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SOC 204
Drugs & Society
Chapter 11 Stimulants
Goldberg
Do you agree with the use of
medication for ADD/ADHD?
A. Yes
B. No
C. I’m not sure
Yes
No
I’m
notsure
0% 0%0%
Questions for Discussion 6
 List three benefits or risks of using
stimulant medication to treat
ADD/ADHD
 Do the benefits or risks change when
prescribing to children?
 Back up your points with research
Historically, cocaine was used as
a local anesthetic.
A. True
B. False
True
False
19%
81%
Stimulants
 Modify (stimulate) a person’s
◦ Activity level
◦ Mood
◦ Central nervous system
 Increased heart rate
 Increased respiration
 Increased blood pressure
 Dilated pupils
https://ww
w.youtube.
com/watch
?v=R3GYI
-Kpf5M
History of Cocaine
 Bush that grows in the Andes
 Natives chewed the leaves for
endurance
 Cocoa wine
 Coca-Cola
 Patent medicines
Cocaine accounts for more ER
visits than any other illegal drug.
A. True
B. False
True
False
40%
60%
History
 Local anesthesia:
Dr. W. S. Halsted
 Early psychiatric uses:
Sigmund Freud
 Used to alleviate fatigue,
depression, opiate
addiction
 Later opposed this use
Legal Control
 46 states passed laws to regulate
cocaine between 1887 and 1914
 Negative publicity about cocaine
influenced the passage of the 1914
Harrison Act
 Anti-Drug Abuse Acts of 1986 and
1988
The majority of powder
cocaine users who enter
treatment are white, and the
majority of crack cocaine
users who enter treatment
are black.
A. True
B. False True
False
44%
56%
Forms of Cocaine
 Processing 500 kilograms of coca
leaves yields 1 kilogram of cocaine
 Coca paste
 Cocaine hydrochloride
 Freebase
 Crack or rock
Mechanism of Action
 Cocaine blocks reuptake of dopamine,
serotonin, and norepinephrine
The depressant effects of alcohol
reduce the stimulating effects of
cocaine, making serious side effects
less likely to occur.
A. True
B. False
True
False
100%
0%
Administration/Elimination
 Routes:
◦ Topical, snorting, IV, smoking
 Cocaine is metabolized by
enzymes in the blood and liver
 Cocaine has a half-life of
about one hour
 Major metabolites (detected
by drug screens) have a half-
life of eight hours
Benefits/Concerns
 Anesthetic
properties
 Acute toxicity
 Damage to nasal
septum
 Paranoid
psychosis
 Damage to heart
muscle
 Dependence
 Some withdrawal
 Use during
pregnancy
Amphetamines
 Ancient Chinese used ephedra
 Chemical version in 1932 –
amphetamine
 Used in WWII to fight fatigue
 1960’s
 Tighter control
After Mexico, the largest producer of
methamphetamine is Canada, because
pseudoephedrine is not regulated there.
A. True
B. False
True
False
60%
40%
Pharmacology
 Chemical structure is similar to
catecholamine neurotransmitters
(adrenaline, noradrenaline)
 Methamphetamine and amphetamine
both cross blood brain barrier
 Increases activity of monoamine
neurotransmitters by stimulating their
release (dopamine, norepinephrine,
serotonin)
Absorption/Elimination
 Peak effects
◦ 1.5 hours oral
◦ 5-20 min snorting
◦ 5-10 min smoking
 Half-life is 5-12 hours
 Rapid tolerance
Boys are more than twice as likely as
girls to be identified with ADHD.
A. True
B. False
True
False
19%
81%
Benefits
 Depression
 Weight control
 Narcolepsy
 ADD/ADHD
 Concentration
 Athletics
ADHD is limited to teenagers and
children. Very few adults have this
disorder.
A. True
B. False
True
False
84%
16%
Risks
 Acute behavioral
toxicity
 High doses may
destroy
catecholamine
neurons
 Contaminants
 Paranoid psychosis
 No withdrawal
 Powerful
psychological
dependence
Methamphetamine
Ritalin, Adderall
 Most commonly
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
Videos
 Caffeine
Humor
◦ http://www.y
outube.com/
watch?v=Tq
FRP5lXTmE
Do you think of Caffeine as a
Drug?
