Slide 1 I 2 cca 1.

min

SLIDE 3 cca. 30 sec.

In order to talk about drug addiction, I believe that we first need to define what
drugs are. The term drug or psychoactive substance refers to any substance
that can change the psychological and behavioural functions of the individual
and cause functional or pathological changes in the central system. The use of
psychoactive substances in ways that are believed to cause psychological
dysfunctions and behavioural disorders is called drug abuse. Because there are
so many different drugs, each drug causes a different form of addiction.

SLIDE 4 cca. 2 min.

Opium alkaloids, derived from crude Papaver somniferum L. plant, are potent
analgesic drugs, but their use is limited because of dependence and
withdrawal. Opium alkaloids activate the mesocorticolimbic dopaminergic
system, which project from the ventral tegmental area to the nucleus
accumbens and medial prefrontal cortex, and dopamine is critically important
in opioid consumption and sustaining. The reward effect resulting from the
activation of the dopaminergic system leads to continued opioid consumption
and occurs opioid dependence. After the development of opioid dependence,
consumption continues to avoid withdrawal syndrome. Opioid dependence is
accompanied with tolerance, which requires the use of high doses to achieve
the same effect. When tolerance develops, the chronic consumer continues to
use opioid above known toxic doses to produce the same effect, which can
result in death regardless of the type of opioid used.
The most famous drugs from the opium alkaloids group are: Morphine,
codeine, thebaine, papaverine, noscapine and heroin.

Morphine - has analgesic, narcotic effects and can lead to unconsciousness.

Symptoms of acute poisoning are constriction of the pupils, drowsiness,
shallow breathing, and death may occur due to respiratory paralysis.

Codeine - has antitussive and analgesic effect. The symptoms of acute

poisoning are constriction of the pupils, drowsiness, shallow breathing,
spasticity, respiratory arrest.

Thebaine - has an analgesic, stimulating effect. The symptoms of acute

poisoning are constriction of the pupils, drowsiness, shallow breathing,
spasticity, respiratory arrest.

Papaverine - has a spasmolytic effect. The symptoms of acute poisoning are

constriction of the pupils, drowsiness, shallow breathing, spasticity, respiratory
arrest.

Noscapine - has an antitussive effect. The symptoms of acute poisoning are

constriction of the pupils, drowsiness, shallow breathing, spasticity, respiratory
arrest.

Heroin - has a euphoric, analgesic effect. Symptoms of acute intoxication are

constriction of the pupils, drowsiness, shallow breathing, spasticity, respiratory
arrest.

SLIDE 5 cca. 1 min

The opioids have a variety of clinical effects, but are predominantly known and
used for their profound pain-relieving effects. Other effects that are often
linked to opiate analgesia include euphoria, changes in mood, drowsiness and
mental clouding. However, the distinctive feature of the analgesia induced by
the opioids is the lack of loss of consciousness. The pain is often described as
less intense, but still present although better tolerated. Thus, the opioids do
not decrease or treat the cause of the painful stimulus, but rather decrease its
perception.

Other effects of opioids include respiratory depression, decreased

gastrointestinal motility, sedation, nausea, vomiting, constipation and intestinal
bloating. Opioids also have direct cardiovascular effects, decreasing blood
pressure, causing vasodilation and decreasing cardiac work.

The most famous representative of synthetic opiates is methadone

(heptanone). It works in a similar way to morphine, has a pronounced analgesic
and antitussive effect, is better absorbed orally and has a longer duration of
action. It is used in the treatment of heroin addiction.

A specific antagonist for morphine and its derivatives is naloxone, which

reversibly inhibits analgesia, miosis, respiratory depression, convulsions, coma
and slowed gastric transit. Abstinence syndrome can occur in addicted patients.

SLIDE 6 cca. 2,5 min

If you suspect someone might be having an opioid overdose, start by

stimulating them to confirm that they are unresponsive. Shout at them – use
their name if you know it. Next do a trapezius squeeze (squeeze the nailbed of
the finger) or pinch the webbing between their thumb and fingers to see if they
respond to pain. Always tell someone what you are going to do before you
touch them.
If the person does not respond to sound or pain, then it is a medical
emergency.
Call 112.
Check the person’s mouth for any obstructions. Items like gum, dentures, or a
syringe cap could be preventing them from breathing properly. Remove any
obstructions. Once you’ve confirmed the mouth is clear, tilt their head back –
this opens their airway.
The next step is to breathe for the person.
Keep the person’s head tilted back, pinch their nose, and give them two
breaths. You should be able to see their chest rise with each breath. Continue
to give one breath every five seconds until the person is breathing on their own
or first responders arrive.
If you are responding by yourself and do not have naloxone, or do not feel
confident about administering naloxone, breaths are more important.
Evaluate: Has the person responded to your breaths?
If they are still unresponsive, continue the rescue breathing (one breath every
five seconds). Now is the time to give naloxone, if you have it. If there is
someone with you, have them prepare the naloxone kit.

