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)
Brutu
s (Buck
eyes)
Rocky &
Rock
sy (R
ockets
)
Derrick
(Oile
rs)
Freddie
and Frie
da (Falco
ns)
0% 0% 0%0%0%
A. Powerful stimulant drug
B. Potent narcotic analgesic
C. Mild hallucinogenic
D. Marijuana-like psychedelic
E. “Ecstasy”; MDMA
Power
ful s
timula
nt dru
g
Potent n
arco
tic a
nalge
sic
Mild
hal
lucin
ogenic
Mar
ijuan
a-lik
e psy
ched
elic
“Ecs
tasy
”; M
DMA
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
FE al
tern
ativ
es to
illic
..
Do NOT
cause
fata
l ove
rdose
s
Should
ONLY
be u
sed b
y th
e...
Seld
om a
bused b
y mid
dle o
r...
NEVER
cause
adve
rse
side ..
.
0% 0% 0%0%0%
A. Elevated blood pressure
B. Rapid heart rate
C. Excitement
D. Drowsiness
E. Pain relief
Eleva
ted b
lood p
ress
ure
Rapid
hea
rt ra
te
Excit
ement
Drow
sines
s
Pain re
lief
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
Dange
rously
eleva
ted h
ear...
Dange
rously
eleva
ted b
loo...
Seizu
res
Heart a
ttack
s
Stro
ke
ALL o
f the ab
ove
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
y
Culture
/Med
iaFu
n
To “f
it in
”
To ap
pear “
grow
n up”
As an e
scape
To co
pe with
Fam
ily p
roble
ms
Peer p
ress
ure
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
Toxic
Therapeutic
Subtherapeutic
Drug
Concentration
Time
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
H
Smack
Boy
Junk
Chiba
China White
Brown Sugar
Black Tar
Heroin
Opiate
- derived from the resin of the opium poppy
Papaver somniferum
Opium Poppy Papaver somniferum
Opium
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
X
C-II - HIGH abuse potential
- current accepted medical use
- e.g. cocaine
amphetamine
methylphenidate
morphine
oxycodone
fentanyl
hydrocodone
oxycodone hydrocodone
(Phenanthrenes)
C-II - HIGH abuse potential
- current accepted medical use
- e.g. cocaine
amphetamine
methylphenidate
morphine
oxycodone
fentanyl
hydrocodone
C-I - HIGH abuse potential
- no accepted medical use
- e.g. heroin
psilocybin
LSD
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,
2009.
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/
Michael M. Milks, Ph.D., R.Ph.Professor of Pharmaceutical SciencesCollege of PharmacyUniversity of Findlay
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
rug
Potent n
arcotic
analgesic
Mild
hallu
cinoge
nic
Mar
ijuana-li
ke p
sych
edelic
“Ecs
tasy
”; M
DMA
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
FE al
tern
ativ
es to
illic
..
Do NOT
cause
fata
l ove
rdose
s
Should
ONLY
be u
sed b
y th
e...
Seld
om a
bused b
y mid
dle o
r...
NEVER
cause
adve
rse
side ..
.
0% 0% 0%0%0%
A. Elevated blood pressure
B. Rapid heart rate
C. Excitement
D. Drowsiness
E. Pain relief
Eleva
ted b
lood p
ress
ure
Rapid
hea
rt ra
te
Excit
ement
Drow
sines
s
Pain re
lief
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
Dange
rously
eleva
ted h
ear...
Dange
rously
eleva
ted b
loo...
Seizu
res
Heart a
ttack
s
Stro
ke
ALL o
f the ab
ove
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
y
Culture
/Med
iaFu
n
To “f
it in
”
To ap
pear “
grow
n up”
As an e
scape
To co
pe with
Fam
ily p
roble
ms
Peer p
ress
ure
0% 0% 0% 0%0%0%0%0%
Michael M. Milks, Ph.D., R.Ph.Professor of Pharmaceutical SciencesCollege of PharmacyUniversity of Findlay