2 - Stimulants.pdf

DRUGS AND POP CULTURE STIMULANTS WHAT ARE STIMULANTS What do you first think of when you hear the word stimulants? WHAT ARE STIMULANTS? AKA "UPPERS" Effects: Increase/enhance brain activity Extend wakefulness; give energy, focus Euphoria Increased confidence Sexual arousal Reduced appetite Rapid hea...

DRUGS AND POP CULTURE STIMULANTS WHAT ARE STIMULANTS What do you first think of when you hear the word stimulants? WHAT ARE STIMULANTS? AKA "UPPERS" Effects: Increase/enhance brain activity Extend wakefulness; give energy, focus Euphoria Increased confidence Sexual arousal Reduced appetite Rapid heartbeat (tachycardia) Increased BP Anxiety Mood swings Examples: Amphetamines Methamphetamine (crystal meth) Cocaine Nicotine Betel nut Khat Bath salts (synthetic cathinones) SIMULANTS Medically used for: Attention deficit hyperactivity disorder (ADHD) Narcolepsy Asthma Obesity Nasal and sinus congestion Hypotension due to anesthesia COCAINE AND THE COCA PLANT Found in leaves of Erythroxylum coca plant Indigenous to the Andean region of South America, Mexico, Indonesia, West Indies o Chew leaves to help with hunger, exhaustion, elevate mood, help digestion, mountain sickness o Religious/spiritual ceremonies Coca is extracted from leaves to produce cocaine Discovered mid-1800s by a German PhD student, Albert Niemann What schedule do you think cocaine is? National Library of Medicine COCAINE Schedule II Medically used today: local anesthetic for dental, ear, and throat procedures COCAINE Street names: Baseball, Bernice, Blow, Bump, C or Big C, Coke, Crack, Dama Blanca, Dust, Gold dust, Flake, Line, Nose Candy, Pearl, Rail, Snow, Sneeze, Sniff, Speedball, Toot, White Rock Effects: euphoria; increased energy, hypersensitivity to sound, sight, and touch, mental alertness Negative effects: dilated pupils, nausea, fast or irregular heartbeat, restlessness, shakes, constricted blood vessels, muscle twitches, increased blood pressure and body temperature, intense sweating, irritability, paranoia, seizure, stroke No treatment for overdose. Overdose can result in death due to seizures, cardiac arrhythmia, or respiratory failure. Cocaine hydrochloride powder (AKA coke) can be snorted or injected Cannot be smoked, breaks down when burned Can be processed into crack cocaine USE IN EUROPE SIGMUND FREUD Father of psychoanalysis; experiment with cocaine in early 1884-1887 Drug companies Merch and Parke-Davis paid Freud for endorsements Wrote 5 papers, Uber Coca (1884) "On Coca" 7 identified uses: stimulant; digestive disorder; cachexia (state of malnutrition); treatment of morphine addiction; asthma; aphrodisiac; local anesthetic “I take very small doses of it regularly and against depression and against indigestion, and with the most brilliant success” - Freud EARLY USE IN U.S. Introduced in U.S. in 1884, by William Steward Halsted, as a nerve block for anesthesia, then used as regional anesthesia 1885 – recommended by Hay Fever Association for head colds Used for toothache (as drops), sinus pain and allergies, asthma nausea pills, pain relief, melancholy, cure for opioid use disorder and alcoholism Available over the counter as cocaine cigarettes, medical powders, mixtures for injection, drops, chocolate cocaine tablets 1914 Harrison Narcotics Tax Act passed 1920s cocaine use declined as amphetamines became more popular COCAINE FOR HAY FEVER (ALLERGIES) “Cocaine in Hay Fever,” Savannah Morning (Savannah, GA), August 5, 1885. COCA-COLA 1886 Atlanta pharmacist and physician John Stith Pemberton invented Coca-cola Sought alternative to morphine COCA-COLA – BRAIN AND NERVE TONIC COCA-COLA TODAY Early 1900s, cocaine was removed from Coca-Cola “decocainized coca leaf extract” COCAINE - FREE BASE 1970s freebasing, became popular way to use cocaine Effects are more potent and faster Freebase can be smoked however it is flammable (burn the user) Cannot be snorted or injected Cocaine hydrochloride powder mixed with a strong base (ammonia). When based is extracted with a solvent (ether) = powder CRACK COCAINE Similar to free base, effects are more potent and faster = great potential for addiction Mid-1980s crack became popular o Cheap to make, highly addictive o Not flammable like free base Crack - derived from the crackling sound it makes when burned Street names: Black rock, Candy, Chemical, Cookies, Dice, Gravel, Grit, Hail, Hard rock, Jelly beans, Nuggets, Purple caps, Rocks, Scrabble, Sleet, Snow coke, Tornado COCAINE