Midterm #1 Flashcards
4 General principles of psychoactive drugs use
1 - drugs aren’t bad or good
2 - every drug has multiple effects
3 - size and quality of the effect depend on the amount taken.
4 - effects depend on individual history and expectations
Drug misuse
use of drugs in a greater amount than suggested or for a purpose other than suggested.
Drug abuse
drug use in a manner, amount, or in a situation that causes social, occupational, psychological, or physical problems.
dependence
when a drug is used so frequently that it would be difficult to stop.
- psychological/behavioural
- physiological/physical
tolerance
reaction to a drug decreases so that larger doses are required to achieve the same effect
- lower effect after repeated use
- body learns to compensate for chemical imbalances.
withdrawal
abnormal physical or psychological effects of stopping drug use.
examples of withdrawal symptoms
- sweating
- tremors
- vomiting
- anxiety
- insomnia
- aches and pains.
Correlate vs. antecedent
correlate - a variable that is statistically related to another
antecedent - a factor that occurs before an event
Correlates to drug use
race/ethnicity/culture gender education personality genetics
NOT SOCIOECONOMIC STATUS or personality problems
Antecedents to drug use
aggressiveness conduct problems poor academic performance attachment to drug-using peers parental and community norms
Risk factors for drug use
- community/peer/parental attitudes toward drugs
- antisocial behaviour
- poor academic performance
Protective factors against drug use
- involved with religion
- perceived harm of drug
Motives fr Drug use
- characteristics of the drug
Motives for TRYING - family/community/societal factors
Motives for CONTINUING - drug properties/charcteristics
drug
any substance, natural or artificial, other than food, that by its chemical nature alters structure or function in a living organism
psychoactive drug
a drug that specifically affects thoughts, emotions, or behaviours
illicit drug
a drug that is unlawful to possess or use.
harm reduction
initiatives of Canada’s Drug Strategy to use public education programs to significant;y reduce the damage associated drug use.
Federal approach to drug regulation in early 1900s?
- relaxed
- laissez-faire
- no regulations
acute behavioural toxicity
intoxication that disrupts to actions of the user and increases danger to others. eg. drunk driving.
acute physiological toxicity
overdose
chronic behavioural toxicity
personality/lifestyle changes and effects on relationships
chronic physiological toxicity
heart disease, lung cancer, cirrhosis, etc.
Examples of Drug Monitoring Systems
- Drug Abuse Warning Network (DAWN)
- Canadian Institute of Health information (CIHI)
- Canadian Vital Statistics (CVS)
- Canadian Centre of Substance Abuse (CCSA)
Drug Abuse Warning Network (DAWN)
- US system
- doesn’t include all hospitals
- doesn’t consider # of users vs. # of reported problems
- doesn’t consider relative danger vs. total impact.
- does NOT tell use how dangerous a drug is, but can give us a picture of the deaths and ER visits due to different drugs.
Canadian Vital Statistics (CVS)
causes of drug related emergency room visits and deaths
Canadian Centre on Substance Abuse (CCSA)
information on mortality due to alcohol, illicit drugs and tobacco.
physical dependence
The body has adapted to the drug’s presence
- tolerance precedes physical dependence
behavioural / Psychological dependence
- emotional desires
- cravings
- behaviour is reinforces by consequences.
- biggest reason for relapse and continued use.
Perspectives on Substance Dependence
- Early Medical model
- Positive Reinforcement Model
- Psychological Dependence
Early Medical Model of Substance Dependence
- a true addiction is defined by physical dependence
- solution = treat withdrawal symptoms.
Positive reinforcement model of Substance Ause
drugs can reinforce behaviour WITHOUT physical dependence.
Psychological Dependence Model of Substance Abuse
- Current understanding
- psychological dependence is the driving force for repeated use.
- evidence against the argument that less addictive drugs are less dangerous.
