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Uppers Downers & All Arounders

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1 Uppers Downers & All Arounders
Uppers/Stimulants Chapter 3

2 Uppers/Stimulants In 1999 about
1.7 million Americans used amphetamines for nonmedical reasons, 4.2 million used cocaine, 68 million smoked cigarettes, 200 million drank coffee, tea, caffeinated soft drinks or an over-the-counter medication containing caffeine. (p. 83).

3 General Classification
Most people use stimulants in the form of: Diet aids Drugs to control hyperactivity Coffee & Tea Cigarettes Caffeinated solf drinks Stimulants are found in plants and in synthetic form

4 General Effects Stimulants force the release of the energy chemicals (epinephrine and norepinephrine along with dopamine and serotonin) Infuses the body with large amounts of extra energy before the body needs it With heavy use the body’s energy supply is depleted leading to crash, withdrawal and depression Crash and withdrawal occurs when energy supplies become depleted and body is left without reserves

5 General Effects All Stimulants activate chemical and electrical activity in central nervous system Increases Heart rate Blood pressure Respiration Effects include Activeness Restlessness Medical uses include treatment of obesity, narcolepsy and Attention-deficit/hyperactivity Disorder

6 General Effects Reward/reinforcement center is artificially over-stimulated Rush of pleasure and strong sense of wellbeing Often accompanied by no basic need for hunger, thirst or sex Weight loss: stimulants fool the body into thinking it has satisfied hunger without eating Cardiovascular side effects include constricted blood vessels, high blood pressure and sometimes arrhythmia Chronic use weakens blood vessels and risk of stroke

7 General Effects Emotional & mental effects:
Initial release causes increase of confidence and euphoria As use continues feeling of euphoria turn to irritability, paranoia, aggressiveness, depression Tolerance & Addiction liability Increases as body loses its ability to synthesize drugs Can also develop with methamphetamine congeners, caffeine, nicotine and other mild stimulants

8 COCAINE Cocaine epidemics seem to occur every few generations
Hardcore use still strong in 2000’s Cocaine is extracted from coca plant 97% grown in South America Colombian drug Cartels control cultivation and production 2/3 of smuggling handled by drug artels in Mexico U.S. consumes 70% of world’s cocaine trade

9 COCAINE: Routes of Administration
Chewing Leaf: Historically Native cultures Drinking: Started in 1880’s in wine, coca cola, and patent medicine. Widely prescribed to womem Injecting: Started after the invention of hypodermic needle in 1853 Intravenous use takes seconds Subcutaneous/intramuscular takes 3-5 minutes Snorting: Self-limiting method The more snorted, the less absorption due to constriction of capillaries in the nose Destructive to nasal passages

10 COCAINE: Routes of Administration
Mucosal & contact absorption Can be absorbed through mucosal tissue in nose, mouth, rectum & vagina Delivery method is also used for dental work, minor surgeries Smoking: First introduced in 1914, but high temperature was needed to keep cocaine cigarettes going Mid-1970’s, cocaine hydrochloride was chemically altered into freebase Fastest form to reach brain… Highly addictive

11 COCAINE: Physical and Mental Effects
Metabolism: Quickly metabolized and disappears faster than methamphetamine Medical Use: Only naturally occurring local anesthetic Used to numb nasal passages, eyes, throat, and chronic sores Neurochemistry & Central Nervous System Forces relase of norepinephrine, epinephrine and dopamine Blocks re-absorption so more intense stimulation Blocks 60-70% of dopamine reuptake Too much dopamine can over stimulate brain’s fright center causing paranoia. Excessive use causes insomnia, agitation and severe depression

12 COCAINE: Physical and Mental Effects
Sexual Effects: At low doses cocaine increases desire for sex and delay ejaculation As use continues sexual dysfunction occurs Aggression, violence & cocaethylene Increases aggression & violence by disrupting inhibitory and fright centers of the brain Cocathylene (metabolite when cocaine & alcohol is combined) induces greater agitation, euphoria and violence Can also induce cardiac conduction abnormalities

13 COCAINE: Physical and Mental Effects
Cardiovascular Effects Can damage circulatory system Raise blood pressure Cause stroke (bursting of blood vessels in brain) Cause heart damage Neonatal Effects: Transmitted within seconds to fetus Increases chances for miscarriage, stroke, SIDS, respiratory ailments, mental delays & other abnormalities Proper pre-natal and post natal treatment can hel cocaine babies

14 COCAINE: Physical and Mental Effects
Tolerance: To the euphoric effect can begin to develop after first injection or smoking session Withdrawal, Craving & relapse: Major effects include anhedonia, lack of energy and intense craving Typical cycle of compulsive use: Bingeing to crashing to detox to resolutions of abstinence or treatment and relapsing 2-4 weeks later.

