Lecture 1 and 2

Question 1

Psychoactive drugs:

Answer 1

Any single chemical compound that interacts with the function of our central nervous system [i.e. the brain and spinal cord], and changes subjective experience or behaviour, or both. Also described as mood altering, as they can change the way we think, feel or act.

Question 2

Classification of psychoactive drugs:

Answer 2

They are classified according to the effects they have on the central nervous system.

Question 3

Depressants:

Answer 3

Supress, inhibit or decrease central nervous system activity. Drugs in this category include alcohol, sedatives, hypnotics [sleeping pills], and opioid drugs such as heroin, morphine and methadone. Generally, if taken in small doses, these drugs produce relaxation or drowsiness. In large doses they can lower respiration and heart rate to the point of unconsciousness or death.

Question 4

Stimulants

Answer 4

Enhance or increase activity in the CNS. These drugs typically increase blood pressure and heart rate, increase respiration and generally increase arousal. Drugs in this category include amphetamines. MDMA, ecstasy, cocaine, caffeine and nicotine. In low doses they can increase energy, feeling of well-being and alertness. Heavy use can result in irritability and insomnia. Stimulants can also produce delusions and hallucinations.

Question 5

Hallucinogens:

Answer 5

Sometimes referred to as psychedelics, act on the CNS to alter perceptions, thinking, feelings and sense of time and place. Some of the adverse effects include unpleasant and frightening hallucinatory experience, post-hallucinogen perception disorder [flashbacks], delusions and paranoia. Drugs in this category include LSD, mescaline and psilocybin [magic mushrooms]. Cannabis may have hallucinogenic and or depressant effects.

Question 6

Most commonly used drugs:

Answer 6

1) Cannabis

2) Ecstasy

Question 7

Self-medication hypothesis:

Answer 7

The use of unprescribed medications or illegal drugs to relieve stress, anxiety or other distressful psychological states.

Question 8

Normative drug use:

Answer 8

Expectations about drinking or other drug use based on perceived use by peers. For example, if a young person forms the view that everyone is using a drug, this may increase the likelihood that they will also use it to conform to what they perceive to be the norm. Perceptions of use are often far greater than actual use.

Question 9

Intoxication:

Answer 9

A condition that follows psychoactive drug use, evidenced by disturbances in the level of consciousness, cognition, perception, judgment, affect or behaviour. Intoxication depends on the type and dose of a drug, tolerance to the drug and personal expectations about the effects of the drug.

Question 10

Tolerance

Answer 10

This refers to the way the body gets used to the repeated administration of a drug, so that higher doses are needed to maintain the same effect.

Question 11

Addiction

Answer 11

A term synonymous with dependence. The continual and excessive use of a drug despite the harms that it causes to the individual and others, and repeated failed attempts to stop or limit use.

Question 12

Dependence liability:

Answer 12

The variable risk of developing dependence associated with different psychoactive drugs. For example, at a population level, the risk of developing cannabis dependence is lower than the risk associated with alcohol or cocaine use.

Question 13

Maturing out:

Answer 13

The process whereby people who experience serious drug problems, including dependence in their younger adult years, reduce their drug intake and associated problems as they mature.

Question 14

Relapse

Answer 14

A return to drug use or drinking after a period of abstinence, often accompanied by reinstatement of dependence symptoms. Some writers distinguish between relapse and lapse fan isolated occasion of drug use or a slip.

Question 15

Chronic relapsing disorder:

Answer 15

Drug dependence is often perceived to be a long-term or life-long condition characterised by periods of uncontrolled use, treatment, abstinence or controlled use and relapse. This is the case for some people, but the majority do not seek treatment and resolve their dependency issues themselves.

Question 16

Drug misuse:

Answer 16

This refers to use of a drug in a way that is likely to cause harm, usually associated with legal drugs and differentiates non-problematic from problematic use.

