THE ADDICTIVE BRAIN SC 212 JANUARY JOHN BUSH

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2 THE ADDICTIVE BRAIN SC 212 JANUARY JOHN BUSH

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4 CANNABINOIDS Compounds that interact with the CB1 or CB2 receptors Natural endocannabinoids-anandamide Natural exocannabinoids-113 in marijuana Psychoactive Δ-9 Tetrahydrocannabinol (THC) Not psychoactive Cannabidiol (CBD) Synthetic psychoactive cannabinoids

5 SYNTHETIC PSYCHOACTIVE CANNABINOIDS John Huffman (JWH), Alexandros Makriyannis (AM), Raphael Mechoulam (HU), Pfizer (CP), Clandestine chemists Marketed since 2008 Some examples: Spice, Bath Salts, K-2, JWH- 018, HU-210, CP-47,497, AM-087, and hundreds more

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8 CANNABINOIDS CONFIRMED THERAPEUTIC BENEFITS Decrease chemotherapy-induced nausea CE Relieve chronic pain SE Reduce multiple sclerosis induced spasticity SE Increase appetite with HIV/AIDS LE Tourette syndrome LE Reduce damage from traumatic brain injury LE Treat addiction NE CE Conclusive evidence SE Substantial evidence LE Limited evidence NE No evidence

9 CANNABINOIDS ADVERSE EFFECTS Cancer No documented risk Chronic cough Definite Heart attack, stroke, diabetes Unclear COPD, asthma Unclear Immune system Unclear Motor vehicle accidents Definite Impaired cognitive performance Definite Schizophrenia, suicidal thoughts(heavy users) Definite Problem cannabis use (Addiction) Definite Increased risk of abuse of other substances No documented risk

10 CANNABIS USE DISORDER (CUD) Definition of the onset of CUD is not agreed 2001 survey: Addiction probability 9.9 % 2015 survey: 23.2 million users and 4.2 million reported with CUD symptoms (18.9%) Risk factors for CUD Youth Male cigarette smoker Frequent, heavy user of marijuana Subject to major depressive disorder

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12 HOW ADDICTIVE IS MARIJUANA? Everybody thinks getting high is cool, you can let it go when you want to let it go. But it s just as potent as alcohol. It s just as potent as cocaine. Rashaan Salaam

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14 DVD LECTURE NINE STIMULANTS FROM COCAINE TO RITALIN

15 ACTION OF PSYCHOSTIMULANTS Most psychostimulants directly increase the dopamine levels in the brain Cocaine blocks the reuptake by transporters Amphetamines reverse the direction of transport Nicotine stimulates the VTA to emit dopamine Caffeine blocks adenosine receptors

16 PSYCHOSTIMULANTS PSYCHOLOGICAL AND PHYSIOLOGICAL EFFECTS Beneficial effects Reduce fatigue Increase alertness Improve focus and concentration Evoke feelings of excitement and euphoria Negatives Cocaine: strokes, itching, hallucinations, heart attacks Amphetamines: tweaking, hyperthermia, psychosis, skin sensations, meth mouth High doses and sustained usage are dangerous There is no approved pharmacologic treatment-high relapse rate

17 POSSIBLE PHARMACOLOGIC TREATMENTS Blebbistatin (Scripps) Ibudilast (UCLA) Ibogaine

18 DESIGNER DRUGS Alexander Shulgin PMMA, PMA, MDPV, Meow meow, Benzo Fury, SMILES, Mephedrone, 2-CE, 5-APB, 5- API, AMT, N-Bomb, BMPEA, Ecstasy, Flakka EROWID web site

19 BREAK

20 DVD LECTURE TEN THE SCIENCE OF POPPIES, PLEASURE AND PAIN

21 BEHAVIORAL DEPRESSANTS (DOWNERS) Depressants lower the level of mental arousal: alcohol, barbiturates, benzodiazepines (Valium, Librium), opioids Can be very dangerous in combination

22 OPIOIDS Natural (opiates-morphine, codeine), Semi-synthetic (heroin, oxycodone) Synthetic (fentanyl, carfentanyl, U47,700) Endogenous (endorphin, enkephalin, dynorphin)

23 BEHAVIORAL EFFECTS OF OPIOIDS Positive Reduction of pain without eliminating sensation Suppression of coughing Suppression of diarrhea Reduced anxiety, stress Intoxication, euphoria Negative Nausea Constipation Suppression of breathing - hypoxia Addiction Death

24 MEDICINAL OPIOIDS

25 PRESCRIPTION OPIOIDS DEATHS Death rate has tracked the prescription rate Almost half of drug deaths are due to prescription opioids: methadone, oxycodone, hydrocodone More than 1000 people/day are treated for prescription opioid misuse Where do they get these drugs?

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28 ILLICIT USE OF OPIOIDS

29 DANGERS OF NON-MEDICAL Death from overdose USE OF OPIOIDS Death from misrepresented or contaminated substances Infections from contaminated needles or nonsterile surroundings Damage to blood vessels or nerves at injection site

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32 U.S. OPIOID CRISIS What crisis? What can be done about it? Use drugs to counter drug abuse fatalities. Strictly regulate access to medicinal opioids Educate medical professionals about the problem and their role in it Improve addiction counseling and treatment Anything else?

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OTC Abuse. Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University

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