Psych of Addiction (Final)

What two events made opium products much more addicting and abusable?

1.) We were able to isolate the ingredients that came out of it. 2.)The syringe needle..Pharmacological developments added to the problems. German pharmacist F.W. Serturner developed a process that separated morphine from opium. Morphine became widely available in the mid 1800s, & w/ the development of the hypodermic syringe (1853) → injected morphine became a major dependence problem in Europe & the U.S.

In what year was marijuana growing begun in Virginia? Was George Washington a pot farmer?

1611 → Jamestown, Virginia → grown for fiber. George Washington was a cannabis farmer.

What were the results of LaGuardia's Committee on Marijuana?

1944 -- Mayor LaGuardia's Committee on Marijuana suggests use of M is not particularly harmful to users/society. Study came back saying that people went to use marijuana, and they didn't see violence, they were actually laid back.

Know the history of discovering endorphins and their receptors.

1960s → altering morphine created naloxone, an opiate antagonist and led to search for receptors. 1970s → brain receptors responding to opiates are discovered ("why do we have these receptors?") 1975 → endorphins, brain's own opiates are discovered.

What are the 3 types of medications for depression? Generally, in what order would a prescriber choose to use these? Why?

19:00 The old antidepressants are dangerous because of their anticholinergic effects. People don't usually start with these. They will usually start with the newer -- serotonin reuptake inhibitors. Monoamine oxidase inhibitors. If all else fails, there is electrocompulsive therapy.

What was the Hser, Hoffman, Grella, & Anglin study and the results?

581 heroin addicts followed for over 33 years. ½ died. 50-100 x general death rate. At the end, 20% were using, 10% refused testing, 14% were in prison, and 128 left. Death from diseases of needle sharing like hepatitis, OD, and street living.

Know the results of the Petrovic et al., (2002) study comparing placebo and opiate drug activity.

A PET scan study compared brain activity in individuals who experienced pain relief produced by placebo and by opiate drugs and found similar patterns in the brain regions that were activated.

What is Methadone? For what is it medically used? Why is it a good drug for this?

A prescription opiate. Withdrawal and abstinence maintenance (treatment for opiate addiction). Methadone can only be administered from licensed clinics. Reduces craving.

What is Narcan/naloxone? How is it used? What impact has it been found to have on acupuncture and placebo that are to reduce pain?

A short-acting opiate antagonist; Reverses/blocks the effects of morphine and other opiate drugs. Pain relief produced by acupuncture may be related to endorphin release because naloxone can reverse acupuncture -- induced analgesia.

What is Fentanyl? How potent is it compared to morphine? Know that it gets mixed in with heroin some times creating a potentially lethal formula.

A synthetic opiate drug. It is at least 50 times (hugely) more potent than heroin and is used primarily to produce anesthesia. It gets mixed in w/ heroin, sometimes creating a potentially lethal formula.

What is the biggest danger of combining benzos with another central nervous depressant? What are medical uses for benzodiazepines?

BZ's potentiate each other and other depressants which can result in overdose. They are used to medically manage withdrawal from alcohol. You can use them for muscle relaxer, it's an anti-anxiety medication, used in rehab for people to detox from alcohol

Compare therapeutic index for barbiturates and benzodiazepines.

Barbiturates -- small TI → 10-20 Benzodiazepines -- very high TI since they have almost no effect on respiratory center in the medulla. Barbiturates will kill you sooner. They are far more potent. Will depress the respiratory center.

Why did Vietnam veterans who used heroin in Vietnam tend to not use when they came home? What percent gave up heroin?

Because of environmental & psychosocial factors. They found heroin far less available. Very few soldiers relapsed → less than 15%.

What are the names of the 3 endogenous morphines. To what is the term endogenous morphine shortened?

Beta-endorphin Enkephalin Dynorphin

What impact did Prohibition have on marijuana usage?

Brecher (1972 book) 'Licit & Illicit Drugs' -- attributes this increase to alcohol prohibition. He writes, "Not until the 18th amendment & the Volstead Act of 1920, raised the price of alcoholic beverages and made them less convenient to secure and inferior in quality did substantial commercial trade in marijuana for recreational use spring up." Use of marijuana went up.

