Drug Abuse – 7약물남용 -7

Facts & Properties of Illicit drugs

Choongnam Natl. Univ.Dept. of Forensic Sciences

충남대 과학수사학과

Aug.- Dec., 2013

최성운 Sungwoon Choi 1

First, Terminology 용어

Euphoria: “An excited state of joy, a good feeling, a state of intense happiness” - 행복감 , 도취감 ? - after “rush” 다행증 . 쾌홀감 ? 매우 강한 행복감 , 유포리아‘High’: “A period of euphoria, from excitement or from an intake of drugs” – 고양감 ? – after “Rush” ‘Crash’: “A comedown of a drug” 술과 유사 , 술 섭취 후 혈중 농도 감소 시 추락 , 실추 , 전락‘Comedown’: “A sudden drop to a lower states, condition or level, a disappointment or letdown” 실망 , 의기소침 “A calm, mellow period experienced after 온화한 , 부드러운 the initial ‘high’ from taking drugs” – 몰락 , 실추 , 전락

Rush – Euphoria – High – Crash(Comedown) 의 순서

2

Review on Drug Terms

Illicit drugs 금제 , 위법 ? 금제약물 legal & Illegal (Schedule I,II) 합법적 약물도 포함 a drug taken outside its regulated or medically prescribed use 의료외적 , 규제 ( 통제 ) 외적 사용Drugs of abuse 남용 약물 (vs. drug use) a common term to refer to recreational drugs, legal & Illegal used in an irresponsible or harmful way 무책임하고 해롭게 , 즐기는 ( 기호성 ) 약물에 대한 말 , 합법 + 불법 포함 Psychoactive drugs 향정신성 약물 – 모든 마약류 포함 , 중추신경 작용 affect the CNS, not all of them are illegal 중추신경계 작용 , 모두 불법은 아님Recreational drugs 기호성 약물 taken for non-medical purposes, for pleasure – 술 , 담배 의료외적 효과 쾌락 , 즐거움 (?) 을 위해Narcotics (“ to numb” by the Greek) Orig. – sleep inducing 마약 psychoactive drugs, Legal. – one that totally prohibited 법정 , 법률 refers specifically to drugs related to opium or its synthetic forms 특징적으로 아편 , 합성 , 반 합성 아편을 말함 – 주의

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마약분류 in South Korea 한국에서의 마약류를 분류 하고 예를 드시오

마약류 : 마약 , 대마 , 향정신의약품 + 유해화학물 ( 유해화합물 ) - 환각성 유기용매 -대마 : 대마초 ( 마리화나 ), 대마수지 ( 해쉬쉬 ), 대마수지기름 ( 해쉬쉬기름 ) - 도취감 , 약한 환각 cannabis

마약 : 천연마약 : 아편 , 헤로인 opium, heroin, 몰핀 코카나무잎 , 코카잎 coca, cocaine 합성마약 : 페치딘류 , 메사돈류 , 프로폭시펜 , 벤조모르핀

향정신성 의약품 : 각성제 : 메스암페타민 , 암페타민류 , 펜플루라민 , 암페르라몬 AMs 환각제 : LDS, 페이요트 , 사일로사이빈 , 메스칼린 억제제 : 바르비탈염류제 , 비바르비탈염류제 , 벤조디아제핀염류제 대개 신경 안정제 , 수면제 등

미국에서는 Schedule 1 to 5 로 분류

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Hard drug vs. Soft drug 의존 , 신체 해로움 에의거

Red: hard drug

Orange: Borderline drug

Yellow: Soft drug

Hard Drugs: Psychoactive drugs: Addictive and perceived as Damaging 중독성 - 손상을주는 탐익성

Soft Drugs: Non-addictive (or minimally addictive) 낮은 중독성 Fewer dangers associated with their use. 사용시 낮은 위험성 ?

“The term "soft drug" is considered controversial by its critics 논쟁의 여지있다 because it implies that the drug causes no or insignificant harm.” 유해성 ?

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Some Chemical Structures of illicit Drugs

N

O

MethadoneSynthetic opioid analgesicAnti-addictive - opioid dependencyAnalgesic - Chronic pain40-90% oral bioavailabilityhepatic metabolism24-36 half lifeSchedule II (US)

O

HO

N

H

OHO

BuprenorphineSemi-synthetic opioid Anti-addictive - opioid addictionAnalgesic - moderate chronic pain40-50% sublingual, ethanolic sol'nhepatic metabolism20-70 half lifeSchedule III (US)

NH

O

Cl

Ketaminehuman, veterinary medicine, No respiratory depressionanesthesia, recreational use, classified as NMDA R antagonistAnalgesia, anesthesis(general), hallucination, etc.40-50% sublingual, ethanolic sol'nhepatic metabolism, renal excretion2-3hs half lifeSchedule III (US)

S

NH24-MTA (4-methylthioamphetamine)illicit drug, research chemicalNon-neurotoxic selective serotonin releasing agent in animalsLack of euphoriaSchedule I (US)

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대부분 진통 , 진정 , 수면 작용

“American Disease” – How about S. Korea?

