Club drugs understanding what they are why people use them and what they do
This presentation is the property of its rightful owner.
Sponsored Links
1 / 84

Club Drugs Understanding What They Are, Why People Use Them, and What They Do PowerPoint PPT Presentation


  • 81 Views
  • Uploaded on
  • Presentation posted in: General

Club Drugs Understanding What They Are, Why People Use Them, and What They Do. Thomas E. Freese, Ph.D. Director, Pacific Southwest Addiction Technology Transfer Center Director of Training, UCLA Integrated Substance Abuse Programs July 7, 2006. The Club Drugs. THE BIG ONES -

Download Presentation

Club Drugs Understanding What They Are, Why People Use Them, and What They Do

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Club drugs understanding what they are why people use them and what they do

Club DrugsUnderstanding What They Are, Why People Use Them, and What They Do

Thomas E. Freese, Ph.D.

Director,

Pacific Southwest Addiction Technology Transfer Center

Director of Training,

UCLA Integrated Substance Abuse Programs

July 7, 2006


The club drugs

The Club Drugs

  • THE BIG ONES -

  • 3,4 methylenedioxymethamphetamine (Ecstasy)

  • Gamma Hydroxy Butyrate (GHB)

  • Ketamine

  • Nitrous Oxide

  • SOME NEW ONES

  • 2C-B

  • DXM


Club drugs understanding what they are why people use them and what they do

MDMA


Ecstacy tabs

Ecstacy Tabs


Ecstasy

Ecstasy

  • MDMA technically 3,4 - Methylenedioxymethamphetamine

  • Hallucinogenic amphetamine

  • Releases serotonin and blocks reuptake

  • Dopamine and adrenergic effects


Ecstasy history

Ecstasy History

  • Developed and patented in Germany in 1912 by Merck

  • Stimulant properties were identified in 1933

  • Scientific studies began in the 1970s

  • Used in psychotherapy in 70’s and early 80’s

  • MDMA emerged in mid 1980s on the “Rave Party Scene”

  • DEA Schedule 1 in 1985


Patterns of use the picture in the late 90s

Patterns of useThe Picture in the Late ‘90s

  • Third most used illicit drug

  • Used recreationally

  • Youth culture centered on “raves”

  • Trend in increase of injection


Percentage of seniors reporting ecstasy as fairly easy or very easy to get

Percentage of Seniors Reporting Ecstasy as ‘Fairly Easy’ or ‘Very Easy’ to get

Source: Monitoring the Future Study, 1999 -- NIDA


Ecstasy rates by grade 2003 2005

Ecstasy Rates by Grade 2003-2005

SOURCE: Monitoring the Future Study, 2005.


Poison control center calls for major substances of abuse 2000 2005

Poison Control Center Calls for Major Substances of Abuse: 2000-2005

Los Angeles County

SOURCE: California Poison Control System, 2006.


Ecstacy tablets

Ecstacy Tablets

Anatomy of a Tab

  • different sizes & shapes

  •  Typical X is 300 mg tab

  • 50-150 mg MDMA (maybe less)

  • coloring

  • binders

     coatings


Mdma packaging

MDMA Packaging

  • Tootsie rolls are softened & X hidden inside-- “Doing rolls” or “Rolling”

  • Skittles--X mixed in

  • Pez containers--they fit


Talk about creative

Talk About Creative

  • Beaded necklaces for the pacifiers can be homemade; even the “fuzzies” come in kits.

  • Ravers have gone as far as drilling their X pills & stringing them into candy necklaces.


