Neurochemistry
Name the three major neurotransmitters that both cocaine and methamphetamine increase and whose reuptake they block.
Dopamine, norepinephrine, serotonin.
List two common immediate physiological effects shared by cocaine, meth, and nicotine.
Increased heart rate and increased blood pressure.
What is "meth mouth" and name two contributing factors.
"Meth mouth": severe dental decay; contributed by bruxism (tooth grinding) and decreased saliva production, poor hygiene, high sugar intake.
How is LSD most commonly administered?
LSD is commonly on blotter paper placed on the tongue
Name one major carcinogenic risk of tobacco smoking.
Cigarette smoking causes around 80% of lung cancer cases; tobacco contains >70 carcinogens.
Explain why large surges of dopamine contribute to tolerance and dependence for stimulants.
Repeated large dopamine surges reduce receptor sensitivity and reward signaling; neurons adapt (downregulate receptors), producing tolerance; dependence follows because normal reward requires drug.
What is formication and which stimulant listed commonly causes it?
Formication = sensation of insects crawling on/under skin; commonly caused by cocaine and methamphetamine.
Describe one long-term pulmonary consequence of chronic cigarette smoking.
Chronic Obstructive Pulmonary Disease (COPD) — chronic bronchial inflammation and alveolar wall breakdown.
Identify two common forms/crystalizations in which cocaine and methamphetamine are sold that change the typical route of administration.
Cocaine: powder (snorted) and crack (rocks, smoked). Meth: crystal (smoked) and powder/pills (snorted or ingested).
Explain why vaping is often considered "less harmful" than smoking but still poses health concerns.
Vaping eliminates combustion byproducts (reducing some carcinogens) but may deliver harmful chemicals depending on liquid contents; devices can also malfunction (explosions).
MDMA primarily causes large increases in which neurotransmitter system linked to mood and social effects?
Serotonin (with effects on empathy/sociality).
Identify three acute symptoms associated with MDMA use that can lead to medical emergencies.
Hyperthermia, dehydration, and bruxism (teeth grinding) — can lead to severe overheating, electrolyte imbalance, or long-term damage.
Explain how chronic nasal insufflation (snorting) of powdered cocaine can lead to structural damage in the nose and roof of the mouth.
Cocaine’s vasoconstriction reduces blood flow causing tissue ischemia; hydrochloride residue can form HCl causing chemical damage; together can cause necrosis and perforations in nasal septum and roof of mouth.
Explain why injecting powdered meth (after melting) increases additional health risks not present with smoking or snorting.
Injection risks include transmission of bloodborne pathogens (Hepatitis B, Hepatitis C, HIV) and complications from non-sterile technique.
Provide two public-health reasons why stimulant or hallucinogen use may increase risk of infectious disease spread.
(1) Shared injecting equipment spreads bloodborne pathogens; (2) impaired judgment may lead to risky sexual behaviors increasing STI spread.
Describe how chronic methamphetamine use can permanently affect dopamine neurons.
Methamphetamine is neurotoxic to dopamine neurons — chronic use can destroy or damage dopamine-producing neurons, reducing the brain’s natural dopamine production.
Explain why LSD doses are measured in micrograms rather than milligrams and one safety implication of this potency.
LSD is extremely potent, so effective doses are micrograms; small dosing errors (contamination or mislabeling) can lead to unexpectedly strong effects or accidental overdoses.
Name two severe lung injuries associated with inhaling crack cocaine smoke and briefly describe each.
Pulmonary edema — fluid in lungs causing shortness of breath and cough; alveolar hemorrhage — bleeding in lung tissue; pneumothorax — collapsed lung from airway/alveolar rupture.
Describe how the method of administration changes the onset and intensity of effects for stimulants when comparing smoking, snorting, and injecting. Include one physiological reason why each route produces different time courses.
Smoking:
Onset and intensity: Rapid onset (seconds to minutes) with high peak intensity because the drug is delivered directly to the lungs and then quickly into arterial circulation and the brain.
Snorting (insufflation):
Onset and intensity: Moderate onset (minutes) with intermediate peak intensity; effects are slower and usually less intense than smoking or injection.
Injecting (intravenous):
Onset and intensity: Fastest onset (seconds) and often the highest immediate intensity since the drug is placed directly into systemic circulation.
Discuss how tolerance and withdrawal can contribute to high relapse rates in stimulant use disorders; cite one statistic or figure from the notes about meth relapse.
Withdrawal and tolerance drive continued use; notes state ~61% relapse within a year for meth users — showing addiction persistence.
Define the First Pass Effect and explain how it can contribute to tolerance for orally ingested hallucinogens.
The First Pass Effect: liver enzymes metabolize orally ingested drugs before they reach systemic circulation; increased enzyme activity with repeated exposure reduces bioavailability and contributes to tolerance.
Compare and contrast the short-term pulmonary effects of smoking crack cocaine versus vaping nicotine-containing liquids.
Crack smoking can cause direct chemical and particulate lung injury (pulmonary edema, alveolar hemorrhage, pneumothorax) due to smoke and additives; vaping typically exposes lungs to vaporized liquids that may be less carcinogenic but can still cause lung injury depending on contaminants and solvents.
Describe how levamisole, commonly used to cut cocaine, can worsen health outcomes for users.
Levamisole suppresses the immune system and can cause vasculitis (inflammation of blood vessels), increasing infection risk and tissue necrosis; it may be undetectable and potentiates dopamine effects.
List three types of adulterants or additional drugs sometimes found in ecstasy/MDMA tablets and one risk each poses.
Adulterants in ecstasy/MDMA tablets: MDA, MDEA, amphetamines/methamphetamine, ketamine, cocaine, opiates — risks include unexpected stimulant or depressant effects, overdose, or neurotoxicity.
Outline a brief harm-reduction advice point for each of the following: (a) someone who insists on using MDMA, (b) someone who smokes crack, (c) a teen considering vaping.
Harm-reduction tips: