1. JOSEPH DE SOTO MD, PHD, FAIC Drugs of Abuse

2. Overview At any given month about 10% of the population is using drugs which are considered illegal. These drugs can be broken down into three categories: 1) Simulants: Amphetamines, cocaine, synthetic cathinones, and methylenedioxymethamphetamine (MDMA) 2) Hallucinogens: Lysergic acid diethylamide (LSD), marijuana, synthetic cannabinoids. 3) Other drugs: Ethanol, prescription drugs

3. Sympathomimetics Sympathomimetics are stimulants that mimic the sympathetic nervous system and hence usually cause tachycardia, hypertension, hyperthermia, and tachypnea. Cocaine: This drug inhibits the reuptake of norepinephrine, serotonin, and dopamine. This drug can stimulates the pleasure center of the brain via the inhibition of the reuptake of dopamine and serotonin. Cocaine has very poor bioavailability when taken orally and hence in the powder form it must be snorted, or injected. Cocaine when mixed with baking soda can be alkalized and in this form it can be smoked.

5. Sympathomimetics Cocaine is highly addictive especially in its alkaloid form and patients can go on binges for days at a time. Cocaine accelerates the atherosclerotic process and can cause fatal cardiac arrhythmias. When cocaine is taken with alcohol cocaethylene is form which is highly cardiotoxic. Other adverse effects include: depression cause (when coming down) from cocaine, agitation, hypertension, paranoia, hallucinations, convulsions, chest pain, and hyperthermia.

6. Sympathomimetics Amphetamines: These drugs produce similar effects as cocaine but the effects are generally longer with more stimulation but less euphoria. Among the more common amphetamines is methamphetamine. These drugs act as monoamine releasing agents. They inhibit VMAT-2, preventing packaging of monoamines into vesicles. As these monoamine neurotransmitters remain in the cytoplasm at an ever- climbing level, the gradient for their transporters becomes progressively less favorable, resulting in monoamine release..

7. Sympathomimetics Recreationally, methamphetamine is used to increase sexual desire, lift the mood, and increase energy, allowing some users to engage in sexual activity continuously for several days straight Adverse effects: loss of appetite, hyperactivity, dilated pupils, flushed skin, excessive sweating, increased movement, meth mouth, headache, irregular heartbeat, rapid breathing, high blood pressure, high body temperature, blurred vision, dizziness, tremors, dry skin, acne, and accelerated aging.

9. Sympathomimetics Methylenedioxymethamphetamine (MDMA): this drug is also known as ecstasy. This drug is a type of amphetamine which causes a large release of serotonin. This drug increase the pleasure of tactile stimulation and is often used by sexual predators to take advantage of others. This drug however, can cause serotonin syndrome inclusive of hyperthermia, altered mental status and movement disorders. Cyproheptadine is useful in serotonin syndrome, however, it is only available orally.

11. Sympathomimetics Synthetic Cathinones: these are also known as bath salts. Some of the bath salts include methcanthinone, butylone, methylene dioxypyrovalerone and naphyrone. These drugs increase the release and inhibit the reuptake of catecholamines and hence, have similar effects as cocaine and methamphetamine. These drugs are usually snorted, smoked or ingested and they can be injected.

13. Hallucinogens Lysergic acid: LSD produces psychedelic effects by acting as a partial agonist to the HT2A receptors. The use of this drug is associated with colorful hallucinations, mood alteration, sleep disturbances, and anxiety. Tolerance develops quickly. This drug is also associated with loss of judgement, and impaired reasoning. Some people, have such a loss of judgement that they panic due to disordered thinking and may even commit suicide. Decreased appetite, sweating, increased blood pressure, and tachycardia can also occur.

15. Hallucinogens Marijuana: The active ingredient affecting psychoactive properties is Δ9- tetrahydrocannabinol. This ingredient acts on the cannabinoid receptor, Stimulation of the cannabinoid receptor is associated with physical relaxation, hyperphagia, increased heart rate, decreased muscle coordination, conjunctivitis. Marijuana does provide some euphoria followed by drowsiness and relaxation. It can cause hallucinations. Marijuana is associate with long term a motivational syndrome.

16. Hallucinogens There is evidence supporting the use of cannabis or its derivatives in the treatment of chemotherapy-induced nausea and vomiting, neuropathic pain, and multiple sclerosis. Lower levels of evidence support the use of marijuana for AIDS wasting syndrome, epilepsy, rheumatoid arthritis, and glaucoma

18. Ethanol Abuse There are two types of alcohol abuse, those who have anti-social and pleasure-seeking tendencies, and those who are anxiety-ridden people who are able to go without drinking for long periods of time but are unable to control themselves once they start. In 2013, 139,000 deaths globally were directly due to alcohol abuse and an additional 384,000 to cirrhosis from excess alcohol consumption. Chronic ethanol usage is associated with degenerative changes of the brain, cardiomyopathy, fatty liver, impaired absorption of nutrients from the intestines, testicular atrophy and myopathy.

20. Methamphetamine Photos

21. Opioid Photos