Chapter 13Chapter 13

Marijuana Abuse and Marijuana Abuse and AddictionAddiction

What do you think? T or FWhat do you think? T or F

The marijuana smoked in the US The marijuana smoked in the US today is more potent than 20 years today is more potent than 20 years ago.ago.

Marijuana use often causes long-Marijuana use often causes long-term damage to the cardiovascular term damage to the cardiovascular system.system.

Drug effects following oral ingestion Drug effects following oral ingestion last longer than after the drug is last longer than after the drug is smoked.smoked.

AnswersAnswers

The marijuana smoked in the US The marijuana smoked in the US today is more potent than 20 years today is more potent than 20 years ago. Tago. T

Marijuana use often causes long-Marijuana use often causes long-term damage to the cardiovascular term damage to the cardiovascular system. Fsystem. F

Drug effects following oral ingestion Drug effects following oral ingestion last longer than after the drug is last longer than after the drug is smoked. Fsmoked. F

IntroIntro

Most controversial substance of Most controversial substance of abuse.abuse.

Cannabis sativa is Latin for Cannabis sativa is Latin for “cultivated hemp”“cultivated hemp”

HistoryHistory

5,000 years ago used by Chinese 5,000 years ago used by Chinese physiciansphysicians

Used to treat malaria, pain, and as an Used to treat malaria, pain, and as an anticonvulsantanticonvulsant

In the 1800s was used as an all purpose In the 1800s was used as an all purpose medicationmedication

Is thought that Mexican laborers brought it Is thought that Mexican laborers brought it north when looking for worknorth when looking for work

Increase in use due to alcohol prohibition Increase in use due to alcohol prohibition

Medicinal MarijuanaMedicinal Marijuana

Decrease nausea with chemotherapyDecrease nausea with chemotherapy Synthetic Marinol a version of one of Synthetic Marinol a version of one of

the chemicals found in marijuanathe chemicals found in marijuana 60%-65% of glaucoma patients 60%-65% of glaucoma patients

experience a decrease in fluid experience a decrease in fluid pressure in the eyepressure in the eye

Relieves symptoms of ALS, MS, RA Relieves symptoms of ALS, MS, RA and chronic pain conditionsand chronic pain conditions

Some evidence that marijuana Some evidence that marijuana helps withhelps with

Weight loss in AIDS patients or cancer ptsWeight loss in AIDS patients or cancer pts Limit damage of strokesLimit damage of strokes AsthmaAsthma Crohn’s diseaseCrohn’s disease AnorexiaAnorexia EmphysemaEmphysema EpilepsyEpilepsy Tumor growthTumor growth

DEADEA

Does not view marijuana as having Does not view marijuana as having medical valuemedical value

Any attempts to classify the drug as Any attempts to classify the drug as such has been blocked. P.495such has been blocked. P.495

In late 1990s California approved the In late 1990s California approved the medical use of marijuana but the medical use of marijuana but the gov. continues to block effortsgov. continues to block efforts

PotencyPotency

Since 1960 growing strains that Since 1960 growing strains that have a more pleasurable effecthave a more pleasurable effect

Marijuana is said to be the biggest Marijuana is said to be the biggest “cash crop” in the US“cash crop” in the US

ConcentrationConcentration Highest concentration in small upper Highest concentration in small upper

leaves and flowering topsleaves and flowering tops Term marijuana is used to identify the Term marijuana is used to identify the

plant that is used for eating or smokingplant that is used for eating or smoking Term hashish is used to identify the dark Term hashish is used to identify the dark

thick resin that is obtained from the thick resin that is obtained from the flowersflowers

Hash oil is a liquid that is extracted from Hash oil is a liquid that is extracted from the plantthe plant

The book uses the generic term marijuana The book uses the generic term marijuana to refer to any part of the plant that is to refer to any part of the plant that is used to be smoked or ingested used to be smoked or ingested

Scope of the ProblemScope of the Problem

World users-200-300 millionWorld users-200-300 million 30% of users live in Asia, US and 30% of users live in Asia, US and

Canada, and Africa each have about Canada, and Africa each have about 24% of the worlds users. Another 24% of the worlds users. Another 20% in Europe20% in Europe

In Us the most frequently abused In Us the most frequently abused illegal drug. Estimates are that 50% illegal drug. Estimates are that 50% of the entire population have used it of the entire population have used it at least once.at least once.

Scope of Problem (cont.)Scope of Problem (cont.)

