SZF

Drugs of Abuse
Drugs of Abuse
When a drug is used inconsistently with
the medical or the social pattern of a
culture
Could produce dependence

2
Physical Dependence
Factors affecting the withdrawal syndrome
The drug being used
The dose and route of administration
Concurrent use of other drug
Frequency and duration of drug use
The age, sex, health and genetic make-
up of the user

3
Psychological Dependence
Much last longer
Primary reason of relapse
Cause of addiction

“I never knew I was addicted until I

tried to stop”
-unknown

4
Five Classes of Drugs
Narcotics
Depressants
Stimulants
Hallucinogens
Anabolic Steroids

“Drugs take you to hell, disguised as

heaven”
5
-Donald Lynn Frost
Narcotics
Also known as opioids
Refers to opium, opium derivatives and their
synthetic substitute
Examples:
– Heroin
– Oxycontin
– Vicodin
– Codeine
– Morphine
6
– Methadone
Poppy or
Papaver somniferum

7
Opiates
Capable of analgesia, sedation and
anesthesia
Derived chemically from opium poppy
Naturally occuring opiates: opium,
morphine and codeine
Chemically modified opiates: heroin,
hydromorphone and oxycodone
(Percodan)
Common Synthetic Opiates: meperidine
(Demerol), methadone (Dolophine),
propoxyphene (Darvon), pentazocine
(Talwin)
 Opiates
Morphine and meperidine increase liver and
pancreatic enzyme
Major cause of drug related death- Darvon
overdose with alcohol
Major metabolites of heroin: N-acetylmorphine
and morphine
Antagonist for opiate overdose: Naloxone
(Narcan)
Toxic effects: respiratory acidosis, myoglobinuria,
cardiopulmonary failure and constriction of pupils
Withdrawal effects: tremor, muscle cramp,
nausea, vomiting and diarrhea
Heroin
Common names
– Big H, Black Tar, Chiva, Hell Dust, Horse,
Negra, Smack and Thunder
Origin
Processed from morphine
Southeast Asia (Thailand, Laos, Myanmar)
Southwest Asia (Afghanistan, Pakistan)
Mexico
Columbia 10
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS
•Euphoria •Drowsiness, •Slow and
•Rush •Respiratory shallow breathing
•Twilight state of depression •Blue lips and
sleep and •Constricted fingernails
wakefulness pupils •Clammy skin
•Nausea •Convulsion
•Warm flushing of •Coma
the skin •Death
•Dry mouth
•Heavy
extremities

11
12
Hydromorphone
Common names
– D, Dillies, Dust, Footballs, Juice and
Smack
Origin
Legally manufactured and distributed in
US
Doctor shopping
Theft from pharmacy
13
14
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Euphoria •Constipation •Severe respiratory

•Relaxation •Pupillary constriction depression
•Sedation •Urinary retension •Drowsiness
•Reduced •Nausea, vomiting progressing to
anxiety •Respiratory stupor and coma
•Mood swings depresion •Lack of skeletal
•Nervousness •Dizziness muscle tone
•restlessness •Impaired •Cold and clammy
coordination skin
•Loss of appetite •Constricted pupils
•Changes in blood •Reduction in blood
pressure pressure and
•Slow or rapid heartrate
heartbeat 15
Methadone
Common names
– Amidone, Chocolate chip cookies, Fizzies,
Maria, Pastora, Salvia, Street Methadone
and Wafer
Origin
Legally manufactured and distributed in
US
Doctor shopping
Theft from pharmacy 16
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Psychological •Sweating •Slow and shallow

Dependence •Itchy Skin breathing
•Sleepiness •Blue fingernails
•Physical and lips
dependence •Stomach spasms
•Anxiety •Clammy skin
•Muscle Tremor •Convulsion
•Nausea •Weak pulse
•Diarrhea •Coma
•Vomiting •Death
•Abdominal Cramps

17
Morphine
Common names
– Dreamer, Emsel, First Line, God’s Drug,
Hows, M.S., Mister Blue, Morf, Morpho and
Unkie
Origin
US

18
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Psychological •Pain relief •Cold, clammy skin

Dependence •Decrease in hunger •Lowered blood
•Physical •Inhibition of cough pressure
dependence reflex •Sleepiness
•Slowed breathing
•Slow pulse rate
•Coma
•Death

