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Chapter 40
Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and
Nicotine
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Drug Abuse IV: Major Drugs of Abuse
Heroin and other opioids General CNS depressants Psychostimulants Marijuana and related preparations Psychedelics 3,4-Methylenedioxymethamphetamine (MDMA,
Ecstasy) Phencyclidine Inhalants Anabolic steroids
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Heroin, Oxycodone, and Other Opioids
Major drugs of abuse Most opioids are Schedule II Patterns of abuse Subjective and behavioral effects Preferred drugs and routes of administration
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Heroin Patterns of use
Greatest use among 18- to 25-year-olds All segments of society First exposure usually social or for pain management
Subjective and behavioral effects Moments after IV injection, lower abdominal sensation that is
similar to sexual orgasm and lasts about 45 seconds Followed by euphoria Initial use causes nausea and vomiting
Preferred drugs and routes of administration Opioid of choice for street use High lipid solubility IV route preferred, but also smoking, nasal inhalation
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Meperidine Nurses and physicians who abuse opioids
often select meperidine Highly effective in oral route (unlike injections,
leaves no sign) Minimal effect on smooth muscle: fewer problems
with constipation and urinary retention
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Oxycodone Opioid similar to morphine
Intended as controlled-release drug (OxyContin) Abusers crush tablet Snort powder or dissolve in water for IV Entire dose absorbed immediately with high risk of
death Tolerance and physical dependence
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Oxycodone Treatment of acute toxicity
Classic triad • Respiratory depression, coma, pinpoint pupils
Naloxone (Narcan) Nalmefene (Revex)
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Tolerance and Physical Dependence
Tolerance Prolonged use Effects for which tolerance develops Effects for which tolerance does not develop
Cross-tolerance Physical dependence
Long-term use Abstinence syndrome Acute phase and second phase
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Opioid Detoxification Detoxification
Methadone substitution • Long-acting oral opioid• Most commonly used agent• Approximately 10 days
Clonidine-assisted withdrawal Rapid and ultrarapid withdrawal
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Drugs for Long-Term Opioid Addiction Management
Three groups of medications Opioid agonists, opioid agonist-antagonists, and
opioid antagonists Methadone
Maintenance and suppressive therapy Buprenorphine
Maintenance therapy and detox facilitation Naltrexone
Discourages renewed opioid abuse
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Sequelae of Compulsive Opioid Use
Few direct detrimental effects Treatment programs vs. street drugs and
subculture Accidental overdose
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General CNS Depressants Barbiturates, benzodiazepines, alcohol, and
other agents Benzodiazepines have unique properties
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Barbiturates Depressant effects are dose-dependent
Mild sedation to sleep to coma and death Subjective effects similar to those of alcohol Agents with short to intermediate duration of
action have highest abuse incidence and are Schedule II Amobarbital, pentobarbital, and secobarbital
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Benzodiazepines Tolerance Physical dependence and withdrawal
techniques Acute toxicity Flumazenil (Romazicon) Benzodiazepines (Schedule IV)
Much safer than barbiturates Overdose rare when taken alone and orally Risk increased with IV or with other depressants
Alcohol and miscellaneous CNS depressants Methaqualone (Quaalude)
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Psychostimulants CNS stimulants (Schedule II) that have a high
potential for abuse Amphetamines Cocaine Related substances
Can stimulate the heart, blood vessels, and other structures under sympathetic control
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Cocaine Extracted from leaves of coca plant CNS effect similar to that of amphetamines Two forms used by abusers
Cocaine “Crack”
Can produce local anesthesia, vasoconstriction, and cardiac stimulation
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Cocaine Cocaine
Cocaine hydrochloride • White powder• Diluted for sale• Taken intranasally
Cocaine base: commonly called “crack”• Also called “crystals” or “rocks”• Heated for use• Taken by IV injection
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Methamphetamines In abuse, usually taken orally, snorted,
smoked, or IV Also called “ice” or “crystal meth”
Form of dextroamphetamine Smoked, snorted, or inserted into rectum
