Drug Education Exam 2

primary stimulants

1. Cocaine 2. Amphetamine 3. Methamphetamine

DSM-V AUD Diagnosis Criteria: Meet at least 2 of the 11 criteria during the same 12-month period

1. Drinking more or for a longer period than intended. 2. Persistent desire, or unsuccessful efforts, to cut down or control use. 3. Spend a lot of time trying to obtain, use, or recover from effects of alcohol. 4. Craving, or a strong desire or urge, to use alcohol. 5. Use frequently results in failure to fulfill major role obligations at work, school, or home. 6. Continued use despite persistent/recurrent social/interpersonal problems caused or exacerbated by the effects of alcohol. 7. Give up or reduce important social, occupational, or recreational activities because of use. 8. Frequent use in situations in which it is physically hazardous. 9. Continued use despite known exacerbation of mental or physical health issues. 10. Experienced increased tolerance. 11. Experienced withdrawal.

Hookah

A water pipe used to smoke specially made tobacco. Charcoal heats the tobacco Smoked tobacco is drawn through the water bowl, cooling the smoke before inhaled With or without nicotine, it's not a healthy alternative to cigarettes 100x the volume of smoke than a cigarette Similar amounts of toxins; similar health concerns Increased risk for herpes

Health Risks of smokeless tobacco

Can lead to nicotine dependence or addiction Nicotine in 1 dip of moist snuff = 4x cigarettes Several types of cancer 80% higher risk of oral 60% higher risk of pancreatic & esophageal Increase risk of fatal heart attack and stroke

Alcohol and the brain

5-6 drinks daily adversely affects cognitive functioning Affects judgment, reasoning, inhibitions, motor activity, impairs senses Stimulates release of serotonin & dopamine 15% to 30% of nursing home patients are admitted because of permanent alcohol-induced brain damage Prenatal exposure of the developing fetus to alcohol has long-term effects Fetal alcohol syndrome spectrum disorders Blocks body's ability to use thiamin development of Wernicke-Korsakoff syndrome Associated with neurotic and psychotic symptoms from depressive reactions to generalized anxiety disorders and panic attacks

Proof

A measure of the alcohol content of a distilled beverage, expressed as twice the percentage of alcohol content.

Binge Drinking

A pattern of drinking that brings BAC to ≥ 0.08 -For women: typically ≥ 4 drinks in a 2-hour timeframe -For men: typically ≥5 drinks in a 2-hour timeframe

What is Tobacco?

A plant grown for its leaves. Today: leaves are dried and fermented before putting into 'tobacco products' The addictive component of tobacco is nicotine

sedative hypnotic drugs

CNS Depressants ▪ Produce relaxation and sleep depending on dosage. ▪ Have a widespread effect in the brain ▪Sedatives treat anxiety ▪Hypnotics treat insomnia Three main types: ▪ Barbiturates ▪ Non-barbiturate sedative ▪ Minor tranquilizers

CABs

Caffeinated Alcoholic Beverages

Diagnosable disorders related to caffeine

Caffeine Intoxication ▪ Consumed a high dose of caffeine (much >250mg) ▪ Display ≥5 symptoms during or shortly after consumption. Caffeine Withdrawal ▪ Most common & persistent symptoms = headache ▪ Can last as long as 3 weeks ▪ Changes in mood ▪ Fatigue & difficulty concentrating ▪ Flu-like symptoms

pharmacology of amphetamines

Can be administered by mouth, injection, snorting, or inhaling Tolerance develops quickly Chemical structure similar to norepinephrine & dopamine

Standard drink definitions vary

internationally

meth labs

Have become the #1 drug problem in some rural areas Accompanying problems Physical injury from explosions, fires, chemical burns, and toxic fumes Environmental hazards Child endangerment Clean-up costs and guidelines

Identifying Problematic Drinking

Hiding or denying drinking behavior Deliberately using to manage difficult situations Feeling uncomfortable when alcohol is not available Ever increasing drinking behavior, more frequent states of intoxication Consuming alcohol in risky situations, such as before or while driving Drinking in the morning or other unusual times often to prevent withdrawal symptoms

Race/Ethnicity Rate of adult smokers

Hispanics 9.8% #1--Non-Hispanic American Indian/Alaska Natives 22.6% Non-Hispanic Asians 7.1% Non-Hispanic Blacks 14.6% #2--Non-Hispanic multi-racial individuals 19.1% #3--Non-Hispanic Whites 15.0% ---------- Rate of smoking decreases as income level increases Rate of smoking decreases as education level increases Adults with disabilities/limitations are more likely to smoke 19.2% compared to 13.0% Adults with serious psychological distress are more likely to smoke 31.6% compared to 13%

Decaf Coffee

How is caffeine removed? ▪ Most common method in US: Soak un-roasted beans in an organic solvent ▪ The Swiss water process: Removes more of the coffee's flavor ( Not used on a large commercial scale in the US) ▪Caffeine removed from coffee is used in soft drinks ▪Coca-Cola owns one of the largest decaffeinating companies ▪1 cup of decaf coffee has 5mg of caffeine.

Economic cost of smoking

In the US, smoking related illness costs >$300 billion annually ---- $170 billion for direct medical care for adults ---- >$156 billion in lost productivity -------- This includes $5.6 billion in lost productivity due to secondhand smoke exposure

0.25 BAC

Inability to stand without help, grossly affected ability to comprehend

Stimulants

Increase alertness, attention, and energy Elevate blood pressure, heart rate, and respiration Some are legal ----Some require prescriptions -------- Highly restricted; treat only a few medical conditions ---- Some don't... -------- OTCs -------- Nicotine & Caffeine Some are illegal & manufactured locally in clandestine labs while others are smuggled into the country

