OTC-Rx-Drugs-of-Abuse.4-28

Report
Devon A. Sherwood, PharmD, BCPP
Assistant Professor
University of New England
College of Pharmacy
Describe the epidemiology and overall impact
of medications commonly abused.
Explain the pathophysiology of abuse and
dependence for commonly abused drugs.
List common over-the-counter (OTC) and
prescription (Rx) drugs of abuse.
Identify side effect profiles and withdrawal
symptoms of OTC and Rx drugs of abuse.
Review available options for detoxification
therapy and abstinence maintenance regarding
common drugs of abuse.
Which of the following increases the
risk of abuse potential?
A. Rapid absorption
B. Potency of drug
C. Lipophilicity and distribution leads to
abrupt offset
D. Short-half life / duration of effect
E. All of the above
Which of the following should not be
recommended for opiate abstinence?
A. Clonidine
B. Methadone
C. Suboxone
D. Naltrexone
Laxative Abuse: True or False?
Effective for weight control
True
False
Physical dependency does not occur
True
False
Long term abuse may contribute to colon
cancer
True
False
Which of the following herbals when
abused is known to cause hallucinations?
A. Ma-huang
B. Kratom
C. Nutmeg
D. Betel nut
E. Kava
Which of the following herbals has
effects on mu and delta receptors,
causing analgesic and addictive
properties similar to opiates?
A. Salvia
B. Morning Glory
C. Kratom
D. Yohimbine
E. Khat
In 2010, 23.1 million Americans aged 12 or older
(9.1% of US population) needed specialized
treatment for a substance abuse problem, but
only 2.6 million (11.2%) received it.
It is estimated 22.6 million Americans aged 12 or
older (8.9%) were current (past month) illicit
drug users
Includes marijuana/hashish, cocaine/crack, heroin,
hallucinogens, inhalants or prescription-type
psychotherapeutics used nonmedically.
1.) National Survey of Drug Use and Health, SAMHSA, 2013
2.) National Survey on Drug Use and Health 2013; National Institute on Drug Abuse (NIDA), National Institute of Health (NIH)
3.) Monitoring the Future; University of Michigan - http://www.monitoringthefuture.org/
First Specific Drug Associated with Initiation of Illicit Drug Use
among Past Year Illicit Drug Initiates Aged 12 or older: 2010
Results from the 2010 National Survey on Drug
Use and Health, US Department of Health and
Human Services, 2012;
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k
10Results.htm#Fig5-1
The incidence of nonmedical usage of
psychotropic drugs has been increasing over the
past 10 years
NSDUH Report from April 11, 2013 identified an
increase in nonmedical prescription drug use
from the 2011 survey:
15.7 million (6.3% of US population) use in last year
6.7 million (2.7% US population) use in last month
1.) National Survey of Drug Use and Health, SAMHSA, 2012
2.) National Survey on Drug Use and Health 2010; National Institute on Drug Abuse (NIDA), National Institute of Health (NIH)
In 2010, about 7 million persons (2.7% of US
population) were current users in the past
month of psychotherapeutic drugs taken
nonmedically
5.1 million = pain relievers
2.2 million = tranquilizers
1.1 million = stimulants
0.4 million = sedatives.
National Survey on Drug Use and Health 2010; National Institute on Drug Abuse (NIDA), National Institute of Health (NIH)
NIDA-NIH: http://www.nida.nih.gov/tib/prescription.html
Monitoring the Future Study (NIH grant in 2011)
Drug Name
8th grade
10th grade
12th grade
Marijuana/Hashish
12.5%
28.8%
36.4%
Vicodin®
2.1%
5.9%
8.1%
Amphetamines
3.5%
6.6%
8.2%
Tranquilizers
2.0%
4.5%
5.6%
OxyContin®
1.8%
3.9%
4.9%
OTC Cough/Cold
2.7%
5.5%
5.3%
Salvia
1.6%
3.9%
5.9%
Any prescription drug abused in 12th grade = 15.2%
1.) National Survey on Drug Use and Health 2011; National Institute on Drug Abuse (NIDA), National Institute of Health (NIH)
2.) Monitoring the Future; University of Michigan - http://www.monitoringthefuture.org/
Substance Use Disorders:
Dependence
Abuse
Substance Induced Disorders
Intoxication
Withdrawal
Polysubstance Dependance
A maladaptive pattern of substance use leading to
clinically significant impairment or distress, as
manifested by one or more of the following (one
symptom in 12 months):
1.) Recurrent substance use resulting in a failure to fulfill
major role obligations at work, school, or home
2.) Recurrent substance use in physically hazardous situations
3.) Recurrent substance-related legal problems
4.) Continued substance use despite having persistant or
recurrent social or interpersonal problems caused or
exacerbated by the effects of substance abuse
A maladaptive pattern of substance use leading to
clinically significant impairment or distress, as
manifested by three or more of the following,
occurring at any time in the same 12-month period:
1.) Tolerance: A need for markedly increased amounts of the
substance to achieve intoxication or desired effect, or
markedly diminished effect with continued use of the
same amount of the substance
2.) Withdrawal: As manifested by the characteristic
withdrawal syndrome for the substance, or the same (or
closely related) substance is taken to relieve or avoid
withdrawal symptoms.
