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INTRODUCTION

Stimulants and hallucinogens have been used to induce euphoria and alter consciousness for centuries. Cocaine and marijuana are two of the most commonly used drugs today. Polydrug use involving concurrent use of several drugs with different pharmacologic effects is increasingly found. Sometimes one drug is used to enhance the effects of another, as with the combined use of cocaine and nicotine, or cocaine and heroin in methadone-maintained pts. Some forms of polydrug use, such as the combined use of IV heroin and cocaine, are especially dangerous and account for many hospital ER visits. Chronic drug use is associated with immune system dysfunction and increased vulnerability to infections, including risk for HIV infection. The concurrent use of cocaine and opiates (“speedball”) is frequently associated with needle sharing by people using drugs intravenously.

PSYCHOSTIMULANTS—PHARMACOKINETICS/PHARMACODYNAMICS, NEUROBIOLOGY, AND EPIDEMIOLOGY

Cocaine

  • A powerful stimulant drug made from the cocoa plant.

  • Local anaesthetic, vasoconstrictor, and stimulant properties.

  • A Schedule II drug, which means that it has high potential for abuse but can be administered by a physician for legitimate medical uses.

Cocaine salt is an acidic, water-soluble powder with a high melting point, used by snorting or sniffing intranasally or by dissolving it in water and injecting it intravenously. Freebase cocaine can be vaporized and inhaled, or crystallized and sold as crack or rock, which is also smoked or inhaled. Street dealers often dilute (or “cut”) cocaine with nonpsychoactive substances such as cornstarch, talcum powder, flour, or baking soda, or adulterate it to increase profits.

Smoked or inhaled cocaine reaches the brain quickly and produces a rapid and intense (yet transient) high, which enhances its addictive potential. Cocaine binds to the dopamine (DA) transporter and blocks DA reuptake, which increases synaptic levels of the monoamine neurotransmitters DA, norepinephrine (NE), and serotonin.

The National Survey on Drug Use and Health (NSDUH), in 2015 estimated that 1.9 million people (approximately 0.7% of the population) were current users of cocaine.

Methamphetamine

  • A stimulant drug usually used as a white, bitter-tasting powder or a pill.

  • Crystal methamphetamine can be inhaled/smoked, swallowed (pill), snorted, or injected after being dissolved in water or alcohol.

Methamphetamine has a similar structure to the DA, NE, serotonin, and vesicular monoamine transporters and reverses their endogenous function, resulting in release of monoamines from storage vesicles into the synapse.

Methamphetamine is more potent and more efficacious than amphetamine; pharmacokinetics and low cost often result in a chronic and continuous, high dose self-administered use pattern.

According to the NSDUH, approximately 897,000 people (0.3% of the population) aged ≥12 were current users of methamphetamine in 2015.

MDMA and Cathinones

  • MDMA (3,4-methylenedioxymethamphetamine) is an illegal drug that has stimulant and psychedelic effects.

  • Individuals experience increased physical and mental energy, ...

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