Commonly Abused Drugs

andAddictive Substances

مردانی فردین دکترکشور قانونی پزشکی سازمان

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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.

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.

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: Benzodiazepines Xanax, 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.

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.

Cannabis & Hashish

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

chemicals called cannabinoids. The major cannabinoids are cannabinol, 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.

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.

Medical Conditions Proposed for Cannabinoid Use

dronabinol and nabilone• Anorexia-cachexia syndrome

secondary to HIV infection'• Anxiety• Asthma• Depression• Epilepsy• Glaucoma• Head injury• Insomnia

• Migraine headaches• Multiple sclerosis• Muscle spasticity and spasms• Nausea and vomiting

(resistant)'• Neurologic disorders• Pain• Parkinson disease• Tourette syndrome

Cannabinoids pharmacodynamics

• 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.

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").

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.

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.

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®).

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.

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.

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.

Stimulants

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

PHARMACOLOGY(Cocain)

inhibits the synaptic reuptake of epinephrine, norepinephrine, dopamine, and serotonin

stimulates the presynaptic release of norepinephrine, leading to increased sympathomimetic activity.

is a powerful vasoconstrictor and may enhance in situ thrombus formation and platelet aggregation.

PHARMACOLOGY(Cocain)

Cocaine + Ethanol = Cocaethylene (more toxic than cocaine itself, has a longer

half-life than cocaine)

Acute Toxicity(Cocain)

sudden death by: - stroke - seizure - cardiac dysrhythmia - acute coronary syndrome

may cause excited(agitated) delirium

PHARMACOLOGY(Methamphetamine)

promote increased norepinephrine release into the synaptic cleft, which then overflows into the circulation, resulting in sympathomimetic effects.

also promote the release of dopamine and serotonin

• Amphetamine increases the concentration of dopamine in the synaptic cleft in 3 ways: • (1) bind to the pre-synaptic membrane of dopaminergic neurones 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.

Acute Toxicity (Methamphetamine)

sudden death by - stroke - seizure - cardiac dysrhythmia excited delirium hyperthermia

tachycardia hypertension rhabdomyolysis disseminated intravascular

coagulation

http://upload.wikimedia.org/wikipedia/commons/b/b4/Effects_of_metamphetamine.png

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

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.

Methamphetamine

Amphetamine type stimulants » شیشه » به موسوم ترکیبات

وایزومر • میباشد آمفتامین آنها ایزومر Dسردسته داشته اثرقوی کمتری Lآن اثردارد

قوی • سبب CNS(psychostimulants)محرک نفرین نوراپی و دوپامین ترشح با بودهمیبرد euphoriaسرخوشی باال را جنسی میل شده

میشود • محسوب زا انرژی داده افزایش را ذهنی هشیاریسال • در دهه 1887ابتدا اواخر تا ولی شد مشخص 1920سنتز آن دارویی اثرات

بود نشدهسپس • میشد استفاده بینی دکونژستانت ودر بود افدرین برای ابتداجانشینی

شد مشخص آن در اشتها سرکوب و کنندگی الغر اثراتایجاد • وجهت ضدخستگی بعنوان متفقین هم و آلمانها هم دوم جهانی درجنگ

میشد استفاده هشیاریداشت • نظامیان و ساده کارگران بین وسیعی مصرف حتی ژاپن در•) ( برابر ده تا است کوکائین از اثرتر طوالنیاست • آور اعتیاد شده وابستگی به منجر آن مصرفمغزدارد • روی قویتری تحریکی اثر بوده شده متیله آمفتامین همان متامفتامینمیگردد • دفع متابولیتها و آمفتامین ادراربیشتربصورت در متامفتامین

Amphetamine type stimulants » شیشه » به موسوم ترکیبات

ماده • پرمصرفترین که حشیش از پس ترکیبات اینمصرف دوم رتبه در است درجهان موردسوءمصرف . وباالخره اپیوئید ترکیبات سوم رتبه دارد قرار جهانی

( تریاک ترتیب به درایران است ،کراک% 40کوکائینشیشه% 30وهروئین سپس (20و قراردارد%

از • منظور اسامی کریستال معموال ولی است متامفتامین.. دارد و آیس،شیشه مثل مختلفی

تزریق • داشته مختلفی رنگهای و شکلدارد خوراکی و مقعد ،ازطریق وریدی،استنشاقی

ساخته • آمفتامین بسادگی پسودوافدرین و افدرین احیای ازمیشود.