3.) Substance is taken in larger amounts or over a longer
period than was intended
4.) Persistent desire or unsuccessful efforts to cut down or
control substance use
5.) A great deal of time is spent in activities necessary to
obtain the substance
6.) Important social, occupational, or recreational activities
are given up or reduced because of substance use.
7.) The substance use continues despite knowledge of having
a persistent or recurrent physical or psychological problem
that is likely caused or exacerbated by the substance.
Ineffective parenting
Chaotic home environment
Lack of mutual attachments/nurturing
Inappropriate behavior in the classroom
Failure in school performance
Poor social coping skills
Affiliations with deviant peers
Perceptions of approval of drug-using
behaviors in the school, peer, and community
environments
www.drugabuse.gov
Strong family bonds
Parental monitoring
Parental involvement
Success in school performance
Prosocial institutions
(ie. family, school, religious organizations)
Conventional norms about drug use
http://www.yanksarecoming.com/wpcontent/uploads/2009/12/BubbleBoy1.jpg
www.drugabuse.gov
DRUG ADDICTION IS A COMPLEX ILLNESS
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov
Opiates
Anxiolytics / sedatives
Benzodiazapines
Barbiturates
Non-benzodiazepines
Stimulants
Studies have shown properly using opiates
exactly as prescribed is safe, manages pain
effectively, and has a low chance of addiction.
Taken by persons not prescribed the
medication, using more than recommended or
using an alternate route than prescribed
(snorting, smoking or injecting) carries a high
risk of addiction and/or overdosage
NIDA Infofacts: Prescription and Over the Counter Medications;
http://www.nida.nih.gov/infofacts/PainMed.html
NIDA-NIH: http://www.nida.nih.gov/tib/prescription.html
Opiate enters the
brain and influences a
range of mechanisms
Slows the heart beat
Constricts the pupils
Mu, delta & kappa agonists
Boosts the activity of
dopamine
Pleasure circuit
Blocks pain
Decreases breathing
Sometimes causing
breathing cessation
Potentially death
Pharmacotherapy: A Pathophysiologic Approach
General effects
Sedation
Anxiety
Lack of interest
Slurred speech
Withdrawal
“Flu-like” symptoms:
Runny nose
Tear secretion
Yawning
Sneezing
Nausea
Vomiting
Diarrhea
Mydriasis
One of the most commonly abused prescription
drugs
80mg Oxycontin tablet = 16 Percocet tablets
Propagated by illicit transactions, theft, and
overprescribing (ie. “Pain clinics”)
Sustained-release delivery is thwarted by
cracking, chewing, smoking and injecting
http://www.prescriptionbuyers.com/freeboard/ubbthreads.php/topics/1045193/NEW_OXYCONTIN_MARKINGS_SEPT_20. Accessed April 1, 2012.
Physical/Psychological addiction
Injection-related problems
Infectious diseases
HIV / AIDS
Hepatitis B and C
Collapsed veins
Bacterial infections
Abscesses
Physical injuries
Detoxification
Taper off opiate + opiate substitute
Clonidine (Catapres®)
Buprenorphine Formulations
(Buprenex®, Suboxone®)
Maintenance of Opiate Abstinence
Methadone
Buprenorphine/Naloxone
Naltrexone
Attenuates the sympathetic response to
withdrawal
Causes a rapid and significant decrease in
withdrawal signs and symptoms
Usual oral dose is 0.1-0.2mg Q6h PO
Watch BP!
