常見濫用藥物危害特性

常見濫用藥物危害特性

及案例介紹劉清輝醫(yī)師高雄市立凱旋醫(yī)院成癮防治科1成癮物質(zhì)的分類鴉片類(Opioids):海洛英(Heroin)、速賜康(Pentazocine)、配西汀(Demerol)安非他命及其相關(guān)化合物(Amphetamine):甲基安非他命(Methamphetamine)、快樂丸(MDMA)古柯鹼(Cocaine)大麻(Cannabis)幻覺劑(Hallucinogens):LSD(Lysergicacid)PCP(Phencyclidine):天使塵2成癮物質(zhì)的分類鎮(zhèn)靜、安眠或抗焦慮劑(Sedatives、Hypnotics、orAnxiolytics)吸入劑(Inhalants):強(qiáng)力膠(Glue)有機(jī)溶劑酒精(Alcohol)尼古丁(Nicotine):香菸咖啡因(Caffeine):咖啡、茶其他:Ketamine、GHB3「毒品危害防制條例」之毒品分級第一級毒品:海洛英(Heroin)、嗎啡(Morphine)、鴉片(Opium)、

古柯鹼(Cocaine)及其相類製品。第二級毒品:罌粟(OpiumPoppy)、古柯(Coca)、大麻(Cannabis)、MDMA、安非他命(Amphetamine)、配西汀(Demerol)、

潘他挫新(Pentazocine)及其相類製品。第三級毒品:西可巴比妥(Secobarbital)、異戊巴比妥(Amobarbital)、Ketamine、GHB、酣樂欣(Triazolam)、FM2(flunitrazepam)、可待因(Codeine)及其相類製品。第四級毒品:Allobarbital、Alprazolam4DiagnosesAssociatedwithClassofSubstancesDependenceAbuseIntoxicationWithdrawalIntoxicationDeliriumWithdrawalDeliriumDementiaAmnesticDisordersPsychoticDisordersMoodDisordersAnxietyDisordersSexualDysfunctionsSleepDisorders5藥物成癮的四個階段:第一階段:初嚐快感

常用藥物:酒、菸、大麻、強(qiáng)力膠一類。第二階段:感受快感的盪漾

常用藥物:加上大麻、大麻油,和安非他命、安眠藥之類。第三階段:迷上快感

常用藥物:加上古柯鹼、迷幻藥、鴉片。第四階段:服用藥物才感覺正常

常用藥物:加上海洛英。6酒精(一)歷史:幾萬年前,人類已知發(fā)酵水果、穀類以製酒。西元800年,阿拉伯發(fā)明蒸餾製酒,’alcohol’乃源自阿拉伯字”alkuhl”,意為精髓(essence)。1849年之瑞典首先提出「酒癮」(alcoholism),之後被廣泛使用。在美國,醫(yī)院自1840年代開始治療酒癮患者,而19世紀(jì)後半,酒癮相關(guān)問題成為醫(yī)學(xué)研究之主要課題。臺灣近年來酒癮有逐年昇高的趨勢。(二)藥理作用:中樞神經(jīng)抑制作用,及影響多種生理、代謝作用。7酒精(三)中毒過量:判斷力損害、言詞含糊、運(yùn)動協(xié)調(diào)障礙、步態(tài)不穩(wěn)、眼球震顫、注意力或記憶力損害、木僵或昏迷。血中酒精濃度0.5%以上:影響呼吸和心跳,可能致命。(四)戒斷癥狀:失眠、焦慮、手抖、噁心或嘔吐、自主神經(jīng)系統(tǒng)活躍、激動、幻覺或錯覺、大發(fā)作癲癇。震顫性譫妄(DeliriumTremens):通常在戒斷後24-72小時發(fā)生,表現(xiàn)為意識不清、波動性變化、激躁不安、自主神經(jīng)系統(tǒng)過度亢奮、高燒、幻覺(主要為視幻覺)。若不治療死亡率高達(dá)20%,死因常為併發(fā)高燒、感染、內(nèi)外科疾病和自主神經(jīng)系統(tǒng)亢奮過久,造成心臟循環(huán)衰竭而死亡。8酒精(五)酒癮相關(guān)疾病:精神科:酒精中毒、戒斷、病態(tài)性中毒、精神病、憂鬱癥、失憶、癡呆等。神經(jīng)科:魏尼基氏腦癥(Wernicke’ssyndrome),柯沙科夫精神病(Korsakaff’ssyndrome),周邊神經(jīng)病變、肌肉病變等。胃腸系統(tǒng):胃炎、酒精性肝炎、脂肪肝、肝硬化、急慢性胰臟炎、膽結(jié)石。血液系統(tǒng):貧血、血小板功能失常等。其他:如代謝問題、意外傷害等。9鎮(zhèn)靜安眠劑(一)歷史:1962年Bayer發(fā)明bartituricacid,1903年barbital問世,1903年至1960年代末期,巴比妥鹽類(barbituates)是最普遍的鎮(zhèn)靜安眠藥,1960年代Benzodiazepine崛起,因其具有較佳的安全性,迅速取代巴比妥鹽類的角色。在臺灣,民國68年之後,因速賜康被管制,此類藥物便逐漸流行氾濫。(二)使用途徑:口服、靜脈注射。(三)藥理作用:作用於GABAtypeA接受器。中樞神經(jīng)抑制作用。具鎮(zhèn)靜、安眠、抗焦慮、肌肉放鬆、抗痙攣等效果。10鎮(zhèn)靜安眠劑劑(四)中毒毒過量:判判斷力損害害、言詞含含糊、運(yùn)動動協(xié)調(diào)障礙礙、步態(tài)不不穩(wěn)、眼球球震顫、、注意力或或記憶力損損害、木僵僵或昏迷。。(五)戒斷斷癥狀:失失眠、焦慮慮、手抖、、噁心或嘔嘔吐、自自主神經(jīng)系系統(tǒng)活躍、、激動、幻幻覺或錯覺覺、大發(fā)作作癲癇。(六)併發(fā)發(fā)癥:中毒或戒斷斷的併發(fā)癥癥可能導(dǎo)致致死亡。精神神經(jīng)科科:感覺、、運(yùn)動、認(rèn)認(rèn)知、情感感、自我控控制等方面面的改變。。其他內(nèi)外科科併發(fā)癥或或意外傷害害。11Rohypnol(FM2)Rohypnol,atradenameforflunitrazepam,hasbeenofparticularconcernforthelastfewyearsbecauseofitsabuseindaterape.Itbelongstoaclassofdrugsknowsasbenzodiazepines.Whenmixedwithalcohol,Rohypnolcanincapacitatevictimsandpreventthemfromresistingsexualassault.Itcanproduce"anterogradeamnesia,"whichmeansindividualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrugs.Also,Rohypnolmaybelethalwhenmixedwithalcoholand/orotherdepressants.12RohypnolRohypnolisnotapprovedforuseintheUnitedStates,anditsimportationisbanned.IllicituseofRohypnolstartedappearingintheUnitedStatesintheearly1990s,whereitbecameknownas"rophies,""roofies,""roach,"and"rope."AbuseoftwoothersimilardrugsappearstobereplacingRohypnolabuseinMiami,Texas,andBoston.Theseareclonazepam,marketedintheU.S.asKlonopinandinMexicoasRivotril,andalprazolam(marketedasXanax).Rohypnol,however,continuestobeaproblemamongtreatmentadmissionsinTexas,particularlyamongyoungHispanicmalesalongtheMexicanborder.13RohypnolSlangorStreetNames:Roofies,Rophies,Roche,Forget-mePillRohypnol?