Ecstacy

Ecstacy

X

Dosage & Ingestion

  •  50-150 mg MDMA in one 300 mg tab (lots of variability (50-300 mg/tab)

    •  1-3x a night

    •  $25 per tablet

    •  taken primarily orally

    •  can be injected (IM, not IV)

    • Snorted

       Rectally (“Plugging“)


Ecstacy1

Ecstacy

Onset & Duration of Effects

Starts:20 – 40 minutes

Peaks:2 – 4 hours

Lasts:Physically: up to 8 hours

Mentally: 24 – 48 hours

Street names: Adam, X, XTC, e

Drug class: Empathogen


Ecstacy2

Ecstacy

Under the Influence

  •  dilated pupils high temp

  •  elevated pulse  insomnia

  • hyperactive  muscle rigidity

  • grinding teeth  sweating

  • increased sensual perceptions

  • hallucinations rare

CNS STIMULANT


Ecstacy3

Ecstacy

X

Dilated Pupils


Pharmacological effects

Pharmacological effects

  • Initial enhancement of extracellular seratonin

    • Eventual decrease in seratonin levels

    • Effects are influenced by ambient temperature

  • Elevation of dopamine

    • Mediates effects of cocaine and amphetamine


Long term effects

Long-term effects

  • Neurotoxicity

    • Damage to neurons containing seratonin

    • Abnormalities in brain morphology

  • Short-term memory impairment


Club drugs understanding what they are why people use them and what they do

BRAIN CHANGES of Ecstasy users as well as people who abstain. Ecstasy users have far less serotonin activity (dark areas). May be permanent.


Club drugs understanding what they are why people use them and what they do

Effects of MDMA on Serotonin Transporters

The Johns Hopkins Medical Institutions


Subjective effects of mdma

Subjective Effects of MDMA

  • Altered time perception

  • Increased ability to interact with others

  • Decreased libido

  • Decreased defensiveness

  • Changes in visual perceptions

  • Increased awareness of emotions

  • Less impulsive


Physical effects

Physical effects

  • Pupil dilation

  • Nystagmus

  • Dry mouth

  • Loss of appetite

  • Bruxism (Jaw tension / teeth grinding)

  • Sweaty palms

  • Hot / cold flushes

  • Tachycardia

  • Motor tics

  • Headaches

  • Lethargy

  • Anorexia


Most significant acute adverse effects

Most significant acute adverse effects

  • Hyperthermia

    • Seizures

    • Disseminated intravascular coagulation

    • Renal and liver impairment

    • Rhabdomyolysis

  • Hyponatraemia

    • Confusion

    • Reduced consciousness

    • Seizures or convulsions


Other acute adverse effects

Other acute adverse effects

  • Seizures without hyperthermia or hyponatraemia

  • Hemorrhage due to changes in blood pressure

  • Respiratory difficulties

  • Chest pains associated with physical exertion

  • Ophthalmic complications


Psychological effects

Psychological effects

  • Euphoria

  • Increased energy

  • Feeling of closeness

  • Depression

  • Increased restlessness

  • Increased anxiety

  • Decreased motivation

  • Anhedonia


Psychiatric sequelae

Psychiatric sequelae

  • Depression

  • Panic disorders

  • Flashbacks

  • Delusions

Risk is greatest when used repeatedly and in conjunction with other drugs


Club drugs understanding what they are why people use them and what they do

MDMA

  • Heavy MDMA have memory problems for at least 2 weeks after use - functional consequences

  • Reduction in number of serotonin transporters - PET Studies

  • Damage of serotonin nerve endings

    (Bolla, McCann & Ricaurte Neurology 51, 1998)


Ecstasy users had poorer performance in three general intelligence tests

Ecstasy users had poorer performance in three general intelligence tests

Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725


Ecstasy users had poorer short term memory performance than non drug users

Ecstasy users had poorer short-term memory performance than non-drug users

Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725


Ecstasy like drug

“Ecstasy-like” Drug

  • Paramethoxyamphetamine (PMA) – a dangerous hallucinogen with stimulant properties

  • Releases serotonin

  • Slow onset - people often take more and they may overdose

  • Not new - deaths were reported in 1970s


Street development

Street Development

Gamma Hydroxy Butyrate (GHB)


Club drugs understanding what they are why people use them and what they do

GHB

  • Available in health food supplements until 1992.

