Drug Use and Abuse Chapter 6 Cocaine, Amphetamines, and Related Stimulants

bando house

"Crack house" house where crack sold and smoked, sexual activities are currency when run out of money

crack

-- dissolve cocaine in alkaline solution, boil off the water, leaves a rocklike substance, "dirty basing" a freebase cocaine produced by mixing cocaine salt with baking soda and water. The solution is then heated, resulting in brittle sheets of cocaine that are cracked into small smokable chunks or rocks

How many ER calls were there related to bath salts?

0 in 2009 298 in 2010 6062 in 2011

When did Cocaine first become popular?

1863 - Angelo Mariani created ◦"Vin Mariani" - Coca wine Celebrity endorsement John Pemberton invented Coca-Cola in 1885 ◦Advertised as a stimulating brain tonic and remedy for headaches, depressed mood ◦(1903 eliminated cocaine from Coca-Cola) Included in various patent medicines

When was the cocaine epidemic? What did this contribute to?

1880's Contributed to 1914 Harrison Narcotics Act including cocaine

speed kills

1960s - widespread abuse associated with increased violence slogan to express the dangerous behavior on amphetamines

When did cocaine become popular for the second time?

1970s-1980s Cocaine was considered a glamorous stimulant

When and why was crack popular?

1985-6 - cheap, smokable -Rapid onset of intense rush - crash and wanting again in 10 - 20 minutes

Cocaine Epidemic II

1986 peak prevalence - High school survey - past year: •4.1% used crack •12.7% used powdered cocaine

When was the highest prevalence of crack and cocaine?

1986ish after the second Cocaine Epidemic

When was the return of Meth?

1990s - "New" stimulant reappeared in West Coast and Hawaii - "ice," "crystal,", "crank,", "meth" Similar to drug used in 1920-1960s and is not NEW

cocaine effect duration

20-80 mins

synthetic cathinones effect duration

3-4 hours

Amphetamines effect duration

4-12 hours meth on longer side

Tachycardia

Abnormally rapid heartbeat

How do we know stimulants are very addictive? tell about experiment

Animals will press a lever hundreds of times for one dose will continue to press for stimulants as long as available May choose stimulants over food

Vin Mariani

Coca wine

What are some stimulants?

Cocaine Amphetamines - amphetamines, methamphetamine Related Stimulants - methylphenidate (RitalinÒ), diet pills Plant stimulants - khat, betel nut, yohimbe Synthetic cathinones aka Bath salts Nicotine Caffeine

How did the image of cocaine change in the 1970s-1980s?

Cocaine was considered a glamorous stimulant ◦Difficult to obtain, expensive, so small amounts used ◦Not seen as dangerous or even addictive by some Then ◦Price decreased and Smokable freebase - late 1970s "Crack" -- 1985-6 - cheap, smokable Rapid onset of intense rush - crash and wanting again in 10 - 20 minutes

mechanism of action of stimulants

Complex actions on monoamine neurotransmitters ◦Dopamine (DA) ◦Serotonin (5HT) ◦Norepinephrine (NE)

What are some withdrawal symptoms of stimulants?

Depression Craving Anhedonia Anergia Increased sleep, vivid and unpleasant dreams Increased appetite Psychomotor agitation, anxiety

Amphetamines routes of administration

Differences across routes of administration similar to those described for cocaine

There are similar effects across stimulants. How do they really differ?

Duration of action is the main difference in user's reported effects of Cocaine, Amphetamines, and Methylphenidate

What is the history of amphetamines?

First synthesized in late 1800s 1920s - used as tx for asthma - first medical application of amphetamines -Sold as nasal spray - dilated bronchioles, general stimulation, and euphoria -Use spread rapidly Used in WWII (and other wars) - alertness -After war - ↑ civilian use of amphetamine and methamphetamine -Subsequent waves of amphetamine abuse -1960s - widespread abuse associated with increased violence - "speed kills"

Ernst von Fleischl-Marxow

Freud's friend -took cocaine to treat his morphine addiction - developed addiction to cocaine -experienced stimulant psychosis, wrote 1st account of experience

acute behavioral effects of stimulants at low/mod doses

Get a bunch of energy and do things to use the energy Increased behavior activity Elation Increased talkativeness and sociability Alertness and arousal Confidence Insomnia Slight Enhanced physical endurance Faster performance on cognitive tasks but more errors Interferes with complex cognitive tasks Some report aphrodisiac at low doses, but dysfunction at higher doses

Coca-Cola

John Pemberton invented Coca-Cola in 1885 ◦Advertised as a stimulating brain tonic and remedy for headaches, depressed mood ◦(1903 eliminated cocaine from Coca-Cola)

Where was/is methamphetamine produced?

Methamphetamine - was primarily produced in small "kitchen" labs in early 2000s, but now majority made in Mexican laboratories

NAMES TO KNOW

Methamphetamine adderall crank crystal crack ice

What is a common polydrug use of stimulants in gay community?

Methamphetamine and meds for erectile dysfunction

What is the normal route of administration for bath salts?

Most often intranasal or injected can be taken in orally

Khat

Native to East Africa Cultivated in Yemen, Somalia, Ethiopia Effects not as strong as amphetamines, but stronger than chewing coca leaves

acute effects of stimulants at high doses

Paranoid, hypervigilant thinking Stimulant Psychosis Compulsive stereotyped behavior Formication syndrome Aggression Overdose - death due to convulsions, seizures, heart attack, or stroke

What was meth considered to be in the 1990s? The 2000s? Why is there a recent decrease?

