1. Individual Drug Info
Winter 2017

2. Similar Properties Across Drugs
Student Question: What is the difference between physical and psychological dependence?
Physical dependence
Psychological dependence
Student Question: Which drug is the most addictive?
Depends on who you ask
Depends on the individual and that person’s reasons for taking the drug
Depends on what substance(s) is/are readily available
Tolerance

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

4. Cannabis - marijuana Student Question: How does weed affect people?
In what states is weed legal?
How does marijuana affect anxiety and depression?
Does marijuana affect respiratory function? Especially during exercise?
Is marijuana more destructive to your brain than alcohol?
Cannabis - marijuana

5. Cannabis Cannabis sativa Active ingredient: THC THC is a cannabinoid
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 source: procon.org, 12/28/16
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)
Arkansas (16)
North Dakota (16)
Florida (16)
Ohio (16)
Pennsylvania (16)

7. Recreational Cannabis
Washington (2013)
Colorado (2013)
Washington, DC (2014)
Oregon (2014)
Alaska (2014)
Maine (2016)
Massachusetts (2016)
California (2016)
Nevada (2016)
Map (governing.com)
Student Question: If weed can be used for medical purposes, then why is it illegal in different states?
Good question
Long-standing influences from culture, government

8. Cannabis Acute effects
THC acts on cannabinoid receptors, increases dopamine, serotonin
Increases appetite
ASAP Science: Your Brain on Marijuana (via YouTube)
Infamous call in Michigan (full call here)
Student Question: Are blunts much worse for health than bongs, joints, and other forms of smoking?
Possibly (more smoke since more product; depends on inhalation, frequency, amount of time passing when one smokes

9. 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 anxiety
Marijuana, conversely, may help those with Post-Traumatic Stress Disorder
Memory inhibition

10. Student Question: What are the negative side effects of smoking weed other than it being bad for your lungs? Can weed kill?
Chronic effects
Respiratory distress
Mood swings
Impaired memory (potential hippocampus damage)
Earlier research
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 <

11. 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

12. Marijuana & Driving? Legal limit is 5 nanograms
Medical patients may have higher levels (tolerance)
If driving dangerously, can be pulled over, regardless of drug influence
Local driving test

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

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)
“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 paper
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 Effects Student Question: What are the Effects of LSD?
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)
USC experimentation (1:40-6:08, via YouTube)
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) blog
Student Question: Is Schizophrenia or Depression Linked with LSD?
Schizophrenia: No proof, but evidence; both feature hallucinations

19. LSD Research - Depression
US Food and Drug Administration allowed LSD research
A study sponsored by Multidisciplinary Association for Psychedelic Studies, carried out by Swiss physician Peter Gasser
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. Research - Depression
Student Question: How do mushrooms trigger hallucinations?
Research has continued to suggest that use of hallucinogens, including psilocybin (mushrooms), can help those with end-of-life depression
Psiloybin acts on specific serotonin receptors, which cause hallucinations
NBC News: mushrooms and cancer patients (1:44)

21. Dimethyltryptamine (DMT)
What is DMT?
How does DMT work as a psychoactive drug?
Dimethyltryptamine (DMT)

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

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

24. MDMA 3,4-methylenedioxy-N-methylamphetamine
How does Ecstasy prove to help people with PTSD?
What exactly is Molly?
How do you overdose Ecstasy? Molly?
MDMA 3,4-methylenedioxy-N-methylamphetamine

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

26. MDMA Increased serotonin release Increased dopamine release
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; 2:30-3:50, 14 subjects, per website)
More on MDMA therapy for PTSD (The Verge via YouTube, MAPS research through 7:00)

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

28. Emergency Department Visits

29. 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)

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

31. 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, 1:44)
Video Clip – London Real (34:00+ = trip described)
Source: Arch Gen Pesychiatry Feb;51(2):

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

33. Adderall Prescriptions, by Year (IMS Health, via Huffington Post)

34. 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
Used especially by students trying to study for exams

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

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

37. Mushrooms

38. 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

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

40. Mushrooms Acute effects: Chronic 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

41. Mushrooms
Student Question: How do they interact with antidepressants?
According to 2006 publication of Australian Pharmacist:
Information on LSD only (hallucinogens impact serotonin)
Taking anti-depressants may increase or decrease hallucinogen’s effects
Avoid stopping SSRI medications
Flu-like symptoms
Headache
Mood changes
Irony? Treatment investigations: OCD, depression, smoking cessation
In depression, psilocybin may “turn off” parts of the brain that are overactive among individuals who are depressed (Discovery, 1/2012)
Johns Hopkins Psilocybin Cancer Project (via YouTube, 0:30-4:03)

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

43. Student Question: Is Heroin or Meth More Addictive?
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 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

44. Student Questions
“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 Treatment

45. Student Question (continued)
WHO ATLAS on Substance Abuse (2010)
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

46. 4-iodo-2,5-dimethoxyphenethylamine
2C-I

47. 2C-I “Smiles” Synthetic substance
Usually inhaled or taken orally; may also be taken via blotter paper
Stimulant & hallucinogenic properties
Schedule I

48. 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
Synthetics often a problem
Who can you trust?
Illegality = no regulation

49. Dextroamphetamine (Adderall)

50. 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

51. Methamphetamine

52. 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)

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

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

55. Methamphetamine Chronic Effects
Before & After Photos

56. Before and After Photos
3 Years and 5 months after starting meth
Meth Awareness Prevention Project:

57. 17 months after starting meth
Before and After
17 months after starting meth
Meth Awareness Prevention Project:

58. Before and After 3 months later
Meth Awareness Prevention Project:

59. Heroin

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