常見(jiàn)濫用藥物危害特性

常見(jiàn)濫用藥物危害特性

及案例介紹劉清輝醫(yī)師高雄市立凱旋醫(yī)院成癮防治科1成癮物質(zhì)的分類鴉片類(Opioids):海洛英(Heroin)、速賜康(Pentazocine)、配西汀(Demerol)安非他命及其相關(guān)化合物(Amphetamine):甲基安非他命(Methamphetamine)、快樂(lè)丸(MDMA)古柯鹼(Cocaine)大麻(Cannabis)幻覺(jué)劑(Hallucinogens):LSD(Lysergicacid)PCP(Phencyclidine):天使塵2成癮物質(zhì)的分類鎮(zhèn)靜、安眠或抗焦慮劑(Sedatives、Hypnotics、orAnxiolytics)吸入劑(Inhalants):強(qiáng)力膠(Glue)有機(jī)溶劑酒精(Alcohol)尼古丁(Nicotine):香菸咖啡因(Caffeine):咖啡、茶其他:Ketamine、GHB3「危害防制條例」之分級(jí)第一級(jí):海洛英(Heroin)、嗎啡(Morphine)、鴉片(Opium)、

古柯鹼(Cocaine)及其相類製品。第二級(jí):罌粟(OpiumPoppy)、古柯(Coca)、大麻(Cannabis)、MDMA、安非他命(Amphetamine)、配西汀(Demerol)、

潘他挫新(Pentazocine)及其相類製品。第三級(jí):西可巴比妥(Secobarbital)、異戊巴比妥(Amobarbital)、Ketamine、GHB、酣樂(lè)欣(Triazolam)、FM2(flunitrazepam)、可待因(Codeine)及其相類製品。第四級(jí):Allobarbital、Alprazolam4DiagnosesAssociatedwithClassofSubstancesDependenceAbuseIntoxicationWithdrawalIntoxicationDeliriumWithdrawalDeliriumDementiaAmnesticDisordersPsychoticDisordersMoodDisordersAnxietyDisordersSexualDysfunctionsSleepDisorders5藥物成癮的四個(gè)階段:第一階段:初嚐快感