Question 17

Harmful drug use:

Answer 17

A pattern of drug use that is causing physical or psychological damage to health (such as hepatitis from injecting or depression associated with alcohol use.). It also often results in social consequences.

Question 18

Substance or drug dependence:

Answer 18

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by a need for increasing amounts of the substance to achieve intoxication, the need to continue to take the substance in order to avoid withdrawal symptoms, unsuccessful attempts to stop or cut down the drug use, and continued use despite harmful consequences.

Question 19

Substance use disorders:

Answer 19

The term used by the American Psychiatric Association (2000) in the Diagnostic and statistical manual to describe a condition that includes substance abuse and substance dependence.

Question 20

Alcoholic

Answer 20

A term consistent with a disease theory of dependence that describes a person experiencing alcohol dependence.

Question 21

Addict

Answer 21

A person who is addicted to or dependent on a psychoactive drug. It implies a lack of control over use of the drug.

Question 22

Brief History of AOD in Australia:

Answer 22

• Before colonisation, Aboriginal peoples had only limited contact with psychoactive substances – some plant-based stimulants and depressants used.
• First Fleet: medicines, drugs and hemp seeds for protection “warm climates and tropical diseases”
• For 150 years early governments actively supported the growing of hemp
– land and other grants
– popular as a medicine
– used as an intoxicant by members of the literati
• Drug use in the late 1800s was mainly opium and cocaine-based stimulants
– used by doctors / nurses, the middle-upper class, housewives (for depression + menstrual pain)
– and then later by Chinese immigrants.

Question 23

Alcohol

Answer 23

– Heavy drinking has been a ‘cultural norm’ since colonisation.
– 1808: Rum Rebellion
– 1830s: ‘the Temperance Movement’ peaking during World War I/Great Depression
• Prohibition in states of Australia
• 1837, laws were passed to prevent Aboriginal access to alcohol
– “six o’clock swill”

Question 24

7 Themes common to drug wars:

Answer 24

1. The notion of public menace
2. Political interests
3. Increased criminal justice response
4. Influence of media coverage
5. Portrayal of drug use as infectious
6. The need to protect vulnerable target groups e.g. women and young people
7. Aggressive, militaristic terminology

Question 25

Pharmacology: The effect a drug has on someone depends on the: (3 things)

