Drugs of Abuse

321 Pages·2011·10.31 MB·English

by  Michael J.

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Drugs
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Copyright © 2012Marshall Cavendish Corporation PHOTOGRAPHICCREDITS
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Library of Congress Cataloging-in-Publication Data
Drugs of abuse / consultants, Michael J. Kuhar,
Howard Liddle.
p. cm.
Includes indexes.
ISBN 978-0-7614-7944-4 (alk. paper)
ISBN 978-0-7614-9973-2 (ebook)
1. Drug abuse. I. Kuhar, Michael J. II. Liddle, Howard
RC563.D7718 2012
362.29--dc22
2011004717
Printed in Malaysia
15 14 13 12 11 1 2 3 4 5 This book is not intended for use as a substitute for advice,
consultation, or treatment by licensed practitioners. The use
Consultants
and supply of many substances and the employment
Michael J. Kuhar, PhD, Charles Howard Candler Professor of techniques discussed in this book may be illegal unless
of Pharmacology, Emory University, Atlanta, Georgia prescribed for medical purposes. The reader is advised that no
action of a medical or therapeutic nature should be taken
Howard Liddle, EdD, Director, Center for Treatment without consultation with licensed practitioners, including
and Research on Adolescent Drug Abuse, University action that may seem to be indicated by the contents of this
of Miami Medical School, Miami, Florida work, since individual circumstances vary and medical
standards, knowledge, and practices change with time. The
Marshall Cavendish publishers, authors, and consultants disclaim all liability and
Publisher: Paul Bernabeo cannot be held responsible for any problems that may arise
from use of this book.
Production Manager: Michael Esposito
Indexer: Cynthia Crippen, AEIOU, Inc.
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Contents
Acetaldehyde 8 DMT 107
Acetorphine and Etorphine 10 Dopamine 108
Acetylcholine 11 Drug Control Policy 110
Adverse Reactions 13 Drug Laws 115
Agonists and Antagonists 15 Drug Receptors 120
Alcohol 17 DXM 124
Amobarbital 23 Ecstasy 125
Amphetamines 24 Ecstasy Analogs 128
Amphetamine Sulfate 26 Endorphins 130
Anabolic Steroids 28 Ephedrine 131
Analogs 35 Epinephrine 133
Antidepressant Drugs 38 Erythropoietin 135
Aphrodisiac Drugs 41 Ethanol 136
Barbiturates 43 Fentanyl 140
Belladonna Alkaloids 47 Gamma-aminobutyric Acid (GABA) 141
Benzodiazepines 50 GHB 143
Betel Nut 55 Glutethimide 144
Blood-Brain Barrier 57 Hallucinogens 145
Bufotenine 59 Harmine and Harmaline 150
Buprenorphine 60 Heroin 152
Caffeine 61 Hormonal Effects 156
Central Nervous System 66 Human Growth Hormone 160
Chloral Hydrate 72 Hydromorphone 161
Chlorpromazine 73 Ibogaine 162
Chocolate 74 Illicit Manufacturing 164
Classification of Drugs 76 Inhalants 167
Clonidine 82 Jimsonweed 172
Club Drugs 83 Ketamine 173
Cocaethylene 85 Khat 174
Cocaine 86 LAAM 175
Coca Leaf 90 Laudanum 176
Codeine 92 Legal Controls 177
Cognitive Impairment 93 Legalization Movement 181
Controlled Substances 95 Levorphanol 184
Crack Cocaine 99 Librium 185
Cutting Drugs 102 LSD 186
Designer Drugs 104 MAOs and MAOIs 190
Disulfiram 106 Marijuana 192
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Meperidine 199 Pharmacokinetics 247
Meprobamate 200 Pharmacy Drugs 253
Mescaline 201 Phenethylamines 256
Metabolism 204 Placebos 261
Methadone 206 Plant-Based Drugs 263
Methamphetamine 210 Potentiation 267
Methanol 212 Prescription Drugs 269
Methaqualone 213 Prohibition of Drugs 274
Methcathinone 214 Prozac 277
Morphine 215 Psilocybin and Psilocin 278
Naloxone 217 Psychotropic Drugs 279
Naltrexone 218 Reserpine 280
Narcotic Drugs 220 Ritalin 281
Nexus 221 Rohypnol 282
Nicotine 222 Secobarbital 283
Nitrous Oxide 226 Sedatives and Hypnotics 284
Norepinephrine 227 Serotonin 286
Opiates and Opioids 229 SSRIs 288
Opium 233 Tobacco 290
Oxycodone 235 Tryptamines 295
Paraldehyde 236 Valium 298
PCP 237 Vicodin 299
PCP Analogs 240 Resources for Further Study 300
Pentazocine 241 Glossary 302
Pentobarbital 242 Drug Table 312
Pharmaceutical Industry 243 Index 314
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Foreword
What does the word drug mean? The ancient Greeks’ substances as drugs; they are defined as nutritional
word for drug was “pharmakon,” and it had three supplements or foods. Most consumers do not think
different but related meanings: remedy, poison, and of their multivitamin pill or herbal tea as a drug, but
magical charm. These three meanings apply to most the substances in the pill or tea can produce changes in
substances called drugs. A specific drug can be a remedy, the human body. In fact, the scientific definition of
used to treat a symptom or disease; a poison, misused in drug excludes, among other things, salt, sugar, and
