood quicker

Meperidine

Demerol

causes the same high as morphine but less constipation and cough suppression

What is the most prescribed opioid today?

hydrocodone

Naloxone

antagonist

used to take people out of opioid overdose because it has a stronger affinity for receptor sites

Naltrexone

used to prevent relapse for alcohol

Prescription drug monitoring program

electronic database that tracks controlled substance prescriptions

Not good across state lines and opiates from the internet are still a problem

What state doesn't have PDMP and what state was the first to have PDMP

Missouri doesn't have it

Kentucky was the first

Opiods have killed how many people?

33,000

Dr. Alan Marlatt

used harm reduction in substance abuse

Why is harm reduction so controversial?

Could appear like you are condoning behavior and not allowing users to feel the full consequences of their actions and keeping them closer to their addiction

Principles of harm reduction

1. accepts illicit drug use as a reality

2. drug use is a continuum (cant be categorized or oversimplified)

3. QOL is a criteria for successful intervention

4-6.non coercive provision of services: can't force someone to change, addict must take ownership and change

7. recognizes health disparities as a factor to drug use

8. doesnt minimize the harm and danger of drug use

Overdose

when a toxic amount of a drug overwhelms the body

Full agonist

excites the cell completely

heroin

Partial agonist

excites most of the cell

methadone

Antagonist

doesnt' activate the cell at all

Naloxone

__________ communities have a take home naloxone program

200

Syringe Exchange Programs

provide free sterile syringes and collect used syringes from drug users to reduce the transmission of blood borne pathogens (Hep B,C and HIV)

cost effective

How many intravenous drug users are HIV+? How many are HCV+?

1-10%

30-70%

Why were syringe exchange programs not successful with hep C?

HCV can survive in open air up to two weeks

caused the program to evolve to drug kits