Individual Drug InfoIndividual Drug InfoFall 2014

Similar Properties Across Similar Properties Across DrugsDrugsWithdrawal (physical

dependence)Psychological dependenceTolerance

DifferencesDifferences

FormsAvailabilityDEA ScheduleEffects

◦Acute◦Chronic◦Overdose

Photo, originally taken by Thoric, available to use in the public domain

Cannabis - marijuanaCannabis - marijuana

How does marijuana affect anxiety and depression?Does marijuana affect respiratory function? Especially during exercise?Is marijuana more destructive to your brain than alcohol?

CannabisCannabis Cannabis sativa

◦ Different subspecies/varietals used for clothing vs drug use

Active ingredient: THC THC is a cannabinoid

◦ Interacts with cannabinoid receptors in brain

◦ Many other cannabinoids exist, but not thought to cause psychoactive reactions

DEA: Schedule I Despite state

regulations, marijuana still federally illegal

Medical cannabis Medical cannabis (10/30/14), source: (10/30/14), source: procon.org)

Alaska (98) Maine (99) New Jersey (10)

Arizona (10) Maryland (14) New Mexico (07)

California (96) Massachusetts (12)

New York (14)

Colorado (00) Michigan (08) Oregon (98)

Connecticut (12)

Minnesota (14) Rhode Island (06)

Delaware (11) Montana (04) Vermont (04)

Hawaii (00) Nevada (00) Washington (98)

Illinois (13) New Hampshire (13)

Washington, DC (10)

Recreational CannabisRecreational CannabisWashington (2013)Colorado (2013)Washington, DC (2014)Alaska (2014)

CannabisCannabisAcute effectsTHC acts on cannabinoid receptors, increases dopamine, serotoninIncreases appetiteASAP Science: Your Brain on Marijuana (via YouTube)Overdose generally doesn’t occur

◦ Large amount required◦ Smoking a lot may induce sleepiness◦ Eating too much may trigger nausea, vomiting◦ Q13 News story, Michigan

Mixing any chemical substances can potentially cause a problem

Alcohol vs CannabisAlcohol vs CannabisMore research on alcoholAge dependentAmount of alcohol/amount of

cannabisMixing substancesAlcohol interferes with neurogenesis

of brain cells (Gary L. Wenk, Psychology Today, 2010)

Cannabis: 2014 study showing regular use impacted decision-making and judgment (Published online before print November 10, 2014, doi:

10.1073/pnas.1415297111. PNAS November 10, 2014)

Depression and AnxietyDepression and AnxietyMany use marijuana to ease moodRegular use may trigger, or worsen, either

condition, especially in younger people2013 Imperial College study showed lower

dopamine levels in regular users, which may lead to more anxiety

Marijuana, conversely, may help those with Post-Traumatic Stress Disorder◦ Memory inhibition

CannabisCannabisChronic effectsRespiratory distressMood swingsImpaired memory (potential hippocampus damage)Earlier research2011 NIMH/NIDA study

◦Daily use may reduce brain receptor number

◦Receptors regenerated with cessation◦ Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry,

molecular imaging shows." ScienceDaily. ScienceDaily, 13 June 2011. <www.sciencedaily.com/releases/2011/06/110606131705.htm>.

Marijuana & Respiratory Marijuana & Respiratory Function During ExerciseFunction During Exercise

Acute effect: any smoke can interfere with oxygen binding to red blood cells

Acute: marijuana can disrupt coordination, balance, reaction time

Acute: increase heart rate and blood pressure

Acute: stored THC in fat could be released into bloodstream during exercise

Chronic: depends on how frequently one smokes, type of exercise

Dimethyltryptamine Dimethyltryptamine (DMT)(DMT)

What is DMT?How does DMT work as a psychoactive drug?

DimethyltryptamineDimethyltryptamine

Chemical structureHallucinogenic

ingredientPresent in a variety of

plantsOccurs naturally in the

bodySchedule I substance

Image source: Wikimedia Commons

DimethyltryptamineDimethyltryptamine

Often consumed via beverage: ayahuasca tea◦ Requires MAO-I

(specific vine)◦ Ceremonial purposes◦ Ashland, OR Brazilian

church lawsuitCan be injected,

inhaled, smoked

Dimethyltryptamine Dimethyltryptamine EffectsEffectsHallucinogenic visualizationsMood changeTime distortionDissociationMuscle twitching, coordination difficultiesNausea, vomitingShorter-lasting effects than other

hallucinogens◦ “businessman’s trip” per DEA◦ 30-60 minutes

Video Clip - The Spirit Molecule, Part 1 (YouTube)

Video Clip – London Real (34:00+ = trip described)

Source: Arch Gen Pesychiatry. 1994 Feb;51(2):98-108.