A. Yes
B. No
C. Not sure
Yes
No
Notsure
54%
15%
31%
Why or why not?
Caffeine
 Sources of caffeine
 Coffee
 Tea
 Soda
 Chocolate
 Energy drinks
 Over-the-counter medications
 NoDoz
 Vivarin
 Anacin
 Excedrin
 Midol
 Diurex
What do you consider an
acceptable level of caffeine
intake?
A. None
B. One beverage a
day
C. 2-5 beverages a
day
D. Any level is ok
NoneOne
beverage
a
day2-5
beveragesa
day
Anylevelisok
0% 0%0%0%
Pharmacology
 Peak blood levels reached 30 minutes
after oral intake
 Half-life is about 3 hours
 Low-grade tolerance does develop
Mechanism of Action
 200 mg
◦ Increased arousal
◦ Mood-elevating effects
 500 mg
◦ Increased heart rate & respiration
◦ Paradoxical effect on blood vessels: dilation
◦ Constriction of blood vessels in the brain =
headache relief
◦ Increased basal metabolic rate (10%) in chronic
users
 Works on the neurotransmitter adenosine
(inhibitory)
◦ Blocks receptors
Effects
 Behavioral
◦ Stimulation
◦ Headache
◦ Hyperactivity
◦ Does not sober one up
 Concerns
◦ Panic attacks
◦ 1980s thought to have a link
to cancer, since disproven
◦ Reproduction
◦ Heart disease (large
amounts)
◦ Caffeinism
Should there be an age limit on
caffeine consumption?
A. Yes
B. No
Yes
No
0%0%
Considerations
 What age?
◦ Infants
◦ Toddlers
◦ School age
◦ Teenage
 What products?
◦ Energy drinks
◦ Soda
◦ Coffee
◦ Tea/iced tea
◦ Hot chocolate
◦ Chocolate
Videos
 Your brain on coffee
◦ http://www.youtube.com/watch?v=hbuCm
O8Bwhs&noredirect=1
◦ http://www.youtube.com/watch?v=gfntvR
Gwpvs
 Children and Caffeine
◦ http://guardianlv.com/2014/02/caffeine-is-
a-drug-for-kids-video/
Wrap-up
 How much
caffeine do
you
consume?
 1981 FDA:
limit of 6 mg
of caffeine
per ounce
◦ No labeling
required
Item Amount of Item Amount of Caffeine
Jolt soft drink 12 ounces 71.2 mg
Mountain Dew 12 ounces 55.0 mg
Coca-Cola 12 ounces 34.0 mg
Diet Coke 12 ounces 45.0 mg
Pepsi 12 ounces 38.0 mg
7-Up 12 ounces 0 mg
Brewed coffee
(drip method)
5 ounces 115 mg
Espresso 1 shot 64 mg
Tea 5 ounces 40 mg
Iced tea 12 ounces 70 mg
Dark chocolate 1 ounce 20 mg
Milk chocolate 1 ounce 6 mg
Cocoa beverage 5 ounces 4 mg
Chocolate milk beverage 8 ounces 5 mg
Cold relief medication 1 tablet 30 mg
Midol 1 tablet 32 mg
Excedrin 1 tablet 65 mg
Monster Energy Drink 16 ounces 160 mg
Red Bull 8 ounces 60 mg
Under what circumstances should a person
consider reducing caffeine intake?
A. When they are
cranky without it
B. When they have
health
complications
C. When they obsess
about it
D. Can’t think of a
time I’d give it up!
W
hen
theyare
cranky
w
...
W
hen
theyhavehealth
...
W
hen
theyobsessaboutit
Can’tthinkofa
tim
e
I’d
g...
