药物滥用咖啡因-安非他明-古柯碱

第十二讲药物滥用-咖啡因-安非他明-古柯碱董钰明兰州大学药学院2013.06.03药物滥用危及全球药物滥用已成为当今全球性的严重社会问题。近年来，受境外毒品活动的影响，我国建国初期已绝迹的阿片烟毒再次为祸我国，严重影响吸毒者的身体健康和灵魂，诱发犯罪，导致家庭破裂，阻碍社会主义精神文明和物质文明建设。药物滥用概念“药物滥用”(DrugAbuse)是60年代中期国际上开始采用的专用词汇，它与我们平时所说的“滥用抗生素”“滥用激素”等滥用药物中的“滥用”概念截然不同。药物滥用的概念是指长期地使用过量具有依赖性潜力的药物，这种用药与公认医疗实践的需要无关，导致了成瘾性以及出现精神混乱和其它异常行为。行为角度解释“药物滥用”有学者从行为角度解释“药物滥用”概念：（1）不论是药品类型，还是用药方式和地点都是不合理的；（2）没有医生指导而自我用药，这种自我用药超出了医疗范围和剂量标准；（3）使用者对该药不能自拔并有强迫性用药行为；（4）由于使用药物，而往往导致精神和身体危害、社会危害。药物滥用的范围（1）麻醉药品。如阿片类、可卡因类、大麻类等。（2）精神药品。包括中枢抑制剂，如镇静催眠药；还有中枢兴奋剂，如咖啡因；此外还有致幻剂，如麦司卡林、LSD等。（3）挥发性有机溶剂。如汽油、打火机燃料和涂料溶剂等，有抑制和致幻作用，具有耐受性甚至精神依赖性。（4）烟草。其主要成分尼古丁长期使用也可致瘾。（5）酒精。长期酗酒也会产生生理依赖和心理依赖性。毒品常识《中华人民共和国刑法》第357条规定“毒品是指鸦片、海洛因、甲基安非他命、吗啡、大麻、可卡因以及国家规定管制的其他能够使人形成瘾癖的麻醉药品和精神药品。药物滥用的预防是系统工程就世界范围而言，目前被滥用的依赖性药物已不仅仅限于阿片类，它们还包括可卡因、大麻、某些中枢兴奋剂、镇静催眠药、致幻剂、挥发性溶剂以及酒精和烟草等。对药物滥用的预防以及依赖性药物引起的中毒进行诊治是关系到国家兴亡、民族昌盛的一项战略任务，也是一项系统工程。不仅需要国家禁毒机构参加，还须依靠社会各界力量积极支持和配合。毒品常识麻醉药品(NarcoticDrug)又称麻醉品。是指连续使用易产生身体依赖性和心理依赖性能成瘾癖的药品。包括阿片类(吗啡、杜冷丁等)、可卡因类、大麻类等药用植物及制剂。K粉(盐酸氯胺酮)也属于麻醉药品。精神药品指作用与中枢神经系统，能使之兴奋或抑制，连续使用产生精神依赖性的药物。该类药品仅限于西药品种，包括中枢兴奋药咖啡因、苯丙胺、强痛定、利他灵及镇静催眠药苯巴比妥、安定等。毒品分类按来源（1）天然毒品，如鸦片、海洛因，吗啡，可卡因、古柯叶，大麻，麦司卡林，致幻蘑菇菌等。（2）化学合成毒品，如苯丙胺类毒品，致幻剂LSD等。按对人体的作用分类：（1）中枢神经镇静型，如鸦片、吗啡、海洛因、安定类、巴比妥类。（2）中枢神经兴奋型，如可卡因、苯丙胺类毒品。（3）致幻型，如LSD、麦司卡林。（4）综合作用型，如大麻。目前滥用最广泛的毒品吗啡MDMA（摇头丸）二亚甲基二氧基苯丙胺，Ecstasy，MDMA甲基安非他明（冰毒）大麻可卡因鸦片药物滥用的危害DrugAbuseisCostlyApproximateCostsofSubstanceAbuseintheU.S.Sources:Rice,19991;ONDCP,20012;Harwood,20003SubstanceAbuseCostsOurNationMorethan$484BillionperYearTheCostsofDrugAbuseareasSubstantialasthatofotherChronicConditions:Diabetescostssociety$131.7billionannuallyCancercostssociety$171.6billionannually药物滥用的危害DrugAbuseisaMajorPublicHealthProblemAmericans'ViewsoftheSeriousnessofHealthProblems(TopTenofThirty-SixProblems)Source:HarvardSchoolofPublicHealthetal.,20004药物滥用的危害Cancer:Tobaccocontributesto11-30%ofcancerdeaths.HeartDisease:Researchershavefoundaconnectionbetweentheabuseoftobacco,cocaine,MDMA(ecstasy),amphetamines,andsteroidsandthedevelopmentofcardiovasculardiseases.Tobaccoisresponsibleforapproximately30%ofallheartdiseasedeathseachyear.HIV/AIDS:Approximatelyone-thirdofAIDScasesreportedin2000(11,635)andmostcasesofhepatitisC(approximately25,000in2001)intheUnitedStatesareassociatedwithinjectiondruguse.ApproximatelyhalfofpediatricAIDScases(4,700reportedthrough2002)resultfrominjectiondruguseorsexwithinjectiondrugusersbythechild'smother.