1: Drug Use and Misuses Def: Nat/Art S x food by chem. nature alters structure or function in a living organism. World Drug Report 2016: (on 2014): 247M drug users, 29M disorders (11.7%) (1/6 people in
treatment) | 12 million PWID, 1/7 HIV, 1/2 Hep C, 1/3 HIV infection among PWID) (risky sex) |~207,400 drug‐related deaths (2014) = 43.5/M 15‐64.(const.) | OD 1/3, most opioids. | Prison ↑ death | Stat:
Cannabis (183 M,2014), amph. (33M), opioids + prescription opioids harm and consequences | General principles: Use!=abuse | Mult effects @ sites | Amount matters | User’s history and expectations
(psychoactive drugs | x Good or Bad | Influences: Ind.+Com.+Fam.+Soc.| Trends (U.S) (MTF) (8-12+C) | (NSDUH) | Here: Arrests 17: 3091, 1249 (40%) | 16: 3265, 1348(New) (41%) | ~1/2 new arr. 20-29
years old | 2017: Methamphetamine (1991, 64%), heroin (848, 27%), cannabis (204 , 7%) most common drugs | Cannabis: 17%↑ in new abusers and 22%↑ in local seizures of cannabis | Youth: National Council
Against Drug Abuse (NCADA) (2016): more open‐minded to drugs vs 2013. Tried marijuana out of curiosity w. diff.ed.bg. The Government's Task Force on Youth and Drugs (2015) Cannabis mid-high socio‐E,
good in school, little parents/drug history, Ice (crystal methamphetamine) lower‐income | Supply: Cannabis most widely cultivated (129), most trafficked (95% coun.),(>1/2 of 2.2 million seizures, UNODC, >
ATS, opioids and coca-related substances). Most consumed (CNB 2016) Opium poppy 2nd (49)> coca (Americas). | “Dark net”: anon. online marketplace, access via “Onion Router” (TOR), paid in bitcoins or
crypto. | Operation Onymous by European Police Office (Europol)( “Silk Road” 2013 or “Silk Road 2.0” 2014). | “voluntary” shutdowns “Agora”, Aug 2015 | SG ↑ arrest drug+ Paraphernalia (equip., product,
accessory, material modified for make, use, or conceal recreational drugs (Glass hashish pipes, crack cocaine pipes, smoking masks, hashish bongs, syringes, etc.)) (30/2015, 201/2016). | Trends: High seizures
of meth+ cannabis , 2016 World Drug Report by United Nations Office on Drugs & Crime (UNODC) meth seizures/ E/SEA*4 (09-14) | Limit: Hard monitor, inaacurate self-report, study in schools
Gateway theory: explains a typical sequence of involvement with drugs. | Gateway substances: One of the first drugs used by a typical drug user (Alcohol) | != cause of future drug use, only early indicators of a
basic pattern of deviant behavior due to diff. psychosocial risk factors | 3 concerns of users: Toxicity: dangerous chemicals? | Dependence: habit‐forming compounds? | Crime: drug users become dangerous? |
Toxicity: Physiological toxicity | Acute: Prescription painkiller overdose (the user stops breathing) | Chronic: Heart Problems, Lung cancer, Cirrhosis (Scarring of the liver) (=Chronic physiological toxicity) |
Behavioral toxicity: Acute: “Drunk driving”, Intox. impairing behavioral functioning | Chronic: Deleterious lifestyle changes, Strain on interpersonal relationships | Non drug-induced toxicity: Specific toxicity
for users who inject drugs, x drug action | Sharing needles AIDS, HIV infection, and hep B and C | Syringe exchange: fund/gov ↓ infection | Drug dependence=Addiction, drug use freq.+consist. Cannot
stop, maybe physiological, =behavioral disorder | Characteristics 1) Tolerance | ↓ effect as repeated use ↑amount| Cross tolerance: ↓ response bc another w/similar structure effects (Heroin & opioids) |
Physical | body constantly crave, tolerance induces PhD, Stop=withdrawal effects | Psychological: mental inability to stop, seen in behave+time person spends to seek drugs based on +ve reinforcement model |
Factors determine dependence? Substance+method of administration | Biological? (Dopamine (neurotransmitter): central role for reward system, gives feeling of enjoyment and wanting, targets by drugs of
abuse like cocaine) | “Sensation-seeking” personality | Family disorder | Disease – defined by Alcoholics Anonymous (AA) | Problems: drug dependence & overdose | Deviance: arrests, fines, jailing, expenses
associated w. prev+treat | Testing: Urine: most drugs up to 3 days | Hair: 90 days, less invasive. | Oral-fluid: recent drugs, up to 1 day; not invasive, cheap and less adultered | Drug Test: x drugs and alcohol
related accidents at workplace, drug-free culture | Typically carried out by drug or substances of abuse screening in muring specimens | Send lab (15-20mL, sterile plastic container, x preservative, labeled/donor
name+identification number, sealed. X adultered) | Analysed: (Mon+Wed+Fri): Ethanol, amphetamines, benzodiazepines, buprenorphine, Cannabinoids(Marijuana/THC), Cocaine metabolite (Benzoylecgonine),
Ketamine, Opiates, (Fri): Barbiturates, Phencyclidine (PCP), Propoxyphene, Methadone, Methaqualone | Limit: Adulteration(substitute, dilute, + “masking agents” (bleach/oxidizers), can test), False +/- results,
x info/state of impairment