0% 0%0%0%

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SOC 204 Goldberg Ch 11

  • 1. SOC 204 Drugs & Society Chapter 11 Stimulants Goldberg
  • 2. Do you agree with the use of medication for ADD/ADHD? A. Yes B. No C. I’m not sure Yes No I’m notsure 0% 0%0%
  • 3. Questions for Discussion 6  List three benefits or risks of using stimulant medication to treat ADD/ADHD  Do the benefits or risks change when prescribing to children?  Back up your points with research
  • 4. Historically, cocaine was used as a local anesthetic. A. True B. False True False 19% 81%
  • 5. Stimulants  Modify (stimulate) a person’s ◦ Activity level ◦ Mood ◦ Central nervous system  Increased heart rate  Increased respiration  Increased blood pressure  Dilated pupils https://ww w.youtube. com/watch ?v=R3GYI -Kpf5M
  • 6. History of Cocaine  Bush that grows in the Andes  Natives chewed the leaves for endurance
  • 7.  Cocoa wine  Coca-Cola  Patent medicines
  • 8.
  • 9. Cocaine accounts for more ER visits than any other illegal drug. A. True B. False True False 40% 60%
  • 10. History  Local anesthesia: Dr. W. S. Halsted  Early psychiatric uses: Sigmund Freud  Used to alleviate fatigue, depression, opiate addiction  Later opposed this use
  • 11. Legal Control  46 states passed laws to regulate cocaine between 1887 and 1914  Negative publicity about cocaine influenced the passage of the 1914 Harrison Act  Anti-Drug Abuse Acts of 1986 and 1988
  • 12. The majority of powder cocaine users who enter treatment are white, and the majority of crack cocaine users who enter treatment are black. A. True B. False True False 44% 56%
  • 13. Forms of Cocaine  Processing 500 kilograms of coca leaves yields 1 kilogram of cocaine
  • 14.  Coca paste  Cocaine hydrochloride  Freebase  Crack or rock
  • 15.
  • 16. Mechanism of Action  Cocaine blocks reuptake of dopamine, serotonin, and norepinephrine
  • 17. The depressant effects of alcohol reduce the stimulating effects of cocaine, making serious side effects less likely to occur. A. True B. False True False 100% 0%
  • 18. Administration/Elimination  Routes: ◦ Topical, snorting, IV, smoking  Cocaine is metabolized by enzymes in the blood and liver  Cocaine has a half-life of about one hour  Major metabolites (detected by drug screens) have a half- life of eight hours
  • 19. Benefits/Concerns  Anesthetic properties  Acute toxicity  Damage to nasal septum  Paranoid psychosis  Damage to heart muscle  Dependence  Some withdrawal  Use during pregnancy
  • 20. Amphetamines  Ancient Chinese used ephedra  Chemical version in 1932 – amphetamine  Used in WWII to fight fatigue  1960’s  Tighter control
  • 21.
  • 22. After Mexico, the largest producer of methamphetamine is Canada, because pseudoephedrine is not regulated there. A. True B. False True False 60% 40%
  • 23. Pharmacology  Chemical structure is similar to catecholamine neurotransmitters (adrenaline, noradrenaline)  Methamphetamine and amphetamine both cross blood brain barrier  Increases activity of monoamine neurotransmitters by stimulating their release (dopamine, norepinephrine, serotonin)
  • 24. Absorption/Elimination  Peak effects ◦ 1.5 hours oral ◦ 5-20 min snorting ◦ 5-10 min smoking  Half-life is 5-12 hours  Rapid tolerance
  • 25. Boys are more than twice as likely as girls to be identified with ADHD. A. True B. False True False 19% 81%
  • 26. Benefits  Depression  Weight control  Narcolepsy  ADD/ADHD  Concentration  Athletics
  • 27. ADHD is limited to teenagers and children. Very few adults have this disorder. A. True B. False True False 84% 16%
  • 28. Risks  Acute behavioral toxicity  High doses may destroy catecholamine neurons  Contaminants  Paranoid psychosis  No withdrawal  Powerful psychological dependence
  • 30. Ritalin, Adderall  Most commonly 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
  • 32. Do you think of Caffeine as a Drug? A. Yes B. No C. Not sure Yes No Notsure 54% 15% 31% Why or why not?
