Chapter 6 Cocaine, Amphetamines, And Related Stimulants


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Chapter 6 Cocaine, Amphetamines, And Related Stimulants

  1. 1. Cocaine, Amphetamines, and Related Stimulants Chapter 6 Speed Kills !
  2. 2. The Coca Leaf <ul><li>Cocaine comes from the coca bush or coca tree of South America </li></ul><ul><li>Native inhabitants of the region, including the Incas, engaged in the practice of chewing the coca leaf for over 3,000 years </li></ul><ul><li>It had religious significance and was called “Mama Coca” but was also used for medicinal and work-related reasons as well </li></ul><ul><li>A coca leaf contained only a tiny amount of cocaine </li></ul>
  3. 3. Early Use of Cocaine <ul><li>Until the 1800s the coca plant was relatively unknown in Europe </li></ul><ul><li>In the 1850s European chemists isolated the more potent active agent which they called cocaine </li></ul><ul><li>This made it possible to administer the drug by intravenous injection and intranasal absorption (sniffing or snorting), producing even more intense effects </li></ul>
  4. 4. <ul><li>Sigmund Freud helped launch a major period of cocaine abuse </li></ul><ul><li>Freud obtained a sample in 1884 and after taking it only a few times felt he had discovered a miracle drug </li></ul><ul><li>In his publication “On Coca”, he advocated it as a local anesthetic and as a treatment for depression, indigestion, asthma, various neuroses, syphilis, morphine addiction, and alcoholism. He also thought is was an aphrodisiac </li></ul>
  5. 5. <ul><li>Cocaine’s use as a local anesthetic turned out to be the only valid use, which in turn revolutionized surgery </li></ul><ul><li>Related “caine” drugs such as procaine and xylocaine are now used more frequently, yet cocaine is still used for surgery on areas such as the face since it reduces bleeding through the constriction of blood vessels and reduces pain through “numbing” </li></ul>
  6. 6. Cocaine Epidemic of the 1880s <ul><li>Attributed to both cocaine’s accessibility and positive popularization </li></ul><ul><li>Prescribed by physicians and readily available in patent medicines and Coca-Cola </li></ul><ul><li>Arthur Conan Doyle depicted Sherlock Holmes as using cocaine to give him energy and aid in his powers of deductive reasoning </li></ul><ul><li>Thomas Edison, Jules Verne, Czar Nicholas of Russia and President Ulysses Grant provided testimonials to the value of cocaine </li></ul>
  7. 7. <ul><li>Freud’s friend, Ernst von-Fleischl experienced paranoid delusions and formication syndrome </li></ul><ul><li>Formication Syndrome – Symptoms of itching and feeling as if insects were crawling under skin, caused by cocaine and amphetamine </li></ul><ul><li>Dramatic accounts of addiction to cocaine and reports of violent acts committed under the influence of the drug led to a dramatic swing of public opinion, culminating in the control of cocaine under the Harrison Narcotic Act of 1914 </li></ul>
  8. 8. The Amphetamines <ul><li>First synthesized in the late 19 th century, this class of drugs includes amphetamine, dextroamphetamine, and methamphetamine </li></ul><ul><li>First medical application developed in the 1920s </li></ul><ul><li>Used for cold and sinus symptoms (original inhalers contained Benzedrine), obesity, narcolepsy, and attention deficit/hyperactive disorder </li></ul><ul><li>Used by soldiers during WWII for their stimulant properties </li></ul>
  9. 9. <ul><li>After the War amphetamine abuse reached epidemic proportions in other countries but not recognized as dangerous in America until the 1960s </li></ul><ul><li>Became a problem when physicians began to prescribe as a treatment for heroin addiction </li></ul><ul><li>Use of injected amphetamine produced the “speed freak”, an individual who may go for days without sleep, eating very little and administering dose after dose attempting to obtain the “rush” as good as the first </li></ul>
  10. 10. <ul><li>It was soon clear that amphetamine in high doses produced the same formication symptoms (“speed bugs” or “crank bugs”) and paranoid delusions as cocaine, thus the term stimulant psychosis </li></ul><ul><li>Stimulant Psychosis – Paranoid delusions and disorientation resembling the symptoms of paranoid schizophrenia caused by prolonged use or overdose of cocaine and/or amphetamine </li></ul>
  11. 11. <ul><li>The slogan “Speed Kills!”, popular by the late 1960s, did not refer to death by overdose but rather to the development of a paranoid state that often led to acts of violence </li></ul><ul><li>After heavy use, amphetamines and cocaine also produced a severe depression that is now recognized as a common withdrawal symptom. This depression could last for days and often led the user back to drugs </li></ul>
