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

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

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  1. 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

  2. The Club Drugs • THE BIG ONES - • 3,4 methylenedioxymethamphetamine (Ecstasy) • Gamma Hydroxy Butyrate (GHB) • Ketamine • Nitrous Oxide • SOME NEW ONES • 2C-B • DXM

  3. MDMA

  4. Ecstacy Tabs

  5. Ecstasy • MDMA technically 3,4 - Methylenedioxymethamphetamine • Hallucinogenic amphetamine • Releases serotonin and blocks reuptake • Dopamine and adrenergic effects

  6. 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

  7. 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

  8. Percentage of Seniors Reporting Ecstasy as ‘Fairly Easy’ or ‘Very Easy’ to get Source: Monitoring the Future Study, 1999 -- NIDA

  9. Ecstasy Rates by Grade 2003-2005 SOURCE: Monitoring the Future Study, 2005.

  10. Poison Control Center Calls for Major Substances of Abuse: 2000-2005 Los Angeles County SOURCE: California Poison Control System, 2006.

  11. Ecstacy Tablets Anatomy of a Tab • different sizes & shapes •  Typical X is 300 mg tab • 50-150 mg MDMA (maybe less) • coloring • binders  coatings

  12. MDMA Packaging • Tootsie rolls are softened & X hidden inside-- “Doing rolls” or “Rolling” • Skittles--X mixed in • Pez containers--they fit

  13. 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.

  14. 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“)

  15. 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

  16. Ecstacy Under the Influence •  dilated pupils high temp •  elevated pulse  insomnia • hyperactive  muscle rigidity • grinding teeth  sweating • increased sensual perceptions • hallucinations rare CNS STIMULANT

  17. Ecstacy X Dilated Pupils

  18. 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

  19. Long-term effects • Neurotoxicity • Damage to neurons containing seratonin • Abnormalities in brain morphology • Short-term memory impairment

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

  21. Effects of MDMA on Serotonin Transporters The Johns Hopkins Medical Institutions

  22. 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

  23. 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

  24. Most significant acute adverse effects • Hyperthermia • Seizures • Disseminated intravascular coagulation • Renal and liver impairment • Rhabdomyolysis • Hyponatraemia • Confusion • Reduced consciousness • Seizures or convulsions

  25. 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

  26. Psychological effects • Euphoria • Increased energy • Feeling of closeness • Depression • Increased restlessness • Increased anxiety • Decreased motivation • Anhedonia

  27. Psychiatric sequelae • Depression • Panic disorders • Flashbacks • Delusions Risk is greatest when used repeatedly and in conjunction with other drugs

  28. 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)

  29. Ecstasy users had poorer performance in three general intelligence tests Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725

  30. Ecstasy users had poorer short-term memory performance than non-drug users Journal of Neurology, Neurosurgery, and Psychiatry 2000; 68:719-725

  31. “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

  32. Street Development Gamma Hydroxy Butyrate (GHB)

  33. 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

  34. 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

  35. 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

  36. GHB Users - Rave/club crowd - Gay community - Exotic dancers/ strippers - Bodybuilders - Rapists - Individuals subject to random or mandatory drug testing

  37. 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)

  38. 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

  39. 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

  40. 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

  41. GHB Indicators • Information not collected in standardized measures • ER Mentions: • 1994 = 55 • 1999 = 2973 • 32% of calls to Boston Poison Control involve GHB

  42. Common Depressant Impairment  depressed  slow slurred speech  impaired attention  intoxicated like ETOH  sleep-ish  difficulty concentrating  under-active  disoriented  droopy eyelids  bloodshot /watery eyes

  43. 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

  44. 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%

  45. 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 less 42.9% • How many times per day • Once 28.6% • 2-3 times 42.9% • 4 or more 28.6% • How much do you use at a time? • < 1 capful 9.5% • 1-3 capfuls 73.8% • > 3 capfuls 14.3% • Other 2.4%

  46. 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

  47. 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