Final Exam Flashcards
(66 cards)
1
Q
Acetylcholine
A
- Found on neuromuscular junctions in somatic system, acts on receptors that excite the muscle
Nicotine = acetylcholine
- stimulates then blocks
- continued occupation at receptor site prevents incoming impulses from having effect (blocks transmission)
- acute nicotine poisoning: tremors–>convulsions–>death bc cholinergic blocking of muscles
2
Q
Adenosine
A
- Inhibitory neurotransmitter, mental sedation
Caffeine = adenosine antagonist
- Blocks adenosine receptors
3
Q
Dopamine
A
- Reward, excitatory
Cocaine/amphetamines
- Cocaine blocks reuptake of NAs
- Amphetamines stimulate release of NAs
4
Q
Endorphines
A
Opioids (morphine, heroin)
endorphins are natural agonists of opioid receptors
Heroin: mimics endorphins
5
Q
GABA
A
- Major inhibitory NA, limits DA release
sedatives increase DA - Agonists: Opioids (mu), benzos, barbs, alcohol work directly on GABA
Opioids=short-acting opioid agonist
6
Q
Glutamate/NMDA
A
- Excitatory
- Cocaine acts on glutamate receptors
- PCP, ketamine (psychs, dissociative)
PCP is an NMDA/glutamate receptor
7
Q
Norepinephrine
A
- Reward, excitatory
Cocaine/amphetamines
- Cocaine blocks reuptake of NAs
- Amphetamines stimulate release of NAs
8
Q
Serotonin
A
- Psychedelics ==> phantasica (act on serotonin 2a receptor)
Indole: (serotonin structure) D LAP
LSD, Psilocybin (shrooms), DMT, Ayahuasca
Catechol: (catecholamine, NE, and DA structure) D M2M
Mescaline/peyote, MDMA, DOM, 2CB
- Cathechol and indole hallucinogens . - act on 2A (serotonin 2A receptor)
9
Q
Monitoring the Future Survey
A
40 yrs; ALLOWS US TO SEE CHANGES OVER TIME IN DRUG USE RATES
15,000 high school seniors/college/8,10
Percentage of college students who have ever used the drug (lifetime)
Used in past 30 days (current)
Daily users in past month
- Most college students have tried alcohol in life, half marijuana, and most never tried any others; daily use for any extremely rare
ILLICIT DRUG USE AMONG HIGH SCHOOL SENIORS HAS NOT CHANGED MUCH IN PAST 15 YEARS
(can’t say more and more young people are using drugs or that kids are starting to use at younger rates)
- -> Rates low when perceived risk (of harm) is high
- -> Perceived availability has remained relatively constant (implying supply is not a large factor)
- -> Best way to reduce use is to convince students of harm (but not causation, correlation, possibility of confound factors)
10
Q
National Survey on Health and Drug Use
A
- Face-to-face, computer-assisted interview done with more than 68,000 individuals in carefully sampled households across the US
11
Q
Drug Abuse Warning Network (DAWN)
A
- no longer exists
- system for collecting data on drug-related deaths or emergency room visits; measure toxicity of drugs other than alcohol
- Up to 6 drugs recorded
12
Q
Years that drug use was highest in the United States
A
- 1979/80 peak years
- Peak in 80s, lower rates in early 90s, not much change over last decade
13
Q
Annual mortality rates of commonly used psychoactive drugs (e.g., alcohol, tobacco, cocaine)
A
Alcohol: 100,000
Tobacco: 400,000
Opioid: 42,000
15,000 for heroin
72k for all drugs
14
Q
War on Drugs
- incarceration rates
- racial disparities
- US annual expenditure
A
- $28 billion spent each year
- 2.2 million people incarcerated
- Black people represent ⅓ of all drug arrests
- State: Blacks 4x more likely to be arrested for marijuana
- Federal: Latinos represent ⅔ of those arrested
15
Q
Pure Food and Drugs Act
A
Regulated pharmaceutical manufacturing and sales
All ingredients, accurate labeling
Protect from deceit, not themselves
Dept of Agriculture
16
Q
Harrison Act
A
1914 tax act, first national drug law
Tax and regulate the production, importation and distribution of opium and cocaine products
- Trading favor with China if helped them reduce opium
- Dealers had to register, pay small fee, and use order forms
- TREASURY DEPT
Did not explicitly prohibit the use of opiates or cocaine
Enforcement of of the new law quickly became increasingly punitive
18th amendment, 21st amendment [cops have nothing to do after repeal]
17
Q
Schedule I vs. Schedule II Drugs
A
Schedule 1: no legal access, high potential for abuse, no medical use, not safe under supervision
ex: Marijuana, heroin, MDMA
Schedule 2: high potential for abuse, yes medical use, abuse could lead to dependence
ex: meth, morphine, cocaine
18
Q
Blood-Brain Barrier Functions
A
Barrier between blood and fluid surrounding neuron
Semipermeable membrane
Drug must be able to pass to have effect
19
Q
Mesolimbic Dopamine Pathway
A
VTA → nucleus accumbens