LSDLSD

Learn the effects of acidAre there different types?

LSDLSD• Albert Hoffman: “Last Friday,

April 16,1943, I was forced to interrupt my work in the laboratory in the middle of the afternoon and proceed home, being affected by a remarkable restlessness, combined with a slight dizziness. At home I lay down and sank into a not unpleasant intoxicated-like condition, characterized by an extremely stimulated imagination. In a dreamlike state, with eyes closed (I found the daylight to be unpleasantly glaring), I perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors. After some two hours this condition faded away.”

LSDLSD• Schedule I hallucinogen synthesized in

1930s• Manufacturing secretive: Nick Sand

(National Geographic, 3:39)• “Types”

• Same basic chemical structure

• Illegal, so cannot guarantee contents, care of product

• Light and air may degrade drug

• Dosage measured in micrograms (very small)

LSD FormsLSD Forms Crystal can be crushed,

mixed with other materials into tablets: microdots

Gelatin squares Converted to liquid paper

◦ Dosed onto sugar cubes◦ Placed on candy (gummy

bears - Lake Tahoe, 2011, e.g.)

Usually taken orally◦ Can be inhaled, injected,

applied transdermally

LSD Acute EffectsLSD Acute Effects• Duration of “trip” = several hours in length• Visual hallucinations (images, color, light)• Altered perception of senses

• “Seeing sounds, hearing colors”• Color, size of objects

• Altered perception of time, depth• Potential anxiety/panic• Experiences can vary widely• Serotonin receptors may be excited or inhibited• LSD experimentation on British soldiers

(YouTube.com)• Overdose thought to be rare, but some individuals

may not respond well, or may experience problems if drug is different than LSD

LSDLSDChronic effects may involve

flashbacks◦Sudden onset of abnormal

perceptions◦Hallucinogen Persisting Perception

Disorder Visual images remain longer than in

consciousness Dr. Henry Abraham (Tufts University)

blog

LSD ResearchLSD ResearchUS Food and Drug Administration

allowed LSD researchRecent study sponsored by

Multidisciplinary Association for Psychedelic Studies, carried out by Swiss physician Peter Gasser◦ Information published 2014◦ 12 patients with terminal illness, end-of-life

anxiety◦ Took two doses of LSD with talk therapy, across

eight weeks◦ Those with larger dose reported improvement

Which Drugs are Most Which Drugs are Most Dangerous?Dangerous?Largely depends on availability

◦Most emergency department (ED) visits: alcohol (DAWN, 2011)

◦Half + of 2.5 million ED visits: illicit substances

Which Drugs are Most Which Drugs are Most Dangerous?Dangerous?

Cocaine – 505,224 Combinations – 10,388

Marijuana – 455,668 Inhalants – 10,032

Heroin – 258,482 Unclassified hallucinogens – 8,043

Amphetamine/meth. – 159,840 LSD – 4,819

PCP – 75,538 GHB – 2,406

Synthetic cannabinoids – 28,531

Ketamine – 1,550

MDMA – 22,498

MDMAMDMA3,4-methylenedioxy-N-methylamphetamine3,4-methylenedioxy-N-methylamphetamine

How does Ecstasy prove to help people with PTSD?What exactly is Molly & why does it kill people?How do you overdose Ecstasy? Molly?

MDMAMDMA

• Molly, Ecstasy, Thizz

• Synthetic drug• Stimulant and

hallucinogenic properties

MDMAMDMA Acute effects on the brain

◦ Increased serotonin release◦ Increased dopamine release◦ Increased norepinephrine release◦ Effects will vary since formula is not standardized or

regulated◦ Effects will vary based on the synthetic nature of

substance◦ MDMA-assisted therapy (Multidisciplinary

Association for Psychedelic Studies, video; 0-2:00; 14 subjects, per website)

◦ More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)