Tobacco cessation- what works? policy

Increased cost of smoking Increasing the price of tobacco smoke = single most effective way to reduce overall consumption 10% increase is estimated to reduce consumption by 3-5% Youth and young adults are more likely to respond to price increases than adults

long term health/physical effects of cocaine

Insufflation/Snorting Nosebleeds Decreased/loss of sense of smell Damage to nasal cavity (including sinuses) Malnutrition Weight loss

other health effects of cocaine

Intravenous use Risk of HIV, viral hepatitis, other infectious diseases Maternal use Constricts blood vessels & reduces blood flow and oxygen to the fetus Detachment of the placenta Premature delivery Low birth weight Dependency in newborn Combined with alcohol Increased risk of death

Caffeine Pharmacology

Key xanthines: ▪ Caffeine → greatest effect of the three. ▪ Theophylline→ higher toxicity. ▪ Theobromine Methods of administration ▪ Most common is oral (Peak blood levels are reached 30 minutes after intake) ----Half-life is about three hours ▪ Can also be administered rectally or through injection Mechanism of action ▪ Xanthines block the brain's receptors for adenosine ▪ Adenosine is an inhibitory neurotransmitter that produces behavioral sedation by inhibiting release of other neurotransmitters Physiological effects ▪ Stimulates the CNS & skeletal muscles ▪ Causes sleep disturbances ▪ Elevates mood and boosts alertness ▪ Constricts blood vessels in the brain ---May explain the ability of caffeine to reduce migraine headaches

Cannabis preparation: Extraction

Kief Highly potent Resin from the trichomes (i.e., hairs) of the plant. Appears as a powder; (typically) sifted from leaves & flowers. Hashish ('hash') Kief that has been pressed into a wax or liquid. The basis of hash oil: ----- A sticky black liquid -----Results from boiling resin in alcohol ----- Using hash is referred to as 'dabbing

common amphetamine names

Adderall (Biphetamine) Vyvanse Evekeo Dexidrine Ionamin Plegine

long term effects of meth

Anxiety Mood disturbances Confusion Insomnia Violent behavior Psychotic features (paranoia, delusions, hallucinations) Weight loss Severe tooth decay and tooth loss ("meth mouth") Skin sores Addiction Tolerance Difficulty feeling pleasure without the drug

meth withdrawal symptoms

Depression Intense cravings for the drug Anxiety Fatigue

short term effects of meth

Euphoria and rush Increased activity and wakefulness Increased attention Decreased fatigue Rapid/irregular heartbeat Increased respiration Hyperthermia

Helping a friend with AUD

If you care, show concern Avoid blaming, lectures, and verbal attacks Keep an open mind about how your friend evaluates his or her situation Encourage non-drinking behavior by planning activities not related to alcohol Limit personal drinking when you are with your friend who has a problem Encourage friend to take advantage of campus or other resources

Tobacco cessation- what works? systems change

Implement a tobacco-user identification system in every clinic. Provide education, resources, & feedback to promote provider intervention. Dedicate staff to provide tobacco dependence treatment, and assess delivery in staff performance evaluations. Promote hospital policies that support and provide inpatient tobacco dependence services. Include effective tobacco dependence treatments as paid or covered services in health insurance packages.

short term health/physical effects of cocaine

Increased energy Euphoria Restlessness, anxiety, panic attack, paranoia, "cocaine psychosis" Narrowed blood vessels, increased body temperature, heart rate, & blood pressure Insomnia Enlarged pupils Headache Decreased appetite Nausea, vomiting, & abdominal pain Heart attack, stroke, seizure, coma

the morning after heavy alcohol consumption

Lowers mood Disrupts sleep Increases anxiety Decreases alertness, and increases fatigue Sustained attention and driving abilities are impaired

administration of meth

Oral ingestion (as with Rx) Snorted Smoked IV injection

common methylphenidate names

Ritalin Concerta Daytrana Focalin Qullivant Quillichew Jornay Adhansia XR

Physical effects of amphetamines

Tremors, dry mouth, ringing in ears, excessive perspiration, increased blood pressure, poor coordination, convulsions Especially harmful to the cardiovascular system Can cause cardiac arrest

Fetal alcohol spectrum disorders (FASD)

Various effects that occur as a result of women who drink alcohol while pregnant Effects can be behavioral, physical, and/or mental Leading known cause of intellectual disability Fetus is especially vulnerable during the first trimester of pregnancy Small brain at birth, head and facial anomalies, stunted growth, CNS problems, malformations of major organs, eye problems

illicit use of methamphetamine

"Crystal meth" or "ice" Person may go on binges Often used in conjunction with other drugs (e.g., cocaine and marijuana)

Factors influencing rate of absorption

-Food or water in the stomach -Type of alcoholic beverage -Carbonation -Strong emotions -Gender

Moderate alcohol consumption

-For women: Drinking up to 1 drink per day -For men: Drinking up to 2 drinks per day

Low risk drinking

-For women: No more than 3 drinks in a single day, and no more than 7 drinks per week -For men: No more than 4 drinks in a single day, and no more than 14 drinks per week.

Health Effects of alcohol

****Alcohol is the third leading cause of preventable death in the US. Estimated that deaths from alcohol-related problems have more than doubled in the past 20 years Largest increase among white women In general, rates are higher for men than women Increases in consumption were larger for those 50+ compared to other age groups Life expectancy of a person with AUD is reduced by 15+ years One recent European study found the difference to be 24-28 years. Effects are determined by frequency and quantity of drinking, not the type of alcohol consumed Alcohol affects 'almost' every organ in the body

Using alcohol wit other drugs

--Synergistic effect increases the drug effect of both drugs Results can be fatal depending on the drug, how much is taken and how frequently --Affects senses, cognition, coordination -- May disrupt liver and heart functions Alcohol may interfere with some antibiotics Unpredictability - confirm with doctor or pharmacist if alcohol use is okay Avoid illicit drugs

Alcohol Pharmacology: Metabolism

-About 90% of alcohol is metabolized in the liver -About 2% of alcohol is excreted unchanged: --In the breath --Through the skin --In the urine

Factors that influence alcohol metabolism

-Genetic variations in the enzyme that break down alcohol -Amount of alcohol an individual consumes, and their overall nutrition -->Liver responds to chronic intake by increasing metabolic enzymes --->Contributes to tolerance among heavy users

Blood alcohol concentration (BAC)

-Measure of the concentration of alcohol in blood -Expressed as a percentage in terms of grams per 100ml

Alcohol and cancer

-Research links alcohol abuse with cancers of the nasopharynx, esophagus, larynx, stomach, liver... and more -Risk of colon cancer is 26% higher for people who have >2 alcohol drinks per day -Drinking beer associated with cancers of the lower GI -Drinking red wine has been associated with reduced risk of prostate cancer and kidney cancer

recovery position

1. Raise the closest arm above the head. Prepare to roll him/her toward you. 2. GENTLY roll the person toward you. Guard the head. 3. Tilt head to maintain airway. Tuck nearest hand under cheek.

