Depressants Abuse and Misuse PDF

DEPRESSANTS ABUSE AND MISUSE IMPH-495 Dr Christos Petrou Click to edit Master subtitle style A Comprehensive Analysis of Stimulant Drugs, Their Uses, and Effects Overview of Depressants CNS Depressants: Substances that reduce brain activit...

DEPRESSANTS ABUSE AND MISUSE IMPH-495 Dr Christos Petrou Click to edit Master subtitle style A Comprehensive Analysis of Stimulant Drugs, Their Uses, and Effects Overview of Depressants CNS Depressants: Substances that reduce brain activity, producing calming effects Therapeutic Uses: Used to manage anxiety, insomnia, seizures (e.g., benzodiazepines, barbiturates) Recreational Uses: Often abused for their relaxing and euphoric effects (e.g., alcohol, opioids) Risks: Addiction, overdose, death when misused Deaths from depressants According to the World Health Organization (WHO), an estimated 500,000 deaths per year are attributable to drug use, with opioids accounting for the majority of these fatalities. In the U.S., over 80,000 overdose deaths in 2021 were attributed to opioid use, marking a record high for the country. Public Health Crisis Rising rates of misuse: Depressants, especially opioids, are increasingly abused worldwide The Opioid Epidemic: A critical driver of overdose deaths, particularly in North America Addiction cycle: Tolerance builds, leading to increased doses and dependency Impact on society: Strain on healthcare, law enforcement, and families Categories and Types of Depressants Category Examples Primary Use Risks Opioids Heroin, Fentanyl, Pain relief High risk of Oxycodone addiction and overdose Benzodiazepines Xanax, Valium, Anxiety and Addiction, Klonopin insomnia dangerous treatment withdrawal symptoms Barbiturates Phenobarbital, Sedation and High overdose Secobarbital seizure control potential Alcohol Beer, Wine, Recreational and Addiction, liver Spirits social use damage Other Ketamine, GHB Dissociation, Cognitive Depressants recreational use impairment, bladder damage Types of Depressants Opioids: Pain relievers, but highly addictive (e.g., heroin, fentanyl, oxycodone) Benzodiazepines: Prescribed for anxiety and insomnia (e.g., Xanax, Valium) Barbiturates: Used for sedation and seizure control Alcohol: Legal but widely abused substance Impact of Misuse Addiction: Physical and psychological dependency Overdose deaths: Rising globally, especially due to fentanyl Mental health effects: Anxiety, depression, and cognitive decline Economic burden: High healthcare costs, lost productivity Opioids Examples: Heroin, fentanyl, oxycodone Mechanism: Bind to opioid receptors in the brain to reduce pain Therapeutic Use: Prescribed for pain relief Risks: High addiction potential, overdose risk Benzodiazepines Common examples: Xanax, Valium, Klonopin Medical use: Anxiety relief, panic disorder treatment Addiction potential: Rapid tolerance build-up, dependency Withdrawal risks: Seizures, hallucinations Barbiturates Medical use: Sedation, seizure control, anesthesia Overdose risk: Narrow therapeutic index Decline in use: Largely replaced by benzodiazepines Examples: Phenobarbital, Secobarbital Alcohol as a Depressant Widely consumed legal depressant Short-term effects: Impairs motor skills, judgment Long-term health risks: Liver damage, heart disease Fetal Alcohol Syndrome: Impact on babies during pregnancy Other Depressants Ketamine: Used as an anesthetic, abused for hallucinogenic effects GHB: Party drug with sedative effects Dangers: Cognitive impairment, 'ketamine bladder' Street Names: Special K, Liquid Ecstasy Short-term Effects of Depressants Euphoria and relaxation: Temporary relief from stress, anxiety Impaired coordination: Risk of accidents, injuries Drowsiness, confusion: Impacts decision-making Respiratory depression: Can lead to coma or death Long-term Effects of Depressants Tolerance: Higher doses needed for the same effect Physical dependence: Withdrawal symptoms upon reduction Cognitive decline: Memory, learning, and decision-making affected Organ damage: Alcohol leads to liver damage; opioids affect respiration Mental Health Impacts Depression, anxiety: Worsened with long-term depressant use Self-medication: Users often use drugs to manage mental health issues Cognitive impairment: Long-term misuse damages brain function Cycle of addiction: Mental health and addiction feed into each other Social Consequences Relationship breakdown: Addiction strains personal relationships Job loss: Difficulty maintaining employment due