(flunitrazepam)belongstotheclassofdrugsknownasbenzodiazepines(suchasValium??,Halcion?,Xanax??,andVersed?).ItisnotapprovedforprescriptionuseintheUnitedStates,althoughitisapprovedinEuropeandisusedinmorethan60countriesasatreatmentforinsomnia,asasedative,andasapresurgeryanesthetic.14RohypnolRohypnolistastelessandodorless,anditdissolveseasilyincarbonatedbeverages.ThesedativeandtoxiceffectsofRohypnolareaggravatedbyconcurrentuseofalcohol.Evenwithoutalcohol,adoseofRohypnolassmallas1mgcanimpairavictimfor8to12hours.Rohypnolisusuallytakenorally,althoughtherearereportsthatitcanbegroundupandsnorted.15RohypnolThedrugcancauseprofound"anterogradeamnesia";thatis,individualsmaynotremembereventstheyexperiencedwhileundertheeffectsofthedrug.ThismaybewhyoneofthestreetnamesforRohypnolis"theforget-mepill"andithasbeenreportedlyusedinsexualassaults.OtheradverseeffectsassociatedwithRohypnolincludedecreasedbloodpressure,drowsiness,visualdisturbances,dizziness,confusion,gastrointestinaldisturbances,andurinaryretention.16鴉片類藥藥物(一)歷歷史：鴉片乃由由罌粟植植物未成成熟之蒴蒴果，以以刀割痕痕取其流流出之汁汁液而得得，六千千年前的的蘇美人人即記載載罌粟為為’快樂的植植物’。滿清政政府於1664年頒發(fā)發(fā)吸菸處處死的律律令,故故”菸民”將鴉片(煙)摻摻入香菸菸裡,以以做為脫脫罪之用用。後來來變成以以吸食鴉鴉片為主主,1840年年”鴉片戰(zhàn)爭爭”戰(zhàn)敗後,對鴉片片沒有任任何管制制。嗎啡是由由德國人人於1806年年在鴉片片內(nèi)提煉煉出主要要的有效效成份,以希臘臘神話裡裡夢幻之之神Morphius命名為為Morphine。。嗎啡在在臨床上上具有鎮(zhèn)鎮(zhèn)痛、止止咳、止止瀉及催催眠作用用。海洛英乃乃由嗎啡啡加上雙雙乙醯合合成,在在1874年在在德國首首先合成成,而由由拜爾藥藥廠生產(chǎn)產(chǎn)製造,其商品品名乃由由德語Heronisch而而來,意為”少量而有有強(qiáng)效之之奇妙藥藥品”。它的止止痛效力力為嗎啡啡的4-8倍,但毒性性則為嗎嗎啡的10倍。。17鴉片類藥藥物(二)使使用途徑徑：吸入入、鼻吸吸、口服服或注射射。(三)藥藥理作用用：鴉片片、嗎啡啡、海洛洛英或合合成的類類似作用用於中樞樞神經(jīng)的的鴉片受受器的化化合物通通稱為鴉鴉片劑(Opiate)。具具強(qiáng)烈的的成癮性性。(四)中中毒過量量：其特徵為為意識障障礙,針針狀瞳孔孔、呼吸吸、心跳跳變慢、、體溫及及血壓下下降(若若嚴(yán)重缺缺氧則可可能瞳孔孔放大,反射消消失,發(fā)發(fā)紺)。。死亡最常常見原因因是呼吸吸抑制。。18鴉片類藥藥物(五)戒戒斷癥狀狀：愈短效的的藥物,其戒斷斷癥狀及及高峰期期越快出出現(xiàn)。一一般海洛洛英(heroin)約在戒戒斷後6小時開開始出現(xiàn)現(xiàn)癥狀,48至至72小小時為為高峰期期,7至至10天天後消失失。戒斷6小時時後：：焦慮慮、失失眠、、哈欠欠、流流汗、、流鼻鼻水、、流淚淚,進(jìn)進(jìn)一步步出現(xiàn)現(xiàn)瞳孔孔放大大,起起雞皮皮疙瘩瘩、發(fā)發(fā)冷、、噁心心、肌肌肉疼疼痛。。18-24小小時後後:加加上呼呼吸、、脈搏搏、血血壓、、體溫溫均上上升、、嘔吐吐。24-36小時時後:加上上腹瀉瀉、脫脫水。。19鴉片類類藥物物(六)併發(fā)發(fā)癥：：生理方方面：：因使使用不不潔或或共用用針頭頭而傳傳染到到愛滋滋病、、肝炎炎、肌肌肉血血管病病變或或敗血血癥等等。心理社社會方方面：：因成成癮者者以追追逐藥藥物使使用為為生活活的重重心,無法法過一一般正正常的的生活活,造造持人人格敗敗壞,家庭庭、人人際關(guān)關(guān)係的的破壞壞,甚甚至為為了籌籌措金金錢而而導(dǎo)致致種種種不法法行為為。20安非他他命(一)歷史史：1887年年合成成，1931年年上市市(噴噴鼻劑劑，主主治鼻鼻塞)，1935年年出現(xiàn)現(xiàn)錠劑劑(主主治嗜嗜睡)，1935至至1946年認(rèn)認(rèn)為安安非他他命有有39種合合法醫(yī)醫(yī)療用用途，，1960年末末濫用用大盛盛,1970年年後因因管制制而減減少。。民國國78年日日本嚴(yán)嚴(yán)格取取締後後臺灣灣開始始?xì)餅E濫，79年年10月列列為麻麻醉藥藥品管管制。。(二)使用用途徑徑：蒸蒸發(fā)吸吸入、、與煙煙草混混合抽抽吸、、口服服、鼻鼻吸或或注射射。(三)作用用機(jī)轉(zhuǎn)轉(zhuǎn)：增增加多多巴安安、新新腎上上腺素素釋放放,並並抑制制回收收。21安非他他命(四)藥理理作用用：自自覺疲疲勞消消失,注意意力、、知覺覺變得得敏銳銳,興興奮、、欣快快感，，心跳跳加速速、瞳瞳孔放放大、、食慾慾及睡睡眠下下降、、血壓壓上升升。