Addiction and drugs of abuse

Question 1

What is the psychoactive component in cannabis?

Answer 1

THC
Binds to CB1 receptors
(Leads to an indirect dopamine release)

Question 2

How long does cannabis remain in the body?

Answer 2

Lipid soluble so remains in system for longer
Days in infrequent use / weeks in chronic use

Question 3

What are the psychological effects of cannabis?

Answer 3

Relaxation
Euphoria
Altered perceptions
Irritability
Paranoia

Question 4

What are the physical effects of cannabis?

Answer 4

Dry mouth
Dry eyes
Tachycardia
Hunger

Question 5

What are the chronic / adverse effects of cannabis?

Answer 5

Low motivation
Depression
Anxiety (major factor in perpetuation of cycle of use)
Psychosis
Associated tobacco risks

Question 6

What effects does MDMA have on the brain?

Answer 6

Blocks SEROTONIN reuptake so increases quantity of free serotonin at synapse
Increases dopamine (reward, pleasure) and noradrenaline (stimulant)

Question 7

What are the psychological effects of MDMA?

Answer 7

Euphoria
Increased EMPATHY towards others
Increased energy
Altered perceptions eg SYNAESTHESIA

Question 8

What are the physical effects of MDMA?

Answer 8

Hyperthermia
Dry mouth
MYDRIASIS
Hypertension
Tachycardia
BRUXISM (clenched / grinding jaw)

Question 9

What are the chronic / adverse / come down effects of MDMA?

Answer 9

COME DOWN: anxiety, low mood, low energy
ADVERSE: low mood, anxiety, overdose, HYPONATRAEMIA secondary to water intoxication –> seizure –> DEATH

Question 10

What effect do amphetamines have on the brain?

Answer 10

DISRUPTS STORAGE OF NEUROTRANSMITTERS such as dopamine, serotonin and noradrenaline in synaptic vesicles
Leads to increased amounts due to transporters running in reverse –> STIMULANT effect

Question 11

What are the physical effects of amphetamines?

Answer 11

TACHYCARDIA
Hypertension
Increased resp rate
DECREASED HUNGER + NEED FOR SLEEP

Question 12

What are the chronic / come down / withdrawal effects of amphetamines?

Answer 12

COME DOWN: low mood, lethargy
CHRONIC: psychosis, depression, anxiety, dependence
WITHDRAWAL: cravings, low mood, increased sleep, anhedonia

Question 13

What effects does LSD have on the brain?

Answer 13

Binds to 5-HT receptors causing serotonin release
ALTERS SHAPE of receptor to form a stronger bind –> LONGER half-life and effect
Increased levels of dopamine and glutamte

Question 14

What are the psychological effects of LSD?

Answer 14

Can vary
Altered perceptual states (synaesthesia, dissolution)
Visual and auditory hallucinations

Question 15

What are the physical effects of LSD?

Answer 15

Mild tachycardia
Mild hyperthermia
Mydriasis

Question 16

What are the come down / adverse effects of LSD?

Answer 16

COME DOWN: anxiety, reduced concentration, reduced appetite
ADVERSE: bad trip, risk of PSYCHOSIS in CHRONIC use but does not induce dependence
HPPD = Hallucinogen Persisting Perception Disorder - continuing to experience perceptual distortions months / years after stopping drug

Question 17

What effect does heroin have on the brain?

Answer 17

A PRO-DRUG - crosses blood-brain barrier and is converted to MORPHINE
Binds to MU-OPIOID receptors –> euphoria and analgesia
Inhibits GABA causing increased DOPAMINE

Question 18

What are the psychological effects of heroin?

Answer 18

Euphoria
Relaxation
Sense of COMFORT
Anxiolytic

Question 19

What are the physical effects of heroin?

Answer 19

REDUCED RESP RATE
Bradycardia
CNS depression
CONSTRICTED PUPILS

Question 20

What are the come down / adverse effects of heroin?

Answer 20

Tolerance soon develops –> dependence
DEATH due to RESPIRATORY DEPRESSION
Significant withdrawal features

Question 21

What are the effects of cocaine / crack on the brain?

Answer 21

Blocks MONOAMINE reuptake transporters
Leading to increased dopamine, noradrenaline and serotonin
Crack = short half-life (minutes), Cocaine = longer, less sharp high

Question 22

What are the psychological effects of cocaine / crack?

Answer 22

Elation
Increased ENERGY
CONFIDENCE

Question 23

What are the physical effects of cocaine / crack?

Answer 23

Dry mouth
MYRDIASIS
Vasoconstriction
TACHYCARDIA
Decreased appetite

Question 24

What are the come down / adverse effects of cocaine / crack?

Answer 24

COME DOWN: low mood, irritability, tremors, difficulty concentrating
ADVERSE: stroke, CARDIAC TOXICITY, ENT complications

Question 25

What are the biological treatment approaches for addiction and drugs of abuse?

Answer 25

ANTIDOTES --> naloxone (opioids), flumazenil (Benzos) DETOXIFICATION --> methadone, diazepam SUBSTATION --> methadone, buprenorphine DETERRENCE --> disulfiram (alcohol) ANTI-CRAVING --> acamprosate (maintenance of abstinence), naltrexone (for cutting down)

Question 26

What is the recommended psychological treatment for substance abuse?

Answer 26

Motivational interviewing - works to increase motivation to stop Brief interventions CBT Contingency management Self help

Question 27

What are the opiate replacement therapy options?

Answer 27

*Both have long half-life and prevent withdrawals without giving an opiate high* METHADONE -Liquid (luminous green, tablet / injection -10-30mg/daily (starting dose) -Maintenance up to 100mg daily under supervision BUPRENORPHINE -Tablet, sublingual or depot -4mg/day (starting dose) -Maintenance up to 8-16mg or 32mg under supervision -Blocking action means illicit use does not produce a high

Question 28

What is important to remember when giving buprenorphine to an opiate user?

Answer 28

Has partial agonist and antagonist properties so can precipitate a WITHDRAWAL in those using high dose opiates

Question 29

What are the key symptoms of opiate withdrawal vs overdose?

Answer 29

OVERDOSE: -RESP DEPRESSION -Bradycardia -Reduced GCS -Pinpoint pupils WITHDRAWAL: -Muscle aches, lacrimation, agitation -Excessive yawning, rhinorrhoea - Sweating, tachycardia, HTN, sleep disturbance (autonomic hyperactivity, N+V+D, dysphoria, craving

Question 30

What is the treatment for overdoses?

Answer 30

NALOXONE Competitive opiate antagonist (V SHORT HALF-LIFE so beware risk of further overdose in cases of long-acting high dose opiates) IM and nasal spray