19
Opium
Common names
– Ah-pen-yen, Aunti, Aunti Emma, Big O,
Black Pill, Chandoo, Chinese Molasses,
Chinese Tobacco, Dover’s Powder, Dream
Gun, Dream Stick, Easing Powder, God’s
Medicine, Hops, Midnight oil, Joy Plant,
Zero, Toys and Toxy
Origin
Before- Mediterranean regions
Now- US 20
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Euphoria •Constipation •Slow breathing

•Relaxation •Dry mouth and •Seizure
•Relief of pain mucus membrane •Dizziness
•Weakness
•Loss of
consciousness
•Coma
•Death

21
Oxycodone
Common names
– Hillbily heroin, Kicker, OC, Ox, Roxy, Perc,
Oxy
Origin
Synthesize from thebaine, a constituent
of the poppy plant

22
 Effects on Effects on the BODY OVERDOSE
the MIND EFFECTS

•Euphoria •Pain relief •Extreme

•Sedation drowsiness
•Respiratory Depression •Muscle weakness
•Constipation •Confusion
•Pupillary constriction •Cold and clammy
•Cough suppression skin
•Can cause liver damage •Pinpoint pupils
with Acetaminophen •Shallow breathing
•Slow heart rate
•Fainting
•Coma
•Death

23
24
Stimulants
Amphetamines
Methylpenidate
Diet aid
Methamphetamines
Cocaine
Methcathion

25
Amphetamines
Common names
– Bennies, Black Beauties, Crank, Ice,
Speed and Uppers
Origin
First marketed as Benzedrine
Acacia berlandieri

26
27
Amphetamines
Used for treating narcolepsy and
attentional deficit disorder
Manifestation: heighten mental and
physical activity, euphoria
Low level intake: dryness of the mouth,
dizziness, blurred vision, excessive
speech, insomnia
Excessive intake: dilusion, hallucination,
panic state and psychosis
Withdrawal: depression, parasomias,
extreme appetite
Method:
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Similar to •Increased blood •Agitation

cocaine pressure and pulse •Increased body
•Psychosis rate temperature
similar to •Insomnia •Hallucination
Schizophrenia •Loss of appetite •Convulsion
•Paranoia •Physical exhaustion •Death
•Auditory and
visual
hallucination

29
30
Cocaine
Common names
– Coca, Coke, Crack, Flake, Snow and Sod
Cot
Origin
Columbia
Peru
Bolivia
Mexico
31
32
Cocaine
An alkaloid salt that can be taken directly
or by inhalation
It is derived from coca plant and used as
additive to some food
Used as local anesthetics for
nasopharyngeal surgery
A potent CNS stimulant that elicits a
sense of excitement and euphoria
Cocaine
Can cause sudden death due to direct
toxicity on myocardium
Overdosage may result to violent
behavior
Inhibitor: Prozac; anti-depressant
Treatment: Benzodiazepine
Toxic Effects: hypertension, arrythmia,
seizure, and myocardial infarction
Urine metabolites: benzoylecgonine
For single use, it can be detected in urine
for 3 days, up to 20 days for chronic users
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Euphoria •Increased blood •Cardiac

•Alertness pressure and heart arrhythmia
•Excitation rate •Ischemic heart
•Irritability •Dilated pupils condition
•Anxiety •Insomnia •Sudden cardiac
•Paranoia •Loss of appetite arrest
•Physical and •Convulsion
mental •Stroke
exhaustion •Death
•addiction

35
Khat
Common names
– Abyssinian Tea, African Salad, Catha,
Chat, Kat, Oat
Origin
From flowering evergreen shrub
East Africa
Arabian Peninsula

36
37
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Hallucination •Increased blood •Delusion

•Paranoia pressure and heart •Loss of appetite
•Nightmares rate •Difficulty with
•Hyperactivity •Brown staining of breathing
teeth •Increased blood
•Gastric disorder pressure and heart
•Physical exhaustion rate