  12. 12. Cocaine Epidemic II <ul><li>As the word spread about the hazards of amphetamine abuse, users searched for other stimulants they thought might be safer </li></ul><ul><li>Due to the expense of the drug, cocaine was being used in low doses intranasally by movie stars, professional athletes, and the upper class who rarely experienced the problems associated with the injection of amphetamines. They did not view cocaine as a dangerous drug </li></ul><ul><li>The contemporary view is that cocaine is very dangerous. What brought about this change ? </li></ul>
  13. 13. <ul><li>Increased availability of cheaper cocaine allowed more people to regularly use the drug in high doses </li></ul><ul><li>Another critical factor was the practice of smoking freebase cocaine or crack </li></ul><ul><li>Freebasing emerged in the late 1970s and crack in 1986 </li></ul><ul><li>Freebasing - Term used to describe the practice of smoking cocaine that does not refer to burning like tobacco, but rather heating the drug until it vaporizes. It is then inhaled </li></ul>
  14. 14. <ul><li>Crack – A freebase cocaine produced by mixing cocaine salt with baking soda and water. The solution is then heated, resulting in brittle sheets of cocaine that are “cracked” into small, smokable chunks or “rocks” </li></ul><ul><li>The name “ crack ” comes from the crackling sound made by the baking soda left in the compound when it is heated </li></ul><ul><li>Because crack was cheaper and produced strong cravings and dependence, a large market for it developed almost overnight </li></ul>
  15. 15. <ul><li>Cocaine continues as one of the nations’ major health problems due to overdose, paranoid emergencies, and the enormous amount of criminal activity generated by its production and distribution </li></ul><ul><li>Organized gangs generally control the cocaine market </li></ul><ul><li>Many drive-by shootings and other acts of urban violence are linked to cocaine </li></ul><ul><li>“ Crack house” – Place where crack is sold and smoked </li></ul>
  16. 16. The Return of Meth <ul><li>Reappeared on West Coast and Hawaii in early 1990s and has gradually moved East </li></ul><ul><li>Concentrations are still highest in the West, Midwest, and parts of the South but some describe the Meth epidemic as a nationwide phenomenon </li></ul><ul><li>Formerly viewed as a “biker” drug and associated with blue-collar white males, now referred to as a “club” drug for young people, particularly college and high school students. </li></ul><ul><li>Treatment admissions are increasing for females and Hispanics </li></ul><ul><li>Method of administration varies by region with smoking the preferred method in the West, snorting in the Midwest, and IV injection most popular in Texas </li></ul><ul><li>Increased penalties for manufacture and trafficking and restricted access to chemicals needed to produce Meth </li></ul>
  17. 17. CONTEMPORARY ISSUE BOX 6.2 Methamphetamine and Health <ul><li>High doses pose a risk of seizures, convulsions, and cardiovascular collapse </li></ul><ul><li>Overdose can produce a stimulant psychosis often associated with violence </li></ul><ul><li>Depression is a common feature of withdrawal </li></ul><ul><li>“ Meth mouth”, or deterioration and loss of teeth, is common among heavy users </li></ul><ul><li>Some studies suggest there may be long-lasting damage to the brain associated with motor and memory impairment that may be irreversible. </li></ul>
  18. 18. Pharmacokinetics of Stimulants <ul><li>One important difference between cocaine and amphetamines is their duration of action </li></ul><ul><li>Cocaine is metabolized rapidly with most of its effects dissipating in 20-80 minutes </li></ul><ul><li>Amphetamines are longer acting with effects that persist 4-12 hours </li></ul><ul><li>Both drugs or their metabolites are detectable in urine for 2-3 days after administration </li></ul>
  19. 19. Mechanism of Stimulant Action <ul><li>Cocaine and amphetamines block reuptake of norepinephrine, serotonin, and particularly dopamine </li></ul><ul><li>Long-term effects of stimulant use involve depletion of these transmitters which research has linked to clinical depression </li></ul><ul><li>Their powerful reinforcing properties stem from their action on dopamine-containing neurons in the mesolimbic dopaminergic pathway, the region of the brain thought to mediate reward (“pleasure center”) </li></ul>
  20. 20. Acute Effects at Low and Moderate Doses <ul><li>Physiological Effects are the same as those seen during emotional arousal and include: </li></ul><ul><ul><li>H eart rate, blood pressure, respiration, and sweating increases </li></ul></ul><ul><ul><li>Blood flow decreases to internal organs and extremities and increases to large muscle groups and the brain </li></ul></ul><ul><ul><li>Body temperature is elevated and pupils are dilated </li></ul></ul><ul><li>Anorectic Effects – Causing one to lose appetite, suppression of eating </li></ul>
