1. Individual Drug Info Winter 2015

2. Similar Properties Across Drugs

3. Differences Forms Availability DEA Schedule Effects ◦ Acute ◦ Chronic ◦ Overdose Photo, originally taken by Thoric, available to use in the public domainThoric

4. CANNABIS - MARIJUANA

5. Cannabis Cannabis sativa Different subspecies/varietals used for clothing vs drug use Active ingredient: THC THC is a cannabinoid Interacts with cannabinoid receptors in brain Many other cannabinoids exist, but not thought to cause psychoactive reactions DEA: Schedule I Despite state regulations, marijuana still federally illegal

6. Medical cannabis (2/26/15), source: procon.org)procon.org) Alaska (98)Maine (99)New Jersey (10) Arizona (10)Maryland (14)New Mexico (07) California (96)Massachusetts (12)New York (14) Colorado (00)Michigan (08)Oregon (98) Connecticut (12)Minnesota (14)Rhode Island (06) Delaware (11)Montana (04)Vermont (04) Hawaii (00)Nevada (00)Washington (98) Illinois (13)New Hampshire (13) Washington, DC (10)

7. Recreational Cannabis

8. Cannabis

9. Alcohol vs Cannabis More research on alcohol Age dependent Amount of alcohol/amount of cannabis Mixing substances Alcohol interferes with neurogenesis of brain cells (Gary L. Wenk, Psychology Today, 2010) (Gary L. Wenk, Psychology Today, 2010) Cannabis: 2014 study showing regular use impacted decision- making and judgment (Published online before print November 10, 2014, doi: 10.1073/pnas.1415297111. PNAS November 10, 2014)

10. Depression and Anxiety Many use marijuana to ease mood Regular use may trigger, or worsen, either condition, especially in younger people 2013 Imperial College study showed lower dopamine levels in regular users, which may lead to more anxietyImperial College Marijuana, conversely, may help those with Post- Traumatic Stress Disorder Memory inhibition CBSNews June 2014 (3:58) CBSNews

11. Chronic effects Respiratory distress Mood swings Impaired memory (potential hippocampus damage) Earlier researchresearch 2011 NIMH/NIDA study ◦ Daily use may reduce brain receptor number ◦ Receptors regenerated with cessation ◦ Society of Nuclear Medicine. "Chronic marijuana smoking affects brain chemistry, molecular imaging shows." ScienceDaily. ScienceDaily, 13 June 2011..

12. Marijuana & Respiratory Function During Exercise Acute effect: any smoke can interfere with oxygen binding to red blood cells Acute: marijuana can disrupt coordination, balance, reaction time Acute: increase heart rate and blood pressure Acute: stored THC in fat could be released into bloodstream during exercise Chronic: depends on how frequently one smokes, type of exercise

13. LSD Learn the effects of acid Are there different types?

14. LSD Albert Hoffman: “Last Friday, April 16,1943, I was forced to interrupt my work in the laboratory in the middle of the afternoon and proceed home, being affected by a remarkable restlessness, combined with a slight dizziness. At home I lay down and sank into a not unpleasant intoxicated-like condition, characterized by an extremely stimulated imagination. In a dreamlike state, with eyes closed (I found the daylight to be unpleasantly glaring), I perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors. After some two hours this condition faded away.”

15. LSD Schedule I hallucinogen synthesized in 1930s Manufacturing secretive: Nick Sand (National Geographic, 3:39) Manufacturing secretive: Nick Sand “Types” Same basic chemical structure Illegal, so cannot guarantee contents, care of product Light and air may degrade drug Dosage measured in micrograms (very small)

16. LSD Forms Crystal can be crushed, mixed with other materials into tablets: microdots Gelatin squares Converted to liquid paperpaper Dosed onto sugar cubes Placed on candy (gummy bears - Lake Tahoe, 2011, e.g.) Usually taken orally Can be inhaled, injected, applied transdermally

17. LSD Acute Effects Duration of “trip” = several hours in length Visual hallucinations (images, color, light) Altered perception of senses “Seeing sounds, hearing colors” Color, size of objects Altered perception of time, depth Potential anxiety/panic Experiences can vary widely Serotonin receptors may be excited or inhibited LSD experimentation on British soldiers (YouTube.com) LSD experimentation Overdose thought to be rare, but some individuals may not respond well, or may experience problems if drug is different than LSD