38
Flakka
Common names
– Zombie drugs, gravel
Origin
Florida
Ohio
Texas

39
Flakka
It affects dopamine and norepinephrine
Chemical name:
– alpha-pyrrolidinopentiophenone
Short-term effects: (Excited Delirium)
– Euphoric sensation
– rapid heart rate and palpitation
– Increase in blood pressure
– Alertness
– Aggressive behavior
At high doses
– increases body temp→ muscle breakdown and
40
kidney damage
Methamphetamine
Common names
– Shabu, Meth, Ice, Crank, Chalk, Crystal,
Fire, go fast and Speed
Origin
Mexico

41
Methamphetamine
Recreational drug
Neurotoxic- used as aphrodisiac and
euphoriant
Low doses:
– Elevate mood, increase alertness, reduce appetite
and promote weight loss
High doses:
– Psychosis, skeletal muscle breakdown, seizure,
bleeding in the brain
Chronic high dose
– Rapid mood swings, delusion, violent behavior 42
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Highly addictive •Increased •Stroke

•Violent behavior wakefulness •Heart attack
•Anxiety •Increased physical •Multiple organ
•Confusion activity problem
•Insomnia •Decreased appetite
•Paranoia •Rapid breathing and
•Aggression heart rate
•Visual and •Irregular heartbeat
auditory •hyperthermia
hallucination
•Mood swings

43
Sedative Hypnotics
They have therapeutic roles and CNS
depressants
Examples: Tranquilizers
Commonly Abused Barbiturates:
Secobarbital,pentobarbital, phenobarbital
Commonly Abused benzodiazepine:
Diazepam (Valium), Chlordiazepoxide
(Librium), and Lozeparam (Ativan)
Sedative Hypnotics
Diazepam: used for rapid control of
acute seizure activity
They are used to potentiate the effects
of heroin
Toxicity of this agents are initiated by
ethanol
Major metabolite: Secobarbital
(Barbiturates)
Toxic Effects: Respiratory Depression
Depressants
This will put you to sleep, relieve pain,
anxiety and muscle spasms and prevent
seizure
Barbiturates
Benzodiazepines

46
Barbiturates
Common names
– Barbs, Block Buster, Christmas Trees,
Goof Balls, Pinks, Red Devils, red and
Blues and Yellow Jackets
Origin
It was first introduced for medical use

47
Barbiturates
Short intermediate acting:
– Amobarbital, butabarbital, butalbital,
pentobarbital
Long acting
– Phenobarbital
Signs and symptoms: Slurred speech,
slow mental function, constricted pupils
and CNS depression
Treatment: Alkalinization of urine
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Mild Euphoria •Slows down the •Shallow

•Lack of CNS respiration
inhibition •Clammy skin
•Relief of anxiety •Dilated pupils
•Sleepiness •Weak and rapid
•Impairment of pulse
memory, •Coma
judgment, and •Death
coordination
•Irritability
•Paranoid
•Suicidal ideation

49
 Nonbarbiturates
Benzodiazepines
Carbamates - Meprobamate (Equanil, Miltown)
Chloral derivatives - Chloral hydrate (Noctec)
Ethchlorvynol (Placidyl)
Piperidines - Glutethimide (Doriden), methyprylon
(Noludar)
Quinazolinone - Methaqualone (Quaalude)
Imidazopyridine - Zolpidem (Ambien), zaleplon
(Sonata), eszopiclone (Lunesta)
Antihistamines (over-the-counter sleep aids) -
Diphenhydramine,d doxylamine
Gamma-hydroxybutyrate (GHB) and its analog
gamma-butyrolactone (GBL) 50
Benzodiazepines
Common names
– Benzos and Downers
Origin
Available through prescription

51
Benzodiazepine
Sedative hypnotics, Muscle relaxant, Anti-
convulsant
Examples: diazepam (Valium),
oxazepam, fluorazepam, lorazepam
(Ativan), Chlordiazepoxide (Librium)
Potentiate GABA
Treat anxiety, seizure and pre-anesthetic
sedation
Rohypnol
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Amnesia •Slows down CNS •Shallow

•Hostility •Sleepiness respiration
•Irritability •Clammy skin
•Disturbing •Dilated pupils
dreams •Weak and rapid
pulse
•Coma
•Death

