Chapter 3:

The Effects of Drugs Part I

Stimulants, Depressants, and Opioids

Introduction

• “Behavioral toxicity”
• the ability of of a drug to cause harm to society.
• Assessed by considering the common result of a “typical” dose in a recreational context and the associated risk to the individual and society.
• Classified by their primary effects on the CNS
• Stimulants: Increase alertness and energy
• Depressants: Slow CNS activity and can induce sleep
• Opioids: Provide pain relief and sedation

Toxicity

• Acute toxicity: problems that come on immediately or very quickly ie drug overdose.
• Chronic toxicity: effects that result from long-term exposure to the drug ie emphysema associated with smoking, cirrhosis caused by alcohol consumption (Hart & Ksir, 2018).

Tolerance and Withdrawal

Figure 3.1 Tolerance and Withdrawal in Response to Alcohol Consumption

Moving Marijuana

• Moving from schedule I to III in Dec 2025
• Rescheduling on the way not complete
• Moving to Schedule III would mean federal recognition of some medical use and lower potential classification than Schedule I.�
• It could enable tax relief for cannabis businesses (by easing IRC §280E limitations) and broaden research opportunities.�
• But rescheduling would not automatically legalize marijuana nationwide or eliminate federal criminal penalties tied to quantities, nor would it require states to change their own laws.

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Key Terms

• Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance, and the degree to which the substance will be used in the face of evidence that it causes harm.
• Withdrawal: Presence and severity of characteristic withdrawal symptoms.
• Tolerance: How much of the substance is needed to satisfy increasing cravings for it and the level of stable need that is eventually reached.
• Reinforcement: A measure of the substance’s ability, in human and animal tests, to get users to take it again and again and in preference to other substances.
• Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.

Stimulants

• Caffeine
• Energy Drinks
• Tobacco
• Cocaine
• Amphetamines
• Adderall
• Bath Salts
• Ecstasy

Cocaineistockphoto.com/nensuria

Tobacco

• History & Usage: Used for centuries; significant cultural and historical impact
• Active Ingredient: Nicotine
• Effects: Stimulating effects; some evidence of cognitive benefits
• Risks: Major cause of preventable deaths; contains thousands of chemicals
• Controversies: Mixed research on potential benefits (e.g., reduced risk of Parkinson’s)

Tobacco Use: Scope of the Problem

• Tobacco use is the leading preventable cause of disease and premature death in the United States.
• 480,000 deaths annually in United States
• Tobacco is the single largest cause of preventable death.

Government Regulation

• 1964: The Advisory Committee to the U.S. Surgeon General reported that cigarette smoking is related to lung cancer.
• 1970: warnings on cigarette labels.

Slide: courtesy of Jackie Blyleven, MPH, CHES

Master Settlement Agreement 1998

• Agreement reached between 47 states and 5 major tobacco companies paid $200 billion and…
• Restricting tobacco advertising, marketing, and promotions, including:
• Prohibiting tobacco companies from taking any action to target youth in the advertising, promotion or marketing of tobacco products.
• Banning the use of cartoons in advertising, promotions, packaging, or labeling of tobacco products.
• Prohibiting tobacco companies from distributing merchandise bearing the brand name of tobacco products.
• Banning payments to promote tobacco products in media, such as movies, televisions shows, theater, music, and video games.
• Prohibiting tobacco brand name sponsorship of events with a significant youth audience or team sports.

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Cartoon Ads

Advertising

Tobacco commercials

E-Cigarette advertising

E-cig ads

TikTok and E-cigs

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https://photos.app.goo.gl/JSBvAGXTCoXK3nM46

https://photos.app.goo.gl/rj3j9b6vJ3nAPUWWA

https://photos.app.goo.gl/KNeUoAAiBkVWbwe49

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https://photos.app.goo.gl/esNynM48irAaKuee6

https://photos.app.goo.gl/1sBvCZf5W2FA48rC6

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https://www.statnews.com/2025/05/28/iqos-philip-morris-heated-tobacco-product-american-rollout-viewed-skeptically-anti-smoking-groups/

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Family Smoking Prevention and Tobacco Control Act 2009

• Gave FDA authority to regulate the manufacture, distribution, and marketing of tobacco products to youth:
• Required disclosure of ingredients in tobacco products and smokeless tobacco product warning labels.
• Ensured that “modified risk” claims are supported by scientific evidence.
• Banned sales to minors, vending-machine sales (except in some facilities that are available to adults only), and the sale of packages of fewer than 20 cigarettes.
• Banned tobacco-brand sponsorships of sports and entertainment events or other social or cultural events, as well as free giveaways of sample cigarettes and brand-name nontobacco promotional items (FDA, 2019a).