(五)中毒毒過量量：多多疑敏敏感、、焦慮慮易怒怒、躁躁動不不安、、妄想想、幻幻覺、、血壓壓上升升、心心跳加加快、、瞳孔孔放大大、高高燒、、心律律不整整、出出血性性中風(fēng)風(fēng)、癲癲癇、、心臟臟循環(huán)環(huán)衰竭竭死亡亡。(六)戒斷斷癥狀狀：心心情低低落易易怒、、疲倦倦、焦焦慮、、睡眠眠障礙礙(嗜嗜睡)、食食慾增增加、、激躁躁或遲遲緩。。最嚴(yán)嚴(yán)重的的癥狀狀是憂憂鬱(甚至至有自自殺意意念或或行為為)。。(七)安非非他命命精神神?。海罕憩F(xiàn)現(xiàn)似妄妄想型型精神神分裂裂癥。。22MethamphetamineMethamphetamineisanaddictivestimulantdrugthatstronglyactivatescertainsystemsinthebrain.Methamphetamineiscloselyrelatedchemicallytoamphetamine,butthecentralnervoussystemeffectsofmethamphetaminearegreater.Bothdrugshavesomemedicaluses,primarilyinthetreatmentofobesity,buttheirtherapeuticuseislimited.23MethamphetamineMethamphetamineismadeinillegallaboratoriesandhasahighpotentialforabuseanddependence.Streetmethamphetamineisreferredtobymanynames,suchas"speed,""meth,"and"chalk."Methamphetaminehydrochloride,clearchunkycrystalsresemblingice,whichcanbeinhaledbysmoking,isreferredtoas"ice,""crystal,"and"glass."24HealthHazardsMethamphetaminereleaseshighlevelsoftheneurotransmitterdopamine,whichstimulatesbraincells,enhancingmoodandbodymovement.Italsoappearstohaveaneurotoxiceffect,damagingbraincellsthatcontaindopamineandserotonin,anotherneurotransmitter.Overtime,methamphetamineappearstocausereducedlevelsofdopamine,whichcanresultinsymptomslikethoseofParkinson'sdisease,aseveremovementdisorder.25HealthHazardsMethamphetamineistakenorallyorintranasally(snortingthepowder),byintravenousinjection,andbysmoking.Immediatelyaftersmokingorintravenousinjection,themethamphetamineuserexperiencesanintensesensation,calleda"rush"or"flash,"thatlastsonlyafewminutesandisdescribedasextremelypleasurable.Oralorintranasaluseproduceseuphoria-ahigh,butnotarush.Usersmaybecomeaddictedquickly,anduseitwithincreasingfrequencyandinincreasingdoses.26methamphetamineAnimalresearchgoingbackmorethan20yearsshowsthathighdosesofmethamphetaminedamageneuroncell-endings.Dopamine-andserotonin-containingneuronsdonotdieaftermethamphetamineuse,buttheirnerveendings("terminals")arecutbackandre-growthappearstobelimited.Thecentralnervoussystem(CNS)actionsthatresultfromtakingevensmallamountsofmethamphetamineincludeincreasedwakefulness,increasedphysicalactivity,decreasedappetite,increasedrespiration,hyperthermia,andeuphoria.OtherCNSeffectsincludeirritability,insomnia,confusion,tremors,convulsions,anxiety,paranoia,andaggressiveness.Hyperthermiaandconvulsionscanresultindeath.27MethamphetamineMethamphetaminecausesincreasedheartrateandbloodpressureandcancauseirreversibledamagetobloodvesselsinthebrain,producingstrokes.Othereffectsofmethamphetamineincluderespiratoryproblems,irregularheartbeat,andextremeanorexia.Itsusecanresultincardiovascularcollapseanddeath.AstudyinSeattleconfirmedthatmethamphetamineusewaswidespreadamongthecity'shomosexualandbisexualpopulations.Ofthesegroups,membersusingmethamphetaminereportedtheypracticesexualandneedle-usebehaviorsthatplacethematriskofcontractingandtransmittingHIVandAIDS.28MethamphetamineSlangorStreetNames:Speed,Ice,Chalk,Meth,Crystal,Crank,Fire,GlassMethamphetamineisatoxic,addictivestimulantthataffectsmanyareasofthecentralnervoussystem.Thedrugisoftenmadeinclandestinelaboratoriesfromrelativelyinexpensiveover-the-counteringredients.Itisbeingusedbydiversegroups,includingyoungadultswhoattendraves,inmanyregionsofthecountry.Availableinmanyforms,methamphetaminecanbesmoked,snorted,injected,ororallyingested.29MethamphetamineMethamphetamineisawhite,odorless,bitter-tastingcrystallinepowderthateasilydissolvesinbeverages.Methamphetamineisnotsoldinthesamewayasmanyotherillicitdrugs;itistypicallysoldthroughnetworks,notonthestreet.Methamphetamineuseisassociatedwithserioushealthconsequences,includingmemoryloss,aggression,violence,psychoticbehavior,andpotentialcardiacandneurologicaldamage.30MethamphetamineMethamphetamineabuserstypicallydisplaysignsofagitation,excitedspeech,decreasedappetite,andincreasedphysicalactivitylevels.Methamphetamineisneurotoxic.Methamphetamineabusersmayhavesignificantreductionsindopaminetransporters.Methamphetamineusecancontributetohigherratesoftransmissionofinfectiousdiseases,especiallyhepatitisandHIV/AIDS.31古柯鹼(一)歷史史：第六世世紀(jì)時,南南美印地安安人以咀嚼嚼古柯葉提提神。十五五世紀(jì)傳入入歐洲,但但未流行。。1860年Niemann純化出出古柯因(Cocaine)並廣被當(dāng)當(dāng)做局部麻麻醉劑使用用。十九世世紀(jì)末時,被注意到到有成癮性性,1930年代因因安非他命命合法、便便宜、容易易取得且效效用相似而而銷聲匿跡跡。在美國國,1970年代安安非他命被被禁止後,再度流行行,1980年代中中期古柯鹼鹼(Cocainefreebase)大大量生產(chǎn),價錢便宜宜而氾濫成成災(zāi)。在臺臺灣也有人人引入國內(nèi)內(nèi)。32古柯鹼(二)使用用途徑：蒸蒸發(fā)吸入、、鼻吸或靜靜脈注射。。(三)作用用機(jī)轉(zhuǎn)：抑抑制多巴安安、新腎上上腺素回收收。(四)藥理理作用、中中毒癥狀、、戒斷癥狀狀：似安非非他命,但但更嚴(yán)重,更容易上上癮。33CrackandCocaineCocaineisapowerfullyaddictivedrugofabuse.Oncehavingtriedcocaine,anindividualcannotpredictorcontroltheextenttowhichheorshewillcontinuetousethedrug.Themajorroutesofadministrationofcocainearesniffingorsnorting,injecting,andsmoking(includingfree-baseandcrackcocaine).Snortingistheprocessofinhalingcocainepowderthroughthenosewhereitisabsorbedintothebloodstreamthroughthenasaltissues.Injectingistheactofusinganeedletoreleasethedrugdirectlyintothebloodstream.Smokinginvolvesinhalingcocainevapororsmokeintothelungswhereabsorptionintothebloodstreamisasrapidasbyinjection.34Crack"Crack"isthestreetnamegiventococainethathasbeenprocessedfromcocainehydrochloridetoafreebaseforsmoking.Ratherthanrequiringthemorevolatilemethodofprocessingcocaineusingether,crackcocaineisprocessedwithammoniaorsodiumbicarbonate(bakingsoda)andwaterandheatedtoremovethehydrochloride,thusproducingaformofcocainethatcanbesmoked.Theterm"crack"referstothecracklingsoundheardwhenthemixtureissmoked(heated),presumablyfromthesodiumbicarbonate.35cocaineThereisgreatriskwhethercocaineisingestedbyinhalation(snorting),injection,orsmoking.Itappearsthatcompulsivecocaineusemaydevelopevenmorerapidlyifthesubstanceissmokedratherthansnorted.Smokingallowsextremelyhighdosesofcocainetoreachthebrainveryquicklyandbringsanintenseandimmediatehigh.TheinjectingdruguserisatriskfortransmittingoracquiringHIVinfection/AIDSifneedlesorotherinjectionequipmentareshared.36HealthHazardsCocaineisastrongcentralnervoussystemstimulantthatinterfereswiththereabsorptionprocessofdopamine,achemicalmessengerassociatedwithpleasureandmovement.Dopamineisreleasedaspartofthebrain'srewardsystemandisinvolvedinthehighthatcharacterizescocaineconsumption.37HealthHazardsPhysicaleffectsofcocaineuseincludeconstrictedperipheralbloodvessels,dilatedpupils,andincreasedtemperature,heartrate