L 2.1 Drug Regulations (Singapore) Prescription Only (Diazepam-Valium tablets) | Pharmacy Only (Codeine Phosphate cough syrup) | General Sale List (Over the counter (OTC) Paracetamol tablets) |
Guidelines: 1961 UN Single Convention on Narcotic Drugs, 1971 UN Convention on Psychotropic Substances | SG both || Health Sciences Authority (HSA) authority for SG: grant import+export licenses
for narcotic drugs (ND) and internationally-controlled Psychotropic Substances (PS) + submit report to International Narcotics Control Board (INCB) on the import, export & dealings of ND+PS | Controlled
Drugs (CDs): sub. specified in the First Schedule of MDA | All 1961, some 1971=CD | Legislations of Controlled Drugs (CDs) (Singapore) The Misuse of Drugs Act, The Misuse of Drugs Regulations,
Medicines Act, Medicines (Export Licence For Psychotropic Substances) Regulations, Health Products Act Health Products (Therapeutic Products) Regulations 2016 (from 1 Nov 2016) | Misuse of
Drugs Act (MDA): 5 Schedules. 1st classifies a list of controlled drugs into Classes A, B and C. S44: Minister may +/-/transfer drugs among classes. MDA list offences: controlled drugs and substances related
to traffick, manufac., imp, exp., possess and consume (severity of punishment: Class A> B> C) (S33 Punishment: Imprisonment + Strokes: 10-30&10-15, 6-30&6-15, 4-20&2-15) | SG: Death in trafficking and
importation of certain prescribed amounts of controlled drugs, Heroin: 10 years imprisonment/$20000 Fine/Both | Presumption: 100g opium, 3g morphine (natural product), 2g diamorphine (heroin-synthetic
product) | 2012 added 33B (Misuse of Drugs (Amendment) Act 2012) to exempt some cases from the mandatory death sentence while boosting enforcement (ex. imprisonment, caning), if can prove their
involvement is a courier (transporter/offer transport) /get cert. of substantive assistance that they assisted Central Narcotics Bureau (CNB)/mental or intellectual disabled | Drug supply offshore, use vulnerable to
transport | Misuse of Drugs Act (MDA): Director of CNB commit abuser for treatment and rehab in a drug rehab centre (6-36months) | Repeated abusers of drugs punishment Fourth Schedule of MDA |
Consume controlled drugs outside Singapore: imprisonment <=10, fines<=S$20000 or both (July 1997)(police record) | The nervous system | Specialized nerve cells in nerv. Sys. receive +send info
accurate+rapid | Dendrites, neuron cell body, axon, myelin sheath (schwann cell), node of raniver, presynaptic terminals | Psychoactive drugs: Alter availability of neurotransmitter in the synapse | Agonists vs
Antagonists: agonist mimics neurotransmitter effect on the postsynaptic cell vs antagonist prevents neurotransmitter effect on postsynaptic cell. | Mechanism: Vesicles in axon terminal release neurotransmitter
which move past synapse to the receptor sites on the membranes of neurons of dentries | Types/neurotransmitter: Dopamine (amphetamines, cocaine), Acetylcholine (tobacco, nicotine), Glutamine (cocaine):
excitatory (euphoria, agitation, paranoia/insomnia) | GABA (alcohol, valium-type barbiturates) & Serotonin (LSD): inhibitory (sedation, relaxation, drowsiness, depression) |
L 2.2 Psychoactive drugs: Substances acting on CNS, altering the brain functions+ temp change perception, mood, consciousness and behavior. | Stimulants (uppers): drugs keep you going M+P when tired. /↑
brain activity, alertness, attention, energy, euphoria |
Cocaine: BC5000 chewed coca leaves by natives of Andes mountains in Peru | Freedom from fatigue and ↑ endurance | consumed during religious ceremonies and working in gold mines. Emphasis on: stimulant
effect(energy) | Niemann (1860 extract) | + wine = coca wine (Vin Mariani): Angelo Mariani, restorative and tonic | +caffeine(1886) CocaCola: 1st cardiac arrest 1886
toxic reactions. | Mechanism of Action:
blocks reuptake of many neurotransmitters: (e.g., Dopamine, norepinephrine) | +ve uses: Stimulatory, local anesthetic, vasoconstrictor | Dosage forms of cocaine: Oral: Slow absorb and effect, IV,| Sniffing
(snorting)(cocaine HCl powder) | Smoking (Crack cocaine): produce rapid (15-30 seconds) and brief (max 15 minutes) effects. Multiple doses needed. | +ve (Positive Reinforcement): Excitement well-being,
Suppression of appetite, Insomnia/Alertness, Effects last on the basis of the route of administration | -ve effects “dysphoric crash”：Fatigue, Depression, Anxiety, Nausea and vomiting, Loss of desire | For heavy
use: Paranoia & Hallucinations | Chornic Markers: Perforation of nasal septum (nose drops) constrict blood vessels | Holes: change administration site | Crackeritis: cornea rubbed off | Dental erosions +
oral lesions for crack cocaine and coca leaves | Causes for Concern: Acute Toxicity: profound brain stimulation, convulsions, respiratory or cardiac arrest(overdose). Deaths not dose-dependent, SIDS |
Chronic Toxicity: Paranoia, hallucinations. Changes in heart and brain. (unexpected deaths even at low doses.) | Tolerance & Dependence Potential: M+P, particularly among inject+inhale, as effect is shorter.