常用藥物:酒、菸、大麻、強(qiáng)力膠一類。第二階段:感受快感的盪漾

常用藥物:加上大麻、大麻油,和安非他命、安眠藥之類。第三階段:迷上快感

常用藥物:加上古柯鹼、迷幻藥、鴉片。第四階段:服用藥物才感覺(jué)正常

常用藥物:加上海洛英。6酒精(一)歷史:幾萬(wàn)年前,人類已知發(fā)酵水果、穀類以製酒。西元800年,阿拉伯發(fā)明蒸餾製酒,’alcohol’乃源自阿拉伯字”alkuhl”,意為精髓(essence)。1849年之瑞典首先提出「酒癮」(alcoholism),之後被廣泛使用。在美國(guó),醫(yī)院自1840年代開(kāi)始治療酒癮患者,而19世紀(jì)後半,酒癮相關(guān)問(wèn)題成為醫(yī)學(xué)研究之主要課題。臺(tái)灣近年來(lái)酒癮有逐年昇高的趨勢(shì)。(二)藥理作用:中樞神經(jīng)抑制作用,及影響多種生理、代謝作用。7酒精(三)中毒過(guò)量:判斷力損害、言詞模糊、運(yùn)動(dòng)協(xié)調(diào)障礙、步態(tài)不穩(wěn)、眼球震顫、注意力或記憶力損害、木僵或昏迷。血中酒精濃度0.5%以上:影響呼吸和心跳,可能致命。(四)戒斷癥狀:失眠、焦慮、手抖、噁心或嘔吐、自主神經(jīng)系統(tǒng)活躍、激動(dòng)、幻覺(jué)或錯(cuò)覺(jué)、大發(fā)作癲癇。震顫性譫妄(DeliriumTremens):通常在戒斷後24-72小時(shí)發(fā)生,表現(xiàn)為意識(shí)不清、波動(dòng)性變化、激躁不安、自主神經(jīng)系統(tǒng)過(guò)度亢奮、高燒、幻覺(jué)(主要為視幻覺(jué))。假設(shè)不治療死亡率高達(dá)20%,死因常為併發(fā)高燒、感染、內(nèi)外科疾病和自主神經(jīng)系統(tǒng)亢奮過(guò)久,造成心臟循環(huán)衰竭而死亡。8酒精(五)酒癮相關(guān)疾病:精神科:酒精中毒、戒斷、病態(tài)性中毒、精神病、憂鬱癥、失憶、癡呆等。神經(jīng)科:魏尼基氏腦癥(Wernicke’ssyndrome),柯沙科夫精神病(Korsakaff’ssyndrome),周邊神經(jīng)病變、肌肉病變等。胃腸系統(tǒng):胃炎、酒精性肝炎、脂肪肝、肝硬化、急慢性胰臟炎、膽結(jié)石。血液系統(tǒng):貧血、血小板功能失常等。其他:如代謝問(wèn)題、意外傷害等。9鎮(zhèn)靜安眠劑(一)歷史:1962年Bayer發(fā)明bartituricacid,1903年barbital問(wèn)世,1903年至1960年代末期,巴比妥鹽類(barbituates)是最普遍的鎮(zhèn)靜安眠藥,1960年代Benzodiazepine崛起,因其具有較佳的平安性,迅速取代巴比妥鹽類的角色。在臺(tái)灣,民國(guó)68年之後,因速賜康被管制,此類藥物便逐漸流行氾濫。(二)使用途徑:口服、靜脈注射。(三)藥理作用:作用於GABAtypeA接受器。中樞神經(jīng)抑制作用。具鎮(zhèn)靜、安眠、抗焦慮、肌肉放鬆、抗痙攣等效果。10鎮(zhèn)靜安眠劑(四)中毒過(guò)量:判斷力損害、言詞模糊、運(yùn)動(dòng)協(xié)調(diào)障礙、步態(tài)不穩(wěn)、眼球震顫、注意力或記憶力損害、木僵或昏迷。(五)戒斷癥狀:失眠、焦慮、手抖、噁心或嘔吐、自主神經(jīng)系統(tǒng)活躍、激動(dòng)、幻覺(jué)或錯(cuò)覺(jué)、大發(fā)作癲癇。(六)併發(fā)癥:中毒或戒斷的併發(fā)癥可能導(dǎo)致死亡。精神神經(jīng)科:感覺(jué)、運(yùn)動(dòng)、認(rèn)知、情感、自我控制等方面的改變。其他內(nèi)外科併發(fā)癥或意外傷害。11Rohypnol(FM2)Rohypnol,atradenameforflunitrazepam,hasbeenofparticularconcernforthelastfewyearsbecauseofitsabuseindaterape.Itbelongstoaclassofdrugsknowsasbenzodiazepines.Whenmixedwithalcohol,Rohypnolcanincapacitatevictimsandpreventthemfromresistingsexualassault.Itcanproduce"anterogradeamnesia,"whichmeansindividualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrugs.Also,Rohypnolmaybelethalwhenmixedwithalcoholand/orotherdepressants.12RohypnolRohypnolisnotapprovedforuseintheUnitedStates,anditsimportationisbanned.IllicituseofRohypnolstartedappearingintheUnitedStatesintheearly1990s,whereitbecameknownas"rophies,""roofies,""roach,"and"rope."AbuseoftwoothersimilardrugsappearstobereplacingRohypnolabuseinMiami,Texas,andBoston.Theseareclonazepam,marketedintheU.S.asKlonopinandinMexicoasRivotril,andalprazolam(marketedasXanax).Rohypnol,however,continuestobeaproblemamongtreatmentadmissionsinTexas,particularlyamongyoungHispanicmalesalongtheMexicanborder.13Rohypnol