Use methadone as an opiate substitute
Medication is taken orally
Suppresses withdrawal for 24 to 36 hours and
relieves cravings
Detox: 15-40 mg/day not to exceed 21 days
Maintenance: 20-120 mg/day
Physicians must be credentialed to do
office-based detoxification
No more than 30 patients at a time for the first
year licensed, then can petition for up to 100
patients per the DATA 2000 waiver
Buprenorphine/Naloxone (Suboxone®) approved
in October 2002
Use buprenorphine monotherapy only in
pregnancy
http://samhsa.gov: Buprenorphine Clinical Guide
A mixed opiate agonist / antagonist
Ceiling effect if dosed too high
Safer for respiratory depression
Suboxone® is a 4:1 ratio of buprenorphine
to naloxone (if taken po only!!)
Usual dose
4-24mg sublingually daily
Safe and effective for office-based detox
16mg buprenorphine daily
Up to 21% avoided outside opiates
vs. 5.8% on placebo (p<0.001)
Retention rates in programs < methadone
High dose buprenorphine may suppress
heroin use > methadone
Doses > 8mg/d have best success
QOD dosing also successful
NEJM 2003;349:949-958. / Cochrane Database of Systematic Reviews 2003;(2):CD002207. /
Addiction 2003;98(4):441-452.
Competitive antagonists at opioid receptor
sites
Not to be used during active withdrawal
Studies with long acting depot form
Vivitrol® in Russia demonstrated
extraordinary outcomes regarding drug
abstinance, treatment retention, and
decreased cravings
Must wait 7-14 days or withdrawal will occur
Reduces opiate cravings
Increases risk for unintentional overdoses
Studies show a reduction in (re)incarcerations
when used with behavior therapy
Compliance and motivation are major factors
32-58% successful in compliant patients
Abstinence rates diminish over time
Cochrane Database of Systematic Reviews 2003;(2):CD001333.
Drug & Alcohol Dependence 1997;47(2):77-86. / Drugs 1988;35(3):192-213.
Which of the following should not be
recommended for opiate abstinence?
A. Clonidine
B. Methadone
C. Suboxone
D. Naltrexone
Short acting opiate receptor blocker
Not used for abstinence
Counteracts the effects of opiods and can be
used to treat overdose
Dosing for overdose of opiate: 0.4 – 2mg IV,
repeat every 2 to 3 min prn
No response after 10mg = reconsider diagnosis!
May administer IM or SUBQ if IV route is unavailable
Micromedex Healthcare Series: Drugdex® Drug Point
Hypnotic Drugs: Dose-response relationships
Respiratory
Depression
BARBS
Coma/
Anesthesia
BDZs
Ataxia
Sedation
Anticonvulsant
Anxiolytic
DOSE
Katzung BG. Basic & Clinical Pharmacology. 10th ed. New York, NY: McGraw Hill; 2007
Goodman LS, Gilman A, Brunton LL. Goodman & Gilman's Manual of
Pharmacology and Therapeutics. 11th ed. New York, NY : McGraw Hill; 2008.
Enhance GABA
GABA decreases brain activity of NT’s = drowsiness
or calming effect
Prescribed to treat anxiety, acute stress
reactions, panic attacks, convulsions, and sleep
disorders.
Short-term relief from sleep problems due to
tolerance and addiction potential
Rapid absorption leads to quick onset
Potency of drug
Lipophilicity and distribution leads to
abrupt offset
Short-half life / duration of effect
Intradose withdrawal
Which of the following increase the risk
of abuse potential?
A. Rapid absorption
B. Potency of drug
C. Lipophilicity and distribution leads to
abrupt offset
D. Short-half life / duration of effect
E. All of the above
Agitation
Increased anxiety
Loss of appetite
Diaphoresis
Nausea
Fatigue and lethargy
Dizziness
Psychosis
Insomnia
Seizures
Poor concentration
Headaches
Increased acuity of
senses
Paresthesias
Photophobia
Dysphoria
Confusion
Based on:
Drug variables
Higher doses
Longer duration of BZD treatment
Drug half-life
Rapid tapering
Clinical variables
Higher pre-taper anxiety and depression
More personality pathology
ie. neuroticism, dependency
Panic disorder diagnosis
History of recreational alcohol or drug abuse
Inpatient versus outpatient treatment
Detoxification is similar to alcohol treatment
Length of treatment may be longer because onset
of withdrawal symptoms may be delayed up to 7
days after discontinuing the drug
After the acute withdrawal phase, minor
abstinence symptoms may last for weeks
Anxiety, insomnia, irritability, sensitivity
to light & sound, and muscle spasms
Success best if CBT is adjunctive
Am J Psychiatry 2004;161:332-342.
