“Rave” Drugs OTCs

Drugs in Sport

Pearl Isaac & Anne Kalvik

Learning Objectives

• To become aware of some substances used on the rave/club scene and their risks

• To recognize OTC products that are abused and their effects

• To develop an understanding of substances abused in sports and their consequences

“Rave” Scene

• is it over?

• PLUR

• clubs, parties

• younger users

• older users & different patterns of use

• raves & alcohol, cannabis use (why not?)

Ontario School Drug Use Survey 2003

• alcohol 66.2%• cannabis 29.6%• tobacco 19.2%• hallucinogens 10%• stimulants 5.8%• solvents 6.1%

• LSD 2.9%• methamphetamine 3.3%• methylphenidate 2.9%• MDMA 4.1%• cocaine 4.8%• ketamine 2.2%• heroin 1.4%• GHB 0.7%

Drugs Used on the “Rave” Scene(or by adolescents)

• LSD• Ecstasy (MDMA)• Herbal Ecstasy• Ketamine (“Special K”)• Methamphetamine (“Crystal Meth”)• Psilocybin (Magic Mushrooms)• GHB• Rohypnol?

MDMA (Ecstasy)

• Ecstasy, e, XTC, X , Adam, MDM, hug drug

• branding (logos)

• price

• doses

• purity & strength

• amphetamine derivative with hallucinogenic properties, but...

MDMA: Effects

• euphoria, energy• increased self-esteem, confidence• increased sociability, benevolence• visual distortions (minimal)• some anxiety, panic, confusion• paranoia• “hangover”• seizures, death

MDMA: Acute Effects

grinding of teeth (jaw pain) sweating, hyperthermia (rhabdomyolysis possible) high BP, increased heart rate decreased appetite insomnia headache, stiffness of back and legs arrhythmias, stroke, MI

MDMA: Long-term Effects

• weight loss• psychiatric issues: depression, memory loss• flashbacks• hepatotoxicity• neurotoxicity

• MDMA plus Viagra =

MDMA and Harm Reduction

• venues

• volunteers, police

• fluids

• loose clothing

• DI questions

• other? SSRI’s??

• useful?

Ketamine “Special K”

• anesthetic related to PCP• diverted from hospitals and vetrinarians• antagonist at NMDA receptor• “dissociation”• impaired thought processes & memory• confusion, dizziness, slurred speech• hallucinations, flashbacks• aspiration, respiratory depression

“Date-Rape” Drugs

• GHB

• Rohypnol

• Ketamine

• Benzodiazepines

• Alcohol

GHB

• Looks like water

• Liquid X, Liquid Ecstasy, GBH, Easy Lay

• Narrow therapeutic window

• CNS depressant

• date rape context

• euphoria

• dizziness, drowsiness, sedation

GHB: Overdose

• nausea & vomiting

• loss of consciousness

• amnesia

• coma

• seizures

• respiratory arrest

GHB

• dependence

• withdrawal

GHB

Precursors

(GBL, Blue Nitro)

Rohypnol (flunitrazepam)

• “roofies”

• availability

• how abused

• change in formulation

• police seizures?

• other benzodiazepines

• alcohol

Jessica

• 16 years old

• goes to raves when she can

• at raves, she uses “e”, “k” and “crystal meth”

• reports feeling depressed over past 6 months

• denies suicidal ideation or intent

Jessica

issues?

OTCs

• why abused?

• patterns of abuse (chronic vs. recreational)

OTCs that are Abused

• codeine preparations (e.g. Tylenol #1)

• dimenhydrinate (e.g. Gravol)

• sleep aids with diphenhydramine

(e.g. Sleep-Eze D, Nytol)

• dextromethorphan

• caffeine

OTCs that are Abused

• cold preparations– with antihistamines– with stimulants/decongestants: ephedrine,

pseudoephedrine (e.g. Sudafed)– with alcohol (Nyquil “all of the above” plus

dextromethorphan)

OTCs that are Abused

• alcohol-containing preparations (including mouthwashes, aftershaves)

• herbals

• solvents

• laxatives

• ipecac

Dimenhydrinate / Diphenhydramine

• antinauseants, sleep aids

• teenagers for high

• hallucinations

• toxicity –seizures, psychosis, arrhythmias

• chronic use of high doses

• psychiatric patients

• tolerance, dependence, withdrawal

Dextromethorphan

• In 50% of cough and cold products (e.g. Robitussin DM, Nyquil, Contac Cold&Fever, Benylin DM etc.)