Stages of alcohol withdrawal syndrome

1. tremors, rapid heartbeat, hypertension, heavy sweating, loss of appetite, and insomnia 2. hallucinations, which are auditory, visual, tactile, or a combination of these; and, rarely, olfactory signs 3. delusions, disorientation, delirium, and amnesia 4. seizures ---Medical treatment is usually sought in stage 1 or 2. ----Rapid intervention with a sedative drug will prevent stage 3 or 4.

Cigarette Smoking Among Adults

13.7% of adults in the US currently smoke cigarettes (2018) 15.6% of adult men 12% of adult women Age groups: 7.8% of 18-24 year-olds 16.5% of 25-44 year-olds 16.3% of 45-64 year-olds 8.4% of 65 years-old and up

History of tobacco in the US

1492 Columbus was offered 'dried leaves' as a gift from American Indians 1500s Tobacco as panacea Headaches Colds Wounds & burns Diseases of the glands on the neck Joint pains Epilepsy Diarrhea Recognized negative effect on reproduction 1600s 1 st tobacco plantation established in the US Ensured the economic survival of the colony Known as the "Golden Weed of Virginia" 1700s Helped finance the revolution by serving as collateral for loans the Americans borrowed from France 1800s Phillip Morris Company established in 1847, selling hand rolled Turkish cigarettes 1849, J.E. Liggett and Brother is established in St. Louis, MO 1875, R.J. Reynolds Tobacco Co. was established to produce chewing tobacco 1883, cigarette rolling machine was patented 1900s The cigarette became the major tobacco product

The history of tobacco and health

1602: Anonymous English author notes soot as cause of disease in chimney sweeps; suggests tobacco may have similar effects 1920s First medical reports linking smoking to lung cancer Newspaper editors refused to report findings because they didn't want to offed tobacco companies 1950s-1960s A series of medical reports confirmed tobacco can cause a range of serious diseases

Cocaine is a schedule ___ drug

2

methamphetamine is a sechedule ___ drug

2

Tobacco cessation- what works? treatment

2008 Public Health Service Clinical Practice Guideline Brief (motivational) tobacco treatment intervention ---- Effectiveness of individual, group, and telephone counseling increases with intensity -------- Practical counseling (problem solving/skills training) -------- Social support delivered as part of treatment Medication Nicotine-based Non-nicotine-based Combination Combined counseling & medication

Environmental tobacco smoke

AKA passive smoking; secondhand smoke Increased risk for diseases associated with active smoking Children and pets are especially at risk Mainstream smoke Smoke inhaled then exhaled by the smoker Sidestream smoke Smoke from burning end of tobacco product Contains twice as much nicotine and tar 5 times more carbon monoxide

How long does it take to metabolize alcohol

About 1 standard drinks per 2-hours.

DRIVING UNDER ALCOHOL INFLUENCE

About one-third of all fatal crashes involve alcohol -Proportion is greatest at night and on weekends --- Midnight to 3am has highest percent at 55% -Greatest proportion are men aged 21-24yo ---90% of the intoxicated drivers involved in fatal crashes have never been convicted of DUI in the past

Pharmacology of cocaine

Action on neurotransmitter system Blocks the reuptake of dopamine causing it to accumulate ---- Feelings of pleasure May also block the reuptake of noradrenaline and serotonin ---- Noradrenaline - feelings of energy ---- Serotonin - feelings of confidence

Toxicity potential of marijuana

Acute physiological effects Increases heart rate & blood pressure Could be harmful for someone with pre-existing CVD Fatal overdose is unlikely Chronic lung exposure (note a lack of studies in the field) No association between smoking marijuana & respiratory symptoms or lung diseases Marijuana smoke contains may of the carcinogens found in tobacco smoke (at similar or higher levels) Unclear if marijuana smokers are at increased risk for cancer

Alcohol and gender

Affects women differently than men Heavy drinking More vulnerable to alcohol-induced brain damage More susceptible to alcohol-related heart disease More likely to have malnutrition Risk factor for becoming a victim of violence and sexual assault In women: -Heavy drinking increases the risk of breast cancer -Chronic heavy drinking is linked to menstrual disorders

View of Alcoholics Anonymous on AUD

Alcohol dependence is a progressive disease characterized by loss of control over drinking The only treatment is abstinence from alcohol Disease model: alcohol dependence is the primary disease and not the result of another underlying cause

Alcohol toxicity

Alcohol overdose is relatively common and dangerous Tips: Avoid drinking games Practice lower risk strategies If someone drinks enough to vomit, stop drinking Vomiting reflex is triggered by rapidly rising BAC, usually above 0.12 percent, and is inhibited when BAC reaches above 0.20

Alcohol and violence

Alcohol use is correlated with: Homicide Assault, spousal and child abuse, and date rape Alcohol is the #1 drug involved in sexual assault and rape Suicide

Alcohol and sexual behavior

Alcohol use may enhance interest in sex but impair physiological arousal Linked to risky sexual behavior

perceptual effects of marijuana

Alters perception of time and space Mood changes marked by anxiety, sadness, laughter, and paranoia Temporary panic reactions triggered by feeling of not being in control Note: the severity of an effect can be dose- and person dependent

A standard drink

Any drink that contains ~14 grams of pure alcohol -12 oz beer -8-9 oz malt liquor -5 oz wine -3-4 oz fortified wine (sherry/port) -1.5 oz of any 80 proof