15 COCAINE: Physical and Mental Effects
Overdose: Can be caused by as little as 1/50 gram Overwhelmingly intense stimulation Injury to heart and blood vessels More often not fatal…just feels that way Severe reaction through in verse tolerance or kindling Miscellaneous Effects: Formication (itching from imaginary bugs) Dental erosion Seizures Gastrointestinal complications Cocaine Psychosis: Paranoid psychosis/schizophrenia caused by excess dopamine Can also activate genetic predisposition to schizophrenia

16 COCAINE: Other Problems with Use
Polydrug Use Alcohol, valium, heroin to take the edge off Adulteration & Contamination Cocaine at street level is almost always cut When injected, bacteria and viruses contaminate drugs and needles Hepatitis C rate for IV drug users is between 50% and 90% Compulsion Use for euphoria, boredom, peer pressure, curiosity, self-medication, escape from personal problems


Pharmacology of smokable Cocaine Began around 1981 Crack epidemic in 1986 Chemically crack is the same as freebase Delivered to the brain faster Ether converts cocaine to freebase Baking soda converts cocaine to crack Effects and Side Effects More intense than snorting or injecting Rush or euphoria last 5 – 20 minutes Replaced by the feeling of irritability and other negative emotions Always used in a binge pattern Chronic use include paranoia, intense cravings, depression, cocaine psychosis, high-risk sexual activity

Respiratory Effects Breathing problems Severe fever Chest pains Coughs Crack lung Hemorrhage Respiratory failure & death Aggravated by cigarette smoking Polydrug use Increases the potential for abuse of depressants

Overdose Mild-rapid heart beat Hyperventilation Fear of dying Kills several thousand a year due to Cardiac arrest Seizure Stroke Respiratory failure Severe hypothermia Consequences of Crack use Economic Social: abuse, family, legal, formation of sex trade Cocaine vs Amphetamines Cocaine’s duration is 40 minutes/ Meth is 4-6 hours Meth is cheaper

21 Amphetamines

22 Amphetamines Classification: “Sympathomimetic agent” History of Use
Stimulate the release of sympathic neurotransmitters Activates the sympathetic nervous system that controls the fight or flight response Stimulates the reward/information center Street names: crank, ice, shabu, glass, clear History of Use First synthesized in 1887 Medically used in 1930s Treats narcolepsy & depression Used by students and truck drivers to stay awake Widely used in pill form during WW II

23 Amphetamines History of Use Japanese epidemic continued after WW II
% of American population used prescribed amphetamines for weight loss Street speed chemists increased production of crank and crystal in late 1980s Ice highly potent smokable form used in 1990’s and common use in Hawaii Recent development of “ya ba” in Thailand

24 Amphetamines (Effects)
Routes of Administration Snorting Intravenous Smoking Oral Neurochemistry Like cocaine, amphetamines increase levels of catecholamines by stimulating their release and blocking reuptake Unlike cocaine, amphetamines block metabolism Long term use alters the ability to produce vital neurotransmitters causing depression and taking mor to stay normal

25 Amphetamines (Effects)
Physical Effects Small to moderate doses cause Increased heart rate Raised body temperature Rapid respiration Higher blood pressure Extra energy Dilation of bronchial vessels Appetite suppression Meth users go on binges for 3, 4 or 10 days Long term use can cause sleep deprivation Heart & blood toxicity Severe malnutrition Bad or rotten teeth Tolerance is more pronounced

26 Amphetamines (Effects)
Mental & Emotional Effects Mild to intense euphoria / sense of wellbeing Prolong use leads to Irritability Paranoia Anxiety Confusion Poor judgement Hallucinations Delusions Can result in violent, suicidal & homicidal thoughts Antisocial behaviors

27 Amphetamines (Effects)
With abstinence, disturbed mental states such as amphetamine psychosis or depression can stop for some people Amphetamines release neurotransmitter that mimics sexual gratification Effects of Ice is greater on the brain than the respiratory and pulmonary system Results in more overdoses Greater mental side effects Longer detoxification