What are the types of cannabinoid receptors? In what areas are each most prevalent?

CB1 → located mostly in areas controlling memory, mood, cognition, motor system. CB2 → most prevalent in immune system (and pain system).

What drugs are included in the sedative-hypnotic classification?

CNS depressants that include: barbiturates, benzodiazepines, & alcohol.

What are other biologically active agents called? Do they tend to be psychoactive?

Cannabidiol & Cannabinol → they tend not to be psychoactive.

What is the name of the plant from which most recreational marijuana comes?

Cannabis sativa.

What are warning signs of use?

Chemical odors on someone's breath/clothing, hidden containers or chemical soaked rags. Slurred speech, nausea/loss of appetite, lack of coordination & irritability.

What are major, negative results/concerns of inhalant use?

Chronic use of inhalants has led to a variety of medical problems such as psychotic behavior, movement disorders, liver and kidney toxicity, and damage to the brain's cortex and cerebellum. With heavy use comes more severe problems, such as numbness of the extremities and permanent peripheral nerve damage.

Why is Clonidine used in detox?

Clonidine is used during detox. Opiates inhibit noradrenergic (NE); During detox these neurons are hyperexcitable, rebound; It helps reverse this, decreasing symptoms like tearing, sweating, cramps & chills. Helps keep cardiovascular to decrease a little bit.

What are medical uses of opiate drugs? What is analgesia?

Cough suppressant & antidiarrheal effects (which can cause constipation). Analgesia = pain relief & no loss of consciousness.

What is the neurotransmitter that impacts THC receptors? From what does it get its name?

Anandamide → Sanskirt for bliss; An endogenous chemical; THC receptors are being discovered. & Aracadinoil (AG).

What is a class of serotonergic drug (legal) that does not produce hallucinations?

Anti-depressants.

What are anxiolytics? What neurotransmitter do they mainly impact?

Anxiolytics → drugs that relieve anxiety, often producing a calm, relaxed state, drowsiness, mental clouding, incoordination, and prolonged reaction time. Their main effect is on enhancing GABA effects.

What is the principle psychoactive agent in marijuana?

Delta-9-tetrahydrocannabinol → THC.

Explain why blood levels of THC drop quickly.

Anything inhaled, it comes in and goes in our lungs, shooting up to our brain. You get a high content of it. Because the psychoactive cannabinoids are highly lipid-soluble. (The cannabinoids are lipids -- they are almost entirely insoluble in water). Leaving blood quickly. THC increases blood flow to cerebral cortex and deeper structures.

Can endorphins and opiates reduce emotional pain?

At higher brain sites, there's an impact on emotional & hormonal aspects.

What are acute effects of opiates? Which ones develop little tolerance? What is a telling symptom of opiate use that can be detected in those who are comatose?

Euphoria, drowsiness, feeling of body warmth w/ actual decreased body temperature, slurred speech, reduced sex interest, nausea/vomiting. Little tolerance develops → constipation & pinpoint pupils. They lift the eyelid up. Might give you Narcan.

What are the acute effects of marijuana? What is the result of the Moore (2007) study?

Euphoria, giddiness, a perception of time elongation, increased hunger, impaired short-term memory; some experience negative emotional feelings like anxiety & dysphoria & negative somatic consequences. Moore 2007 → Marijuana users were found to have a 40% higher chance of developing a psychotic disorder later in life, compared to non-users. Relationship not found to be causal; younger ages may be more impacted.

What is California Prop 215?

Exempts patients and defines caregivers who possess marijuana for medical treatment recommended by a physician from criminal laws which otherwise prohibit possession of marijuana.

What are the symptoms of opiate withdrawal?

Flu-like symptoms (tearing, runny nose, nausea, sweating, diarrhea, tremor, & irritability), pupil dilation, decreased eating, increase in heart rate, blood pressure, etc.

What is hashish and from what part of the plant is it made?

From dust of the resin that helps protect plant from sun. Resin increases in warmer temperatures. Usually has stronger psychoactive effects than leaves.

Who was Harry Anslinger and what effect did he have on the usage and acceptance of marijuana?

