1. The financial loss because of drug abuse in HK last year was__________________

4.3 billion dollars (0.3% of the gross domestic production)

2. What are the two most commonly abused chemicals?

Alcohol and cigarettes (smoking)

3. What are ‘Anaesthetics’ and ‘Analgesics’?

Anaesthetics are drugs that make the body unable to feel pain. while analgesics are painkillers

A pandemic problem – occurs in developed, developing and under-developed countries Abuse of psychotropic drugs is most common

Substance Abuse

Chemical Abuse? Drug Abuse?

物質濫用化學劑濫用 ?

藥物濫用 ?

Psychotropic Drug Seizure in

Different Regions in 1990 and 1998

Region 1990 1998 (% Global Seizure)

East & South Asia* 22 41

Europe# 20 38

North America 14 18

*The amount of psychotropic substances seized reached 31.6 tones in 2000.

# The rise occurred mainly in Eastern Europe

(Source: United Nations Commission in Narcotic Drugs)

Scientific issues:• How do drugs affect behaviour? • What are the effects of drug abuse?• Why do some people use drugs?• Do abusers idsplay any abnormal signs of habits?

We do not use ‘drugs’, why should we study “Drug abuse”?

Drug abuse is an important social problem:• Causes heavy financial loss in society• Rapid increase in drug abusers recently• Related to organized crime or triad society activities

Number of People Arrested for Drug OffencesNumber of People Arrested for Drug Offences

0

2000

4000

6000

8000

10000

12000major offences

minor offences

YearYear

Peo

ple

Ar r

este

dP

e op

l e A

rre s

t ed

濫用精神藥物者 ( 一九九五至二零零零年 )Psychotropic substance abusers (1995-2000)

0

1000

2000

3000

4000

5000

6000

7000

1995 1996 1997 1998 1999 2000

0

5

10

15

20

25

30

35

No

. o

f p

ers

on

s

Percen

tage

比分

百數

人

濫用精神藥物者人數 Number of psychotropic substance abusers

濫用精神藥物者佔同年被呈報並備有藥物種類資料的人數百分比

% of psychotropic substance abusers among all individuals with type of drug reported in that year

資料來源 : 藥物濫用資料中央檔案室Source: Central Registry of Drug Abuse

Reasons for drug use

Reason Percentage

Peer influence /to identify with peers 45.7

Avoid discomfort of its absence 45.7

Curiosity 27.5

To seek euphoria or sensory satisfaction 23.2

Relief of boredom/depression/anxiety 21.4

For self-medication 4.3

Under influence of the partner 1.4

Other reasons 2.5

資料來源 : 藥物濫用 資料中央檔案室 Source: Central Registry of Drug Abuse

A chemical used in the diagnosis, prevention or treatment of diseases

A chemical used in the treatment of diseases

用作診斷、預防及治療疾病的化學劑用作治療疾病的化學劑

什麼是藥物 ?What is a drug?

All drugs should be used with extreme care

所有藥物必需小心使用

Side (Undesirable) effects [ 副作用 ]

Overdose toxicity [ 過量毒性 ( 過量性中毒 )]

Allergic reaction(s) [ 過敏性反應 ]

Tolerance [ 耐藥性增加 ]

Addiction [ 成癮 ]

Adverse Effects of Drugs 藥物的不良作用

Path Leading to Addiction ( 成癮 )

Experimental use 試探性使用 Social use 社交性使用 Episodic abuse 偶發性使用

Tolerance 耐藥性增加 Addiction 成癮

1. Drugs can be divided into ‘Hard’ and ‘Soft’ drugs???

No. All drugs have undesirable effects!

2. ‘Soft’ drugs will not cause addiction???

No. Misuse of any drug is harmful & dangerous.

Possession of a ‘restricted’ drug/chemical, in any form, is illegal

True or False ?

Mood/mind-altering substances used by some teens and young adults who attend rave parties, nightclubs, karaoke clubs, etc

Said to increase stamina (ability to endure physical and mental strain) and intoxicating highs that are said to deepen the rave or trance (hypnotic state) experience

Some commonly abused club drugs in HK are: MDMA (Ecstasy), Rohypnol, GHB & Ketamine.

