How did Britain and China interact regarding opium?
Britain brought opium and tobacco to China, Britain continued to sell them opium as it was the only item they could sell to China.
- 1729: Opium smoking outlawed in China, but smuggling was widespread.
- British East India Company was involved in opium trade, legally in India and illicitly (but indirectly) in China.
- Pressure grew and eventually war broke out between the British and Chinese
When it was outlawed, Lucky Luciano brought to US from France and Turkey, then center moved to Golden Triangle (Thailand, Laos and Myanmar).
What is morphine and what's the potency (vs. opium)?
- 1806: Active ingredient in opium isolated
- 10 times as potent as opium
- Named morphium after Morpheus, the god of dreams
- 1832: Another alkaloid of opium discovered Named codeine from the Greek word for “poppy head”
Who was Galen?
A physician in 150 A.D., who (first definition for addiction) documented that it was better to endure pain than become bound to the drug opium
Why did the use of morphine spread in the 1800s?
- 1. 1853: Hypodermic syringe allowed delivery of morphine directly into the blood
- 2. Widespread use during war provided relief from pain and dysentery
Who created morphine and what was the irony in that?
Sertürner: German pharmacist in 1806 isolated morphine from opium, irony is that he witnessed the death of his own wife because of morphine overdose, warned the world of its addictive nature, but it was too late.
Why was morphine considered better than alcohol?
Morphine was believed to be better than alcohol because "it cures alcoholism, kills pain, better pain suppressant; opium addicts didn’t become violent or beat one another or their wives, the morphine addict was quiet and reclusive, considered a better alternative than the violent alcoholic"
What were the 3 types of opioid dependence developed in the U.S. in the second half of the 19th century?
- Oral intake increased as patent medicines spread
- Opium smoking increased after 1850, as Chinese laborers arrived in the U.S.
- Injection of morphine—the most dangerous form of use
Why was opioid dependence in the 19th and early 20th century not considered a problem?
- Opium smoking was limited to certain groups (the Chinese)
- Patent medicines were socially acceptable
- Opioid dependence was viewed as a “vice of middle life”
- Typical user was a 30-to-50-year-old middle class white woman, wife, and mother
- Drugs purchased legally in patent medicines
- High drugs levels in patent medicines meant that withdrawal symptoms were severe and relieved only by taking more
What changed opioid usage in 1914?
- Passage of Harrison Act which restricted usage to those with prescription, heavily taxed physicians
- MDs are the ones most arrested, “due course of treatment,” in the first years of the law.
- Oral use declined; the primary remaining group of users were those who injected morphine or heroine
- Only sources of drugs were illegal dealers
- Cost and risk of use increased, so the most potent method(intravenous injection) was favored
- Addicts were looked upon as weak and self-indulgent rather than as victims
When did the term "illegal drugs" come into existence?
- In 1924, first description of "illegal drugs" with the Heroin Act which made it illegal to sell, use, or manufacture heroin
- By 1925, heroin permanently banned and removed from medical use.
What happened with heroin use in Vietnam and what was "Operation Golden Flow?"
- Heroin use skyrockets in the 60s, especially in the Vietnam War.
- Nixon reinvents the drug laws creates DEA
- The first day in office, the drug czar was sent to Saigon.
- “Operation Golden Flow” began the first widespread use of urine testing system, vowing that vets would "get clean" before leaving Vietnam.
- Rate of use = about 5 percent
- Heroin was Inexpensive
- About 95 percent pure (compared to 5 percent in the U.S.)
- Easy to obtain
- Most users smoked or sniffed the drug
- Most users stopped when they returned to the U.S.
How did opium, morphine, and heroin influence the social and legislative changes that have transformed (and possibly created) the drug culture of the 20th century?
- Laws like Pure Food & Drug Act and Harrison Tax Act legislated drug use
- Creation of DEA "drug czar"
- Coining term "illegal drug" use
- Making it illegal created drug cartels
- People of color targeted (first Chinese, then Blacks during 60s)
- At first socially acceptable (white, middle-class women), then not (people of color)
What influences did opioids have on medicine, war, and legislation?
- Opioids removed pain from the equation of war
- Allowed MDs to perform surgery not just amputations
- The injuries and pain of war was quelled by morphine/codeine
What happened to the production of heroin in the 1970s?
