Commonly Abused Drugs and Addictive Substances

1. Commonly Abused DrugsandAddictive Substances دکتر فردین مردانی سازمان پزشکی قانونی کشور Fardin_rz76@yahoo.com

2. Addictive Substances • Addictive substances can affect the brain in different ways. • Stimulants: make a person feel more energetic • Depressants: bring a feeling of relaxation. • Hallucinogens: change the way someone experiences reality. • Some drugs fall into more than one classification.

3. Legal Addictive Substances • Caffeine:Coffee, tea, soda, sports drinks. Coffee has roughly twice as much caffeine as other sources. Moderate consumption is three cups or less of coffee per day. Ten cups is considered excessive and results in nervousness, sleeping difficulty, increased heartbeat, headaches, anxiety and nausea. • Nicotine:Cigarettes, cigars, nicotine patches. Both coffee and nicotine are stimulants that not only increase dopamine levels, but boost adrenaline. Increased adrenaline raises the user's heart rate and blood pressure, and interferes with the release of insulin by the pancreas, leading to elevated blood sugar. Nicotine can also act as a depressant. • Alcohol: Wine, beer, liquor. Alcohol is a depressant that affect neurons in the central nervous system which leads to relaxation, drowsiness, lack of inhibition, sleep, coma and even death. Addiction to alcohol is called alcoholism. • Inhalants: Aerosols, solvents, gases and nitrates. Products range from paint thinners to hair spray to propane tanks, and inhalation results in a high similar to that of alcohol. Even one-time use of inhalants can kill or cause heart failure.

4. Controlled Addictive Substances • available by prescription only. • Amphetamines: Stimulants that boost alertness and concentration. Adderall, dexedrene and other drugs are normally prescribed for treatment of ADHD. Abuse occurs when they're taken in quantities other than those prescribed or by someone other than the intended patient. • Sedative-hypnotic drugs: BenzodiazepinesXanax, Valium, barbiturates, Seconol, phenobarbital. Benzodiazepines are also known as depressants because they depress brain activity. These drugs are prescribed for insomnia, anxiety, seizures and symptoms of bipolar and manic depressive disorder. Even a small overdose of barbiturates used for anesthesia can result in coma, respiratory distress or death. • Opioids: Heroin, morphine, oxycodone, codeine and other narcotic pain relievers are very useful when prescribed. They interfere with the way pain messages are sent to the brain and how they brain receives them. Heroin, an illegal drug processed from the poppy-plant product, morphine, is highly addictive. Can be injected, smoked or snorted.

5. Illegal Addictive Substances • illegal in all cases, but can still be widely available. • Cannabis:Marijuana, grass, pot, hashish. The most commonly used illegal drug in the U.S., it relaxes the user and concentrated doses may bring euphoria, hallucinations or paranoia. Long-term use can be addictive for some people. Prescribed legally in some states for medical use because it curbs nausea. • Cocaine: Coke, crack. Brings users a strong sense of euphoria and energy before leading to agitation, depression and paranoia. A white powder, cocaine comes from the coco plant and is the second most-used illegal drug in America. Can be snorted, sniffed, injected or smoked (crack). • Hallucinogens: LSD, ecstasy. Changes the way users perceive time, motion, colors, sound and their own thoughts. Disruption of normal thinking can lead to dangerous behavior. • Phencyclidine (PCP):Angel dust. Anesthetic approved only for animal use. A hallucinogen that has sedative qualities producing a dissociative state, or out-of-body experience, along with a euphoric rush. Can be sprinkled on marijuana or other substances and smoked, snorted or taken in pill form. Users can become violent or suicidal, and experience muscle contractions so severe they can lead to bone fractures.

6. Cannabis & Hashish

7. Cannabis & Hashish • Cannabis is a collective term referring to the bioactive substances from Cannabis sativa. • The C. sativa plant contains a group of more than 60 chemicalscalled cannabinoids. • The major cannabinoidsarecannabinol, cannabidiol, and tetrahydrocannabinol. The principal psychoactive cannabinoid is ~9-tetrahydrocannabinol (THC). • Marijuana is the common name for a mixture of dried leaves and flowers of the C. sativa plant. • Hashish and hashish oil are the pressed resin and the oil expressed from the pressed resin, respectively.