Inject the naloxone into a muscle.

Evaluate: Monitor the person to see if they respond to the naloxone. Do they
start beathing again? Do they regain consciousness?

If not, keep giving one breath every five seconds.

If they have not regained consciousness after three to five minutes
(approximately 40 breaths), you can give a second dose of naloxone.
Monitor the person after each dose is given for three to five minutes
(approximately 40 breaths) before giving additional doses.
Naloxone is a safe medication, but people who are dependent on opioids may
experience unpleasant withdrawal symptoms like pain, sweating, agitation and
irritability. For this reason, it is important to give the lowest dose of naloxone
required to reverse the overdose. Naloxone can take three to five minutes to
work, so waiting five minutes between doses is important.
SLIDE 7 cca. 1,5 min

Cocaine is the main alkaloid of Erythroxylon coca and Erythroxylon

novogranatense var. truxillense. The highest concentration is found in the
leaves. It can also be obtained synthetically. Cocaine leads to localised
insensitivity and vasoconstriction. It is taken orally in a dose of 50 milligrams
and works by eliminating the feeling of hunger, banishing tiredness and leading
to euphoria. Cocaine is also used as a local anaesthetic in concentrations of 1 to
20%.

Any use of cocaine is considered abuse because it is an illegal substance.

Cocaine is a central nervous system stimulant that affects the brain by
stimulating high levels of dopamine, a brain chemical associated with pleasure
and reward. Over time, cocaine negatively effects every part of the body with
potential for severe long-term effects. It can cause changes to genetics in brain
cells, nerve cells and proteins, among other permanent effects.

How people use cocaine also alters the potency and duration of the effects. The
effects of snorting it are short-lived, lasting approximately 15-30 minutes.
Smoking or injecting cocaine is more intense but lasts for an even shorter
period, about 5 to 10 minutes. Most cocaine users will dose frequently in order
to maintain the desired effects. Injecting the drug poses a higher risk of
overdose than snorting.
Cocaine abuse is particularly dangerous because continued use can cause strain
on the heart. The most common cause of death in frequent cocaine users is
stroke or cardiac arrest.

SLIDE 8 cca. 1,5 min

Amphetamines and their derivatives are stimulants for the central nervous
system. Amphetamine derivatives can be found on the market in the form of
diet pills due to their pronounced anorexic effect. Their stimulating effect leads
to a brightening of the user's mood, creates a feeling of increased vigour,
eliminates tiredness and prevents drowsiness. The effect of amphetamine is
individual and depends not only on the dose taken. The method of
administration is oral or by injection.

The most popular, known synthetic analogue of amphetamine is MDMA or

ecstasy. Like other synthetic analogues of amphetamine, ecstasy is a very
widely used drug, especially by adolescents and younger age groups.

A person may experience the intoxicating effects of MDMA within 45 minutes

or so after taking a single dose. Those effects include empathy for others,
willingness to engage in an emotional discussion, increase in body
temperature, hypertension, weakness, panic attack, loss of consciousness,
clenching of the jaw, loss of appetite, restless legs, nausea, sweating,
headaches, stiffness of the joints, depression, anxiety, aggression, sleep
disturbance, heart disease.

However, MDMA can also cause a number of acute adverse health effects. For
example, while fatal overdoses on MDMA are rare, they can potentially be life
threatening with symptoms including high blood pressure (hypertension),
faintness, panic attacks, and in severe cases, a loss of consciousness and
seizures.

SLIDE 9 cca. 1. min

Psychedelics are a type of drug that changes a person’s perception of reality.

Also known as ‘hallucinogens’, they make a person see, feel and hear things
that aren’t real, or distort their interpretation of what’s going on around them.
Some you will feel their effects quickly, others will take longer before you feel
something. Being under the influence of a psychedelic is commonly referred to
as ‘tripping’.

Some psychedelics are manufactured, like LSD (lysergic acid diethylamide), PCP
(phencyclidine, or ‘angel dust’) Others are naturally occurring compounds
found in particular plants. For instance, the peyote cactus produces the
hallucinogen mescaline, while psilocybin is found in certain mushrooms, known
as ‘magic mushrooms.’