End of the “French connection” in the early 1970s:heroin grown in Turkey, converted to heroin in southern France, and imported into the U.S.
- By 1975, most U.S. heroin came from Mexico
- Opium processed into morphine by a different process, resulting in pure heroin with a brown or black color ,so-called Mexican brown or black tar heroin
How does heroin work on the brain?
Heroin mimics natural opiates and binds to opiate receptors in the brain, turning off dopamine inhibition.
- Dopamine is allowed to flood the synapse, producing immediate feelings of sedation and well-being.
- Morphine-like neurotransmitters
- Enkephalins: found in the brain and adrenals Endorphins: found in the brain and pituitary gland
Opiate receptors are in the part of the brain responsible for stress response, transmission of pain signals and emotional attachment
TRUE OR FALSE?
All users experience euphoria from initial dose
Tolerance to negative effects may develop more rapidly than tolerance to positive effects
Withdrawal is often similar to a mild case of the intestinal flu
People become dependent after one dose
All users experience euphoria from initial dose -FALSE
Tolerance to negative effects may develop more rapidly than tolerance to positive effects -TRUE
Withdrawal is often similar to a mild case of the intestinal flu TRUE
People become dependent after one dose - FALSE
What is an opioid antagonist and how does it work?
Drugs that block the action of opioids Examples: Naloxone (Narcan) and nalorphine
- Effects: Reverse depressed respiration-opioid overdose
- Precipitate withdrawal syndrome
- Prevent dependent individuals from experiencing a high from subsequent opioid use
What happens with an opioid overdose (toxicity)?
- Depress respiratory centers in the brain Effects with alcohol are additive Occasionally, nausea and vomiting
- Opioid overdose triad
- 2.Depressed respiration
- 3.Pinpoint pupils
- Counteracted with naloxone
- Clouding of consciousness
Name the family of drugs for hallucinogens:
Entheogen and entactogen
Phantastica: world of fantasy in our minds
Psychotomimetic: “Mimicking psychosis”
Entheogens: create spiritual or religious experiences
Entactogens: enhance feelings of empathy
Hallucinogens: A drug that produces profound alterations in perception
What are the two major groups of phantastica hallucinogens?
Indole hallucinogens = drugs that have the indole structure (in the neurotransmitter serotonin)
Catechol hallucinogens = drugs that have the catechol nucleus (basic structure of the neurotransmitters norepinephrine and dopamine)
What happened with LSD experiments in the military in the 50s and 60s?
- 1950s and 1960s, hundreds of soldiers and civilians were unknowingly given the drug
- Believed they were losing their minds.
Suffered psychiatric disorders and others had difficulties adjusting to their usual lives.
Army/CIA-sponsored research was poorly done andviolated many ethical codes
Who synthesized LSD and what is he known for?
Dr Hofmann - could be used to enhance humans’ understanding of their place in nature.
Timothy Leary and LSD, what was the connection?
Experiments by psychologist Timothy Leary @ Harvard– were criticized in 1966:
Leary started a religion, the League of Spiritual Discovery, with LSD as the sacrament
Motto was “turn on, tune in, and drop out”
- Use peaked in 1967 & 1968, then fell “bad trips”
- prolonged psychotic reactions
- worries about possible chromosome damage self-injurious behavior
What's the pharmacology of LSD?
Odorless, colorless, tasteless, & 1 of the most potent psychochemicals known
- No known human overdose deaths
- LD50 is about 400 times the behaviorally effective dose
- Usually taken orally
- Absorbed rapidly through the GI tract
- Metabolized by the liver
- Half-life is about 3 hours
- Tolerance - w/in 3-4 days of daily doses Equally rapid recovery
- Cross-tolerance: LSD, mescaline, and psilocybin
- No physical dependence
- Sympathomimetic agent
- Autonomic signs appear quickly
- Resembles & acts on serotonin receptors Acts by stimulating the serotonin-2A subtype of receptor
What is a LSD "trip?"
- Typically last 6-9 hours
- Autonomic responses occur over the first 20 minutes
- Alterations in mood, perception, and sensation begin in thenext 30-40 minutes
- Full intoxication occurs w/in 1 hr
- Unique and variable experiences
- Expansive and pleasant—uncovering great secrets or profundities
- Constricted and negative—paranoia & feelings of persecution
- Each trip is a unique experience
- Impact on creativity
- Therapeutic usefulness?