In case of overdosage, flumazenil
(Romazicon®) can be used:
0.2mg IV over 30min, increase to 0.3 if no
effect after another 30 min,
Further doses of 0.5mg over 30min up to
max of 3mg if no response, or max of 5mg if
partial reponse
Micromedex Healthcare Series: Drugdex® Drug Point
Cocaine
Methamphetamine
Dextroamphetamine (Dexedrine®)
Methylphenidate (Concerta®, Methylin®,
Ritalin®)
Amphetamines (Adderall®)
Modafinil (Provigil®)
OTC:
Watch for ephedrine-related compounds!
Ma-huang, psuedoephedrine
Mechanism of Action:
Increase the release and block reabsorption of
dopamine
Dopamine is involved in reward, motivation, experiencing
pleasure, and motor function.
Levels too high in the brain reward center = euphoria and
add to addiction potential.
The more rapid dopamine is released to reward
centers of the brain, it higher chance of
stimulant abuse.
www.drugabuse.gov
www.drugabuse.gov
Poll from Nature in the April 2008 newsletter
revealed 20% of researchers utilized a CPEM
1400 people from over 60 countries responded
Nature 452, 674-675 (2008)
Taken repeatedly or in high doses,
stimulants can cause:
Anxiety
Paranoia
Dangerously high body temperatures
Irregular heartbeat
Seizures
Depression
Common OTC & Herbal Drugs of Abuse
Dextromethorphan
Antihistamines:
Diphenhydramine
Dimenhydrinate
Laxatives
Synthetic Cannabinoids:
K2, Spice, others…
“Opiate Like” Compound:
Kratom
Bath Salts
Dextromethorphan
Synthetic opioid dextro-isomer of levorphanol
MOA: Decreases sensitivity of cough receptors
& interrupts cough impulse transmission
Indication: Antitussive/Cough suppressant,
T ½ = 2-4 hrs; renal excretion
Popular products of abuse: Coricidin,
Corcidin C&C, Robitussin DM
Street names: Dex, DXM, CCC, Triple C, Robo,
Skittles, Poor Man’s PCP
Dextromethorphan
Withdrawal symptoms:
Dysphoria, intense cravings
Tolerance develops with continued use
Max dose = 120mg/day
100-200mg
200-400mg
mild stimulant effect with hyperexcitability
mild hallucinations, slurred speech and memory
impairment
300-600mg
‘out-of-body’ state with altered senses and
nystagmus
full dissociative phase
600-1500mg
Dextromethorphan
Acute overdose: CNS depression, coma,
hypotension, tachycardia and respiratory
distress are noted
Polyingestion increases risk of cardiorespiratory
complications and can be fatal
Use supportive measures
Dehydration  fluids
Hyperthermia  Cooling/Sedatives
Agitation  BZD
Chronic (over 2-4 weeks): toxic syndrome
(“bromism”) characterized by irritability,
headache, confusion, anorexia, slurred speech
and lethargy
Timeline of Dextromethorphan (DM) abuse
as reported by new DAWN-ED:
National Estimates of Non-Medical
Dextromethorphan ED Visits
.
Emergency Department Visits
12000
10000
8000
6000
ED Visits
4000
2000
0
2004
2005
2006
2007
2008
Prevalence of Dextromethorphan abuse
True prevalence of DM
misuse is unknown
NSDUH suggests it is
most common in 12 –
20yo
Since 2006, SAMHSA's
NSDUH reported a
17.2% decrease in
usage in 2011.