  • Odorless liquid, frequently clear with a salty taste

  • Precursor, GBL available until recently in health food supplements


Club drugs understanding what they are why people use them and what they do

GHB

  • Hypnotic (nonanalgesic) anesthetic

  • Epileptogenic agent in animals

  • Increases growth hormone

  • Promotes slow wave sleep

  • Treatment of narcolepsy

  • Trials for the treatment of opiate and alcohol withdrawal


A dose of ghb

A Dose of GHB

  • 1 teaspoon (approx 2.5 g) - 4 tablespoons (30 g)

  • Dependent users 25 grams/day (357.14 mg/kg for a 70 kg man)

  • 50-70 mg/kg dose - anesthesia

    >60 mg/kg coma

  • Sleep studies - 50 - 60 mg/kg/night 2 doses

  • Alcohol studies - 50 - 150 mg/kg day divided doses


Ghb users

GHB Users

- Rave/club crowd

- Gay community

- Exotic dancers/ strippers

- Bodybuilders

- Rapists

- Individuals subject to random or mandatory drug testing


Club drugs understanding what they are why people use them and what they do

  • liquid: clear, odorless, colorless

  • salty taste

  •  solid: white powder usually mixed in water

  •  mixed in drinks to mask taste

  •  one dose = 1/2 to 3 teaspoons (1/2 - 1 cap full)

Gamma Hydroxy Butyrate (GHB)


Gamma hydroxy butyrate

Gamma hydroxy butyrate

Onset & Duration of Effects

  • Cap concentration varies 500mg-5g

  • Rapidly absorbed, peak concentration 20-60 min

  • Almost completely oxidized to carbon dioxide

  • Readily crosses the blood brain barrier and placenta


Club drugs understanding what they are why people use them and what they do

GHB

  • Also known as:

    GHB, G, Jib, Scoop, Liquid E, Liquid X, Sodium Oxybate, Woman’s Viagra, Grievous Bodily Harm, Easy Lay, Gamma 10, Salty Water, GH Buddy, Aminos, Blue Nitro, Blue Thunder, Thunder Nectar, Renewtrient, Revivarant, Remforce, Firewater, Invigorate


Analogs of ghb

Analogs of GHB

Blue Nitro, Renewtrient, Revivarant, Remforce, Firewater Serenity, FX, Weight Belt Cleaner, Enliven, Biosul

- 1, 4 butanediol (BD or BDO)

- sold legally as a floor stripper


Ghb indicators

GHB Indicators

  • Information not collected in standardized measures

  • ER Mentions:

    • 1994 = 55

    • 1999 = 2973

  • 32% of calls to Boston Poison Control involve GHB


Club drugs understanding what they are why people use them and what they do

Common Depressant Impairment

 depressed  slow slurred speech

 impaired attention  intoxicated like ETOH

 sleep-ish  difficulty concentrating

 under-active  disoriented

 droopy eyelids  bloodshot /watery eyes


Ghb gbl analogs and reported uses

Gamma-Butylactone

2(3H) Furanone di-hydro

1,4 Butanediol

Sodium oxybate

Improve sleep

Insomnia

Dancing

Avoid drug testing

Antidepressant

Antianxiety

Socialize

Weight lifting

GHB/GBL Analogs and Reported Uses


Ghb survey

GHB Survey

  • Convenience sample - recruited by a news paper advertisement

  • 120 callers

  • 42 came in for an interview

  • Male 76%

  • Caucasian 73%

  • Heterosexual 70%

  • Employed 69%


Ghb use survey study n 42

GHB Use Survey Study N=42

  • How often do you use GHB

    • Every day 21.4%

    • 1-6 days/ week 35.7%

    • 1X/month or less42.9%

  • How many times per day

    • Once28.6%

    • 2-3 times42.9%

    • 4 or more28.6%

  • How much do you use at a time?