Started out as "biker drug" in 1990s Then in 2000s "club drug" Also use became more common among women, nonwhites, gay/lesbian Opiods and extasy replace

DSM-5 stimulant effects of chronic use

Stimulants - very addictive substances Tolerance is complex/inconsistent With smoking route of administration - effect lasts short time, prompting binge use pattern

acute physiological effects of stimulants low/mod dose

Sympathomimetic drugs Increase HR, BP, respiration, body temp, sweating (can cause hyperthermia) Blood flow goes to larger muscles and decreases going to internal organs and extremities pupils dilate decreased appetite (anorectic effects)

Two different crack pipes

The cheap pipe in back uses a little plug of regular tobacco behind the rock of "crack" in order to keep the "coke" from being sucked back. In the forward pipe, a small screen (not shown here) is used to keep the rock of "crack" in place

The Coca Leaf

Used for centuries in South America where it is grown 1850s European chemists isolated potent active agent from the leaf - named cocaine Led to new era - cocaine drug abuse

Is methamphetamine an amphetamine?

Yes

Bathsalts

a psychoactive "designer drug" that is synthesized from various amphetamine-like chemicals and can be inhaled, swallowed, smoked, or injected

Cocaethylene

active metabolite when use alcohol and cocaine

List some inconsistent/complex tolerance of stimulants

acute tolerance with cocaine on subjective effects Inconsistent evidence regarding tolerance to all effects ◦ Methamphetamine - after a few days, tolerance to positive subjective effects Diet pills - tolerance for anorectic effect, not recommended approach to obesity tx

sympathomimetic

agent that mimics the effects of the sympathetic nervous system

Synthetic Cathinones

aka Bath Salts ("Plant food") mephedrone, methylone, MDPV, flakka Mephedrone synthesized in 1920s Used as insecticide in Israel in early 2000s a Club drug in Israel Appeared In US in 2010 Stimulant and hallucinogenic effects

Cocaine hydrochloride

aka street cocaine ◦Oral - most metabolized before absorbed ◦Snort - route of administration slows absorption ◦Inject - rush

anorectic effects

causing one to lose appetite; suppression of eating

speed ball

combination of opioid (often heroin) and cocaine (or other stimulant) associated with enhanced pleasurable effects and increased cardiovascular effects

What does an overdose look like for stimulants?

death due to convulsions, seizures, heart attack, or stroke

compulsive stereotyped behavior of stimulants at high doses

e.g., rocking, hair pulling, chain smoking

Delusions

false beliefs

What are the effects of cocaethylene?

greater agitation, euphoria, and violence; effect lasts longer

Anhedonia

inability to feel pleasure

What are some examples of plant stimulants?

khat, betel nut, yohimbe

Anergia

lack of energy

When was freebase popular? What is freebase?

late 1970s regular freebase is the practice of smoking cocaine involves inhaling vaporized cocaine Mix street cocaine w/ highly flammable substance

Effects of chronic use of stimulants

life revolving around use crack houses meth mouth violence

acute effects of stimulants

low/mod doses

Long-term use leads to depletion of __________________. Describe why and how this happens. Is it long-term?

monoamines Notable depletion of monoamines in Mesolimbic dopaminergic pathway - esp. amphetamines This is thought to be behind the decreased ability to experience pleasure Can be long-term, ?permanent monoamine system changes

Bath salts acute toxicity and results of it

panic attacks, paranoia, hallucinations, hostility, self-mutilation, tachycardia, and high blood pressure High ER visits and calls to poison control center (700 in June 2011)

stimulant psychosis

paranoid delusions and disorientation resembling the symptoms of paranoid schizophrenia, caused by prolonged use or overdose of cocaine and/or amphetamine paranoid delusions and disorientation resembling paranoid schizophrenia

Ice and glass

smokable form of methamphetamine

formication syndrome

symptoms of itching and feeling as if insects were crawling under skin, caused by cocaine and amphetamine ("speed bugs") - symptoms of itching and feeling as if insects were crawling under skin

Methcathinone

synthetic stimulant like Khat Seen in some larger US cities

meth mouth

the decaying of teeth due to decreased saliva production in methamphetamine users bad gums and rotted teeth

state-dependent learning

when learning under the influence of a drug is best recalled when one is in the same "state"

Was the Harrison Narcotics Act affected for decreasing cocaine use?

yes, but cocaine is not a narcotics

How do cocaine and amphetamines affect neurotransmitters?

◦Block reuptake of DA, 5HT, NE

What are the the 2 active stimulants when khat leaves chewed?

◦Cathine ◦Cathinone ◦Only pharmacologically active when leaves are fresh

How do amphetamines and methylphenidate affect neurotransmitters?

◦Increase release of DA, NE

Why did we "outsource" meth making?

◦Significant social/health problem use of toxic chemicals Flammable chemicals/process By-products - bio-health hazard

How do cathinones affect neurotransmitters?

◦Some increase release of monoamines, some block reuptake

Freebasing vs Crack

◦freebase- Mix street cocaine w/ highly flammable substance ◦"Crack" - dissolve cocaine in alkaline solution, boil off the water, leaves a rocklike substance, "dirty basing" "SAFER"

How did Freud feel about Coca?

◦recommended use of cocaine -Local anesthetic -Treatment for depression, indigestion, asthma, various neuroses, syphilis, morphine addiction, alcoholism Wrote his first paper on it