No evidence of increase of marijuana No evidence of increase of marijuana abuse since 1991abuse since 1991

Use peaks in early adulthood and Use peaks in early adulthood and usually discontinues by age 30usually discontinues by age 30

10% who use is do so daily, 20%-10% who use is do so daily, 20%-30% use it once a week30% use it once a week

Estimates are 17% of users smoke Estimates are 17% of users smoke more that 5x a week and are more that 5x a week and are considered “addicted”considered “addicted”

CriminalizationCriminalization

Varies from state to state, then some Varies from state to state, then some states will change the laws againstates will change the laws again

In some states a small amt. is like a In some states a small amt. is like a traffic tickettraffic ticket

PharmacologyPharmacology

The principal psychoactive agent in The principal psychoactive agent in cannabis has been labeled delta-9-cannabis has been labeled delta-9-tetrahydrocannabinol or THC.tetrahydrocannabinol or THC.

Is thought to bind to receptor sites Is thought to bind to receptor sites which involves neurotransmitters which involves neurotransmitters that are involved in mood, memory, that are involved in mood, memory, cognition, perception, coordination, cognition, perception, coordination, sleep, appetite.sleep, appetite.

Pharmacology (cont)Pharmacology (cont)

THC rapidly reaches heart, lungs and THC rapidly reaches heart, lungs and brain then fat tissuesbrain then fat tissues

Repeated use over a short time will Repeated use over a short time will cause THC to be stored in fat tissuescause THC to be stored in fat tissues

Drug screens of heavy users will Drug screens of heavy users will continue to test positive for weeks or continue to test positive for weeks or monthsmonths

Tolerance develops rapidly Tolerance develops rapidly

AdministrationAdministration Orally-user does not feel effects for 1 hour. Orally-user does not feel effects for 1 hour.

Cookies and BrowniesCookies and Brownies Smoked-typical cigarette 500 mg-750 mgSmoked-typical cigarette 500 mg-750 mg Blunts-filling empty cigar with marijuana mixed Blunts-filling empty cigar with marijuana mixed

with chopped cigar tobaccowith chopped cigar tobacco Smoking tech. different than cigs. Must inhale Smoking tech. different than cigs. Must inhale

smoke deeply into lungs and hold. Why?smoke deeply into lungs and hold. Why? Effects begin in seconds or minutes and reach a Effects begin in seconds or minutes and reach a

peak within 30 min.peak within 30 min. Avg. person would need to smoke 100 #s of pot Avg. person would need to smoke 100 #s of pot

for 15 min. to OD-least toxic drug knownfor 15 min. to OD-least toxic drug known

Subjective effectsSubjective effects

2 phase reaction-mild anxiety at first 2 phase reaction-mild anxiety at first followed by relaxationfollowed by relaxation

Release of dopamineRelease of dopamine Many users report altered sense of Many users report altered sense of

time and mood swingstime and mood swings Feeling of wellbeing, happiness, Feeling of wellbeing, happiness,

splitting of consciousnesssplitting of consciousness

Adverse effects of occasional useAdverse effects of occasional use

2,000 metabolites of the 400 chemicals of 2,000 metabolites of the 400 chemicals of the plant found in the bodythe plant found in the body

Blood shot eyesBlood shot eyes Drug induced anxiety/panic attacksDrug induced anxiety/panic attacks Impaired reflexesImpaired reflexes Drug induced psychosis-p.169Drug induced psychosis-p.169 Sexual dysfunctionSexual dysfunction depressiondepression

Consequences of chronic useConsequences of chronic use

Precancerous cellsPrecancerous cells Decrease in immune systemDecrease in immune system Pot has 10 & 20 times the tar as cigsPot has 10 & 20 times the tar as cigs Pot smoker will absorb 5x as much Pot smoker will absorb 5x as much

carbon monoxide as cig. Smokercarbon monoxide as cig. Smoker 4 joints has the same negative 4 joints has the same negative

impact on the lungs as 20 cigs.impact on the lungs as 20 cigs. Pot smoke 5-15x amt. of carcinogens Pot smoke 5-15x amt. of carcinogens

as tobacco smoke-canceras tobacco smoke-cancer

Consequences (cont.)Consequences (cont.)