药物滥用的危害ManyofAmerica'stopsocialproblemsalsorelatetoorimpactdrugabuse:DruggedDriving:TheNationalHighwayTrafficSafetyAdministrationestimatesthatdrugsareusedbyapproximately10to22percentofdriversinvolvedincrashes,oftenincombinationwithalcohol.Violence:Atleasthalfoftheindividualsarrestedformajorcrimesincludinghomicide,theft,andassaultwereundertheinfluenceofillicitdrugsaroundthetimeoftheirarrest.Stress:Exposuretostressisoneofthemostpowerfultriggersofsubstanceabuseinvulnerableindividualsandofrelapseinformeraddicts.ChildAbuse:Atleasttwo-thirdsofpatientsindrugabusetreatmentcenterssaytheywerephysicallyorsexuallyabusedaschildren.滥用药物治疗中心至少三分之二患者说，他们在儿童时遭受过身体或者性方面的虐待。药物滥用的危害AddictionAffectsEveryone药物滥用的危害Drugabuseimpactstheindividual,family,andcommunity.Everybodyknowssomeonewhoisaffectedbydrugabuse.AddictionAffectsEveryoneIndividual:Adolescence:Thisisatimeperiodofhighvulnerabilitytodrugabuseandotherrisktakingbehaviors.MentalIllness:Peoplewithmentalillnessareparticularlyatriskforproblemsrelatedtosubstanceabuse.ConsequencesofSubstanceAbuse:Thesecanincludeillness,injuries,anddeath.Eachyearapproximately40milliondebilitatingillnessesorinjuriesoccuramongAmericansastheresultoftheiruseoftobacco,alcohol,oranotheraddictivedrug.Deaths:In2000,approximately460,000deathswereattributabletoillicitdrugabuseandsmoking.药物滥用的危害AddictionAffectsEveryoneFamiliescanbedestroyedbydrugabuse:Prenatal:Smoking:Infantsborntowomenwhosmokeduringpregnancyhavealoweraveragebirthweightandmaybeatincreasedriskforattentiondeficithyperactivitydisorder,conductdisorders,andchildhoodobesity.Cocaine:Babiesborntomotherswhoabusecocaineduringpregnancycanbebornprematurelyandhavelowbirthweights.Theremaybeasmanyas45,000cocaine-exposedbabiesperyear.ChildAbuse:Approximately50%to80%ofallchildabuseandneglectcasessubstantiatedbychildprotectiveservicesinvolvesomedegreeofsubstanceabusebythechild’sparents.药物滥用的危害AddictionAffectsEveryoneDrugAbuseAffectsUsAllCommunity:Homelessness:31%ofAmerica'shomelesssufferfromdrugabuseoralcoholism.Crime:Asmanyas60%ofadultsinFederalprisonsaretherefordrug-relatedcrimes.Education:Childrenwithprenatalcocaineexposurearemorelikely(1.5times)toneedspecialeducationservicesinschool.Specialeducationcostsforthispopulationareestimatedat$23millionperyear.TheWorkplace:In1997,illicitdrugusersweremorelikelythanotherstohavemissed2ormoredaysofworkinthepastmonthandtohaveworkedforthreeormoreemployersinthepastyear.药物滥用的危害DrugAbuseisanEqualOpportunityDestroyerNopopulationgroupisimmunetosubstanceabuseanditsdamage.Drugabuseaffectsthoseatalllevelsofsociety,includingpeoplewemayadmire.Theeffectsofaddictionreachacrossthelifespan,acrosscultures,andac