Answer 25

``` Person Age Gender Individual health Cognitions/expectations ``` ``` Drug How it’s taken (Oral, IV, smoked etc…) Amount used Frequency of use Duration of use/history Drug interactions ``` Environment Social factors

Question 26

Pharmacokinetics

Answer 26

has to do with absorption, distribution, metabolism and excretion of a drug, or ‘what the body does to the drug’

Question 27

Pharmacodynamics

Answer 27

has to do with the biochemistry, pharmacology, and effects of the drug, or ‘what the drug does to the body’

Question 28

Absorption

Answer 28

Via the skin (e.g. Patches, absorbed through skin into circulation) Oral (Small intestine – Liver – Circulation) Smoked (Mouth/lung lining – Circulation) IV (Directly into circulation)

Question 29

Distribution

Answer 29

Organs with high blood flow first (Brain etc…) | Fat, muscles and skin later

Question 30

Drug dependence/neuroadaptation

Answer 30

After period of continual use can become dependant on a drug | Social, psychological, not just physical dependence

Question 31

Drug tolerance

Answer 31

When dependant, less affected by drug/need more to feel effects

Question 32

Drug withdrawal

Answer 32

When physically dependant, cessation results in withdrawal | In general withdrawal symptoms have opposite effect of the drug

Question 33

Cross-dependence

Answer 33

One substance can take place of another to continue physical dependence and avoid withdrawal

Question 34

Agonist effect

Answer 34

an increase or stimulation the action of a neurotransmitter

Question 35

Antagonist effect

Answer 35

decrease or inhibition of the action of a neurotransmitter

Question 36

Dopamine

Answer 36

Dopamine – Neurotransmitter related to reward/pleasure

Question 37

Pharmacokinetocs- What the body does to the drug: Half life

Answer 37

Time for drug in blood to reduce by 50% | Short half life/short action more likely to be abused (e.g. Cocaine and Nicotine)

Question 38

Pharmacokinetocs- What the body does to the drug: Metabolism and excretion

Answer 38

Mostly via urine, some through lungs or gut

Question 39

Pharmacodynamis- What the drug does to the : | SYNAPSES

Answer 39

Brain - millions of pathways (nerves) similar to a mass of electrical wires Communication using chemical messages (neurotransmitters) Everything that we think, feel and do are the result of these chemical communications

Question 40

PharmacologyPharmacodynamics - What the drug does to the body

Answer 40

Many drugs act by mimicking normal neurotransmitters | Occupying receptor sites and sending “false” messages

Question 41

Agonistic Drug Effects (6)

Answer 41

1) Drug increases the synthesis of neurotransmitter molecules (e.g. by increasing the amount of precursor 2) Drug increases the number of neurotransmitter molecules by destroying degrading enzymes 3) Drug increases the release of neurotransmitter molecules from terminal buttons 4) Drug binds to autoreceptors and blocks their inhibitory effect on neurotransmitter release 5) Drug binds to postynaptic receptors and either activates them or increases the effect on them of neurotransmitter molecules 6) Drug blocks the deactivation of neurotransmitter molecules by blocking degradation or reuptake

Question 42

Antagonistic Drug Effects 5

Answer 42

1) Drug blocks the synthesis of neurotransmitter molecules (e.g. by destroying synthesising enzymes) 2) Drug causes the neurotransmitter molecules to leak from the vesicles and be destroyed by degrading enzymes 3) Drug blocks the release of the neurotransmitter molecules from terminal buttons 4) Drug activates autoreceptors and inhibits neurotransmitter release 5) Drug is a receptor blocker; it binds to the postsynaptic receptors and blocks the effect of the neurotransmitter

Question 43

Types of drugs: Depressants

Answer 43

Slow down brain and body May cause initial high/euphoria Impair coordination Some appear to cause emotional depression Small doses: relaxation, drowsiness and loss of inhibitions Large doses: can cause loss of consciousness, respiratory inhibition, and even death Particularly dangerous when drugs are combined

Question 44

Depressants- Alcohol and Benzodiazepines

Answer 44

Mechanism of action: GABA agonist – reduces overall brain activity Glutamate antagonist – excitatory function reduced (effect of BZD on this system is not clear) So, overall depressant effect Benzodiazepines focussed on anxiolytic or sedative effects depending on type Also differences in half-life and strength Benzodiazepines and Alcohol are cross-dependant due to the similar action on GABA system

Question 45

Alcohol

Answer 45

Immediate effects after a few drinks happy, more relaxed, less concentration, slow reflexes, less inhibited A few more disinhibited, more confidence, less coordination, slurred speech, intense moods A few more confusion, blurred vision, poor muscle control More still nausea, vomiting, sleep Even more coma or death

Question 46

Long term health effects of heavy drinking

Answer 46

Long term health effects of heavy drinking Nervous system Brain damage – effects on memory (Korsakoff’s syndrome) Liver Damaged by alcohol processing – (Cirrhosis, Liver Cancer) Withdrawal related risks Seizures and in worst case death Other health effects Heart, Muscles, Pancreas, Sexual organs, Skin, Stomach, Intestines etc… Emotional/Psychological/Social

Question 47

Korsakoff Syndrome

Answer 47

Caused by brain impairment due to chronic, heavy alcohol consumption severely depleting vitamin B1 (thiamine) Effects the formation of new memory

Question 48

Cannabis

Answer 48

``` THC is the main active ingredient Binds to cannabinoid receptors Interferes with normal functioning of brain Cerebellum Affects coordination Hippocampus Affects memory Cerebral cortex Affects thinking ```

