Club Drugs Flashcards
d-Methamphetamine
Large crystals of pure D-isomer are often smoked, much like CRACK snorted and IV use to Long duration of action Similar "runs" then crash New "high-tech" drug Longer acting than CRACK Effective weight reduction
Psychiatric Complications d-Meth
Acute anxiety Acute paranoid psychosis Chronic schizophreniform psychosis Possible induction of panic attacks not due to latent psychosis
MDMA vs Molly
Molly more a pure form than MDMA
devoid of adulterants and is claimed to be safer and non-addictive
Molly is the powder form so it can be snorted
MDMA is typically sold as a pressed pill and is swallowed
MDMA Effects
Induced altered state of conciousness
Patients receptive to psychotherapy
Facilitates communication skills and heightens empathy– spiritual pursuit
Adjunct to insight oriented psychotherapy
No memory deficits
Neuropsychological test performance is impaired with chronic use
MDMA Abuse Liability
MDMA is self administered by rhesus monkeys and baboons
MDMA shared discriminative stimulus effects with amphetamine
MDMA is reinforcing in human volunteers
MDMA USE Profile
Oral dose of 100-200 mg
Smoked, snorted, or injected
Stacking or piggybacking- taking 3 or more tablets at a time
Used at parties often with other drugs
MDMA mechanism of action
Binds to 5-HT transporters in plasma membrane and secretory vesicle
Enter the vesicle and causes massive release of serotonin
Extra serotonin binds to receptors
Half life of 8-9 hours
Next day “pleasant”effects due to its MDA metabolite that exerts LSD like effects
Effects of MDMA on serotonin
Once effects wane, users tempted to take another dose, but serotonin levels are low
Serotonin dip that may last days to weeks- depressed mood
Prolonged use will cause a depletion in serotonin
Continued use will also cause a down regulation of serotonin receptors
Likely cause of depression in MDMA users
MDMA and other drugs
Some obtain Prozac to deal with depression
others get ritalin to increase concentration
Mix of drugs is dangerous
Tolerance develops to its effects with prolonged use
Toxicity- MDMA
Psychiatric Toxicity Induction of panic disorder Long-lasting neuropsychiatric syndromes Psychosis, visual illusions and hallucinations Flashbacks Neurotoxicity Cerebral infarcts Subarachnoid hemorrhage Hyponatremia with stupor
General Toxicity MDMA
Sympathomimetic reactions
hyperreflexia, hyperthermia and rhabdomyolysis
Kidney failure, seizures, coma and death
Hyperthermia secondary to neurotransmitter depletion
Fatal or near fatal reactions
Mechanism of Toxicity MDMA
Mechanism unclear– first thought to be hypersensitivity reaction
Recognized as due to overdose
MDMA is metabolized to MDA, more potent neurotoxin
Neuronal Damage MDMA
Can damage neurons that make serotonin
Damage is long lasting (6 years)
Neuronal damage persists long after effets have worn off
Nerve fibers regrow in some brain areas, but make abnormal connection, and some do not regrow
Rohypnol
Roofies
Sedation, amnesia, muscle relaxation, slowed relexes
Often used in combination with ethanol, marihuana or cocaine to produce a very rapid and dramatic high
Used as a parachute with heroine and cocaine users when coming off the high
Inexpensive on the street, sold in bubble packets
Gamma hydroxybutyrate
GHB does not act directly on GABA receptors
May inhibit release of dopamine, resulting in stored levels that are released later
Stimulates GH release and PRL rises
PCP
Made in 1950s as anesthetic
Analgesia, muscle relaxation, no cardiovascular or respiratory depression, no amnesia after surgery
During recovery, many patients have emergent nightmares that last 4-5 days
PCP joints called sherms
Lab animals self administer PCP
NMDA receptor antagonist
Ketamine
Analogue to PCP
Currently used in veterinary medicine
Applied as a powder to marihuana or tobacco cigarettes and smoked
Powder form is snorted like cocaine
IV has rapid onset
High doses can result in delirium, amnesia, impaired motor function, and sometimes fatal respiratory effects
PCP and Ketamine Mechanism of Action
Antagonists at the NMDA receptor which binds glutamate and glycine to allow neural transmission to occur
Other drugs act in a similar manner to produce dissociative, hallucinogenic euphoria include dextromethorphan, methoxetamine and nitrous oxide
Psychotomimetic
Agent that produces effects that resemble psychosis
LSD Effects
Restlessness, dizziness, drunk
Stream of plastic and vivid images accompanied by intense splay of colors
altered sense of time
reduced sensory input
Synesthesia, mixing of senses
Higher doses: marked distortion of vision, unable to move and transformed senses
LSD
4000 times more potent than mescaline
Used to model psychosis to improve treatment
Felt one could access the subconscious mind through dreamlike quality of the experience
LSD uses
Adjunct to psychotherapy
Treatment for alcoholics
Help terminal cancer patients understand their mortality
LSD illegal
LSD Pharmacology
Similar structure with serotonin suggests that it acts as an agonist at 5-HT receptors
Serotonergic antagonist do not block all of LSD effects and can act as an agonist or antagonist on different serotonergic systems
High correlation between binding potency in rat brain and potency to produce hallucinations in humans
LSD Patterns of USe
Formulated as a powder, capsule, pill, or solution
Use is infrequent, tied to specific events along with friends
Recent increased use due to lower unit dose and fewer adverse effects
LSD Adverse Reactions
Difficult to determine dose
Panic reactions
Flashbacks can occur months later
Brief recurrence of either psychotic or nonpsychotic effects
Mostly before sleep or under stress or after marihuana or barbiturates
Prolonged Psychotic Reaction LSD
Prolonged psychotic reactions (Up to 3 weeks)
Schizophrenic- like is most common, but catatonic depression paranoia and manic psychosis is all noted
Reports after a single dose have appeared
Originally though it happened with people with underlying psychiatric conditions- can occur in people with no psychiatric disorders
Psilocybin
Dried mushroom contain 0.2-5%
Effects similar to LSD
Metabolized to psilocin, 1.5 times more potent
Amateur production
Taken with ethanol, effects difficult to percieve
Psilocybin Use
Treating tobacco dependence
Mescaline
Found in cactus
Buttons softened in saliva and softened
Active item is mescaline, one of 30 different psychoactive chemicals
Need 20 mescal buttons to achieve average dose
Mescaline Pharmacology
Binds and activates 5-HT receptors
Absorbed orally but does not easily pass the blood brain barrier, high doses needed for psychoactive effects
Doses of 200-250 result in pleasurable experiences while 350-450 mg produce frank hallucinations
Blocked by 5-HT antagonists
Cross tolerant with LSD
Mescaline Effects
Mydriasis, hyperthermia, anxiety hallucinations and altered body image
Body parts may disappear
High doses induce bradycardia, reduced respiratory rate, smooth muscle contractions, in coordination, loss of time perception
Effects persist for 10-12 hours
Salvia Divinorum
Mexican herbal sage that produces type of divine innebriation
Effects are not like any other drug- best used by those wanting deep meditation
Salvinorum A- kappa opioid agonist and D2 receptor partial agonist with mild hallucinogenic properties
Used in more quiet settings for introspective contemplation and meditation
Salvia Divinorum Pharmacology
Buccal absorption via either chewing leaves or tincture takes longer to appear
Most rapid onset via smoking, but need high temperature to release it
Fortified leaf is preferred
High LD50 so relatively safe
Smoking produces effects nearly immediately, peak within 5-10 min
Therapeutic Potential Salvia Divinorum
Modulator of opiate receptors that regulate dopamine levels- stimulant abuse
Psychotherapy- not likely to be approved