Reduced sperm count Reduced sperm count Men have 50% lower testosteroneMen have 50% lower testosterone Failure to ovulateFailure to ovulate ““flashbacks” if used hallucinogensflashbacks” if used hallucinogens Minor reduction in user’s ability to Minor reduction in user’s ability to

learn new info. while usinglearn new info. while using Memory deficits of chronic users Memory deficits of chronic users

usually reverse after 2 weeks of usually reverse after 2 weeks of abstinenceabstinence

Amotivational SyndromeAmotivational Syndrome

Conflicting evidenceConflicting evidence Consist of decreased drive, ambition, Consist of decreased drive, ambition,

attention span, distractibility and attention span, distractibility and tendency not to make plans beyond tendency not to make plans beyond the present daythe present day

Study cited on p.171Study cited on p.171 A.S. challenged-even chronic abusers A.S. challenged-even chronic abusers

are successfulare successful

Cause of DeathCause of Death

Slows cells renewalSlows cells renewal Users experience 30%-50% increase Users experience 30%-50% increase

in heart ratein heart rate Causes reduction in the strength of Causes reduction in the strength of

the heart contractions and oxygen the heart contractions and oxygen which is serious for people with heart which is serious for people with heart diseasedisease

Addiction potentialAddiction potential

W/D- irritability, aggressive, anxiety, W/D- irritability, aggressive, anxiety, insomnia, loss of appetite, sweating insomnia, loss of appetite, sweating and vomiting.and vomiting.

W/D begins 1-3 days, peaks between W/D begins 1-3 days, peaks between 2nd and 102nd and 10thth day lasting up to 28 day lasting up to 28 daysdays

Tolerance does developTolerance does develop

Other issuesOther issues

““gateway” druggateway” drug lifestylelifestyle

Chapter 14Chapter 14

Opiate Abuse and AddictionOpiate Abuse and Addiction

Intro-phenomenon of painIntro-phenomenon of pain– pain meds viewed with distrustpain meds viewed with distrust

Historically abusedHistorically abusedDr.s are hesitant to prescribeDr.s are hesitant to prescribeUnder prescribedUnder prescribedDEA diversion of prescribed narcoticsDEA diversion of prescribed narcotics

HistoryHistory Evidence that opium was used in religious rituals Evidence that opium was used in religious rituals

10,000 years ago10,000 years ago Opium is from the poppy plant and is “juice” –a Opium is from the poppy plant and is “juice” –a

resinresin Widespread use around 7,000 B.C.E.Widespread use around 7,000 B.C.E. Gift from the Gods, relieve every form of painGift from the Gods, relieve every form of pain Early 1800s scientist isolated a pure alkaloid base Early 1800s scientist isolated a pure alkaloid base

from opium-morphine from opium-morphine Morphius-greek God of dreamsMorphius-greek God of dreams 1857, Alexander Wood invented hypodermic 1857, Alexander Wood invented hypodermic

needleneedle

Smoking opiumSmoking opium

Chinese Immigrants Chinese Immigrants By 1900 ¼ of the opium imported to By 1900 ¼ of the opium imported to

the US was used for smokingthe US was used for smoking 2/3 to ¾ addicted were women2/3 to ¾ addicted were women Harrison Act of 1914, prohibited use Harrison Act of 1914, prohibited use

of narcotics without a prescriptionof narcotics without a prescription

ClassificationClassification

Page 176-177Page 176-177

Where produced:Where produced:

75% of all opium is produced in 75% of all opium is produced in AfghanistanAfghanistan

Most of the morphine still comes from Most of the morphine still comes from the poppythe poppy

Opiates as Drugs of AbuseOpiates as Drugs of Abuse

Why use?Why use?Feels goodFeels goodActivates the brains reward systemActivates the brains reward systemDrug euphoriaDrug euphoriaRush like a orgasmRush like a orgasmNoddingNoddingNarcotics mimic the action of brains Narcotics mimic the action of brains

naturally occurring neurotransmitters-the naturally occurring neurotransmitters-the nucleus accumbens and ventral tegmentum, nucleus accumbens and ventral tegmentum, pleasure responsepleasure response

Opoids trigger massive amts. of dopamineOpoids trigger massive amts. of dopamine

HeroinHeroin

Widespread abuse of synthetic Widespread abuse of synthetic narcotics-Vicodin and Oxycontinnarcotics-Vicodin and Oxycontin

Globally 9 million people addicted to Globally 9 million people addicted to heroin and maybe up to 1 million in heroin and maybe up to 1 million in US addictedUS addicted

Heroin deaths account for about ½ of Heroin deaths account for about ½ of all illicit drug use deaths in USall illicit drug use deaths in US

HistoryHistory

Dev. By chemist at Bayer Dev. By chemist at Bayer Introduced in 1898Introduced in 1898 Obtained from raw opiumObtained from raw opium Drug made people feel “heroic”Drug made people feel “heroic” Civil war men were given heroin to Civil war men were given heroin to

w/d from morphine, thought non-w/d from morphine, thought non-addictive, cureaddictive, cure

During 1920’s term “junkie”During 1920’s term “junkie”