  • 33. Caffeine  Sources of caffeine  Coffee  Tea  Soda  Chocolate  Energy drinks  Over-the-counter medications  NoDoz  Vivarin  Anacin  Excedrin  Midol  Diurex
  • 34. What do you consider an acceptable level of caffeine intake? A. None B. One beverage a day C. 2-5 beverages a day D. Any level is ok NoneOne beverage a day2-5 beveragesa day Anylevelisok 0% 0%0%0%
  • 35. Pharmacology  Peak blood levels reached 30 minutes after oral intake  Half-life is about 3 hours  Low-grade tolerance does develop
  • 36. Mechanism of Action  200 mg ◦ Increased arousal ◦ Mood-elevating effects  500 mg ◦ Increased heart rate & respiration ◦ Paradoxical effect on blood vessels: dilation ◦ Constriction of blood vessels in the brain = headache relief ◦ Increased basal metabolic rate (10%) in chronic users  Works on the neurotransmitter adenosine (inhibitory) ◦ Blocks receptors
  • 37. Effects  Behavioral ◦ Stimulation ◦ Headache ◦ Hyperactivity ◦ Does not sober one up  Concerns ◦ Panic attacks ◦ 1980s thought to have a link to cancer, since disproven ◦ Reproduction ◦ Heart disease (large amounts) ◦ Caffeinism
  • 38. Should there be an age limit on caffeine consumption? A. Yes B. No Yes No 0%0%
  • 39. Considerations  What age? ◦ Infants ◦ Toddlers ◦ School age ◦ Teenage  What products? ◦ Energy drinks ◦ Soda ◦ Coffee ◦ Tea/iced tea ◦ Hot chocolate ◦ Chocolate
  • 40. Videos  Your brain on coffee ◦ http://www.youtube.com/watch?v=hbuCm O8Bwhs&noredirect=1 ◦ http://www.youtube.com/watch?v=gfntvR Gwpvs  Children and Caffeine ◦ http://guardianlv.com/2014/02/caffeine-is- a-drug-for-kids-video/
  • 41. Wrap-up  How much caffeine do you consume?  1981 FDA: limit of 6 mg of caffeine per ounce ◦ No labeling required Item Amount of Item Amount of Caffeine Jolt soft drink 12 ounces 71.2 mg Mountain Dew 12 ounces 55.0 mg Coca-Cola 12 ounces 34.0 mg Diet Coke 12 ounces 45.0 mg Pepsi 12 ounces 38.0 mg 7-Up 12 ounces 0 mg Brewed coffee (drip method) 5 ounces 115 mg Espresso 1 shot 64 mg Tea 5 ounces 40 mg Iced tea 12 ounces 70 mg Dark chocolate 1 ounce 20 mg Milk chocolate 1 ounce 6 mg Cocoa beverage 5 ounces 4 mg Chocolate milk beverage 8 ounces 5 mg Cold relief medication 1 tablet 30 mg Midol 1 tablet 32 mg Excedrin 1 tablet 65 mg Monster Energy Drink 16 ounces 160 mg Red Bull 8 ounces 60 mg
  • 42. Under what circumstances should a person consider reducing caffeine intake? A. When they are cranky without it B. When they have health complications C. When they obsess about it D. Can’t think of a time I’d give it up! W hen theyare cranky w ... W hen theyhavehealth ... W hen theyobsessaboutit Can’tthinkofa tim e I’d g... 0% 0%0%0%

Editor's Notes

  1. 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
  2. Coca is a bush that grows in the Andes and produces cocaine Coca has been harvested for thousands of years and actively cultivated for over 800 years Natives of the Andes chewed coca leaves to give them greater strength and endurance The coca leaf was an important part of Inca culture Used in religious ceremonies and as currency 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 Bolivia and Peru account for a small percentage of cocaine production
  3. Coca wine: Angelo Mariani Used coca leaf extract in many products including lozenges, tea, and, especially, wine Coca extract was later used in the United States in early versions of Coca-Cola and in many patent medicines
  4. 1800s
  5. 420,000 in 2009 Powder cocaine accounts for three times as many ER visits
  6. Local anesthesia: Dr. W. S. Halsted Experimented with ability of cocaine to produce local anesthesia Delivered via newly developed hypodermic syringe Cocaine was isolated before 1860 Processing 500 kilograms of coca leaves yields 1 kilogram of cocaine Early psychiatric uses: Sigmund Freud Studied use of cocaine as a treatment for depression and morphine dependence Later opposed use of the drug after nursing a friend through cocaine psychosis 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
  7. 46 states passed laws to regulate cocaine between 1887 and 1914 Press and politicians made unsubstantiated claims about cocaine use among southern blacks: Widespread Associated with increased violent crime Negative publicity about cocaine influenced the passage of the 1914 Harrison Act Cocaine use began to increase again at the end of the 1960s Prior to 1985, the major form of the drug available was cocaine hydrochloride, which was snorted Cocaine was relatively expensive and its use was associated with status, wealth, and fame Then an inexpensive ($5 to $10 a hit) form of smokable cocaine became available—crack Smoked cocaine has a greater abuse potential than snorted cocaine Media and politicians focused on crack use among urban blacks Associated with violence and dependency Anti-Drug Abuse Acts of 1986 and 1988 Penalties for sale of crack cocaine significantly more severe than penalties associated with powder cocaine Tougher penalties for first-time users of crack Concerns about federal cocaine sentencing policy Does it overstate the seriousness of most crack cocaine offenses? Does it disproportionately affect the black community?