SLIDE 10 cca. 0,5 min

Psychoactive substances with hallucinogenic effects are produced from herbal

preparations. Examples include dry parts of cacti containing mescaline or plants
containing dimethyltryptamine. These plants are legal until they start
producing substances for abuse. You can purchase these substances via the
internet or smart shops. The most famous among them are: Salvia (Salvia
divinorum), Kratom (Mitragyna speciosa), Kava kava, Iboga (Ibogaine), Peyolt
(Mescaline), FLY (2C-B-FLY), Magic mashrooms (Amanita muscaria), the
phenethylamine group (Bees , Nexus, Triptasy, N-Bomb) and the 2C
phenethylamine group.
SLIDE 11 cca. 0,5 min
New psychoactive substances are a worldwide phenomenon and problem that
mimic the effects of controlled drugs. Every day there is a growing number of
new substances that are created by small changes in the chemical structure
and are therefore not on the list of drugs, psychotropic substances and plants
from which drugs can be extracted.

Acute intoxication, overdose and death are the biggest problems associated
with the use of new psychoactive substances, as only a very small amount is
required for their effects and users often reach for larger doses in order to
achieve the fastest and strongest effect. They are also known as designer drugs.
They include: synthetic cannabinoids, synthetic cathinones and synthetic
phenylethylamines.

SLIDE 12 cca. 1,5 min

According to the definition of the World Health Organisation, drug addiction is
a psychological and sometimes also a physical condition caused by the
interaction between a living organism and an addictive substance, and
characterised by a change in behaviour and other reactions which always
include an urgent compulsion to take the addictive substance occasionally or
regularly, either for its desired effects or to avoid the suffering that occurs
when use is discontinued

Addict is defined by 3 of 7 criteria by the DSM-V:

SLIDE 13 cca 1,5 min
Neurons are the cells that process information in the brain. Neurotransmitters
are chemicals released by neurons to communicate with other neurons. When
a neuron is activated it releases a neurotransmitter into the synapse, the gap
between two neurons (figure l-l). The molecules of the neurotransmitter move
across the synapse and attach, or bind, to proteins called receptors in the outer
membrane of an adjacent ceil. Once a neurotransmitter activates a receptor, it
unbinds from the receptor and is removed from the synapse. This is done
either by the neurotransmitter being taken backup into the neuron that
released it or by its being chemically broken down.

For each neurotransmitter in the brain, there are several specific receptors to
which it can attach. Binding by the neurotransmitter activates the receptor.
Receptors can be linked to a variety of membrane and cellular mechanisms that
are turned on or off by the activation of the receptor. while receptors are
specific for a neurotransmitter, there maybe a variety of receptor subtypes,
linked to different cellular mechanisms and to different neuronal circuits, that
all respond to the same neurotransmitter. In this way one neurotransmitter can
have diverse effects indifferent areas of the brain. Many chemicals have been
identified as neurotransmitters. Sores are of particular relevance to the
rewarding properties of drugs of abuse. These include dopamine,
norepinephrine, serotonin, opioids and other neuropeptides, gamma amino
butyric add (GABA), and glutamate.

A neuron can have thousands of receptors for many different

neurotransmitters. Some neurotransmitters activate neurons (excitatory
neurotransmitters), while others decrease neuron activity (inhibitory
neurotransmitters). Sometimes a receptor for one neurotransmitter can affect
a receptor for another neurotransmitter. In such cases, the receptors are
biochemically coupled: the activation of one modulates the function of the
other, either increasing or decreasing its activity. A neuron can also have
receptors for the neurotransmitter it releases. Such receptors are acted on by
the neuron’s own neurotransmitter to regulate the release of the
neurotransmitter. Thus, these so-called autoreceptors act as a feedback
mechanism to regulate a neuron’s activity. The activity ofa neuron will be
determined by the cumulative activity of all of its various receptors.

Drugs that work in the brain, including drugs of abuse, alter normal
neuropharmacological activity througha varietyofdifferent mechanisms. They
can affect the production, release, or reuptake of a neurotransmitter, they can
mimic or block the action of a neurotransmitter at a receptor, or they can
interfere with or enhance the activity of a membrane or cellular mechanism
associated with a receptor. Prolonged drug use has the potential to alter each
of these processes.
SLIDE 14 cca 1 min

There are 6 steps during the process of drug addiction recovery; Inpatient,
OutpTIENT, Medical Detox, Therapy, Holistic Treatments, Cognitive Behavioral
Therapy.
But the most important procedures in the addiction treatment programme are:
- pharmacotherapy (for opiate addicts, use of opiate agonists - methadone
and buprenorphine)
- addiction psychotherapy
- family support and psychotherapeutic procedures
- education about the disease and learning relapse prevention strategies
- prevention of infections (HIV, viral hepatitis, syphilis), including testing
- social interventions
- social reintegration support measures
- urine control for the presence of drug metabolites
- comorbidity therapy
SLIDE 15 cca 15 sec

Addiction is a disease that needs to be treated like any other disease. We

need to take the stigma away from people who become addicted because
there are many reasons why someone turns to drugs. Each patient should be
approached with the best treatment method and of course each patient should
be individually cared for and the therapy adapted to them so that it achieves
the best and most favourable effect for them.