29 Amphetamine Congeners/Lookalikes
Methylphenidate (Ritalin) Most widely used Prescribed as mood elevator, narcolepsy and to treat Attention-deficit/hyperactivity disorder Diet Pills Only recommended for short-term use Careful monitoring by physician Long-term use associated with abuse Lookalikes Prescription drugs that contain ephedrine and pseudoephedrine (anti-asthmatics) Decongestants Caffeine Ephedra & ephedrine

30 Miscellaneous Plant Stimulants
Khat & methcathione Used in Arab and African countries Produces amphetamine like highs Insomnia, anorexia Chronic abuse cause exhaustion, violence & depression Methcathione: AKA ephedrone is synthesized in illegal labs in U.S. Sold as a powerful alternative to methamphetamine

31 Miscellaneous Plant Stimulants
Betel Nuts (seed of betel palm) Used by 200 million people in Arab world, India and Asia Effects similar to nicotine High doses can be toxic and produce psychological dependence Yohimbine Spicy extract from African yohimbe tree Used in tea Medicine Aphodisiac Produces mild euphoria and occassional hallucinations

32 Miscellaneous Plant Stimulants
Ephedra Ephedra bush Mild stimulant used as medicine, tea & tonic Also used by athletes for energy boost Banned in U.S. because of overdoses This drug and synthetic version is main ingredients in methamphetamine & methcathione Herbal Ecstasy and Herbal Nexus are two herbal products marketed as stimulants and as buffers for illegal drugs Contains herbal forms of ephdrine, caffeine, herbs and vitamines

33 Miscellaneous Plant Stimulants
Caffeine Most popular stimulant in the world Found in teas, coffee, soft drinks, chocolate & hundreds of medications History Tea: drunk in China as early as 2700 B.C. Introduced to Europe in 16th Century Coffee: Cultivated in Ethiopia A.D. 650 and spread to Arabia then Europe Classified as a drug and banned in many cultures Cocoa: Mayan and Aztec royalty Only small amount of caffeine in cocoa

34 Miscellaneous Plant Stimulants
Pharmacology Classified as an akaloid of the chemical class called xanthines Found in more than 60 plants Takes hours for 95% of the caffeine to be excrete by the body Physical and Mental Effects Mild stimulant 5-7 cups of coffee can cause anxiety, insomnia, nervousness Higher doses can cause muscle twitching, increased heart rate, palpatations Letal at about 10 grams (100 cups of coffee)

35 Miscellaneous Plant Stimulants
Tolerance, withdrawal & addiction Dosages vary depending on person Symptom includes throbbing headache Dependence can occur with 5 cups of coffee 10 cola drinks or 8 cups of tea Nicotine Cigarettes account for 90% of all tobacco use in U.S. Discover in American and spread to Europe Smokeless tobacco: moist snuff, powder snuff & loose-leaf Absorbed by mucosal in the mouth and nise


37 Nicotine/Tobacco Pharmacology
Nicotine is the most important ingredient Average cigarette contains 10 mg of nicotine Central Nervous system stimulant that disrupts the balance of neurotransmitters Dopamine Endorphins epinephrine, Acetylcholine Constricts blood vessels Raises heart rate Depresses appetite Produces mild euphoria Deadens senses

38 Nicotine/Tobacco Two most important reasons people smoke tobacco is:
Weight loss Craving One must keep a certain level in blood stream to avoid withdrawal Tolerance develops quickly Withdrawal causes: Headaches Nervousness Fatigue Severe irritability Intense craving Poor concentration Sense of relaxation from smoking a cigarette is actually a withdrawal symptom being subdued

39 Nicotine/Tobacco Addiction Side Effects
Tobacco is pure example of addiction process 80% want to quit & 10% want to cut down May have a genetic predisposition to nicotine addiction Side Effects Tobacco & smoke contain more than 4,000 other chemicals of which 400 are classified as toxic 43 are known as carcinogens

40 Nicotine/Tobacco 1997: 3.5 million premature deaths
In U.S. 392,000 die prematurely 50,000 die of second hand smoke Cardiovascular & Respiratory effects: Plaque formation Hardening of the arteries Leading cause of heart attacks Lung cancer Men who smoke are 22 x’s more chance of cancer Women 12 x’s more chance of cancer

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