  8. True but not by much. 48% of powder cocaine users are white, 53% of crack users are black
  9. Coca paste Crude extract created during the manufacture of cocaine Can be mixed with tobacco and smoked Cocaine hydrochloride Most common form of pure cocaine Stable water-soluble salt Freebase Prepared as a chemical base Can be heated and the vapors inhaled Crack or rock Lumps of dried, smokable cocaine Prepared by mixing cocaine with water and baking soda
  10. Coca paste Crude extract created during the manufacture of cocaine Can be mixed with tobacco and smoked Cocaine hydrochloride Most common form of pure cocaine Stable water-soluble salt Freebase Prepared as a chemical base Can be heated and the vapors inhaled Crack or rock Lumps of dried, smokable cocaine Prepared by mixing cocaine with water and baking soda Readily available in all major U.S. cities Street cocaine averages about 50-75 percent pure Most illicit cocaine comes from Peru, Bolivia, and Columbia 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 areaCrack 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 Many addicts exchange sex for crack Rates of AIDS are high 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
  11. Chemical structure does not tell us how or why cocaine affects the brain Cocaine blocks reuptake of dopamine, serotonin, and norepinephrine Physical effects 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 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 Talkativeness Mood swings Hallucinations Repetitive behaviors Extreme depression Neglect of personal hygiene Rage and violent behavior Delusions Distorted perceptions Depersonalization Suicidal ideation Paranoia
  12. Chewing or sucking coca leaves Slow absorption and onset of effects “Snorting” through nasal mucous membranes Rapid absorption and onset of effects Injected intravenously Rapid and brief effects Smoked Rapid and brief effects Cocaine is metabolized by enzymes in the blood and liver Cocaine has a half-life of about one hour Major metabolites (detected by drug screens) have a half-life of eight hours 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 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
  13. ACUTE: Local anesthetic properties of cocaine were discovered in 1860, but the drug was not used medically until 1884 Synthesized drugs have largely replaced cocaine for medical use Cocaine remains in use for surgery in the nasal, laryngeal, and esophageal regions Acute cocaine toxicity causes profound CNS stimulation, which can lead to respiratory or cardiac arrest Significant individual variation in the uptake and metabolism of cocaine Difficult to estimate the size of a lethal dose Rare, severe, and unpredictable reactions can cause cardiac failure Cocaine combined with alcohol can cause the formation of the toxic chemical cocaethylene CHRONIC: Risks of regularly snorting cocaine Damage to the nasal septum Paranoid psychosis Damage to the heart muscle Dependence occurs in some users Animal and human studies have shown that cocaine is a powerfully reinforcing drug Some people experience withdrawal symptoms Cocaine use during pregnancy Increased risk of miscarriage and torn placenta Long-term effects of prenatal cocaine exposure still under study 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 WITHDRAWAL 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 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 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 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 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
  14. The Chinese used a medicinal tea made from ma huang (Ephedra) Active ingredient = ephedrine Ephedrine is a sympathomimetic drug Stimulates the sympathetic branch of the autonomic nervous system New synthesized chemical similar to ephedrine, called amphetamine, was patented in 1932 Amphetamine was used medically Asthma Narcolepsy Hyperactivity in children Appetite suppressant Stimulant Use by soldiers in World War II to fight fatigue 1960s Amphetamine + heroin injected together = speedball Most street amphetamines came from prescriptions “Speed scene” = a time and place in which people used and became dependent on intravenous amphetamine Amphetamines became more tightly controlled Many look-alikes appeared Some users switched back to cocaine Illicit manufacture of methamphetamine grew Limited amphetamine availability increased the number of illicit laboratories making methamphetamine Manufacture of methamphetamine is dangerous and associated with toxic fumes and residue Methamphetamine hydrochloride crystals Ice or crystal meth Smokable Methamphetamine abuse began in the western United States and then spread east; it is also now considered a “club drug” 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 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
