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Introduction to substances of abuse. Dr. Darwin Telias Maimonides University Ben-Gurion University [email protected] “DRUGS” DO NOT EXIST. WE CREATE THEM WITH OUR INCORRECT USE OF SUBSTANCES. ALMOST ANY SUBSTANCE MAY BE ABUSED. ABUSED SUBSTANCES MAY GIVE PLEASURE OR PAIN

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Introduction to substances of abuse

Introduction to substances of abuse

Dr. Darwin Telias

Maimonides University

Ben-Gurion University

[email protected]


Drugs do not exist
“DRUGS” DO NOT EXIST

WE CREATE THEM WITH OUR

INCORRECT USE OF

SUBSTANCES


Almost any substance may be abused
ALMOST ANY SUBSTANCE MAY BE ABUSED

ABUSED SUBSTANCES MAY GIVE PLEASURE

OR PAIN

OR MAY KILL

OR MAIM

DEPENDING ON WHATWE DO


Some examples at home
SOME EXAMPLES AT HOME:

GLUE

SPICES LIKE NUTMEG

LIGHTERS GAS

AIR CONDITIONERS GAS

DILUENTS

CORRECTION FLUID

BANANA ESSENCE


There are some misconceptions about drugs
THERE ARE SOME MISCONCEPTIONS ABOUT “DRUGS”

“DRUGS” ARE ILLEGAL

WRONG!

THE MOST ABUSED SUBSTANCES, ALCOHOL AND TOBACCO, ARE LEGAL IN MOST PLACES


Drugs cause addiction
“DRUGS” CAUSE “ADDICTION”

WRONG

MOST SUBSTANCES OF ABUSE DO NOT CAUSE DEPENDENCE

THERE IS A SERIOUS DIFFERENCE BETWEEN“ADDICTION”AND“DEPENDENCE”


The subject continues to use the substance because he she likes its effects no withdrawal syndrome

THE SUBJECT CONTINUES TO USE

THE SUBSTANCE BECAUSE HE/SHE

LIKES ITS EFFECTS,

NO WITHDRAWAL SYNDROME

ADDICTION


Dependence
DEPENDENCE

THE SUBJECT CONTINUES USING

THE SUBSTANCE BECAUSE HE/SHE

IS AFRAID OF THE

WITHDRAWAL SYNDROME


VTA

HYPOTHALAMUS



OPIOIDS MIMICK IN THE BODY CAN CAUSE DEPENDENCE

“ENDORPHINS”


COCAINE ACTS ON IN THE BODY CAN CAUSE DEPENDENCE

“DOPAMINE”


THC MIMICKS IN THE BODY CAN CAUSE DEPENDENCE

“ANANDAMIDES”


Drugs are harmful or kill
“DRUGS” ARE HARMFUL OR KILL IN THE BODY CAN CAUSE DEPENDENCE

NOT NECESSARILY

MANY SUBSTANCES OF ABUSE CAUSE LITTLE OR NO DAMAGE

SOME OF THOSE THAT CAUSE DAMAGE DO SO BECAUSE THEY ARE ILLEGAL


Whoever uses drugs
WHOEVER USES DRUGS IN THE BODY CAN CAUSE DEPENDENCE

IS

STUPID!!