WITH OTHER SUBSTANCES Speedball = cocaine mixed with heroin o Or any depressant mixed with stimulant Alcohol and cocaine are commonly used together o Cocaethylene is formed o Proongs high (half-life of 150 min vs 90 min) o Minimized dysmopic feelings o Increased mortality rate o Alcohol inhibits cocaine metabolism (increased concentration) AMPHETAMINES Ephedra (ephaedra sinica) shrub has been used in Chinese medicine for over 5000 years 1885 Japanese chemist studying in Germany identified active chemical in ephedra (stimulant ephedrine) 1887 Romanian chemist Lazăr Edeleanu synthesized an amphetamine-like substance while working at University of Berlin 1927 American chemist Gordon Alles synthesized the first true amphetamine AMPHETAMINES 1932, pharmaceutical company Smith, Kline & French (SKF) sold non-prescription nasal decongestant Benzedrine inhaler, cotton strip soaked in amphetamine oil o Misused by opening the inhaler, taking out the cotton, and eating or injecting the amphetamine o Capsaicin (hot pepper), black dye, then picric acid added as a deterrent AMPHETAMINES 1935 SKF introduced Benzedrine onto the market o Indications: narcolepsy (for which it is still used today), mild depression, post-encephalitic Parkinsonism plus other uses 1937 SKF isolated dextroamphetamine (d-amphetamine) to market as Dexedrine 1930s-40s amphetamine containing medication use grew dramatically o Primarily marketed for depression and weight loss Observed Benzedrine and Dexedrine helped with academic performance – reduce stress and improve concentration o Students and medical professionals o 1937 found benefits for children with "behavior problems" Over time other similar compounds were identified for use in ADHD o Example - Methylphenidate 1950s WORLD WAR II AND "ENERGY PILLS" Used by military to combat fatigue in servicemen The US and British military used Benzedrine o 5-mg tablets, for routine use in aviation, as a general medical supply, and in emergency kits o Estimated 150 million Benzedrine tablets were supplied to British and American service personnel (1946 review by WR Bett) German and Japanese military used methamphetamines o German pharmaceutical company Temmler marketed as Pervitin PBS episode "Secrets from the Dead: World War Speed" WWII GERMANY AMPHETAMINE USE Hitler fascination with medical and technology advances (stuka tablet) German bomber mission crews used methamphetamine for alertness (offset fatigue) & emergency kits o 12-hour roundtrip flights (Norway-Germany, attacks over England) o Withstand G-force plunges "dive bomb"(stuka) - stuka tablet o Energized, fearless, need for less sleep/rest 1940 war in France – huge German success o 35 million pills delivered to armed forces o 10-day march with 22 miles/day o Veteran fear of never being able to sleep again PBS epicose "Secrets of the Dead 'World War Speed' WWII U.S. AND BRITISH AMPHETAMINE USE "PEP TABLETS" Amphetamine use for alertness but also increase morale, wellbeing, courage, counter "post-adrenal crash" after bombing o British army surgeon (Wallace) experimented with use in soldiers, noticed aggression, suppression of fear o Battle of El Alamein in north Africa, British brigade given amphetamine 20 mg/day (double dose) - immediate release tablet ▪ British success After war, medical professionals noticed positive effects for "shell shock" or "combat fatigue" now known as PTSD "By the end of war, up to 16 million Americans had been exposed to Benzedrine pills." - Nicholas Rasmussen "By the end of World War II in 1945, less than a decade after amphetamine tablets were introduced to medicine, over half a million civilians were using the drug psychiatrically or for weight loss, and the consumption rate in the United States was greater than 2 tablets per person per year on a total-population (all ages)" American Journal of Public Health | June 2008, Vol 98, No. 6 Benzedrine Advertisement from the American Journal of Psychiatry, March 1945, and California and Western Medicine, April 1945 RAINBOW DIET PILLS Diet pills – colorful "eye catching" Highly promoted to doctor by drug companies "You should have at least more than one color of every medication because [imagine] here come two women together. Do not give them the same color tablet. Don’t let them go out and say, “Well, all you have got to do is get those blue pills.” Give one of them blue and one of them pink. After all, it is individual medication for that patient. That’s a little psychology and is