Cocaine (stimulant) + Alcohol(depressant): Coca-ethylene (generated in the liver): more toxic and addictive, more likely to cause sudden death | Pregnancy concerns “crack baby phenomenon” overstated:
Most of the abnormalities (low birth weight, prematurity…) are more likely related to life-style than to any pharmacological effect of cocaine itself. | Women in general are: Older, Malnourished, Suffering from
HIV infection and hepatitis, Cigarette smokers, Drinkers | CRACK (Children Requiring a Caring Kommunity) program:US$300, birth control or sterilized. Critics: purchase drug (↑ addiction) | no -ve association
between prenatal cocaine exposure and physical growth (Exception: Vasoconstriction ↓ nutrients to the fetus) | Crime: South Asia for new routes | Largest liquid cocaine @ Bangladesh: soft security hub|
Agencies focused on heroin + synthetic drugs, no testing for cocaine!)
Amphetamines: Used for centuries (Ma Huang-Ephedra Chinese tea) | Active ingredient: Ephedrine | Late 1930s, synthesized to replace ephedrine in asthma treatment | Patented 1932, 1939-Used by German and
Japanese soldiers + efficiency| After WWII, sold without a prescription to reduce the stockpiles | 1960s- known as speed and used with heroin to have euphoric effects | Drug-abusing hippies- the “flower
children’’ | Effects | Body: ↓ appetite, ↑ breathing rate, Can’t sleep, Convulsions | Mind: ↓ fatigue, ↑ feeling of alertness, Hallucination, Psychosis | Benefits: FDA: approved only for narcolepsy, for
short-term reduction of weight and for Attention-Deficit-Hyperactivity Disorder (ADHD) | obtained legally with a prescription | Consumption: Oral, Intravenous, Smoking | Mechanism of Action: Like
cocaine, ↑ activity of neurotransmitters (E.g., Dopamine) by stimulating their release
Methamphetamine: Tighter controls on legally manufactured amphetamines lead to | Made in illicit laboratories “Superlabs” | Late 1990s- became the next drug fad - “Smoking” of Ice-methamphetamine HCl
crystals (users) Adolf Hitler and Paul Erdos | Most potent and fast acting of amphetamines. One of the most abused drug in Singapore (2016). | Rarely taken orally, usually snorted, smoked, injected | Short-term
effects: Euphoric “rush” or “flash” that many users experience. | Repeated methamphetamine use can easily lead to dependence | Chronic Toxicity: Psychosis, hallucinations, and delusions (sensation of insects
crawling under the skin) | Brain changes-reduced motor skills, impaired verbal learning, emotion/cognitive problems | Physical and Psychological Dependence: especially if the drug is injected: Amphetamine
user tolerant to cocaine (cross tolerance!)
Caffeine: 350AD China 1400s Arab, 1500s ME ,1600s Europe (England and France.) US (x as soda + lifestyle changes) | Tax on tea offset alcohol-related tax rev. loss. Importation of tea monopolized: English
East India Company. High taxes on tea in new colonies of America –Boston Tea Party of 1773: resistance against the Tea Act because of “No taxation without representation”. Colonists destroyed the shipment of
tea by EIC. Tea drinking =crown loyalty | Most frequently consumed psychoactive drug, in colas and medicines. Normal avg daily intake of caffeine = 2 cups coffee a day (200 mg of caffeine) | Most in coffee
and tea Mechanism of action: different from meth: Blocks adenosine receptors in brain. (produces tiredness + sleep need) ie. dopamine and norepinephrine still high lv. | Effects: Max 30-40 minutes from Coffee |
Brain: Enhances alertness, diminishes fatigue, Insomnia & anxiety, initiation of muscle twitches, > 5 cups: panic sensations, nausea, clumsiness, Extreme high doses (10 g= 50-100): convulsions & potent death |
Heart: high doses (>5 cups) heart contraction ↑ palpitations (extreme if > 20 cups) | Toxicity: Caffeinism: feelings of nervousness (anxiety neurosis) | Dependence: Caffeine withdrawal syndrome tiredness,
lethargy, headache, Mood and cognitive performance can deteriorate | Red Bull: high content (80 mg), taurine and ginseng: “Clubbers’ Drinks” + alcohol (Vodka Bull) | Green tea: less caffeine. antioxidants,
antiaging, anticancer product | Karoshi: overwork (cardiovascular/suicide)
L3 Stimulants D:(excite CNS+sleepless) vs Anti-depressants (raise depressed mood to normal, no excitation/sleepless) vs depressants (↓ CNS act. + sedation) | CNS depressant (Sedatives/anxiolytics/Hypnotics)
(↓anxiety, induce sleep, epilepsy) | 1900s: Chloral hydrate (hypnotic agent): orally onset 30 mins, 1 or 2g<1hr sleep (Mickey Finn) | 1829 Paraldehyde (bad taste/smell, mental Hos. < 1950, slight respiratory