,andbloodpressure.Thedurationofcocaine'simmediateeuphoriceffects,whichincludehyper-stimulation,reducedfatigue,andmentalclarity,dependsontherouteofadministration.Thefastertheabsorption,themoreintensethehigh.Ontheotherhand,thefastertheabsorption,theshorterthedurationofaction.Thehighfromsnortingmaylast15to30minutes,whilethatfromsmokingmaylast5to10minutes.Increasedusecanreducetheperiodofstimulation.38cocaineSomeusersofcocainereportfeelingsofrestlessness,irritability,andanxiety.Anappreciabletolerancetothehighmaybedeveloped,andmanyaddictsreportthattheyseekbutfailtoachieveasmuchpleasureastheydidfromtheirfirstexposure.Scientificevidencesuggeststhatthepowerfulneuropsychologicreinforcingpropertyofcocaineisresponsibleforanindividual'scontinueduse,despiteharmfulphysicalandsocialconsequences.Inrareinstances,suddendeathcanoccuronthefirstuseofcocaineorunexpectedlythereafter.However,thereisnowaytodeterminewhoispronetosuddendeath.39cocaineHighdosesofcocaineand/orprolongedusecantriggerparanoia.Smokingcrackcocainecanproduceaparticularlyaggressiveparanoidbehaviorinusers.Whenaddictedindividualsstopusingcocaine,theyoftenbecomedepressed.Thisalsomayleadtofurthercocaineusetoalleviatedepression.Prolongedcocainesnortingcanresultinulcerationofthemucousmembraneofthenoseandcandamagethenasalseptumenoughtocauseittocollapse.Cocaine-relateddeathsareoftenaresultofcardiacarrestorseizuresfollowedbyrespiratoryarrest.40AddedDanger:CocaethyleneWhenpeoplemixcocaineandalcoholconsumption,theyarecompoundingthedangereachdrugposesandunknowinglyformingacomplexchemicalexperimentwithintheirbodies.NIDA-fundedresearchershavefoundthatthehumanlivercombinescocaineandalcoholandmanufacturesathirdsubstance,cocaethylene,thatintensifiescocaine'seuphoriceffects,whilepossiblyincreasingtheriskofsuddendeath.41強(qiáng)力膠(一)歷史史：1960年代流流行於美國國,1965年傳入入日本,1972傳傳入臺灣,在青少年年中流行起起來。(二)使用用途徑：裝裝入塑膠袋袋搓揉使其其揮發(fā)而吸吸食。(三)藥理理作用：主主要成份為為甲苯(44%)。。生理反應(yīng)應(yīng)與酒精類類似,具中中樞神經(jīng)抑抑制作用。。先有去抑抑制化現(xiàn)象象,欣快感感、飄浮感感,繼而進(jìn)進(jìn)入幻旅(trip),出現(xiàn)現(xiàn)錯覺、幻幻覺,然後後進(jìn)入抑制制期,略微微嗜睡、口口齒不清。。42強(qiáng)力膠(四)中毒毒過量：頭頭暈、視覺覺障礙(模模糊或複視視)、眼球球震顫、運(yùn)運(yùn)動協(xié)調(diào)障障礙、言辭辭含糊、步步態(tài)不穩(wěn)、、震顫、欣欣快感。更更高劑量會會導(dǎo)致昏睡睡、精神運(yùn)運(yùn)動性遲滯滯、廣泛肌肌肉無力、、反射降低低、木僵或或昏迷。(五)戒斷斷癥狀：輕輕微,可能能會失眠、、胃口不佳佳、顫抖、、噁心嘔吐吐。(六)併發(fā)發(fā)癥：感覺覺異常、運(yùn)運(yùn)動障礙、、聽力喪失失、周邊神神經(jīng)病變、、心肌病變變、肝腎傷傷害、缺氧氧、窒息、、意外死亡亡。43新興藥物濫濫用形態(tài)新的藥物濫濫用形態(tài)“毒品”v.s.“非法法藥品”v.s.“合法法物質(zhì)”“成癮”v.s.“控控制使用””44俱樂部用藥藥ClubdrugPub,Rave,夜總總會,地地下舞廳,KTV網(wǎng)咖私私人聚會45俱樂部用藥藥Recreationaluse,助興,流行Perceivedharm下降降A(chǔ)vailability增增加使用容易公開及半公公開使用46新聞媒體報報導(dǎo)的clubdrugs快樂丸搖頭丸搖腳丸,一一粒沙(elisa)神仙水安非他命(甲基安非非他命)FM2大麻K安笑氣Others...47ClubDrugsAnumberofourNation'sbestmonitoringmechanismsaredetectingalarmingincreasesinthepopularityofsomeverydangeroussubstancesknowncollectivelyas"clubdrugs."Thistermreferstodrugsbeingusedbyyoungadultsatall-nightdancepartiessuchas"raves"or"trances,"danceclubs,andbars.MDMA(Ecstasy),GHB,Rohypnol,ketamine,methamphetamine,andLSDaresomeofthecluborpartydrugsgainingpopularity.NIDA-supportedresearchhasshownthatuseofclubdrugscancauseserioushealthproblemsand,insomecases,evendeath.Usedincombinationwithalcohol,thesedrugscanbeevenmoredangerous.48"Clubdrug"isavaguetermthatreferstoawidevarietyofdrugs.Uncertaintiesaboutthedrugsources,pharmacologicalagents,chemicalsusedtomanufacturethem,andpossiblecontaminantsmakeitdifficulttodeterminetoxicity,consequences,andsymptomsthatmightbeexpectedinaparticularcommunity.Noclubdrugisbenign.ChronicabuseofMDMA,forexample,appearstoproducelong-termdamagetoserotonin-containingneuronsinthebrain.Giventheimportantrolethattheneurotransmitterserotoninplaysinregulatingemotion,memory,sleep,pain,andhigherordercognitiveprocesses,itislikelythatMDMAusecancauseavarietyofbehavioralandcognitiveconsequencesaswellasimpairingmemory.49ClubdrugsBecausesomeclubdrugsarecolorless,tasteless,andodorless,theycanbeaddedunobtrusivelytobeveragesbyindividualswhowanttointoxicateorsedateothers.Inrecentyears,therehasbeenanincreaseinreportsofclubdrugsusedtocommitsexualassaults-yetanotherreasonwhyNIDAisalertingyoutotheseescalatingtrends.50GHB1.Gammahydroxybutyrate(GHB)isanillicitchemicalthathasbecomeamajorcauseofdrug-relatedcomasintheUSandothercountries.Infact,thenumberofGHBoverdosesintheUnitedStateshasnowout-pacedoverdosesfromMDMA(Ecstasy).2.GHBwasrejectedbytheAmericanmedicalcommunityinthe1960s,buthasbecomepopularamongmanypeopleforitsabilitytocrosstheblood-brainbarrierfreelyanddepressconsciousness,resultingineuphoriaandintoxication.51GHB3.ItisalsotoutedontheInternetasasleepaid,ananti-depressantandweightlossproduct,althoughtheseusesarenotsubstantiatedbyrealityandmaycarryapotentiallydeadlytwist.4.Startingfirstasanalternativetosteroidsinthelate1980s,whensteroidswerebeingcontrolled,GHBhasgrownintoamulti-headedmedicalnightmare,drainingemergencyroomservices,shatteringthelivesofthosewhohavelostlovedonestoit,andterrifyingfamilies/friendsofthoseaddictedtoit.Yetitisstillamysterytomostlawenforcementofficers,medical/coronerpersonnel,andparents.52GHBhasalsobeenasociatedwiththesocalled"daterape"drugs.GHBcanbeproducedinclearliquid,whitepowder,tablet,andcapsuleforms,anditisoftenusedincombinationwithalcohol,makingitevenmoredangerous.GHBisusuallyabusedeitherforitsintoxicating/sedative/euphoriapropertiesorforitsgrowthhormone-releasingeffects,whichcanbuildmuscles.53GHBGHBisacentralnervoussystemdepressantthatcanrelaxorsedatethebody.Athigherdosesitcanslowbreathingandheartratetodangerouslevels.GHBintoxicatingeffectsbegin10to20minutesafterthedrugistaken.Theeffectstypicallylastupto4hours,dependingonthedosage.OverdoseofGHBcanoccurratherquickly,andthesignsaresimilartothoseofothersedatives.54GHBGHBisclearedfromthebodyrelativelyquickly,soitissometimesdifficulttodetectinemergencyroomsandothertreatmentfacilities.55GHBGHBwasfirstsynthesizedinFrancemorethan40yearsagoasapossibleanesthetic,butbecauseofitsundesirablesideeffectswasrejectedbytheAmericanmedicalcommunity.Itslegaluseanywhereisdwindlingascountriesarebeginningtorecognizetheproblems.GHBresurfacedin1987asanorphandrugbeingresearchedtotreatthecombinationofsleepdisordersknownasnarcolepsy/cataplexy.56GHBAtaboutthesametime,steroidusersweretoldthatitmightenhancethebody’sproductionofgrowthhormone(indeepsleepstate).However,duetogrowingnumbersofoverdoses,itwasorderedofftheshelvesofstoresinNovember1990.Unfortunately,ithasgainedstatusasarecreationaldrugandasarapedrug,andhasbecomedangerouslycommon.AsaresultofincreasedrestrictionsonGHBitself,its““analogs,”orchemicalcousinsthatturnintoGHBinthebody,havebecomeincreasinglyprevalent.57USERSOFGHB*Attendeesatdanceclubsor““rave”partiesareperhapsthemostprominentusersofGHBtoaltermood.