Lecture 9 Flashcards
What is the nature of stimulants?
- Most widely consumed drugs in the U.S.
- Increase alertness and increase energy
Examples: Amphetamines, cocaine, nicotine, and caffeine
What is the DSM-5 criteria for stimulant intoxication?
Recent stimulant use leading to significant cognitive impairment and psychological changes
- Accompanied by physical changes (e.g., change in HR/BP, dilated pupils, weight loss, vomiting, weakness, chills)
What are the effects of amphetamines?
- Produce elation, vigor, reduce fatigue
- Such effects are usually followed by extreme fatigue and depression
Amphetamines stimulate CNS by…?
- Enhancing release of norepinephrine and dopamine
- Reuptake is subsequently blocked
What are amphetamines?
A racemic mixture of equal parts d-amphetamine and I-amphetamine
(levoamphetamine + dextroamphetamine)
This term is used informally when referring to either d or l mixed or separate
d-isomer is more potent - clinically effective
What are amphetamines used to treat?
They are used to treat ADHD and narcolepsy (Ritalin, Adderall, etc)
Binge-eating disorder Lisdexamfetamine (Vyvanse) long-acting amphetamine
True or False: Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence
True
True or False: Decreases in D2 receptors are associated with decreases in prefrontal cortical activity
True
Why were amphetamines given to soldiers during WWII?
- Given to soldiers during WWII to enhance alertness, and decrease need for sleep
- “Go Pills”
- Wasn’t frowned upon like other drugs that provided “an escape” instead of “enhanced mental capacity” in civilians as well
Nazi were supplied with a methamphetamine called Pervitin… American and British were supplied with….
Nazi were supplied with a methamphetamine called
Pervitin
American and British→ Benzedrine.
Which ADHD drugs are amphetamines?
Adderall and Ritalin
Ecstasy and crystal meth both have…?
Both drugs have a high risk of dependence
What is the DSM-5 Criteria for Stimulant Use Disorder?
A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
(1) The stimulant is often taken in larger amounts or over a longer period than was intended
(2) There is a persistent desire or unsuccessful efforts to cut down or control stimulant use
(3) A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects
(4) Craving, or a strong desire or urge to use the stimulant
(5) Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home
(6) Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant
(7) Important social, occupational, or recreational activities are given up or reduced because of stimulant use
(8) Recurrent stimulant use in situations in which it is physically hazardous
(9) Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant
(10) Tolerance, as defined by either (a) a need for markedly increased amounts of the stimulant to achieve intoxication or desired effect or (b) a markedly diminished effect with continued use of the same amount of the stimulant
(11) Withdrawal, as manifested by either (a) the characteristic withdrawal syndrome for the stimulant or (b) the stimulant is taken to relieve or avoid withdrawal symptoms
How do you determine the severity of stimulant use disorder?
Mild: Presence of 2-3 symptoms
Moderate: Presence of 4-5 symptoms
Severe: Presence of 6 or more symptoms
True or False: amphetamine is a derivative of methamphetaime?
FALSE.
MA is a derivative of amphetamine
When were amphetamines first studies?
Amphetamines were studied first in the early 1930s
What is a CNS stimulant?
Stimulates the sympathetic nervous system
How were amphetamines used medically?
Medical use as a nasal spray -bronchial passage dilation, narcolepsy, reducing activity in hyperactive children, suppressing appetite, and enabling people to stay awake for extended periods
What is the main effect of methamphetamines?
Main effect is increases levels of dopamine, also noradrenaline and serotonin
It blocks transporters and inhibits monoamine oxidase
Leads to feelings of euphoria, alertness and increased energy
How were methamphetamines manufactured?
Illegally manufactured by combining the amphetamines ephedrine or pseudoephedrine with other chemicals and added to a solvent such as gasoline and heated to crystallize
What are the street names for methamphetamine?
Crystal meth
Glass
Ice
What can you say about the high of methamphetamine?
