WELCOME TO STREET DRUG PHARMACOLOGYRandall Webber, M.P.H.

ESSENTIAL ISSUES IN UNDERSTANDING STREET DRUG PHARMACOLOGYPsychoactivity DependenceToleranceToxicityPsychiatric ImpairmentSet and settingSubstance misrepresentation/misidentification

Psychoactivity = ability to affect mood, thinking and/or behavior

CONTROLLED SUBSTANCESSchedules I-VSchedule I: High potential for abuse, tendency to produce dependence, no accepted medical use in USSchedules II-V: Potential for abuse, tendency to produce dependency, does have accepted medical application

SCHEDULE I SUBSTANCESLSDHeroinCannabisPCP

SCHEDULE II SUBSTANCESMorphineCocaineShort-acting barbituratesAmphetamines

DESIGNATED PRODUCTS:State of IllinoisSchedule II substances with a higher potential for abuse and addiction - amphetamines - cocaine- short-acting barbs- methadone- morphine- OxyCodone

DRUG NAMESChemical (7-chloro-1,3-dyhydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one

Generic: diazepam

Brand : Valium

Street: No common street names for Valium

DRUG MEASUREMENTmetric: micro = 1/1,000,000. Microgram (mcg./m, also called a "gamma) = 1/1,000,000 gram)Streetnickel/nickel bag & dime/dime bag = $5 or $10 worth of drugeightball = 1/8 oz. (3.75 grams)

DRUG MEASUREMENTStreetsixteenth = either 1/16 oz (1.875 gm) or 1/16 gm (62.5 mg, about three lines of cocaine)line = an elongated pattern of powdered drug. Quantity = whatever the user decides.joint = a marijuana cigarette.

DRUG FORMSplant/botanical matter (marijuana, opium poppies, khat, coca, peyote, psilocybin mushrooms, jimsom weed).liquids (alcohol, pure LSD, injectable pharmaceuticals)powders (cocaine hcl., heroin, PCP, methamphetamine)

DRUG FORMSpills (tablets, capsules, caplets of either pharmaceutical or illicit origin)other forms (ex: "rocks" of crack cocaine).

Potency, purity & misrepresentation of street drugspotency = strength, compared to some other drug of a similar type.purity = the major determinant of potency. The more pure the drug, the more potent. Street drugs are seldom pure, but are commonly misrepresented in one of three ways

DRUG MISREPRESENTATION adulteration: (to adulterate = to "step on"/"hit"/"dance on" "cut" a drug).Substitution/misrepresentation-1: None of the alleged drug is present, but another drug/drugs is/are.substitution/misrepresentation -2: None of the alleged drug is present, and neither is any other drug or active substance.

The Problem with Pill Identifications:New York City May 2000 AmphetamineChicago May 2000 MDMATucson AZ July 2000 PMAPortland Oct 2000 MDMA

TIME FACTORS Onset of action: How quickly does the drug produced its effect?Duration of action: How long does the drugs effect last?Residual effects: After-effects, extended drug reaction, flashbacks

The route of circulation.Blood flows in a circle according to this pattern: Capillaries- veinsvena cava - right side of the heartLungs- left side of the heartAorta- body (capillaries, etc.)

Route of Circulation

METHOD OF ADMINISTRATIONIngestion (oral): slower onset/longer durationInsufflation (sniffing/snorting): faster onset/shorter durationIntravenous (I.V.) Injection: faster onset (seconds)/shortest durationSmoking: fastest onset/shortest duration

METHOD OF ADMINISTRATIONIngestion (oral): slower onset/longer durationInsufflation (sniffing/snorting): faster onset/shorter durationIntravenous (I.V.) Injection: faster onset (seconds)/shortest durationSmoking: fastest onset/shortest duration

METHOD OF ADMINISTRATIONIngestion (oral): slower onset/longer durationInsufflation (sniffing/snorting): faster onset/shorter durationIntravenous (I.V.) Injection: faster onset (seconds)/shortest durationSmoking: fastest onset/shortest duration

Abscesses Associated with I.V. Injection

THE RUSH OR FLASHA highly pleasurable sensation produced by the instantaneous effect of i. v. injection or smoking** If entire dose administered at once

METABOLISM AND EXCRETIONThe break-down of a drug into simpler substancesThe removal of the drug from the body

TOLERANCEHomeostasisThe human bodys natural tendency to move toward a state of equilibrium or constancy

SET POINT RESPONSE TO DRUG USE

TOLERANCENeed to increase the dose of a drug in order to obtain the desired effectDecreased effect of drug after repeated administrationDependent on prior dosage levelDevelops in hours (cocaine), days (LSD), or weeks

TOLERANCEEffective dose (ED)Intoxicating dose (ID)Lethal dose (LD)

TYPES OF TOLERANCEEnzyme induction PharmacodynamicBehavioral Need to increase the dose of a drug in order to obtain the desired effect

DEPENDENCEAddiction

Physical dependence

ADDICTION POTENTIALWhat percentage of first-time users will enjoy the effect of the drug enough that they will seek it out again?If an individual uses the drug on a regular basis, how likely is it that s/he will become dependent on the substance?

