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Albia Dugger • Miami Dade College
Chapter 11Stimulants
Types of Stimulants
• Stimulants modify a person’s activity level, mood, and central nervous system
• Some stimulants, such as cocaine and methamphetamines, are illegal
• Others, such as amphetamines, require a prescription
• Legal stimulants such as caffeine and nicotine are among the most widely used drugs in the world
Cocaine
• Cocaine comes from the leaves of the coca plant, Erythroxylon coca
• Natives of the Andes Mountains chew coca leaves to relieve fatigue, for spiritual reasons, or to enhance well-being
• Colombia is the largest producer of cocaine
Sources of Cocaine
• Bolivia and Peru account for a small percentage of cocaine production
Properties of Cocaine
• Cocaine is an odorless, crystalline, white powder that produces intense euphoria, alertness, and energy
• Cocaine may be used in a Brompton’s cocktail, which is used to manage cancer pain
• Cocaine is used in surgical procedures on the facial area
Mode of Intake
• Injected cocaine reaches the brain the fastest, and euphoria is rapid and intense
• Snorted cocaine is absorbed into the bloodstream through the nasal mucous membranes
• Crack cocaine is made by heating cocaine after mixing it with baking soda and water
• Freebase cocaine is separated from its hydrochloride salt by heating, using a volatile chemical such as ether
Crack Cocaine
Cocaine Paraphernalia
Forms of Cocaine
Historical Use of Cocaine
• Cocaine was isolated from coca leaves by the German scientist Niemann around 1859
• Freud recommended cocaine to alleviate opiate addiction, depression, and fatigue
• Cocaine was originally included in Coca-Cola
• The Harrison Narcotic Act of 1914 designated cocaine as a narcotic
Early Products Containing Cocaine
Current Use of Cocaine
• Cocaine use increased again in the 1970s, accompanied by an increase in cocaine-related deaths
• In the 1980s celebrity users made cocaine glamorous
• In 2010, an estimated 1.5 million Americans aged 12 and older were cocaine users
2010 Drug Use
Crack
• Crack is usually smoked, but it can also be injected
• Because it comes in small units, the cost is low
• The euphoria is brief (about 10 to 20 minutes), and the desire to repeat usage is high
• Crack use is a problem among impoverished, inner-city adolescents
Crack
• Many addicts exchange sex for crack
• Rates of AIDS are high
Crack Law
• In 1984, laws mandated harsher penalties for individuals arrested for crack cocaine than for powder cocaine
• In 2010, the United States Sentencing Commission reversed that law
• The law was viewed as racially discriminating – 85% of offenders are African American, only 5% are White
Crack Arrests
Cocaine and the Media
• Drugs and musicians:• Jazz musicians commonly used cocaine during the 1930s
and 1940s• Starting in the 1960s, references to drugs in music were
conspicuous• In the early 1990s, rap musicians promoted cocaine use
• The media offer a paradoxical view of cocaine – the drug is connected with high status, yet the messages often carry a negative connotation
Physical Effects of Cocaine
• Elevated blood pressure• Excessive perspiration• Nausea, vomiting,
abdominal pain• Headache• Tightened muscles • Slower digestion• Anorexia• Nutritional deficiencies• Rapid pulse• Faster breathing rate
• Increased body temp• Urge to urinate,
defecate, belch• Inflammation of trachea
and bronchi• Hoarseness or laryngitis• Wheezing and coughing• Coughing up pus,
mucus, blood• Seizures• Hallucinations
Physical Effects of Cocaine
• Physical effects of cocaine depend on how the drug enters the body
• The speedball, an injected mixture of cocaine and heroin, carries a higher risk of dependency and overdose
• Smoked cocaine can affect the heart to the point of congestive heart failure and death
• Injected cocaine has been linked to inflammation of the heart lining and liver
Psychological Effects of Cocaine
• Talkativeness• Mood swings• Hallucinations• Repetitive behaviors• Extreme depression• Neglect of personal
hygiene
• Rage and violent behavior
• Delusions• Distorted perceptions• Depersonalization• Suicidal ideation• Paranoia
Rates of Emergency Room Visits
Cocaine Dependence
• Cocaine users build up tolerance to the drug, but not to the health risks
• Withdrawal symptoms include depression, lack of energy, poor appetite, restlessness, and agitation
• Scientists are working on a vaccine for preventing addiction to cocaine and other drugs
Three phases following abstinence
• Intense craving, agitation, anorexia, and deep depression –the desire for cocaine may increase