They exert their effects by acting on the brain

Some of them are highly addictive

What are Club/Party Drugs?

How Are Psychoactive Substances Taken?

Sleeping pills & Amphetamines

Mouth Stomach/Intestine Blood Brain

Heroin

Injection Blood Brain

Cocaine, Marijuana & Organic solvents

Inhaling or Sniffing Nose Respiratory tract /Lungs Blood Brain

Note: Regardless of the routes, they all enter the brain and affect brain functions and alter behaviour

1. Which of the following drugs would affect behaviour: aspirin, Panadol, antibiotics and heroin?

Heroin

2. Heroin alters behaviour by affecting ______ (an organ).

Brain

The ‘Central nervous system consists of ________ and ____________.

The brain and spinal cord

Central Nervous System

Controls all activities in our body

(like the CPU of a computer)

Brain

Spinal cord

Structures: Brain & Spinal cord

Functions:

Brain: controls thinking & behaviour

Spinal cord: Transmit signals from the brain to other par

ts and back

Parietal lobe:

movement,reasoning, memory, etc.

Spinal cord:

convey motor & sensory messages

Cerebellum:

modulate motoractivities, etc

Occipital lobe:

vision, etc

Temporal lobe::

memory, speech, etc

Frontal lobe:

cognition, judgment, speech, thinking, writing, etc

Brain Function

Different areas perform different functions

Neurons are building blocks of the nervous system

There are 1-10 billion in the brain

Neurons have many shapes

They are specialized cells that transmit (carry) signals in the nervous system (from one neuron to another)

Neuron (Nerve cell)

神經細胞

突觸裂隙突觸前細胞

突觸後細胞

Neurons 神經細胞

細胞核軸索( 突 )

Note: Neurons are not in direct contact with one another

Axon

Synaptic cleft

Nucleus

Pre-synaptic neuron

Post-synaptic neuron

Psychotropic drugs 精神科藥物的分類

1. Narcotic analgesics (heroin, morphine) 止 (鎮 )痛藥 ( 鴉片類 )2. Depressants (benzodiazepines; ketamine) 鎮靜 (抑制 )藥 ( 十字架、氯胺酮 )3. Stimulants (amphetamines, caffeine) 興奮藥 (安非他明、咖啡因等 )4. Hallucinogens (marijuana; LSD) 幻覺藥 (大麻、黑芝麻 [LSD] 等 )

5. Anti-psychotics (clozapines; haloperidol)* 治療精神病藥

*Rarely abused

Commonly Abused Drugs by Persons of All Ages in HK (2001)

Drug Percent*

Heroin ( 海洛英 ) 71.8

Ketamine ( 氯胺酮 ) 15.7

Ecstasy ( 忘我 ) 14.5

Cannabis ( 大麻 ) 6.3

Ice ( 冰 ) 5.4

Total > 100% as some abusers use more than one type of drug•Source: Central Registry of Drug Abuse 48th Report (2001),

Narcotics Division

Commonly Abused Drugs by Persons Under 21 in HK (2001)

Drug Percent* Ecstasy ( 忘我 ) 56.6Ketamine ( 氯胺酮 ) 56.4Cannabis ( 大麻 ) 14.3Heroin ( 海洛英 ) 14.2Ice ( 冰 ) 10.6

*Total > 100% as some abusers use more than one type of drugSource: Central Registry of Drug Abuse 48th Report (2001), Narcotics

Division

Sources of Drugs in Hong Kong

Heroin: Golden Triangle Mainland China* HKMDMA (Ecstasy): Europe HKMethylamphetamine (Ice): Mainland China* HKCannabis: Golden Triangle & Cambodia Mainland China* HKCocaine: South America HKBenzodiazepines (sleeping pills) & ketamine: Local

dispensary operators, medicine brokers & unscrupulous medical practitioners

*Mainly through Guangdong Province

After a cup of black coffee or strong tea, you feel awake and more alert. The major chemical that causes these effects is_______.

To heroin abusers, what are 『港紙』 and 『美金 』 ?

???????? Will tell you later!