Question 49

Cannabis common effects

Answer 49

``` THC Common effects Feeling of intoxication Loss of coordination & concentration Increased appetite Reddened eyes Anxiety or panic Hallucinations Paranoia Confusion ```

Question 50

Long term effects of cannabis

Answer 50

Long term effects of heavy use Health Risks Bronchitis, lung cancer & respiratory disease Lowered sperm count / irregular menstrual cycle Brain function Loss of concentration, memory & learning abilities ‘Amotivational syndrome’ Loss of interest in activities, loss of energy, boredom Less sex drive Severe psychotic behaviour (Drug induced psychosis) Causal link not certain

Question 51

Medicinal Cannabis Research

Answer 51

Medicinal Cannabis Research Improvement in seizure disorders, especially in children, pain management, nausea associated with chemotherapy, and some other conditions Role of CBD – antipsychotic, antidepressant, anxiolytic? However, controversial due to potential for misuse/inappropriate prescription, and risks associated with cannabis use (e.g. Psychosis) Also, are there not effective alternative medications for these problems?

Question 52

QLD health on medicinal cannabis

Answer 52

Conditions that may benefit Current limited evidence suggests that medicinal cannabis may be suitable to treat: severe muscular spasms and other symptoms of multiple sclerosis chemotherapy-induced nausea and vomiting some types of epilepsy with severe seizures palliative care (loss of appetite, nausea, vomiting, pain). There is no evidence that medicinal cannabis is an effective treatment for cancer. Patients should not: consider medicinal cannabis as an alternative treatment for cancer defer their standard treatment in favour of using medicinal cannabis.”

Question 53

Opiates

Answer 53

``` Opiate receptors – pain relief Endorphins Affects dopamine (reward effects) Pain relief – Physical and Psychological Overdose risk high Common effects Feelings of well-being or euphoria Pinpoint pupils Sedation Shallow breathing Nausea and vomiting ```

Question 54

Long term effects of heavy use of opiates

Answer 54

``` Health effects Constipation Weight loss / malnutrition Chronic heart / lung conditions Infertility in women Irregular periods Injecting risks Loss of sex drive Dependency The biggest risk with opiate use is overdose The role of Narcan (Naloxone) ```

Question 55

Depressants- Inhalants Immediate effects

Answer 55

All areas of the body affected Can cause serious health effects to body including death Psychological effects Such as confusion Hangovers and headaches can last for several days

Question 56

Depressants- Inhalants- Long term effects

Answer 56

Significant Long Term Health effects Tremors, poss of sense of smell & hearing, problems with blood production, Irregular heart beat & damage to heart muscle, Liver & kidney damage Effects on brain function Forgetfulness/memory impairment, Inattention/reduced ability to think clearly & logically Psychological effects Irritability, hostility, feeling depressed or feeling persecuted

Question 57

Stimulants

Answer 57

Increase the body’s state of arousal Accelerate central nervous system Small doses: increase awareness and concentration, decrease fatigue and amplify positive moods Larger doses: can cause excessive activity, irritability, nervousness, insomnia, delusions and hallucinations (drug-induced psychosis), convulsions, death

Question 58

Stimulants- Nicotine

Answer 58

Dopamine agonist – reinforcing Glutamate agonist – stimulant ``` Short term effect, small half-life Highly addictive Pros and Cons Improves short-term memory Serious long term health effects of smoking ```

Question 59

Stimulants- Methamphetamines

Answer 59

Significantly alters levels of dopamine (extreme agonist) and norepinephrine Common effects Speeding up of bodily functions Dry mouth, sweating, large pupils, headaches Energetic & increased confidence Awake & alert Talkative, restless, excited, trouble sleeping Panic attacks Reduced appetite Anxiety, hostility, aggression

Question 60

Long term effects of heavy use of methamphetamines

Answer 60