What is psilocybin?
- Long history of use - natives of Mexico
- Psilocybe mexicana
- Primary active ingredient is the indole
- Dried mushrooms are 0.2 to0.5 % psilocybin
What are some other indole hallucinogens?
- Morning Glories
- Ololiuqui, seeds of the morning glory plant
- Rivea corymbosa
- Seeds contain several active alkaloids, including d-lysergic acidamide
- Hawaiian Baby Woodrose Seeds, Argyreia nervosa, have also been used recreationally
- Seeds contain d-lysergic acid amide
- Outer coating of seeds contain toxic cyanogenic glycosides
What is Dimethyltryptamine (DMT)?
- Worldwide, an important naturally occurring hallucinogen Active agent in Cohoba snuff, used in some South American and Caribbean Indian rituals
- Usually snuffed, smoked, or taken by injection
- Ineffective when taken orally
- Effects - very brief, but tolerance doesn’t develop to its psychological effects
What is ayahuasca?
- “Vine of the Soul”
- Ayahuasca, from the Amazon region
- Name for the vine Banisteriopsis caapi brew made from the vine
- Brew commonly combines Banisteriopsis,contains harmaline, with leaves of another plant containing DMT Harmaline allows oral DMT to have psychoactive effects
What is peyote?
- Peyote (from the Aztec peyotl) small, spineless, carrot-shaped cactus (hallucinogen)
- Mostly subterranean, with only the pincushion-like top appearing above ground
- Mexican Indians - used ceremonially
- Mescaline - primary psychoactive agent in peyote.
- Peyote cult moved north and became widely established among Indians of the plains by the late 19th century
- American Indian uses:
1. Religious ceremonies
2. Treatment for illness
- 3. Worn as a protective amulet
- Current laws governing the use vary from state to state
What is mescaline?
- Mescaline was isolated and synthesized by 1918
- Bad trips, nausea & physical discomfort
- San Pedro cactus: Another mescaline-containing cactus, Trichocereus pachanoi, used for thousands of years
- Rapidly absorbed if taken orally
- Half-life is about 6 hours
- Effects Low dose - primarily euphoric
- Higher doses - full set of hallucinogenic effects
- Most mescaline is excreted unchanged
- Psychoeffective dose causes sympathetic arousal
- LD50 is about 10 to 30 times the dose needed to cause behavioral effects
- Tolerance develops more slowly
- Cross-tolerance between LSD and mescaline
- Act directly on serotonin 2A receptors
What is a club drug, amphetamine derivative?
- A group of synthetic hallucinogens
- Chemically related to amphetamines
- Act much more like mescaline
- MDA and others
- Includes “designer drugs” that are not all specifically listed as controlled substances DOM STP (“serenity, tranquility, peace”)
- More potent MDMA (Ecstasy)
What is MDMA?
- Similar in structure to MDA but acts differently
- Prior to the scheduling, used by psychiatrists
- Effects Psychological
- Heightened sense of “closeness” with others
- Increased sociability
- Physiological Increased heart rate & blood pressure
- Other autonomic effects May cause brain damage
- Listed as a Schedule I drug
What is a deliriant (in the class of hallucinogens?)
- Produces mental confusion and a loss of touch with reality
- Act through a number of different brain mechanisms
What is PCP?
- 1-(1-phenylcyclohexyl) piperidine hydrochloride
- Initially appeared to be a good anesthetic Mechanism of action of PCP
- PCP alters many neurotransmitter systems Sigma receptor may be selective for PCP
- Effects: psychological reactions were unpredictable
- By 1960, Anesthetic for monkeys
- Medically safe but psychologically troublesome anesthetic for humans
- A hallucinogen with profound effects on body perception
- Currently, licensed for use as an animal
- Other drugs like PCP include ketamine, dextromethorphan, & nitrous oxide
- Causes different degrees of depressant and dissociative effects
What are Anticholinergic Hallucinogens?