depression + wide safe margin) | 19th Bromide salts (induce sleep:NaBr) (toxic)(Minor: dermatitis, constipation, Major: Delirium and psychosis
Barbituates(BB) (phenobarbital, amobarbital, XXbarbital)( Ultra short:<4hr, rapid onset, sleep, high doses)(Intermediate (4-6) and long>6, delayed onset, ↓anxiety, low doses) | Concerns: Overdose deaths,
Misuse and dependence (rapid: psychological, short-acting: physical) (Euthanasia legal in NCCBL) | Thiopental Sodium (ultra short-acting bar., rapid IV, lipid soluble, enter brain, anesthetic in surgery, small
dose talkative (in psychotherapy/interrogations), Lethal injections (unconscious, pancuroniuum bromide paralyses respiratory mus., KCl stops heart) | Benzodiazepines(BZ): Chlordiazepoxide (Librium, 1960),
less drowsy than BB, 1970s Diazepam (Valium),(little PhD/PsD, no OD)(dose+time course)(Onset+Action)(Withdrawl: Convulsions, psychosis, anxiety, insomnia) | Rohypnol: Mix alcohol intoxication (date
rape: 1997 +color) | z-drugs: ~BZ, diff structure, Zolpidem (Ambien – most widely prescribed hypnotic) (Short d+rapid)(hv withdrawl s)
Effect: BZ+BB: bind receptors on GABA receptor complex, enhance inhibitory effect GABA | NonBZ: selectively bind to diff sites on receptor complex) | Usage: Anxiolytics (4 BZ top 100 common US),
Hypnotics (sedative, 1/3US: 2016 SGD1.3M), Anticonvulsants (epilepsies, others combined) | Concerns: Tolerance (Chronic), Seizures (withdrawl) Dependance: Psychological, Physical (~alcohol: BZ: anxiety,
impaired concentration+memory, insomnia, nightmares, muscle cramps, increased sensitivity to light and touch)(More serious: Delirium tremens, delusions, convulsions) (Cross-dependence among BB,BZ,
Alcohol) | Acute toxicitiy: Behavioral: impaired judgment and coordination, physiological: Respiratory depression | Abuse: associated with oral use (Old tolerance, young mix/high dosage) |
Inhalants: Gasoline, glue, hair spray, paint (~depressants) (Gaseous anesthetics (Nitrous oxide, ether), nitrites, volatile solvents, petroleum derivatives) | Affect GABA receptors and blocks glutamate receptors) |
Effects: Floating euphoria (omnipotence, impulsive behavior), nausea, cough, damage heart, kidney, brain, hypoxia, death | SG: 9/2008 (counseling on direct CNB supervision + anti inhalant abuse posters) (sale
restriction, add irritating ingredients, warning labels | GHB (gamma hydroxybutyrate/liquid ecstasy)(Metabolised to GABA and competritive inhibition)(Date rape, +alcohol depressant)(High dose: muscular
incoordination, slur speech) | Syren (NA salt/GHB) Cataplexy + EDS (narcolepsy)
Alcohol CNS depressant | Standard drink 10g pure alcohol (% or proof: twice % of alcohol by weight)(Small Int. absorb, slow food+h20, fast carbonated beverages)(BAC: %, g per 100ml)(SG: 0.8mg/ml,
0.08%)(liver metabolizes 0.25 ounces of alcohol/hr)(7.5ml) | Alcohol + alcohol dehydrogenase Acetaldehye + Aldehyde dehydrogenase Acetic Acid | Alcohol metabolism: Stable rate + liver increase
enzyme activity slow metabolism of other drugs when present for heavy users(Women susceptible: less weight+high prop. Body fat (absorb more), alcohol dehydrogenase less active)
Enhance inhibitory effect of GABA at receptors ~ BB/BZ, high dose block glutamate | Behavioral: Mood changes (euphoria, reduced anxieties, reduced inhibitions)(Effect determined by BAC+Time
course+experience+Expectations)(low: complex and abstract, high: simple) | DUI: 1&5, <6/3&10, <12/>30, <3 (Vomit suppressed at BAC>0.20) | Hangover (upset stomach, fatigue, headache, thirst, depression,
anxiety) (BC Withdrawl, dehydration, gastric irritation, low blood suger, accumulate acetaldehyde) | Chronic toxicity (Brain tissue loss, cognitive impairment, heart+liver disease)
Fetal Alcohol syndrome (FAS): facial+developmental abnormalities bc mother alcohol use)(BAC+duration of exposure)(0.2-1.5/1000)(Growth retardation + Pattern of abnormal features on face and head, CNS
abnormality)(development abnormalities: 80~n00/1000)(+ risk spontaneous abortion) | Serious abstinence (1/7 morality) (1: tremor, rapid heartbeat, hypertension, heavy sweating, lose apeetite, insomnia, 2:
hallucination, 3: delusions, disorientation, delirium, 4: seizure)(detox in inpatient medical setting)(BZ treat)(reduce 1)(slow onset)
L4: Opiates vs opioids: Chem compounds/natural plant matter (Opium, morphine, codeine) vs Synthetic drugs w/opium-like effects (oxycodone, methadone, fentanyl) or drugs derived/opium (opiates)
