SPECIFIC DRUGS
The Major (vs. minor) Stimulants
Cocaine and Amphetamine
Major Stimulants - Cocaine
* Free association
COCAINE
* What is coke and where does it come from?
coca leaf / coca bush Incas and Spanish Freud American history (VIP usage)
Major Stimulants - Cocaine
street cocaine: coca paste and hydrochloric acid =
type of salt--powder sniffed or snorted
more addictive uses:
can inject it if mix with water--IV quicker smoking: freebase - powder and ether crack - dissolve cocaine salt in baking soda solution, boil off water, left with rock
Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of cocaine, which may be more cardiotoxic via increased half-life of cocaine
Dependence Potential of Psychoactive DrugsVery High: Heroin (IV)
Crack cocaineHigh: Morphine
Opium (smoked)Moderate/High: Cocaine powder
Tobacco cigarettesPCP (smoked)
Moderate: Diazedpam (Valium)AlcoholAmphetamines (oral)
Moderate/Low: CaffeineMDMA(Ecstasy”)Marijuana
Low: KetamineVery Low: LSD, Mescaline
Psilocybin
Major Stimulants - CocainePrevalence
1998 2003Cocaine (Crack) Cocaine (Crack)
Past month .8% (.2%) 1.0% (.3%)
Past year 1.7% (.4%) 2.5% (.6%)
Lifetime 10.6% (2.0%) 14.7% (3.3%)
cheapness of crack--national crisis
shift of users from college educated to high school dropouts
smoking cocaine becoming more popular, especially among young users
Major Stimulants - SpeedAmphetamines• ephedrine, principal chemical in these drugs, has been known for thousands of years; used as Chinese medicinal herb
• ephedrine first isolated in late 1800's, and synthesized in 1920s when it was named “amphetamine”
• first medically used in 1920's for treating obesity, narcolepsy, colds, and much later ADHD
• used to enhance performance, decrease fatigue – sport & military applications (e.g., go and no-go pills)
Major Stimulants - SpeedPrevalence – 2003
Stimulants (Methamphetamine)
Lifetime 8.8% 5.2%
Past year 1.2% 0.6%
Past month 0.5% 0.3%
*ages 12 and older, from NSDUH
Major Stimulants
• Neurotransmitters and behavioral pharmacology
• Effects of the Major Stimulants
– Desired effects– Negative effects– Overdose
• Withdrawal SXs
Major Stimulants
•Medical Effects
• Fetal Exposure during Pregnancy
• Other Co-morbid Diagnoses
• Factors in Initiation of use leading to
dependence
Major Stimulants Treatment of Cocaine Dependence
A. Drug TX
B. Psychological TX
• Community reinforcement
• Payment for abstinence• Relapse prevention (triggers, cravings…)
• Lifestyle modification• Self-help Groups (CA - cocaine anonymous)
U.S. Banned Ephedra in 2004
• used primarily for weight loss and body building in the U.S.
• linked to 155 deaths and dozens of heart attacks and strokes.
• Derived from a plant (powdered and then put in pills)
• Contains ephedrine & pseudoephedrine
ephedra ban, cont…
• side effects can be life threatening even for a health individual (constricts blood vessels, raises blood pressure).
• FDA was aware of a problem for 8 years, however the high profile death of Baltimore Orioles pitcher, Steve Bechler stimulated concern from the FDA as well as many others.
• 1st government ban on a dietary supplement