  15. Countries in SE Asia are the second largest producers. Canada contributes very little.
  16. Chemical structure of amphetamine is similar to the catecholamine neurotransmitters The structure of methamphetamine allows it to more easily cross the blood-brain barrier Ephedrine and PPA are less able to cross the barrier and so produce more peripheral than central nervous system effects Causes increased activity of monoamine neurotransmitters (dopamine, norepinephrine, serotonin) by stimulating their release 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 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: They are excreted through urine after being transformed by liver enzymes They are deactivated and removed by adding molecules to the amphetamine compound
  17. Peak effects 1.5 hours after oral ingestion 5-20 minutes after intranasal administration 5-10 minutes following intravenous injection or smoking Half-life 5-12 hours Rapid tolerance (tachyphylaxis) can occur after high doses
  18. For every 4 girls with ADHD, 10 boys are diagnosed.
  19. Previous use for depression to temporarily elevate mood Adjunctive therapy- a treatment used together with primary treatment. The benefit of amphetamines is that their effects occur rapidly compared with standard antidepressant medications. Weight control Widely use to reduce food intake and body weight Effect is real but small Combination of fenfluramine and phentermine was associated with heart valve damage and lung disease in some people Narcolepsy (uncontrolled daytime episodes of muscular weakness and falling asleep) Stimulants used to keep patients awake during the day Newer drug modafinil (Provigil) promotes wakefulness by increasing the activity of norepinephrine and dopamine Low abuse potential Doesn’t induce tolerance Treatment of attention-deficit hyperactivity disorder (ADHD) Characterized by problems with inattention, hyperactivity, and impulsivity Stimulant medications can reverse catecholamine-associated deficits that may underlie ADHD Due to side effects and concerns about the risk of abuse, other treatments for ADHD are being studied “Smart pills” At a low level of arousal, may improve performance At a high level of arousal, may decrease performance, especially on complex or difficult tasks that require concentration Athletics Under some circumstances, may produce slight improvements in athletic performance
  20. Acute behavioral toxicity Increases in feelings of power, suspicion, paranoia Potential risk of violent behavior Very high doses may destroy catecholamine neurons Contaminants formed during the manufacture of illicit methamphetamine may have toxic effects on brain cells Paranoid psychosis Two possible reasons for the psychosis Heavy methamphetamine users have schizoid personalities. Caused by sleep deprivation. Higher risk among those who inject the drug Often no obvious withdrawal symptoms Produce psychological dependence Capable of producing dependence as defined by DSM criteria A potent reinforcer Physical 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 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 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
  21. The Chemical Difference amphetamine/methamphetamine The main difference between amphetamine and methamphetamine involves a bit of chemistry. The easiest way to explain this is as follows. Both drugs are stimulants of the central nervous system. However, amphetamine is chemically phenylethylamine, while methamphetamine is referred to as N-methylamphetamine. These drugs are processed differently in the user's body due to the chemical makeup is different. Methamphetamine breaks down into amphetamine when it is metabolized. This means that the meth turns into amphetamine in the user's body and is excreted as amphetamine. Methamphetamine is a derivative of amphetamine. It was developed in the 1950's and was prescribed to people with depression, alcoholism, Parkinson's, and obesity. The public caught onto methamphetamine rather quickly and began to use it to stay alert and/or lose weight. Eventually it began to be heavily used by people, especially those working in the trucking industry. In 2000, a study was done and approximately 5% of people in the USA had used methamphetamines or were still using; this number is thought to be much greater. 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 Speed Ice Crystal Meth Chicken powder Go-fast Glass Crank Christy Crystal-meth Chalk Peanut butter-crank Shabu-shabu Zip 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 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
  22. 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