Other cannabinoids

Anywhere from 80 to >100 cannabinoids produced by cannabis Cannabidiol (CBD) Non-intoxicating, antianxiety, antipsychotic, and antidepressant effects Cannabinol (CBN) Results from the breakdown of THC, found in aged cannabis, about 25% of the potency of THC

early barbiturates

Barbitol ▪ The original barbiturate ▪ Introduced into medicine in 2903 ▪ Used to treat anxiety & depression ▪ Brand name Veronal Phenobarbital ▪ Second to be developed,1912 ▪ Produce relaxation and relieves anxiety

Heavy drinking

Binge drinking on each of 5 or more days in the past 30 days

cocaine chronic toxicity

Binge use Drug is taken repeatedly and at increasingly high doses Leads to a state of increasing irritability, restlessness, and paranoia Can result in paranoid psychosis Most people seem to recover once the drug leaves the system

Hangxiety

Bounce back effect of glutamate A night after heavy drinker, several neurotransmitters are depleted, including Gamma-Amino Butyric Acid (GABA) Also serotonin & dopamine

methamphetamine medicinal use

Brand name = Desoxyn ® Treatment for: ADHD Exogenous obesity (short term, few weeks) Narcolepsy

In general, alcohol depresses the

CNS

Signs of alcohol poisoning

Can't get him/her to wake up Breathing slow less than 8 breaths/min Irregular breathing - 10 sec + between breaths Cool, pale, bluish skin Hypothermia body temperature ↓ 95◦ F YOU NEED TO Call 911 immediately Do not leave the person alone Do not try to give the person anything to eat or drink Do not put the person in a cold shower Do not just let them "sleep it off" Don't wait for all the symptoms to be present A person who has passed out may die Don't try to guess how drunk they are; call 911 Place person in recovery position Stay with the person Check breathing and heart rate often Be prepared to give emergency personnel as much information as possible

Consequences of excessive caffeine

Cancer ▪ The 1984 American Cancer Society nutritional guidelines indicated that caffeine is not a risk factor in human cancer Reproductive effects ▪ High consumption of caffeine reduces a woman's chances of becoming pregnant, increases the chances of miscarriage, and slows the growth of the fetus Heart disease ▪ Increase the risk of heart attacks, particularly in people with other risk factors ▪ Small amounts of coffee may lower the risk

delta- 9tetrahydrocannabinol (THC)

Cannabinoid Psychoactive agent Levels influenced by several factors including the sex of the plant, part of the plant, and soil and climate conditions

Fermentation

Certain yeasts act on sugar in the presence of water, and this chemical action is fermentation. Forms the basis of all alcoholic beverages .

Smokeless Tobacco

Chewing tobacco Loose leaf, plug, and twist form Snuff Finely ground; dry, moist, or in a pouch Dissolvable tobacco Sweet and candy-like Strips, lozenges, etc., that melt away in the mouth, held in the mouth, chewed, or sucked

Smoking and health today

Cigarette smoking remains is the leading cause of preventable death in the US. Tell me... What are the health risks associated with tobacco use? What are the health benefits associated with tobacco use?

Tobacco smoke

Cigarettes, cigars, and pipe tobacco smoke Nicotine Thousands of chemicals ---- More than 70 carcinogens Tar Poisonous gases ---- Carbon monoxide ---- Nitrogen oxide Tobacco leaves used to make cigarettes and cigars contain radioactive material

types of barbiturates

Classified based on their duration of action Ultra short-acting ▪ Effects felt in ~ 1 minute after IV administration Short-acting ▪ Less than 4 hours Intermediate-acting ▪ 4-6 hours Long-acting ▪ > 6 hours, as long as 24 hrs

Forms of cocaine

Coca Plant -Crude Cocaine: low concentration (chewing leaves) -Cocaine hydrochloride: intravenously or snorted (an organic solvent is added to crude cocaine ----From cocaine HCL: ----------Freebase: high concentration with ether or ammonia added (to be smoked) ----------Crack: high concentration with baking soda and water

Cocaine description

Cocaine hydrochloride Odorless, crystalline, white powder Derived from the leaves of the coca plant History of use among Natives of the Andes Mountains ---- To relieve fatigue ---- For spiritual purposes ---- To enhance feelings of well-being Schedule II drug Past and current medical use Largest producer is Columbia Bolivia and Peru account for a small percentage

common methods of administration of cocaine

Common methods of administration 1. IV Injection Euphoria is rapid 2. Insufflation/Snorting Placed in nasal cavity 3. Inhalation Smoked as crack or freebase Euphoria is rapid and intense

World Health Organization uses a measure called: heavy episodic drinking

Consuming ≥ 60 grams of alcohol on at least one occasion in the past 30 days

Alcohol consumption patterns

Consumption patterns are influenced by cultural factors Trends in the U.S. Alcohol use rose through most of the 1970s and peaked in 1981 Use of illicit drugs also reached a peak about the same time Declined between the years 1981 and 1995 Gender differences (in the US) Males are more likely to drink than females Males are more likely than females to report binge drinking within the past 30 days Drinking among college students (US) College students drink more among others in the same age group Many campuses have banned the sale or advertising of alcohol Many fraternities have banned keg parties There is some evidence that this is helping -Fewer students are binge drinking and Fewer students are driving after drinking