Caffeine ( 咖啡因 )

They are pain-killers

4 major forms: heroin ( 海洛英 ), morphine ( 嗎啡 ), opium ( 鴉片 ) & codeine ( 可待因 , cough syrup)

Heroin is a white or brownish powder

Heroin (diacetylmorphine) most potent and highly addictive

Street heroins are diluted with sugar, starch, powdered milk, quinine, caffeine, antipyrine, theophylline, car

betapetane, acetaminophen ( 必理痛 ) or even with strychnine or other poisonous substances

麻醉止 (鎮 ) 痛劑

Narcotics analgesics (Opiates)

Heroin is usually injected, sniffed/snorted or smoked. Effects: Intravenous injection > intramuscular

injection > sniffing or smoking [ 鼻吸或口吸 ( 追 龍 )]

Street names:

• Heroin : smack, H, skag, junk, 白粉 , 粉 , 灰 ,四仔 , 港紙 (純度約 15-65%), 美金 ( 純

度約 70- 90%)

• Codeine : MB, 高甸 , 止咳水 , 囉囉攣• Methadone: 美沙酮 , 蜜瓜汁

Narcotics analgesics (Opiates)

Short-term Effects of Heroin Abuse

Euphoria ("rush") warm flushing of the skin, a dry mouth, and heavy extremities

Clouded mental function

Respiration depression Death

AIDS & hepatitis infection

Pupil constriction

Constipation

海洛英

* Through use of common syringes & needles among addicts

Collapsed veins, infection of the heart lining and valves

Liver & lung diseases

Develop tolerance, physical dependence & addiction

AIDS and hepatitis*

Long-term Effects of Heroin Abuse

* Through use of common syringes & needles among addicts

海洛英

Withdrawal Symptoms of Heroin Addiction

Chills

Sweating

Runny nose and eyes

Abdominal cramps

Muscle pains

Insomnia

Nausea

Diarrhea

海洛英

斷癮徵狀

2. Which of the following is toxic: methyl alcohol (wood alcohol) or ethyl alcohol?

1.What happens when you have too much alcohol?

3. Why is ‘ketamine’[ 氯胺酮 } called a date-rape drug?

Methyl alcohol

Drunk and don’t remember anything. WHY???

It is colourless, odourless and tasteless drug and can be slipped into drinks to cause disinhibition in the unwitting victim.

CNS Depressants

Sedative Hypnotic Compounds

鎮靜 (抑制 )藥

Chemicals that slow down normal brain function

Because of this property, some CNS depressants are useful in the treatment of anxiety and sleep disorders

Examples: Alcohol, Inhalants (organic solvents & cigarette lighter fluid)

Ketamine*, Barbiturates* & Benzodiazepines*

*Medicinal drugs

What Are CNS Depressants?

A non-selective depressant of the nervous system

Used in social & recreational occasions

One of most commonly used chemicals

Absorbed rapidly in stomach/intestine

70% is bactericidal (in 1-2 minutes)

Alcohol content: beers (~5-10%), table wine (9-15%), spirit (40%)

Methyl alcohol (wood alcohol) is toxic.

Ethyl Alcohol

酒精 ( 乙醇 )

Do not drive if > 50 mg/100ml (or .05%). WHY?

Social activities (short-term)

Impaired psychomotor performance

Chronic use nutrients insufficiency*

Damage to the CNS memory loss

Damage to the liver (fatty liver & liver cirrhosis)

Death (accidents, respiratory control, etc)

* Loss of appetite & inability to absorb nutrients properly.

Effects of Alcohol

Volatile substances that produce chemical vapors that can be inhaled to induce psychoactive, or mind-

altering, effects.

Inhalant (Harmful) chemicals found in household products:

toluene; methylene chloride; acetone; benzene; isoamyl nitrate; isobutyl nitrite; butane; propane; freon*; butane; isopropane etc

*A refrigerant.

What Are Inhalants?

溶解劑 , 氣油和打火機氣體

How are inhalants used?

