1. SPECIFIC DRUGS The Major (vs. minor) Stimulants Cocaine and Amphetamine

2. Major Stimulants - Cocaine * Free association COCAINE * What is coke and where does it come from? coca leaf / coca bush Incas and Spanish Freud American history (VIP usage)

3. Major Stimulants - Cocaine street cocaine: coca paste and hydrochloric acid = type of salt--powder sniffed or snorted more addictive uses: can inject it if mix with water--IV quicker smoking: freebase - powder and ether crack - dissolve cocaine salt in baking soda solution, boil off water, left with rock Cocaine - ETOH combo (coca-ethylene) - may alter metabolics of cocaine, which may be more cardiotoxic via increased half-life of cocaine

5. Major Stimulants - Cocaine Prevalence 19982003 Cocaine (Crack)Cocaine (Crack) Past month.8%(.2%)1.0%(.3%) Past year1.7%(.4%)2.5%(.6%) Lifetime10.6%(2.0%)14.7%(3.3%)  cheapness of crack--national crisis  shift of users from college educated to high school dropouts  smoking cocaine becoming more popular, especially among young users

6. Major Stimulants - Speed Amphetamines ephedrine, principal chemical in these drugs, has been known for thousands of years; used as Chinese medicinal herb ephedrine first isolated in late 1800's, and synthesized in 1920s when it was named “amphetamine” first medically used in 1920's for treating obesity, narcolepsy, colds, and much later ADHD used to enhance performance, decrease fatigue – sport & military applications (e.g., go and no-go pills)

7. Major Stimulants - Speed Prevalence – 2003 Stimulants (Methamphetamine) Lifetime8.8%5.2% Past year1.2%0.6% Past month0.5%0.3% *ages 12 and older, from NSDUH

8. Major Stimulants Neurotransmitters and behavioral pharmacology Effects of the Major Stimulants – Desired effects – Negative effects – Overdose Withdrawal SXs

9. Major Stimulants Medical Effects Fetal Exposure during Pregnancy Other Co-morbid Diagnoses Factors in Initiation of use leading to dependence

10. Major Stimulants Treatment of Cocaine Dependence A. Drug TX B. Psychological TX Community reinforcement Payment for abstinence Relapse prevention (triggers, cravings…) Lifestyle modification Self-help Groups (CA - cocaine anonymous)

11. U.S. Banned Ephedra in 2004 used primarily for weight loss and body building in the U.S. linked to 155 deaths and dozens of heart attacks and strokes. Derived from a plant (powdered and then put in pills) Contains ephedrine & pseudoephedrine

12. ephedra ban, cont… side effects can be life threatening even for a health individual (constricts blood vessels, raises blood pressure). FDA was aware of a problem for 8 years, however the high profile death of Baltimore Orioles pitcher, Steve Bechler stimulated concern from the FDA as well as many others. 1 st government ban on a dietary supplement