Mediates schizophrenia
(overactivation of DA neurons produces hallucinations → combated by DA-blocking drugs)
20
Q
Nigrostriatal Dopamine Pathway
A
Substantia nigra → striatum
Mediates movement
(lack of DA neurons inhibits movement….Parkinson’s)
Treatment: L-dopa as precursor bc penetrates BB barrier
21
Q
Pharmokinetic Properties of Drugs
theories for each
A
Half-life Onset speed (route of administration)
Theory: shorter half-life: more likely to produce withdrawal symptoms
Shorter onset: likely to cause addiction
Hypnotics tend to use larger dose (larger dose, comes on fast, wears of quickly ~~shorter half-life) = good for sleep pill
Sedatives smaller (lower dose, comes on slower, wears off longer ~~longer half-life) = good for daytime sedative
22
Q
First-pass Metabolism
A
Relation to common routes of administration
Drug broken down before reaching general blood circulation and brain
broken down in liver
oral most broken down, little with intranasal
23
Q
Understand the similarities and differences of the following drugs: heroin, methadone,
buprenorphine, naloxone and naltrexone
A
Heroin - opioid agonist, short-acting
Methadone - opioid agonist, LONG duration so take less, take at program, more dangerous (FDA+)
Buprenorphine - partial opioid agonist (blocks opioid agonists such as heroin), low overdose potential, long duration (FDA+)
Naloxone - overdose reversal bc short-acting antagonist on receptor, displaces opioid agonists
Naltrexone - antagonist, used as treatment, prevents you from getting high, long-acting naloxone
24
Q
Nicotine Therapies
A
Substitutes
- Patch
- Gum
- Nasal spray
- Inhaler
25
Anti-drug Abuse Act
Crack cocaine 80s → reversal of comprehensive drug abuse and prevention act of 1970
Brought back longer sentences, mandatory minimums, no-paroles
100:1 crack cocaine
→ huge prison growth
26
Understand the effects of smoking tobacco during pregnancy
Nicotine, hydrogen cyanide, and carbon monoxide in mother smoker's blood
- 1/2 pound lighter (dose-response rate) (reduced O2)
must give up by month 4
- body size, neuro problems, reading/math skills, hyperactivity at various ages, sudden infant death syndrome
- miscarriage
- nicotine dependence in teens
27
Know which neurotransmitter caffeine primarily works through to produce its effects
Xanthines block adenosine receptors
Adenosine usually causes sedation (inhibits other NT)
Caffeine's stimulant action blocks adenosine receptors' inhibitory effect
28
Understand caffeine-related potential beneficial and detrimental effects
Pros:
- stimulation
- energy, offsets exhaust
- headache reducer
- high does decrease hyperactivity
- no evidence of birth defects
Cons:
- harder to get pregnant
- miscarriage
- slow growth of fetus --> low birth weight
- lower heart disease in moderates, raise in extreme drinkers
- caffeinism
29
Know the opioid receptor subtypes and understand opioid pharmacology as presented in lecture
Mu - pain
Kappa - pain
Delta - chronic
Opioids act as agonists at mu receptor on GABA neurons
Disinhibition
inhibit GABA - increase DA release
Most drugs increase DA
30
Know something about the opium wars as described in the text
outlawed -> smuggled -> chests destroyed -> Chinese killed -> war -> brits won
Opium smuggling began when outlawed, very popular
Brits went to war so they could continue pouring opium into China against Chinese gov't wishes
British would import tea in order to illegally sell opium
EIC --> British firms --> Chinese merchants
China seized opium chests, destroyed them --> (*)drunk American and British sailors killing Chinese man
British won -- were given HK, trading rights, $6m to reimburse destroyed opium
31
Understand the problems with using phrases such as “heroin epidemics” to describe heroin use
"An increase, often sudden, in the number of cases of a disease"
“a sudden outbreak of a disease that spreads quickly and affects many individuals at the same time”
**past few years (2014-16) remained about the same ~4%
[NSDAH}
**CDC data 2000-2017 OD death has steadily increased
**in terms of use, used far less than other drugs (marijuana 40 million past-year users...heroin <100,000) [NSDAH]
**(CDC 2016 data) 42,000 opioid deaths (13%)
15,000 heroin deaths (5%)
**75% deaths involve sedative combo
Guns and automobiles 40,000 (11%)
**- if in body, doesn't mean it caused it (multiple present), CDC gets data from MEs around country (not standardized)
**2-3x more occasional users
Reasons:
- Scapegoat for society's problems
- Recreational drug use lack a strong lobby
- Moralism