ADDICTION POTENTIALAfter being introduced to the drug, do sub-human animals (e.g., monkeys, rats, mice) seek out opportunities to self-administer the substance? Do they do so to the exclusion of eating, consuming water and engaging in reproductive behavior?

ADDICTION POTENTIAL CAN ALSO BE PREDICTED IN PART BY OBSERVING ANIMAL SELF-ADMINISTRATION

ADDICTION POTENTIALAbility to stimulate the brains reward circuitsAbility to meet a individualized neurochemical needPhysical dependency potentialIntensity of withdrawal symptoms

ADDICTION POTENTIALAbility to stimulate the brains reward circuitsAbility to meet a individualized neurochemical needPhysical dependency potentialIntensity of withdrawal symptoms

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Dopamine Levels in the Shell of the Nucleus Accumbens (% of baseline)

Peripheral Nervous System

NEUROTRANSMITTERSNaturally-occurring brain chemicals

Many psychoactive drugs resemble neurotransmitters:

NEUROTRANSMITTERSDRUGNEUROTRANSMITTER

LSDSerotonin

Methamphetamine Norepinepherine

heroinEndorphins

NEUROTRANSMITTERSDRUGNEUROTRANSMITTER

THCAnandamide

PCPReceptor site identified but not associated neurotransmitter

ADDICTIONCompulsive drug-takingLoss of controlContinued use despite negative consequencesTolerance and physical dependence not required but may be part of the addiction picture

TOXICITYAbility to produce physical damage to the human bodyLong-range = months, yearsShort-range = days, weeksPhysical vs behavioral

TOXICITYPhysical

Behavioral

Acute Vs Long-Term

PSYCHIATRIC IMPAIRMENTAbility of drug to produce negative changes in thinking, learning, perception, mood or behaviorAcute vs chronic

PSYCHIATRIC IMPAIRMENTShort-term

Long-term

Affective Disorders

Thought Disorders

CNS StimulantsAmphetamines/Similar-Acting Stimulants CocaineKhatOTC Stimulants

CNS Stimulants pulse, breathing, BPAlertness/Reversal of fatigueReduction in appetiteDilated pupilsEuphoria, elation, grandiosity, confidenceTalkativenessRacing thoughts

CNS Stimulants (Amphetamines)"speed", "white cross", "black beauties", "357's", "purple heartsamphetamine sulfate (Obetrol)dextroamphetamine (Dexedrine)methampetamine (Desoxsyn) ("meth", "crystal", crank, go fast")Mixed amphetamine: (Adderall)

Methamphetamine Crystal

Methamphetamine Ice

WHITE CROSS

Track Marks and Abssesses Associated with I.V. Drug Use

CRANK

ICE

CNS Stimulants (Non-Amphetamines)benzphetamine (Didrex)mazindol (Sanorex)methylphenidate (Ritalin)phenmetrazine (Preludin/Prelud-2)diethylpropion (Tenuate)phedimetrazine (Plegine/Bontril)phentermine (Fastin)

Ritalin

CNS Stimulants (Cocaine)Local anesthesia coca (Erythoxlum Coca)cocaine hydrochloride (hcl) ("coke", "toot", "nose/nose candy", "blow", "freeze", "snow", "girl", "white lady", "la mujer blanca")alkaloidal cocaine ("free base", "crack", "rock/ready rock", "basuco")

ERYTHROXYLOM COCA FLOWER

COCA FARMER

MAKING COCAINE

Cocaine Hcl

COCAINE PARAPHERNALIA

VIALS OF CRACK

MORE CRACK

Crack Packaged for Sale

Crack Pipes

CNS Stimulants (General Characteristics)Addiction potential high (Except OTCs)Physical dependence absent or mildTolerance develops (for cocaine, tachyphylaxis)Immediate and long-range toxicity moderate to high (low for OTCs)

CNS Stimulants (General Characteristics)High potential for acute psychiatric impairment (except OTCs)Paranoid psychosis, confusion, violenceCrash: depression, anhedoniaModerate potential for persistent psychiatric impairment (Depression, anhedonia)

CNS Stimulants (General Characteristics)Methamphetamine: Potential for acute and persistent cognitive impairment due to neurological damage.

