Michael M. Milks, Ph.D., R.Ph. Professor of Pharmaceutical ... · The drug becomes a necessity for...

transcript

Michael M. Milks, Ph.D., R.Ph.Professor of Pharmaceutical SciencesCollege of PharmacyUniversity of Findlay

Welcome

Syllabus/Roll

Scheduled Speakers

Typical Presentation

DISCUSSION

Reflection and interaction

Personal and Collective ACTION

Program Overview

Define and discuss “drug”

Differentiate drug abuse from drug addiction

Inventory of common psychoactive drugs

Hazards associated with drug abuse

Antecedent Behavior (“Gateway” drug use)

Dopamine: The “Reward” Chemical

Heroin, morphine, oxycodone, hydrocodone

A. Klondike (Polar Bears)

B. Brutus (Buckeyes)

C. Rocky & Rocksy (Rockets)

D. Derrick (Oilers)

E. Freddie and Frieda (Falcons)

Klondik

e (Pola

r Bear

s (Buck

Rocky &

ockets

Derrick

Freddie

and Frie

da (Falco

0% 0% 0%0%0%

A. Powerful stimulant drug

B. Potent narcotic analgesic

C. Mild hallucinogenic

D. Marijuana-like psychedelic

E. “Ecstasy”; MDMA

timula

nt dru

Potent n

ogenic

“Ecs

”; M

0% 0% 0%0%0%

A. Are SAFE alternatives to illicit drugs such as heroin or cocaine

B. Do NOT cause fatal overdoses

C. Should ONLY be used by the specific patient for a specific condition

D. Seldom abused by middle or high school students

E. NEVER cause adverse side effects or toxicity

Are SA

Do NOT

Should

bused b

side ..

0% 0% 0%0%0%

A. Elevated blood pressure

B. Rapid heart rate

C. Excitement

D. Drowsiness

E. Pain relief

lood p

Pain re

0% 0% 0%0%0%

A. Dangerously elevated heart rate

B. Dangerously elevated blood pressure

C. Seizures

D. Heart attacks

E. Stroke

F. ALL of the above

rously

ear...

rously

loo...

Heart a

f the ab

0% 0% 0%0%0%0%

A. CuriosityB. Culture/MediaC. FunD. To “fit in”E. To appear “grown up”F. As an escapeG. To cope with Family

problemsH. Peer pressure

Curiosit

Culture

To “f

pear “

n up”

As an e

pe with

Peer p

0% 0% 0% 0%0%0%0%0%

- A chemical substance- Alters the state of the mind or

body- Used in the diagnosis, prevention,

or treatment of a disease

THERAPEUTIC USE

MISUSE

CASUAL (CULTURAL) OR “RECREATIONAL” (SOCIAL) USE

RELIGIOUS CEREMONIES

CIRCUMSTANTIAL USE

EXPERIMENTAL USE

Use, usually by self-administration, of any drug in a manner that deviates from the approved medical or social patterns within a given culture

Willful use of a drug in violation of social norms

Involves bad consequences that can occur even after only ONE use. “snapshot”

Hazards of drug abuse depend on: Frequency of useDose or amount of drug taken Route of administrationDuration of use

Continuous, problematic use of a drug

“photo album” The drug takes control of your body

and mind Fatal disease when left untreated

Loss of CONTROL COMPULSIVE use CONTINUED use despite bad

consequences

The drug becomes a necessity for life instead of something to “escape” the real world.

This is the reason that most people become addicts. It drives them to use more frequent.

Signs of psychological dependence▪ Use drugs alone▪ Stockpiling drugs▪ Willing to take increased risks in order to use▪ Changing friends (avoiding ridicule)▪ Denial and becoming defensive**

Intoxication

Withdrawal

Other Substance-Induced Mental Disorders

Essential Feature….”cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues to use the substance despite significant substance-related problems”

Underlying CHANGES in brain circuits that may persist beyond detoxification

1. Escalating dose/frequency2. Persistent desire to reduce or regulate

the use of the substance3. The individual spends a great deal of

time obtaining and using the substance, and/or recovering from its effects

4. Craving (intense desire or urge to use)

5. Failure to fulfill major role obligations at work, school, or home

6. Continued substance abuse despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

7. Abandoned or reduced important social, occupational, or recreational activities

8. Substance use during physically hazardous situations

9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem arising from the use of the substance