Opioid overdose IS a real concern (49k deaths)...but the issues above prevent us from getting to the bottom of what is really going on; makes it more difficult to treat
(1) implies sporadic appearance
- obfuscates the origins and structure that can produce drug problems, as if the substance had a life of its own
- drug is not seen as a behavior
- When we blame the substance itself, our efforts to correct drug-related problems tends to focus exclusively on eliminating the substance, ignoring the factors that led to abuse in the first place
(2) doesn't impact people equally, as a disease would
- ignores predispositions (mental health)
- poverty, stress, joblessness, and structural injustice
- Black people represent ⅓ of all drug arrests
- State: Blacks 4x more likely to be arrested for marijuana
- Federal: Latinos represent ⅔ of those arrested
32
According to the text, understand the lessons learned about heroin use from military personnel who
experimented with heroin while in Vietnam
Worry that Vietnam war
Golden Flow: 5% had traces
1-2% used when returned to country (same % when entering)
heroin addiction and compulsive use not inevitable
under better conditions, more recreational use
- availability, low cost, purity, less stress and sanctions
33
2. Giving someone Adderall to treat methamphetamine use disorder is just trading one addiction
for another.
- Addiction has to cause impairment and distress, adderal prescription can function more happily and healthfully bc it’s cheaper
- know dosage, more security, affordable-
34
Understand why the following individuals are linked to psychedelics: Albert Hofmann, Timothy Leary, and Roland Griffiths
- Hofman: "father of LSD" first synthesized LSD, recorded experiences, advocacy for responsible use, help understand place in nature, spurred research 1950s-70s
- Leary: Harvard prof, unsound experiments, started own religion
- Griffiths: Johns Hopkins 2006 study psilocybin produces positive mystical effects, replicated "Good Friday" exp findings
35
Be able to identify psychedelics from the following classes: indole, catechol, and anticholinergic; and
something about the effects produced by them
Two major types of phantasica - act on serotonin 2a receptor, can still communicate/describe
Indole: (serotonin structure) D LAP
- perceptual distortion
LSD, Psilocybin (shrooms), DMT, Ayahuasca
Catechol: (catecholamine, NE, and DA structure) D M2M
Mescaline/peyote (similar to indole), MDMA, DOM, 2CB (amphets)
Deliriants: loss of touch with reality, mental confusion. clouding of consciousness, no memory
Anticholinergic: acetylcholine antagonist
Belladonna, mandrake, henbane, datura
36
Be familiar with the Marijuana Tax Act of 1937 and the role played by Harry Anslinger in ensuring
its passage
1937 Marijuana Tax Act
- Did not outlaw
- Taxed the grower, distributor, seller, and buyer
- Released 10 stamps
- Made it, administratively, impossible for people to have anything to do with marijuana
- Declared unconstitutional, overturned in 1969
Targeted Mexicans in Texas, black people in south [horrible crimes under the influence
--> can’t go after a despised group specifically, but you can go after an activity associated with them
Concern raised about drug in 1930s
Harry Anslinger
Commissioner of Bureau of Narcotics (1930-62)
Helped to finance PSAs and films (Reefer Madness)
- Congressional hearings: had Treasury agents testify with anecdote, exaggerated accounts
- Anecdote written about in medical journal
- Anslinger would write article citing medical journal
May 1969 ruled unconstitutional
Timothy Leary
Controlled Substance Act of 1970: placed on schedule 1
37
Know the first five medical cannabis states and the ten that have legalized it for recreational purposes
[CAMOW]
California, Alaska, Oregon, Maine, Washington = medical use
Recreational:
- Washington
- Oregon
- California
- Nevada
- Colorado
- Alaska
- Michigan
- Maine
- Vermont
- Massachusetts
38
Be familiar with the LaGuardia report
showed that marijuana was not dangerous
unpopular conclusion
- impairs general intellectual functioning
- no personality change
- self-confidence
- no mental/physical deterioration
39
Know the different types of cannabinoid receptors
THC and other cannabinoids known to bind to two receptors
- CB1 - found throughout body but primarily in brain, receptors much more abundant than receptors for morphine and heroin,
WIDSPREAD ACTION - BASAL GANGLIA, cerebellum, hippocampus, cerebral cortex, nucleus accumbens
-- suggesting widespread actions of cannabinoids, most concentrated at BASAL GANGLIA (coordinates body movements)
......also in......