Effects Arousal, euphoria, sense of increased physical
strength and mental capacity Hallucinations, psychotic state, sympathomimetic
actions
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Methamphetamines Other adverse effects Tolerance, dependence, and withdrawal Treatment
Bupropion (Wellbutrin, Zyban) Modafinil (Provigil, Alertec)
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Marijuana Cannabis sativa (hemp)
Marijuana and hashish are derivatives Common names: “grass,” “weed,” “pot”
Most commonly used illicit drug in the United States
95 million Americans have tried marijuana at least once
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Marijuana Psychoactive substance
Delta-9-tetrahydrocannabinol (THC) Routes
Smoking• 60% of THC content absorbed, effects begin in minutes
and peak within 20–30 minutes Oral
• Majority of THC is inactivated by first-pass effect
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Marijuana
Increased production of prostaglandin E2 Behaviors
• Euphoria• Sedation• Hallucinations
Therapeutic uses• Antiemetic• Appetite stimulant• Neuropathic pain
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Marijuana Effects
Low to moderate dose High dose Long-term use
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Marijuana Effects
Low to moderate dose High-dose Long-term use Schizophrenia
Cardiovascular Dose-related increase in heart rate
Respiratory Acute: bronchodilation Chronic: airway constriction
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Marijuana Reproduction
Males and females affected Altered brain structure
Hippocampal volume left hemisphere Tolerance and dependence
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Therapeutic Use Marijuana Approved uses for cannabinoids Unapproved uses for cannabinoids Medical research on marijuana Legal status of medical marijuana
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Therapeutic Use Marijuana Comparison of marijuana with alcohol
Aggressive behavior is rare with marijuana use Loss of judgment is less with marijuana Increased appetite with marijuana: fewer problems
with nutritional deficiencies Marijuana produces increased toxic psychosis,
dissociative phenomena, and paranoia, more so than with alcohol
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Psychedelics Lysergic acid diethylamide (LSD)
Acts on serotonin receptors of brain Routes: oral, IV, smoked Alters the following (as otherwise occurs only in
dreams):• Thinking• Feelings• Perception • Relationship to environment
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Other Psychedelic Drugs Subjective and behavioral effects are similar
to those of LSD None approved for medical use Salvia Mescaline
From peyote cactus Psilocybin Psilocin Dimethyltryptamine
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Dissociative Drugs Phencyclidine (PCP) and ketamine
Original use: surgical anesthetics Recreational use: distort sight and sound and
produce dissociation Act in the cerebral cortex and limbic system
PCP synthesized/manufactured easily by amateurs
Routes: oral, intranasal, IV, smoking Ketamine
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Dissociative Drugs Phencyclidine (PCP)
Effects• Low to moderate doses, high doses
Toxicity Ketamine
Similar to PCP in structure, mechanism, and effects
Shorter duration of effects
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Dextromethorphan OTC cough suppressant
Low dose for antitussive: no psychologic effects At doses 5–10 times higher, produces euphoria,
disorientation, paranoia, altered sense of time, and hallucinations
Also used in combination cold products Highly abused by adolescents and teenagers
OTC = over-the-counter.
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3,4- Methylenedioxymethamphetamine Common names: MDMA, Ecstasy
Complex drug with stimulant and psychedelic properties
Structurally related to methamphetamine (stimulant) and mescaline (hallucinogen)• Low doses: mild LSD-like psychologic effects• Higher doses: amphetamine-like effects
Promotes release of neurotransmitters Usually taken orally; also snorted, injected, or
taken by rectal suppository
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MDMA, Ecstasy Adverse effects
Can injure serotonergic neurons, stimulate the heart, and dangerously raise body temperature
Neurologic effects Seizures, spasmodic jerking, jaw clenching, teeth
grinding Confusion, anxiety, paranoia, panic
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Inhalants Term can refer to many drugs; common
characteristic is administration by inhalation Anesthetics Volatile nitrites Organic solvents
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Anabolic Steroids Androgens
Taken to enhance athletic performance Increase muscle mass and strength Massive doses that are often used have high risk
for adverse effects Most are classified as Schedule III drugs