CNS Depressants Barbiturate HypnoticsNon-Barbiturate HypnoticsMinor Tranquilizers (benzodiazepines)Ethyl Alcohol (Ethylene)Opiates

CNS Depressants(Barbiturates Hypnotics) ("barbs", "beans", "downers")secobarbital (Seconal) ("reds")pentobarbital (Nembutal) ("yellow jackets")apobarbital (Alurate)mephobarbital (Mebaral)phenobarbital (Luminal)

CNS Depressants(Non-Barbiturate Hypnotics) triazalam (Halcion)ethchlorvynol (Placidyl)flurazepam (Dalmane)estazolapam (ProSom)profol injection (Diprivan)tempazepam (Restoril)quazepam (Doral)

CNS Depressants(Non-Barbiturate Hypnotics) zolpidem tartrate (Ambien)Rohypnol (roofies)GHB/gamma hydroxy amino acid (Liquid G/Somatomax/G-riffic)

CNS Depressants(Hypnotics) Addiction potential moderate to highPhysical dependence possible. Severity of withdrawal = moderate to high/potentially life-threatening (A & B), Tolerance develops, but at a different rate for intoxicating Vs lethal dosePotential for immediate toxicity = moderate to high/very high mixed with alcohol

CNS Depressants(Hypnotics) Potential for long-range toxicity = mild to moderate Potential for immediate and persistent psychiatric impairment low except for during withdrawal

CNS DepressantsMinor Tranquilizers (benzodiazepines)

chlorazepam (Tranxene)chlordiazepoxide (Librium)clonazepam (Klonopin)diazepam (Valium)oxazepam (Serax)prazepam (Centrax)alprazolam (Xanax)lorazepam (Ativan)

Xanax

Valium

Klonopin

CNS DepressantsMinor Tranquilizers (benzodiazepines)

Addiction potential moderate to highPhysical dependence possible.High dose/short durationLow/therapeutic dose/long duration Severity of withdrawal = low for low dose/moderate to high for high doseTolerance developsPotential for immediate toxicity = moderate to high/high when mixed with alcohol

CNS DepressantsMinor Tranquilizers (benzodiazepines)

Potential for immediate toxicity = moderate to high/high when mixed with alcoholPotential for long-range toxicity = mild Potential for immediate psychiatric impairment = low Potential for chronic psychiatric impairment = low

CNS Depressants(Ethyl Alcohol)Beer/Wine coolersWineFortified winesDistilled spirits

CNS Depressants(Ethyl Alcohol)Addiction potential moderate to highPhysical dependence possible. Severity of withdrawal = moderate to high/seldom life-threateningTolerance developsPotential for immediate toxicity = moderate to high Potential for long-range toxicity = high

CNS Depressants(Ethyl Alcohol)Potential for immediate psychiatric impairment except for alcohol-related personality change/pathological intoxication/hallucinosis and psychiatric impairment during withdrawal Potential for chronic psychiatric/neurological = high

CNS Depressants(Opiates)Organic/semisynthetic opiatesopiumcodeine (Tylenol/Empirin w/codeine, some Rx cough syrups)hydrocodone (Vicodin)morphine sulfate (M.S.-Contin)diacetylmorphine (Heroin) ("junk", "smack", "boy", "chicle", "black tar", "china white")

"Thou has the keys of Paradise, oh just, subtle and mighty opium"

Thomas de QuincyConfessions of an English Opium-Eater

Brown & White Heroin

Black Tar Heroin (El Chicle)

CNS Depressants(Opiates)Synthetic opiatesoxycodone (Percodan/Percocet/OxyContin)oxymorphone (Numorphan)hydromorphone (Dilaudid)meperidine (Demerol)oxycodone (Percodan)dolophine (Methadone)levorphanol (Levo-Dromoran)fentanyl (Sublimaze)

CNS Depressants(Opiates)Synthetic opiatesdiphenoxylate/atropine (Lomotil)pentazocine/pentazocine w/ naloxone (Talwin/Talwin-NX)"Karachi" (Chicago area): Drug composition varies. Usually includes an opiate (ex: Methadone) and at least one sedative (ex: diazepam, phenobarbital).

OxyContin

Methadone

***************Both drug users and police are often mislead by what drug they suspect a pill really contains by looking at the shape color or head stamp. All the pills on this page are the same size shape and color (although the various photographs give the illusion of slightly different colors). All the pills display the distinctive Mitsubishi automobile three diamond logo. Drug users who have a good experience taking an Ecstasy pill displaying the Mitsubishi logo will ask for it again. This brand name demand puts pressure on drug dealers to provide what the public wants. In addition drug dealers who do not have access to Ecstasy can successfully pass off unwanted drugs by mimicking a popular pill logo. The top pill discovered in New York City in May of 2000 was sold as Ecstasy but only contained common amphetamine. The two middle pills are virtually identical to the New York City pill but they contained the sought after Ecstasy. The bottom pill also looks the same but it contains the very dangerous drug PMA. The Mitsubishi 3-diamond car logo is one of the most popular longest lasting head stamps for true Ecstasy pills.PMMA is another MDMA analog but it has not been seen in the US.**********************************************************************************************************