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Páleníček,2002. 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,

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Drug abuse addiction

Páleníček,2002

Drug abuse & addiction

T. Páleníček

Psychiatrické centrum Praha

3. Lékařská fakulta Univerzity Karlovy


History

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


Today

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


Definitions

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


Terms

Páleníček,2002

Terms

  • Use

  • Abuse

  • Tolerance

  • Dependence - physical & psychic

  • Whitdrawal syndrom


Addiction
Addiction

  • 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)

Páleníček,2002


General risks of drug use
General risks of drug use

  • Toxic effects

  • Form of application – i.v. - infections

  • Loss of control – addiction

  • Social consequences - loss of work, living place, friends

  • Changes in mood, personality

Páleníček,2002


Classification

Páleníček,2002

Classification

  • Natural versus synthetic

  • Through the effect

    • Sedatives, tranqulisers, hypnotics

    • Stimulants

    • Halucinogens

    • Entactogens

    • Inhallants

  • Legal versus illegal


  • Opiats

    Páleníček,2002

    Opiats

    • 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



    Other sedatives tranqulisers hypnotics

    Páleníček,2002

    Other sedatives, tranqulisers, hypnotics

    • Benzodiazepines

    • Barbiturates

    • Toluen

    • Alcohol

      High addictive potential, physical dependence (often mixed with others), live threatening withdrawal


    Stimulants

    Páleníček,2002

    Stimulants

    • 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


    Stimulants1

    Páleníček,2002

    Stimulants

    • 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


    Halucinogens

    Páleníček,2002

    Halucinogens

    • Natural – (cannabis), psylocin, mezcal, ayahuasca, ibogain, muscarin

    • 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


    Halucinogens1

    Páleníček,2002

    Halucinogens

    • Halucinations - tripping

    • Most are not addictive

    • Bad trip, flashbacks, risk of injury, psychosis

      • LSD (acid, trip) – trips, crystal, liquid

      • DOM, DOB – trips, pills

      • Ketamine, PCP – white powder


    Cannabis

    Páleníček,2002

    Cannabis

    • 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)


    Entactogens

    Páleníček,2002

    Entactogens

    • MDMA, MDEA, MDA

    • 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

    Ecstasy

    E, madam, eve, pill, xtc…

    • Ecstasy - MDMA (MDA, MDEA)

    • Ecstasy - tablet (capsule)


    Páleníček,2002

    Use of MDMA

    • Young people (15 – 30 yrs)

    • All social groups

    • Connection with parties

    • polydrug users

    • „recreational users“

    • Per os, snorted


    Effects

    Páleníček, 2002

    effects

    • Metabolised by (CYP2D6) (cytochrom P450)

    • 5-9% white population is defficient

      • Poor metabolisers

      • Increased risk of acute toxicity

      • Drug-drug interactions (virostatics - ritonavir)

  • Acute effects – release of 5-HT and DA

  • Chronic effects – toxic effects


  • Effects1

    Páleníček,2002

    effects

    • 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


    Treatment of addiction
    Treatment of addiction

    • 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

    Páleníček,2002


    Prevence
    Prevence

    • Primární – vzdělávání cílové populace

    • Sekundární – práce s vyléčenými (abstinujícími) závislými

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

    Páleníček,2002


    D kuji v m za pozornost
    Děkuji vám za pozornost

    Páleníček,2002


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

    • rapheální jádra

    • neocortex

    • caudatum, putamen

    • thalamus

    • hypothalamus

    • amygdala, hipocampus

    • substantia nigra

    • neurovaskulární orgány komor

    • mozeček

    • mícha

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

    Serotonergní dráhy

    Páleníček,2002


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