The NSDUH Report - - Misuse of Over-the-Counter Cough
and Cold Medications among Persons Aged 12 to 25
Trends in Annual use of OTC Cough & Cold
meds among 8th, 10th, and 12th Graders
2006 2007
2008
2009
2010
2011
2012
8th grade 4.2
4.0
3.6
3.8
3.2
2.7
3.0
10th
grade
12th
grade
5.3
5.4
5.3
6.0
5.1
5.5
4.7
6.9
5.8
5.5
5.9
6.6
5.3
5.6
Monitoring the Future 2012 Executive Report
2009 Annual prevalence of use of OTC Cold & Cough meds among 8th,
10th, and 12th Graders:
Racial and Gender comparisons
OTC Cold & Cough Medicines
8th
10th
12th
Total
4
6
6
Male
Female
3.7
3.8
5.9
6.0
8.1 *
4.1
White
Black
Hispanic
3.7
2.7
3.6
6.4
2.1
5.5
5.9
4.5
6.0
Source. The Monitoring the Future study, the University of Michigan, 2009
Anti-histamine abuse
Benadryl (Diphenhydramine, DP)
H1 receptor antagonist
Indication: Allergic rhinitis, Insomnia
Dramamine (Dimenhydrinate, DMH)
= diphenhydramine + 8-chlorotheophylline
H1 receptor antagonist + methylxanthine (55%
/ 45%)
Indication: Motion sickness
Anti-histamine abuse
Abuse potential due to
Hallucinogenic/Euphoric
Sedative/Anxiolytic properties
Risk factors
History of illicit drug use
History of psychiatric disorder
Anti-histamine abuse
Acute overdose
750-1250 mg DMH
~ 800mg = hallucinations,
tactile and visual
sensations, catatonic
stupor
~1250mg = confusion,
violence
(750mg DMH = 400mg DP)
Illicit drug users
Chronic use
Tolerance develops
overtime
Withdrawal:
Depressed affect,
lethargy, irritability, loss
of appetite and
amnesia. agitation,
hostility, clumsiness,
nausea and craving
Psychiatric patients
**Treatment is supportive and symptomatic;
there is no specific antidote**
Laxative abuse
Presentation & Diagnosis:
High clinical suspicion
Objective evidence
should be collected
Self-report may be
difficult
Signs
melanosis coli
serum electrolytes (↓ K+)
fecal electrolytes (↑ Mg)
Symptoms
alternating
diarrhea/constipation
GI cramping
GI pain
Laxative Abuse
Long term complications:
Internal organ damage
Cathartic colon or megacolon = Stretched or “lazy” colon,
colon infection
Irritable Bowel Syndrome (IBS)
Liver damage (rare)
May increase risk of colon cancer
Prevalence of laxative abuse in the general
population and adolescents
Lifetime occurrence of laxative
abuse:
4.18% (general population)
Lifetime occurrence of laxative
abuse:
14.94% (bulimia nervosa)
3-fold increase
Ranges from 18% - 75%
Prevalence of laxative abuse in
adolescent females:
3.2 - 5.5% (high school)
0 - 1.8% (middle school, 13–15 yoa)
32% (anorexia nervosa)
Laxative Abuse: True or False?
Effective for weight control
True
False
Physical dependency does not occur
True
False
Long term abuse may contribute to colon cancer
True
False
Percentage of 12th Graders in Each Category of an Illicit Drug Use Index Who Have
Tried Various Over-the-Counter Stimulants, 2007
Source. The Monitoring the Future study, the University of Michigan, 2007
Nonprescription Diet Pills: Trends in Lifetime and Annual Prevalence of
Use by Gender and Race in Grade 12
Nonprescription Diet Pills
Prevalence of use
2006
2007
Total
13.7
10.4
Males
7.0
5.1
Females
18.3
14.3
Total
9.4
6.7
Males
5.7
3.4
Females
12.5
9.2
White
10.7
9.3
Black
4.2
3.2
Hispanic
7.7
4.9
Lifetime
Annual
Annual
Level of significance of difference between the two most recent classes: s = .05, ss = .01, sss = .001
Source. The Monitoring the Future study, the University of Michigan, 2007
Stimulants/Diet pills
Phenylpropanolamine (Rx only in US)
Ephedrine – Watch for herbal supplements!
Ma-huang still available
Pseudoephedrine
Caffeinated products
Caffeine
Stimulants/Diet pills
Xanthine (adenosine receptor antagonism)
Found in diet pills, stay-awake pills, energy
drinks, etc
Guarana (herbal product)
Alcoholic energy drinks:
“Four loko” teen/college
student deaths
No longer has caffeine, others
available
Bath Salts: Not part of your spa package!
Concentrated version of the
stimulant in Khat
Methendioxypyrovalerone
(MDPV), mephedrone, &
methylone are the most
common ingredients
Often found in plant foods or
insect repellant
http://womenscenter.missouri.edu/wpcontent/uploads/2010/11/National+Bubble+Bath+D
Recent News:
Bath Salts
Most commonly known as Bliss, Ivory Wave, Purple Wave &
Vanilla Sky
Others: Blue Silk, Bolivian Bath, Cloud Nine, Drone,
Energy-1, Lunar Wave, Meow Meow, Ocean Burst, Pure
Ivory, Red Dove, Snow Leopard, Stardust, White Dove,
White Knight, White Lightning
October 1, 2011: DEA made possession and sale of the 3
common ingredients illegal temporarily illegal
Calls to Poison Control Centers for Human
Exposure to Bath Salts, 2010 to January 2012
Maine Law – LD 1589
The bill made the following changes to state law:
Possession increased from a civil violation to a Class
D misdemeanor crime, punishable by up to a year in
jail.