    • < 1 capful9.5%

    • 1-3 capfuls73.8%

    • > 3 capfuls14.3%

    • Other2.4%


Subjective effects of ghb reported by 50 of participants

Euphoria

Increased sexuality

Wellbeing

Relaxation

Talkative

Tranquility

Drowsiness

Optimism

Increased energy

Giddiness

Increased sensitivity to sound

Silliness

Sweaty

Loss of consciousness

Subjective Effects of GHB Reported by > 50% of participants


Subjective effects after ghb use

60 - 30 %

Exhaustion

Sluggishness

Amnesia

Confusion

Clumsiness

29 - 15%

Anxiety

Insomnia

Mumbling

Weakness

29 - 15%

Agitation

Stiff muscles

Babbling

Craziness

Depression

Tremor

Overdose

Pessimism

Sadness

Dizziness

Subjective Effects After GHB Use


Club drugs understanding what they are why people use them and what they do

FACTORS ASSOCIATED WITH GHB OVERDOSE


After ghb withdrawal clinical concerns

After GHB Withdrawal –Clinical Concerns

Severity of “protracted withdrawal” associated with severity acute withdrawal

  • Depression

  • Anhedonia - negative symptoms

  • Panic attacks

  • Tremor

  • Paresthesia

  • Overdose


Ghb withdrawal

GHB Withdrawal

  • Tolerance to GHB developed within months of use in this case series

  • Withdrawal was reported by high dose users

    • The onset of withdrawal occurred with in 2-24 hours of last use

  • A spectrum of withdrawal signs and symptoms was seen:

    • Mild: tremor, anxiety, insomnia, mood lability

    • Severe: above plus, delerium, psychosis, autonomic instability, tachycardia, blood pressure elevation, extreme agitation


Symptoms of ghb withdrawal

Symptoms of GHB Withdrawal

++

+++

++

+++

+++

++

+

++

+++

++

+++

+++

++

+

+++

++

+

+

++

+

+

++

+

+

++

+

++

+

+

++

Key:Mild = +Moderate = ++ Severe = +++


Treatment of adverse ghb effects

Treatment of adverse GHB effects

  • Extended delirium

  • Extreme cognitive dysfunction and amnesia

  • Medical monitoring needed

  • Response to treatment with standard medications is highly variable and potentially dangerous

  • Only treatment is often supportive care


Club drugs understanding what they are why people use them and what they do

Ketamine


Ketamine

Ketamine

  •  Extensive use in Vietnam War

  •  Current use on animals & humans

  •  Behavioral Analog of PCP

  •  1/4th the strength of PCP

  •  Medically in liquid injectable form


Ketamine1

Ketamine

  • Can be heated in oven/microwave to make powder

  • Powder looks like cocaine/methamphetamine


Ketamine special k

Ketamine – “Special K”

  • Snorted or smoked

  • Dissociative effects called a “K-hole” – your brain is active but your body isn’t, “like you’re in a tunnel, your hear echoes, you’re in a semi-conscious state”

  • Used at rave/dance club scene, not as popular as in past

  • “like living inside a big cotton ball,” “everything is in slow motion”

  • flashbacks


Ketamine2

Ketamine

  • Central nervous system depressant

  • Rapid acting-acting dissociative anesthetic

  • Sedative-hypnotic, analgesic and hallucinogenic properties

  • Structurally similar to PCP

  • N-methyl-D-aspartate (NMDA) antagonist


Ketamine3

Ketamine

Sources & Distribution

 Diversion

 Theft

 Mexico


Ketamine4

Ketamine

  • Administration: injected, intranasal, oral

  • 10 ml vials provide 5 illicit doses

  • Sell for $20 a dosage unit

  • Rapid onset of effects

  • Duration of effects 4-6 hours


Ketamine5

Ketamine

Street Names

 K  Vitamin K

 Ket  KitKat

 Special K Super Acid

 K-Land K-Hole

 K-Head Super K


Ketamine6

Ketamine

Dose

  • DoseOnsetDuration

  • IM25-125mg1-5 min’s45 min’s-3 hrs

  • Oral50-450mg5-20 min’s1.5 hrs

  • Nasal25-150mg5-15 min’s10-30 min’s


Ketamine7

Ketamine

  • Muscle spasm

  • Blurred vision

  • Dizziness

  • Slurred speech

  • Visual “flashbacks”