- Naturally occurring agents - potato family Effects from 3 pharmacologically active alkaloids that are central and peripheral cholinergic blocking agents
- Atropine (dl-hyoscyamine)
- Scopolamine (l-hyoscine)
- l-hyoscyamine used as poisons and for hallucinogenic effects
- Blocks production of mucus in the nose and throat and prevent salivation
- Mouth becomes dry and perspiration stops Temperature can increase to fever levels Heart rate increases
- Eyes dilate
- At high doses, behavior pattern resembles toxic psychosis
- The original deliriants
What is Belladonna?
- Active ingredient is atropine Anticholinergic Hallucinogens:
- Name Atropa belladonna comes from two major historical uses
- As a deadly poison: Atropos, one of the Three Fates in Greek mythology 14 berries - lethal dose of atropine
- As a beauty aid: Belladonna, or “beautiful woman” Extract of the plant dilates the eyes
- Sensation of flying
- Tied to witchcraft and the activities ofwitches
What is mandrake?
- Contains all three anticholinergic hallucinogen alkaloids
- Close association with love and lovemaking Forked root - resemble a human body
What is henbane?
- an anticholinergic hallucinogen
- Contains scopolamineand l-hyoscyamine Used as a poison for ex. Shakespeare’s Hamlet
What is datura?
- anticholinergic hallucinogen
- Contain all 3 anticholinergic alkaloids
- Long history of religious and medicinal use
- China: Used to treat colds and nervous disorders
- Ancient Greece: Oracle to Apollo
- India: Worship of Shiva, ingredient in love potions
- Native Americans: Used Daturainoxia (jimsonweed)
What are synthetic anticholinergic hallucinogens?
- Used to treat Parkinson’s disease; still used to treat pseudoparkinsonism
- Concern about “anticholinergicsyndrome” Rarely used for delirium-producingproperties
What is Amanita muscaria?
- “Fly agaric”
- Common poisonous mushrooms
- Can cause severe effects of intoxication Twitching limbs
- Raving drunkenness
- Vivid hallucinations
- Followed by hours of partial paralysis with sleep and dreams
- Hallucinogen is excreted unchanged
- Sacramental use mentioned in the poems of the Rig Veda (India) Ambrosia (“food of the gods”)
- Cult that became Christianity
- Siberian nomadic tribes
- A holy plant - several tribal groups in the Americas
What is Salvia Divinorum(“Diviner’s Sage”)?
- Used in Oaxaca, Mexico, in religious ceremonies
- Traditional methods of use
- Chew Drink Smoke
- Produces a hallucinatory effect
- Mechanism of action
- Active ingredient: salvinorin
- A Highly potent agent
- Binds selectively to the kappa opioid receptor, acting as anagonist
What are the three species of cannabis?
- Cannabis sativa: used primarily for its fibers from which hemp rope is made
- Cannabis indica: grown for its psychoactive resins
- Cannabis ruderalis: grows primarily in Russia
What are the preparations of cannabis?
- delta-9-tetrahydrocannabinol (THC)
- Primary psychoactive agent in Cannabis THC is concentrated in the resin
- Potency of Cannabis preparations depends on the amount of resin present
- Most of the resin is in the flowering tops
- Less in the leaves
- Little in the fibrous stalks
- Hashish Most potent preparation
- In its purest form it consists of pure resin that has been carefully removed from the surface of leaves and stems
- Relatively rare in the U.S. About 1% of confiscated marijuana samples
- Sinsemilla 2nd most potent preparation
- Consists of dried flowering tops of plants with pistillate flowers (i.e., female plants)
- Average THC content is 11%
- Smokable marijuana in U.S., can vary widely in potency from Cannabis
- Preparations 1% THC (low-grade product) 11% THC (high-grade sinsemilla)
- About 50% of confiscated marijuana is sinsemilla
Marijuana History: U.S. Regulation?