to absenteeism Financial instability: Cost of drugs and inability to work Social isolation: Withdrawn from friends, family, exacerbating the issue Physical Health Consequences Accident risks: Increased due to impaired motor skills Respiratory depression: Fatal if mixed with alcohol Organ damage: Liver (alcohol), kidneys (opioids), brain (benzodiazepines) Overdose risks: Especially high when mixing multiple depressants Heroin Global production: Illegal opioid: Afghanistan, Derived from Mexico are key morphine producers Effects: Euphoria Risks: High followed by deep overdose relaxation, slowed potential, respiration especially when mixed with fentanyl  Heroin Synthesized from morphine. It is one of the most dangerous and addictive drugs in the world, known for its rapid onset of euphoria and high overdose potential. Street Names: H, Smack, Brown Sugar. Production: Afghanistan remains the largest producer of heroin, followed by Mexico. Heroin is often trafficked across borders by criminal organizations, with the U.S. being a major consumer market. Effects: Heroin produces an intense euphoria, followed by a deep sense of relaxation. However, it also slows heart rate and respiration, leading to a high risk of fatal overdose. Global Heroin Trade According to the United Nations World Drug Report, heroin production in Afghanistan has reached record levels in recent years, supplying up to 90% of the world's heroin Global Heroin Supply Historically, most of the world's illicit opium for heroin has been grown in the Golden Triangle of Southeast Asia. However, over the last decade, opium production in the Golden Triangle has declined while cultivation and production rates in Southwest Asia have increased considerably. In 2010, Afghanistan, as the world's largest opium supplier, accounted for nearly 80 percent of the world's opium, according to UN estimates. During the 1990's, Latin America evolved as the primary supplier of heroin to the United States, with Mexican heroin most prevalent west of the Mississippi and Colombian heroin most prevalent east of it. https://obamawhitehouse.archives.gov/ondcp /global-heroin-market Fentanyl Synthetic opioid: 50-100 times stronger than morphine Medical use: Severe pain management Illicit use: Major cause of opioid overdose deaths Overdose risk: Tiny amounts can be lethal Fentanyl Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. While it is used medically for pain management, it has become a leading cause of overdose deaths due to its potency and frequent presence in the illicit drug market. Street Names: China White, Jackpot. Role in the Opioid Epidemic: Fentanyl is responsible for a significant proportion of opioid overdose deaths in North America. It is often mixed with heroin or pressed into counterfeit pills, leading to accidental overdoses. Effects: Fentanyl can cause rapid sedation and respiratory failure, leading to death within minutes if not treated with naloxone, an opioid antagonist. Oxycodone Prescription painkiller: Used for moderate to severe pain Role in the opioid crisis: Overprescribed, leading to addiction Transition to illicit use: Many users switch to heroin or fentanyl Risks: Addiction and overdose, especially when mixed with alcohol Street Names: Oxy, Percs, Hillbilly Heroin. Effects: Euphoria, relaxation, and pain relief, but with a high risk of addiction and overdose. Dangers: When prescriptions run out, many users turn to illicit opioids like heroin or fentanyl, increasing the risk of overdose. Comparing Overdose Risks Fentanyl: Lethal dose is less than 2 mg Heroin: Often mixed with fentanyl, increasing risk Oxycodone: Moderate overdose risk, but can escalate with misuse Polydrug use: Combining opioids increases risk significantly Kratom What is Kratom? Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia, particularly found in countries like Thailand, Malaysia, and Indonesia Traditionally used for its stimulant and sedative effects. Current Use Gained popularity in the U.S. as an herbal remedy for pain and opioid withdrawal. Potential for abuse and significant health risks.  