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Benefits of Cessation (1 of 3)

Cocaine

• Origin: Derived from coca leaves; used by indigenous peoples for millennia
• Chemical Form: Cocaine hydrochloride; modification leads to crack cocaine
• Effects: Euphoria, increased alertness, elevated heart rate, appetite suppression
• Administration Routes: Snorting, IV injection, Smoking (for crack)
• Risks: High psychological addiction; 'dysphoric crash' following use
• Combined with alcohol → formation of cocaethylene (increases risk of sudden death)

The “INTELLECTUAL BEVERAGE” and “TEMPERANCE DRINK” contains the valuable TONIC and NERVE STIMULANT properties of the Coca plant and Cola (or Kola) nuts, and makes not only a delicious, exhilarating, refreshing and invigorating Beverage but a valuable Brain Tonic, and a cure for all nervous afflictions—SICK HEADACHE, NEURALGIA, HYSTERIA, MELANCHOLY, &c. (as cited in Ray & Ksir, 2004, p. 338, as original)

Cocaine Administration

• Form of administration is important in determining intensity of cocaine’s effects, its abuse liability, and likelihood of toxicity.
• Reaches brain:
• Orally: chewing of the coca leaf 10-30 minutes
• Inhaled: into the nasal passages (“snorting”) 1-3 min
• Injected: intravenously 15-30 sec
• Smoked: freebasing, crack; crack babies 10 sec

“Crack”

“Crack is made by dissolving cocaine hydrochloride in water and adding baking soda to make a solution that is then boiled or put in a microwave and finally cooled, often in ice or a freezer. The result is a yellowish-white substance that looks like soap, and small chunks (often called “rocks”) are broken off and smoked, making “cracking” sounds when burned—hence the name “crack” (Gahlinger, 2001).”

Your Brain on Crack

Amphetamines

• Overview: Synthetic stimulants derived from adrenaline/ephedrine
• Examples: Benzedrine, Dexedrine, Methamphetamine
• Effects: Increased energy, alertness, appetite suppression
• Medical Applications: Treatment for ADHD and narcolepsy
• Risks: High potential for abuse and 'runs' or binges

Prescription Stimulants (ADD Drugs)

• Common Medications: Adderall (amphetamine mixture), Ritalin (methylphenidate)
• Intended Use: Treatment of ADHD to improve concentration and impulse control
• Similarities to Other Stimulants: Effects comparable to cocaine/methamphetamine when misused
• Abuse & Misuse: Widespread among adolescents and college students

Trends in Decline

Ecstasy (MDMA)

• History: Developed early in the 20th century; experimented with for medical/military use
• Effects: Euphoria, enhanced empathy, emotional openness
• Mechanism: Increases serotonin, dopamine, and adrenaline
• Risks: Overdose risk (hyperthermia), adulterated pills, 'crash' effects

Overview of Depressants

• Definition: Substances that reduce CNS activity and can induce sedation
• Main Categories: Alcohol, Barbiturates, Benzodiazepines, GHB, Inhalants
• General Risks: Respiratory depression, overdose, dangerous withdrawal symptoms

Alcohol

• Historical Context: Used since ancient times; integral to many cultural practices
• Effects: Reduces inhibitions, alters judgment, can enhance sociability
• Acute & Chronic Risks: Overdose (respiratory depression, asphyxiation on vomit)
• Long-term: liver disease, cardiovascular problems, brain damage

Benzodiazepines

• Development: Introduced as safer alternatives to barbiturates.
• Examples: Valium, Xanax, Rohypnol
• Effects: Sedation, reduced anxiety, muscle relaxation
• Risks: Dependence and withdrawal symptoms; potential misuse

Gamma-Hydroxybutyric Acid (GHB)

• Overview: Initially synthesized as an anesthetic; later used as a recreational depressant
• Effects: Euphoria, sedation, reduced inhibitions
• Risks: Very narrow safety margin; high overdose risk

Inhalants

• Categories: Solvents, Aerosols, Gases, Nitrites
• Effects: Quick onset of euphoria, dizziness, impaired coordination
• Risks: Acute toxicity; risk of sudden death, especially with solvents/gases

Overview of Opioids

• Definition: Drugs that bind to opioid receptors to produce analgesia and euphoria
• Categories: Natural opiates, Semi-synthetic opioids, Synthetic opioids
• Uses: Pain management, anesthesia
• Risks: High addiction potential, narrow therapeutic index, overdose risks

Opium and Morphine: History & Use

• Opium: Used for millennia in various cultures; found in poppy seedpods
• Morphine: Isolated from opium; became a primary pain reliever
• Historical Impact: Widely used in wartime

Heroin and Derivatives

• Heroin: Semi-synthetic opioid derived from morphine
• Pharmacology: Increased lipid solubility → rapid brain entry and potent effects
• Usage & Risks: High addiction potential, rapid tolerance, and risk of overdose

Fentanyl and Synthetic Opioids

• Fentanyl: Synthetic opioid 30–100 times more potent than heroin
• Medical Use: Administered via injection, patches, or lozenges
• Risks: Extremely high overdose risk

Nonopioid Analgesics

• • Examples: Aspirin, Acetaminophen, NSAIDs
• • Characteristics: Provide pain relief without significant psychoactive effects
• • Risks: Overdose can cause liver damage, gastrointestinal problems