Unlawful trafficking of the drug increased from a
Class E misdemeanor to a Class B felony, punishable
by up to 10 years in prison.
Aggravated trafficking increased from a Class C to a
Class A felony, with a maximum penalty of 25 years.
Unlawful furnishing and aggravated furnishing
increased from Class E and D misdemeanors
respectively to Class C and B felonies.
Maine County Statistics
Common Adverse Effects of Bath Salts
Acute:
Tachycardia
Hypertension
Hyperthermia
Vasoconstriction
Muscle spasm/tremor
Seizures
Rhabdomylysis
Behavioral/Psychiatric:
Severe Panic Attacks
Psychosis
(hallucinations &
delusions)
Paranoia
Agitation
Insomnia
Irritability
Violent Behavior
Suicides are reported
Herbal Drugs of Abuse - Hallucinogens
Common Name/Active Ingredient
Salvia divinorum - Salvinorin A
Morning Glory - LSA (lysergic acid)
Hawaiian baby woodrose - LSA
Nutmeg - Myristicin, elemicin
Peyote - Mescaline
Ayahuasca - DMT (N, N-dimethyltryptamine)
Jimsonweed - Atropine, scopolamine, hyoscopamine
Anticholinergic effects
Absinthe – Thujone
Known for its euphoric effects
Herbal Drugs of Abuse – Stimulants, etc.
Common Name/Active Ingredient
Stimulants:
Ma-huang - Ephedra alkaloids
Khat - Cathinone, cathine
Betel nut - Arecoline
Yohimbine - Yohimbine
Guarana – Caffeine, xanthine alkaloids
Miscellaneous effects:
Kava – Kavalactones
Anxiolytic
Cloves – Eugenol, nicotine
Analgesic, stimulant
Kratom – Mitragynine, 7-hydroxymitragynine
Analgesic, euphoric properties
Which of the following herbals when
abused is known to cause hallucinations?
A. Ma-huang
B. Kratom
C. Nutmeg
D. Betel nut
E. Kava
Notable Herbal Products of Abuse
Salvia divinorum
Active compound: Salvinorin A
Potent hallucinogen
Rapid onset and duration
Overdose and dependence
True risk is unknown
Illegal in most states
Maine prohibited sale to minors < 18yo
Synthetic cannabinoids
Most commonly known as K2 or Spice
Other names: Bliss, Black Mamba, Bombay Blue,
Blaze, Genie, Spice, Zohai, JWH -018, -073, -250,
Yucatan Fire, Skunk, Moon Rocks
March 1, 2011: DEA published a final order in
the Federal Register temporarily placing five
synthetic cannabinoids as Schedule I in the CSA
Calls Received by U.S. Poison Control
Centers for Human Exposure to Synthetic
Marijuana, 2010 to July 2012
The number of calls in 2011 were
more than double that in 2010
6,959
3,821
2,906
SOURCE: American Association of Poison Control Centers, Spice Data, updated August 2012.
Kratom
Mitragyna speciosa korthals species
Botanical Classification: In the Rubiaciae family
(Similar to the cofffee plant)
Opiate like substance with analgesic properties
MOA: Acts on mu-opiod receptor
Used in Southeast Asia for opiate withdrawal symptoms,
constipation, anxiolytic
Which of the following herbals has
effects on mu and delta receptors,
causing analgesic and addictive
properties similar to opiates?
A. Salvia
B. Morning Glory
C. Kratom
D. Yohimbine
E. Khat
Treatment = less expensive than alternatives
Not treating or incarcerating = greater costs
Ie.) avg methadone maintenance x 1 year = $4,700 per person
avg imprisonment costs = $18,400 per person
Every $1 yields up to $7 in reduced crime related costs
Savings can exceed costs 12:1 when healthcare costs
are included
Reduced interpersonal conflicts
Increased workplace productivity
Fewer drug-related accidents
www.drugabuse.gov
NIDA 2012: http://www.drugabuse.gov/publications/topics-in-brief/medications-development-nida
www.drugabuse.gov

similar documents