Street Names Kratom is known by several street names, including: Biak Mitragynine Ketum Kakuam Ithang Thom https://www.euda.europa.eu/publications/drug- profiles/kratom_en Effects of Kratom The effects of kratom vary based on the dosage. At lower doses, kratom acts as a stimulant, increasing energy, alertness, and sociability. Users often compare its stimulant effect to that of coffee, as both contain alkaloids that act on similar receptors. At higher doses, kratom has sedative and opioid-like effects, which can lead to drowsiness, relaxation, and euphoria. This dual nature of kratom makes it appealing for both recreational and self- medicating purposes. Kratom Withdrawal Kratom withdrawal can produce symptoms similar to those of opioid withdrawal, though typically less severe. Common symptoms include: Muscle aches Irritability Anxiety Insomnia Runny nose Nausea These symptoms can vary in intensity depending on the duration and quantity of kratom use. Users who attempt to quit kratom abruptly after prolonged use may find it challenging without medical support.  Use Traditionally, the fresh or dried leaves of kratom are chewed or brewed into tea. When making tea, lemon juice is often added to facilitate the extraction of plant alkaloids; before drinking, sugar or honey may be added to mask the bitter taste of the brew. The dried leaves are occasionally smoked. To experience vigour and euphoria, traditional ‘kratom eaters’ chew one to three fresh leaves at a time. The veins are usually removed from the leaves before eating and sometimes salt is added ‘to prevent constipation’. Only the masticated material is swallowed. Consumption is followed by drinking warm water or coffee, tea or palm sugar syrup. Regular and addicted users chew 3 to 10 times a day. When kratom is not available, the leaves of Mitragyna javanica (other name Mitragyna parvifolia) are used as substitute. In southern Thailand, in recent years homemade ice-cold cocktails, called ‘4x100’, have become popular for their alleged alcohol-mimicking effect among young Muslim people. The cocktails are made from kratom leaves, a caffeine- containing soft drink, and codeine- or diphenhydramine-containing cough syrup as the three basic ingredients to which ice cubes, an anxiolytic, an antidepressant or an analgesic drug is added. Kratom effects Stimulant vs. Sedative Effects Low Doses: Acts as a stimulant, increasing energy, alertness, and sociability.High Doses: Acts as a sedative, leading to drowsiness, relaxation, and euphoria. Dual Nature Appeals to both recreational users and individuals self- medicating for pain or anxiety. Mitragyna speciosa Neither Mitragyna speciosa nor mitragynine or other alkaloids from the plant are listed in any of the Schedules of the United Nations Drug Conventions. Mitragyna speciosa and/or mitragynine and/or 7-hydroxymitragynine have been reported to be controlled in at least 12 EMCDDA countries. Denmark, Estonia, France, Italy, Latvia, Lithuania, Poland, Portugal, Romania, Finland, Sweden, Turkey. Six Asian and four African Mitragyna species are known to be used in traditional medicine but the stimulant/sedative- narcotic/psychoactive effects are characteristic only for Mitragyna speciosa. In South East Asia, kratom is used as an antidiarrheal, a cough suppressant, an antidiabetic, an intestinal deworming agent and wound poultice as well as to wean addicts off heroin. Benzodiazepines Common examples: Xanax, Valium, Klonopin Medical use: Anxiety relief, panic disorder treatment Addiction potential: Rapid tolerance build-up, dependency Withdrawal risks: Seizures, hallucinations Barbiturates Barbiturates were once the primary treatment for anxiety, insomnia, and seizures but are now rarely prescribed due to their high overdose potential. However, they are still misused in certain populations. Street Names: Barbs, Downers. Effects: Sedation, relaxation, impaired motor function. Dangers: Barbiturates have a narrow therapeutic index, meaning even a slight increase in dose can cause overdose. Medical use: Sedation, seizure control, anesthesia Overdose risk: Narrow therapeutic index Decline in use: Largely replaced by benzodiazepines Examples: Phenobarbital, Secobarbital Benzodiazepines Benzodiazepines remain widely prescribed for anxiety and insomnia but are highly addictive and often misused. Street Names: Xannies, Benzos. Effects: Relaxation, sedation, and anxiety relief, but with the risk of dangerous withdrawal symptoms when used long-term. The Dangers of Combining Benzodiazepines with Opioids The combination of benzodiazepines with opioids significantly increases the risk of fatal overdose. This is because both drug classes depress the central nervous system, leading to slowed breathing, heart rate, and potentially death. Other Depressants Ketamine: Used as an anesthetic, abused for hallucinogenic effects GHB: Party drug