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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
Páleníček,2002
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
Páleníček,2002
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
Páleníček,2002
Terms
• Use
• Abuse
• Tolerance
• Dependence - physical & psychic
• Whitdrawal syndrom
Páleníček,2002
Addiction
Páleníček,2002
• 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
Páleníček,2002
• 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
Páleníček,2002
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
Páleníček,2002
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
Páleníček,2002
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
Páleníček,2002
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
Páleníček,2002
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
Páleníček,2002
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)
Páleníček,2002
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
Páleníček,2002
1. Ecstasy - MDMA (MDA, MDEA)2. Ecstasy - tablet (capsule)
Ecstasy
Páleníček,2002
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
Páleníček,2002
Páleníček, 2002
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
Páleníček,2002
• 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
Páleníček,2002
• 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
Páleníček,2002
• Primární – vzdělávání cílové populace
• Sekundární – práce s vyléčenými (abstinujícími) závislými
• Terciární – minimalizace rizik (harm reduction, substituční léčba, testování drog)
Prevence
Serotonergní dráhy
Páleníček,2002
(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