- 1926: Series of newspaper articles linked marijuana and crime
- Public interest increased
- 1936: All states had laws regulating the use, sale, and/or possession of marijuana
- Most early regulation efforts based on concerns about use and criminal behavior
- Concerns not based on direct evidence
- Followed the regulation-by-taxation theme of the 1914 Harrison Act
- Grower, distributor, seller, and buyer were taxed
- Result: administratively almost impossible to deal in Cannabis
- State laws made possession and use illegal 1969: U.S. Supreme Court declared the Marijuana Tax Act unconstitutional
- Cost of marijuana increased significantly LaGuardia Report (1944):
- Concluded that marijuana use had less serious effects than commonly believed
- Report elicited strong negative reactions
- Use of marijuana increased throughout the1950s–1960s
- Use peaked in 1970s
- Marijuana use decreased in the 1980s
- But rose again in the 1990s
- After smoking
- THC is absorbed rapidly by the blood and travels to the brain and then the rest of the body
- Peak mood-altering and cardiovascular effects occur within 5 to 10 minutes
- After oral administration
- THC is absorbed more slowly
- Peak effects occur about 90 minutes following ingestion
- Metabolism THC has a half-life of 19 hours
- Complete elimination of THC and its metabolites may take 2–3 weeks
Brain mechanism of action for cannabis?
- CB1 receptors
- Found primarily in the brain but also throughout the body
- High density in specific brain regions
- Basal ganglia and cerebellum (movement coordination)
- Hippocampus (memory storage)
- Cerebral cortex (higher cognitive functions) Nucleus accumbens (reward)
- CB2 receptors
- Found mainly outside the brain in immune cells
- Potential role of cannabinoids in the modulation of the immune system
What is primary prevention?
- Primary prevention
- Aimed at young people who have not yet tried
- Goals: Encourage abstinence
- Teach people how to view the potential influence
- Avoid arousing children’s curiosity and encouraging them to try
What is secondary prevention?
- Aimed at people who have experimented but aren’t suffering serious consequences
- Many college students fall into this category
- Prevent use of other, more dangerous substances
- Prevent more dangerous forms of use
What is tertiary prevention?
- Aimed at people have been through treatment or stopped using on their own
- Goal is prevent relapse
- Conduct follow-up programs
What are other types of prevention?
- IOM’s “continuum of care”
- Classification scheme for prevention efforts Universal prevention: entire population
- Selective prevention: high-risk groups
- Indicated prevention: individuals
What are school-based prevention programs?
- Knowledge-Attitudes-Behavior model
- Affective education
- Anti-drug norms
- Social influence model
- DARE and other programs
What is the Knowledge-attitudes-behavior model of school prevention?
- Programs typically involve presentations by police and former users
- Model questioned by research findings
- Evaluation of effectiveness depends on program goals
What is the Affective Education prevention model?
- Focus on emotions and attitudes
- May reduce drug use if children are helped
- To know & express their feelings
- To achieve altered emotional states w/out drugs
- To feel valued & accepted
- Values clarification Assumes students have factual info
- Alternatives to drugs Assumes that one reason young people take drugs is for the experience of altered states of consciousness
- Personal and social skills Assumes that personal and social problems are causes of drug use
- Challenges: Affective education approaches Too experiential
- Too little emphasis on peer pressure skills
What is the Anti-Drug norm prevention model?
- Refusal skills and pressure resistance strategies
- Focus: teach students to recognize and respond to peer pressure
- Drug-free schools 1986: Government began providing direct aid to local school districts for drug-prevention activities
- DOE recommended school policies
- 1984 review of drug prevention programs
- Lacking appropriate evaluation component
- Few successes of actual substance abuse prevention
- Increased knowledge didn’t impact substance abuse
What is the Social Influence prevention model?
- Key elements
- 1. Training in refusal skills through films, discussion,
- and practice
- 2. Public commitment such as making a public pledge
- 3. Countering advertising by inoculating children against it
- 4. Normative education to teach students that they may overestimate the number of their peers who smoke
- 5. Use of teen leaders to talk to younger students about cigarettes
What is D.A.R.E.?
- Developed in 1983 in Los Angeles; spread to all states by the early 1990s
- Contains many components of earlier prevention models
- Studies on effectiveness of DARE
- 1994: affect self-esteem but no evidence for longterm reduction in drug use
- 1994: increase knowledge about drugs and knowledge about social skills, but the effects on drug use were marginal
- 2004: effect is small and not statistically significant
What are some prevention programs aimed at youth which work?
- Based on social influence model
- Project ALERT Targeted cigarette smoking, alcohol use and marijuana use
- Life Skills Training Teaches resistance skills, normative education, media influences, and general self-management and social skills
What is the Peer-based model of prevention?