some way to cause harmful effects; and a magical fruits and vegetables that contain vitamins. But all of
charm, when it is used in the belief that it is a “wonder these substances can produce changes in the human
drug” that will cure any illness and solve life’s problems. body. So the meaning of the word drug can vary,
The scientific definition of a drug is any substance, depending upon how it is used by particular people
other than food, that by its chemical or physical nature and the situations in which it is used. In this book, the
alters the structure or function of a living organism, focus is on drugs that may be abused and lead to harm,
resulting in physiological or behavioral changes or both. whether they are legal or illegal.
Various Definitions Recreational Drugs
The meaning of the word drug, however, often varies There are drugs, such as caffeine, alcohol, and tobacco,
with the context in which it is used. For instance, the that people use for reasons that are not medical. Is
scientific definition of drug can include substances that caffeine a drug? Most people who drink coffee each day
are agricultural and industrial chemicals but are not do not consider caffeine, coffee’s main ingredient, to be
intended for use by humans, because if humans were a drug. When heavy coffee drinkers do not get their
exposed to these substances, extremely harmful effects daily dose of caffeine, however, they can experience
would occur. Substances used to treat symptoms and unpleasant effects, which many scientists believe are
diseases in humans or to prevent health problems are withdrawal symptoms. A few decades ago, most people
considered drugs by almost everyone. There are drugs did not consider smoking tobacco to be the use of a
that require a prescription from a doctor before a drug (nicotine). But increasing public awareness of the
patient can get the drugs from a pharmacist; these many dangerous effects from smoking, including its
include antibiotics and tranquilizers. There are other ability to produce addiction, has led to the widespread
drugs that people can get without a prescription from a realization that tobacco use is drug use.
pharmacy or supermarket, such as antacids, some Many drinkers of alcoholic beverages, especially
allergy medications, and cough and cold remedies. The most young people, do not think that they are using a
distinction between prescription and nonprescription drug. Yet alcohol produces many effects in the human
drugs is based on laws and regulations passed as recently body, can cause a great deal of harm, and represents the
as the 1950s. Laws are one way of classifying different single, most important drug problem in society today.
drugs. The Controlled Substance Act of 1970 created Many other drugs, including heroin and Ecstasy, are
categories of drugs based on their abuse potential and illegal to use for any reason. There is almost no
value as medicines. Another way of classifying confusion about considering these substances as drugs,
individual drugs is based on their psychoactive effects, but alcohol continues to occupy a unique position.
for example, by classifying them as narcotics,
stimulants, sedatives or depressants, and hallucinogens. Sources of Drugs
There are other substances that people use to treat Many drugs are substances that occur naturally in plants
health problems, such as herbal remedies, or other living things, and people can use the natural
homeopathic medicines, and vitamins. Many people, materials or extract the active ingredients from them.
especially most health professionals, consider these Examples include opium, cocaine, and mescaline, as
substances to be drugs, but the U.S. Food and Drug well as the active ingredients in marijuana, tobacco,
Administration does not legally define these coffee, and many herbal remedies. Other drugs are
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made by humans using chemical processes to synthesize the United States, the United Kingdom, and according
and manufacture compounds that act in the body and to the International Narcotics Control Board (INCB).
brain. Examples include most prescription medications, The 124 articles in this book are supplemented by other
such as antidepressants, steroids, tranquilizers, sleeping articles on the use of drugs in general, their effects on
pills, and painkillers. People also make alcohol. individuals, and the medical and social responses to
In addition, the human body makes its own drug abuse that can be found in the companion, single-
chemicals that act like drugs to help the body function. volume workSubstance Abuse, Addiction, and Treatment.