“Sniffing” or “snorting” fumes from containers

Spraying aerosols directly into the nose or mouth

“Bagging”–sniffing or inhaling fumes from substances sprayed or deposited inside a plastic or paper bag

溶解劑 , 氣油和打火機氣體

Short-term Effects of Inhalants

Low doses:

Initial excitation Disinhibition of behaviour*

Drowsiness, Lightheadedness, & Agitation

High doses:

Anaesthesia Loss of sensation, Loss of respiratory control Unconsciousness Death

* Inhibition of ‘inhibitory neurons’

溶解劑 , 氣油和打火機氣體

Harmful Effects of Some Inhalants

Chemical Harmful Effects

Amyl/Butyl nitrite Immune function; death

Benzene Immune function; bone marrow injury; risk of leukemia; death

Butane/Propane Heart function; death

Freon Respiratory obstruction; death

Methylene chloride

Oxygen carrying capacity in blood; heart beat; death

Nitrous oxide Perception, heart function & muscle coordination; death

Toluene Coordination & cognition; brain, liver and kidney damage; death

Long-term Effects of Inhalants

Dizziness, drowsiness, slurry speech, lethargy, depressed reflexes, general muscle weakness & stupor

Impaired judgment & functioning in work or social situations

Belligerence (Aggressive behaviour)

Apathy (Lack of interest & enthusiasm)

Memory loss (permanent)

Brain, kidney and liver damage Death

溶解劑 , 氣油和打火機氣體

What is ketamine?

An anaesthetic used primarily for veterinary use

Street names:‘Special K’, ‘Vitamin K’, ‘Lady K’, ‘Super K’, ‘K’, ‘OK’, ‘KO’

Liquid (injection); in illicit use ketamine is generally evaporated to form a powder that is snorted or compressed into pills

A ‘Date Rape’ drug (clourless, odourless & tasteless)

氯胺酮 /K 仔

氯胺酮 /K 仔

Effects of ketamine

Low doses:

Sociability, euphoria, slurry speech, dry mouth, respiration, racing heart

Senses, judgment, and coordination (stumbling, clumsy, or 'robotic' movement delayed reaction time, irrationality, violent or aggressive behavior)

Nausea and/or vomiting (anaesthetic effects)

Confusion, hallucination (visual, altered body image & dreamy thinking)

Effects of ketamine

氯胺酮 /K 仔

High doses:

Oxygen supply to muscle and brain Death

Pregnancy:

Triggers widespread cell death in the brains of developing rats

Not yet seen in humans

1. Can you name two commonly (mis)used stimulants?

3. Which is more dangerous: taking sleeping pills with water or sleeping pills with alco

hol?

Sleeping pills with alcohol. Why????

Caffeine and nicotine (cigarette smoking)

2. Which is more dangerous: taking (smoking) cocaine or cocaine and drinking

alcohol?Cocaine with alcohol. WHY???

Chlordiazepoxide [Librium, Librax, 利眠寧 ] -- 綠豆仔 Diazepam [Valium, 安定 ] -- 羅氏五號 ; 羅氏十號 Zopiclone, 佐匹克隆 -- 白瓜子 Flunitrazepam [Rohypnol, 氟硝西泮 , 氟硝安定 ] –

十字架 Midazolam [Dormicum, 咪達唑侖 , 速眠安 ] -- 藍精靈

Benzodiazepines 苯二氮 類藥物 Types (Brand names) & Street names*

Street names mainly derived from the shapes, colours and signs on the tablets

Short-term Effects of Benzodiazepines

At low doses:

some types of behavior (talk more freely and feel less shy)*

At high doses:

Depression and mood swings

Impaired memory & thinking

Sedative, psychomotor responses, anxiety,

respiration, blood pressure, heart rate & induce sleep

* Inhibition of ‘inhibitory neurons’

Long-term Effects of Benzodiazepines

Slurred speech, sleep disorders & disorientation Impaired memory & thinking Develop mental diseases Tolerance, addiction & withdrawal Liver and kidney damage# If taken during pregnancy, baby addictive

# Liver is the major site of metabolism (detoxification) and kidney site of excretion

What is GHB*? [G 水、迷暈水 ]

Short form for gamma hydroxybutyrate

A naturally occurring compound in human cells

A colourless, odourless, bitter or slightly salty taste liquid or in crystal powder form

Causes changes in behaviour

A ‘date-rape’ drug*

An addictive substance

* Precautions: At parties, Never leave your drink unattended and takebottled drinks only.

