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Drugs: The Straight Shoot

Drugs: The Straight Shoot

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Drugs: The Straight Shoot

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  1. Drugs:The Straight Shoot Rachel Haroz, M.D. November 24, 2009

  2. Outline • I Intro/History • II Specific Drugs • Amphetamines/Methamphetamines • Cocaine • Opioids • Dextromethorphan • Club Drugs: Ecstasy, GHB, LSD, Ketamine • Hallucinogens • Inhalants • IV Contest • V Conclusion

  3. Drugs in the U.S. • Opium - 1850s • Chinese Immigrants - California • Opium dens • Laudanum, paragoric • Cocaine - 1970s • “champagne of drugs” - middle/upper class • Inner city - crack • Drug cartels

  4. Who’s High on What???

  5. Methamphetamine • Aka… • Crack meth, crank, cristy, crystal meth, speed, leapers, tweak, wire, Hawaiian salt, dexies, glass, ice • Cost $30-150 per gram • Depends on purity and amount purchased

  6. Amphetamines • Phenylethylamines - substitutions • Uses: Narcolepsy, ADD, weight loss • Mode of action: • Release/block reuptake of catecholamines (Dopa/Norepi) • Stimulate alpha/beta receptors • Serotonin release • Lipophilic - crosses BBB readily • Resistant to COMT (catechol-O-methyl transferase) • 96% -- Methamphetamine • Inexpensive • Easy to produce/obtain • Effects last LONG

  7. Methamphetamine

  8. History • Germany 1887 • Used as an asthma inhaler 1930s “Benzedrine” • Popular • energy, sleep requirements, fatigue • Military - > 200 million tabs to US troops • >WWII - OTC -->prescription • Early 70s peaked --> skyrocketed in 1990s

  9. Air Force/Navy Use • Go Pill - dextroamphetamine (Dexedrine) • 5mg dose - repeated • No buzz • No Go Pill - Ambien • 10mg • 6 hours from ingestion to briefing

  10. How to get high… • Snort • 5-20 min onset - lasts 6-12 hours • Smoke • Pipe • Heated foil…”chasing the dragon” • ICE - (crystal meth) • Pure 93-98% • 1 gram lasts 10-25 hits • 8-16 hours • Expensive!! • Eat - slower onset • Inject - chronic, die hard users

  11. Meth and crystal meth

  12. Others… • Yaba - “crazy medicine” • Golden Triangle - Burma, Laos, Thailand • Tabs • Increased use in the Asian community • CAT - methoathnone • Derived from Khat (plant)…Somalia/Ethiopia • Russia 1970s • Wisconsin 1991 - moving east • Ma Huang - herbal supplement - ephedrine • Other synthetics: MDMA, 2CB etc

  13. Physical Effects • CNS stimulation/Sympathomimetic • Exhilaration, euphoria, confusion, hallucinations, talkativeness • Increased heart rate, blood pressure, temperature • Mydriasis, diaphoresis • Complications • Life threatening agitation, psychosis, seizures, dysrhythmias, MI, rhabdomyolysis, necrotizing vasculitis • Weight loss drugs (Aminorex 60s, Fenfluramine) • Primary pulmonary hypertension • Valvular heart disease • Treatment - Benzodiazepenes

  14. METH MOUTH

  15. Timeline • Rush - initial exhilaration 5-30 minutes • High - stimulation 4-16 hours • Binge - repeated use 3-15 days • Tweaking - end of binge cycle • Paranoia, depression • Aggressive! • Crash - sleep 1-3 days

  16. Meth labs • 2002 - 13,791 labs seized • Most in S. California • Mexican Drug Cartel • Moved regularly • Health hazard • Hazardous waste dumped 110-150 tons • Phosphoric acid, sulfuric acid, toluene, red phosphorus, mercuric chloride, freon, acetone • Fire/Explosions • Oregon 30% of labs discovered

  17. Cocaine • Aka • Coke, dust, nose candy, crack, Roxanne, white girl, snow, Big C, Bernice, blow, C, happy dust • Cost $40-200/gram • $20-125/gram - crack

  18. History • South America - Andes • cultural/religious use • Spanish outlawed • 1860 - German Albert Nieman • ‘wonder drug’ - Sigmund Freud • 1886 - cardiac arrest • 1890s - US - provided to workers

  19. Extensive Product Use

  20. Suppliers: Columbia, Peru, Bolivia • 2002 - 167 tons seized - 30% • Drug smuggling • High speed boats • Tunnels, surfboards • Body stuffers, packers and carriers • Pharmacology • Release of Epi/Norepi • Inhibits Dopa reuptake • CNS stimulation • Na channel blocker

  21. Cocaine smuggling

  22. Basics • Powder (duff) • Flake $$$ • Rock • Freebase • Purified form (ammonium hydroxide, ether) • Crack • Cocaine and baking soda --> microwave --> crack