10. Tolerance (need for markedly increased dose to achieve the same effects)

11. Withdrawal (syndrome of physicaldistress upon diminishing drug levels)

303.90 Alcohol Use Disorder 304.00 Opioid Use Disorder 304.10 Sedative, Hypnotic, or Anxiolytic

Use Disorder (including benzodiazepines and barbiturates)

304.20 Cocaine Use Disorder 304.30 Cannabis Use Disorder 304.40 Amphetamine-Type Use Disorder

304.50 Other Hallucinogen Use Disorder 304.60 Inhalant Use Disorder 304.60 Phencyclidine (or Phencyclidine-

Like) Use Disorder 304.90 Other (or Unknown) Substance Use

Disorder 305.10 Tobacco Use Disorder

Therapeutic

Subtherapeutic

Concentration

Main Point:

•Therapeutic rangeis small.

•It is easy to reach toxic range…

ESPECIALLY when taking multiple drugs .

David Nutt, Leslie A

King, William

Saulsbury, and

Colin Blakemore

Lancet Vol 369,

1047-1053

(March 24, 2007)

(Levinthal CF. Drugs, Behavior,

and Modern Society, Needham

Heights, MA: Allyn & Bacon,

1996; p. 46)

Curiosity

Belief that drugs improve physical and mental

performance

Belief that drugs are not harmful

Belief that drugs alleviate the symptoms of depression

As an attempt to cope with traumatic experiences, for

example, childhood sexual abuse, or school failure

Sensation-seeking behavior

Substance use by family members

Peer pressure

Community norms

Exposure to pro-use message in mass media

Access and availability

Kandel, D. B., and Yamaguchi, K. (2002). Stages of drug involvement in the U.S. population.

In Stages and Pathways of Drug Involvement: Examining the Gateway Hypothesis (D.B. Kandel,

Ed.), pp. 65–89. Cambridge University Press, Cambridge, UK

Alcohol tends to precede cannabis use

Alcohol or tobacco use almost always

precedes the use of hard

More than two-thirds of drug abusers are

regular tobacco smokers (3X rate of

non-abusing population)

Compared with lifetime nondrinkers,

adults who have consumed alcohol

were statistically much more likely to

currently use illicit drugs and/or abuse

prescription drugs in the past year.

26X for cocaine

14X for cannabis

13 X for psychedelics

Individuals addicted to opioid drugs are

40X more likely to be addicted to

heroin

HEROIN

China White

Brown Sugar

Black Tar

Heroin

Opiate

- derived from the resin of the opium poppy

Papaver somniferum

Opium Poppy Papaver somniferum

Opium Alkaloids

morphine (4-21%)

codeine (0.8-2.5%)

papaverine (0.5-2.5%)

noscapine (4-8%)

thebaine (0.5-2%)

Opiate

Chemically modified morphine

Morphine

C-II - HIGH abuse potential

- current accepted medical use

- e.g. cocaine

amphetamine

methylphenidate

morphine

oxycodone

fentanyl

hydrocodone

Morphine

(Phenanthrenes)

morphine heroin(diacetylmorphine)

Opioid Receptors

-Agonists: Increase dopamine

release in the “pleasure center”

(nucleus accumbens)

Reinforcing Effects of Opiates

and Opioids

Desperately Seeking …..that

Dopamine BUZZ (2011)

[DRUG] [Users in the Past 30 Days]

HEROIN 281,000 AMPHETAMINES 400,000 COCAINE 1,900,000 MARIJUANA 18,071,000 ALCOHOL (“binge”) 58,100,000 NICOTINE 70,900,000 CAFFEINE 278,100,000

(http://www.oas.samhsa.gov September 1, 2013)

Adverse Drug Effects

Toxicity / Overdose

Tolerance

Dependence

(http://www.samhsa.gov/data/ September 1, 2013)

Heroin 258,482

Rx Opioids/Opiates 556,551

Rx Narcotic Analgesics 420,040

oxycodone 175,229

hydrocodone 97,183

methadone 75,693

codeine 11,060

Emergency Department Visits

(Non-Medicinal Use) (2011)

morphine oxycodone

(Phenanthrenes)

OxyContin®

(Purdue Pharma LP)

Roxicodone®

(Mallinckrodt Pharm.)