Low doses: Sense of well-being & relaxation Sociability & sense of touch Confidence & inhibition (talk more freely) Drowsiness & headache

High doses: Confusion, agitation & hallucination Stiffening of muscle, disorientation Vomiting & convulsion Impaired movement & speech Unconsciousness, amnesia & respiratory collapse

Short-term Effects of GHB

Long-term Effects of GHB

Physical and physiological dependence (Addiction)

Difficulty in sleeping

Vertigo (Dizziness [ 頭暈 ])

Worrisome chest pains

G 水、迷暈水

Stimulants

興奮藥 (劑 )

Chemicals or drugs that increase nervous system activity

Types of CNS Stimulant

Caffeine ( 咖啡因 ; coffee)

Nicotine ( 尼古丁 ; tobacco)

Amphetamines * [ 安非他明 ( 命 ) 類 ]

Cocaine * ( 可卡因 )

* Behaviour and mood altering drugs/chemicals

Caffeine

Sources: coffee, tea, cola drinks and chocolates

Effects: Slightly elevates pulse rate (1 cup/day)

Alertness and Fatigue (1 cup or more)

Loss of calcium in the urine (5 cups/day)

A possible human teratogen (>6 mg/kg)

Calorie intake

Affect sleep patterns

Withdrawal: Headaches, gastrointestinal effect & diarrhea

咖啡鹼 , 咖啡因

Nicotine (Smoking)

Sources: Tobacco (1 cigarette contains 1-10 mg nicotine)

Effects:

heart rate, bloods pressure and stimulating heart muscle (small doses)

Affects respiration & inducing tremors, convulsion,vomiting (large doses)

Chronic smoking: emphysema, lung cancer (tobacco contains tar), spontaneous abortion, etc

尼古丁 (煙草 )

Amphetamine & Related Compounds

3 major types: Amphetamine, Methamphetamine & Ecstasy

Potency: Ecstasy > Methamphetamine > Amphetamine

Methamphetamine – White/brownish crystalline powder; street names: Meth, crystal meth, speed, ice, black beau

ties, bennies, dexies, dextroamphetamine, beans, crank, 冰 etc

Ecstasy: Tablets/capsules in various shapes and colours; street names: MDMA, X, ecstasy, Adam, XTC, hug, beans, 亞 甲 二 氧 基 甲 基 安 非 他 明 , 狂 喜 , 忘 我 etc

安 非 他 明 類

Short-Term Effects of Amphetamine Abuse

Activity & Attention Fatigue & Appetite Euphoria (Rush) Chills & Sweating Heart rate & Blood pressure Teeth clenching (involuntary) Blurred vision High doses Schizophrenic symptoms

安 非 他 明 類 “ Ecstasy” and “Ice”

Long-Term Effects of Amphetamine Abuse

Dependence & Addiction Paranoia & Mood Disturbances Hallucinations Weight loss Stroke Brain damage Liver damage

安 非 他 明 類 “ Ecstasy” and “Ice”

Cocaine

可卡因 , 可可精 , 古柯鹼

A very strong stimulant

A white powder

Obtained from coca plant grown in South America

Taken by sniffing or injection

Street names: coco, snow, crack, coke, etc

Effects of Short-term Cocaine Abuse

Low doses:

Euphoric, energetic, talkative & mentally alert, especially to sight, sound, and touch

Loss of appetite & insomnia

↑ Temperature, heart rate & blood pressure

High doses:

Bizarre, erratic & violent behavior

Cardiac arrest or seizures ⇒ Respiratory arrest

⇒ Death. 可卡因 , 可可精 , 古柯鹼

Effects of Long-term Cocaine Abuse

Tolerance & Addiction

Irritability & Mood disturbance

Toxic Psychosis

Auditory hallucinations

Heart & Kidney failure

可卡因 , 可可精 , 古柯鹼

1. Psychoactive drugs dissolve readily in alcohol

2. Pass thro’ the blood–brain barrier readily

3. Alcohol + psychoactive drugs

Alcohol heart rate

entry into the brain

Overdose Death

Do Not take psychoactive drugs with alcohol!

Why?