Pharmacology Pharmacology

Once in the body it is Biotransformed Once in the body it is Biotransformed into morphineinto morphine

Lipid soluble so crosses blood-brain Lipid soluble so crosses blood-brain barrier 100x faster than morphinebarrier 100x faster than morphine

½ life2 min. to 36 minutes½ life2 min. to 36 minutes Opiates mimic endorphins in brain-Opiates mimic endorphins in brain-

natural pain killernatural pain killer

NarcaneNarcane

Blocks the effects of opiatesBlocks the effects of opiates Opoids antagonistOpoids antagonist Reverses the effects of ODReverses the effects of OD

NaltrexonNaltrexon

EndorphinsEndorphins

Brain has its own morphine/pain Brain has its own morphine/pain relief systemrelief system

Opiates stimulate the endorphin Opiates stimulate the endorphin receptor sitesreceptor sites

Injury, battlefield-feel no painInjury, battlefield-feel no pain

Subjective effectsSubjective effects

IV useIV useRushRushFlashFlashFeeling of warmthFeeling of warmthDry mouthDry mouthNauseaNauseaNasal congestionNasal congestion Itchy skinItchy skinSense of floating or light sleepSense of floating or light sleepClouded mental functionClouded mental function

TodayToday

Avg. age at first use dropped from 27 Avg. age at first use dropped from 27 in 1988 to 19 by mid 90sin 1988 to 19 by mid 90s

12-17 yr olds make up 22% of users12-17 yr olds make up 22% of users Oversupply of heroinOversupply of heroin High purity and low costHigh purity and low cost

Brand namesBrand names VicodinVicodin DilaudidDilaudid PercodanPercodan OxycontinOxycontin DemerolDemerol DarvonDarvon TalwinTalwin CodeineCodeine HydrocodoneHydrocodone MethadoneMethadone fentanylfentanyl

Explosion of OxyExplosion of Oxy Illicit use of prescribed opiates triple from Illicit use of prescribed opiates triple from

1990 to 20011990 to 2001 Into in mid 90sInto in mid 90s Synthetic opiate found in PercodanSynthetic opiate found in Percodan Designed to treat server chronic pain Designed to treat server chronic pain

contains higher dose of oxycodonecontains higher dose of oxycodone Percodan 5 mg. of oxy, oxycontin 20-160 Percodan 5 mg. of oxy, oxycontin 20-160

mg. time released to last up to 12 hoursmg. time released to last up to 12 hours Crush and injectCrush and inject DEA forced pharm. Co. to discontinue high DEA forced pharm. Co. to discontinue high

dose-160 mg.dose-160 mg.

Methods of useMethods of use

Skin poppingSkin popping MainliningMainlining SmokingSmoking SnortingSnorting Chasing the dragonChasing the dragon speedballspeedball

Scope of problem Scope of problem

Est user will use for 2 yrs to develop Est user will use for 2 yrs to develop dependencedependence

ChippersChippers Est. heroin addict spends $250 week Est. heroin addict spends $250 week

to support habitto support habit Males make up ¾ of those addictedMales make up ¾ of those addicted

Scope of the problemScope of the problem

Est. 1.6 million abuse prescribed narcotic Est. 1.6 million abuse prescribed narcotic for the first time in U.S.for the first time in U.S.

People “share” prescriptionsPeople “share” prescriptions Many abusers go from clinic to clinicMany abusers go from clinic to clinic 1 in 4 who abuse opiates will become 1 in 4 who abuse opiates will become

addictedaddicted Half of those who repeatedly abuse heroin Half of those who repeatedly abuse heroin

will go on to become addictedwill go on to become addicted Est. 3 million people in U.S. have used Est. 3 million people in U.S. have used

heroin at least once, 1.4 million addictedheroin at least once, 1.4 million addicted

How addicts obtain opiatesHow addicts obtain opiates

Doctor shopping/manipulatingDoctor shopping/manipulating Relationships with terminally illRelationships with terminally ill DealersDealers Health care professionals who steal Health care professionals who steal

the drugsthe drugs

ComplicationsComplications

Withdrawal-peak at 72 hours and lasts Withdrawal-peak at 72 hours and lasts about a weekabout a week

Signs of w/dSigns of w/d Extended w/d lasting months-restlessness, Extended w/d lasting months-restlessness,

fatigue, anxietyfatigue, anxiety Lifestyle health risksLifestyle health risks Strokes, liver problems, sexual Strokes, liver problems, sexual

dysfunction, hypertension, organ failure, dysfunction, hypertension, organ failure, infectionsinfections

Cotton feverCotton fever