``` Long term effects of heavy use Health effects Rapid & irregular heart beat High blood pressure Major sleeping problems Malnutrition Injecting risks ``` Psycho-pathology Anxiety and tension Amphetamine psychosis

Question 61

Hallucinogens

Answer 61

Distort the brain’s perception of reality Can cause auditory, tactile, or visual hallucinations Include varying degrees of depression or stimulation depending on the substance

Question 62

Ecstacy- hallucinogens

Answer 62

``` MDMA affects serotonin 6-10 hr half life Ecstasy – 3 phases Coming up – Drug starting to take effect Nausea, increased body temp, heart rate increase, difficulty focusing or make sense of what you are seeing, confusion, or panic Plateau – Effects levelling off Heightened sensations, increased energy, confidence, talkativeness, feeling of warmth towards others Coming down – Effects wearing off Flat, depressed, exhausted ```

Question 63

High does and long term effects of ecstasy (hallucinogen)

Answer 63

``` High doses Convulsions Vomiting Floating sensations Irrational or bizarre behaviour Hallucinations Long Term Effects Brain damage? – Serotonin Depression, anxiety, paranoia? ```

Question 64

Emerging psychoactive substances

Answer 64

Similar metabolic structures – mimic effects Sufficiently different to avoid detection – metabolites Examples: Cannabis (JWH-018, JWH-073, cannabicyclophexonal) – cannabiniod agonist Mephedrone (4-methylmethcathinone, 4-methylephedrone) – substituted cathionones NBOMe (251-NBOMe, 2C-I-BOMe) – psychedelic DMT (N,N-Dimethyltryptamine) and AMT (α-Methyltryptamine) general tryptamines Ultimately unknown effects due to wide variety of drugs and subtle variations in chemical structure

Question 65

Prescription drug abuse

Answer 65

Many opiates, benzodiazepines, amphetamines, and maybe in the near future cannabis, are available via prescription from a doctor All of these drugs have the same potential for harms as the illicit substances Prescription drug abuse is a large and growing problem in Australia Important consideration in the argument about medicinal cannabis…

Question 66

General trends

Answer 66

Smoking—a significant decline in daily smoking between 2010 and 2013 (from 15.1% to 12.8%); Alcohol—fewer people in Australia drank alcohol in harmful quantities in 2013 Illicit use of drugs—declines in use of some illegal drugs in 2013, others relatively stable

Question 67

Tobacco use in Australia patterns of use in australia

Answer 67

In general, smoking gradually decreasing since early 90’s Daily smoking declined (from 15.1% to 12.8%). Daily smoking rates almost halved since 1991 (24.3%). Younger people delaying the take up of smoking— from average age 14.2 in 1995 to 15.9 years in 2013 (14-24 yo) average number of cigarettes smoked per week reduced; from 111 to 96

Question 68

Who smokes the most?

Answer 68

Men more likely to be daily smokers and smoke more cigarettes per week Females were more likely to have ‘never smoked’ People aged 40-49 most likely to be daily smokers However, 50-59 age group smoke most cigarettes per week

Question 69

Patterns of use: Alcohol

Answer 69

In general, drinking in Australia is in recent decline 2016 results necessary to assess this trend Daily drinking declined significantly between 2010 and 2013 (from 7.2% to 6.5%) lowest level seen since 1991. Significant increase in those never consumed a full serve of alcohol (from 12.1% to 13.8%). Fewer 12–17 yo drinking abstainers increased significantly (from 64% to 72%). Younger people (14-24) delaying first drink - average age from 14.4 in 1998 to 15.7 years in 2013. In 2013, fewer people drank in quantities that exceeded the lifetime risk and single occasion risk guidelines 18.2% exceeded lifetime risk guidelines (20% 2010) (More than 2 st drinks per day on average) Males were twice as likely as females to exceed lifetime risk Single occasion risk also declined - 29% to 26%. (More than 4 st drinks on one occasion) Men in their 40s and late 20s were most likely to drink at risky levels (32%), 18-24 for women (14.6%).