DSM-V criteria for a substance related and addictive disorder
6/11 symptoms
Impaired Control
- taken in large quantities for longer periods of time
- persistent desire & unable to cut down
- lots of time spent getting, using, and recovering from drug use.
- cravings
Social Impairment
- failure to fulfill major obligations
- continued use despite social and interpersonal problems
- withdrawal from family, friends, and hobbies.
Risky Use
- use of the drug in physically unsafe situations
- failure to stop, despite know it is physically or psychologically damaging.
Pharmacokinetics
- withdrawal
- tolerance
10 categories of drugs in DSM-V
- cannabis
- alcohol
- hallucinogens
- inhalants
- opioids
- sedatives
- hypnotics & anxiolytics
- stimulants
- tobacco
- caffeine
List the Theories of the Cause of Dependence
- the subatcne
- biological
- personality
- family
- biopsychosocial
The Substance - Theory of Dependence
- some drugs are more likely to cause dependence
- nature of the drug
- perpetuates the “war on drugs”
- perpetuates the idea that drugs themselves are bad.
Biological - Theory of Dependence
- biochemical and physiological processes of the brain cause dependence.
- we can’t know if this is the cause because we are unable to test it.
- genetics have been implicated but none have solid evidence
- even if there is some biological relationship to dependence, environmental factors are still required to induce the effect.
Personality - Theory of Dependence
- we see relationships between certain personality types and drug dependence
eg. sensation-seeking and impulsive personality types. - unsure if the personality causes the drug problem or if the drug problem causes the personality to change.
Family - Theory of Dependence
- dysfunctional family relationships play a role in dependence.
- comes from families with a history of alcohol abuse.
- even if there is some familial relationship, other factors are required.
Biopsychosocial - Theory of Dependence
Currently agreed upon
- biological
- personality
- social interactions/environment.
4 ways drug use might cause increased crime
- drug use changes people’s personalities
- people under the influence are more likely to commit crimes. (lowered inhibitions, more aggressive, etc.)
- crimes are often carried out to obtain money for drugs
- drug use itself is a crime.
Timeline of important historic events in Drug Policy
1908 - Opium Act 1909 - Patent Medicine Act 1911 - Opium & Drug Act 1950's - decline in drug use 1961 - Narcotic Control Act 1969 - Le Dain Commission 1960's/1970's - incline in drug use 1987 - Canada Drug Strategy 1996 - Bill C8 (the controlled Drugs and Subatnces Act) 2003 - Canada's Drug Strategy Renewal 2007 - National Anti-Drug Strategy 2013 - Bil S-10 (Safe streets and communities act)
The Opium Act
- 1908
- beginning of drug regulation in Canada
- public fear of East Asian Immigrants
- couldn’t sell, but could still possess and use.
Conclusions of the Opium Act
1 - opium smoking was growing in popularity among whites
2 - Chinese merchants were profiting from the opium trade
3 - the opium trade was in violation of current provincial pharmacy legislation
4 - Canada has a moral responsibility to serve as a leader in the campaign against opium use.
Patent Medicine Act
- 1909
- much stricter on prescription drugs
- created the federal department of health (replaced in 1920)
- minister of health could cancel drug licenses
Patent Medicine Act requirement of prescription drugs
- documentation and approval
- No cocaine
- list all ingredients
- other specific requirements - licensing, etc.
The Opium and Drug Act
- 1911
- beginning of the enforcement era
- response to failure of the opium act.
- favored imprisonment
- targeted Chinese immigrants, excluded Canadians.
The Narcotic Control Act
- 1961
- highly punitive
- criminalization of drugs
- challenged by emerging public health movement.
The Le Dain Commission (1969) recommendations
- gradual decriminalization
- possession of cannabis - not an offense
- more lenient for possession of other illicit drugs
- no imprisonment
- government research required.
Canada Drug Strategy
- 1987
- new era of drug prohibition
- Canada follows suit w/ Ronald Reagan - “The War on Drugs”
- substance abuse disorders viewed as a health issue.