About 4% of World’s Population - U.S.A. 세계인구의 4% 차지 But consumes 65% of World’s Supply of “Hard Drugs” ~4% 인구에비해 ~65% 의 하드드럭소모

General Two Attitudes on Illegal Drugs 불법약물에 대한 2 가지 일반적 태도

1) Health Issues – Illegal Drug Use is an “Illness” 마약류 사용 - 전통적 한국적 사고 Drugs are “Evil” – Infectious Disease 악 - 감염 , 질병과 동일시 Threat to Individual’s well-being & Society 개인 , 사회안녕협박

2) “The Forbidden Fruit” - Bold, Adventurous Attitude 금단열매 Drug Use is Sensuous & Fun 감각을 기쁘게 / 즐거운 Drug Prohibition is Unnecessarily Severe 금지는 불필요하게 심하다

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Some Drugs are Illegal, Why ? 왜 불법화 했나 ?

Danger to Self toxic to the body & mind 특히 자가처방 시 - 자신 ( 몸 / 마음 ) 에 위험 solvent inhaler – gasoline, glue & paint thinner – toxic, used to get “high”, not illegal (has practical use) 용매흡입 환각성유기용매 – 불법이 아님

Danger to Others 다른 사람에 위험 unpredictable or compulsive behavior – bring sufferings to friends family, co-workers 예측 , 조절이 어려운 / 강박적인 행동

Danger to Society 사회에 위험 less respectful of regulation & traditions 사회 , 전통 , 규범등에 반항적 hard to control, may lead to a breakdown in social harmony 조절이 어려워서 alcohol & tobacco – socially tolerable 사회조화를 깬다 술 , 담배 - 견딜만함 ? 사회적 허용

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Types of Illegal Drugs Use – 단계 – 불법약물 사용 마약류 사용을 단계별로 설명하시오

Usually begins with Curiosity, Encouragement by friends, or Desire to find relief from boredom, Pain, Anxiety, or Depression. 보통 호기심에서 무료함 통증 불안 , 염려 우울증 에서 해방 친구의 권유에서 1)Experimental Use 실험적 사용 , 단기간 , 비규칙적 사용 , 호기심에서 short-term, random use, out of curiosity, encouragement by friends , or desire to reach an altered state of mind 격려 , 장려 친구에의한 2)Recreational Use 기호적 사용 most often with friends, out of interest or pleasure 친구들과 , 쾌락 , 흥미충족 3)Circumstantial Use 상황적 사용 used for specific purpose, to cope with a problem 특정 목적 , 문제 극복 용도 or to achieve a certain mood( 기분 ), with friends, strangers, or alone 친구 , 제 3 자 , 단독4)Compulsive Use 강박적 사용 – 조절 사용시 큰 문제 없음 –쉽게 통제불능상태도달 drug addiction, dominated by getting & using the drug, can function well when have access and use it in a regulated way( 조절사용 시 - 정상기능 ),

easily uncontrollable & lead to physical, social, & legal problem 쉽게 조절불가 상태로 전환 - 문제야기 사회적 , 법적 문제 9

Drug use illness 마약류 사용시 발생하는 문제점을 설명하시오

Single-Dose problems 일회사용상 / 시 ( 량 ) 발생 문제점

IV drug use 정맥주사

Overdose 과량투여

Long-term problems 장시간 문제

Withdrawal 금단

Pregnancy 임신상 문제

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Problems with single-dose, IV, overdose, long-term use

