Substance Use Disorder, Intentional Self-Harm, Gun Violence, and HIV/AIDS
Amy J. Litterini, Christopher M. Wilson in Physical Activity and Rehabilitation in Life-threatening Illness, 2021
SUD first begins by experimentation with substances, which leads to stimulation of the dopamine reward pathway of the brain. Depending on the form of the substance, a stimulant or a depressant, certain physiological effects are experienced by users, with some causing feelings of euphoria through reward circuit activation (e.g. cocaine, methamphetamine, and heroin). Addiction is subsequently marked by symptoms of craving, followed by increased physiologic tolerance for the substance. Tolerance is demonstrated by the need for increased amounts to achieve the desired effect, and markedly diminished effects with continued use of the same amount of the substance. Attempts to reduce, or eliminate use of the substance, are met with withdrawal symptoms, which is indicative of dependence.
Critical Review of Evidence for Neonatal Cocaine Intoxication and Withdrawal
Richard J. Konkol, George D. Olsen in Prenatal Cocaine Exposure, 2020
Cocaine may be ingested, snorted, smoked, or taken intravenously. Average peak venous plasma concentrations range from 200 to 600 ng/ml, while peak arterial concentrations are several times higher than venous after smoking.24 It is the high arterial concentrations that are presented to the uterus and placenta for tissue uptake of cocaine, while venous plasma levels are reported in the literature. Under controlled situations, euphoria and cardiovascular effects are reported at plasma concentrations above 80 to 100 ng/m1.69 Among coca leaf chewers, plasma concentrations range from 10 to 150 ng/ml, and clinically are associated with anorexia and a hyper alert state.70 When intranasal cocaine solutions were used during medical procedures, the peak plasma concentration ranged from 120 to 475 ng/m1.71 Individual South American cocaine paste smokers maintain their plasma cocaine levels between 250 and 900 ng/ml 72 In patients presenting with cocaine-associated seizures and strokes, the plasma concentrations ranged from 1 to 1700 ng/ml with a median concentration of 34 ng/m1;73 seventy-five percent of the patients had plasma cocaine levels below 100 ng/ml. Among chronic cocaine users enrolled in a methadone maintenance program, the average plasma cocaine concentration was 19 ng/m1.74 Lethal plasma levels of cocaine, inferred from autopsy data, indicate the average plasma concentration of cocaine found in cocaine related deaths is 5300 ng/ml, with a range of 900 to 21,000 ng/m1.75
Hallucinogens and Phencyclidine
Frank Lynn Iber in Alcohol and Drug Abuse as Encountered in Office Practice, 2020
With hallucinogens the onset of action begins within 15 min after oral ingestion on an empty stomach and peaks after 45 to 60 min with the oral route. Other forms of ingestion peak more rapidly. The person has manifestations that are somatic, perceptual, and affective. Often euphoria is present, but interrupted with bursts of anxiety and lability of mood. Perceptual errors (illusions) are common, and there is almost always a deranged interpretation of sensory input analogous to the sensory-deprivation syndrome. Hallucinations occur in only a minority of uses, and these usually appear with higher doses. In nearly all users there are alterations in mood, distortion of time, and altered shapes and colors. This is not frightening and is usually depersonalized. An observer will witness rapid change in moods, hostility of expression, incoordination and ataxia, and may witness agitation, nystagmus, and inability to reach the person through ordinary conversation.
A primer on sleeping, dreaming, and psychoactive agents
Published in Journal of Social Work Practice in the Addictions, 2023
Synthesized depressants including barbiturates and benzodiazepines were created in part with the goal of aiding sleep. These drugs, that with chronic use produce both a physical and psychological dependency, are also able to relieve anxiety, tension, and convulsions by producing calmness and muscular relaxation through their inhibition of GABA. However, individuals not requiring these drugs for therapeutic use experience a significant sense of euphoria when self-administering. Barbiturates, which are no longer prominently dispensed or used illicitly, disrupt both the sleep and dream cycles; thus, while people often took these drugs to aid in sleeping, it is now known that they do not produce normal sleep patterns, with users feeling tired and irritable upon waking, regardless of what early advertising of the drugs promoted. Barbiturates are among the few psychoactive agents that are not readily flushed from the human body, as they accumulate in body fat. With regular use, tolerance develops to their effects; it develops more slowly to the harmful effects than to the sleep-inducing or intoxicating effects. At high doses or when mixed with other CNS depressants, particularly alcohol, respiratory depression and/or cardiovascular depression leading to death are possible. Temporary sleep disturbances may lead a user to incorrectly decide that more of the drug is required, also leading to risk of overdose. There is a high cross-tolerance between barbiturates and other depressants, particularly alcohol (Hancock & McKim, 2018).
Fentanyl use disorder characterized by unprescribed use of transdermal patches: a case report
Published in Journal of Addictive Diseases, 2022
Cavid Guliyev, Zehra Olcay Tuna, Kültegin Ögel
Fentanyl is a pure mu receptor agonist that crosses the blood–brain barrier rapidly. Its analgesic effect is 75–100 times higher than that of morphine.1 The routes of administration for prescribed use include oral, intravenous, epidural, transdermal, intranasal, and transmucosal routes. Transdermal fentanyl patch (TFP) has been widely used as an effective analgesic since 1990.2 TFP has several clinical advantages, such as long-acting analgesic effect and low incidence of undesirable side effects compared to morphine. Owing to such features, the use of TFP has been accepted as a noninvasive method for pain relief.3 Because of its low molecular weight and lipophilic properties, fentanyl is easily absorbed through skin.4 TFPs are available in doses of 25, 50, 75, and 100 mcg/hour. The effect of fentanyl lasts for up to 72 hours when used as transdermal patches.2 Compared to other forms, TFPs have a reduced possibility of misuse due to the fact that TFPs release the drug in a sustained and long-acting manner with a stable serum concentration.5 In addition, it is accepted that the risk of developing tolerance and use disorder is minimal because it rarely causes euphoria.6
Cocaine induced heart failure: report and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sherif Elkattawy, Ramez Alyacoub, Abraham Al-Nassarei, Islam Younes, Sarah Ayad, Mirette Habib
Cocaine is a highly addictive stimulant that alters human behavior through the limbic system’s activity, a structure in the brain involved in motivation, emotion, learning, and memory. The nucleus accumbens (NA) is a specific area within the limbic system that receives connections through dopaminergic neurons. When stimulated, the accumulation of dopamine at the NA causes euphoria, conditioning the brain to establish a reward pathway in association with a stimulant. Cocaine inhibits dopamine transport protein (DAT) embedded within presynaptic neurons of the NA, forming a reward pathway; thus, explaining the drug’s highly addictive nature and potential for abuse [1, 5]. Although the overall incidence of recreational cocaine use has been declining over the years within the United States, the global prevalence of cocaine is still approximately 0.4%. Many studies have provided significant evidence explaining the relationship between cocaine use and the onset of cocaine-induced morbidity (including cardiovascular, neurovascular, psychiatric, and infectious illnesses) and mortality over time.[2,3,4,6,7]
Related Knowledge Centers
- Aerobic Exercise
- Behavioral ADDiction
- Mania
- Neurological Disorder
- Affect
- Pleasure
- Happiness
- Laughter
- Mental Disorder
- Romance