SlangorStreetNames:Roofies,Rophies,Roche,Forget-mePillRohypnol?(flunitrazepam)belongstotheclassofdrugsknownasbenzodiazepines(suchasValium?,Halcion?,Xanax?,andVersed?).ItisnotapprovedforprescriptionuseintheUnitedStates,althoughitisapprovedinEuropeandisusedinmorethan60countriesasatreatmentforinsomnia,asasedative,andasapresurgeryanesthetic.14RohypnolRohypnolistastelessandodorless,anditdissolveseasilyincarbonatedbeverages.ThesedativeandtoxiceffectsofRohypnolareaggravatedbyconcurrentuseofalcohol.Evenwithoutalcohol,adoseofRohypnolassmallas1mgcanimpairavictimfor8to12hours.Rohypnolisusuallytakenorally,althoughtherearereportsthatitcanbegroundupandsnorted.15RohypnolThedrugcancauseprofound"anterogradeamnesia";thatis,individualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrug.ThismaybewhyoneofthestreetnamesforRohypnolis"theforget-mepill"andithasbeenreportedlyusedinsexualassaults.OtheradverseeffectsassociatedwithRohypnolincludedecreasedbloodpressure,drowsiness,visualdisturbances,dizziness,confusion,gastrointestinaldisturbances,andurinaryretention.16鴉片類藥物(一)歷史：鴉片乃由罌粟植物未成熟之蒴果，以刀割痕取其流出之汁液而得，六千年前的蘇美人即記載罌粟為’快樂(lè)的植物’。滿清政府於1664年頒發(fā)吸菸處死的律令,故”菸民”將鴉片(煙)摻入香菸裡,以做為脫罪之用。後來(lái)變成以吸食鴉片為主,1840年”鴉片戰(zhàn)爭(zhēng)”戰(zhàn)敗後,對(duì)鴉片沒(méi)有任何管制。嗎啡是由德國(guó)人於1806年在鴉片內(nèi)提煉出主要的有效成份,以希臘神話裡夢(mèng)幻之神Morphius命名為Morphine。嗎啡在臨床上具有鎮(zhèn)痛、止咳、止瀉及催眠作用。海洛英乃由嗎啡加上雙乙醯合成,在1874年在德國(guó)首先合成,而由拜爾藥廠生產(chǎn)製造,其商品名乃由德語(yǔ)Heronisch而來(lái),意為”少量而有強(qiáng)效之奇妙藥品”。它的止痛效力為嗎啡的4-8倍,但毒性則為嗎啡的10倍。17鴉片類藥物(二)使用途徑：吸入、鼻吸、口服或注射。(三)藥理作用：鴉片、嗎啡、海洛英或合成的類似作用於中樞神經(jīng)的鴉片受器的化合物通稱為鴉片劑(Opiate)。具強(qiáng)烈的成癮性。(四)中毒過(guò)量：其特徵為意識(shí)障礙,針狀瞳孔、呼吸、心跳變慢、體溫及血壓下降(假設(shè)嚴(yán)重缺氧則可能瞳孔放大,反射消失,發(fā)紺)。死亡最常見(jiàn)原因是呼吸抑制。18鴉片類藥物(五)戒斷癥狀：愈短效的藥物,其戒斷癥狀及頂峰期越快出現(xiàn)。一般海洛英(heroin)約在戒斷後6小時(shí)開(kāi)始出現(xiàn)癥狀,48至72小時(shí)為頂峰期,7至10天後消失。戒斷6小時(shí)後：焦慮、失眠、哈欠、流汗、流鼻水、流淚,進(jìn)一步出現(xiàn)瞳孔放大,起雞皮疙瘩、發(fā)冷、噁心、肌肉疼痛。18-24小時(shí)後:加上呼吸、脈搏、血壓、體溫均上升、嘔吐。24-36小時(shí)後:加上腹瀉、脫水。19鴉片類藥物(六)併發(fā)癥：生理方面：因使用不潔或共用針頭而傳染到愛(ài)滋病、肝炎、肌肉血管病變或敗血癥等。心理社會(huì)方面：因成癮者以追逐藥物使用為生活的重心,無(wú)法過(guò)一般正常的生活,造持人格敗壞,家庭、人際關(guān)係的破壞,甚至為了籌措金錢而導(dǎo)致種種不法行為。

20安非他命(一)歷史：1887年合成，1931年上市(噴鼻劑，主治鼻塞)，1935年出現(xiàn)錠劑(主治嗜睡)，1935至1946年認(rèn)為安非他命有39種合法醫(yī)療用途，1960年末濫用大盛,1970年後因管制而減少。民國(guó)78年嚴(yán)格取締後臺(tái)灣開(kāi)始?xì)餅E，79年10月列為麻醉藥品管制。(二)使用途徑：蒸發(fā)吸入、與煙草混合抽吸、口服、鼻吸或注射。(三)作用機(jī)轉(zhuǎn)：增加多巴安、新腎上腺素釋放,並抑制回收。21安非他命(四)藥理作用：自覺(jué)疲勞消失,注意力、知覺(jué)變得敏銳,興奮、欣快感，心跳加速、瞳孔放大、食慾及睡眠下降、血壓上升。(五)中毒過(guò)量：多疑敏感、焦慮易怒、躁動(dòng)不安、妄想、幻覺(jué)、血壓上升、心跳加快、瞳孔放大、高燒、心律不整、出血性中風(fēng)、癲癇、心臟循環(huán)衰竭死亡。(六)戒斷癥狀：心情低落易怒、疲倦、焦慮、睡眠障礙(嗜睡)、食慾增加、激躁或遲緩。最嚴(yán)重的癥狀是憂鬱(甚至有自殺意念或行為)。(七)安非他命精神?。罕憩F(xiàn)似妄想型精神分裂癥。