well worth it... it is particularly designed for them." Advertisement in California Medicine, in February 1970 1950s – public health concerns over U.S. amphetamine use, both rainbow pills and recreational use. Use continued and picked up into the 1960s 1968 – 1.) Live magazine published article on dangers of diet pills, highlighted dealth of women 2.) FDA seized 43 million tablets in 2 months for misbranding and tightened control on prescribing By 1970, 5% (9.7 million) of Americans used prescribed amphetamines, 3.2 million were adiction 1970 – Controlled Substance Act. Amphetamine was Schedule III, then 1 year later became schedule II 1980 Metropolitan Life ad METHAMPHETAMINE N-Methyl-1-phenylpropan-2-amine More rapid absorption into CNS compared to amphetamine Street names: meth, crystal meth, speed, crank, white cross, cotton candy, rocket fuel, scooby snax, bikers coffee Schedule II Brand name: Desoxyn – 5 mg tablet for ADHD and obesity (20-25 mg/day) 1893 Synthesized by Japanese chemist Nagai Nagayoshi 1919 Akira Ogata first to synthesize it in the crystalline form Gained popularity in 1940s-50's with similar use as amphetamines o Sold as Methedrine and Norodin powder oral injestions o Depression, attention/focus, wakefulness, weight loss METHAMPHETAMINE Injested orally Smoke/inhale Inject Snort (Bump) METHAMPHETAMINE SIDE EFFECTS Chest pain, tachycardia (rapid heart rate), elevated blood pressure, other cardiac complications, pulmonary edema Intracranial hemmorhage Skin picking, skin infections (cellulitis, abcess) Infections – HIV, Hepatitis C, other STDs Meth mouth o Xerostomia o Sugary soda drinks o Poor nutrition and hygeine METH & PUBLIC FIGURES “President John F. Kennedy received regular injections of a methamphetamine, together with vitamins and hormones, from a German-trained physician named Max Jacobson. Jacobson would go on to treat... Truman Capote, Tennessee Williams, and the Rolling Stones” - "Speed" Nicholas Rasmussen METHAMPHETAMINE 1960s removed from market for medical purposes 1996 Methamphetamine Control Act 2005 federal law to regulate the sale of methamphetamine ingredients (pseudoephedrine, ephedrine) o Behind the counter o Can only purchase max of 3.6 g of pseudoephedrine per day o Photo ID "Smurfing" - sending people to different pharmacies to purchase pseudoephedrine Bring pseudoephedrine from Mexico METH PRODUCTION AND USE '60S - TODAY 1962 - First illegal manufacturing Haight-Ashbury, San Francisco Party drug Mid 1980s – more sophisticated meth labs Outlaw Motorcycle Gangs (OMG) (Hells Angels, Banditos, Pagans, and Outlaws) 1960s-80s OMG distributed in Pacific Northwest o 70s-80s responsible for up to 90% of meth production in US o 1980s meth primarily used by white, blue-color males Motorcycle gangs would hide methamphetamine in bike crankcases = ‘crank' Use spread from West Coast to Midwest in 1990s o "Mom and Pop" labs mostly in rural areas METH PRODUCTION Extract meth from pseudoephedrine or ephedrine o o o o o o o o o o o o Acetone (paint thinner or polish remover) Battery acid Iodine crystals Phosphorous (flare guns or matches) Ether or chloroform Anhydrous ammonia (household cleaners) Sulfuric acid or HCl acid (drain cleaners) Toluene (brake fluid) Freon (air-conditioner) Alcohol Benzene or gasoline Lithium (car batteries) Contains highly flammable ingredients Produces toxic fumes and waste METH LAB EXPLOSION SUPER METH - P2P Reinvented process after restrictions on ephedrine and pseudoephedrine Cheaper to make Manufactured with phenylacetone (phenyl-2-propanone) o Schedule II Pure, long lasting and more potent o Leaves user incapacitated ADDITIONAL READINGS Goldstein RA, DesLauriers C, Burda AM. Cocaine: History, Social Implications, and Toxicity – A Review. Disease-a-Month. 2009; 55(1) 638, https://doi.org/10.1016/j.disamonth.2008.10.002. Blakemore, EA. Speedy History of America’s Addiction to Amphetamine. Smithsonian Magazine; Oct 27, 2017. https://www.pbs.org/newshour/show/cocaine-how-miracle-drug-nearlydestroyed-sigmund-freud-william-halsted Heal DJ, Smith SL, Gosden J, Nutt DJ. Amphetamine, past and present – a pharmacological and clinical perspective. J Psychopharmacol. 2013 Jun; 27(6): 479-496. doi: 10.1177/0269881113482532. Rasmussen, Nicolas “On Speed—The Many Lives of Amphetamine” 2008. NYU Press. Rasmussen N. Medical Science and the Military: the Allies' use of amphetamine during World War II. J Interdiscip Hist. 2011; 42(2): 205-33. Doi: 10.1162/jinh_a_00212