Drug abuse & addiction

T. Páleníček

Psychiatrické centrum Praha

3. Lékařská fakulta Univerzity Karlovy

Páleníček,2002

History• „Primitive cultures“ – Egypt,

indians, chinese …..

• Medical indications, raw material,

shamanic use

• Old continent – canabis, opiats,

mushrooms,

• New continent – mushrooms,

coca, peyotl, ayahuasca

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Today• Illicit substances (most of them) in most

countries arround the world

• Many new drugs – chemistry

• Purity

• Lost of the traditional consequences of use – misuse

• New ways of application

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Definitions• Affects the perception of the reality –

psychotropic effect & addictive Potential (Presl)

• Any substance, that if gets into the organism, affects one or more of its function (pharmacological def.)

• Drug (substance) abuse – psychological or physical state of servility vis-a-vis the drug

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Terms

• Use

• Abuse

• Tolerance

• Dependence - physical & psychic

• Whitdrawal syndrom

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Addiction

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• First experience• Recreational use• Abuse• Dependece

• Based on the reward – drug seeking – aplication of the drug –

effect(reward) – reinforcing effect –

• Neurobiological substrate – DA system (NAC)

General risks of drug use

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• Toxic effects

• Form of application – i.v. - infections

• Loss of control – addiction

• Social consequences - loss of work,

living place, friends

• Changes in mood, personality

Classification

1. Natural versus synthetic

2. Through the effect• Sedatives, tranqulisers, hypnotics• Stimulants• Halucinogens• Entactogens• Inhallants

3. Legal versus illegal

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Opiats

1. Morfin, heroin, kodein, buprenorfin …• Acts through own receptors (µ, κ, σ)• Analgesic effect, euphoria, sedation• Vagotonic effect• Supression of breathing• High addictive potential – physical and

psychological• Tolerance – overdose

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Opiats

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Other sedatives, tranqulisers, hypnotics

• Benzodiazepines

• Barbiturates

• Toluen

• Alcohol

High addictive potential, physical dependence (often mixed with

others), live threatening withdrawalPáleníček,2002

Stimulants

1. Kokain, crack• inhibitor of DA and NA reuptake • euphoria, state of high, increased speach,

feeling „ I am the best“• increased locomotion• elevates heart rate, blood presure• snorted, smoked, injected, on genitals• psychological dependece• heart attack, stroke

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1. Amphetamine, methamphetamine (speed, ice, meth)

• Release of DA• Speed feeling, insomnia, anorexia, increased

speach, stereotyped behaviour• Increased heart rate, blood presure• Snorted, injected, smoked, per os• Psychological dependence• Heart attack, stroke, toxic hepatitis,

neurotoxic, toxic psychosis

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Stimulants

Halucinogens1. Natural – (cannabis), psylocin, mezcal,

ayahuasca, ibogain, muscarin

2. Synthetic – LSD, DOB, DOM (STP), TMA, DMT, Ketamine (Special K), PCP (Angel dust)

• Most affect 5-HT system - 5HT2a receptors• Cannabis – CB1 & CB2 receptors• Ketamine, PCP – NMDA antagonists

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Halucinogens

1. Halucinations - tripping

2. Most are not addictive

3. Bad trip, flashbacks, risk of injury, psychosis

• LSD (acid, trip) – trips, crystal, liquid• DOM, DOB – trips, pills• Ketamine, PCP – white powder

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Cannabis1. Marijuana, hashish…

• many states of being, often upside-down – stimulation, sedation, anxiosity, anxiolytic effect, laugh, halucinations, euforia, taste to eat

• anxiety disorders, memory deficits, insulted spermatogenesis

• a lot of terapeutical indications (CB – recptor agonists, antagonists, natural medicine)

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Entactogens

1. MDMA, MDEA, MDA

2. PMA, PMMA, 4-MTA, 2C-B, 2C-T-7, MBDB

Entactogen = „the touch within“producing state of well being, empathy, belonging

to others, feeling of love, peace

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1. Ecstasy - MDMA (MDA, MDEA)2. Ecstasy - tablet (capsule)

Ecstasy

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E, madam, eve, pill, xtc…

• Young people (15 – 30 yrs)

• All social groups

• Connection with parties

• polydrug users

• „recreational users“

• Per os, snorted

Use of MDMA

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effects

1. Metabolised by (CYP2D6) (cytochrom P450)

2. 5-9% white population is defficient

• Poor metabolisers

• Increased risk of acute toxicity

• Drug-drug interactions (virostatics - ritonavir)

3. Acute effects – release of 5-HT and DA

4. Chronic effects – toxic effects

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• Chronic: neurotoxicity - cognitive defficit, sleep

disorders, parkinsonism???, toxic hepatitis,

teratogenic, imune dysfunction, flashbacks, psychosis

• Risks: serotonin syndrom, stroke, rhabdomyolysis,

acute liver failure

• Neurotoxicity: selective degeneration of 5-HT and DA

axons

effects

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• Motivation• Decission to stop• First contact with proffesionals (K-centre,

hospital …)• Again motivation and testing the decision to

stop• Detoxification• Therapy – ambulant, in hospital, in

community• Susequent care – getting back to society• Relaps

Treatment of addiction

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• Primární – vzdělávání cílové populace

• Sekundární – práce s vyléčenými (abstinujícími) závislými

• Terciární – minimalizace rizik (harm reduction, substituční léčba, testování drog)

Prevence

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Děkuji vám za pozornost

Serotonergní dráhy

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(upraveno podle Manter and Gatz´s essentials of clinical Neuroanathomy and Neurofysiology, 1992)

1. rapheální jádra

2. neocortex

3. caudatum, putamen

4. thalamus

5. hypothalamus

6. amygdala, hipocampus

7. substantia nigra

8. neurovaskulární orgány komor

9. mozeček

10. mícha

5-HT vlákna vycházejí zejména z mediálních a dorsálních rapheálních jader a projikují se do řady podkorových i korových

oblastí mozku