with sedative effects Dangers: Cognitive impairment, 'ketamine bladder' Street Names: Special K, Liquid Ecstasy Ketamine Ketamine is a dissociative anesthetic that has some hallucinogenic effects. Ketamine distorts the perception of sight and sound and makes the user feel disconnected and not in control. It is referred to as a “dissociative anesthetic hallucinogen” because it makes patients feel detached from their pain and environment. Ketamine can induce a state of sedation (feeling calm and relaxed), immobility, relief from pain, and amnesia (no memory of events while under the influence of the drug) and is abused for the dissociative sensations and hallucinogenic effects. Ketamine has also been used to facilitate sexual assault. Street Names: Cat Tranquilizer, Cat Valium, Jet K, Kit Kat, Purple, Special K, Special La Coke , Super Acid, Super K, Vitamin K Medical Use: Used as an anesthetic and, more recently, in low doses for treating depression. Effects: Hallucinations, dissociation, and sedation. Long-term misuse leads to cognitive impairment and bladder damage (known as "ketamine bladder"). GHB WHAT IS GHB Gamma-Hydroxybutyric acid (GHB) is another name for the generic drug sodium oxybate. Xyrem® (which is sodium oxybate) is the trade name of the Food and Drug Administration (FDA)-approved prescription medication. Xyrem® is approved as a treatment to improve daytime sleepiness and muscle weakness with narcolepsy (a disorder marked by sudden, unexplained, spontaneous fatigue, napping, or falling asleep throughout the day). Analogues that are often substituted for GHB include GBL (gamma butyrolactone) and 1,4 BD (also called just “BD”), which is 1,4-butanediol. WHAT IS GHB Common street names include: Easy Lay, G, Georgia Home Boy, GHB, Goop, Grievous Bodily Harm, Liquid Ecstasy, Liquid X, and Scoop GHB and its analogues are misused for their euphoric and calming effects and because some people believe they build muscles and cause weight loss. GHB overdose can cause coma and death. Treatment Options Medication-Assisted Treatment: Methadone, buprenorphine for opioids Naloxone: Emergency treatment for opioid overdose Therapy: CBT and support groups help manage addiction Tapering: Necessary for benzodiazepine withdrawal Withdrawal Symptoms of Opioids Early symptoms: Muscle aches, anxiety, sweating Later symptoms: Nausea, vomiting, diarrhea, cravings Severe withdrawal: More intense with fentanyl Street Names: 'Kicking' (slang for heroin withdrawal symptoms) Withdrawal Symptoms Drug Withdrawal Symptoms Heroin Muscle pain, insomnia, nausea, vomiting, diarrhea, cold sweats, cravings. Fentanyl Severe anxiety, muscle spasms, nausea, vomiting, cravings. Oxycodone Flu-like symptoms, nausea, vomiting, insomnia, anxiety. Benzodiazepines Seizures, panic attacks, hallucinations, confusion, insomnia. Barbiturates Seizures, agitation, hallucinations, delirium, death in severe cases. Alcohol Delirium tremens (shaking, confusion, hallucinations), seizures. Benzodiazepine Withdrawal Potentially life-threatening: Seizures, severe panic attacks Gradual tapering: Recommended to avoid dangerous symptoms Street Names: 'Benzo shakes' (slang for benzodiazepine withdrawal) Risks: Long-term withdrawal effects lasting weeks or months Alcohol Withdrawal Delirium tremens (DTs): Life-threatening with shaking, confusion Seizure risk: High risk of fatality without medical supervision Street Names: 'Shakes' (slang for alcohol withdrawal symptoms) Timeline: Symptoms onset 6 to 48 hours after last drink The Risk of Overdose Polydrug use: Combining depressants magnifies overdose risk Fentanyl contamination: Common cause of accidental overdose Street Names: 'Speedballing' (mixing heroin with cocaine) Combining opioids and alcohol: Frequently leads to respiratory failure Medication-Assisted Treatment (MAT) Methadone and buprenorphine: Reduce opioid cravings and withdrawal Long-term support: Helps manage addiction over time Street Names: 'Liquid handcuffs' (methadone maintenance treatment) Chart: MAT effectiveness in opioid addiction recovery Naloxone: Opioid Overdose Reversal Life-saving intervention: Street Names: Blocks opioid 'Narcan' (common receptors to brand for reverse overdose naloxone) Available as nasal Immediate effect: spray or injection Must be administered quickly for best results Detoxification for Alcohol and Benzodiazepines Medical detox: Safe detox: Always Tapering: Gradual Essential to Street Names: conducted in dose reduction for prevent