1. Patty Ghazvini, PharmD. CGP.

2. Cannabis World-wide, most commonly used illicit substance In the United States, 42% of persons over age 12 have used cannabis at least once in their lifetime Between 2007 and 2010, past month use among youth aged 12 to 17 increased from 6.7 to 7.4%, corresponding with a decrease in perception of risk over that same period.

3. Cannabis Primary psychoactive component – ????? Potency – percentage of THC in the dry weight of the sample Substantial increases in the potency of street samples over the last few decades

5. Physiologic Effects of Marijuana Stimulation of the sympathetic nervous system????????? It has been shown to increase cardiac output by????????????????????????????????????? HR increases start? Causes an increase in carboxyhemoglobin levels – ??????????

6. Somatic Consequences Physiologic effects – Immediate pulmonary effects – Heavy use – Metabolites cross the placenta and are found in human milk – babies weigh less, shorter

7. Behavioral and Cognitive Consequences Acute effects – ???? Regular use – More likely to use “harder” drugs such as cocaine

8. Cannabis Withdrawal Dysphoric mood – ????? Disturbed sleep GI symptoms Decreased appetite Most symptoms begin during the first week of abstinence and resolve after a few weeks

9. Treatment for Withdrawal No medications are approved Cross-tolerant – ? Lithium – In clinical studies, 600-600mg/day for 6 days reduced withdrawal symptoms Depakote

10. CNN NEWS – Synthetic Marijuana Teen narrowly escapes death after smoking synthetic marijuana

11. One month after the life-changing night, Emily is blind. Each day since has been a fight -- a fight to move a finger, a fight to whisper something to her family, a fight for life, according to her big sister.

13. Amphetamine and Related Compounds Crystal – Powder(inhaled, injected) Crank – Tablet, Capsules Ice and Glass - Smokeable

14. Meth Videos http://www.youtube.com/watch?v=CfI5lCoA3b8&list= PL7307BDF42924AC44 http://www.youtube.com/watch?v=CfI5lCoA3b8&list= PL7307BDF42924AC44 http://www.youtube.com/watch?v=v5KL_mc1nx4

15. Drug and Alcohol Data Information System: 2009

16. Medical Complications Organ SystemAcute ComplicationsChronic Complications CNS Cardiovascular Pulmonary GI Liver Head and Neck Sexual Function Reproductive System

19. Treatment Amphetamines can be withdrawn abruptly If sedation is necessary – ??????? (avoid phenothiazines, can worsen dysphoria and highten agitation) Severe hypertension –?????? for vasodilation (avoid beta or beta-alpha blockers – worsen stimulant- induced cardiotoxicity) Most signs of intoxication clear in 2-4 days

20. Hallucinogen- Related Disorders Lysergic Acid Diethylamide Magic Mushrooms

21. LSD video http://www.youtube.com/watch?v=qxmqx7Ifu8s

22. Lysergic Acid Diethylamide (LSD) Prototype of the hallucinogen class “Psychedelic” Street names:???????????????? Stimulates both dopamine and serotonin receptors Early drugs effects??????????????????? No physical or psychological addiction; however, chronic use – psychosis and hallucinogenic persistent perception disorder – “flash backs”

23. Intoxication Somatic symptoms: Psychomimetic symptoms: Treatment: Supportive care and BZDs for agitation

24. Psilocybin (Magic Mushrooms) Structural analogues of serotonin In one study of 174 adolescents with a history of substance abuse, 45 (26%) reported having used hallucinogenic mushrooms at some point in their life, often combined with alcohol or marijuana. Carter OL, Pettigrew JD, Burr DC, et al. Psilocybin impairs high-level but not low-level motion perception. Neuroreport. Aug 26 2004;15(12):1947-51.

25. Magic Mushrooms From data collected from September 2008 to December 2009, the Youth Risk Behavior Surveillance System reported that 8% of students had used an hallucinogenic drug, including LSD, PCP, angel dust, mescaline, or mushrooms, at least once in their life. Use was more common among males and Caucasians than among females and African Americans and Hispanics. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ. Jun 4 2010;59(5):1-142.

26. Clinical Symptoms of Intoxications Alterations in perception begin within 30 minutes and subside after 6 hours. CNS manifestations: euphoria, visual and religious hallucinations, and feeling closer to nature have been reported. Visual hallucinations may include perceived motion of stationary objects or surfaces.

27. Treatment Activated charcoal – Most useful if administered within 2 hours of ingestion Benzodiazepines