Percodan®

(Endo)

Percocet®

(Endo)X

- e.g. cocaine

amphetamine

methylphenidate

morphine

oxycodone

fentanyl

hydrocodone

oxycodone hydrocodone

(Phenanthrenes)

- e.g. cocaine

amphetamine

methylphenidate

morphine

oxycodone

fentanyl

hydrocodone

C-I - HIGH abuse potential

- no accepted medical use

- e.g. heroin

psilocybin

marijuana

mescaline

Heroin

Twelve Steps of AA

Compared and contrasted drug abuse and

drug addiction

Discussed “gateway theory”

Reviewed the neuropharmacology of why

psychoactive drugs so powerfully

reinforce continued use/abuse

Summarized the chemistry, pharmacology, and

some of the adverse effects of heroin

Katzung BG, Masters SB, and Trevor AJ. Basic & Clinical

Pharmacology, 11th ed. New York, NY: McGraw-Hill,

Brunton LL, Chabner BA, and Knollmann BC. Goodman

& Gilman’s The Pharmacological Basis of Therapeutics,

12th ed. New York, NY: McGraw-Hill, 2011.

Hart CL and Ksir C. Drugs, Society, and Human Behavior,

14th ed. Boston, MA: McGraw-Hill, 2010.

Inaba DS and Cohen WE. Uppers, Downers, All Arounders,

Physical and Mental Effects of Psychoactive Drugs 7th

ed. Medford, OR: CNS Publications, Inc. 2011.

National Institute on Drug Abuse, National Institutes of

Health, U.S. Dept. Health and Human Services. Drugs,

Brains, and Behavior - The Science of Addiction.

(Accessed September 10, 2011)

http://www.nida.nih.gov/scienceofaddiction/

Muhuri PK, Gfroerer JC, and Davies MC. Associations

of Nonmedical Pain Reliever Use and Initiation of

Heroin Use in the United States, CBHSQ Data

Review, Center for Behavioral Health Statistics

and Quality, Substance Abuse and Mental Health

Services Administration, U.S. Dept. Health and

Human Services. (Accessed September 1, 2013)

http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.htm

2013 National Survey on Drug Use & Health.

Substance Abuse and Mental Health Services

Administration, U.S. Dept. Health and Human

Services. (Accessed September 1, 2013)

https://dawninfo.samhsa.gov/data/

FINAL EXAMINATION

A. Powerful stimulant drug

B. Potent narcotic analgesic

C. Mild hallucinogenic

D. Marijuana-like psychedelic

E. “Ecstasy”; MDMA

Powerfu

l stim

ulant d

Potent n

arcotic

analgesic

cinoge

ijuana-li

edelic

“Ecs

”; M

0% 0% 0%0%0%

A. Are SAFE alternatives to illicit drugs such as heroin or cocaine

B. Do NOT cause fatal overdoses

C. Should ONLY be used by the specific patient for a specific condition

D. Seldom abused by middle or high school students

E. NEVER cause adverse side effects or toxicity

Are SA

Do NOT

Should

bused b

side ..

0% 0% 0%0%0%

A. Elevated blood pressure

B. Rapid heart rate

C. Excitement

D. Drowsiness

E. Pain relief

lood p

Pain re

0% 0% 0%0%0%

A. Dangerously elevated heart rate

B. Dangerously elevated blood pressure

C. Seizures

D. Heart attacks

E. Stroke

F. ALL of the above

rously

ear...

rously

loo...

Heart a

f the ab

0% 0% 0%0%0%0%

A. CuriosityB. Culture/MediaC. FunD. To “fit in”E. To appear “grown up”F. As an escapeG. To cope with Family

problemsH. Peer pressure

Curiosit

Culture

To “f

pear “

n up”

As an e

pe with

Peer p

0% 0% 0% 0%0%0%0%0%

Michael M. Milks, Ph.D., R.Ph. Professor of Pharmaceutical ... · The drug becomes a necessity for...

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