0.50 BAC

Deep coma or complete unconsciousness, if not already dead

beneficial uses of amphetamines

Depression Treatment of choice during the 1950s and early 1960s Now used as an adjunctive therapy Major advantage: antidepressant effects occur relatively rapidly Weight control In the mid-1960s, it was widely used to reduce appetite and food intake for short periods of time Methamphetamine is currently FDA approved Long-term effects on obesity are unclear Narcolepsy Uncontrolled daytime episodes of muscular weakness and falling asleep Amphetamines and other stimulants are used to keep patients awake during the day "Smart pills" May improve performance that had been disrupted by fatigue or sleep deprivation at low doses May decrease complex performances at high doses Athletics May produce slight improvements in athletic performance at appropriate doses under some circumstances Treatment of Attention-Deficit / Hyperactivity Disorder (AD/HD) Characterized by problems of inattention and hyperactivity Amphetamines reduce activity levels and improve concentration in hyperactive children and adults Stimulant medications can reverse catecholamine associated deficits that may underlie ADHD Concerns about abuse and side effects have led to other treatment options Suppression of height and weight increases during drug treatment is a drawback of stimulant therapy Data suggest that stimulant therapy is protective against substance abuse

chronic effects of marijuana

Difficult to make definitive statements about effects on long-term cognitive functioning --- Studies have had divergent findings and interpretations Current evidence suggests that after abstaining for more than a month, regular marijuana use produces few effects on cognition

0.15 BAC

Distorted perception & judgment, impaired mental & physical functions, less responsible behavior

Alcohol Pharmacology: Distribution

Distributed throughout the body fluids, but not much into fatty tissues

cannabis/marijuana

Dried leaves, flowers, stems, and seeds from the cannabis plant. Referred to as weed, pot, grass, herb, bud, ganga, etc. "Most commonly used illegal substance in the U.S." (SAMHSA) State laws vary. As of January 1, 2020: 33 states, plus DC, have legalized medical use of marijuana 11, plus DC, of those have legalized recreational use, too.

Amphetamine and methylphenidate

Early uses Decongestant & bronchodilator Depression Narcolepsy Appetite suppressant Hyperactivity in children Increase work capacity Ward off fatigue

Cannabis preparation from extraction to edibles

Edibles are typically made with highly concentrated cannabis Hash oil, infused butter, infused oil Consumed as food, it contains none of the risks associated with smoking Consider: Oral ingestion means delayed effects. Dosing is difficult to know. Oral ingestion means the effects last longer.

Alcohol and the elderly

Especially vulnerable to the effects of alcohol Alcoholism accelerates aging Older people may also be taking medications that can speed up the effects of alcohol

signs of possible marijuana overdose

Extreme anxiety or panic attacks Psychotic reaction Fast heart rate, chest pain, or heart attack Uncontrollable shaking or seizures Pale skin color Unresponsiveness Sudden high blood pressure with headache

Alcohol enhances the inhibitory effect of ________ at the __________ receptor

GABA at the GABA-A receptor

At high doses, alcohol blocks the effects of ____________ at some of its receptors

GLUTAMATE at some of its receptors ---Enhances alcohol's overall inhibitory actions

medical uses of marijuana

Glaucoma Reduces pressure behind the eye Nausea & vomiting An effective anti-emetic to counteract nausea & vomiting associated with chemotherapy Asthma Dilates the bronchial tubes Additional medical uses: Appetite stimulant Pain relief Muscle relaxation Anti-inflammation Recommended for epilepsy, insomnia, rheumatoid arthritis, chronic pain conditions, premenstrual syndrome, and menstrual cramps Use in children is extremely controversial

0.05 BAC

Less alert, less inhibited, slightly impaired judgment, slight euphoria

Cannabis preparation: Bhang

Lower stems, leaves, and seeds Contain less THC

general effects of marijuana use

Many users Pleasant euphoria Sense of relaxation Heightened sensory perception Laughter Altered perception of time Increased appetite Other users Anxiety Paranoia Fear Distrust and panic

Cannabis preparation: Sensemilla

Marijuana 'without seeds' A method of growing more potent marijuana

0.20 BAC

Marked affected psychomotor ability, difficulty staying awake

Physiological effects of nicotine

Mechanism of action Mimics acetylcholine First stimulates and then blocks the receptors Causes the release of adrenaline (norepinephrine) Symptoms of nicotine poisoning Low-level poisoning --Nausea, dizziness, general weakness --Often experienced by beginning smokers Acute poisoning ----Tremors, convulsions, paralysis of muscles used in respiration, & death CNS & circulatory system effects Increased heart rate, blood pressure, & heart oxygen needs Decreased oxygen-carrying ability of blood Increased platelet adhesiveness ---- Increases the tendency to clot Increased electrical activity in the cortex Reasons for decrease in hunger after smoking Inhibition of hunger contractions of the stomach Increased blood sugar level Deadening of taste buds

Hangover

Mental & physical symptoms, experienced the day after a single episode of heavy drinking, starting when the BAC approaches zero. Symptoms Upset stomach Fatigue General malaise Irritability Headache Thirst Nausea Depression Anxiety Cause from alcohol Gastrointestinal effects Electrolyte imbalance Vasodilation Dehydration Immune system effects Difficulty sleeping Affected neurotransmitters Serotonin GABA

Cocaine metabolism and elimination

Metabolized by enzymes in the blood and liver Cocaine has a half-life of about one hour Metabolites of cocaine last longer in the system Detected by urine screening tests Takes ~ 3 days for metabolites to be completely eliminated after moderate use

Alcohol and the GI tract

Moderate amounts Aids digestion by increasing gastric juice in the stomach Too much/heavy use Can irritate the stomach, leading to internal bleeding Implicated in acute pancreatitis Interferes with the body's ability to utilize nutrients -->malnutrition

Alcohol and the cardiovascular system

Moderate use Can reduce risk of heart disease, boosts good (HDL) cholesterol and helps prevent type 2 diabetes Heavy use Degeneration of heart muscle Strokes Cardiac arrhythmias High blood pressure Ischemic heart disease

Alcohol and the immune system

Moderate use Reduce immunity Heavy use Infections such as pneumonia & peritonitis Alcohol interferes with white blood cells, particularly T lymphocytes, which help to resist infections Alcohol dependence Reduces immunity to diseases such as HIV

Behavioral Effects of alcohol

Mood changes can include: euphoria reduced anxieties reduced inhibitions (Effects depend on the BAC)

methsmphetamine

More potent form of amphetamines Schedule II drug Majority of meth in US is supplied via illicit manufacturing and trafficking rather than the Rx drug distribution process

patterns of abuse of depressants

Most abuse is associated with the oral use of legally manufactured products Two types of typical abusers ▪ Older adults using prescription drugs who develop tolerance and increase their dosage ▪ Younger people who obtain drugs to get high ▪ May take high doses, mix several drugs, or drink alcohol with the drug

Concerns about barbiturates led to search for "safer" medications

Non barbiturate sedatives ▪Paraldehyde ▪Bromides ▪Meprobamate

Caffeine use disorder?