*SexualpredatorsofallagesareattractedbythedisinhibitingandeuphoriceffectsofGHB,fortheyknowausermaybeeasilytakenadvantageofinanassault.Someexoticdancersandstrippersself-dosewithGHB,seekinga““sexier””performance.*Bodybuildersandotherathletes,includingprofessionalathletes,aretheleastrecognizedusers.Infact,thisgroup,oftenusingitonadailybasis,aretheonesmostlikelytobecomeaddicted.*BusinessprofessionalswhotravelfrequentlyandthinkGHBisasafesleepaid(comparabletomelatonin,forexample)areanotherunrecognizedgroup,alsosubjecttoaddictionandwithdrawal.58USERSOFGHB*Theelderlyarealsopotentialvictims,beingtoldthatGHBisananti-agingcompound.*GayandlesbianpopulationsalsouseGHBasarecreationaldrug.Insomecases,itisalsousedinthiscommunityforrapeorrobberypurposes..*PeoplesubjecttodrugtestingprogramsuseGHBasanalcoholsubstituteandtobypassdrugtesting.NOTE:IdentificationofGHBiscomplicatedbytheshortdurationoftimethatitpersistsinbodyfluidsandbytheabsenceofGHBtestingfromthenormaltestingproceduresofmostagencies.Thiswillchange,asrisksofGHBaremorewidelyrecognized.59ANALOGSOFGHBOverthepastseveralyears,avarietyofstates,haveaddedGHBtotheirlistsofcontrolledsubstances,thusmakingitpossibleforcriminalpenaltiestobeadministeredforuseofthedrug.Thisforcedgammabutyrolactone(GBL)and1,4-butanediol(BD),tostepintothespotlight.GBLisbothaprecursor(aprimaryingredientinmakingGHB)andanactiveanalog(asubstancethatconvertstoGHBinthehumanbody,withthesamephysicaleffectasGHB).BDisanactiveanalog,alsoconvertingrapidlytoGHBinthebody.Anotheranalogthathassurfaced,gammahydroxyvalerate(GHV),isonitswaytobecomingasuniversalasGBLandBD.BothGBLandBDachievethisconversioninsideofthebody,andGBLcantransformintoGHBbothinsideandoutsideofthebody.60ANALOGSOFGHBGHBremainsaccessibletoabusersthroughthissimpleconversion,thoughallareillegalforhumanconsumptionsinceMarch2000,whenGHBwasfederallyscheduled.Whatisunsettling,though,ishoweasyitistogetaholdoftheseprecursors.GBLandBDandvalericacidsubstancesareavailableatgyms,chemicalsupplystores,theInternet,andthroughmailorder.Theyaresoldaspowders,capsules,gelsorliquidsandcanbefoundinavarietyofconcentrations,colors,andflavors.Therearemorethan80streetandtradenamesforGHBanditsanalogs61EFFECTSOFGHBGHB’’sdepressanteffectsonthebraininlowdosesproduceahighoreuphoricfeelingasinhibitionsaredepressed.Whenthedoseisincreased,profoundcomaresults.Theheartratemayalsobedepressedorslowed.Effectsonthenervoussystemmayresultinaspasmofmusclecontractionscalledmyoclonus,producingseizure-likemovements.62EFFECTSOFGHBOthereffectssuchasconfusion,amnesia,vomitingandirregularbreathingaredangerouswhencombinedwiththemajordepressanteffectsofGHB.OtherdrugsincombinationwithGHB,especiallyotherdepressantssuchasalcohol,mayworsenthedepressiveeffectsandincreasethepossibilityofafataloutcome.63EFFECTSOFGHBThe““desired””effectsforGHBinlowdosesmaysoundinviting,buttheconsequenceofthewrongdosemaybedeath.ThedosageresponseofGHBisquitesteep,meaningthatatinyincreaseindosemaycauseadramaticincreaseinsymptomsand,thus,inrisk.Variableeffectsmeanthatateaspoonmightbeperfectonetime,butmaybecomeanoverdosethenexttime!ItisalsoimportanttobeawareoftheconsequencesthatoccurwhenGHBismixedwithotherchemicals.Forinstance,mixingGHBwithalcoholorotherdepressantsisevenmorelikelytoresultindeath.Theeffectslastaboutfourhoursandcanresolvequitesuddenly.64GHBOVERDOSEThemostdistinctiveandterrifyingfeatureofGHBisitsoverdosetimecourse.Within15minutesaperson’sstateofmindbecomesalteredandthereisahighpossibilityofalossofconsciousnessoranactualcoma.Breathingcanslowtoonlyfourtosixbreathesperminute!Mostpeopledo““sleepoff”aGHBoverdose;thosewhodon’tarecalled““dead.”AGHBoverdoseISa911emergency.65THEFUTUREOFGHBWhetherGHBcontinuestobeawidelyuseddrugdependsonthestepsthataretakentoeducatethepublic.Insteadofbeingperceivedasadietarysupplement,peopleneedtorecognizeGHBforwhatitis:anillictanddangerousdrug.EventhoughGHB(alsoknownassodiumoxybate,tradenameXyrem)hasbeenapprovedformedicalpurposes,itsdeadlyrisksforrecreationaloranyunsupervisedandunmonitoreduseremainthesame.ThereisnoevidencethatprofessionallymadeGHBisanylessdangerousintheabusearena.HealthcareprovidersandlawenforcementofficersneedtobecomefullyawareoftheeffectsanddangersofGHBsothattheycanplayanimportantroleininformingthepublic.66GHBGHBisusuallyliquid&maybehiddeninanytypeofcontainer.Water/drinkbottles,eye&nasalspray&mouthwashcontainersarecommon.Becauseofitsusuallysaltyorchemicaltaste,itisoftendisguisedinsweetorfruitydrinkswhengiventounknowingvictimsforrapeorrobbery.67GHBDescription:Aclearliquid.Looksjustlikewater.Canbemistakenforwaterbecauseitisusuallyfoundinasmall(30ml)clearplasticbottle,awaterbottle,orevenGatoradebottles,whichcontainsseveraldoses.Onequicktaste,andyou'llknowit'snotwater.Notascommon,butalsofoundasawhitepowder.Infactpowderuseisontherise!68GHBEffects:Intoxication,increasedenergy,happiness,talking,desiretosocialize,feelingaffectionateandplayful,milddisinhibition,sensuality,enhancedsexualexperience,musclerelaxation,lossofcoordinationduetolossofmuscletone,possiblenausea,difficultyconcentrating,lossofgagreflex.69GHBManypeoplehavebadreactions.Thesecanincludenausea,headaches,drowsiness,dizziness,amnesia,vomiting,lossofmusclecontrol,respiratoryproblems,lossofconsciousness,beingconsciousbutunabletomove,anddeath-Especiallywhencombinedwithalcoholorotherdrugs.70GHBEffectsoflargedoses:Disinhibition,sedation,desiretosleep,ramblingincoherentspeech,giddiness,silliness,difficultythinking,slurredspeech,passingout,anddeath.Effectsofoverdose:Sleepordeepsedationfromwhichyoucannotbeawakenedbyanymeansforaboutthreehours,andinmanycases,death.71GHBYourbodymanufacturesGHBforitsnormalmetabolism.TheonlyreasonpeopletakeGHBatapartyistogethigh,notfortheirhealth.Peoplearekiddingthemselvesiftheyimaginethey'retakingavitaminsupplementoraminoacid,eventhoughGHBhasbeenmarketedassuch.Justbecausetrace,minuteamountsofGHBarefoundinahumanbodydoesn’tm