Goals
- control and enforce
- prevention
- treatment & rehab
- harm reduction
Canada Drug Strategy Renewal
- 2003
more focused on harm reduction and prevention - reduce harm
- control substances, alcohol, and drugs.
- promote education, prevention, and health promotion.
National Anti-Drug Strategy
- 2007
- aim to reduce supply and demand
Bill C8
- 1996
- The Controlled Drugs and Substances Act
- regulations for anything imported, exported, produced, sold, provided or possessed in Canada.
- prescription drugs from a doctor only and no sharing
- convictions for trafficking, possession, export, import, or trade.
- responsible for sentencing, drug paraphernalia laws, regulations on sales of alcohol/tobacco, impaired driving, and diversion to treatment
Bill S-10
- Safe street and communities act
- ended in 2013
- Stephen Harper
- mandatory prison time, jail sentences for marijuana, sentencing for aggravating factor
Impacts - target marginalized groups
- more punishment than protection.
Pharmaceutical Regulation in Canada - Federal level
- regulated by Health Canada
- Health Products and Food Branch (HPFB)
includes - human and animal drugs
- medical devices
- NHPs
- other therapeutic products
New Drug Submission process
New Drug Submission Process
- Clinical trials and scientific evidence have to show results for safety, efficacy, and quality
- File a New Drug Submission (NDS) with HPFB
- releasing a generic brand? - must show comparable bioavailability
- any changes to a drug must submit a new NDS
Successful submission of a New Drug Submission?
- Notice of Compliance (CIN)
- Eight digit drug identification Number (DIN)
Pharmaceutical regulations in Canada - Provincial
- drug benefits
- assess drug or medical device eligibility for inclusion in drug formularies
- manage drug formularies
- assess whether a brand-name & it’s generic competitor are interchangeable.
3 phases of clinical research for a new drug
1 - low dose. 20-80 health volunteers
2 - 200 patients who could benefit
3 - 1000-5000 patients.
Marijuana Medical Access Regulations (MMAR)
- 2001
- Through health Canada (Federal)
- allows possession and production of marijuana for individual use
Who could apply?
- Compassionate end of life / symptoms associated with specified medical conditions
- Debilitating symptoms.
Marijuana for Medical Purpose Regulations (MMPR)
- 2014
- Through provincial health care - pharmacist, doctor, health care practitioner.
- individuals aren’t licensed to produce marijuana anymore, only licensed producers.
Complaints leading from MMAR -> MMPR?
- application process
- single strain
- potential for diversion to illicit markets (feds can’t monitor it as closely)
- risk of violence and home invasions
- fire hazards
Benefits of switching from MMAR -> MMPR
- more efficient
- more authorized practitioners that can allow access.
- more straings and suppliers
- quality-controlled
NHP regulation in Canada
Natural Health Products Directorate (NHPD) - regulatory authority
What is a NHP?
- vitamins & minerals
- herbal remedies
- homeopathic medicines
- tradition medicines (Chinese, Ayurvedic)
- probiotics
- amino aicds
- essential fatty acids
Why have NHPs become so popular?
- interest in foods that can be used as prevention and treatment
- growing belief that NHPs are better than chemical drugs
- aggressive multi-level marketing organizations distributing NHPs
Health Canada Concerns with NHPs
- NHPs are classified as food, not drugs
- evidence for safety, but not efficacy
- exempt from providing contraindications, side effects, etc.
Aggravating factor
anything involving youth
drug
any substance “manufactured, sold, or represented for use in the diagnosis, treatment, mitigation or prevention of a disease, disorder or abnormal physical state, or its symptoms, in human beings or animals
food
any article manufactured, sold, or represented for use as a food or drink for humans.
NHP
a variety of substances that are formulated, packaged, and/or promoted in a manner similar to drugs but were classified and regulated as foods.