Drug users – unknown amounts of drugs from unreliable source

사용자 – 믿을 수 없는 소스로 부터 모르는 용량 – 과량투여 가능성

A danger of a bad reaction 부작용의 일종 /총칭 위험

From impurities in the drug, from infection, overdose 불순물 , 감염 , 과용

or other physical condition 신체 , 물리적 상황

Can occur after minutes, hours, days, or even years 급성적 / 만성적 발생

1960s – sharing needles – hepatitis C, HIV 60년대 주사기공유

간염 , 에이즈

11

Problems with single-dose, IV, overdose, long-term use

A danger from IV use 정맥주사 시 위험성

No body defenses vs. smoking, snorting, chewing, ingesting

신체 방어기능이 없다 immune cells on the surface of the lungs

표면면역세포

다른 투여경로에 비해 & mucosal membranes 또한 경구투여에 반해서

Non-sterile powders or crushed pills in water 비 살균 가루 사용 문제

fine particles irritate the blood vessels 미세입자 - 혈관 자극

- vascular inflammation, permanent damage

- undissolved fragments can lodge(막다 ) in tiny vessel

of the lungs, heart, brain, eyes – 폐 , 심장 , 뇌 에서

causing hemorrhage, strokes, blindness

녹지 않은 미세조각 – 주요 장기에서 미세혈관 막음

- 출혈 , 스트로크 , 시각상실 12

A danger form IV use ( 정맥주사 ) - continued

“Cotton fever” – filter the drug through a pinch of cotton 소량 면으로여과시도

remove large fragments but tinier fragments form the cotton itself

- cause a strong immune responses from the body 면역반응야기

- begins about 10-20 minutes after IV inj. 정맥주사후 10-20 분 후

- headache, chills, breathless, nausea, vomiting, pain in the

muscles, joints, abdomen, and lower back 여러 문제 야기

- disappear in 12 to 24hs 두통 , 한기 , 숨참 , 구토 , 여러부위 통증

면화에 기인한 발열 문제

IV drug users die from – 11% from overdose, ~ 50% from the HIV virus

정맥주사 - 통상 11% 는 과량투여로 사망

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A danger from long-term drug use 장기간 사용에서 오는 위험

a withdrawal syndrome due to development of tolerance 내성 - 금단증상

the cumulative impact – MDMA, Amphetamine – gradual erosion 뇌세포파괴

누적 /축적효과 ,영향 of brain nerve cells – not noticed until old age

most common effect – loss of interest & motivation in life

가장 흔한 영향 인생 흥미 , 동기 상실

14

Drug use illness - continued

Pregnancy 임신에 영향 The fetus – during the first 8 weeks – greater risk to the unborn child 태아 increase in the risk of miscarriage, infant deformity ,sudden infant death syndrome (SIDS) 유산 , 기형 , 유아급사증

Addiction 탐익 /닉성 Substance Dependence 물질에 대한 의존성 Psychological dependence – craving for the drug, desperate to get more 갈망 , 욕망 --- 정신적 의존 can be addicted without withdrawal symptoms Physical dependence – physical symptoms of withdrawal 신체금단증상 hangover, body aches, a flue-like 감기 / 몸살느낌 feeling --- 신체적 의존

American Psychiatric Association (APA) “A maladaptive pattern of substance use leading to impairment 적응성 없는 or distress( 고통 ), with at least three of the following:” --- next slide 물질사용에서 야기되는 고통 , 손상

15

Drug use illness - continued

American Psychiatric Association (APA) – 탐닉성 정의 ---addiction “A maladaptive pattern of substance use leading to impairment 비적응 형태 or distress, with at least three of the following:” 손상 , 고통 , 괴롭힘 최소 3 가지 이상 보임Tolerance 내성

Withdrawal: Some drugs cause a withdrawal syndrome after stop taking them (Opposite effects). Opiates – numbness, euphoria, dry skin & mouth, constipation, slow pulse, pinpoint pupils etc. pain, anxiety, runny nose, diarrhea, rapid pulse, dilated pupils etc. 금단증상 대부분 반대 - 투여 시에 비해 상반된 증상Increasing amounts - larger amounts and/or longer period 용량 / 사용기간 증가

Attempts to stop use – cut down, try to control 사용량조절 , 중지시도

Drug-seeking behavior – spend lots of time to get the drug 약물취득위해 장시소모

Neglecting other activities 다른 일반 활동 무시

Drug problems – continue to use 지속사용 16

Stages of Addiction 중독 / 탐닉의 과정을 설명하시오

Addiction dose not occur immediately – from gradual process 천천히 ( 서서히 ) 발생 약물 중독 / 탐닉 – 서서히 발생Experimental Stage 단순호기심 , 절차 -관례 simple curiosity, a rite of passage into a social group, peer pressureSocial Stage still feels normal 여전히 정상느낌 the use of the drug is a big part of social acceptance, identityInstrumental Stage 도구로 사용 for a specific purpose: pleasure, cope with anger, shame, guilt, stress, boredom, or loneliness 특정목적위해 도구로 away from old friends, more time with heavy users – getting “high” tolerance, extreme mood swings no longer feels normal 더 이상 정상적이라 느끼지 못함Compulsive Stage 강제 , 억지 the final stage, preoccupied with drug & will do anything to get it - theft, prostitution 약물에 몰두 / 열중