Opium: Juice/poppy p. (Relive pain+Pleasure +Relief/anxiey)(Shallow cut unripe seedpods, resinous substance)(M+C: rom raw O., Heroin from M) | Egypt 1500BC, Greece, Arabic (social), Europe (16 th
laudanum: has O), India+China(16th) traded O and poppy w/Arab, US: China labor (1850-65) | 1729 Outlawed, 1796 Edict, BEAC: legal India, not China | M (1806): Natural, Primary active agent O, spread as
1853: hypodermic syringe intravenal delivery, US Civil war relief from pain+dysentery soldier’s disease(dependence) | H(1874): Synthetic, Diacetyl morphine, 3x potent, faster action (2 add. Groups) |
C(1832):Natural, f/poppy head, 2nd active ingred.in O, antitussive | Dextromethorphan: Opiod analogue, more selective as antitussive, high dose hallucinate (simpler struct.) | Opioid action: Opioid receptor
activated, same group/receptors controlled/ endo. Substance (enkephalins & endorphins), ↑ dopamine release, block pain transmission/ spinal cord or brain stem (morphine pain reliever+analgesic standard) |
Effects: Analgesia/nausea+ vomit/pinpoint pupils/breathe depressed/constipation/reduced libido dependence: oral via med.+smoking+inject (% addicted: 1% pop, early 20th: ethnic limit+social accepted+mid-life
vice)(mid age-class white women, patent med.) | 1914 Harrison Act: Tax Law (Treasury) produce, import, manufacture, compound, deal in, dispense, give away opium+derivatives pay tax (hard obtain): ↓oral, ↑
injection, cost+risk ↑, addicts=criminals | WWII: usage ↑ low income areas| 60-70s: Minority pop.| Rockefeller Drug laws NY | Heroin production: Poppies in Mexico+Colombia SEA & GT Afghanistan,
Russia consume 20% via Balkan Route (Purity ↑: 5 20-40%)(Most in SG) |
Prescription Opioids: Oxycodone, Hydrocodone (2012: 2% US >12 use oral+injection)(3 rd ER visit, 1st Death, combined w/Alcohol) | Cross tolerance among opioids | Dependence: Phy Dep. Accompanies
tolerance (Cross dependence prevented by opioid agonist methadone (also Psy)(Rewarding feeling+ +ve reinf.) | Opioid withdrawl: H or M vs Methadone (less signs, longer hrs) | Toxicity potential: Acute:
depress respiratory centres (coma, dr, pinpoint pupils), stim. Brain (nausea+vomiting), less active and alert, no chronic | +ve: Pain relief, intestinal disorders, cough suppressants | Methadone: narcotic addicts,
oral relieve 24 hrs, psy+phy dep. (ex. Subutex/buprenorphine) |
Hallucinogens: Alter sensory processing in brain, pcpt disturbances, change thought process, depersonalization: T1: Phantastica (aware of reality+rmb later: LSD, Mescaline, Ecstasy) | LSD | Pure no color
odor taste (acoustic to optical): change pcpt., synesthesia (mixing senses), enhanced emotions, no repeat, 1/most potent psychoactive drugs (lethal x400 effective), oral, act on serotonin receptors, rapid tolerance
(3-4 days)(quick recovery)(cross tol.)(no phy. Dependence) | Psilocybin: in mushrooms (0.2/5%) (1958, Hoffman) (Acute: dose-dependence change mood, pcpt., thought, pleasurable, anxiety higher
dose)(Chronic no) | Mescaline (peyote, >30 compounds)(1918) | Aptm Derivatives: synthetic hallucinogens (MDMA-ecstasy)(Theraputic aid)(+heart rate+blood p, euphoria, sociability, closeness)(destruction of
serotonin neurons in animals) | T2 Deliriants (ment. Confuse +lose touch/reality: PCP & Ketamine) | PCP: Pencyclidine (anesthetic/animals, unpredictable psy. Anesthetic for humans) (sprinked onto herbs
as marijuana: “angel dust”)( ↓$ +easy: common cause to ER)(Alter neurotransmitter) | Ketamine: depressant and dissociative effects
L5: Marijuana and Tobacco: CB: Most used, cult., traf. Species: Sativa(fibers Hemp rope)/Indica(psychoactive resins)/Ruderalis(Russia) | Preparations: delta-9-tetrahydrocannabinol (THC)(1964): Pri.
Psychoactive agen, conc. In resin (most in flowering tops >leaves>stalks) | Hashish: Most potent, pure resin/ leaf & stem surface (20%THC) (Rare) | Sinsemilla: 2nd m.p., dried flowering tops/female plants (11%
THC)(50% conf. samples) |
Marijuana: smoked, leafy material (3-6%) | 2737 BC Shen Nung, 1000AD Muslim+N.Af. 1926 link to c & v, 1936 US laws | 1914 Harrison Act(grow, dist., sell, buy), 1937 M. Tax Act (possess+use illegal), ↓
c&v, cost ↑, use ↑ from 50s, peaked @70s, >400 chem.,70 cannabinoids | THC most pharm. Active cannabinoid(Smoking: absorb/blood brain body, mood-alter+cardiovas. Effect 5-10min peak) (Oral: Slow
ab.,90 min peak)(Red eyes, dry mouth+throat) | Oral abuse potential modest | related eff. distinguished | Social factor || Effect: Subj.: Euphoria, high, hunger, stimulation, infreq intense, high conc.