Not a specified diagnosis by the DSM. Instead it is a condition for further study. ▪Suggested diagnosable symptoms: ▪ Ongoing desire or non-successful attempt to decrease use ▪ 'Use despite harm' ▪ Withdrawal

Route of administration

Orally-> esophagus

Other sources of caffeine

Other soft drinks ▪ The United States per capita soft drink consumption is about 45 gallons per year Energy drinks ▪ Compete with soft drinks in the market Over-the-counter drugs ▪ Many nonprescription drugs include caffeine, some in quite large amounts The average American consumes about 200 to 250 mg of caffeine per day

amphetamine chronic toxicity

Paranoid psychosis may result after sustained amphetamine use Psychosis may result from dopaminergic stimulation, probably in the mesolimbic system No good evidence for permanent behavioral or personality disruption exists

Amphetamine Absorption and Elimination

Peak effects occur: 1-2 hours after oral ingestion (instant release) 5 to 20 minutes after intranasal administration 5 to 10 minutes following intravenous injection or smoking Half-life 5 to 12 hours Completely eliminated within 2 to 3 days of the last dose Rapid tolerance or a tachyphylaxis can occur after high doses

Blood Alcohol Concentration (BAC)

Percentage of alcohol in the blood stream Rises when alcohol is consumed at a rate exceeding the rate at which it is metabolized or leaves the body As BAC increases, behavioral and subjective effects become more pronounced Drinking too much alcohol in a short time can be fatal

Physiological effects of alcohol

Peripheral circulation --- Dilation of peripheral blood vessels ------ Increases heat loss from the body but makes the drinker feel warm Fluid balance ---Alcohol has a diuretic effects ------ Increases urine flow ------ Lowers blood pressure in some individuals Hormonal effects ---Chronic alcohol abusers can develop a variety of hormone-related disorders ---Testicular atrophy and impotence in men ---Impaired reproductive functioning in women

Alcohol Withdrawal Syndrome

Physical dependence associated with prolonged heavy use of alcohol is revealed when alcohol intake is stopped. Abstinence syndrome is medically more severe and more deadly than withdrawal from opioid drugs If untreated, mortality can be as high as 1 in 7 Detoxification should be carried out in an inpatient medical setting

cocaine acute toxicity

Potential toxicity increases with larger doses Acute cocaine poisoning can lead to profound CNS stimulation ---- Can lead to respiratory or cardiac arrest Illicit cocaine is often adulterated Adulterants may be more toxic than the drug

acute cognitive effects of marijuana

Slowed cognitive processing - harder to learn new information Disrupted short-term memory Loss of sustained concentration Research shows that individuals recover from at least some cognitive deficits after 4 weeks of abstinence.

0.10 BAC

Slower reaction time, impaired muscle control, reduced visual and auditory acuity

Medical uses of barbiturates

Primary uses ▪ Anxiety ▪ Tension ▪ Sleep disorders Occasionally used to treat convulsive disorders

Distillation

Process in which a solution containing alcohol is heated, and the vapors are collected and condensed into liquid form again.

Amphetamine acute toxicity

Psychological Effects Acute behavioral toxicity can cause dangers User may become suspicious to the point of paranoia when higher doses are administered for extended periods When this is combined with lack of sleep and poor nutrition, there is even greater concern about the psychological and physical well-being of the person

nitrites (inhalants)

Relax blood vessels ▪ Increase blood flow and briefly lowers blood pressure ▪ Used as a treatment for cyanide poisoning ▪ With high doses, there might be a brief sense of lightheadedness or faintness resulting from lower blood pressure Used in various cleaning products ▪ some users have inhaled these products to achieve the effect of inhaling nitrites

physical effects of marijuana

Reproductive System Men Decreases testosterone levels, sperm count, and libido Possibly related to gynecomastia Women May inhibit ovulation due to its effect on estrogen These effects appear reversible, as they are associated with recentness of use, and not duration or frequency

dangers of inhaling solvents

Several solvents have been linked to: ▪ Kidney damage ▪ Brain damage ▪ Peripheral nerve damage ▪ Irritation of the respiratory tract ▪ Severe headache ▪ Death by suffocation

pharmacology of barbiturates

Slows brain function by increasing the activity of GABA ▪ GABA decreases brain activity, produces feelings of drowsiness & calmness ▪ Also affects activity of muscle tissue, the heart, and respiration

Nicotine Tolerance and Dependence

Smokers and chewers build up tolerance quickly, some in a matter of weeks. Most people continue to use tobacco products because nicotine is addictive and produces dependency. 90% of smokers first tried smoking before 18yo. 98% of smokers first tried smoking before 26yo.

Methods of Administration of marijuana

Smoking & vaping Rapid onset duration is shorter Metabolized quickly in the body Felt in 5-10 minutes; peak mood & CV effect within 30 minutes; lasting 1-3 hours (& lingering for up to 8 hours) Oral ingestion THC is absorbed more slowly Felt in 30-60 minutes; peak within 90 minutes; lasting 4-6 hours (& lingering for up to 12 hours) Transdermal THC & CBD patches Applied directly to skin

1964 Surgeon General's Report

Smoking and health - Report of the Advisory Committee to the Surgeon General of the Public Health Service ---386-page report On the basis of 7,000 articles related to smoking and disease, the Advisory Committee concluded that cigarette smoking is: --- A cause of lung and laryngeal cancer in men --- A probable cause of lung cancer in women --- The most important cause of chronic bronchitis

0.40 BAC

State of unconsciousness or coma, 50% mortality level w/o medical intervention

cardiovascular effects of marijuana

Stimulant effects Dilates peripheral blood vessels Increases heart rate and blood pressure THC increases heart rate in a dose-dependent fashion Time course differs depending on route of administration