8. History • Cannabis has been used for more than 4000 years. The earliest documentation of the therapeutic use of marijuana is the 4t century BC in China. • Cannabis use spread from China to India to North Africa, reaching Europe around AD 500.

9. Medical Conditions Proposed for Cannabinoid Use dronabinol and nabilone Migraine headaches Multiple sclerosis Muscle spasticity and spasms Nausea and vomiting (resistant)' Neurologic disorders Pain Parkinson disease Tourette syndrome • Anorexia-cachexia syndrome secondary to HIV infection' • Anxiety • Asthma • Depression • Epilepsy • Glaucoma • Head injury • Insomnia

10. Cannabinoidspharmacodynamics • Before the 1980s, it was often speculated that cannabinoids produced their physiological and behavioral effects via nonspecific interaction with cell membranes, instead of interacting with specific membrane-bound receptors. The discovery of the first cannabinoid receptors in the 1980s helped to resolve this debate. At present, there are two known types of cannabinoid receptors, termed CB1 and CB2,with mounting evidence of more.

12. DEA Schedule • Schedule I Controlled Substances: Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse. • Examples: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4methylenedioxymethamphetamine ("Ecstasy").

13. DEA Schedule • Schedule II/IIN Controlled Substances (2/2N): Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence. • Examples of Schedule II narcotics: hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl(Sublimaze®, Duragesic®).  Other Schedule II narcotics include: morphine, opium, and codeine. • Examples of Schedule IIN stimulants: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®). • Other Schedule II substances: amobarbital, glutethimide, and pentobarbital.

14. DEA Schedule • Schedule III/IIIN Controlled Substances (3/3N): Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence. • Examples of Schedule III narcotics: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin®), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®). • Examples of Schedule IIIN non-narcotics: benzphetamine(Didrex®), phendimetrazine, ketamine, and anabolic steroids such as Depo®-Testosterone.

15. DEA Schedule • Schedule IV Controlled Substances • Substances in this schedule have a low potential for abuse relative to substances in Schedule III. • Examples of Schedule IV substances: alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).

16. DEA Schedule • Schedule V Controlled Substances • Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics. • Examples of Schedule V substances: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and ezogabine.

17. CannabinoidsAcute Toxicity • decreases in coordination, muscle strength, and hand steadiness. Lethargy, sedation, postural hypotension, inability to concentrate, decreased psychomotor activity, slurred speech, and slow reaction time. - Life-threatening ventricular tachycardia (200 beats/min) has been reported. - acute cardiovascular deaths(?) - risk of myocardial infarction is increased five times over baseline in the 60 minutes after marijuana use. - It is not known to cause death via direct drug toxicity.

18. CannabinoidsAcute Toxicity • In children: - 250 to 1000 mg of hashish resulted in obtundation in 30 to 75 minutes. - Less commonly: apnea, cyanosis, bradycardia, hypotonia, and opisthotonus.

19. Stimulants

21. Stimulants • Health Risks - Weight loss, insomnia; cardiac or cardiovascular complications; stroke; seizures; addiction • Also, for cocaine – Nasal damage from snorting • Also, for methamphetamine – Severe dental problems

23. PHARMACOLOGY(Cocain) • inhibits the synaptic reuptake of epinephrine, norepinephrine, dopamine, and serotonin • stimulates the presynaptic release of norepinephrine, leadingto increased sympathomimeticactivity. • is a powerful vasoconstrictor and may enhance in situ thrombus formation and platelet aggregation.