22MethamphetamineMethamphetamineisanaddictivestimulantdrugthatstronglyactivatescertainsystemsinthebrain.Methamphetamineiscloselyrelatedchemicallytoamphetamine,butthecentralnervoussystemeffectsofmethamphetaminearegreater.Bothdrugshavesomemedicaluses,primarilyinthetreatmentofobesity,buttheirtherapeuticuseislimited.23MethamphetamineMethamphetamineismadeinillegallaboratoriesandhasahighpotentialforabuseanddependence.Streetmethamphetamineisreferredtobymanynames,suchas"speed,""meth,"and"chalk."Methamphetaminehydrochloride,clearchunkycrystalsresemblingice,whichcanbeinhaledbysmoking,isreferredtoas"ice,""crystal,"and"glass."24HealthHazardsMethamphetaminereleaseshighlevelsoftheneurotransmitterdopamine,whichstimulatesbraincells,enhancingmoodandbodymovement.Italsoappearstohaveaneurotoxiceffect,damagingbraincellsthatcontaindopamineandserotonin,anotherneurotransmitter.Overtime,methamphetamineappearstocausereducedlevelsofdopamine,whichcanresultinsymptomslikethoseofParkinson'sdisease,aseveremovementdisorder.25HealthHazardsMethamphetamineistakenorallyorintranasally(snortingthepowder),byintravenousinjection,andbysmoking.Immediatelyaftersmokingorintravenousinjection,themethamphetamineuserexperiencesanintensesensation,calleda"rush"or"flash,"thatlastsonlyafewminutesandisdescribedasextremelypleasurable.Oralorintranasaluseproduceseuphoria-ahigh,butnotarush.Usersmaybecomeaddictedquickly,anduseitwithincreasingfrequencyandinincreasingdoses.26methamphetamineAnimalresearchgoingbackmorethan20yearsshowsthathighdosesofmethamphetaminedamageneuroncell-endings.Dopamine-andserotonin-containingneuronsdonotdieaftermethamphetamineuse,buttheirnerveendings("terminals")arecutbackandre-growthappearstobelimited.Thecentralnervoussystem(CNS)actionsthatresultfromtakingevensmallamountsofmethamphetamineincludeincreasedwakefulness,increasedphysicalactivity,decreasedappetite,increasedrespiration,hyperthermia,andeuphoria.OtherCNSeffectsincludeirritability,insomnia,confusion,tremors,convulsions,anxiety,paranoia,andaggressiveness.Hyperthermiaandconvulsionscanresultindeath.27MethamphetamineMethamphetaminecausesincreasedheartrateandbloodpressureandcancauseirreversibledamagetobloodvesselsinthebrain,producingstrokes.Othereffectsofmethamphetamineincluderespiratoryproblems,irregularheartbeat,andextremeanorexia.Itsusecanresultincardiovascularcollapseanddeath.AstudyinSeattleconfirmedthatmethamphetamineusewaswidespreadamongthecity'shomosexualandbisexualpopulations.Ofthesegroups,membersusingmethamphetaminereportedtheypracticesexualandneedle-usebehaviorsthatplacethematriskofcontractingandtransmittingHIVandAIDS.28Methamphetamine