  23. Most widely used psychoactive drug Some people regularly consume much more Can cause dependence and interfere with functioning Belongs to a class of chemicals known as xanthines Three plants containing xanthines have been used by humans for thousands of years: Coffee—from the Middle East Tea—first grown in China Cacao—from the Americas All three played important cultural and economic roles Coffee originated in Ethiopia Legend of its discovery by an Ethiopian goat herder, Kaldi, who noticed unusually boisterous activity in his goats after they consumed the berries The practice then spread to Egypt and other Arabic countries by the 1400s, throughout the middle east by the 1500s and into Europe in the 1600s. Coffeehouses spread: a location to relax, learn the news of the day, seal bargains, and listen and learn from literary and political figures England 1674: “The Women’s Petition Against Coffee” argued against the use of coffee on the grounds that it made men impotent Coffee consumption in the United States Use increased following taxation of tea and the American Revolution Use also increased during and after Prohibition Per capita U.S. coffee consumption Peaked in 1946 Declined as soft drink consumption increased Current = about 25 gallons of coffee per year Originally: people chewed on coffee beans or put raw beans in hot water Roasting improves the flavor, aroma, and color of the drink made from the beans Coffeehouses and individuals originally roasted and ground their own beans 1790: Commercial roasting 1900: Vacuum packing for long-term storage of ground coffee Introduced into the East Indies and then Latin America About half of American coffee comes from Latin America, the rest from Vietnam, Indonesia, and Thailand Over $5 billion was imported to the US in 2008 Variations in coffee characteristics Different varieties of the coffee shrubs caffea arabica- milder flavor, take longer to develop after planting and require a near tropical climate to grow. caffea robusta- stronger and more bitter flavor and a higher caffine content, used in less expensive blends and to make instant coffee. Different growing and processing conditions Decaffeinated coffee Soaking unroasted beans in an organic solvent removes the caffeine Alternative Swiss water process not widely used It removes more of the coffee’s flavor Caffeine removed from coffee is used in the manufacture of soft drinks The caffeine content of coffee depends on how it is prepared Type Average caffeine content Brewed, drip (5 oz) 115 Brewed, percolator (5 oz) 80 Instant (5 oz) 65 Decaffeinated, brewed (5 oz) 3 Decaffeinated, instant (5 oz) 2 Tea (Camellia sinensis) originated in China Legend of its creation by Daruma, the founder of Zen Buddhism, who cut off his eyelids to remain awake while meditating A new plant grew from the spot where his eyelids touched the earth, with leaves that made a brew that would keep a person awake AD 350: Chinese manuscript describes many medicinal uses AD 780: Nonmedical cultivation and use of tea 1610: Dutch delivered tea to Europe English East India Company Concentrated on importing spices, so the first tea was taken to England by the Dutch. As demand grew, the company expanded its imports from China. Most tea sold in coffeehouses In Britain, major marketing campaigns promoted the switch from coffee to tea After the American Revolution, to be a tea drinker was to be loyal to the Crown Tea and the American Revolution American colonists were big tea drinkers Anger over a tax on tea that they had not helped formulate “Taxation without representation” Legal tea sales dropped due to a boycott Illegal smuggling of tea increased Tea and the American Revolution A special arrangement was made for the English East India Company, angering American merchants The result was “The Boston Tea Party” of 1773 Annual per capita tea consumption 4.5 pounds in the United Kingdom 1/2 pound in the United States Tea starts its life on a four- to five-foot bush high in the mountains of China, Sri Lanka, India or Indonesia. Bushes are regularly pruned to aid in harvesting new growth Tea leaves are picked by hand, about every 6 to 10 days Preparation: tea leaves are Dried Rolled to crush the cells in the leaves Placed in a cool, damp place for fermentation (oxidation) Black tea is fully oxidized leaves Green tea is nonoxidized leaves Oolong tea is greenish-brown and consists of partially oxidized leaves Iced tea accounts for 75 percent of all tea consumed in the U.S. Flavored teas are mixtures of tea and mint, spices, or other flavors Herbal teas contain a mix of plant leaves and flowers but no actual tea (see right) Caffeine Pound for pound, tea has more caffeine than coffee BUT 1 pound of tea leaves = 200 cups of tea 1 pound of coffee = 50 to 60 cups of coffee Tea has about 40 to 60 mg of caffeine per cup depending on the type and strength of the brew Theophylline Tea contains a very small amount of theophylline In high