- Cerebellum - fine body movements
- Hippocampus - memory
- Cerebral cortex - integration of higher cognitive function
- Nucleus accumbens - reward
IMMUNE
- CB2 - found mainly outside the brain in immune cells, suggesting role in immune response
CB1 (primarily in brain)
CB2 (outside brain)
40
Be familiar with some brain regions (and their functions) that contain high densities of cannabinoid
receptors
THC and other cannabinoids known to bind to two receptors
- CB1 - found throughout body but primarily in brain, receptors much more abundant than receptors for morphine and heroin,
WIDSPREAD ACTION - BASAL GANGLIA, cerebellum, hippocampus, cerebral cortex, nucleus accumbens
-- suggesting widespread actions of cannabinoids, most concentrated at BASAL GANGLIA (coordinates body movements)
......also in......
- Cerebellum - fine body movements
- Hippocampus - memory
- Cerebral cortex - integration of higher cognitive function
- Nucleus accumbens - reward
IMMUNE
- CB2 - found mainly outside the brain in immune cells, suggesting role in immune response
CB1 (primarily in brain)
CB2 (outside brain)
41
Understand how dronabinol (Marinol) is related to cannabis
Marijuana in a pill: Marinol (dronabinol)
Δ9-THC IN gelatin capsule
FDA-approved (Schedule III)
chemotherapy-induced nausea (1985)
Originally approved on schedule II (you can't write refills); then moved to schedule III (allows for refills)
42
```
Know the conditions that cannabis has been proposed to treat (as presented in class and the text) and
the states that have approved the medical use of cannabis
```
```
Nausea
Lack of appetite
Various types of pain
Glaucoma
Anticonvulsant
Multiple sclerosis-related spacity
PTSD
```
states: CAMWOW
California, Alaska, Oregon, Maine, Washington
43
Be able to evaluate the potential toxic affects cannabis might produce on: lung functioning,
motivation, and reproduction
Lungs
- Chronic lung exposure - chronic smoking impairs lung function
Reproduction
- lower sperm count
- but no birth abnormalities in babies from low-level smoking mothers
Motivation
- Amotivational syndrome
- but no evidence, lab data does not support
44
Understand some reasons why some members of society are concerned about drug use by athletes
- fairness
- morality
- amphet. margins
TEST of amphetamines to placebos in runners, swimmers, weight throwers — small performance enhancement
- Even 1% makes a difference for them, there is an amphetamine margin
45
Be able to describe the withdrawal syndrome associated with the following drugs of abuse: alcohol,
tobacco, cocaine, cannabis, and heroin
Alcohol
- acute alcohol withdrawal syndrome: tremors, rapid heartbeat, hypertension, sweating, insomnia, hallucinations, seizures
Tobacco
- anxiety, depression, dysphoria, irritability, lower concentration, more food, cigarette craving
Cocaine
- depression, nervousness, dysphoria, anhedonia (lack of emotion), fatigue, irritability, sleep and activity disturbances, cocaine craving
Marijuana
- No DSM-5 withdrawal
- negative mood, bad sleep, less food, aggressive
Heroin
Nausea, ache/cramps, Teary eyes, Runny nose, Pupillary dilation, Sweating, Fever , Diarrhea, Piloerection, Anxiety
Insomnia
```
----------------------
Only ones you can die from: BAB
Benzos
Alcohol
Barbs
==> because they work directly on GABA —> seizure, die
```
46
Please know the medications that are FDA-approved to treat substance use disorders
- 3 for alcohol
Naltrexone -
Antibuse - stops acetylaldehyde breakdown (get sick)
- 3 Opiiod
- 2 pills for nicotine + patches/lozenge
47
Understand the probability or likelihood of death as a result of withdrawal from the following drugs:
alcohol, caffeine, cocaine, heroin, LSD, cannabis, methamphetamine, and nicotine
```
Only ones you can die from: BAB
Benzos
Alcohol (1 in 7)