He served in the U.S. Government (1918-1963) under 9 president's; assistant commissioner of prohibition; commissioner of the Treasury Department's Bureau of Narcotics. He was convinced that Marijuana represented a major threat to the safety and well-being of the country. He successfully encouraged many states to restrict the trafficking & use of marijuana. His efforts culminated in the M Tax Act.

How much more potent is heroin than morphine?

Heroin (diacetylmorphine) is twice as potent as morphine. Sometimes more so.

Does morphine or heroin cross the BBB better? Why? To what is heroin metabolized after crossing the BBB?

Heroin passes the BBB better than morphine. Small amount of morphine passes the BBB; Heroin is more lipid-soluble which means is passes easily and is converted to morphine.

What are huffing and bagging?

Huffing → Fumes are sniffed from a container of the substance on a saturated rag. Bagging → being sniffed from a plastic or paper bag.

What were the provisions of the Marijuana Tax Act of 1937?

It permitted medical use of marijuana. Physicians could prescribe it after paying $1 for license.

What are the 3 opioid receptors, their main areas of distribution, and their main activities?

Mu → widely distributed in brain & spinal cord areas. Resulting in analgesia, positive reinforcement, cardiovascular & respiratory depression, cough control, nausea, and vomiting. Delta → (receptors are more restricted than mu) neocortex, substantia nigra, nucleus accumbens, and olfactory areas. Not as many of them. Starts to have an impact on memory -- people aren't going to be able to learn/remember everything. Kappa → receptors have distinct & limited distribution in sub-cortex areas regulating bodily functions like water balance, temperature control, and neuroendocrine function. Messes up our sex hormones. Alters people's appetite.

What are the opiate antagonists? Why do we need longer acting ones?

Naloxone/Narcan → short acting; used for overdose w/ complete reversal of symptoms; usually injected; ½ life shorter than heroin. Naltrexone (Trexan) → longer acting than Narcan; taken orally. Revex → longer acting than naltrexone. These all keep patients from getting high.

What are the effects of marijuana on fetuses?

No evidence for major teratogenic effects. Effects are similar to cigarettes: premature birth, shorter body length, and lower birth weight.

Does THC cross BBB?

No. It crosses the placental barrier.

What are opiates? Opioids?

Opiate = A remedy containing/deriving from opium (opiates, heroin, morphine). Opioid = Any synthetic narcotic that has opiate-like activities but isn't derived from opium (dynorphins, endorphins, and enkephalins).

What are the ways opiates are usually used?

Opiates are usually taken orally, inhaled, snorted & injected.

What do opiates do to membrane excitability? What are the results of this?

Opiates reduce membrane excitability -- it slows cells from firing and inhibition of NT release.

From what plant does opium come?

Opium comes from the sap of the Papaver Somniferum poppy plant.

Who is credited with introducing in the U.S. the practice of smoking marijuana?

Origins in early part of this century are not clear, but most agree that one of the earliest introductions was through Mexican laborers crossing the border into the U.S. Prohibition -- not enough alcohol to go around so pot became more popular.

Know the brand name Oxycontin, its generic form, why/how it was originally abused, why it is no longer injected, and what impact this had on heroin use.

Oxycontin → "oxycodone". High dose, crushed, injected or snorted. Originally available in 160mg. In 2010, it was reformulated, so if crushed, it was glue-like to prevent injection. Former users of these opiate drugs may be switching away from the reformulated compounds to injectable heroin.

What correlates with the potency of the serotonergic hallucinogen? (affinity for binding to serotonin 5HT- 2a).

The ability for the hallucinogens to impact the serotonergic receptors compares to their potency. The affinity for the receptor equates to the potency of the drug.

In what countries are a lot of opium poppy plants grown?

The opium poppy is native to the Middle East, in the areas that border the Mediterranean Sea, but it's now cultivated throughout Asia & the Middle East.

Marijuana is made from what parts of the plant? Which part has the most THC?

The top, leafy part of the plant and buds. The buds -- has the most THC.

What is the Therapeutic Index for marijuana? Why is it so high without being lethal?

Therapeutic Index is hugely high. The lethal dose has been estimated to be somewhere between 20,000 to 40,000 times the normal dose.

What are problems with barbiturates?

