Chapter 6 The Major Stimulants

Question 1

What are the three effects of cocaine?

Answer 1

Stimulant effects, vasoconstriction, and local anesthesia

Question 2

What is cocaine a purified product of, and where is it grown?

Answer 2

It’s a purified product of the leaves of the coca plant, and it is grown in the Andes Mountains: Bolivia, Peru, and Columbia

Question 3

What is coca believed to help with?

Answer 3

Energy and altitude sickness. Coca products such as coca tea are legally sold locally; efforts to eradicate it has not been met with great success

Question 3

When was cocaine first isolated from coca leaves?

Answer 3

1860; “Vin Mariani” was made by soaking coca leaves in wine and the alcohol dissolved the active ingredient

In the 1880’s, American surgeon William Halsted showed that injecting cocaine into a nerve would produce safe, effective, temporary anesthesia.

Question 4

Why was the medical community concerned about cocaine use by the early 1900’s?

Answer 4

Cocaine tended to become habitual and unlike morphine, cocaine addicts weren’t very functional. Before, cocaine had been used briefly to treat morphine addiction and other maladies.

Question 5

Which Act restricted both cocaine and morphine?

Answer 5

The Harrison Narcotics Act; cocaine appeared in the later 1970’s as a fashionable, expensive drug. Cocaine was associated with the 1980’s conspicuous consumption, the “yuppie” lifestyle, and so on.

Question 5

Cocaine became associated with what group in the public’s mind?

Answer 5

African Americans; it spawned wild (and racist) rumors about cocaine-crazed black men who were strong, depraved, and had incredible marksmanship.

Question 7

What is crack cocaine and when did it first appear?

Answer 7

Crack cocaine is a smokable form of cocaine with a short high; it is seemingly cheap and associated with “ghetto”. The appearance of crack diminished cocaine’s status considerably.

It first appeared in the mid-1980’s.

Question 7

What effect did the 1986 Anti-Drug Abuse Act have on crack cocaine?

Answer 7

It treated crack as 100 times the same amount of cocaine (i.e., 10 grams of crack had the same legal penalty as 1,000 grams of cocaine).

This 100-fold difference was reduced in 2010 to 18-fold, and groups have continuously worked to eliminate any difference at all

Question 7

How is cocaine used?

Answer 7

As a powder, smoked, or as a solution.

Question 7

What is the onset of effects when cocaine is sniffed as a powder, and how long does the high last?

Answer 7

The onset of effects is a little longer than one might think because of the vasoconstrictive properties, but it still only takes a matter of minutes.

The high is fairly brief, peaking at 15-20 minutes and lasting an hour or so.

Question 7

What are the physical effects of cocaine?

Answer 7

• alertness and wakefulness
• agitation and restlessness
• increased heart rate and blood pressure
• increased body temperature

Question 7

What ways can cocaine be administered so that the onset of effects is very rapid?

Answer 7

Either converted into crack and smoked, or put into a solution and inject, typically through an IV.

Question 8

What are the psychological effects of cocaine?

Answer 8

• euphoria, but also anxiety and volatility
• increased self-confidence, feeling powerful
• increased (even pressured) speech, especially boastfulness
• racing thoughts

Question 9

What are the possible risks of high doses of cocaine?

Answer 9

• heart arrhythmia, heart attack, seizures, hemorrhagic stroke
• hyperthermia and possible renal failure
• paranoia
• compulsive behavior
• pulmonary issues and nasal septum perforation

Question 10

What are the withdrawal symptoms of cocaine use?

Answer 10

• depression and dysphoria
• irritability
• sleep disturbance
• intense drug craving

Question 11

Does cocaine use while pregnant cause extreme issues with the fetus?

Answer 11

No; the “crack baby” scare from the late 1980’s was overblown, but there are effects of prenatal exposure to cocaine. Some may be due to the vasoconstrictive effects, and even more so to other drugs take at the same time. It is difficult to separate the effects of prenatal cocaine exposure from the poor environment you might expect in these situations.