SlangorStreetNames:Speed,Ice,Chalk,Meth,Crystal,Crank,Fire,GlassMethamphetamineisatoxic,addictivestimulantthataffectsmanyareasofthecentralnervoussystem.Thedrugisoftenmadeinclandestinelaboratoriesfromrelativelyinexpensiveover-the-counteringredients.Itisbeingusedbydiversegroups,includingyoungadultswhoattendraves,inmanyregionsofthecountry.Availableinmanyforms,methamphetaminecanbesmoked,snorted,injected,ororallyingested.29MethamphetamineMethamphetamineisawhite,odorless,bitter-tastingcrystallinepowderthateasilydissolvesinbeverages.Methamphetamineisnotsoldinthesamewayasmanyotherillicitdrugs;itistypicallysoldthroughnetworks,notonthestreet.Methamphetamineuseisassociatedwithserioushealthconsequences,includingmemoryloss,aggression,violence,psychoticbehavior,andpotentialcardiacandneurologicaldamage.30MethamphetamineMethamphetamineabuserstypicallydisplaysignsofagitation,excitedspeech,decreasedappetite,andincreasedphysicalactivitylevels.Methamphetamineisneurotoxic.Methamphetamineabusersmayhavesignificantreductionsindopaminetransporters.Methamphetamineusecancontributetohigherratesoftransmissionofinfectiousdiseases,especiallyhepatitisandHIV/AIDS.31古柯鹼(一)歷史：第六世紀(jì)時(shí),南美印地安人以咀嚼古柯葉提神。十五世紀(jì)傳入歐洲,但未流行。1860年Niemann純化出古柯因(Cocaine)並廣被當(dāng)做局部麻醉劑使用。十九世紀(jì)末時(shí),被注意到有成癮性,1930年代因安非他命合法、廉價(jià)、容易取得且效用相似而銷聲匿跡。在美國(guó),1970年代安非他命被禁止後,再度流行,1980年代中期古柯鹼(Cocainefreebase)大量生產(chǎn),價(jià)錢廉價(jià)而氾濫成災(zāi)。在臺(tái)灣也有人引入國(guó)內(nèi)。32古柯鹼(二)使用途徑：蒸發(fā)吸入、鼻吸或靜脈注射。(三)作用機(jī)轉(zhuǎn)：抑制多巴安、新腎上腺素回收。(四)藥理作用、中毒癥狀、戒斷癥狀：似安非他命,但更嚴(yán)重,更容易上癮。33CrackandCocaineCocaineisapowerfullyaddictivedrugofabuse.Oncehavingtriedcocaine,anindividualcannotpredictorcontroltheextenttowhichheorshewillcontinuetousethedrug.Themajorroutesofadministrationofcocainearesniffingorsnorting,injecting,andsmoking(includingfree-baseandcrackcocaine).Snortingistheprocessofinhalingcocainepowderthroughthenosewhereitisabsorbedintothebloodstreamthroughthenasaltissues.Injectingistheactofusinganeedletoreleasethedrugdirectlyintothebloodstream.Smokinginvolvesinhalingcocainevapororsmokeintothelungswhereabsorptionintothebloodstreamisasrapidasbyinjection.34Crack"Crack"isthestreetnamegiventococainethathasbeenprocessedfromcocainehydrochloridetoafreebaseforsmoking.Ratherthanrequiringthemorevolatilemethodofprocessingcocaineusingether,crackcocaineisprocessedwithammoniaorsodiumbicarbonate(bakingsoda)andwaterandheatedtoremovethehydrochloride,thusproducingaformofcocainethatcanbesmoked.Theterm"crack"referstothecracklingsoundheardwhenthemixtureissmoked(heated),presumablyfromthesodiumbicarbonate.35cocaineThereisgreatriskwhethercocaineisingestedbyinhalation(snorting),injection,orsmoking.Itappearsthatcompulsivecocaineusemaydevelopevenmorerapidlyifthesubstanceissmokedratherthansnorted.Smokingallowsextremelyhighdosesofcocainetoreachthebrainveryquicklyandbringsanintenseandimmediatehigh.TheinjectingdruguserisatriskfortransmittingoracquiringHIVinfection/AIDSifneedlesorotherinjectionequipmentareshared.36HealthHazardsCocaineisastrongcentralnervoussystemstimulantthatinterfereswiththereabsorptionprocessofdopamine,achemicalmessengerassociatedwithpleasureandmovement.Dopamineisreleasedaspartofthebrain'srewardsystemandisinvolvedinthehighthatcharacterizescocaineconsumption.37HealthHazardsPhysicaleffectsofcocaineuseincludeconstrictedperipheralbloodvessels,dilatedpupils,andincreasedtemperature,heartrate,andbloodpressure.Thedurationofcocaine'simmediateeuphoriceffects,whichincludehyper-stimulation,reducedfatigue,andmentalclarity,dependsontherouteofadministration.Thefastertheabsorption,themoreintensethehigh.Ontheotherhand,thefastertheabsorption,theshorterthedurationofaction.Thehighfromsnortingmaylast15to30minutes,whilethatfromsmokingmaylast5to10minutes.Increasedusecanreducetheperiodofstimulation.38cocaineSomeusersofcocainereportfeelingsofrestlessness,irritability,andanxiety.Anappreciabletolerancetothehighmaybedeveloped,andmanyaddictsreportthattheyseekbutfailtoachieveasmuchpleasureastheydidfromtheirfirstexposure.Scientificevidencesuggeststhatthepowerfulneuropsychologicreinforcingpropertyofcocaineisresponsibleforanindividual'scontinueduse,despiteharmfulphysicalandsocialconsequences.Inrareinstances,suddendeathcanoccuronthefirstuseofcocaineorunexpectedlythereafter.However,thereisnowaytodeterminewhoispronetosuddendeath.39cocaineHighdosesofcocaineand/orprolongedusecantriggerparanoia.Smokingcrackcocainecanproduceaparticularlyaggressiveparanoidbehaviorinusers.Whenaddictedindividualsstopusingcocaine,theyoftenbecomedepressed.Thisalsomayleadtofurthercocaineusetoalleviatedepression.Prolongedcocainesnortingcanresultinulcerationofthemucousmembraneofthenoseandcandamagethenasalseptumenoughtocauseittocollapse.Cocaine-relateddeathsareoftenaresultofcardiacarrestorseizuresfollowedbyrespiratoryarrest.40AddedDanger:CocaethyleneWhenpeoplemixcocaineandalcoholconsumption,theyarecompoundingthedangereachdrugposesandunknowinglyformingacomplexchemicalexperimentwithintheirbodies.NIDA-fundedresearchershavefoundthatthehumanlivercombinescocaineandalcoholandmanufacturesathirdsubstance,cocaethylene,thatintensifiescocaine'seuphoriceffects,whilepossiblyincreasingtheriskofsuddendeath.41強(qiáng)力膠(一)歷史：1960年代流行於美國(guó),1965年傳入,1972傳入臺(tái)灣,在青少年中流行起來(lái)。(二)使用途徑：裝入塑膠袋搓揉使其揮發(fā)而吸食。(三)藥理作用：主要成份為甲苯(44%)。生理反應(yīng)與酒精類似,具中樞神經(jīng)抑制作用。先有去抑制化現(xiàn)象,欣快感、飄浮感,繼而進(jìn)入幻旅(trip),出現(xiàn)錯(cuò)覺(jué)、幻覺(jué),然後進(jìn)入抑制期,略微嗜睡、口齒不清。42強(qiáng)力膠(四)中毒過(guò)量：頭暈、視覺(jué)障礙(模糊或複視)、眼球震顫、運(yùn)動(dòng)協(xié)調(diào)障礙、言辭模糊、步態(tài)不穩(wěn)、震顫、欣快感。更高劑量會(huì)導(dǎo)致昏睡、精神運(yùn)動(dòng)性遲滯、廣泛肌肉無(wú)力、反射降低、木僵或昏迷。(五)戒斷癥狀：輕微,可能會(huì)失眠、胃口不佳、顫抖、噁心嘔吐。(六)併發(fā)癥：感覺(jué)異常、運(yùn)動(dòng)障礙、聽(tīng)力喪失、周邊神經(jīng)病變、心肌病變、肝腎傷害、缺氧、窒息、意外死亡。43新興藥物濫用形態(tài)新的藥物濫用形態(tài)“”v.s.“非法藥品”v.s.“合法物質(zhì)”“成癮”v.s.“控制使用”44俱樂(lè)部用藥ClubdrugPub,Rave,夜總會(huì),地下舞廳,KTV網(wǎng)咖私人聚會(huì)45俱樂(lè)部用藥Recreationaluse,助興,流行Perceivedharm下降A(chǔ)vailability增加使用容易公開(kāi)及半公開(kāi)使用46新聞媒體報(bào)導(dǎo)的clubdrugs快樂(lè)丸搖頭丸搖腳丸,一粒沙(elisa)