Effect of Multi-drugs【 Depressant + Stimulan

t 】XXXMuch Greater Effects

Brain death ( 植物人 )

Death Death (( 死亡死亡 ))

No Effect??

Stimulant + Depressant 0 Why?

Stimulant + Depressant Death Why?

Different psychoactive Drugs:Different psychoactive Drugs:

Affect different brain areasAffect different brain areas

Affect different processes of transmissionAffect different processes of transmission

CocaineCocaine DDopamine re-uptake opamine re-uptake

Benzodiazepines GABA receptorGABA receptor

Which of the following is a synthetic hallucinogen: LSD or marijuana [草 ]?

LSD

Where does the name ‘marijuana’ come from?

From Spanish Maria-Juana (Mary-Jane)

Do drug abusers show some easily recognizable signs that they are taking drugs?

Yes, they do. Can you name some?

What Are Hallucinogens?

Sometimes called ‘psychedelics’

Substances that cause emotions to swing wildly -- from real-world sensations to assume

unreal, sometimes frightening aspects

People see images, hear sounds, and feel sensations that seem real but do not exist

Examples: LSD, marijuana (marihuana) mescaline* (from cactus) ,

psilocybin*(from magic mushrooms) & ibogaine* (from Star Jasmine)

* Not common abused drugs in Hong Kong 迷幻藥

LSD

Short form for ‘lysergic acid diethylamide’

A synthetic compound

Most potent hallucinogen

A clear or white, odorless, water-soluble material

No accepted medical use

Taken orally (sometimes inhaled or injected)

Highly addictive

麥 角 副 酸 二 乙 基 胺

迷幻藥

Short-term Effects of LSD

Physical effects: numbness; muscle weakness and trembling; rapid reflexes; blood pressure, heart rate, and temperature; impaired motor skills and coordination; dilated pupils; nausea; dizziness, loss of appetite, dry mouth, sweating, and, occasionally, seizures

Distorted perceptions of vision (unreal colors and shapes); time (minutes seem like hours) & distance

迷幻藥

Long-term Effects of LSD

Tolerance (needs larger doses to produce similar effects)

Mental disorders

1. Psychosis - the disorganization of a person's capacity to recognize reality, think rationally, or communicate with others

2. Hallucination – experiencing episodes of spontaneous, repeated, sometimes continuous recurrences of some of the sensory distortions originally produced by

LSD.

Higher risk of spontaneous abortion and congenital abnormalities in babies born to women who

regularly used LSD during pregnancy

迷幻藥

What is Marijuana?

Grey mixture of dried, shredded leaves, stems, seeds and flowers of hemp plant

Hashish – a stronger form of marijuana

A psychoactive substance

Highly addictive

大麻、草

Short-term Effects of Marijuana

Distorted perception (sights, sounds, time & touch)

Trouble with thinking & problem-solving ability

Loss of coordination

Heart rate & anxiety

大麻、草

Long-term Effects of Marijuana

Tolerance and addiction

Problem with memory and learning

Breathing problems: emphysema & lung cancer

Damage to the immune system

May lead addict to other psychoactive substances

Harmful to fetus if taken during pregnancy

大麻、草

Can you tell if a friend is using club drugs?

Problems remembering things they recently said or did (Amnesia)

Loss of appetite & body weight

      Loss of muscle coordination, dizziness, fainting

      Depression

      Confusion

      Sleep problems

      Chills or sweating (for no medical reasons)

     Slurred speech

Addiction & Withdrawal

Affects heart, kidney & liver functions

Affects brain function

by interfering with neuronal transmission

May cause Death ( 死亡死亡 )) Impurities

Overdose [Concentrations vary]

Poly-drug use

Effects of Psychoactive Drug Abuse

Ways to say “No”

Avoid places where drug-uses are likely

Keep ‘suspected’ abusers at arm’s length

When offered drugs:

Say “No” decisively, and tell them the harmful effects of drugs

Change the subject or excuse yourself and leave the place

Accept the offer, and tell them that you would like showing it to your teachers/social worker at school/friends

Other means……..

Hong Kong:

Life imprisonment

Confiscation of properties

Mainland:

Death

Confiscation of properties

Highest penalties for drug-related crimes