MDMAMDMA Chronic effects are controversial, per Carl Hart,

Columbia University (YouTube)◦ Well-circulated animal studies showing neuron

damage

Emergency Department Emergency Department VisitsVisits

Synthetics are currently Synthetics are currently popularpopular 2C-I, MDMA, bath salts, synthetic cannabis Lower price (think about economy’s influence) Drug popularity changes with time (synthetics were

popular in 1970s) Health-related issues will subsequently ebb and flow

as drugs move in and out of favor That acknowledged, some can be devastating:

Krokodil (CBS, 2013)

Which drugs are the most popular? Which drugs are the most popular? (by country (by country here)

MushroomsMushrooms

mushroomsmushrooms Psilocybin/psilocin are

two active psyhoacticve substances found in “magic mushrooms”

Couple dozen species Taken orally Recognized for centuriesProbably used in religious rites Hallucinogen Schedule I

mushroomsmushrooms Acute effects:

◦ Relaxation◦ Altered perception of reality◦ Altered perception of time◦ Sense of connection to others/universe◦ Visual hallucinations (images, color, light)◦ Potential for anxiety and subsequent panic, heart

rate & blood pressure increase Chronic effects:

◦ A “bad trip” may trigger fear◦ Hallucinogens may exacerbate mental illness

Being investigated as treatment for OCD, depression, smoking cessation◦ Johns Hopkins Psilocybin Cancer Project (via

YouTube, 0:30-4:03)

Dextroamphetamine Dextroamphetamine (Adderall)(Adderall)

About AdderallAbout AdderallStimulantWorks on dopamine

and norepinephrineUsed as prescription

for ADHD, narcolepsySome abuse Adderall

for its performance-related effects

60 Minutes program, April 2010

Schedule II

Adderall AvailabilityAdderall AvailabilityReadily available across U.S.$5-10 per pill

Adderall Prescriptions, by Adderall Prescriptions, by Year Year (U.S. Department of Justice)(U.S. Department of Justice)

Adderall EffectsAdderall Effects Increased alertnessEuphoriaSelf-assuredness Increased heart rate, blood pressureEmotional changesWeight lossStomach discomfort (nausea, cramps)Long-term effects are not yet known

Adderall FormsAdderall Forms

Tablet (5-30mg)Time release

capsule (10-25mg)

Adderall OverdoseAdderall OverdoseAccording to Dailymed (National Library

of Medicine), traditional symptoms can develop: anxiety, confusion, restlessness

2C-I2C-I4-iodo-2,5-dimethoxyphenethylamine

2C-I2C-I• “Smiles”• Synthetic

substance• Usually inhaled or

taken orally; may also be taken via blotter paper

• Stimulant & hallucinogenic properties

• Schedule I

2C-I2C-I• Impacts dopamine &

serotonin• Onset of effects may

not be immediate, triggering overdose

• Little information on brain impact

• Additives, chemical changes make drug unpredictable, similar to bath salts

MethamphetamineMethamphetamine

MethamphetamineMethamphetamine Famous/notorious for laboratory production, short-

term dopamine effects & long-term effects Stimulant (blood pressure, heart rate, alertness) DEA: Schedule II substance (Desoxyn: ADD,

narcolepsy, weight control)

Methamphetamine acute Methamphetamine acute effectseffects Intense high/euphoria

◦ May last up to 12 hours (longer than cocaine)◦ Meth Inside and Out video describing effects

Energetic, talkative, excitable Insomnia Increased heart rate, blood pressure Sweating Dry mouth Jaw clenching Nausea, vomiting Comparison: meth vs cocaine,Brookhaven

National Laboratory, 2008

Methamphetamine chronic Methamphetamine chronic effectseffects Chronic users may experience hallucinations, rage,

paranoia, heart “meth mouth;” damage to dopamine-, serotonin-containing nerve cells◦ Crank Bugs (Meth Project)◦ Meth Mouth (Meth Project)◦ Ashley’s Story (Meth Project)◦ Research supports both brain damage as well as lack of

brain damage

Methamphetamine Methamphetamine Chronic EffectsChronic Effects

Before & After Photos

Before and After Photos

3 Years and 5 months after starting methMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

Before and After

17 months after starting methMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

Before and After

3 months laterMeth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

HeroinHeroin

HeroinHeroinNarcoticSynthesized from morphine in late

1800’s◦ Morphine synthesized from opium poppy◦ Heroin 10x more powerful than morphine◦ Was thought to be less addictive◦ After many people became addicted,

heroin was outlawed in 1920’s◦ Drug Ads (wings.buffalo.edu)

Schedule I