doses, theophylline is used as an asthma medication Chocolate originated in Mesoamerica Legend: Cacao tree was a gift to humans from paradise from the Aztec god Quetzalcoatl Linnaeus named the cacao tree Theobroma, meaning “food of the gods” Aztecs cultivated cacao widely, and the cacao bean was an important part of their economy and culture Chocolatl—from the Mayan words choc (“warm”) and latl (“beverage”)—was a thick, bitter liquid flavored with vanilla Cortez introduced chocolate into Europe Chocolate drinking spread slowly Chocolate was often sold alongside coffee and tea in established coffeehouses Prior to 1828, the traditional Aztec process was still used Cacao pods were dried in the sun, then roasted to remove the husk Kernels were ground to obtain a thick liquid (baking chocolate) 1828: Dutch patent issued for a process that removes about two-thirds of the fat (cocoa butter) and produces a powder 1876: Milk chocolate introduced by the Swiss Theobromine Chocolate contains the unique xanthine theobromine It acts in a parallel fashion to caffeine, but it is much less potent in its CNS effects Caffeine An average cup of cocoa contains about 4 mg of caffeine Soft Drinks: Coca-Cola Developed as a nerve tonic in the late 1800s; ingredients included: Caramel Fruit flavoring Phosphoric acid Caffeine A secret mixture called Merchandise No. 5 Named for two flavoring agents: coca leaves and cola (kola) nuts Up until 1906, the beverage did contain a small amount of cocaine Other soft drinks All types of soft drinks are popular U.S. per capita soft drink consumption is about 50 gallons per year Energy drinks Over-the-counter medications 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-Caffeine energy drinks 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 DECAF 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)
  24. Three key xanthines Caffeine Theophylline Theobromine Time course Rapid absorption if taken orally Peak levels reached in 30 minutes Half-life is about 3 hours Dependence Reinforcing properties Withdrawal symptoms include headache and fatigue Mechanism of action Xanthines block inhibitory receptors for adenosine, thereby having a stimulant effect Physiological effects Stimulates the CNS and skeletal muscles Causes sleep disturbances Elevates mood Constricts blood vessels in the brain May explain the ability of caffeine to reduce migraine headaches Stimulation Caffeine partially offsets the effects of fatigue on both mental and physical tasks, but it may not improve performance in well-rested individuals High caffeine consumption among college students is associated with lower academic performance Headache treatment: Helps relieve both migraine and nonmigraine headaches Hyperactivity treatment: High doses may decrease hyperactivity Sobering up? Caffeine does not lower blood alcohol concentration and will not help a person sober up 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 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 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
  25. Mechanism of action Xanthines block inhibitory receptors for adenosine, thereby having a stimulant effect Physiological effects Stimulates the CNS and skeletal muscles Causes sleep disturbances Elevates mood Constricts blood vessels in the brain May explain the ability of caffeine to reduce migraine headaches Stimulation Caffeine partially offsets the effects of fatigue on both mental and physical tasks, but it may not improve performance in well-rested individuals High caffeine consumption among college students is associated with lower academic performance Headache treatment: Helps relieve both migraine and nonmigraine headaches Hyperactivity treatment: High doses may decrease hyperactivity Sobering up? Caffeine does not lower blood alcohol concentration and will not help a person sober up
  26. There is no clear evidence that moderate caffeine consumption is dangerous Cancer: Caffeine is not a risk factor in human cancer Reproductive effects: High consumption of caffeine reduces a woman’s chances of becoming pregnant and slows the growth of the fetus Research is mixed on whether caffeine increases the risk of miscarriage Heart disease: High intake of caffeine may increase the risk of heart attack, particularly in people with other risk factors Caffeinism (excessive use of caffeine) Toxicity is relatively low It would require about 100 cups of coffee to receive a fatal dose from oral caffeine Unpleasant symptoms do occur: Nervousness Irritability Tremors Muscle twitching Insomnia Flushed appearance Elevated temperature Palpitations Heart arrhythmias Gastrointestinal disturbances 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 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 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