delirium 'Dry out' (detox medical settings benzodiazepines tremens for from alcohol) to manage severe alcohol symptoms Cognitive Behavioral Therapy (CBT) in Addiction Recovery Addresses underlying issues: Anxiety, depression, trauma Teaches coping skills: Manage stress without substances Relapse prevention: Identifies triggers and replaces negative thought patterns Combines with MAT: For opioid and benzodiazepine addictions Support Groups and Recovery Networks Narcotics Anonymous (NA): Peer support for addiction recovery Alcoholics Anonymous (AA): 12-step recovery program for alcohol dependence Importance of peer support: Accountability and shared experiences Building sober communities: Involvement in social groups and sober events Relapse Triggers and Strategies for Prevention Environmental triggers: People, places associated with substance use Emotional triggers: Stress, anxiety, depression Behavioral strategies: Developing new coping mechanisms and healthy routines Social support: Building a sober network to avoid relapse Global Perspectives on Addiction Treatment Portugal's decriminalization: Focuses on treatment rather than punishment Switzerland's harm reduction: Safe injection sites to prevent overdose Canada: Naloxone access and harm reduction strategies Lessons learned: How different countries tackle addiction Economic and Social Impact of the Opioid Crisis Financial cost: Over $1 trillion spent on healthcare, lost productivity Impact on families: Children placed in foster care due to parental addiction Community disruption: Drug-related crimes and homelessness Government response: Lawsuits, prevention programs, treatment funding Future of Drug Policy and Harm Reduction Harm reduction strategies: Safe injection sites, needle exchanges Decriminalization discussions: Reducing the criminal penalties for drug use Increasing access to treatment: Expansion of MAT and naloxone availability Lessons from successful programs: What’s working and how to scale it The Opioid Epidemic and Purdue Pharma History of the Epidemic In the late 1990s, Purdue Pharma released OxyContin, a long- acting form of oxycodone, and marketed it aggressively to physicians, claiming that it had a low risk of addiction. Purdue’s marketing campaign, coupled with the increased emphasis on pain management in the medical community, led to a dramatic increase in opioid prescriptions. By the early 2000s, it became clear that many patients were becoming addicted to opioids. However, by that time, millions of prescriptions had already been written, and the damage had been done. As prescriptions became harder to obtain, many individuals turned to street drugs like heroin and, eventually, fentanyl. Consequences of the Opioid Epidemic According to the Centers for Disease Control and Prevention (CDC), nearly 500,000 people died from opioid overdoses between 1999 and 2019. The opioid epidemic has had devastating consequences on families, communities, and public health systems. The economic costs of the opioid epidemic are staggering, with estimates suggesting that it has cost the U.S. economy over $1 trillion in healthcare costs, lost productivity, and law enforcement expenses. Conclusion: Addressing the Crisis Public health approach: Coordinated efforts from healthcare, law enforcement, and community Early intervention: Education and awareness to prevent addiction Comprehensive treatment: Combining MAT, therapy, and peer support Hope for the future: Reducing stigma and increasing access to care Illegal Production and Trade of Depressants Heroin Heroin is produced primarily in Afghanistan, which supplies more than 90% of the world's heroin. The drug is smuggled into consumer markets by organized crime groups, including Mexican cartels, which control much of the heroin trade into the United States. Fentanyl Fentanyl is primarily manufactured in clandestine labs in China and Mexico. The drug is often mixed with heroin or pressed into counterfeit pills, making it difficult for users to know the true potency of the drugs they are taking. In 2020, the DEA reported a significant increase in fentanyl seizures at the U.S.- Mexico border, as cartels began trafficking larger quantities of the drug to meet growing demand in the U.S. Benzodiazepines Illicit benzodiazepines are often produced in illegal labs, particularly in Eastern Europe and Asia. These counterfeit pills are frequently mixed with fentanyl or other dangerous substances, increasing the risk of overdose.