53
Gamma-Hydroxybutyric Acid
Common names
– Easy Lay, G, Georgia Home Boy, GHB,
Goop, Grievous bodily Harm, Liquid
Ecstacy, Liquid X and Scoop
Origin
Available as Sodium Oxybate
Sold as supplement for body building, fat
loss, baldness drug addiction and insomnia
Also sold as fish tank cleaner, ink stain
remover, ink cartridge remover and nail
54
enamel remover
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Euphoria •Unconsciousness •Death

•Drowsiness •Seizure
•Decreased •Slowed Heart Rate
anxiety •Greatly Slowed
•Confusion Breathing
•Memory •Lower body
Impairment temperature
•Vomiting
•Nausea
•Coma

55
Rohypnol
Common names
– Circle, Forget-Me Pill, La Rocha, Lunch
Money Drug, Mexican Valium, Reynold,
Roach, Roapies, Rophies, Wolfies and
Date-Rape Drug
Origin
US
Mexico

56
57
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Drowsiness •Slurred Speech •Severe sedation

•Sleep •Loss of motor •Unconsciousness
•Decreased Coordination •Slow Heart rate
anxiety •Weakness •Respiratory
•Amnesia •Headache Supression
•Impaired mental •Respiratory •Death
functioning Depression
•Confusion
•Agression
•Excitability

58
Methaqualone
A 2,3-disubstitute quinazoline with
anesthetic, antihistamine, and
antitussive property
Has a sedative hypnotic properties
Has a similar symptoms of toxicity to
barbiturates, as well as pyramydal
signs
Hallucinogen
Found in plant and fungi
Known to alter human perception and
mood
Examples
– Ecstacy / MDMA
– K2/Spice
– Ketamine
– LSD
60
Ecstacy / MDMA
Common names
– Adams, Beans, Clarity, Disco Biscuits, E,
Eve, Go, Hug Drug, Lover’s Speed, Peace,
STP, X, Party drug and XTC
Origin
Canada
Netherland
US

61
3,4 Methylenedioxymethampetamine
MDMA or ECSTACY
Route: orally, inhalation, ingestion,
smoking
Signs of acute intoxication: hyperpyrexia
Toxic effect: hypertension, cardiac
arrythmias and convulsion, pancytopenia
Half life: 8-9 hours
Effect: euphoria, heightened sexual drive,
expand consciousness
Effect at increased dose: hyperthermia,
tachycardia, seizure, DIC
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Confusion •Same with •Hypertheermia

•Anxiety amphetamines •Liver, kidney and
•Depression •Affects motor cardiovascular
•Paranoia activity, alertness, system failure
•Sleep Problems heartrate and blod •Interfere with
•Drug craving pressure metabolism
•Affects •Muscle tension •Pancytopenia
Serotonin •Tremor •DIC
•Involuntary teeth
clenching
•Muscle cramps
•Nausea, sweating
•Faintness, chills
•Blurred vision 63
LSD
Common names
– Acid, Blotter Acids, Dots, Mellow Yellow
and Window Pane
Origin
US

64
Lysergic Acid Diethylamide
(LSD)
A semisynthetic indolalkylamine and
hallucinogen
Most potent pharmacological material
known
Produces effects at low doses-
________
Causes blurred or undulating vision
Most common adverse reaction: panic
reactions
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Hallucination •Dilated pupils •Psychosis

•Distorted •Higher body •Death
perception of temperture
shape and size •Increased heartrate
of the object, and blood pressure
movement, color, •Sweating
sound, touch •Loss of appetite
and the user’s •Sleeplessness
own body image •Dry mouth
•Anxiety •tremors
•depression

66
Marijuana/ Cannabis
Common names
– Aunt Mary, BC Bud, Blunts, Boom, Dope,
Gangster, Ganja, Grass, Hash, Hash-ish,
Herb, Kif, Joint, Mary Jane, Pot, Reefer,
Sinsemilla, Skunk, Smoke, Weed and
Yerba
Origin
US
Canada
Mexico
67
South America
Cannabis sativa

68
Cannabinoids
Naturally occurring cannabinoids: marijuana
and hashish
Tetrahydrocannabinol (THC) is the most
potent component or the psychoactive
substance of marijuana (induces euphoria)
Associated with impairment of short-term
memory and intellectual functions
After a single use, THC-COOH can be
detected in urine for 3-5 days; up to 4 weeks
for chronic users
Urinary metabolites: 11-nor-
deltatetrahydrocannabinol
Physiologic Effects: reddening of the conjuctiva
and tachycardia
 Effects on the Effects on the OVERDOSE
MIND BODY EFFECTS