Wrong
WRONG! IN THE BODY CAN CAUSE DEPENDENCE

NOT EVERYBODY RESPONDS THE SAME TO DRUGS

SOME PEOPLE OBTAIN FROM DRUGS SOMETHING THEY DIDN’T HAVE IN THEMSELVES

NEUROLOGY EXPLAINS IT


Reward pathway
REWARD PATHWAY IN THE BODY CAN CAUSE DEPENDENCE


Opiate binding sites
OPIATE BINDING SITES IN THE BODY CAN CAUSE DEPENDENCE


Cocaine binding sites
COCAINE BINDING SITES IN THE BODY CAN CAUSE DEPENDENCE


Thc binding sites
THC BINDING SITES IN THE BODY CAN CAUSE DEPENDENCE


OPIATE AND DOPAMINE RECEPTORS IN THE BODY CAN CAUSE DEPENDENCE


SOCIAL PRESSURE IN THE BODY CAN CAUSE DEPENDENCE


SOCIAL PRESSURE IN THE BODY CAN CAUSE DEPENDENCE

PSYCHOLOGICAL PRESSURE


SOCIAL PRESSURE IN THE BODY CAN CAUSE DEPENDENCE

PSYCHOLOGICAL PRESSURE

BIOLOGICAL FACTORS


THE THERAPEUTIC BRIDGE IN THE BODY CAN CAUSE DEPENDENCE


SUBSTANCES COMMONLY ABUSED IN THE BODY CAN CAUSE DEPENDENCE

ACCORDING TO CHARACTERISTICS OF THE WITHDRAWAL SYBDROME

* - ONLY PSYCHOLOGICAL SYMPTOMS OF WITHDRAWAL

** - PSYCHOLOGICAL AND BIOLOGICAL SYMPTOMS AND SIGNS


THC IN THE BODY CAN CAUSE DEPENDENCE


Lsd blotters
LSD IN THE BODY CAN CAUSE DEPENDENCEBLOTTERS


More blotters
MORE BLOTTERS IN THE BODY CAN CAUSE DEPENDENCE


LSD MICRODOTS IN THE BODY CAN CAUSE DEPENDENCE


Lsd tarts pills
LSD TARTS (PILLS) IN THE BODY CAN CAUSE DEPENDENCE


Lsd is based upon ergot
LSD IS BASED UPON ERGOT IN THE BODY CAN CAUSE DEPENDENCE


Lsd hallucinations
LSD HALLUCINATIONS IN THE BODY CAN CAUSE DEPENDENCE


Extasy xtc adam etc etc
EXTASY (XTC, ADAM, ETC. ETC.) IN THE BODY CAN CAUSE DEPENDENCE


XTC IN THE BODY CAN CAUSE DEPENDENCE

PILLS


Toxiciy of mdma
TOXICIY OF MDMA IN THE BODY CAN CAUSE DEPENDENCE

  • - HYPERTHERMIA – UP TO 43-44 C.

  • - RHABDOMIOLYSIS

  • - CARDIAC IMPAIRMENT

  • - CARDIAC ARREST

  • - LIVER IMPAIRMENT

  • - RENAL IMPAIRMENT

  • - PSYCHOTIC EPISODES


Datura datura inoxia
DATURA ( IN THE BODY CAN CAUSE DEPENDENCEDATURA INOXIA)


Morning glory
MORNING GLORY IN THE BODY CAN CAUSE DEPENDENCE


Morning glory jimson s weed
MORNING GLORY IN THE BODY CAN CAUSE DEPENDENCE(JIMSON’S WEED)


Nutmeg
NUTMEG IN THE BODY CAN CAUSE DEPENDENCE


NUTMEG IN THE BODY CAN CAUSE DEPENDENCE


NUTMEG IN THE BODY CAN CAUSE DEPENDENCE


Psyloscibes mushrooms
PSYLOSCIBES MUSHROOMS IN THE BODY CAN CAUSE DEPENDENCE


Other type of psyloscibes
OTHER TYPE OF PSYLOSCIBES IN THE BODY CAN CAUSE DEPENDENCE


Ammanita muscarias
AMMANITA MUSCARIAS IN THE BODY CAN CAUSE DEPENDENCE


Who is missing here
WHO IS MISSING HERE? IN THE BODY CAN CAUSE DEPENDENCE


Peyote cactus
PEYOTE CACTUS IN THE BODY CAN CAUSE DEPENDENCE


San pedro cactus
SAN PEDRO CACTUS IN THE BODY CAN CAUSE DEPENDENCE


Salvia divinorum
SALVIA DIVINORUM IN THE BODY CAN CAUSE DEPENDENCE


Bananas
BANANAS IN THE BODY CAN CAUSE DEPENDENCE


SAPO IN THE BODY CAN CAUSE DEPENDENCE


Bufotensin glands
BUFOTENSIN GLANDS IN THE BODY CAN CAUSE DEPENDENCE


SUBSTANCES COMMONLY ABUSED IN THE BODY CAN CAUSE DEPENDENCE

ACCORDING TO CHARACTERISTICS OF THE WITHDRAWAL SYBDROME

* - ONLY PSYCHOLOGICAL SYMPTOMS OF WITHDRAWAL

** - PSYCHOLOGICAL AND BIOLOGICAL SYMPTOMS AND SIGNS


Cocaine
COCAINE IN THE BODY CAN CAUSE DEPENDENCE


SUBSTANCES COMMONLY ABUSED IN THE BODY CAN CAUSE DEPENDENCE

ACCORDING TO CHARACTERISTICS OF THE WITHDRAWAL SYBDROME

* - ONLY PSYCHOLOGICAL SYMPTOMS OF WITHDRAWAL

** - PSYCHOLOGICAL AND BIOLOGICAL SYMPTOMS AND SIGNS


% OF ALCOHOL IN BEVERAGES IN THE BODY CAN CAUSE DEPENDENCE

  • BEER330 ccat 6% (AVERAGE)=19.80

  • WHISKY50 ccat 40% = 20.00


DELIRIUM IN THE BODY CAN CAUSE DEPENDENCE

TREMENS


Poppy
POPPY IN THE BODY CAN CAUSE DEPENDENCE


Poppy seed pod
POPPY SEED POD IN THE BODY CAN CAUSE DEPENDENCE


Raw black opium
RAW BLACK OPIUM IN THE BODY CAN CAUSE DEPENDENCE


Heroin powder
HEROIN POWDER IN THE BODY CAN CAUSE DEPENDENCE


Injection marks
INJECTION MARKS IN THE BODY CAN CAUSE DEPENDENCE



THAT IS THE REASON AMOUNT OF OPIOIDS

WHY THE ACUTE WITHDRAWAL SYNDROME FROM OPIATES LASTS

ONE TO TWO WEEKS



FOR THAT REASON LEVELS NEVER RETURN TO AMOUNT OF OPIOIDS0, AND THE PATIENT REMAINS AT RISK ALL OF HIS/HER LIFE


THAT IS THE CAUSE OF THE PROTRACTED OR CHRONIC WITHDRAWAL SYNDROME, CALLED “DUDE” IN THE STREET


Acute and chronic withdrawal syndromes from opiates
ACUTE AND CHRONIC WITHDRAWAL SYNDROMES FROM OPIATES SYNDROME, CALLED “DUDE” IN THE STREET