The “high” lasts longer than other stimulants
6-12 hours- the drug is metabolized by the body at a much slower rate
How is methamphetamine available to treat obesity and ADHD?
Available in prescription as Desoxyn® to treat obesity and ADHD (must be >6 years)
True or False: Second leading cause of overdose deaths in the U.S. and a leading cause of emergency room visits
TRUE
What was the production and use of methamphetamines?
- In the 1960s and 1970s in the USA, motorcycle gangs based in California were the primary producers and distributors of methamphetamine, appealing to white, male, blue-collar workers.
- Eventually broadened, encompassing white-collar workers, students, ethnic minorities, and women.
- Law enforcement frequently discovers domestic labs in the USA and globally, notably in Asian regions.
- Industrial-scale producers trafficking substantial quantities of the drug.
- Mexico and Canada play primary roles in large-scale production, smuggling methamphetamine across the US border.
- Currently, most methamphetamine in the United States is produced by transnational criminal organizations (TCOs) in Mexico
How did the production of methamphetamine change after 2005?
Congress passed the Combat Methamphetamine Epidemic Act in 2005
- Pharmacies and other retail stores must keep logs of purchases of products containing pseudoephedrine
- Behind the counter instead of on the shelves.
- Limits the amount that can be purchased per day.
- Dramatically reduced domestic production
- Ex: In 2010, 15,256 domestic methamphetamine laboratory raid: 3,036 in 2017.
Who is using methamphetamines?
Historically, adult male with a lower-than-average income.
- More recently, of all ages and economic status use methamphetamine.
- Slightly higher in minority populations of color.
- Subculture of men who have sex with men. MSM
- 9.6 million U.S. residents aged 12 and older used methamphetamine at least once in their lifetime.
- In 2022, an estimated 0.2% of 8th graders, 0.3% of 10th graders, and 0.5% of 12th graders reported using it in the past 12 months.
- Individuals 12 or older in 2021 -0.6% (1.6 million people) had a methamphetamine use disorder in the past 12 months
What are the methods of using methamphetamines?
- Sniffed
- Smoked
-Orally - Injected
What are the fastest routes of absorption for methamphetamines and what are the times?
Smoking and injection are the fastest routes
- Smoking: 10 seconds
- IV: 15 seconds
- Sniffing: 3-5 minutes
- Orally: 20-30 minutes
What are the motivation for using meth?
Physical Domain
- Physical sensations, secual and non-sexual
- Facilitation of sex
Emotional Domain
- Emotional enhancement
- Escape
Social Domain
- Social interaction
- Overcoming social inhibitions
What are the reported positive effects of methamphetamines?
- Increases alertness, concentration, attention
- Decreases fatigue
- Improves cognition
- Increases libido
- Increases sexual performance time
- Some report enhances sexual experience
- Increases sense of well being
- Hallucinogenic effects
What is the associated harm with methamphetamines?
More likely to experience severe medical and psychiatric consequences
Worsen the progression of HIV and outcome. Preclinical studies: increase in viral replication.
Abnormalities in cellular fat metabolism,
Inflammation +rise in formation of ceramides (pro-inflammatory molecules that increase cell aging and death).
Degraded physical and social functioning
Withdrawal Symptoms: anhedonia, irritability, fatigue
What are the long-term associated harm with using meth?
Chronic use can result in profound neuropsychological deficits
- Impaired Impulse Control
- Impaired Working Memory
- Focus on small immediate rewards (Bad Deck)
- Impaired Judgement
- Psychosis (paranoid delusions, hallucinations)
- Focus on small and immediate rewards
- Decreased working memory Physical deterioration
- Premature Aging
- Dental Problems (Tooth Decay and Loss)
- Psychomotor dysfunction
What is the relation between Methamphetamines and dental issues?
Research suggests MA smoking has more deleterious effects on teeth due to the chemicals contacting enamel.
Also causes oral sores and infections
Injectors experience some decay due to dry mouth and excessive clenching and grinding.
Enamel begins to flake off, and eventually teeth deteriorate.