• Withdrawal, during which the person is incapable of feeling normal pleasure, but depression moderates and sleeping becomes easier
• Extinction, during which improvement is considerable, but periods of depression and craving can occur
Drugs to treat cocaine withdrawal
• The African hallucinogen ibogaine is a controversial drug given to cocaine addicts
• Propranolol eases withdrawal symptoms, making it easier for cocaine addicts to remain in treatment
• Disulfiram, a drug used to treat alcoholism, has also shown potential as a treatment for cocaine addicts
• Typically cocaine addicts are given antidepressants to lessen withdrawal symptoms
Death from Cocaine
• Cocaine can cause irregular heartbeat (cardiac arrhythmias), high blood pressure, chest pains and heart attacks
• Coronary artery disease leading to death is relatively common in cocaine users
• Some fatalities result from uncontrolled seizures, strokes, or paralysis of breathing muscles
• People who inject cocaine are in danger of contracting HIV and other potentially fatal infections
Cocaine and Pregnancy
• 1 out of every 25 women use an illegal drug while pregnant
• Cocaine constricts blood vessels and reduces blood flow and oxygen to the fetus
• Cocaine can cause detachment of the placenta, as well as premature labor
• Cocaine may reduce immunity in the fetus, increasing the risk of HIV infection
Cocaine and Pregnancy
• Prenatal exposure to cocaine delays growth and language development
• Some babies have neurological problems, perhaps caused by strokes before birth
• Babies have higher rates of congenital heart defects, lower birth weights, seizures, and are at risk for sudden infant death
• Babies tend to be born with smaller heads, and are more prone to urinary tract problems
Amphetamines
• Amphetamines were developed as inhalers to treat asthma, sold under the name Benzedrine
• Amphetamines were used for treating depression, for increasing work capacity, and for treating narcolepsy
• It then was used to suppress appetite and ward off fatigue
• In the late 1930s, it was given to hyperactive children
Common Amphetamines
Pharmacology of Amphetamines
• Amphetamines can be administered by ingestion, injection, snorting, or inhalation
• Tolerance develops quickly – many users increase the dosage or go on binges to maintain their high
• Amphetamines are sympathomimetic drugs – their effects are similar to those in people who are emotionally aroused
• Their chemical structure is similar to that of the neurotransmitters norepinephrine and dopamine
Pharmacology of Amphetamines
• The half-life is 10 to 12 hours, and they are not totally eliminated from the body for about two days
• Amphetamines are removed from the body in two ways:1. They are excreted through urine after being transformed
by liver enzymes2. They are deactivated and removed by adding molecules
to the amphetamine compound
Pharmacology of Amphetamines
• Psychological effects include paranoia, violence, restlessness, agitation, hallucinations, confusion, and anxiety
• Physical effects are tremors, tinnitus (ringing in ears), dry mouth, excessive perspiration, increased blood pressure, poor coordination, and convulsions
• Amphetamines are especially harmful to the cardiovascular system and can cause cardiac arrest
The Amphetamine Trade
• In the 1940s, Japan and Sweden had severe problems with amphetamine abuse
• In the 1930s, people in the US could legally obtain amphetamines
• In 1970, they represented about 8% of prescriptions
Consequences of Amphetamine Use
• Most people who are dependent on amphetamines experience withdrawal, continue using them despite problems, cannot stop, develop tolerance, and give up other activities to use amphetamines
• Stimulants can improve mental and physical performance for simple tasks – but not for tasks requiring complex thinking, such as problem-solving and decision-making
Consequences of Amphetamine Use
• High doses negatively affect judgment and decision-making skills, and can cause severe behavioral problems
• Gross motor skills improve; fine motor skills are impaired
• Amphetamine psychosis – marked by paranoia, aggressiveness, fearfulness, disordered thinking, mania, and hallucinations – is a significant problem related to chronic use
Methamphetamines
• Methamphetamines (speed) are more potent forms of amphetamine
• “Speed freaks” go on binges, shooting up every few hours over a five- or six-day period before crashing
• Many users take methamphetamines in conjunction with other drugs such as cocaine and marijuana