安非他命(甲基安非他命)FM2大麻K安笑氣Others...47ClubDrugsAnumberofourNation'sbestmonitoringmechanismsaredetectingalarmingincreasesinthepopularityofsomeverydangeroussubstancesknowncollectivelyas"clubdrugs."Thistermreferstodrugsbeingusedbyyoungadultsatall-nightdancepartiessuchas"raves"or"trances,"danceclubs,andbars.MDMA(Ecstasy),GHB,Rohypnol,ketamine,methamphetamine,andLSDaresomeofthecluborpartydrugsgainingpopularity.NIDA-supportedresearchhasshownthatuseofclubdrugscancauseserioushealthproblemsand,insomecases,evendeath.Usedincombinationwithalcohol,thesedrugscanbeevenmoredangerous.48"Clubdrug"isavaguetermthatreferstoawidevarietyofdrugs.Uncertaintiesaboutthedrugsources,pharmacologicalagents,chemicalsusedtomanufacturethem,andpossiblecontaminantsmakeitdifficulttodeterminetoxicity,consequences,andsymptomsthatmightbeexpectedinaparticularcommunity.Noclubdrugisbenign.ChronicabuseofMDMA,forexample,appearstoproducelong-termdamagetoserotonin-containingneuronsinthebrain.Giventheimportantrolethattheneurotransmitterserotoninplaysinregulatingemotion,memory,sleep,pain,andhigherordercognitiveprocesses,itislikelythatMDMAusecancauseavarietyofbehavioralandcognitiveconsequencesaswellasimpairingmemory.49ClubdrugsBecausesomeclubdrugsarecolorless,tasteless,andodorless,theycanbeaddedunobtrusivelytobeveragesbyindividualswhowanttointoxicateorsedateothers.Inrecentyears,therehasbeenanincreaseinreportsofclubdrugsusedtocommitsexualassaults-yetanotherreasonwhyNIDAisalertingyoutotheseescalatingtrends.50GHB1.Gammahydroxybutyrate(GHB)isanillicitchemicalthathasbecomeamajorcauseofdrug-relatedcomasintheUSandothercountries.Infact,thenumberofGHBoverdosesintheUnitedStateshasnowout-pacedoverdosesfromMDMA(Ecstasy).2.GHBwasrejectedbytheAmericanmedicalcommunityinthe1960s,buthasbecomepopularamongmanypeopleforitsabilitytocrosstheblood-brainbarrierfreelyanddepressconsciousness,resultingineuphoriaandintoxication.51GHB3.ItisalsotoutedontheInternetasasleepaid,ananti-depressantandweightlossproduct,althoughtheseusesarenotsubstantiatedbyrealityandmaycarryapotentiallydeadlytwist.4.Startingfirstasanalternativetosteroidsinthelate1980s,whensteroidswerebeingcontrolled,GHBhasgrownintoamulti-headedmedicalnightmare,drainingemergencyroomservices,shatteringthelivesofthosewhohavelostlovedonestoit,andterrifyingfamilies/friendsofthoseaddictedtoit.Yetitisstillamysterytomostlawenforcementofficers,medical/coronerpersonnel,andparents.52GHBhasalsobeenasociatedwiththesocalled"daterape"drugs.GHBcanbeproducedinclearliquid,whitepowder,tablet,andcapsuleforms,anditisoftenusedincombinationwithalcohol,makingitevenmoredangerous.GHBisusuallyabusedeitherforitsintoxicating/sedative/euphoriapropertiesorforitsgrowthhormone-releasingeffects,whichcanbuildmuscles.53GHBGHBisacentralnervoussystemdepressantthatcanrelaxorsedatethebody.Athigherdosesitcanslowbreathingandheartratetodangerouslevels.GHBintoxicatingeffectsbegin10to20minutesafterthedrugistaken.Theeffectstypicallylastupto4hours,dependingonthedosage.OverdoseofGHBcanoccurratherquickly,andthesignsaresimilartothoseofothersedatives.54GHBGHBisclearedfromthebodyrelativelyquickly,soitissometimesdifficulttodetectinemergencyroomsandothertreatmentfacilities.55GHBGHBwasfirstsynthesizedinFrancemorethan40yearsagoasapossibleanesthetic,butbecauseofitsundesirablesideeffectswasrejectedbytheAmericanmedicalcommunity.Itslegaluseanywhereisdwindlingascountriesarebeginningtorecognizetheproblems.GHBresurfacedin1987asanorphandrugbeingresearchedtotreatthecombinationofsleepdisordersknownasnarcolepsy/cataplexy.56GHBAtaboutthesametime,steroidusersweretoldthatitmightenhancethebody’sproductionofgrowthhormone(indeepsleepstate).However,duetogrowingnumbersofoverdoses,itwasorderedofftheshelvesofstoresinNovember1990.Unfortunately,ithasgainedstatusasarecreationaldrugandasarapedrug,andhasbecomedangerouslycommon.AsaresultofincreasedrestrictionsonGHBitself,its“analogs,”orchemicalcousinsthatturnintoGHBinthebody,havebecomeincreasinglyprevalent.57USERSOFGHB