Paranoia)(Calorie ↑)(↓verbal ex.) | Infreq. Disrupt cognitive perf. (↓cog. Processing, short-term mem., inhibitory control, sustained concentration/vigilance) | Freq. less dramatic: ↓cog. Processing, may tolerant |
Chronic: uncertain, abstain>1 month, regular use few effects on cognition | Med. uses (pre-1937 x)(1970-) glaucoma, cancer treatment, epilepsy, neuropathic pain), 1999 Institute of medicine: Failure of current
approve medications, symptoms relieved by rapid onset, treatment under supervision | Legalization: 29 states+Guam+Puerto Rico, Colombia (1st Colorado)(FDA not approve it as safe and effective drug) |
Tolerance: (high lv use) | Withdrawl syndrome (<24hr)(2 mental symptoms (irritability, restless, anxiety, depress, aggressive, lose appetite, sleep disturbance)+>1 physical symptom (pain, shiver, sweat, ↑body
temp,, chills) | Potential: Actue physio. Effects: ↑heart rate, no overdose, Chronic lung exposure (carcinogen in tobacco, x evidence lung cancer), Reproductive (↓testosterone men), Anxiety (fear of loss of
control), Marijuana madness(↑psychotic symptoms/episode) | Usage disorders: Defined in Diagnostic & Stat. manual of mental disorders (DSM-5)(distinguishes btwn harmful and dependent use of cannabis) ,
International stat. classification of diseases and related health problems (ICD-10)(classified by health impairments into mild, moderate, and severe)(Withdrawl)
Tobacco: Native Americans (Columbus 1492)(Tabaco: Spanish)(tabbaq medicinal herbs)(Nicot propose, 1828 isolate, 1890s dropped from Pharmacopoeia)(fresh leaves)(cured (remove moisture+chlorophyll
and fermented)(Smooth, rich flavors in the cigar) | 2 species: tobacum(large leaf, SA)/rustica (W.Indies+E.North Am.) | Cigars (1920) | Cigarettes (most popular) |2Cs compare: Wrapper, Time, Nicotine content,
filters, inhaled (also snuff/chew) | 1604 King James, 1908 NY Illegal, 30s Smoking & Cancer, 1964 US Surgeon General (Lung cancer), 1965 Warning labels, 1971 Ban ads, 1990 banned buses and flights, 1995
further regulation | Council for Tobacco Research & mkt filter cigarettes | Current use: M 25%, F 20% | HS/UG/Non-C/C: 28/11/19/5 || SG: Adult(22.5/4.3), Child(11.7,5.9) | Filtered: low nicotine & tar (brown
mat. On filter)(1975: 87.7%)(nico. Intake x ↓/lung cancer x↓) | Smokeless t. (moist sniff, nicotine absorbed through membrane)(↓$, social accept) | Health: ↑Dental+oral disease, carcinogen, dependence |
Hookah: Water pipe, arab, milder, h2o filtered tb smoke | Eff.:Lung cancer, cardiovascular disease, chronic obstructive lung disease | Risk ↑: Start young, many cigarettes, continue for long | (Kill 8M, 2020)(SG:
2500smokers+250 non)(Lung 2nd frequent) | 2nd hand: smoke inhaled from environment (Mainstream(exhaled/smoker)+Sidestream(ash))(Lung C.+Cardiovascular d.))(1993: EPA-carcinogen) | ↑risk/Miscarriage,
low birth weight, SIDS + Physio & cog. (neurological prob.+reading+math) | Mech: mimics acetylcholine, release adrenaline | Symptoms: Low level (nausea, dizziness, weakness), actue(tremors, convulsions,
paral./breathing mus.) | Physio. CNS&circ.sys. (↑heart rate, bp, shortness breath, tendency to clot) | ↓hunger (inh. Hunger contraction, deadening taste buds) | Behavior (Pri. Reinforcing sub. In tobaccopsychological dep.)(mild stimulant+relaxation effect) | Nicotine dep.: (US Surgeon Gen. R) tobacco addicting | nicotine causes | similar process | (2015) 8.9 Billion marketing, prevention inad. | Stop:
Replacement therapy (delivery w/o tar or CO, gum, patches, nasal spray, inhalers) (Pharma. Therapy, bupropion) | SG: Tobacco (CoAS) act (↓smoking prevalence)(rest. Access, inform public via labels, ban ad) |
Tobacco (Control of Advertisements & Sales)(Licensing of Importers, Wholesalers and Retailers) Regulations 2010 (sold with license and renew)(x loose stick)(<18)| Licensee’s Obligations: (x ad)(x free
gift)(>20 sticks)(notice/prohibition)(x imitation prod.)(warnings) | 2015 National Campaign support | Min age 21 | 1 Feb 2018 x Imitation T.Products ($2000 fine)(importation, sales, distribution illegal)
L6 Dev & Drug ↑HDI ↑D Use (xAmphe., cannabis, cocaine, ecstacy, opiates), margin.+unemp. | UNODC: Social D.(女幼(C:T.16.2, end abuse, exploit, traffick & violence against)(Y:T.4.1, 2030 ↑ no./youth
+adults w/relevant skills, tech+voca., employ+job+entre.))Economic D.(T1: End all forms /poverty, Thai+Andean)Enviro. Sus.(Coca deforest, T.15.2, 2020 sustainable man. Of forests halt deforest, restore
degraded, ↑ deforest & afforest ) Peaceful+Inclusive & Just Soc. (PJI)(16.1: ↓ all forms/violence & death rates )(Cocaine route/illicit crop prod.)(Excess imprison x eff. ↓ recidivism)(Evi-based T.+care service)
