basic pharmacology of commonly misused prescription...
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BasicPharmacologyofCommonlyMisusedPrescriptionDrugs
LaneWallace,PhD
Who We Are
Vision
To contribute to student success nationally by achieving a measurable reduction in alcohol and
drug misuse on America’s campuses and promoting recovery efforts.
MissionThe mission of the Higher Education Center for Alcohol and
Drug Misuse Prevention and Recovery, in partnership with the nation’s colleges and universities, is to:
• Promote student success nationally by providing data-driven solutions to alcohol and drug misuse
• Lead the dialogue on collegiate alcohol and drug misuse and recovery in the national agenda
• Ensure the long-term sustainability and effectiveness of the Center’s efforts
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Lane Wallace received his PhD in Pharmacology from the University of Utah. Dr. Wallace is now a Professor and former Chair of Pharmacology at The Ohio State University. He specializes in neuropharmacology, mechanisms of action for addicting drugs, computational neurobiology of dopamine signaling and neurodegenerative diseases.
Prescription Drugs
Physician visit – Prescription
FDA approval for a specific use
Quality control
Some, manageable, risk
Misusetaken for purpose other than that for which prescription written
taken by person other than for whom the prescription written
Potential Dangers of Misuse“overdose” problems
emergency room visitsdeath
addiction liability
“Generation Rx” culture
Addictioncompulsion to use drugs
loss of control over amount of drug use
continuing use in spite of adverse consequences
Generation Rxexcessive reliance on pharmaceuticals
Polling Question:Do you feel that students frequently misuse
prescription drugs in any of these ways?
A. Taking a drug for a purpose other than that for which the prescription was written
B. Giving one of their prescription medications to someone else
C. Taking a drug prescribed for someone elseD. All of the above
PharmacologyThe interaction of chemicals (drugs) with living biological systems
Receptorchemical with which a drug primarily interacts to produce pharmacological effects
often a proteinoften the target for a hormone or neurotransmitter molecule
Agonist
“runner’s high”
“high”
enkephalin + mu-opioid receptor
morphine + mu-opioid receptor
Antagonist
nothing
naloxone + mu-opioid receptor
Enkephalin + naloxone + mu-opioid receptor
nothing
Drug Classes (Families)
set of drugs with similar effectsall have similar effect on same target can substitute in therapymay differ in
duration of actionamount of drug needed to produce an effect
Polling Question:
Which of these drug classes are prone to misuse?
A. Opioid pain medications (e.g., OxyContin, Vicodin)
B. Stimulants (e.g., Adderall, Ritalin)C. Sedatives (e.g., Xanax, Valium)D. All of the above
DoseDose is the amount of drug a person takes.
The spectrum of effects experienced by a person is a function of the dose of drug.
The intensity of a particular effect experienced by a person is a function of the dose of drug.
Building Temperature
PainHomeostatic system
lessens injuryhelps learn behaviors to prevent injurycan be modulated to adapt to current conditions
Marked variability within individual over timebetween individuals
Physical Paindetectors in tissues
sensitivity is modifiable
first level integration in spinal cordcontrol reflexes
signals sent to brainintegration in brain
determines response
Mu-Opioid receptor is the target for opioid pain-relieving drugs
A Manglik et al, Nature 485:321, 2012
Mu-opioid receptors (targets for morphine) are located in several sites processing pain information
LS Stone and DC Molliver, Mol Interventions 9:234, 2009
Agonists at µ-Opioid Receptorshydrocodone
morphine
propoxyphene
oxycodone (Oxycontin)
tramadol
Opioids for Chronic Pain in USA320 million people in USA100 million with chronic pain
(includes headache, low back pain, cancer pain, arthritis pain, etc.)
5-8 million treated chronically with opioid drugs
~ 2% of total USA population
Prescriptions for opioids have increased over the last two
decades.
Polling Question:
Which of the following are reasons often given by students for first misuse of a
prescription drug?A. Self-medication for pain, anxiety, etc.B. CuriosityC. Seeking a mental feeling or stateD. All of the above
Misuse often characterized by
preference for higher doses of drug
preference for faster onset of drug effectinjectedsnortedsmoked
Oxycodone Extended Release Tablet
Time-release Capsules
~2% of people >12 years old (~5 million people) have mis-used opioids in the last month.
SAMSHA: Results from the 2013 National Survey on Drug Use and Health
Polling Question:
Where do students most frequently obtain prescription medications for misuse:
A. The InternetB. A drug dealerC. From multiple physiciansD. From family members or friends
Where do non-medical opioid users get their drugs?
SAMSHA: Results from the 2013 National Survey on Drug Use and Health
“Doctor Shopping”~ 2% of opioid prescriptions1 in every 143 patientsaverage of 32 opioid prescriptions per person per year from 10 different prescribers
McDonald and Carlson, PLoS One July 17, 2013
Approximately 1 million people in USA are dependent on or abuse pain relievers
SAMSHA: Results from the 2013 National Survey on Drug Use and Health
Death from Opioid OverdoseCombination of drugs
alcohol anti-anxiety/tranquilizers
Switch to more potent drugfail to account for different dose requirement
Stimulant Drugs
Stimulant DrugsEffects
elevation in mood, confidencelessen fatiguedecrease appetitelessen power of distractionsincrease heart rate and blood pressure
Used to treat ADHD
Dopamine transporter is target for stimulant drugs
Wikipedia
Dopamine Signalingcurrent situation is
unexpectedimportant
mobilizes brain for learning
Stimulant Drugs Affect Learning and Memory
Polling Question:
What do we know about the misuse of prescription stimulants among college students?
A. This behavior is on a downward trendB. Students who misuse these medications as
“study aids” typically have higher grade-point averages
C. Students often have inflated perceptions of the misuse of these substances by other students
D. All of the above
~0.5% of people >12 years old (~1.2 million people) have mis-used stimulants in the last month.
SAMSHA: Results from the 2013 National Survey on Drug Use and Health
Anti-anxiety Agentsbenzodiazepine family
alprazolam
clonazepam
diazepam
lorazepam
Depressant Effects as a Function of Dose
Anti-anxiety Agentsuses (all benzodiazepines)
treat anxiety
uses (some benzodiazepines)hypnosis (sleep aid)treat panic attackspre-operative sedationanesthetictreat epilepsymuscle relaxant
Anti-anxiety Agentsimpair short-term memory
sometimes adversesometimes beneficial
dependence / addiction
GABA receptor is target for
anti-anxiety drugs.
Wikipedia
~1% of people >12 years old (~2.5 million people) have mis-used anti-anxieties in the
last month.
SAMSHA: Results from the 2013 National Survey on Drug Use and Health
Factors Predisposing to Addiction
geneticsstresschildhood abusemental illness
depressionobsessive compulsivemanic depressant
motive for using drugs
Conclusions
Opioids, stimulants, anti-anxiety are commonly used therapeutic drugs
A small percent of medical users will develop addiction
A small percent of prescriptions are diverted
ConclusionsPeople misusing drugs often prefer
higher dosesfaster onset of action
Death from overdose often involvescombinations of drugsswitching to a more potent form
ConclusionsLiability for addiction
geneticsstressful life experiencesmotivation for using drugs
Questions?
Thank you!