*Attendeesatdanceclubsor“rave”partiesareperhapsthemostprominentusersofGHBtoaltermood.*SexualpredatorsofallagesareattractedbythedisinhibitingandeuphoriceffectsofGHB,fortheyknowausermaybeeasilytakenadvantageofinanassault.Someexoticdancersandstrippersself-dosewithGHB,seekinga“sexier”performance.*Bodybuildersandotherathletes,includingprofessionalathletes,aretheleastrecognizedusers.Infact,thisgroup,oftenusingitonadailybasis,aretheonesmostlikelytobecomeaddicted.*BusinessprofessionalswhotravelfrequentlyandthinkGHBisasafesleepaid(comparabletomelatonin,forexample)areanotherunrecognizedgroup,alsosubjecttoaddictionandwithdrawal.58USERSOFGHB*Theelderlyarealsopotentialvictims,beingtoldthatGHBisananti-agingcompound.*GayandlesbianpopulationsalsouseGHBasarecreationaldrug.Insomecases,itisalsousedinthiscommunityforrapeorrobberypurposes..*PeoplesubjecttodrugtestingprogramsuseGHBasanalcoholsubstituteandtobypassdrugtesting.NOTE:IdentificationofGHBiscomplicatedbytheshortdurationoftimethatitpersistsinbodyfluidsandbytheabsenceofGHBtestingfromthenormaltestingproceduresofmostagencies.Thiswillchange,asrisksofGHBaremorewidelyrecognized.59ANALOGSOFGHB

Overthepastseveralyears,avarietyofstates,haveaddedGHBtotheirlistsofcontrolledsubstances,thusmakingitpossibleforcriminalpenaltiestobeadministeredforuseofthedrug.Thisforcedgammabutyrolactone(GBL)and1,4-butanediol(BD),tostepintothespotlight.GBLisbothaprecursor(aprimaryingredientinmakingGHB)andanactiveanalog(asubstancethatconvertstoGHBinthehumanbody,withthesamephysicaleffectasGHB).BDisanactiveanalog,alsoconvertingrapidlytoGHBinthebody.Anotheranalogthathassurfaced,gammahydroxyvalerate(GHV),isonitswaytobecomingasuniversalasGBLandBD.BothGBLandBDachievethisconversioninsideofthebody,andGBLcantransformintoGHBbothinsideandoutsideofthebody.60ANALOGSOFGHB