Behavioral effects of caffeine

Stimulation ▪ Partially offsets fatigue-induced performance quality of motor tasks ▪ Prolongs the amount of time one can perform physically exhausting work Headache treatment ▪ Helps relieve both migraine and non-migraine headaches Hyperactivity treatment ▪ High doses may decrease hyperactivity

Alcohol Absorption occurs in the

Stomach about 20% Small intestines about 80%

0.30 BAC

Stuporous but conscious; inability to r, not likely to remember events the next day

0.35 BAC

Surgical anesthesia; 1% will die at this level BAC

Marijuana metabolism

THC has a half-life of 19 hours Complete elimination of THC and its metabolites may take 2 to 3 weeks. Fat solubility allows the metabolites to remain in the fatty tissue of heavy users for up to several weeks. First time use, eliminated within ~ 3 days Several times per week use, eliminated within ~ 7 days Everyday use, eliminated after 30 days

Mechanisms of action of marijuana

THC stimulates the release of dopamine THC has similar chemical structure to endogenous cannabinoids that function as neurotransmitters ---- Attaches to their receptors and alters normal brain communication

Alcohol also affects dopamine, serotonin, and acetylcholine neurons

TRUE

Third hand smoke

Tobacco smoke residue on indoor surfaces, and to clothing and hair . The after 'smell' is thirdhand smoke Nicotine & other chemicals react with indoor pollutants to form carcinogens. Increasing research suggests that thirdhand smoke may have some of same negative health effects as second hand smoke especially in children.

AUD: Alcohol Use Disorder

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders V (DSMV): A chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake and negative emotional state when not using. In 2018, 5.8% of US adults (18+) had AUD. Diagnosis Meet at least 2 of the 11 criteria during the same 12-month period. Severity is graded as mild, moderate, or severe

Absorption and metabolism

The role of the liver Enzymes responsible for nicotine deactivation ----Contributes to tolerance ---- May decrease the effects of other medication Nicotine is deactivated in the liver, with 80-90% being modified and then excreted through the kidneys

Alcohol and stimulants

The stimulant can mask the depressant effects Don't realize impairment ---> BAC remains the same Stimulant can ↑ heart rate and blood pressure Mixing ↑ risk of alcohol poisoning Caffeine most frequently used stimulant Both are diuretics - ↑ risk for dehydration Caffeinated Alcoholic Beverages (CABs) ---- 2010 FDA ban - failed to meet safe standard

Xanthine content in chocolate

Theobromine ▪The unique xanthine in chocolate ▪Similar to caffeine, but much less potent in its effects on the central nervous system The average cup of cocoa contains 200 mg of theobromine and 4 mg of caffeine

Alcohol and the liver

Three main types of alcohol-related liver disease Fatty liver Alcohol hepatitis Cirrhosis

Where do we find caffeine

Three plants containing xanthines have been used by humans for thousands of years ▪ Coffee: Originated from the Middle East ▪ Tea: First grown in China ▪ Cacao: Originated from the Americas ▪Also added to energy drinks & soft drinks

marijuana tolerance and dependence

Tolerance is more likely to develop among daily users Many experts agree that physical dependence does not occur 2014 study in Journal of Addiction Medicine 40% of teens who were heavy smokers & 60% of regular smokers experienced withdrawal when they stopped using Symptoms included irritability, nausea, vomiting, diarrhea, sweating, anxiety, & insomnia

Two species of cannabis

Two species: Cannabis sativa Used primarily for its fibers from which hemp rope is made Cannabis indica Grown for its psychoactive resins The species are said to differ only slightly in THC and CBD levels.

cocaine dependence/addiction

Users build up tolerance Withdrawal symptoms: Depression Lack of energy, tiredness, slowed thinking Vivid unpleasant dreams Restlessness, agitation, paranoia Cravings for the drug Hypersomnia followed by insomnia

Reasons for stimulant abuse

Weight loss Suppress appetite Academic performance Increase wakefulness and attention Athletic performance Increase endurance, reduce fatigue, suppress appetite To get 'high' Feelings of euphoria

Pharmacology of nicotine

When smoked, quickly absorbed by the lungs Can reach the brain in ~ 10 seconds Stays in the body for 8 to 12 hours Releases norepinephrine Depression follows arousal Constricts blood vessels Increased blood pressure & heart rate Highly toxic in large doses (60mg in humans)

is caffeine safe?

▪ In low to moderate doses, for most people, it is safe There is evidence that caffeine can: ▪ Cause dependence ▪ Interfere with normal functioning ▪ Have negative health consequences

You may want to cut back if you experience any of these side effects:

▪ Migraine headache ▪ Insomnia ▪ Nervousness ▪ Irritability ▪ Restlessness ▪ Frequent urination or incontinence ▪ Upset stomach ▪ Fast heartbeat ▪ Muscle tremors

How much caffeine is safe to consume

▪ Most healthy adults: 300-400mg of caffeine appears safe ▪ Adults who are pregnant, or who have heart conditions or type II diabetes: less than 200mg Children ▪ Under 12 years-old: not recommended ▪ 13-18 years-old: Under 100mg

long term effects of inhalants

▪ Nosebleeds ▪ Liver & kidney damage ▪ Weight loss ▪ Depression ▪ Irritability ▪ Disorientation ▪ Paranoia ▪ Hostility ▪ Bone marrow abnormalities

barbiturate withdrawal

▪ Profuse sweating ▪ Insomnia ▪ Muscular twitching ▪ Paranoia, vomiting, aches and pains ▪ Cramps ▪ Quick temper ▪ Nightmares ▪ Hallucination

Inhalants

▪"A variety of substances whose main common characteristic is that they are rarely, if ever, taken by any route other than inhalation." (NIDA) ▪Breathed in through nose or mouth - "huffing" ▪Many have anesthetic-like qualities but are not classified as sedative-hypnotic drugs. ▪Most frequently used class of illegal drugs among adolescents aged 12 & 13 years. (After marijuana) Classes of inhalants ▪ Volatile Solvents ▪ Gases ▪ Nitrites

Combining caffeine with other substances

▪Be aware that some herbal supplements interact with caffeine ▪ Ephedrine, theophylline, Echinacea ▪Combining caffeine with other stimulants can increase your risk of side effects and negative health effects.