Examples of these are hormones (messenger chemicals), Additional information is also available in the three-
vitamins, and neurotransmitters (nerve and brain volume set Drugs and Societyand the online Drugs and
chemicals), such as serotonin, dopamine, and Societydatabase at www.marshallcavendishdigital.com.
endorphins.
In Drugs of Abuse, each article on a particular drug Michael Montagne, PhD, Massachusetts College
includes a “Key Facts” panel, which details the drug’s of Pharmacy and Health Sciences,
street names, form, dangers, and legal classification in Boston, Massachusetts
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Consultants and Contributors
Consultants Ankur Kapur, BS, Dept. of Pharmacology, University of
Michael J. Kuhar, PhD, Charles Howard Candler Professor Alberta, Edmonton, Canada
of Pharmacology, Emory University, Atlanta, Georgia Thomas H. Kelly, PhD, Dept. of Behavioral Science,
College of Medicine, University of Kentucky,
Howard Liddle, EdD, Director, Center for Treatment and Lexington, Kentucky
Research on Adolescent Drug Abuse, University of Nathan Lepora, PhD, London, UK
Miami Medical School, Miami, Florida Francesco Leri, PhD, Dept. of Psychology, University of
Guelph, Guelph, Ontario, Canada
Ian L. Martin, Professor of Pharmacology, School of Life and
Health Sciences, Aston University, Birmingham, UK
David E. Arnot, PhD, Institute of Cell, Animal, and Duane McBride, PhD, Director, Institute for the
Population Biology, University of Edinburgh, Prevention of Addiction, Andrews University, Berrien
Edinburgh, UK Springs, Michigan
Kirk J. Brower, MD, Dept. of Psychiatry, University of John McMahon, PhD, Centre for Alcohol and Drug
Michigan Addiction Research Center, Ann Arbor, Studies, University of Paisley, Paisley, UK
Michigan Darlene A. Mitrano, BS, Dept. of Molecular and Systems
Martin Clowes, BSc, Nottingham, UK Pharmacology, Emory University, Atlanta, Georgia
Cynthia A. Conklin, PhD, Western Psychiatric Institute Meryl Nadel, PhD, Social Work Department, Iona
and Clinic, University of Pittsburgh Medical Center, College, New Rochelle, New York
Pittsburgh, Pennsylvania J. Glen Newell, PhD, Dept. of Pharmacology, University
Ross Coomber, PhD, Dept. of Sociology, University of of Alberta, Edmonton, Canada
Plymouth, Plymouth, UK David E. Nichols, PhD, Dept. of Medicinal Chemistry
William DeJong, PhD, Dept. of Social and Behavioral and Molecular Pharmacology, Purdue University, West
Sciences, Boston University, Boston, Massachusetts Lafayette, Indiana
Colleen Anne Dell, PhD, Dept. of Sociology and Daniel J. O’Connell, PhD, Center for Drug and Alcohol
Anthropology, Carleton University, Ottawa, Canada Studies, University of Delaware, Newark, Delaware
Jason Derry, BS, Dept. of Pharmacology, University of Kenneth Perkins, PhD, Western Psychiatric Institute and
Alberta, Edmonton, Canada Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
Susan M. J. Dunn, PhD, Dept. of Pharmacology, Kelly B. Philpot, PhD, Neurosciences Division, Emory
University of Alberta, Edmonton, Canada University, Yerkes Primate Research Center, Atlanta,
Erin J. Farley, MA, Center for Drug and Alcohol Studies, Georgia
University of Delaware, Newark, Delaware Joseph P. Reoux, MD, Dept. of Psychiatry and Behavioral
Graeme Fitzpatrick, BSc, University of Nottingham, Sciences, University of Washington, Seattle, Washington
Nottingham, UK Henry Russell, MA, London, UK
Dwayne W. Godwin, PhD, Dept. of Neurobiology and Harry Shapiro, DrugScope, London, UK
Anatomy, Wake Forest University Baptist Medical Matthew D. Spigelman, BA, Dept. of Anthropology,