  • Psychological effects

  • Tolerance


Street development1

Street Development

Common Ketamine Impairment

 slow slurred speech

 intoxicated like ETOH

 impaired attention

 difficulty concentrating

 disoriented

 bloodshot /watery eyes


Nitrous oxide

Nitrous Oxide


Nitrous oxide1

Nitrous Oxide

  • Large canisters stolen from dentist or medical supply house

  • Medium canisters from performance vehicle shops

  • Little canisters from kitchen stores for whipped cream makers


Nitrous oxide2

Nitrous Oxide

Whippets, “cracker” & balloon

Regular whipped cream


Club drugs understanding what they are why people use them and what they do

s

Onset & Duration of Effects

  • Onset

     Immediate

  • Duration

  •  5 minutes max


Nitrous oxide3

Nitrous Oxide

Common Inhalant Impairment

 depressed  slow slurred speech

 impaired attention  intoxicated like ETOH

 sleep-ish  difficulty concentrating

 chemical odor  disoriented

 droopy eyelids  bloodshot /watery eyes


The new ones

The New Ones

2C-B

DXM


The new ones1

The New Ones

2C-B

4-Bromo-2,5-dimethoxyphenethylamine

  • Originally synthesized in 1974

  • White powder pressed into tablets or gel caps.

  • Enactogen (literally “touching within”)


Club drugs understanding what they are why people use them and what they do

2C-B

The Effects

  • Lower doses

    • Feeling in touch with themselves and emotions

    • Erotic feelings

    • Being “in ones body”


Club drugs understanding what they are why people use them and what they do

2C-B

  • Higher Doses

    • Visual effects

      • Trails

      • Geometric patterns

      • Breathing objects

      • See the music

    • Nausea, trembling, nervousness

  • Very dose sensitive—a few miligrams can produces significantly more effect.

  • No known deaths—but safety not known

The Effects


The new ones2

The New Ones

Dextromethorphan

DXM

Robo

Skittles

CCC

Tripple Cs

DexTussin

Vitamin D


Dextromethorphan

Dextromethorphan

Poison Control Center Calls

  • According to Partnership for a Drug-Free America, 10 percent of teens (2.4 million) have intentionally abused cough medication to get high.


Dextromethorphan1

Dextromethorphan

  • Clinical Dose

    • 15-30 mg every 6-8 hours

    • 60 mg every 12 hours for extended release

  • Abuse Doses

    • Often as high as 240-360 mg per administration


Dextromethorphan2

Dextromethorphan

  • Effects at high doses

    • LSD-like high

    • Out of body experience

    • Hallucinations

    • Vivid dreams with visions


Dextromethorphan3

Dextromethorphan

Consequences of Abuse

  • Sweating

  • Delusions

  • Hallucinations

  • High body temperature

  • Loss of consciousness

  • Tachycardia

  • Blurred vision

  • Confusion

  • Seizures

  • Vomiting


Rave toys

Rave toys


The rave drug scene

The Rave Drug Scene


Best friends til the trip ends

Best friends ‘til the trip ends

  • Raves create an instant community

  • Offers everything a teenager wants

    - acceptance

    - attention

    - popularity

  • Fosters sexual or intimate behavior


Club drugs understanding what they are why people use them and what they do

Thomas E. Freese, Ph.D.

[email protected]

www.psattc.org

www.clubdrugs.org


  • Login