They are often called 'sleeping pills', and can be effective. In low doses, they are also anxiolytic, and if the dose is high enough, these can produce surgical anesthesia. Effects are similar to alcohol. Depresses respiration leading to overdose & death.

For what is phenobarbital commonly used?

Used for epilepsy.

Know what Vicodin is and its generic name.

Vicodin → "hydrocodone". Often prescribed for pain.

Is there tolerance or withdrawal syndrome with pot? Explain. What are results of Budney et al., 2004?

Withdrawal syndrome. Development of cannabinol/anandamide antagonist allowed demonstration of acute withdrawal symptoms in laboratory animals. Budney et al. 2004 → support a withdrawal syndrome of irritability, sleep disturbance, nausea, restlessness. People started to feel uncomfortable.

Marijuana fibers have been used for

sails, rope, and clothing.

What is the relationship of marijuana to amotivational syndrome?

Studies of amotivational syndrome do not support a causal relationship with marijuana use.

What is Suboxone? Buprenorphine?

Suboxone → partial agonist/antagonist at opioid receptors. Buprenorphine → less potent for pain and less constipation; less respiratory depression & risk for dependence; oral.

What is harm reduction and examples of it in the management of opiate use?

Substitution of harmful behaviors w/ less harmful ones.

What is Buspar?

Serotonin; no withdrawal; not abused; for long-term, takes a month or so to kick in. Doesn't appear to have addictive qualities.

Explain the role of marijuana as a possible gateway drug.

Majority of marijuana users don't go on to heroin or cocaine. Teens who experiment w/ tobacco, alcohol, and/or marijuana are more likely to use cocaine and other 'hard' drugs.

What are medical uses for marijuana? What are medications utilizing THC? What Schedule are they?

Marijuana has been shown to have a beneficial effect on nausea, lack of appetite, pain relief, weight loss, reducing impact of chemotherapy, AIDS, and Crohn's disease. Marinol = THC in Sesame oil and.. Cesamet = a synthetic THC which have been shown to be clinically effective as anti-nausea treatments, patients' reactions to these vary w/ some reports of dysphoria using the synthetic version.

What is the "soldier's disease"?

Morphine dependence was so common among soldiers on both sides during the Civil War. About this time, morphine was readily available. There were lots of men who had been named at war. Pain comes from this; it was morphine addiction after Civil War.

How much more potent is morphine than opium?

Morphine is a major active chemical in opium & is about 10X more potent.

How is pain reduced via endorphin system/substance P?

Pain site sends a 'message' and it gets transmitted by a NT called substance P. Endorphins and enkephalins attach themselves to opioid receptor and blocks pain transmission by substance P.

What is an entactogen?

People feel warm and fuzzy.

What is the Native American Church? What year was it incorporated? What is the Peyote Road?

Peyote Road -- is the Native American Indian Church. A combination of traditions and christianity. Their using Jesus teachings, and elderly teachings. 1918-- they incorporated those beliefs to live a better life. They use Peyote as their sacrament because it's a traditional thing.

What is hash oil? How high might its THC content be?

Potent distillate of marijuana or hashish; it has been found to have up to 60% THC.

What are the major immediate effects/symptoms of inhalant use?

Repeated use can damage irreversibly heart, liver, kidneys, lungs & the brain. Brain is especially vulnerable to inhalant toxicity. Blood irregularities, respiratory arrest (single dose can lead to fatal cardiac arrhythmias= sudden sniffing death syndrome), and choking from inhalation of vomit. Repeated use can lead to mild withdrawal syndrome.

What caused the "frozen" addicts and what was given to them to decrease their symptoms?

San Francisco, people showing up and looking like they had Parkinson's disease. An underground chemist began to produce a designer heroin called MPPP. Due to a poor lab technique, some product was a highly toxic compound -- MPTP. There was a number of drug users who were hospitalized w/ complete paralysis. Similar symptoms as Parkinson's disease. L-Dopa was successful enough that the paralyzed patients were able to at least talk a little.

On what Schedule is marijuana placed?

Schedule 1. There is 2 prescriptions (Marinol & Cica Met) on schedule 3.

What is sinsemilla? How is the higher potency pot being grown?

Seedless, unpollinated female plants. People are dabbing joints with wax (hashish) which has increased. "Home-grown" tends to be highest.