Center, Winston-Salem, North Carolina University of Wisconsin, Milwaukee, Wisconsin
L. John Greenfield, Jr., MD, PhD, Medical Director, Lis Stedman, BA, Chelmsford, Essex, UK
Neurology Clinic, Medical College of Ohio, Toledo, Ohio John A. Tauras, PhD, Dept. of Economics, University of
Wendy A. Horan, BSc, Croydon, Surrey, UK Illinois at Chicago, Chicago, Illinois
Roger W. Horton, Professor, Pharmacology and Clinical Yvonne Terry-McElrath, MSA, Institute for Social
Pharmacology, St. George’s Hospital Medical School, Research, University of Michigan, Ann Arbor, Michigan
London, UK Patricia L. Torchia, LCPC, CADC, Prairie Psychotherapy
Richard G. Hunter, PhD, Neurosciences Division, Emory Associates, Springfield, Illinois
University, Yerkes Primate Research Center, Atlanta, Aleksandra Vicentic, PhD, Neuroscience Division, Emory
Georgia University, Yerkes Primate Research Center, Atlanta,
Jason Jaworski, PhD, Neurosciences Division, Emory Georgia
University, Yerkes Research Center, Atlanta, Georgia Chris Woodford, MSc, Burton-on-Trent, Staffordshire, UK
Judith L. Johnson, PhD, School of Psychology and Joycelyn S. Woods, MA, President, National Alliance of
Counseling, Regent University, Virginia Beach, Virginia Methadone Advocates, New York, New York
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Acetaldehyde
Acetaldehyde is a poisonous substance that forms in the human body through
the biotransformation of alcohol. Acetaldehyde can cause adverse reactions to
alcohol consumption and a range of chronic health problems.
Acetaldehyde is an organic compound (formula acetaldehyde is a vasodilator—an agent that makes
CH CHO) that forms by the action of oxidizing blood vessels expand and thus increases the flow of
3
agents on ethyl alcohol (ethanol, CH CH OH). The blood. The overall sensation is unpleasant enough to
3 2
oxidation corresponds to the loss of two hydrogen deter most people from drinking, which is the basis
atoms from each alcohol molecule. of disulfiram therapy for alcoholics. Alcohol-related
In the human body, acetaldehyde is the first product flushing and associated effects occur in people who
in the sequence of reactions that eliminate alcohol have unusually active ADH (and therefore convert
from the bloods tream. The enzyme that promotes this alcohol into acetaldehyde rapidly) and people who
reaction is alcohol dehydrogenase (ADH), which have ALDH deficiency (and therefore dispose of
exists to deal with the small amounts of alcohol that acetaldehyde slowly).
are produced naturally by the human metabolism— Chronic effects.Acetaldehyde is highly reactive, and
around 1 ounce (30 g) per day—or that are ingested, its reactions with amines and other nucleophiles
for example, in fermenting food. When alcoholic (molecules attracted to a positive charge) feature in
drinks are consumed, these enzyme molecules in the its chemistry. Acetald ehyde can react with proteins,
liver are soon working at their maximum, converting DNA, and other molecules of the human organism
around 0.3 ounces (8 g) of alcohol into acetaldehyde that contain either nitrogen bases or other nucleo-
each hour for an average adult. In the normal philic groups. When it does, it changes the structures
course of events, another type of enzyme—aldehyde and funct ions of these molecules. Reactions of acet-
dehydro genase (ALDH), also in the liver—rapidly aldehyde with proteins cause hardening of the
converts aceta ldehyde into acetic acid (CH COOH), arteries, wrinkles, and loss of skin elasticity; reactions
3
which is quite harmless and can be excreted in urine. with DNA cause abnormal cell functions.