Street Names

• Meth• Crystal• Crystal meth• Glass• Shabu• Shaboo• Ice• Go fast

• S• Speed• Snap• Tina• Crank• Shabs• Shard• Batu

Sources: UNODC, Annual Reports Questionnaire Data, UNODC, Individual Drug Seizure Database, other government sources.

Locations of amphetamines manufacture and main trafficking routes

Club Drugs

Club Drugs• Club drugs, Rave drugs, are a loosely-defined category of

recreational drugs which 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.

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

Hallucinogens

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.

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

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.

Mescaline• Mescaline or 3,4,5-

trimethoxyphenethylamine is a naturally occurring psychedelic alkaloid of the phenethylamine class, known for its hallucinogenic effects similar to those of LSD and psilocybin. It shares strong structural similarities with the catecholamine dopamine.

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-HT serotonin receptor in the brain, where it mimics the effects of serotonin.

LSD• LSD affects a large number of the

G protein-coupled receptors, including all dopamine receptor subtypes, and all adrenoreceptor subtypes, as well as many others.Most serotonergic psychedelics are not significantly dopaminergic, and LSD is therefore rather unique in this regard.

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

Deliriants• induce a state of delirium in the user, characterized by

extreme confusion and an inability to control one‘s actions.

• Atropa belladona(deadly nightshade), Brugmanasia species (Angel's Trumpet), Datura stramonium(Jimson weed), Hyoscynamus niger(henbane), Mandragora officinarum (mandrake), and Myristica fragrans (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)

LSD decorated paper

Structural Classifications of Hallucinogens

lysergamides• d-Lysergic acid diethylamide (LSD)• Lysergic acid hydroxyethylamide• Ipomoea violacea (Morning glory)• Ololiuqui (South American Morning

glory)• Ergine• Argyreia nervosa (Wood rose) Indolealkylamines/Tryptamines• 5-Methoxy-N,N-dimethyltryptamine• N,N-Dimethyltryptamine• Psilocin• Psilocybin Phenylethylamines• Mescaline• MDMA (3,4-

methylenedioxymethamphetamine)

• 2C-8• 2C-T-7 Tetrahydrocannabinoids• Marijuana• Hashish Belladonna alkaloids• Jimsonweed (Datura stramonium)• Henbane (Hyoscyamus niger)• Deadly nightshade (Atropa belladonna)• Brugmansia spp Miscellaneous• Kava Kava• Ketamine• Kratom• Nutmeg• Phencyclidine (PCP)• Salvia divinorum

Hallucinogenseffects

• Acute Effects - Altered states of perception and feeling; hallucinations; nausea

• Also, for LSD - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid shifts in emotion

• Also, for Mescaline - Increased body temperature, heart rate, blood pressure; loss of appetite; sweating; sleeplessness; numbness, dizziness, weakness, tremors; impulsive behavior; rapid shifts in emotion

• Also, for Psilocybin - Nervousness; paranoia; panic• Health Risks, for LSD - Flashbacks, Hallucinogen Persisting

Perception Disorder

Dissociative Drugseffects

• Acute Effects - Feelings of being separate from one’s body and environment; impaired motor function

• Also, for ketamine - Analgesia; impaired memory; delirium; respiratory depression and arrest; death

• Also, for PCP and analogs - Analgesia; psychosis; aggression; violence; slurred speech; loss of coordination; hallucinations

• Also, for DXM - Euphoria; slurred speech; confusion; dizziness; distorted visual perceptions

• Health Risks - Anxiety; tremors; numbness; memory loss; nausea

• Acute Effects, for Anabolic steroids - No intoxication effects• Also, for Inhalants (varies by chemical) - Stimulation; loss of

inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing

• Health Risks, for Anabolic steroids - Hypertension; blood clotting and cholesterol changes; liver cysts; hostility and aggression; acne; in adolescents—premature stoppage of growth; in males—prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females—menstrual irregularities, development of beard and other masculine characteristics

• Also, for Inhalants - Cramps; muscle weakness; depression; memory impairment; damage to cardiovascular and nervous systems; unconsciousness; sudden death

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