Partnership(14: Narcotics C.+else: 180000M) | Policies: Dev+Counter D Prob work in symbiosis, policy sensitive to Gender+EcoFriend.+Sci evi.+Overcome Stig+NOLB+prevent U+C, treat @ prison | SG:
15(3343,1309), 16 (3285, 1348) | 16: 41% abuser arrested<30 , ~2/3 new abusers <30 | Legal drug small problem, Goal: ↓abuse+harm x prevent all use | PH Model: Pri(x tried)+Sec(experimented)+Ter(through
treat.) | Continuum: Univ.+Selective (high risk group)+Indicated(ind. w/signs of prob) | Prevention: Knowledge-Attitudes-Behavior (Present+Scare+Info, ↑know↓atti.+Behav.)+Affect-ed(Emo+At.)(x fund. Skills
to resist PeerP) (DF School+Refusal S.)(Banned SG: Retail(mall/complex+shop+market)+School+Libraries) +Social influence (RefusalS+↓PeerP+Leaders+Public Comm.+Counter ads)(26/6 WDD) | Treat:
Behav/psychosocial (Motiv. Enhance. Therapy) (Contingency Man.)(Cog-beh. Therapy) & Pharmacotherapy | Goals (Absti+Controlled use) | MET: Shift f/denial, motive change. Mot.al interviewing (nonconfront) (Stage: Pre-contemplation, contemp., prep., action, maintain.) | CM: Receive reward/xdrug urine | CBT: Cognitive therapy+behav. S. training (identify+change relapse behaviors) | P: drug x cure
chronic, relapsing, behavioral disorder | Detox. (medic alleviate withdrawal symp.) + maintenance (x relapse) | Maintenance therapy: Agonist (cross-tol.), Antagonist(x reinforce), Punishment (prod. aversive
reaction) | Alcohol: D(Benzodiazepines)( ↓tremors, heart, seizure), M(Disulfiram(P)(inh. Aldehyde dehydrogenase), acamprosate(antag)(normalize basal GABA(inh. Nrtmt. Concen.) | Nicotine: (patch, gum,
vapor, spray), Bupropion (Zyban)(xN) | Opioids: “rapid detox”(anesthetized+O. antag.-->imm. Withdraw) (Risk+aftercare) (OD), detox (Methadone(agon), buprenorphine (Subutex)(Agon), main (Methadone) |
Cocaine (↑dopamine, x use) | Cannabis(irri., amxiety, aches, sleep dis.)(x) | Treatment Effective (7:1 B:C)
L7 Poisons (GHS: Global harmonized sys./classification & labelling of chem.)(Cause harm (ill,injury, death) org.)(LD50: dose kill 50% test pop)(ED50: Theraputic Eff.) | Use: Kill+Medic+Cos. |
Arsenic (AS): Trace El.+x odor, xt aste, arsenic sulfur com. CP, Mary Ann Cotton(16)(1873)(Cu+Acid(H) Dark Grey, HgBr Paper Yellow-brown st.)(As. Act and Pharm. Act 1868) | Ancient:
Syphilis+Arthritis (Albertus Magnus 1250)(Vic. Era: complexion ↑)(Thomas Fowler: F Sol., As+K.Bicarbonate)(Leukemia, hodgkin’s disease, eczema, asthma)(Erlich: Salvarsan: Syphilis & Trypanosomiasis)|
Source: Well H20(US,SA,TW), ground H20(BG), fish+shelf. | Med Use: AsO3 anti-cancer (Acute Promyelocytic leukemia (APL) x 1st line therapy or recurrent) (Carcinogen & Chemotherapeutic) |
Mech: Carcinogenesis by interact/Reactive Oxygen Species (ROS) & alter cell signal pathway DNA Damage | Acute: chloera-like gastrointestinal (GI) Sym. (vomit(w/b), diarrhea(rice-watery, w/b), dehyd.,
shock) Chornic: (Insidious, manifest as classical dermatitis), nails whitish lines |
Organophosphate (OP) nerve agents (Chem war) (Potent anti-cholinesterase nerve agents: G-series, tabun(GA), sarin(GB), soman(GD), cyclosarin(GD), VX (GA cyanide, GB,D,F: Fluoride), VX sulfur sub.) |
Debilitating effects | G-agents visc. Liquids,.vary volatilies (x smell, lethal) | Mech: accumulate acetylcholine (Ach) @neuromuscular junction (Ach=Ch+acetyl CoA, Ach broken down by acetylcholinesterase in
synaptic cleft, choline transported back to axon terminal)(x reactive enzyme as aging)(GD mins, VX days) | Acute: Excess Salivary, eye & intestinal secretions. Sweat, twitch, weak, convulse, x consciousness,
↓respiratory.drive | Antidote: depend on agent/route/extent (severe only)(Anti-cholinergics (Atropine), Benzodiazepams (x seizure) |
Mustards: Sulfur (Chem. Vesicant)(skin+eye damage)(liquid)(oily, low water sol.)(garlic odor)(WWI+ME+ Full protect.+ Vapour in skin, eyes, lungs) ) (Acute: Skin, res. Tract, eyes
nausea, vomit,
fever)(Chronic: Mutagenic+Carcinogenic(Lung Cancer)) | Nitrogen (Therapeutics (Cyclophosphamide – anti-cancer ag.)(Vesicant, liquid+oily+WWII warfare agent))(Toxicity: Skin blistering, Respirat. Tract
injury, Eye Damage, Mutagenic, Skin cancer following therapeutic application/skin diseases)(xantidote) | Action: DNA Strand breaks+ x normal DNA replicate |
Thalidomide (non-barbituate)(S-Isomer: Teratogenic (fetal malform)(In: dotted) vs R-Isomer (Out: Filled) (Hypnotic+ Sedative)) | 5-7K/10K Phocomelia (limb malform), ½ death (heart/urinary tract deform,
blind/deaf) | Teratogenicity: Oxidative stress, x DNA replicate, inhibit new blood vessel (Angiogenesis) | Frances Kelsey: 62 Gold Medal Award/ Distinguished Civilian Service, concern peripheral neuropathy,