  • LEVELSNEVER RETURN TO NORMAL

Acute

Protracted

HIGHER DANGER OF RELAPSE

YEARS

2 WEEKS

MONTHS



TREATMENTS AIMED AT TOTAL WITHDRAWAL: YEARS:

BETWEEN 0.5 AND 20%


MAINTENANCE TREATMENTS (WITH METHADONE (ADOLAN) OR BUPRENORPHINE (SUBUTEX)

ABOUT 60% TOTALLY DRUG-FREE, AND A SERIOUS REDUCTION IN ILLEGAL ACTIVITIES


MAINTENANCE TREATMENTS WITH MEDICATIONS BUPRENORPHINE (SUBUTEX) MUST ALWAYS BE ACCOMPANIED OF PSYCHO-SOCIAL INTERVENTIONS


Withdrawal syndrome from cocaine
WITHDRAWAL SYNDROME FROM COCAINE BUPRENORPHINE (SUBUTEX)

CAUSES AND TREATMENT


COCAINE DISPLACES DOPAMINE BUPRENORPHINE (SUBUTEX)


Characteristics of cocaine withdrawal
CHARACTERISTICS OF COCAINE WITHDRAWAL BUPRENORPHINE (SUBUTEX)

Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after cessation or diminishing use

  • (1) fatigue

  • (2) vivid, unpleasant dreams

  • (3) insomnia or hypersomnia

  • (4) increased appetite

  • (5) psychomotor retardation or agitation


MEDICAL TREATMENT OF COCAINE WITHDRAWAL BUPRENORPHINE (SUBUTEX)

(e.g., dopa; tyrosine)

neurotransmitter precursors,

dopaminergic agonists, (bromocriptine)

antiparkinson drugs that affect the dopaminergic system (amantadine)

Tricyclic antidepressant drugs

(desipramine, imipramine)

Other antidepressants: MAOI, SSRI, etc


GENERAL RESULTS OF MEDICAL TREATMENT FOR COCAINE: BUPRENORPHINE (SUBUTEX)

BAD IN THE LONG TERM

TREATMENT WITH BETTER RESULTS:

LONG-TERM PSYCHO-SOCIAL TREATMENT


Withdrawal from thc
WITHDRAWAL FROM THC BUPRENORPHINE (SUBUTEX)

  • DSM IV does not provide diagnostic criteria.

  • ICD 10 mentions:

  • anxiety, irritability, tremor of outstretched hands, sweating, and muscle aches.

  • NO SPECIFIC TREATMENT RECOMMENDED


Most common benzodiazepines bzd
MOST COMMON BENZODIAZEPINES (BZD) BUPRENORPHINE (SUBUTEX)

  • DIAZEPAM (Valium)

  • CLONAZEPAM (Clonex)

  • LORAZEPAM (Lorivan)

  • (FLUNITRAZEPAM (Hypnodorm)


Principal actions of bzd
PRINCIPAL ACTIONS OF BZD BUPRENORPHINE (SUBUTEX)

  • - ANXYOLITIC

  • - HYPNO-INDUCTOR

  • - MUSCULAR RELAXANTS

  • - ANTIEPILEPTICS



Problems with bzds
PROBLEMS WITH BZDs BUPRENORPHINE (SUBUTEX)

  • Tolerance and physical dependence occur with prolonged high doses (at least 2-3 months of 30 mg/day Valium). Withdrawal symptoms, including seizures and serious psychosis, may occur if the drug is abruptly discontinued. Adverse reactions to the benzodiazepines include drowsiness, muscle incoordination, and increased aggression and hostility.


Abuse of medications
ABUSE OF MEDICATIONS BUPRENORPHINE (SUBUTEX)

  • PRACTICALLY ANY MEDICATION MAY BE ABUSED

  • MEDICATIONS WITH PSYCHOACTIVITY ARE GENERALLY ABUSED

  • PHYSICIANS AND NURSES MUST BE AWARE OF THIS.

  • OVER-PRESCRIPTION IS AS DANGEROUS AS UNDER-PRESCRIPTION


Thank you for your attention
THANK YOU FOR YOUR ATTENTION! BUPRENORPHINE (SUBUTEX)

  • IF YOU NEED ANY MORE INFORMATION, YOU MAY REACH ME AT:

  • [email protected]

  • or by fax at: xx-972-8-6481-468

  • or by cell phone: xx-972-50-6331-222

  • (050-6331-222 IN ISRAEL)


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