Homeostasis
a state of equilibrium - temperature, acidity, water, sodium, glucose, physical/chemical factors
Properties of Glial cells
- brain structure and support
- bring nutrients and eliminate waste
- form myelin
- BBB
- communication
Types
- astrocytes
- microglia
- oligodendrocytes
Properties of Neurons
analyze and transmit information regions - dendrite - body - axon - presynaptic terminal
Steps of an Action Potential (AP)
1 - resting period - K open, Na closed 2 - threshold - Na opens - ion influx - depolarization 3 - overshoot - voltage-gated Na channels open - continued influx and depolarization 4 - undershoot - inactivation of Na, K open - ion eflux - repolarization & hyperpolarization
Dopamine
- ganglia
- reward, pleasure, motor function, compulsions
- nigrostriatal pathway - muscle rigidity
- mesolimbic pathway - psychotic behaviour, potential reward pathway involvement.
Acetylcholine
- cerebral cortex and basal ganglia
- learning and memory
- Alzheimers
- Rhodiola Rosea - inhibits Ach esterase & improves memory.
Norepinephrine
arousal, attentiveness, wakefulness, food intake, body weight
Serotonin
- brain stem (raphe nuclei)
- mood, memory processing, sleep, cognition, impulsivity, aggression, depression, control of food & alcohol intake
Drugs that target Serotonin Pathways
- LSD/Hallucinogens
- Sibutamine - diet drug - SNRi
- SSRIs - depression drug
GABA
- inhibitory
- found everywhere
- sedative drugs target GABA pathways
Glutamate
- excitatory
- found everywhere
- euphoric effects of cocaine associated.
Endorphins
- opioid-like chemicals naturally occuring in the brain
- pain relief
- plays a role in drug abuse and dependence but it isn’t understood well.
Life Cycle of an NT
- NT precursor circulates in blood
- uptake of precursor
- synthesis of NT in cell
- storage in a vesicle
- AP = release of vesicle
- NT binds to receptor on postsynaptic terminal (excitatory or inhibitory effect)
- re-uptake or metabolism
Brain imaging techniques
- PET scan
- MRI
Major Drug Categories
- Stimulants
- Depressants
- Opioids/Narcotics/Analgesics
- Hallucinogens
- Psychotherapeutics
dose-response relationship
determines how much of a drug causes a particular effect in the body.
effective dose (ED)
the dose of a drug that produces a meaningful effect in some percentage of the test subjects
ED50
the effective dose for half the subjects of a drug test
Lethal Dose (LD)
the dose of a drug that has a lethal effect in some percentage of test subjects
LD50
the lethal dose for half the subjects in a drug test.
Therapeutic Index
LD50 / ED50
> 1
* always want LD50 to be higher than ED50.
drug effects
behavioural, cognitive, and emotional changes produced following drug action
nonspecific effects
derived from the user’s unique background, expectations, perceptions, adn environment.
- subjective
specific effects
depend on the presence of a chemical at certain concentrations
- objective
placebo effect
effects produced by an inactive chemical that the user believes to be a drug.
- used in addiction treatment
therapeutic effects
the intended, desired effects of a drug
side effects
the unintended effects that accompany therapeutic effects
potency
measured by the amount of a drug required to produce a given effect.
- only refers to relative effective dose (ED)
toxicity
capacity of a drug to do damage or cause adverse effects
safety margin
lowest dose that produces the desired therapeutic effect.
Pharmacokinetic factors of drug action
A - absorption
D - distribution
M - metabolism
E - excretion
routes of arministration
- oral
- inhalation
- intravenous injection
- intramuscular injection
- subcutaneous injection
- topical application
Blood Brain Barrier
- only small lipophilic molecules can pass through
- structural barrier by glial cells
- active transport required
- trauma and infection can disrupt the Blood Brain Barrier
Types of tolerance
- drug disposition/pharmacikinetic tolerance - increased metabolism reduces effect of the subsequent dose
- behavioural tolerance - same biochemical effect with reduced behavioural effect as the individual learns to compensate for nervous system impairment
- pharmacodynamic tolerance - sensitivity of neurons changes