Gasses (inhalants)

▪Butane lighters & propane tanks ▪Whipped cream dispensers (whippets) ▪Refrigerant gases ▪Ether ▪Chloroform ▪Nitrous oxide (laughing gas)

Gamma-hydroxybutyrate (GHB)

▪CNS depressant that produces relaxation & sleepiness ▪Commonly referred to as a "club drug" or "date-rape" drug ▪Can shut down the respiratory system, resulting in death ▪When mixed with alcohol or benzos, can cause memory loss and loss of consciousness Other effects ▪ Vomiting ▪ Nausea ▪ Seizures ▪ Hallucinations ▪ Coma ▪ Respiratory distress

high caffeine consumption

▪Caffeinism: excessive use of caffeine ▪Toxicity is relatively low ▪ 70-100 cups of coffee would be required to cause death (in a healthy person) ▪Caffeinism can cause unpleasant symptoms ie Nervousness, irritability, tremulousness, muscle twitching, insomnia, flushed appearance, elevated temperature, palpitations, heart arrhythmias, and gastrointestinal disturbances

Caffeine

▪Central nervous system stimulant ▪Most commonly used psychoactive drug in the world In the United States: ▪ More than 90% of adults in the US use it regularly ▪ Average consumption is >200mg

Coffee

▪Coffee is made from coffee beans. ▪Coffee beans come from the coffee plant. ▪Beans are found in the center of coffee cherries How much caffeine? ▪ Varies by bean size and darkness of roast ▪ 1 bean = 6mg ▪ Average per cup = 95mg

Chocolate

▪Comes from the cacao bean Origin of chocolate ▪ The Aztecs called the cocoa tree "Theobroma," which means "food of the gods" ▪ Legend: Cacao tree was a gift to humans from paradise from the Aztec god Quetzalcoatl 17th century ▪ Chocolate became more of a social drink ▪ Sold alongside coffee & tea in established coffeehouses

short term effects of inhalants

▪Drooling ▪Nausea ▪Sneezing ▪Hypersensitivity ▪Loss of coordination ▪Coughing

psychological effects of barbiturates

▪Euphoria, tranquility, and temporary relief of anxiety in small doses ▪Impaired cognitive functioning with larger doses ▪Inadequate emotional control with larger doses

Other sources of caffeine: Soft drinks

▪Ex: Coca-Cola ▪ Developed as a "nerve tonic" in the late 1800s ▪Name was conceived to indicate the nature of its two ingredients with tonic properties: coca leaves and cola, or Kola, nuts ▪Today, the coca leaves are decocainized and shipped to the Coca-Cola Plant in Atlanta

minor tranquilizers

▪First developed in the 1950s ▪Used primarily to treat anxiety,tension,panic attacks, insomnia, convulsions ▪Benzodiazepines, the most common minor tranquilizer, were developed in the 1960s.

benzodiazepines: rohypnol

▪Generic name: Flunitrazepam ▪Commonly referred to as a "club drug" or "date-rape" drug ▪5-10x more powerful than Valium ▪Especially dangers in combination with alcohol ▪Can cause sedation, muscle relaxation, blackouts, complete memory loss, death ▪Takes effect in 20-30 minutes; lasts 2-10 hours ▪Causes dependency and produces withdrawal symptoms

pharmacology of inhalants

▪Most abused inhalants, except for nitrites, act as an anesthetic ------Produce a pleasurable effect by depressing the CNS ▪Nitrites dilate and relax blood vessels ▪The high generally lasts only a few minutes

Volatile Solvents (inhalants)

▪Paint thinners & removers, gasoline, lighter fluid, correction fluids, felt-tip marker fluid, glue ▪In general, abuse tends to occur as localized fads Most users are very young ▪ 4.6% of eighth-graders reported use in the past year ▪ 2% of high-school senior class reported the use past year

Caffeine in tea

▪Pound for pound, loose black tea has more caffeine than coffee beans ---1 pound of dry tea leaves equals 200 cups of tea --- 1 pound of coffee equals 50 to 60 cups of coffee ▪Most teas have about 40 to 60 m g of caffeine per cup --- Depends on the brand and strength of the brew ▪Theophylline is present only in very small, nonpharmacological amounts in tea ▪Prescribed for use by asthmatics

benzodiazepines

▪Primarily an anxiolytic ▪Produce tolerance and withdrawal symptoms ▪Have a wider margin of safety, fewer side effects, and less severe side effects than barbiturates ▪Inconsistent data concerning effects of use during pregnancy

Chocolate processing stages

▪Prior to 1828, the traditional Aztec procedure was used to produce chocolate --- Cacao pods were dried in the sun & roasted before removing the husk --- Kernels in the pods were ground to obtain a thick liquid called chocolate liquor ▪ In 1828, a Dutch patent was issued for the manufacture of "chocolate powder" by removing about two-thirds of the fat from the chocolate liquor --- The fat that was removed was called cocoa butter ▪ In 1847, the first chocolate bars appeared ▪Slabs or bars were formed using a mixture of cocoa butter, sugar, and chocolate powder ▪ In 1876, milk chocolate was invented by the Swiss

physical effects of barbiturates

▪Small doses produce calmness and muscle relaxation ▪Large doses cause impaired coordination, and slurred speech ▪High doses can cause unconsciousness and death ▪Combining alcohol and barbiturates can lead to accidental or intentional overdose

Tea production

▪Tea is grown in China, Sri Lanka, India, and Indonesia ▪Tea leaves are picked by hand Process of making tea ▪ Leaves are dried ▪ Rolled to crush the cells in the leaves ▪ Placed in a cool, damp place for fermentation or oxidation