But, only small % fall into this category, most of them stop before this stage 적은 수의 사용자만 마지막 상태 빠짐 , 대부분 이전 단계에서 중지 17

Top 10 reasons to use illegal drugs 불법약물을 사용하는 이유를 열거하시오

1) To numb the body 신체로부터의 영향을 무력화시키기위해 escape pain, dissociate from the body, achieve a sort of mental vacation - ex. Prostitutes: the body is no longer a source of embarrassment, suffering 신체로부터의 고통 등 , 정신적 휴가2) Recreation - simply for pleasure ( 쾌락 ), most common reason 일종의 취미 가장 일반적 이유3) To join a social group 친목 , 사교 그룹 합류

4) Social functioning – MDMA, Amphetamine help shy, inhibited people to open up socially, business dealings 내성적 , 부끄럼움 등 , 사업상5) Mind expansion – explore other realms of consciousness, for music? 새로운 경험 , 음악 ? 6) Religion – to contact God 종교적 목적

7) To improve performance – taken for energy and endurance( 인내 ) (Cocaine, Amphetamine) 일 능률증가

18

Top 10 reasons to use illegal drugs - continued

8) To change the body 몸을 변화 시키려고 amphetamines for weight loss, GHB to increase muscle mass 체중감소 근육 량 증가

9) Self-medication 자가처방 - 복용 for a specific illness, medical use of marijuana 특정질병에 사용 - help cope with anxiety, depression, other illness 근심 , 우울 등 벗어나려고

10) Because the are illegal 단순히 불법이니까 the Greek myth of Pandora ( 호기심 -본능 ?) 판도라 박스 the story of the forbidden fruit – the book of Genesis (Bible) 성경의

금단열매 Adolescents – tend to question authority, risk-taking behavior 특히 사춘기 청소년

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How?

Education

Stages of Recovery 재활단계 중독으로 부터의 재활 단계를 설명하시오

1) Pre-contemplation – deny that a problem exists, blame others 문제존재 거부 , 제 3 자 비난

2) Contemplation 정관 , 명상 , 숙고 – recognize a problem, 문제인식 still focus on the past, problem not future and the solution 여전히 과거 , 문제집착 해결 , 미래지향불능 3) Preparation – set a date for action 준비 단계 , 계획필요 4) Action – time & energy – strong encouragement and support 격려 , 도움필요 5) Maintenance – remain focused to avoid lapses & relapses 퇴보 , 재발 can last from 6 months to a life time 유지 6 개월에서 평생 걸릴 수 있음6) Termination – no temptation 유혹 , 충동 사라짐 But addiction is a lifelong issue that never entirely disappears 중독은 평생문제 – 결코 완전히 사라지지 않는다

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The Fastest way to the Brain - 5 common methods of drug use

1) Smoking – lungs to (left side of heart) brain – 7 to 10 seconds ( 수사와 과학 , p257 참고 )

2) Injecting (IV) – slower than smoking – to the heart(right side), 정맥주사 then to the lungs, to the heart(left side) to the brain – 15 to 30 seconds (iv) IM, SC (3 to 5 minutes)

3) Snorting – to the heart – 3 to 5 minutes 비강

4) Contact – through the skin, eyes, mouth, vagina, or anus – 3 to 5 minutes (for eyes), 15 to 30 minutes (for skin, other areas)

5) Ingesting – eaten, drunk, taken as a pill to stomach – 20 to 30 minutes 경구

일반적인 마약류 투여 경로 ( 사용방법 ) 를 열거하고 특징 및 흡수속도를 비교 설명하시오

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The pupil (눈동자 , 동공 ) on Drug

Constricted (miosis) Dilated (mydriasis) Kerky (nystagmus)

BarbituratesCodeineHeroinMorphineOther OpiatesGlutethimide

AmphetaminesBufotenineCathinoneCocaineDMTIbogaineLSDMDMAMescalinePeyotePsilocybin

BarbituratesGHBPCP

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The Business of Illegal drugs – 특징 마약류 사업의 특징을 열거하시오