  21. 21. <ul><li>Behavioral effects include: </li></ul><ul><ul><li>In moderate doses, a sense of elation and mood elevation </li></ul></ul><ul><ul><li>Increased talkativeness and sociability </li></ul></ul><ul><ul><li>Increased alertness and arousal; marked insomnia often develops </li></ul></ul><ul><ul><li>Performance is enhanced on tasks involving physical endurance </li></ul></ul><ul><ul><li>Increased resistance to fatigue and boredom and thus their common use as a study aid for “all-nighters” </li></ul></ul>
  22. 22. <ul><li>Several problems with this type of stimulant use are: </li></ul><ul><li>State-dependent Learning – Learning under the influence of a drug is best recalled when one is in the same drug-induced state. Thus a person who learns the information while “high” will have difficulty retrieving the information when they are sober or straight </li></ul><ul><li>Example: Alcoholic airline pilot who had to attend flight school again when he got sober </li></ul>
  23. 23. <ul><li>Experimental evidence shows that stimulants may impair one’s ability to learn complex tasks and may impair performance in complex reasoning. The notion that cocaine enhances intellectual performance is a myth </li></ul><ul><li>Also a myth is the idea that cocaine and amphetamines enhance sexual prowess as surveys suggest that while some report enhanced sexual feelings and performance, most people do not. In fact, many men report impotence and women report a decline in sexual interest </li></ul>
  24. 24. Acute Effects at High Doses <ul><li>Paranoid delusions are the most common symptom of stimulant psychosis </li></ul><ul><li>Another common symptom is compulsive stereotyped behavior like rocking, hair pulling, chain smoking, or “fiddling with things” </li></ul><ul><li>Hallucinations and formication </li></ul><ul><li>Convulsions or seizures that may result in respiratory collapse, myocardial infarction (heart attack) due to coronary artery spasm, and stroke </li></ul>
  25. 25. Effects of Chronic Use <ul><li>Tolerance </li></ul><ul><ul><li>Acute tolerance develops with cocaine and dissipates within 24 hours </li></ul></ul><ul><ul><li>Studies of the development of long-term, protracted tolerance to cocaine and amphetamines have not yielded consistent findings </li></ul></ul><ul><ul><li>Some studies have shown reverse tolerance or sensitization following repeated administration </li></ul></ul>
  26. 26. <ul><li>Dependence </li></ul><ul><ul><li>Users do not show dramatic signs of physical illness upon withdrawing from these drugs </li></ul></ul><ul><ul><li>Primary symptoms are depression, anxiety, changes in appetite, sleeping disturbances, and craving for the drug </li></ul></ul><ul><ul><li>Some go through distinct stages of withdrawal, though variability is considerable </li></ul></ul>
  27. 27. Stages of Withdrawal <ul><li>The “crash” – Several days of intense craving and exhaustion alternating with deep depression </li></ul><ul><li>Withdrawal – Several weeks of intense cravings, moderate to severe depression, and an inability to experience normal pleasure (anhedonia) </li></ul><ul><li>Extinction – Considerable improvement occurs though the addict may continue to experience intermittent cravings for months and even years when exposed to cues associated with cocaine use </li></ul>
  28. 28. Stimulant Drugs and ADHD <ul><li>In 1937 a physician discovered the paradox that hyperactive children (children suffering from attention deficit / hyperactivity disorder, or ADHD) were calmed by amphetamines </li></ul><ul><li>Since then millions of children with ADHD have been treated with stimulant drugs such as Concerta, Ritalin, Adderall, and Cylert </li></ul><ul><li>Estimated over 4% of U.S. school-aged children take Ritalin or some other prescription stimulant drug with even higher estimates of 6-10% for children ages 6-12 years of age </li></ul>
  29. 29. <ul><li>Such drugs improve performance but include side effects for some such as insomnia, loss of appetite, weight loss, and growth delays </li></ul><ul><li>New nonstimulant drugs such as Strattera and Provigil appear to be effective in the treatment of ADHD with fewer problems </li></ul><ul><li>Recent studies suggest that the growth delays previously thought to be managed with “drug holidays” still may occur as mild growth suppression </li></ul>
  30. 30. <ul><li>ADHD is increasingly being diagnosed in adults and an estimated 1.5 million adults between the ages of 20 and 64 in the U.S. are currently prescribed medication for ADHD </li></ul><ul><li>Prescription stimulants are increasingly being diverted and Ritalin is now a popular “club” or “dance” drug </li></ul>
  31. 31. Enough already !