- Peer influence approaches
- Open discussion among children or adolescents
- Opinions of an adolescent’s peers are significant influences on behavior
- Peer participation programs
- Emphasize becoming participating members of society
- Focus on youth in high-risk areas
- May involve activities ie. paid community service
What are the Parent and Family models of prevention?
- Informational programs for parents
- Rationale for these programs is that well-informed parents can teach appropriate attitudes
- Can recognize potential problems
- Parenting skills programs
- Focus on communication, decision-making, setting goals and limits
- Parent support groups
- Key adjuncts to skills training or in planning community efforts
- Family interaction approaches
- Families work as a unit
- Improve family communication and strengthen knowledge and skills
What are community-based prevention models?
- Reasons for organizing on the community level
- Coordinated approach at different levels can have a greater impact
- Programs that involve many groups can receive more widespread community support
- Community-based programs can involve other resources
- Communities Mobilizing for Change on Alcohol
- Community policy changes
- Encourages participation of many community organizations and businesses
How does one define treatment goals?
Treatment goals are influenced by the underlying theoretical view of substance abuse
Treatment goal for alcohol abuse?
- View that substance dependence is a biological disease that someone either has or does not have
- Only acceptable treatment goal is complete abstinence
- View that substance dependence represents one end of a continuum of drinking
- A possible treatment goal is controlled social use
Treatment goal for opioid abuse?
- View that substance dependence undermines the physical and mental health of its victims
- Only acceptable treatment goal is abstinence (traditional view)
- View that dependence on legal methadone is preferable to dependence on illegal heroin
- Goal of treatment has changed from eliminating opioid use to eliminating heroin use
How do you define treatment goals?
- How to evaluate treatment outcomes of reduced use as opposed to abstinence?
- Researchers are beginning to develop cost/benefit analyses
- Cost of treatment vs. Cost savings from increased employment and decreased crime after treatment
What is the AA treatment model?
- Founded in 1935
- Based on the disease model of dependence
- Major approaches are group support & a buddy system
- Formal evaluations of AA have not been very positive
- Evaluation is important because many treatment programs follow the 12-step model of AA
- for example, Betty Ford Center, Hazelden, Phoenix House
What is Motivational Enhancement Therapy?
- Conventional wisdom “rock bottom”
- Problem is that very serious consequences may occur before the abuser is ready for treatment
- Attempts to shift the focus away from denial and toward motivation to change
What is motivational interviewing?
- Used to boost the motivation to change of an ambivalent or less ready substance abuser
- A non-confrontational process of determining the abuser’s current stage of change and then helping the individual move forward
- Goals of motivational interviews
- Help the client focus on problem behaviors
- Help the client move forward to the next stage of change
What is contingency management?
- An approach in which individuals receive immediate rewards for providing drug-free urine samples
- Clients also participate in weekly skill-building counseling sessions
What is CBT?
- Cognitive Behavioral Therapy(CBT)
- Combines cognitive therapy techniques with behavioral skills training
- Learn to identify and change behaviors that could lead to relapse
- More effective than most therapies
- Considered challenging
- Despite this, it remains one of the most widely used substance abuse treatment strategy
What are pharmacotherapies and detoxification?
- Research efforts focus on developing medications for treatment Pharmacotherapies alone will not cure substance abuse
- Pharmacotherapies can provide a window of opportunity for behavioral/psychosocial treatments
- Detoxification is the initial and immediate phase of treatment
- Medications are administered to alleviate unpleasant and/or dangerous withdrawal symptoms
What is maintenance therapy and what are the three types?
- A longer-term strategy used to help avoid relapse
- Three general categories
- Agonist or substitution therapy
- Induces cross tolerance
- Antagonist therapy
- Prevents the reinforcing effects
- Punishment therapy
- Produces aversive reaction
What is the big picture in treatment for substances in US?
- Most frequently reported drugs for substance abuse treatment admissions
- Alcohol (42%)
- Opioids (21%)
- Marijuana (18%)
- Cocaine (9%)
- Stimulants (6%, primarily methamphetamine)
- Average age of those admitted is 34
- Sites of treatment
- 57% treated as outpatients
- 20% treated as hospital inpatients (detoxification)
- 17% treated in a residential setting
- 6% treated in medication-assisted opioid programs