Producing, Marketing, Distributing & Selling – Normal (?) Economic Activities A hierarchy of agents 피라미드형직제 Specialists 전문가 Personal, financial risks (very high) 개인 / 금전 위험 매우크다 By an organized crime syndicate – corrupt police, government itself Basic Economy: Follows “Supply & Demand” 수요 -공급 The War on Drugs (USA) – on reducing supply 공급감소에 초점 - demand remain high, higher prices for illegal drugs 수요 / 가격 - increase in drug-related crime, number of people in prison - more people into the drug trade (economic downturn) 불경기 - not sensitive to threats of punishment 처벌에 불감증

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The Business of Illegal drugs – 특징 마약류 사업의 특징을 열거하시오

Youth Employment 젊은 층 고용 - 돈에 쉽게 빠짐 , 다른 적은 기회 - naïve, easily impressed by money, few other opportunities etc. Lookouts – warn dealer about police, rival dealers, gangs etc. 망보기 딜러에게 경찰존재경고 , 경쟁딜러 /갱단 경고 Spotters – direct buyer to an ideal location to make the purchase 찍기 구매자를 안전한곳으로 유도 Couriers – carry drugs around the town 조달 , 수송 Young dealers Enforcers – gang members, protect territory etc. 강화 - 구역보호등 expendable (injured, imprisoned or dead)

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The Business of Illegal drugs – 특징 - continued

Prostitution 매춘

Smuggling – highly lucrative business, freight inside or disguised as other produ. 밀수 high volume of international trade – hard to detect 매우 이윤이 높음 hired travelers – “mules” 노새 “body stuffers” “body packing” – can cause accidental over dose 체내 이동 – 사고적 흡수 - 과량사고World drug trade 50% of all crimes in USA – drug related 미국 50% 범죄 – 약물 관련 War on Drug – estim. $18 billion / a year 1 Million south American – involved in cocaine (growing, harvesting ,into cocaine) usu. for USA

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Neurotransmitter & Basic Chemistry --- review

HO

HO

NH2

Dopamine (DA)CatecholamineDA1 - DA5 ReceptorsCan't cross BBBCognition, Movement, MotivationPunishment-Reward etc. ---CocaineDAT - reuptake & Monoamine Oxidase to 3,4-dihydroxyphenylacetic acid

NH

HO NH2

Serotonin (5-HT)Tryptamine - Indole5-HT ReceptorsMood, Appetite, Sleep etc. - MDMA, AM, Cocaine etc.SERT - reuptake & Monoamine Oxidase to 5-Hydroxyindoleacetic acid

H2NOH

Ogamma-Aminobutyric acid (GABA)Amino acid - major inhibitory neurotransmitter - CNSGABA Receptors - ligand-gated ion channel(GABA-A) GABA-B: metabotropic - G protein-coupled RRegulate excitability of Nervous SystemBrain development etc. - GHB

HO

HO

OH

O

NH

HO OH

O

26

Neurotransmitter & Chemistry --- review -- continued

N

NH

NH2

HistamineImmune responses, neurotransmitterH1 - H5 R (GPCR), H2 - GI gastric acid secretionImmune system disorder, allergies, schizophreniaH2 antagonist - cimetidine etc. - Libido lossH1 antagonist - classical antihistamines: produce sleep

ON

O+

AcetylcholineCNS & Peripheral neurotransmitter - 자율신경Nicotinic, Muscarinic Ach RAcetylcholinesterase - choline + acetate ---- neurotoxin Nerve agents: Sarin, VX, pesticides (organophosphates & carbamates) Botulin, black widow spider, methylmercury

HO

HO

NH2

OH

Norepinephrine (NE, noradrenaline)

HO

HO

HN

OH

Epinephrine (Adrenaline)

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Legal & Illegal drugs – 일반적 특징 증상 마약류 종류별 증상을 설명하시오

Slurred Speech, slow reaction time, impaired judgment, reduced coordination - depressants- alcohol, barbiturates & tranquilizers 억제제 술 , 진정 , 마취 , 신경안정 – 언어장애 , 반응시간저하 , 판단저하 , 협동조절저하 Intense emotional responses, anxiety, altered sensory perceptions 환각제 / 대마 - hallucinogens- marijuana, LSD, PCP & MDMA 강한 감정반응 , 불안 (근심 , 염려 ), 감각인식변화Alertness, feelings of strength and confidence, rapid speech and movement decreased appetite 경각심증가 , 자신감 / 용기상승 , 빠른언어와 행동 - stimulants- Am, Meth, cocaine 흥분제 - 각성제 식욕감퇴

Drowsiness, intense feeling of well-being, relief from pain( 진통 ) 마약 - narcotics- heroin, morphine, codeine, synthetic opiates 졸림 , 심한 다행 / 행복감 , 진통

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