18. LSD Chronic effects may involve flashbacks Sudden onset of abnormal perceptions Hallucinogen Persisting Perception Disorder Visual images remain longer than in consciousness Dr. Henry Abraham (Tufts University) blogblog

19. LSD Research US Food and Drug Administration allowed LSD research Recent study sponsored by Multidisciplinary Association for Psychedelic Studies, carried out by Swiss physician Peter Gasserstudy Information published 2014 12 patients with terminal illness, end-of-life anxiety Took two doses of LSD with talk therapy, across eight weeks Those with larger dose reported improvement

20. MUSHROOMS

21. Mushrooms Psilocybin/psilocin are two active psyhoacticve substances found in “magic mushrooms” Most from psilocybe genus, couple dozen species Taken orally Recognized for centuries Probably used in religious rites Hallucinogen Schedule I

22. Mushrooms Dose Varies Fresh vs dried User Trip desired ~1 mushroom or less for new user

23. Mushrooms Acute effects: ◦ Relaxation ◦ Altered perception of reality ◦ Altered perception of time ◦ Sense of connection to others/universe ◦ Visual hallucinations (images, color, light) ◦ Potential for anxiety and subsequent panic, heart rate & blood pressure increase Chronic effects: ◦ A “bad trip” may trigger fear ◦ Hallucinogens may exacerbate mental illness

24. Mushrooms

25. Largely depends on availability Carl Hart, Columbia University, on drug abuse (0-2:40)drug abuse Most emergency department (ED) visits: alcohol (DAWN, 2011)DAWN, 2011 Half + of 2.5 million ED visits: illicit substances Cocaine – 505,224Combinations – 10,388 Marijuana – 455,668Inhalants – 10,032 Heroin – 258,482Unclassified hallucinogens – 8,043 Amphetamine/meth. – 159,840LSD – 4,819 PCP – 75,538GHB – 2,406 Synthetic cannabinoids – 28,531Ketamine – 1,550 MDMA – 22,498

26. Depends on availability, mode, reasons for use 2008 study by Hser et. Al.: Researchers examined data from five studies Assessed 10-year drug behaviors among 629 heroin users, 694 cocaine users, 474 meth users Heroin users: used 13-18 days per month Cocaine: used 8-11 days per month Meth: 12 days per month Groups – “consistently high use,” “increasing use,” “decreasing use,” “moderate use,” “low use” Heroin over-represented in “consistently high use,” under- represented in “low use” 2011 study by Novak et. Al. – injection users were more likely to abuse and become dependent

27. “Why do we focus more on jailing addicts than recovery options? What helps people quit these substances? Are there any positive uses that have been proven and could be used under a doctor’s watch?” History, government, culture Cocaine, opium available in 1800s, early 1900s Harrison Act in early 1900s regulated these substances – taxing Those who did not pay the tax were in legal trouble (tax evasion) Alcohol prohibited (prohibition later appealed) Heroin Act, Narcotic Drug Import & Export Act 1970 Drug Abuse Prevention & Control Act NIDA Principles of Effective TreatmentPrinciples of Effective Treatment

28. Student Question (continued) WHO ATLAS on Substance Abuse (2010)ATLAS on Substance Abuse Alcohol main problem Other drug issue is cocaine 39 deaths per 100,000 (35 due to alcohol) Not enough government resources Africa – out of pocket treatment costs Beds: 1.7 per 100,000 Many other issues

29. 2C-I 4-iodo-2,5-dimethoxyphenethylamine

30. 2C-I “Smiles” Synthetic substance Usually inhaled or taken orally; may also be taken via blotter paper Stimulant & hallucinogenic properties Schedule I

31. 2C-I Impacts dopamine & serotonin Onset of effects may not be immediate, triggering overdose Little information on brain impact Additives, chemical changes make drug unpredictable, similar to bath salts CNN 2014 report about 2C-I deaths in North Dakota CNN Synthetics often a problem Who can you trust? Illegality = no regulation

32. DIMETHYLTRYPTAMINE (DMT) What is DMT? How does DMT work as a psychoactive drug?

33. Dimethyltryptamine Chemical structure Hallucinogenic ingredient Present in a variety of plants plants Occurs naturally in the body Schedule I substance Image source: Wikimedia Commons

34. Dimethyltryptamine Often consumed via beverage: ayahuasca tea Requires MAO-I (specific vine) Ceremonial purposes Ashland, OR Brazilian church lawsuit Can be injected, inhaled, smoked