• DXM, Robo, DEX • high doses for LSD-like high• toxicity: hypertension, seizures, hallucinations,

coma • chronic use - psychiatric issues

OTC Stimulants

• CAFFEINE

• “Wake Ups”, an ingredient in many OTC’s

• sold as energizer, to stay awake

• herbal (Guarna, Herbal Ecstacy)

• high doses associated with anxiety, mood, sleep disorders

• dependence & withdrawal

OTC Stimulants

• Street Stimulants– Caffeine, Ephedrine, Phenylpropanolamine

• Pseudoephedrine (e.g. Sudafed)/Ephedrine– weight loss, sports, energy– precursor for methamphetamine– new legislation – herbals (e.g. ephedra herb, Ma Huang)– toxicity: stroke, arrhythmias, MI

OTC Abuse

What can you do in the pharmacy?

Drugs Used in Sports

Anabolic steroids

(“roids”, “juice”)

Other Drugs Used in Sports

• Stimulants– amphetamine, caffeine,

pseudoephedrine– clenbuterol– modafinal

• diuretics• laxatives• beta-blockers• pain relievers

• urine tampering– probenecid

• hormones– HCG, HGH, EPO– thyroxine– insulin, OCs– mifespristone

• GHB• antidepressants

Other Drugs/Techniques Used by Athletes

• local anesthetics, corticosteroids

• nutritional supplements (e.g. creatine)

• acetylcholine• Deprenyl

• cannabis• alcohol• tamoxifen• clomiphene• blood-doping

Drugs Used in Sports

• ergogenic

• therapeutic

• recreational

Anabolic Steroids

• androgenic (masculinizing)

• anabolic (tissue building)

• human

• veterinary

Medical Uses for Anabolic Steroids

• testosterone deficiency in males (including delayed puberty

• chronic tissue wasting conditions

• anemia

• osteoporosis

• others

Reasons Why Athletes Use Anabolic Steroids

• more lean mass & less body fat

• increased endurance & strength

• decreased recovery time

• increased aggression & ability to compete

• faster healing time from injuries

• winning “edge”

• better appearance

Reasons for Others to Abuse Anabolic Steroids

• enhance physical appearance• improve physical condition• personal enjoyment (“high”)• increased self-esteem• personality disorders• coach/parent/scholarship pressure• employment (e.g. law enforcement)• withdrawal symptoms?

Patterns of Use

• doses often 100x higher than for medical use

• “cycling”

• “pyramiding”

• “stacking”

Some Injectable Steroids

• nandrolone (Deca-Durabolin)

• stanozolol (Winstrol V)

• testosterone (Depo-Testosterone, Delatestryl, etc.)

Tetrahydrogestrinone(THG)

Some Oral Steroids

• danazol (Cyclomen)

• methyltestosterone (Metandren)

• oxandrolone (Anavar)

• stanozolol (Winstrol)

• testosterone undecanoate (Andriol)

Adverse Effects of Anabolic Steroids

• endocrine– testicular atrophy, impotence, acne,

gynecomastia, masculinization etc.

• liver– jaundice, hepatitis, cancer etc.

• musculoskeletal– premature closure of long bones (adolescents)– tendon ruptures

Adverse Effects of Anabolic Steroids

• cardiovascular– MI, enlarged heart, clots, increased LDL,

decreased HDL, fluid retention

• GI– nausea, vomiting, irritation

• behavioural– “roid rage”, mood swings, anxiety, paranoia,

insomnia, psychosis, changes in libido, etc.

Indirect Adverse Effects of Steroids

• infections (hepatitis, HIV)– from needle sharing and improper technique

• abscesses & clots– from improper injection technique, repeated

injections at same site, contaminants

• consequences of “roid rage”

Tolerance, Dependence & Withdrawal

• no evidence of tolerance• physical dependence and withdrawal (may

simulate opioid withdrawal) have been reported

• psychological dependence? euphoria ? reward mechanism in brain ? natural opioids

• not included in DSM-IV

Treatment

• psychosocial counselling

• stop smoking

• nutritional counselling

• ? pharmacological treatment

• ? prevention strategies

• ? harm reduction