Any abuse of drugs that is neither socially nor medically approved

Compulsive need for a drug resulting in frequent self-administration despite substantial negative effects

effect of drug decreases with continued use and hence must increase dose to maintain desired effect

A change in the physical or psychological state resulting from continued use of a drug that requires continual use in order to avoid the physiological and psychological discomforts of withdrawal

Unpleasant effects when drug is stopped abruptly

Drugs of abuse

Stimulants

(3)

• Cocaine
• Methamphetamine
• Designer Amphetamines (MethyleneDioxyMethAmphetamine)

Drugs of abuse

Cocaine*

Routes of administration

(4)

• Oral
• "Snorting" 
• CNS stimulation w/in minutes, lasts 30-40 minutes and then subsides
• Intravenous
• Effects w/in seconds
• Inhalation
• Most intense, effets w/in seconds

Drugs of abuse

Cocaine

Mechanism of Action

CNS- blocks dopamine, 5HT, and norepinephrine reuptake

Drugs of abuse

Cocaine

Pharmacological Effects

(4)

• Euphorial, increased energy
• Increased alertness
• increased wakefulness
• increased self confidence

Drugs of abuse

Cocaine

Therapeutic Effects

(2)

• Local anesthetic
• Vasoconstrictor

Drugs of abuse

Cocaine

Toxicity

(4)

• Increased HR and BP, arrhythmias
• Increased body temperatures, seizures
• increased risk of intracerebral hemmorhage, stroke, heart attacks, seizures
• irritability, paranoia, instability of mood

Drugs of abuse

Cocaine

Abstinence phases

Drugs of Abuse

Methamphetamine

Routes of Administration 

(5)

• Smoking
• Sniffing
• Injecting
• Oral
• "Run"

Drugs of Abuse

Methamphetamine

Mechanism of Action

Causes release of norepinephrine, dopamine, and 5HT

Drugs of Abuse

Methamphetamine

Pharmacological Effects

(4)

• Extreme elation
• Increased wakefulness and energy
• Increased self confidence
• Reduced apetite

Drugs of Abuse

Methamphetamine

Adverse Effects

Drugs of Abuse

Designer Amphetamines (Methylendioxymethamphetamine)

Introduction

• Raves
• Hallucinogen/stimulant

Drugs of Abuse

Designer Amphetamines (Methylendioxymethamphetamine)

Routes of Administration

Generally oral

Drugs of Abuse

Designer Amphetamines (Methylendioxymethamphetamine)

MOA

Release 5HT, Dopamine

Drugs of Abuse

Designer Amphetamines (Methylendioxymethamphetamine)

Adverse Effects

• Hyperthermia
• Persistent 5HT deficits???

Drugs of Abuse

Marijuana

MOA

(2)

• Cannabinoid receptors
• Anandamide
• delta-9-tetrahydrocanabinol

Drugs of Abuse

Marijuana

Pharmacological and Adverse Effects

(9)

• Increased appetite, antiemetic
• Euphoria/relaxation
• Problems with memory, learning, and motivation
• Loss of coordination
• Vasodilator
• Smoke/carcinogen/irritant-note also bronchodilator
• Tolerance
• Dependence
• Withdrawal

Drugs of Abuse

Marijuana

Proposed Therapeutic Uses

(3)

• Antiemetic
• Increased appetite
• Glaucoma

Drugs of Abuse

Marijuana
Therapeutic Agents Acting at CB1 Receptors

(2) 

• Marinol
• Dronabinol

Drugs of Abuse

Marijuana
Therapeutic Agents Acting at CB1 Receptors

Marinol (Dronabinol)

(6)

• CB1 agonist indicated for the treatment of:
• anorexia associated with weight loss in patients with AIDS; and 
• nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments
• contraindicated in any patient who has a history of hypersensitivity to any cannabinoid or sesame oil
• side effects include a dose-related “high” (easy laughing, elation and heightened awareness) reported by some patients receiving marinol in both the antiemetic and the lower dose appetite stimulant clinical trials
• May interact with other CNS medications

Bath Salts

• Mephedrone and MDPV
• Administered orally, snorting, IV
• One of many constituents of bath salts is mephedrone

Hallucinogens

Lysergic Acid Diethylamide

Intro

(3)

• Synthetic drug
• Sophisticated Chemistry
• Very potent

Hallucinogens

Lysergic Acid Diethylamide

MOA

• Affects all 5HT subtypes (Esp. 5HT2?? and DA and Adrenergic), although mechanism unclear

Hallucinogens

Lysergic Acid Diethylamide

Forms of Administration

• Sophisticated chemistry
• Oral ("blotters")

Hallucinogens

Lysergic Acid Diethylamide

Pharmacological/Adverse effects

(8)

• Delusions, hallucinations
• Increased HR
• Increased BP
• Sleeplessness
• Loss of Appetite
• Tolerance
• Dependence
• Withdrawal

Drugs of Abuse

Narcotics

Definition

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Routes of Administration

• Often intravenous, but can "snort", or smoke

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

MOA

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Withdrawal and Treatment

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Treatment

(3) 

• Methadone
• Buprenorphine
• Vivitrol (Naltrexone injection)

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Treatment

Methadone

(5)

• µ opioid agonist
•  mechanism of action involves “cross dependence.”  In particular, “if physical dependence has developed to a specific opioid (e.g., heroin), stimulation of opioid receptors with another opioid will prevent the appearance of the abstinence syndrome.  In addition, by stimulating opioid receptors, these drugs reduce feelings of craving.”
•  does not generally produce euphoria
• patients often treated for life
• side effects: sedation, nausea, vomiting and constipation 

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Treatment 

 Buprenorphine

(4)

•  partial µ  agonist
•  first narcotic available for treatment of opiate dependence than can be prescribed in office setting
•  can be administered with naloxone
• side effects: vomiting, headaches, sleeping difficulties

Drugs of Abuse

Narcotics (Heroin - diacetylmorphine)

Treatment 

Vivitrol (Naltrexone injection)

•  intramuscular injection once every 4 weeks
• can cause liver damage
•  not for use in individuals using opiates or street drugs, or people who have used opiates within the past 10 days.