35. Dimethyltryptamine Effects Hallucinogenic visualizations Mood change Time distortion Dissociation Muscle twitching, coordination difficulties Nausea, vomiting Shorter-lasting effects than other hallucinogens ◦ “ businessman ’ s trip ” per DEA ◦ 30-60 minutes Video Clip - The Spirit Molecule, Part 1 (YouTube) Video Clip - The Spirit Molecule, Part 1 Video Clip – London Real (34:00+ = trip described) Video Clip – London Real Source: Arch Gen P e sychiatry. 1994 Feb;51(2):98-108. e

36. MDMA 3,4-METHYLENEDIOXY-N-METHYLAMPHETAMINE How does Ecstasy prove to help people with PTSD? What exactly is Molly & why does it kill people? How do you overdose Ecstasy? Molly?

37. MDMA Molly, Ecstasy, Thizz Synthetic drug Stimulant and hallucinogenic properties

38. MDMA Acute effects on the brain Increased serotonin release Increased dopamine release Increased norepinephrine release Effects will vary since formula is not standardized or regulated Effects will vary based on the synthetic nature of substance MDMA-assisted therapy (Multidisciplinary Association for Psychedelic Studies, video; 0-2:00; 14 subjects, per website) MDMA-assisted therapy More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)YouTube

39. MDMA Chronic effects are controversial, per Carl Hart, Columbia University (YouTube)Carl Hart Well-circulated animal studies showing neuron damage

40. Emergency Department Visits

41. Synthetics are currently popular MDMA, bath salts, 2C-I, synthetic cannabis Lower price (think about economy’s influence) Drug popularity changes with time (synthetics were popular in 1970s) Health-related issues will subsequently ebb and flow as drugs move in and out of favor That acknowledged, some can be devastating: Krokodil (CBS, 2013)Krokodil

42. Which drugs are the most popular? (by country here)here

43. Dextroamphetamine (Adderall)

44. About Adderall Stimulant Works on dopamine and norepinephrine Used as prescription for ADHD, narcolepsy Some abuse Adderall for its performance-related effects 60 Minutes program, April 2010 Schedule II

45. Adderall Availability Readily available across U.S. $5-10 per pill

46. Adderall Prescriptions, by Year (U.S. Department of Justice)

47. Adderall Effects Increased alertness Euphoria Self-assuredness Increased heart rate, blood pressure Emotional changes Weight loss Stomach discomfort (nausea, cramps) Long-term effects are not yet known

48. Adderall Forms Tablet (5-30mg) Time release capsule (10-25mg)

49. Adderall Overdose According to Dailymed (National Library of Medicine), traditional symptoms can develop: anxiety, confusion, restlessness

50. METHAMPHETAMINE

51. Methamphetamine Famous/notorious for laboratory production, short-term dopamine effects & long-term effects Stimulant (blood pressure, heart rate, alertness) DEA: Schedule II substance (Desoxyn: ADD, narcolepsy, weight control)

52. Methamphetamine acute effects  Intense high/euphoria ◦ May last up to 12 hours (longer than cocaine) ◦ Meth Inside and Out video describing effectseffects  Energetic, talkative, excitable  Insomnia  Increased heart rate, blood pressure  Sweating  Dry mouth  Jaw clenching  Nausea, vomiting  Comparison: meth vs cocaine,Brookhaven National Laboratory, 2008Brookhaven National Laboratory, 2008

53. Methamphetamine chronic effects Chronic users may experience hallucinations, rage, paranoia, heart “meth mouth;” damage to dopamine-, serotonin-containing nerve cellsmeth mouthdamage to dopamine ◦ Crank Bugs (Meth Project) Crank Bugs (Meth Project) ◦ Meth Mouth (Meth Project) Meth Mouth (Meth Project) ◦ Ashley’s Story (Meth Project) Ashley’s Story ◦ Research supports both brain damage as well as lack of brain damage

54. Methamphetamine Chronic Effects Before & After Photos

55. Before and After Photos 3 Years and 5 months after starting meth Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

56. Before and After 17 months after starting meth Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

57. Before and After 3 months later Meth Awareness Prevention Project: http://www.mappsd.org/Faces%20of%20Meth.htm

58. Heroin

59. Narcotic Synthesized from morphine in late 1800’s Morphine synthesized from opium poppy Heroin 10x more powerful than morphine Was thought to be less addictiveless addictive After many people became addicted, heroin was outlawed in 1920’s Drug Ads (wings.buffalo.edu)Drug Ads Schedule I