  23. How to Use • Snort - • 20 to 60% absorbed • Onset 3-5 min, lasts 60 min • Cx - perforation • Inhale - (liquid lady) • Inject - dissolve with water • Smoke - crack • Glass pipe • Onset 1-5 min, lasts 10-20 min • Mix with other drugs • speedballing

  24. Physical Effects • Sympathomimetic • Increased HR, BP, T, dilated pupils, diaphoresis, aggression, hallucinations • Arrhythmias, strokes, seizures • Cocaine crash • 1 hour post use • Dysphoria, apathy • Cocaethylene - increased lethality • Cocaine washout • Rx - Use BZ, avoid BB

  25. Heroin • Aka • Antifreeze, Big Daddy, Big H, brown sugar, garbage, lemon dope, rufus, , white stuff, skag, chocolate, gumball, black tar, smack, china white, junk • Cost - $70-400/gram

  26. Background • Narcotic analgesic • “heroisch” - powerful/large • Increased purity - decreased prices • Columbia • Southeast Asia • HIV/Hepatitis C, endocarditis, malnutrition • Opiates - natural • Opioids - synthetic

  27. History • Assyrians 9,000 yrs ago - medicinal • Sumerians, Greeks, Chinese • 1803 - German F.W. Serturner - isolated opium - Morphius • Medicinal - cough, diarrhea, pain, alcoholism • Laudanum - opium + spices + wine • 1800s - Opium smoking by Chinese laborers • 1900 - 500,000 addicts • 1956 heroin outlawed

  28. Sources • Papaver somniferum • Seed pod after fertilization - large amt of opium • Slits made - opium scraped • Morphine (12%) extracted - converted to heroin • Poppy Straw - Spain, Turkey, Australia • Black Tar - Mexico • Smuggling - industry • Children often used

  29. More Poppies

  30. Forms of Heroin • Powder form • White ->dark brown • Mexican Tar • Thick, gummy • Carried in glass vials, small balloons • Cut • About 27 substances • Quinine, starch, cellulose, mannitol, glucose, brown sugar • Scopalamine, strychnine (death hit) • Clenbuterol, Fentanyl

  31. Ingestion • Injection • Most common • Metal spoon, heat, lemon juice, cotton • Syringe - short strokes • Veins, IM, skin popping • Mexican Tar - Botulism, skin infections • Snorting • Improved with better purity • Smoking • Chasing the Dragon • Spongiform leukoencephalopathy

  32. Physical Effects • Relaxation, wellbeing, euphoria • Opioid toxidrome (µ) • Miosis, decreased respirations, decreased mental status • Treat with Narcan (dose) • Withdrawal • Agitation, vomiting, piloerection, sweating, diarrhea, increased blood pressure/heart rate, yawning • Methadone, Clonidine, Buprenorphine

  33. Drug Diversion • The diversion of legal pharmaceuticals and chemicals for illegal purposes • Narcotics, depressants, stimulants

  34. Dextromethorphan • Cough suppressant • Opiate, NMDA, serotonin • Effects • Euphoria, hallucinations (visual, tactile, auditory), disorientation • HTN, normal pupils, nystagmus, diaphoresis • Aka • Vitamin D, robo, dex, Red devils • Robitussin - heated with lemon juice

  35. PCP • Aka • Ace, angel dust, crystal, DOA, dust, formaldehyde, jet fuel, juice, monkey, tic, tac, wet, water, fry, hydro, illy, dip • Cost - $100-3,000 /liquid ounce • One cigarette saturated - $5-20 • 5-15mg - regular dose

  36. History • Phencyclidine • Dissociative anesthetic • NMDA antagonist • General anesthetic 1957 “Sernyl” - emergence phenomenon • 1960s- PeaCe Pill • Manufacture process - simple • Powder, liquid • Laced cigarettes • Mentholated cigs - “supercools” • No Formaldehyde!!

  37. Ingestion • Smoke - 75% users • Shermans • Lasts 4-6 hours • Inject • Oral ingestion • Snort • Physical Effects • Sympathomimetic • Increased BP, HR, flushing, rotatory nystagmus, seizures • Reduced sensitivity to pain, “increased strength” • Flashbacks • Stored in fat cells

  38. Club Drugs • GHB - easy lay, everclear, G, GBH, Georgia home boy, Liquid E(ecstasy), water, grievous bodily harm • MDMA - Adam, ecstasy, X, XTC, love drug, doctor, clarity • LSD - Acid, blue heaven, California sunshine, cub, big D, paper acid, ticket • KETAMINE - cat valium, special, super and vitamin K, K, kit kat

  39. GHB • Occurs naturally - precursor to GABA • History • French 1960s • Bodybuilding/Health food stores 80s • 1990s - rave culture • Precursors • GBL, BD…internet • Liquid/powder form

  40. GHB Physical Effects • Similar to ETOH • Small doses • inhibitions, sensuality/sexuality • Higher doses • Difficulty with speech/coordination • Unarousable deep sleep • Withdrawal • Seizures/agitation