Nicknames for Methamphetamines
• Speed• Ice• Crystal• Meth• Chicken powder• Go-fast• Glass
• Crank• Christy• Crystal-meth• Chalk• Peanut butter-crank• Shabu-shabu• Zip
Methamphetamine Laboratories
• In the US, methamphetamines have become the number-one drug problem in rural areas
• Types of harm associated with meth labs:• Physical injury from explosions, fires, chemical burns, and
toxic fumes• Environmental hazards• Child endangerment
Methamphetamine’s Effects
• Slurred speech• Loss of appetite• Excitement• Increased blood
pressure and heart rate• Irregular heartbeat• Pounding heart• Severe chest pain• Hot flashes• Excessive perspiration• Anxiety
• Tremors• Confusion• Insomnia• Convulsions• Memory loss• Violent behavior• Elevated body temp• Paranoia• Auditory hallucinations• Death
Methamphetamine “Ice”
Ritalin and Adderall
• Ritalin (methylphenidate) and Adderall are the most prescribed drugs for ADHD
• Ritalin and other stimulants enhance the functioning of the reticular activating system, which helps children focus attention and filter out extraneous stimuli
• Side effects include insomnia, weight loss, headaches, irritability, nausea, and dizziness
Caffeine
• Caffeine is the world’s most frequently consumed stimulant
• Tea contains caffeine and theophylline, a stimulant from the same chemical family as caffeine
• Products containing caffeine include gum, mints, beer, candy, sunflower seeds, many prescription medicines, and chocolate
• Another stimulant in chocolate, theobromine, is related chemically to caffeine but is less powerful
High-Energy Caffeinated Beverages
• The FDA does not regulate caffeine in food and drinks –however, it suggests that a safe level is 72 mg per 12 ounces
• Many beverages such as Red Bull, Monster, and Rock Star exceed that level
• To counter the sedating effects of alcohol, some individuals alternate with these high-energy drinks when drinking alcohol
Caffeine Content
Pharmacology of Caffeine
• Caffeine acts as an antagonist to receptors for the inhibitory neurotransmitter adenosine
• Peak effects occur 30 to 45 minutes after consumption
• Caffeine use by well-conditioned athletes has been found to improve endurance on a short-term basis
• Extreme caffeine intake has been linked to a low blood sugar condition called hypoglycemia
Properties and Risks of Caffeine
• Caffeine is a xanthine – stimulants that improve work capacity, alertness, motor performance, and curb fatigue
• Caffeine may delay the progression of Alzheimer’s disease; help asthmatics breathe easier; and may reduce risk of type 2 diabetes in younger and middle-aged women
• Caffeine taken on an empty stomach releases stomach acids and digestive enzymes, causing an upset stomach
Properties and Risks of Caffeine
• Side effects include nervousness, anxiety, insomnia, heartburn, and symptoms of premenstrual syndrome
• Caffeine has been implicated in cardiovascular conditions from heart disease to hypertension
• Caffeine might contribute to breast lumps, breast tenderness, and cysts
• Caffeinated coffee decreases the likelihood of certain cancers
Effects of Caffeine
• At moderate levels, caffeine increases blood pressure, body temperature, blood sugar levels, metabolism, urination, and hand tremors, and decreases appetite and coordination
• In large amounts, it causes nausea, diarrhea, shaking, headache, and nervousness
• At worst, caffeine can cause convulsions, respiratory failure, and, if one drinks 70 to 100 cups of coffee, death
Effects of Caffeine
• Caffeine users need the drug to achieve alertness and to eliminate withdrawal symptoms
• Withdrawal symptoms appear in people who consume 2½ cups of coffee or more daily
• Withdrawal symptoms include headache, depression, lethargy, lower energy level, drowsiness, and irritability
Decaffeinated Coffee
• Caffeine is displaced from the coffee bean using a hot water solution – then is taken out of the water an organic solvent
• The original solvent, trichloroethylene, is potentially carcinogenic – it was replaced by methylene chloride, which also might contribute to cancer
• Decaffeinated coffee still has some caffeine: 5 mg to 32 mg per 10 to 12 ounces (compared to 100mg)
Caffeinism
• Excessive caffeine consumption resulting in caffeine dependency is called caffeinism
• More than one-half of moderate coffee drinkers who stop drinking it experience moderate to severe headaches
• Caffeinism is marked by irritability, depression, insomnia, headaches and morning lethargy
• About one-fourth of users experience withdrawal symptoms when they discontinue drinking caffeine