pregnancy | Interconvertible: require systematic testing/dev. Toxicity | Abortion: South Aus. 1960s, SG Abortion Act 29/12/1969, 20/3/1970 (terminate by medic. Practitioner @ request w/ written consent)
Insulin: Pancrea (1921 discover), Control Glucose level+Prod., store as Glycogen | Diabetes: T1 Pancrea x insulin, T2 Insulin Resistance, Gestational Preg | <70 deaths, hypoglycemic shock of phy.+nurse,
elder/child | Beverly Gail Allitt (4 Children)(59 Days)(May 1993: 13 LifeS)(Munchausen’s Syndrome by proxy)(MSBY) | Sport: ↑Performance (Bodybuild: + anabolic steroids ↑ musc. Mass) (Run: ↑Glycogen
fuel) via hyperinsulinaemic clamp (insulin+glucose simultaneously taken)(x detect fatal comma)(Banned 1998 IOC)
L8 Poisons: Strychnine: alkaloid (comp. w/N) in plants genus Strychnos, bitter, (196 species), As+Am+Af, seeds+bark, white and odorless, stable | 1946 (Robert Robertson determine)(47), 1954 (Woodward
synthesize)(65) | Kill vertebrates, ↑appetite & endurance, restorative(↓dose) | Mech: S=Neurotoxin, antagonist of glycine @ gly.receptor, prevent inhib. Effect of gly. On postsynaptic neuron. No inh. Sig easy
activate neuron & victim spastic mus. Contract, death/asphyxiation (WADA x), absorbed GI tract, mucous mem, oral c., metab. Liver | ↑ Deg. Acute (oral+ocular): Agitation, restless, mus. Spasm, arching
back+neck, rigid arms, tight jaw, diff. breath, convulse | Killed Li Yu (Nux Vomica) | Treat: x Spec., (Oral) activated charcoal infusion, gastric lavage/tannic acid & KMnO4, Benzodiazepine limit seizure
UN Numbers & Shipping names (acc. To hazard class + composition) (SName: idtfy dang. art./subs.) Cat A: UN2814 (Inf. sub affecting ppl/ppl+anm)(Exp: permanent disability, life-threaten/fatal disease),
UN2900 (anm), Cat B: UN3373 (Bio substance/diagnostic or investigative Purposes)(Virus culture/pathology specimins) | Inf. Sub: Contain pathogens: micro-org diseases
Ricin toxin-biohazard (An. Egypt: oil lube, beans constipation) (Cat B bioterrorism agent): castor beans mash after oil ex., Ehrlich: Response to challenge produce antibodies (1908)(est. immunology) | Georgi
Markov 78 & Bill Frist 03 (Greenville, SC mail-sorting) | Toxicity: Inhib. Protein synthesis, LD50: 22microg per KG weight (inject/inhale)(2milig kill), oral x toxic(stomach deact.), Hours/Days(Ingestion: pain,
inflammation, bleeding in GI mucous mem.)(inhale: cough+fever)(skin/inhale: develop allergy: lip+eye swell, asthma, sore throat, blister) | Antidote: Vacc (Rivax:$24.7M) (US N.Instit. of Allergy & Infec.
D)(Emergent Biosolutions & Soligenix)
Anthrax: Infectious caused by Bacillus anthracis (rod-shaped), can fatal as anthrax exotoxin (name: black eschar lesion)(Wool-sorters D) | Cycle: Spores in anm (germ/shell) contact/farm anm | 1752 Clin.
Descript of Cutaneous anthrax 1877 Robert Koch (Koch Postulates: 1 Found abund in all org. suffering from disease, absent in normal 2 isolated and cultured 3 cause disease healthy 4 Iso+inoculate from host
and=original)(Est. causative rlts btwn micorg & dis.) 1881 Louis Pasteur Vac 1937 Anm Vac=human 1944 Penicillin 1950s Human vac 1970s Released | Cat A Hazard: 1914 WWI, 32 Japan, 42 US GBR, 72
Treaty prohibit 79 USSR outbreak 01 USA attacked | Mech: Allow bac. Evade immune system, proliferate+kill host (Infection: Skin, inhale, GI, Inject) | Symptom: All types can spread+Kill (1D-2M):Cutaneous
(blister+itchy bumps, BEL), Inhale (Chest discom., short breath, cough), GI (nausea+vomit(w/b), abdomen swell), Inject(Swell, Abscesses) | Treat: Antibiotics, Antitoxin if spread, BioThrax vacc. (AVA)
Botulinum: botulism anaerobic, spore forming bac: Clostridium botulinum(CB)(soil), bacteria exotoxin produce chem. disease (Food, infant, wound) | Comprise a family/neurotoxic proteins produced by
discrete bacteria strains, LD50: 1.3ng/kg (most potent known substance) | Mech: paralysis (long term W/M) as block Ach release @ neuromuscular junc., die when aff. Breathe | Botulinum toxin (BTX):
neurotoxic pro. Prod. By CB (Med. 1989+Cos+RS) (Type A: Botox, FDA 2002, cosmetic (x wrinkles, ↑30%(2002)(24-72hr, 2-6 Months) + crossed eyes/blepharospasm)(Type B:Myobloc, cervical dystonia) |
Safety of Botox: 16 Deaths from both(black box warning(prescript. D label call attn to risks): poten. Spread from inject to whole body and risk serious diff.(swallow/breathe) (principally safe) |
SG Legislation: Poisons Act (1939 Gazetted) (General prohibition wrt import and sales/poisons: x person shall w/o license f/licensing officer import, possess, sale/sell, offer poison) | Mortality from unintentional
poisoning: 1.5/100K, Af. ↑ | SG General Hospital: Drug& P Info Center