Announcements:Lab day October 16 which means no classPaper 2 is due October 21TopicsDepressants: Opioid medication treatmentsStimulants: CocaineGoalsIntroduction to “replacement therapies” for addictionUnderstand motivations for stimulant use and cocaineDepressants follow-upOpioid replacement therapiesE.g., buprenorphine, methadoneOccupy opioid receptors, blocks heroin and other opiates, decreases cravings, relieves some withdrawal symptomsTreatment can last a year or longerCommunity concerns: program attracts “addicts” and crimeFurther notes:To treat opiates give someone another opiate that has very mild psychoactive affects and an opiate that produces less negative social and less negative health affects.Opioid receptors, heroin binds to it and then occupies that part and activates it. Other drugs bind to the receptor but the level of activation is much milder. First of all because it binds to the receptor it helps with the withdrawal, receptor activated in mild ways so it helps withdrawal. Also it binds to the receptor so that means that if the person shots heroin, it won’t activate the receptor as much since the receptor is already occupied. So the new treatment for opioids helps even if someone decides to take heroin again.Video Notes:On methadone people can function in school, or work, or anything else. These are safer drugs, only partially activated receptor so hard to overdose on. A doctor can give a supply to a patient who can then have their addiction treated; craving reduced or eliminated, and then can still live a relatively normal life.These medications can really help change people who are addicted to opiates.Another issue is the availability of these drugs. There are multiple providers in somewhere like Madison. You need special training to distribute these drugs. It could be hard to find someone certified to prescribe the medication in a small town.Replacement therapiesReplacement therapies improve many aspects of a person’s life…But no treatment is perfectSome argue that “replacement therapies”, and particularly methadone, simply replace one addiction for anotherWhat do you think?-Some people take methadone for years and years.-Some people tapered off of it and feel good or feel terrible and return to use and then put back on methadone. It really depends on the person.-If people don’t respond to the lowest level does the dose increase? Yes. Some people will respond well to a specific dose it can be changed throughout the course of treatment.-Withdrawal and tolerance are there. People would meet criteria for withdrawal and tolerance to these drugs. In that sense they would be addicted to another drug while they are on this.-At least here people cannot overdose from this medication and it reduces cravings.-One question is, is it okay to be addicted to something else, while still addicted to heroin or other opiates, when risks are definitely reduced? This new method doesn’t cause much harm so it seems better…-If you are on prescribed drugs you can be monitored so at least for these replacement drugs are moderated.-With drugs like methadone you can get high off of them and the way that this works is that people save a bunch of them and then take them. That is another criticism of it. But there is a drug in the replacement therapy category that if you take a bunch of it there isn’t a way to get high.Policy issues from opiatesThere is a cycle that has really been identified by real people and researchers in that we are seeing an exchange between prescription opiate misuse and heroin use. If they don’t have a prescription anymore they can still often get the pills from friends or another source. And when these people cannot find that prescription drug anymore they can turn to heroin because it is easier to get. But also the reverse too. People switch from heroin to prescription opiates.Effective policies for reducing prevalence of opiate addictionStatewide prescription drug monitoring databasesPenalties for doctors who overprescribeRequire pain clinics to register with the statePharmacies, drug wholesalers, and pharmacists obligated to report questionable purchases-If pharmacists see a doctor prescribe opiates through the roof they can report that.Wisconsin InitiativesWI heroin deaths jumped by 50% in 2012 to ~187 a yearLegislation in Wisconsin to address opiate epidemic (October 4, 2013)Media CampaignWI Prescription Drug Monitoring Program (Implemented June 1, 2013)-prevention program-nice online intervention to help reduce opiate use-even in Wisconsin there are these help programsSedativesGeneral effectsCalming effect, reduces anxiety (anxiolytic)Sleep-inducing (hypnotic)Some of the effects are similar to alcoholMedical useAnxiety, insomnia, seizure management, prevent alcohol withdrawalPopular sedative/hypnoticsBenzodiazepinesMany are DEA Schedule III and IVSleep medications: Lunesta, Ambien, SonataBarbituratesMore popular in early-mid 20th centuryGABA receptorMany sedatives increase effects of the GABA neurotransmitterReceptor lets ions into the neuron, changes the neuron’s chemical compositionReduces the neuron’s activity (inhibitory effects)-there are a bunch of chemicals endogenous and exogenous transmitters that bind to the receptor. Many chemicals bind to the receptor but can be on a different place. If you take a benzodiazepine or drink alcohol directly bind to the receptor. And when this happens it actually opens the receptor up and the ions can flow through and can change the chemical composition of the receptor. It reduces ability for neuron to fire. It slows you down. If you take more than one of these things like a benzodiazepine and alcohol they both bind to the receptor. Rather than a 5 to a 3 you go from a 5 to a 1. They enhance each other’s effects.Undesired properties of benzodiazepinesMemory impairmentTolerancePsychological and physical dependenceWithdrawal is similar to alcohol and can be fatalMixing with alcohol: synergistic effect (act together, enhance each other) on GABA receptor, particularly risky-More likely to suffer a blackout if you use alcohol with benzodiazepines.Done with depressants moving on to uppers/stimulants-many people’s drug of choiceStimulantsStimulants “keep you going” mentally and physicallyMentalEuphoria, rush, confidence, concentrationPhysicalEnergy, weight loss, decongestant, staying awake-now stimulants not affective for weight loss. It reduces your appetite, but if you use the