Question 12

What are the teratogenic effects of cocaine use?

Answer 12

• spontaneous abortion and stillbirth
• prematurity
• ADHD
• small size for gestational age
• irritability and difficulty in soothing

Question 12

What do the local anesthetic effects of cocaine do?

Answer 12

They block sodium channels on nerves that carry pain information.

Question 13

What do the stimulant effects of cocaine do?

Answer 13

They block dopamine reuptake, by binding to the transport proteins on the neuron’s terminal buttons. Dopamine accumulates in the synapse.

Question 14

A “cocaine vaccine” is in development by at least one drug company. How would it work?

Answer 14

It would be used as a treatment to prevent craving or block the euphoria of cocaine. Cocaine or similar molecules are attached to another molecule that would stimulate an immune response. There are two results:
1. an antibody will attach to any cocaine the person uses, and the cocaine/antibody complex will not cross the blood brain barrier
2. cocaine is destroyed by the immune system, as opposed to its metabolism by the liver

Question 14

Would a cocaine vaccine actually work?

Answer 14

Human trials suggest that it is effective when immune response is great enough; variability in immune response makes it tricky. Even with a good immune response, a determined user could still escalate the dose enough to get an effect.

Question 15

When were amphetamines patented?

Answer 15

1932 and they were freely available for a period of time. They are considerably newer than cocaine.

Question 16

What were the original uses of amphetamines?

Answer 16

Asthma (as an inhaler), weight loss, wakefulness, narcolepsy, and ADHD. Today, they have been largely replaced for the first four but are still used for ADHD.
They also improve memory, but the effect is not profound.

Question 17

What are the mechanisms of action for amphetamines?

Answer 17

Include d-amphetamine, amphetamine (combo of d and l), and methamphetamine.

• Adderall is a mix of amphetamine and a-amphetamine. Methamphetamine crosses the BBB more readily than others.

Question 18

How do amphetamines enter the terminal buttons?

Answer 18

The transport proteins used for reuptake; amphetamines force the release of dopamine.

Question 19

How does the entry of the drug potentially explain how amphetamines can harm neurons?

Answer 19

Amphetamines can seriously damage neurons over time. It is believed that free radicals are produced when the neurons treat the drug as it would the neurotransmitter, and free radicals are known to be neurotoxic

Question 20

What are the multiple routes of administration for amphetamines?

Answer 20

They can be inhaled (via inhalers in the earlier days, more recently by smoking crystal meth), taken orally, injected, or snorted.

They often follow a “run” and “crash” pattern of use; tolerance is seen during a run.

No legitimate injectable forms on amphetamine are produced.
The duration of effect varies but is considerably longer than cocaine.

Question 20

What is the relationship between cocaine and amphetamines?

Answer 20

Historic trends suggests that they have an inverse relationship, suggesting that people will use whatever they can find and buy. It also suggests that if cocaine availability decreases, amphetamine use will go up and vice versa.

Question 21

What are the short term effects of amphetamine use?

Answer 21

• wakefulness, euphoria, energy
• appetite suppression
• increased feeling of power and confidence
• increased blood pressure and heart rate
• at higher doses (esp. after repeated use): paranoia, suspiciousness, stereotypies, aggressive outbursts and delusional parasitosis, and neurotoxicity

Question 22

How can amphetamines kill you?

Answer 22

Seizures, heart attack, stroke, or excess fever

Question 23

What are the teratogenic effects of amphetamines?

Answer 23

They are not clearly described, but are in the direction of those described for cocaine users.

Question 24

Why is methamphetamine so popular?

Answer 24

• it’s relatively easy to make and there are several different methods
• it’s cheap and lasts a long time (half-life of smoked meth is about 11 hours)
• it produces serious dependences; users often neglect family or responsibilities
• chronic use is associated with neurotoxicity: reduction in gray matter and increased ventricular size, and a leaky BBB
• production of meth causes environmental damage and can render a home unlivable