Barbs
==> because they work directly on GABA —> seizure, die
```
48
1. Drug use is not drug abuse.
Simply using doesn't equate to a problem
Most users of a given substance do not use it in ways that can be defined as either abuse or dependence
Abuse: use of a substance in a manner, amounts, or situations such that the drug causes problems or greatly increases chances of problem occurring
49
2. Dose is critically important.
```
dose = how much you take
set = mood, expectations
setting = environment
```
drug effects can change rapidly depending on dosage
even a small dose increase can cause overdose
- fentanyl 50-100x more potent than heroin
Dose: dose-response (sometimes all-or-none [maximal engagement when activated], new response systems engaged with dose increases (ATAXIA, COMATOSE)
Hoffman: 5-8x higher
50
3. Psychoactive drug effects are influenced by the user’s history and environmental factors.
Set:
- experienced users may have less disruption, more positive effects bc of associations in previous use
CIA research, psychoactive disturbances
51
4. Drugs are not good or bad.
It is the behavior, the way the drug is being used, not the drug itself
The chemicals of the drug itself do not possess evil intent, it is how it is used
Any drug that produces effects has the potential to produce both benefit and harm
ex: heroin = painkiller
ex: cocaine = local anesthetic
ex: meth = ADHD and obesity\
When we blame the substance itself, our efforts to correct drug-related problems tends to focus exclusively on eliminating the substance, ignoring the factors that led to abuse in the first place
52
Describe the similarities and differences between heroin and morphine. In your answer, please
mention the receptor(s) through which they exert their effect(s), their chemical structure, and how
they might be used in medicine.
Heroin and morphine essentially the same drug
(Identical pharmacology except:)
- Adding 2 acetyl group to heroin
- Makes it more lipid-soluble → crosses BBB more readily, enters brain more rapidly
Morphine:
- Hypodermic needle development - people believed morphine injection would not produce same craving that oral use did (later found false)
- Civil War, Prussian-Austrian War, Franco-Prussian War
pain relief --> high dependency
soldier's disease
Heroin:
- add 2 acetyl groups
- Makes it more lipid-soluble → crosses BBB more readily, enters brain more rapidly
- 3x more potent
additional groups then detach, yielding morphine (effect same)
- first marketed as non-addictive cough-suppressant, substitute for codeine and morphine
USES:
(1) pain relief - morphine reduces emotional response, without causing sleep
(2) intestinal disorder - stop colic, diarrhea
(3) cough suppressant - decrease activity in cough control area, medulla; antitussive
Opioids binds to mu receptor located on GABA neurons
Morphine = SCHEDULE 2, heroin = SCHEDULE 1
Heroin (despised groups, hipsters, minority groups, poor) v. morphine (allowed to use morphine; fake argument: heroin far more potent and dangerous)
53
Make an argument for the pros and cons of medical cannabis (smoked).
Smoked Medical Cannabis (Smoked)
- Quicker onset
- Shorter half-life
PROS:
- Titration: can control dosage more
- No first-pass metabolism: being able to better control you dosage, more potent, you get everything you’re putting in
- Very possible other factors are giving therapeutic effect (Ex: CMD, and over other cannabinoids, Complex mixture of 400 chemicals)
- Quicker onset, shorter duration —> supposedly higher abuse potential
CONS:
- Better medications available
- Side-effect profile (anxiety, snacking)
54
Compare and contrast the evidence supporting and opposing the role of cannabis in causing a
psychosis disorder.
- Few thousand adults separated into 2 groups
Marijuana users v. non-drug users
- Then level of psychosis determined by questionnaire
No Psychologist, no Psychiatrist....just survey
20-item questionnaire - Qs vary widely
e.g." hear voices that other do not” OR “I sometimes feel uncomfortable in public”
- - One could endorse psychotic symptoms without meeting criteria for disorder
- -No study to date has determined causality
There CAN be a seen a correlation between cannabis and psychosis
BUT correlation is NOT specific to cannabis (anxiety, bipolar, and mood disorders all correlated with cannabis)
Also, psychosis correlated with heavy tobacco smoking, heavy alcohol use, inappropriate stimulant use, sedative use
- hard to disentangle effects of cannabis from other drugs
- which came first? drug use or psychosis
Precipitated psychoses?
- Effect may be limited to predisposed individuals
55
Please explain how steroids work to increase muscle mass.