•Influences: •Sedation •No death

•Pleasure •Blood shot eyes
•Memory •Increased heart
•Thought rate
•Sensory and •Coughing
time perception •Increased appetitie
•Coordinated •Decreased blood
movement pressure
•Restlessness
•Irritability
•Sleep difficulty

70
Phencyclidine
A depressant, stimulant, and has
hallucinogenic and anesthetic properties
Can be ingested or inhaled by smoking
About 10-15% is unchanged when excreted in
urine
Major metabolite: Phencyclidine HCl
Low dose: sense of dissociation, euphoria
and numbness
High dose: loss of feeling in lower extremities,
disorganize thoughts and disconnection to
reality
Overdose: sense of superhuman strength
Toxic effects: Stupor and coma
Steroid
Common names
– Arnolds, Juice, Pumpers, Roids, Stackers,
and Weight Gainers
Origin
US

72
Annabolic Steroid
Chemically associated with male hormone
testosterone
Improves athletic performance by
increasing muscle mass
Toxic effects: chronic hepatitis,
atherosclerosis, abnormal platelet
aggregation and cardiomegaly
Effect by continued uptake:
– In male- testicular atrophy, infertility,
gynecomastia
– In female: masculine traits, breast reduction, nd
sterility
74
Effects on the MIND Effects on the OVERDOSE
BODY EFFECTS

•Mood swings •Early sexual •Adverse effects

•Increased feeling of development
hostility •Acne
•Impaired judgment •Stunted growth
•Increased level of •Physical changes
aggression •Sterility
•Addiction •Increased risk of
•suicide prostate cancer

75
Methods for Identifying and
Measuring Drugs of Abuse
Specimen for Drug Testing
Urine- 30-60 mL/ 30-45mL
Blood- 10 mL (Red)
Saliva-30 mL
Hair
Tissue
Fingernails
Sweat
Urine Requirement
Temperature: 32.5 to 37.7
Specific Gravity: 1.003-01.005
Urine creatinine: < 20 mg/dL
Electrolytes: within physiologic limit
Adulterants
Water
Liquid soap
Salt vinegar
Baking soda
Glutaraldehyde
Lemon juice
Cologne
Bleach
Methods
1. Enzymatic
2. Immunoassay
3. Capillary Electrophoresis
4. Chromatographic Methods
a. Thin Layer Chromatography
b. Liquid Chromatography-MS
c. High Performance Liquid
Chromatography
d. Gas Chromatography
Enzymatic Testing
Alcohol Testing
Quantify the sum of all alcohols present
in the sample
It does not distinguish alcohol from its
metabolites during quantification

Immunoassay
EMIT- uses enzyme-labelled drug that
competes with the drug in the sample
Capillary Electrophoresis
Different analyte selectivity is based on
different physicochemical principles of
separation without changes in
instrumental hardware
Chromatographic Method
Thin Layer Chromatography
Uses serum, urine, or gastric fluid for analysis
Extraction is pH dependent- acidic drug at pH 4.5,
alkaline drugs at pH 9.0

Liquid Chromatography
Used to confirm positive test result from a
screening test (non-volatile compounds)
Used for poisoning detection, therapeutic drug
identification and quantification, pharmacokinetics
and drug metabolism studies
Chromatographic Method
High Performance Liquid Chromatography
Allows quantitative measurements of drugs as well as
separation of these same drugs especially
antidepressant including active and inactive
metabolites

Gas Chromatography
Gas Liquid Chromatography- legally accepted method
for ethanol testing
Gas Chromatography-mass spectrometry
– “GOLD STANDARD” for confirming screening methods
– Give rise to fingerprint pattern of each compound
analyzed
– Allows detection of low levels of drugs
 EMIT GCMS
(ng/mL) (ng/mL)
1. Amphetamines 500 250
2. Marijuana 50 25
3. Cocaine 150 100
4. Opiates 2000 2000
5. Phencyclidine 25 25