Question 70

Fun facts

Answer 70

Tobacco smoking is the single most preventable cause of ill health and death... It is responsible for more drug-related hospitalisations and deaths than alcohol and illicit drugs combined.” (AIHW 2010) “Alcohol causes the deaths and hospitalisation of slightly more children and young people than do all the illicit drugs combined…”

Question 71

Patterns of use in australia: Illicit drugs

Answer 71

Changes in the use of illicit drugs were mixed In 2013, 42% lifetime illicit drug use including misuse of pharmaceuticals. 3 million (15.0%) in last 12 months, 2.7 million (14.7%) in 2010. Significant declines in use of ecstasy, heroin, and GHB all relatively low rates compared to other illicit drugs Misuse of pharmaceuticals increased (4.2% to 4.7%) Use of the remaining drugs relatively stable Cannabis most commonly used illicit drug: 10.2% recently; 35% lifetime Males were more likely than females to use illicit drugs (18.1% compared with 12.1%) People aged 50 or older lowest rates of recent illicit drug use However, recently shown the largest increase in illicit drug use (8.7% to 11.1% for 50–59yo; 5.1% to 6.4% for 60+) No significant increase in meth/amphetamine use in 2013: powder use decreased (51% to 29%), ice (crystal methamphetamine) more than doubled (22% to 50%) Significant increase in daily or weekly use (from 9.3% to 15.5%), particularly among ice users (from 12.4% to 25.3%)

Question 72

Patterns of use in Australia: Gender Variations

Answer 72

In general males more likely to use illicit drugs than females, with some notable exceptions Among 14-17 age group (females) more likely to have used illicit drugs recently (13.3% vs 15.7%) Similar to results from previous surveys as well Why is this gender variation only seen in the 14-17 age group?

Question 73

Patterns of Use in Australia: Heroin

Answer 73

1. 4% of Australians have used heroin 0. 2% recently Recent use of heroin much higher in 1998 than 2013 1998 - males 1.1%, females 0.5% 2013 - males 0.3% and females 0.2%

Question 74

Patterns of use in Australia: International comparisons of alcohol and tobacco

Answer 74

Worldwide, tobacco consumption in decline. Australia one of the lowest smoking countries – OECD (Organisation for Economic Co-operation and Development) Conversely, Australia ranked 14th highest in the world per capita consumption of alcohol 9.8 litres equivalent of pure alcohol per person per year Up from 7.5 litres in 2003 Equivalent to approx. 500 pints of beer each Lowest: Turkey 1.3 litres Highest: Luxembourg 15.5 litres

Question 75

Patterns of Use in AustraliaCommunity Concern and Support: Tobacco

Answer 75

Support for policies aimed at reducing harm caused by tobacco remained high Support for stricter enforcement law and penalties for supplying to minors (9 in 10 supportive) Reduction in concern about tobacco generally

Question 76

Patterns of Use in AustraliaCommunity Concern and Support: Alcohol

Answer 76

More people thought alcohol caused most drug-related deaths for the first time was higher than tobacco. Excessive use of alcohol the drug issue of most concern (4 in 10 people). Support for policies to reduce alcohol harm more severe penalties for drink driving (85%), stricter enforcement of the law against supplying to minors (84%).

Question 77

Patterns of Use in AustraliaCommunity Concern and Support: Illicit drugs

Answer 77

Meth/amphetamines illicit drug of greatest concern (increase from 9.5% to 16.1%) Increase in belief meth/amphetamines caused most deaths (4.7% to 8.7%), still lower than heroin (14.1%). Proportion nominating cannabis and heroin as ‘drug problem’ declined, Proportion nominating meth/amphetamines and pain-killers/analgesics increased. Most people try illicit drugs because they are curious (66%), And continue use to enhance experiences (30%) or for excitement (17.5%).