24. PHARMACOLOGY(Cocain) • Cocaine + Ethanol = Cocaethylene (more toxic than cocaine itself, has a longer half-life than cocaine)

25. Acute Toxicity(Cocain) • sudden death by: - stroke - seizure - cardiac dysrhythmia - acute coronary syndrome • may cause excited(agitated) delirium

26. PHARMACOLOGY(Methamphetamine) • promote increased norepinephrine release into the synaptic cleft, which then overflows into the circulation, resulting in sympathomimeticeffects. • also promote the release of dopamine and serotonin

27. Amphetamine increases the concentration of dopamine in the synaptic cleft in 3 ways: • (1) bind to the pre-synaptic membrane of dopaminergicneurones and induce the release of dopamine from the nerve terminal • (2) interact with dopamine containing synaptic vesicles, releasing free dopamine into the nerve terminal • (3) bind to the dopamine re-uptake transporter, causing it to act in reverse and transport free dopamine out of the nerve terminal. Amphetamine can also cause an increased release of noradrenaline into the synaptic cleft.

28. Acute Toxicity(Methamphetamine) tachycardia hypertension rhabdomyolysis disseminated intravascular coagulation • sudden death by - stroke - seizure - cardiac dysrhythmia • excited delirium • hyperthermia

30. Stimulants Pharmacokinetics Duration of Action • Cocaine - oral onset in 2-3 min with peak in 15-20 min • duration less than 1 hr • IV or smoked - onset in 10 sec & peak in 5-10 min • Amphetamine - oral effects after 30 min & peak in 2-3 hrs • duration 10-12 hrs • IV or smoked - onset 5 min & lasts up to 7 hrs

31. designer amphetamine? • The term ‘designer amphetamine’ is often used to describe synthetic chemicals that are derived from amphetamine or methamphetamine. Designer amphetamines, like other designer drugs, are often created to avoid regulation by existing drug laws.

32. Methamphetamine

33. Amphetamine type stimulantsترکیبات موسوم به «شیشه» • سردسته آنها آمفتامین میباشد وایزومرD آن اثرقوی داشته ایزومرL اثر کمتری دارد • محرک قوی CNS(psychostimulants) بوده با ترشح دوپامین و نوراپی نفرین سبب سرخوشی euphoria شده میل جنسی را بالا میبرد • هشیاری ذهنی را افزایش داده انرژی زا محسوب میشود • ابتدا در سال 1887 سنتز شد ولی تا اواخر دهه 1920 اثرات دارویی آن مشخص نشده بود • ابتداجانشینی برای افدرین بود ودر دکونژستانت بینی استفاده میشد سپس اثرات لاغر کنندگی و سرکوب اشتها در آن مشخص شد • درجنگ جهانی دوم هم آلمانها و هم متفقین بعنوان ضدخستگی وجهت ایجاد هشیاری استفاده میشد • در ژاپن حتی مصرف وسیعی بین کارگران ساده و نظامیان داشت • طولانی اثرتر از کوکائین است(تا ده برابر) • مصرف آن منجر به وابستگی شده اعتیاد آور است • متامفتامین همان آمفتامین متیله شده بوده اثر تحریکی قویتری روی مغزدارد • متامفتامین در ادراربیشتربصورت آمفتامین و متابولیتها دفع میگردد

34. Amphetamine type stimulantsترکیبات موسوم به «شیشه» • این ترکیبات پس از حشیش که پرمصرفترین ماده موردسوءمصرف درجهان است در رتبه دوم مصرف جهانی قرار دارد.رتبه سوم ترکیبات اپیوئید وبالاخره کوکائین است( درایران به ترتیب تریاک 40%،کراک وهروئین 30% و سپس شیشه 20% قراردارد) • معمولا منظور از کریستال متامفتامین است ولی اسامی مختلفی مثل آیس،شیشه و..دارد • شکل و رنگهای مختلفی داشته تزریق وریدی،استنشاقی ،ازطریق مقعد و خوراکی دارد • از احیای افدرین و پسودوافدرین بسادگی آمفتامین ساخته میشود.

35. Street Names • Meth • Crystal • Crystal meth • Glass • Shabu • Shaboo • Ice • Go fast • S • Speed • Snap • Tina • Crank • Shabs • Shard • Batu

36. Locations of amphetamines manufacture and main trafficking routes Sources: UNODC, Annual Reports Questionnaire Data, UNODC, Individual Drug Seizure Database, other government sources.