GHBremainsaccessibletoabusersthroughthissimpleconversion,thoughallareillegalforhumanconsumptionsinceMarch2000,whenGHBwasfederallyscheduled.Whatisunsettling,though,ishoweasyitistogetaholdoftheseprecursors.GBLandBDandvalericacidsubstancesareavailableatgyms,chemicalsupplystores,theInternet,andthroughmailorder.Theyaresoldaspowders,capsules,gelsorliquidsandcanbefoundinavarietyofconcentrations,colors,andflavors.Therearemorethan80streetandtradenamesforGHBanditsanalogs61EFFECTSOFGHB

GHB’sdepressanteffectsonthebraininlowdosesproduceahighoreuphoricfeelingasinhibitionsaredepressed.Whenthedoseisincreased,profoundcomaresults.Theheartratemayalsobedepressedorslowed.Effectsonthenervoussystemmayresultinaspasmofmusclecontractionscalledmyoclonus,producingseizure-likemovements.62EFFECTSOFGHB

Othereffectssuchasconfusion,amnesia,vomitingandirregularbreathingaredangerouswhencombinedwiththemajordepressanteffectsofGHB.OtherdrugsincombinationwithGHB,especiallyotherdepressantssuchasalcohol,mayworsenthedepressiveeffectsandincreasethepossibilityofafataloutcome.63EFFECTSOFGHB

The“desired”effectsforGHBinlowdosesmaysoundinviting,buttheconsequenceofthewrongdosemaybedeath.ThedosageresponseofGHBisquitesteep,meaningthatatinyincreaseindosemaycauseadramaticincreaseinsymptomsand,thus,inrisk.Variableeffectsmeanthatateaspoonmightbeperfectonetime,butmaybecomeanoverdosethenexttime!ItisalsoimportanttobeawareoftheconsequencesthatoccurwhenGHBismixedwithotherchemicals.Forinstance,mixingGHBwithalcoholorotherdepressantsisevenmorelikelytoresultindeath.Theeffectslastaboutfourhoursandcanresolvequitesuddenly.64GHBOVERDOSE

ThemostdistinctiveandterrifyingfeatureofGHBisitsoverdosetimecourse.Within15minutesaperson’sstateofmindbecomesalteredandthereisahighpossibilityofalossofconsciousnessoranactualcoma.Breathingcanslowtoonlyfourtosixbreathesperminute!Mostpeopledo“sleepoff”aGHBoverdose;thosewhodon’tarecalled“dead.”AGHBoverdoseISa911emergency.65THEFUTUREOFGHB

WhetherGHBcontinuestobeawidelyuseddrugdependsonthestepsthataretakentoeducatethepublic.Insteadofbeingperceivedasadietarysupplement,peopleneedtorecognizeGHBforwhatitis:anillictanddangerousdrug.EventhoughGHB(alsoknownassodiumoxybate,tradenameXyrem)hasbeenapprovedformedicalpurposes,itsdeadlyrisksforrecreationaloranyunsupervisedandunmonitoreduseremainthesame.ThereisnoevidencethatprofessionallymadeGHBisanylessdangerousintheabusearena.HealthcareprovidersandlawenforcementofficersneedtobecomefullyawareoftheeffectsanddangersofGHBsothattheycanplayanimportantroleininformingthepublic.66GHBGHBisusuallyliquid&maybehiddeninanytypeofcontainer.Water/drinkbottles,eye&nasalspray&mouthwashcontainersarecommon.Becauseofitsusuallysaltyorchemicaltaste,itisoftendisguisedinsweetorfruitydrinkswhengiventounknowingvictimsforrapeorrobbery.67GHBDescription:Aclearliquid.Looksjustlikewater.Canbemistakenforwaterbecauseitisusuallyfoundinasmall(30ml)clearplasticbottle,awaterbottle,orevenGatoradebottles,whichcontainsseveraldoses.Onequicktaste,andyou'llknowit'snotwater.Notascommon,butalsofoundasawhitepowder.Infactpowderuseisontherise!68GHBEffects:Intoxication,increasedenergy,happiness,talking,desiretosocialize,feelingaffectionateandplayful,milddisinhibition,sensuality,enhancedsexualexperience,musclerelaxation,lossofcoordinationduetolossofmuscletone,possiblenausea,difficultyconcentrating,lossofgagreflex.69GHBManypeoplehavebadreactions.Thesecaninclude

nausea,headaches,drowsiness,dizziness,amnesia,vomiting,lossofmusclecontrol,respiratoryproblems,lossofconsciousness,beingconsciousbutunabletomove,anddeath-Especiallywhencombinedwithalcoholorotherdrugs.70GHBEffectsoflargedoses:Disinhibition,sedation,desiretosleep,ramblingincoherentspeech,giddiness,silliness,difficultythinking,slurredspeech,passingout,anddeath.Effectsofoverdose:Sleepordeepsedationfromw