CH06 Cocaine and other stim

Drug Use and Misuse

  • Author and Edition: Ninth Edition by Stephen A. Maisto, Mark Galizio, Gerard J. Connors.

  • Chapter Overview: Focus on Cocaine, Amphetamines, and Related Stimulants.

Approach to Discussing Drugs/Drug Classes

  1. History, Prevalence, etc.

  2. Pharmacology

  3. Effects

Controlled Stimulants

  • Table 6.1 - Controlled Stimulants

    • Cocaine: No brand name; slang terms include angel powder, diosa blanca.

    • Dextroamphetamine: Brand names Adderall, Vyvanse; slang includes Addy, speed.

    • Methamphetamine: Brand name Desoxyn; slang terms chicken feed, speed.

    • Methylphenidate: Brand names Ritalin, Concerta; slang kiddie coke, Vitamin R.

    • Methcathinone: No brand name; slang cat.

    • Mephedrone: No brand name; slang bath salts, bubbles, meow-meow.

The Coca Leaf

Brief History of the Coca Leaf

  • Indigenous Usage: Chewed by indigenous peoples of Bolivia, Ecuador, Argentina, and Peru for thousands of years.

  • Cultural Significance: Important in Incan culture; used for medicinal and stimulant purposes.

  • European Awareness: First noticed in the 1800s with the isolation of cocaine in 1850.

  • Methods of Absorption: IV injection or smoking provides rapid absorption compared to chewing leaves.

Early Use of Cocaine

19th-Century Introduction

  • Freud's Advocacy: Sigmund Freud promoted cocaine for treating various medical issues.

  • Surgical Use: First local anesthetic used in surgeries; declined by end of 19th century due to abuse.

  • Regulation: Harrison Narcotics Act of 1914 established control over cocaine and similar substances.

The Amphetamines

History and Use

  • Transition from Cocaine: Shift to amphetamines after the Harrison Narcotics Act; synthesized in the late 19th century.

  • Medical Applications: Initially used for colds, obesity, narcolepsy, and ADHD by the 1920s.

  • Military Use: Widely given to WWII soldiers for performance enhancement.

  • Post-War Issues: Became problematic due to misuse and dependency.

Injection Effects of Amphetamines

  • Immediate Effects: Intense "flash" after injection; repeated use results in stimulation without the initial "rush."

  • Side Effects: Appetite suppression, formication, paranoid delusions, and stimulant psychosis with overdose.

  • Withdrawal Symptoms: Commonly include depression post-heavy use.

Cocaine Epidemic II

Reemergence of Cocaine

  • Glamorization: In the 1970s, cocaine became more accessible and glamorized.

  • Crack Cocaine: Emerged in the late 1970s; produced intense but brief highs.

  • Market Growth: Developed rapidly due to affordability and intense cravings.

Development of Crack Cocaine Use and Problems

  • Crisis Reports: By late 1980s, crack use increased dramatically; rise in overdose deaths.

  • Statistics: Survey data indicating fluctuations in crack and powdered cocaine use among high school seniors from 1986 to 2016.

Cocaine Drug Wars

  • Colombian Cartel Control: Historical monopolization of cocaine distribution by Colombian cartels.

  • Government Action: U.S. and Colombian governments attempted to restrict smuggling; led to violence.

  • Production Shift: Decline in Colombian production offset by increases in Peru and Bolivia.

The Coca Leaf in Latin America

  • Cultural Continuance: Coca cultivation continues in Andean countries; government support.

  • Evo Morales: Bolivian President's symbolic consumption of coca at UN to represent traditional use.

Legislation Against Crack Cocaine

  • Anti-Drug Acts: Enacted severe penalties for crack cocaine at disproportionate rates.

  • Racial Disparities: Laws affected African American communities significantly; measures taken to address inequities.

The Return of Meth

Methamphetamine Overview

  • Historical Use: Meth reappeared in the U.S. in the early 1990s; largely spread via illegal labs.

  • Demographic Usage: Evolved from a "biker drug" to mainstream usage in club settings.

  • Public Health Risks: Risks associated with illegal labs include explosions and biohazards.

Bath Salts: New Synthetic Stimulants

  • Existence and Risks: Rarely seen before 2009; linked to acute psychosis and overdose deaths.

  • Chemical Properties: Classified as synthetic analogs of cathinone, which mimics stimulants found in the khat plant.

Mechanism of Stimulant Action

How Stimulants Affect the Brain

  • Neurotransmitter Interaction: Primarily affect monoamines (dopamine, norepinephrine, serotonin).

  • Action Mechanism: Block reuptake or increase release of these neurotransmitters.

Pharmacokinetics of Stimulants

Administration Routes and Effects

  • Onset and Duration: Varies significantly between oral and IV use; inhalation provides rapid effects.

  • Metabolism: Cocaine metabolizes quickly while amphetamines have longer action durations.

Acute Effects at Low and Moderate Doses

Physiological Effects

  • Sympathomimetic Effects: Increase heart rate, respiration, and blood pressure.

  • Appetite Suppression: Used for weight loss but often leads to weight regain after cessation.

Behavioral Effects

  • Mood Enhancements: Increased sociability, alertness, and performance in physical tasks.

  • Learning Challenges: State-dependent learning can impede recall without drug influence; potential increase in errors.

Acute Effects at High Doses

Risks Associated with High Doses

  • Stimulant Psychosis: Can cause paranoia and compulsive behaviors; treatable with antipsychotics.

  • Overdose Risks: Severe health consequences including respiratory collapse and heart attacks.

Effects of Chronic Use

Tolerance Development

  • Types of Tolerance: Acute versus chronic tolerance, with variances in heart rate and blood pressure responses.

Dependence and Withdrawal

  • Withdrawal Symptoms: Primary symptoms are psychological (depression, agitation, sleep disturbances).

  • Craving Phases: Initial crash followed by extinction, linked to environmental cues.