Problems occur when the bloodstream concen- Other damage occurs because acetaldehyde readily
tration of acetaldehyde rises. This can happen because forms free radicals by oxidation in the body. Free
the ADH system is abnormally active, producing more radicals are fiercely reactive molecular fragments
acetaldehyde than the ALDH system can handle. characterized by an unpaired electron. They react
Alternatively, the ALDH system can be the root of the with a multitude of substances in the body, causing
problem, either because it is genetically deficient or effects that range from cell damage and generalized
because it has been knocked out by a substance that aging to cancer. Acetaldehyde may also cause
prevents the ALDH enzymes from working properly. abnormal fetal development. Mothers who drink
In either case, the concentration of acetaldehyde alcohol while pregnant run the risk of giving birth to
increases with every alcoholic drink consumed. a child with fetal alcohol syndrome. This syndrome
is recognizable by physical and mental symptoms,
Toxic effects such as learning disabilities, growth retardation, and
Acetaldehyde produces a broad spectrum of toxic facial abnormalities such as a small head size.
effects, ranging from those that occur immediately
after alcohol consumption (acute effects) to those Racial variations
that occur as a result of repeated episodes of As already explained, the amount of acetaldehyde
acetaldehyde accumulation (chronic effects). that builds up in the body and the length of time
Acute effects. The immediate symptoms of an taken to eliminate acetaldehyde depend on the
acetaldehyde buildup include reddening of the face efficiency of the ADH and ALDH enzyme systems.
and earlobes (flushing), nausea, dizziness, and a Genes govern the formation of ADH and ALDH,
throbbing headache. These symptoms arise because and different forms of those genes, called alleles,
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ACETALDEHYDE
code (specify the protein structure) for enzymes that
differ in how quickly they transform alcohol into
acetaldehyde, and acet aldehyde into acetate. Some
alleles occur predomi nantly in people of specific
racial heritages, and affect their drinking habits.
One such allele is ADH2*3, which occurs in some
people of African or Native American heritage.
ADH2*3 codes for a variant of ADH that is more
efficient than others, so when a person whose ADH is
of this type consumes alcohol, the enzyme produces
acetaldehyde faster than would happen in other
people. A mild flushing reaction results and is usually
sufficient to discourage excessive drinking. The
reaction is less severe than that which happens with
disulfiram, since the ALDH enzyme still works but
struggles to cope with the rapid production of
acetaldehyde. Studies have shown that African
American families who possess ADH2*3 are less likely
to have alcoholic family members than the population
as a whole. Pregnant women in this group are less
likely to give birth to alcohol-damaged children, partly
because they are less likely to be alcoholics who would
drink during pregnancy. Similarly, there is evidence Racial variations in alcohol metabolism may cause a
to suggest that some Jewish people may be protected different reaction in each of these girls.
from alcoholism by the presence of the allele
ADH2*2, which in one study was found to be flushing increase the risk of certain types of cancers.
common in Jewish men with a low alcohol intake. Almost 10 percent of alcoholics in Japan become so
Another genetic variation that affects acetaldehyde despite having an ALDH deficiency.
metabolism occurs in peoples of East Asian descent;
in this case, the affected enzyme is ALDH. In Japan, Acetaldehyde and alcoholism
around 2 percent of the population are completely The relationship between acetaldehyde and
lacking in ALDH, and thus have no tolerance for alcoholism is complex. While the physical symptoms
alcohol, reacting to alcohol as if taking disulfiram. of acetaldehyde accumulation are a clear disincentive
Almost half the population of Japan have a milder to abuse alcohol in those who are sensitive to alcohol
form of the genetic mutation, which reduces their flushing, the action of acetaldehyde in the brain is
ALDH system to one-third its normal capacity, and less clear-cut. Acetaldehyde competes with certain
these people have a reduced tolerance to alcohol. neurot ransmitters and reduces their inhibitory
Around 85 percent of the same groups of people also effect, making the brain more excitable. It can also
have a variant of ADH that is particularly active, so react with neurotransmitters to form substances
those who have hyperactive ADH and deficient called isoquinolines. Some researchers suggest that
ALDH produce acetaldehyde more rapidly but isoq uinolines, which are produced in higher quan-
dispose of it more slowly than other people. tities in people with ALDH deficiency, can interact
Despite the unpleasant consequences, some people with opioid receptors in the brain, and that this
with ALDH deficiency persist in drinking—often inter action could be a route to alcoholism.
as a result of social pressure to drink with work M. CLOWES
colleagues or friends. The consequences of ignoring
the flushing reaction can be serious, since the high SEEALSO:
concentrations of acetaldehyde signaled by the Alcohol (cid:129) Disulfiram
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