Protein synthesis
Cellular repair
normally takes 48 hrs, steroids as quickly as 24 hrs
- Anabolic steroids: building tissue, constructive
56
Please explain why someone might conclude that amphetamines are the real performance enhancing
drugs in baseball rather than steroids. Please include data in your response.
- Smith and Beecher: amphetamines to placebos in runners, swimmers, weight throwers — small performance enhancement
- Even one percent makes a difference for them, there is an amphetamine margin
Amphetamines Mental v. Physical — not quite sure; endurance in lab studies, could be masking fatigue effects, allowing a person to perform under utter exhaustion
Baseball - alertness, vigilance, movement
28 prescriptions in 2006, 113 in 2015 adhd
10% of MLB
More violations for amphetamines than steroids
57
Reports, readings
x
58
When discussing cannabis why is it important to know Ramarly Graham, Trayvon Martin, and
Sandra Bland?
```
Ramarley Graham (toilet)
Trayvon Martin (claimed was high)
Michael Brown (in system), Sandra Bland (found dead in cell, snuck marijuana into prison)
```
Police killings where fictitious dangers posed by cannabis used as justification
- Black people represent ⅓ of all drug arrests
- State: Blacks 4x more likely to be arrested for marijuana
59
Please explain why focusing exclusively on heroin-removal, as a strategy to deal with so-called
heroin overdose deaths, is probably not the best approach. In your response, please think about the
number of heroin users and the likely cause of these deaths.
heroin use not problem
- adulteration, miseducation
NPS - new variants of drugs
- Imposible to schedule everything
- Little structural differences
60
MDMA-PTSD Reading
- PTSD 6 mos+, Clinician-Administered PTSD Scale (CAPS-IV) of 50+
- 3 different dose groups + psychotherapy
- 30 mg (control), 75 mg, 125 mg
- Administered orally in 8-hour sessions
- Primary outcome: mean change in CAPS-iv total from baseline to 1 month
61
Understand the effects of using caffeine during pregnancy
- Pregnant mice --> large doses of caffeine produce skeletal abnormalities in pups
- But no relationship in humans and birth defects
- More than 300 mg a day
- harder to become pregnant
- increase miscarriage
- slow growth of fetus (low birth weight)
62
Clinical v. Statistical Significance
practical importance of the treatment effect, whether it has a real, palpable, noticeable effect on daily life
p < 0.05, unlikely to have occurred by chance
63
Explain why a breathalyzer probably will not be useful for determining cannabis-related levels of
intoxication. In your answer, please compare and contrast with alcohol.
Why is it difficult to develop a blood-alcohol test for cannabis?
- No breath alcohol test gonna happen for
- Alcohol is very small molecule with virtually no BBB
- since it is so water soluble and a small molecule
What's in the bloodstream is pretty much what's in the brain with alcohol (pretty much the only drug that does this)
- Cannabis must be transported across BBB
- Binds to blood protein
- Takes a while
- With alcohol, what is in the blood is in the brain
- Not the same for cannabis
- lipid solubility
- what's in the blood is not equivalent to what's in the brain
- Marijuana in blood a lot longer
Blood levels don’t tell you ascending/descending (absorption/elimination) blood levels could be as high as 100 during latter phase, but not dangerous; only see impairment in ascending
* Ascending - rapid blood level rising (smoke?), where you see impairment
* If you take orally, blood levels never ingest that high
* Descending - could still be as high as 100, but not dangerous
64
Please write an essay describing a person who meets DSM-5 criteria for a heroin use disorder
(moderate). Then, describe an evidenced-based course of treatment discussed in lecture or the text. In
your response, list the symptoms that the patient exhibited in order to meet criteria for heroin use
disorder.
2,3=mild, 4-5=moderate, 6+=severe
9/11 behavioral
Clinically significant distress
Must have 4-5 to be moderate
- craving
- tolerance (more amount, continued less effect)
- withdrawal
- great deal of time spent on activities to obtain
- unsuccessful desire to cut down
- important parts of life reduced
Treatment:
- Provide education about specific drug combinations
- Broaden treatment options (hydromorphone)
- Set up free anonymous drug-purity testing services
- Increase the availability of naloxone
- Supervised consumption facilities
- Individual level: use prescription opioids
65
Titration
finding your right amount, reduces symptoms while avoiding side effects
you can feel effects more rapidly so can better control
66
Controlled Substance Act of 1970
1970
Got rid of mandatory minimum penalties and death penalty
5 “schedules” of controlled substances were established
Balancing potential medical benefits with drug’s abuse potential