37. Club Drugs

39. Club Drugs • Club drugs, Rave drugs, are a loosely-defined category of recreational drugswhich are associated with discothèques in the 1970s and dance clubs, parties, and raves in the 1980s to the 2000s, are a "category of convenience," which includes drugs ranging from phenethylamines such as the popular ecstasy to the lesser known 2C-B, inhalants (nitrous oxide and amyl nitrite "poppers"), stimulants (such as amphetamines and cocaine), and hallucinogens such as LSD and psilocybin mushrooms. Dancers at all-night parties use these drugs for their stimulating or psychedelic properties. "Club drugs" vary by country and region; in some areas, even opiates such as heroin are sold at clubs, though this practice is relatively uncommon.

40. Club Drugseffects • Acute Effects, for MDMA - Mild hallucinogenic effects; increased tactile sensitivity; empathic feelings; lowered inhibition; anxiety; chills; sweating; teeth clenching; muscle cramping • Also, for Flunitrazepam - Sedation; muscle relaxation; confusion; memory loss; dizziness; impaired coordination • Also, for GHB - Drowsiness; nausea; headache; disorientation; loss of coordination; memory loss • Health Risks, for MDMA - Sleep disturbances; depression; impaired memory; hyperthermia; addiction • Also, for Flunitrazepam - Addiction • Also, for GHB - Unconsciousness; seizures; coma

41. Hallucinogens

42. Hallucinogens • psychedelics • dissociatives • deliriants - can cause subjective changes in perception, thought, emotion and consciousness. - Unlike other psychoactive drugs, such as stimulants and opioids, these drugs do not merely amplify familiar states of mind, but rather induce experiences that are qualitatively different from those of ordinary consciousness.

43. Psychedelics (classical hallucinogens) • LSD (Lysergic acid diethylamide) • Psilocybin(more than 200 species of mushrooms, collectively known as psilocybin mushrooms) • DMT(Dimethyltryptamine) • 2C-B (4-bromo-2,5-dimethoxyphenethylamine) • mescaline(peyote cactus, the San Pedro cactus , and in the Peruvian torch) • DOB (2,5-Dimethoxy-4-bromoamphetamine) • Other tryptamines • Other phenethylamines

44. Mescaline • Mescaline is produced when products of natural mammalian catecholamine-based neuronal signalling such as dopamine and serotonin are subjected to additional metabolism via methylation, and mescaline's hallucinogenic properties stem from its structural similarities with these two neurotransmitters.

45. Mescaline • Mescaline or 3,4,5-trimethoxyphenethylamine is a naturally occurringpsychedelicalkaloid of the phenethylamine class, known for its hallucinogenic effects similar to those of LSD and psilocybin. It shares strong structural similarities with the catecholaminedopamine.

46. Psilocybin • Psilocybin is rapidly dephosphorylated in the body to psilocin, which is a partial agonist for several serotonergic receptors. Psilocin has a high affinity for the 5-HTserotonin receptor in the brain, where it mimics the effects of serotonin.

47. LSD • LSD affects a large number of the G protein-coupledreceptors, including all dopamine receptor subtypes, and all adrenoreceptor subtypes, as well as many others.Mostserotonergic psychedelics are not significantly dopaminergic, and LSD is therefore rather unique in this regard.

48. Dissociatives • Dissociatives produce analgesia, amnesia and catalepsy at anesthetic doses. They also produce a sense of detachment from the surrounding environment, • ketamine, phencyclidine (PCP), dextromethorphan (DXM), nitrous oxide, Salvia divinorum

49. Deliriants • induce a state of delirium in the user, characterized by extreme confusion and an inability to control one‘s actions. • Atropabelladona(deadly nightshade), Brugmanasia species (Angel's Trumpet), Daturastramonium(Jimson weed), Hyoscynamusniger(henbane), Mandragoraofficinarum (mandrake), and Myristicafragrans (nutmeg), as well as a number of pharmaceutical drugs, when taken in very high doses, such as diphenhydramine (Benadryl) and its close relative dimenhydrinate (Dramamine)