Podcast Summary
Xylazine and Fentanyl: A Deadly New Drug Combination: Xylazine, a large animal tranquilizer, is entering the human illicit drug market in combination with Fentanyl, making the drug threat deadlier. Xylazine shuts down norepinephrine in the brain, making small doses potentially lethal. The DEA has seized Xylazine and Fentanyl mixtures in nearly every state.
Xylazine, a large animal tranquilizer, has entered the human illicit drug market, often in combination with the potent opiate, Fentanyl. This dangerous combination is making the drug threat facing our country even deadlier than fentanyl alone. Xylazine functions as a sedative and deepens the euphoric response to Fentanyl, but it's not an opioid and cannot be reversed by Narcan. It works by turning off the locus coeruleus, which in turn shuts down the reticular activating system and cortical neurons that depend on norepinephrine input to maintain their firing rate. This efficient way of turning off norepinephrine in the brain makes very small doses of both Xylazine and Fentanyl potentially lethal for humans. The DEA has seized Xylazine and Fentanyl mixtures in 48 of 50 states, and approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained Xylazine. This new development in the drug market is an important topic for healthcare professionals to understand, and our podcast episode on this subject, along with others, offers continuing medical education credits.
Xylazine: The 'Zombie Drug' Causing Sedation and Respiratory Arrest: Xylazine, a potent alpha-2 agonist, causes severe sedation and respiratory arrest when combined with opioids, leading to ICU-level care. It suppresses arousal systems, causes vasoconstriction, and doesn't show up on standard drug tests.
Xylazine, also known as the "zombie drug," is a powerful alpha-2 agonist that can cause severe sedation and respiratory arrest when combined with opioids. It works by suppressing the two major monoamine arousal systems that maintain consciousness, effectively putting people into a state of unconsciousness. This drug also causes severe vasoconstriction and necrosis at the injection site, leading to skin ulceration. In the ER, healthcare professionals may initially mistake this sedation for opioid overdose and administer naloxone, but it won't reverse the effects of Xylazine. Patients may require intensive care unit (ICU) level care, including IV fluids, cardiac catheterization, and various medications like dexmedetomidine, phenobarbital, tizanidine, and clonidine. Xylazine is significantly more potent than drugs like clonidine or quanfacine and won't show up on standard drug screening tests, making it a dangerous and challenging drug to treat.
Combination of Xylazine and Fentanyl: A Deadly Duo: Xylazine and Fentanyl, used together, can lead to long-lasting overdoses requiring ICU-level care, with no specific antidote. Underlying reasons for drug use include trauma, despair, and mood issues, and treatment focuses on opioid use disorder methods.
The combination of Xylazine and Fentanyl, both potent and lethal drugs, is rapidly gaining popularity in the illicit drug community. This combination can lead to a range of dangerous health effects, including bradycardia, respiratory depression, hypotension, and potential seizures or strokes due to blood pressure changes. The long-lasting overdoses, which can last from 8 to 72 hours, require ICU-level care and supportive treatment as there is no specific antidote for Xylazine. The underlying reasons for drug use often involve trauma, despair, and mood issues, leading to a cycle of seeking increasing euphoria and trying to avoid intensifying anhedonia. While research is ongoing, current treatment approaches focus on addressing opioid use disorder through day treatment programs, 12-step programs, and pharmacological agents like buprenorphine. Neurosurgical approaches to addiction, such as ablation or deep brain stimulation, are not yet a mainstream treatment option.
Effects of Methamphetamines on the Brain: Methamphetamines cause a rush of dopamine, leading to euphoria and hyperactivity, but also result in a crash and long-term changes in brain chemistry, causing lethargy, anger, and altered sexual preferences.
Methamphetamines, also known as "ice" or "crystal," are highly addictive substances that can have severe, life-altering effects on the user. Unlike prescription medications like Adderall, which are used to treat conditions like ADHD, methamphetamines are often used in much larger doses, leading to a significant increase in dopamine release in the brain. This flood of dopamine leads to feelings of euphoria and hyperactivity, but also results in a crash where the user becomes hypersomnolent, hyperphagic, and may exhibit aggressive behavior. Long-term use can lead to depletion of dopamine, resulting in a state of lethargy and anger. Additionally, methamphetamine use can lead to changes in sexual preferences and heightened sexuality. It's important to note that this discussion is based on current research and understanding, and experts are encouraged to share their knowledge and clarify any misrepresentations.
Methamphetamine-induced psychosis: Disturbing experiences and brain areas involved: Methamphetamine use can cause hallucinations, paranoia, and aggressive behavior, affecting the nucleus accumbens, mesolimbic dopamine circuit, and medial amygdala. Approach users with empathy, as symptoms can resemble primary psychosis.
Methamphetamine use can lead to a range of disturbing experiences, including hypersexuality, compulsive behaviors, paranoia, agitation, irritability, and tactile hallucinations. The overstimulation of certain brain areas, particularly the nucleus accumbens, mesolimbic dopamine circuit, and medial amygdala, can result in these symptoms. The initial presentation of a person using methamphetamines can be difficult to distinguish from someone with a primary psychosis due to their agitated, paranoid, and irritable behavior. It's important to approach these individuals with empathy and understanding, allowing them to gradually come back towards homeostasis rather than rushing to a diagnosis or judgment. Methamphetamine use can also amplify the risk of violent behavior in individuals with underlying psychotic illnesses. The paranoid nature of methamphetamine-induced psychosis sets it apart from primary psychosis, making it a significant concern for both individuals and society.
Paranoia's Different Manifestations: Paranoia can stem from various causes, leading to different manifestations. Methamphetamine use results in a more generalized paranoia, while primary psychosis involves systematized delusions. Military use of methamphetamines led to addiction, decreased functionality, and devastating consequences for families, particularly children born to addicted mothers.
Paranoia can manifest differently depending on the cause. While a primary psychotic individual may have systematized delusions, someone under the influence of methamphetamines exhibits a more generalized paranoia, seeing everything and everyone as dangerous. Historically, militaries have used methamphetamines to make soldiers more resilient and aggressive, but the downside includes increased addiction rates and decreased functionality post-high. Methamphetamine, developed in Germany in 1887, has had a significant impact on warfare and society, leading to devastating consequences such as lab explosions and the wreckage of entire families, particularly those with children born to addicted mothers. These children often face developmental delays and emotional dysregulation.
Substance abuse during pregnancy harms the developing fetus: Amphetamines, marijuana, alcohol, cocaine, and opiates can negatively impact fetal development. Maternal lifestyle and genetic factors contribute to addiction vulnerability, worsened by prenatal substance exposure.
Substance abuse during pregnancy can lead to various negative outcomes for the developing fetus. Amphetamines, specifically when abused as in methamphetamine use, can cause significant harm. However, therapeutic use of stimulants for ADHD does not pose similar risks. Other substances like marijuana, alcohol, cocaine, and opiates also have detrimental effects, with fetal alcohol syndrome being particularly well-known. The overall lifestyle of substance-abusing mothers often contributes to their children's challenges, including social difficulties. Genetic and social factors play a role in vulnerability to addiction, and prenatal exposure to substances can further increase that vulnerability. Substance abuse offers an initial sense of normalcy or improvement, but the long-term effects often disappoint and perpetuate the cycle of addiction.
Amphetamines vs Methamphetamines: Differences in Addiction Potential: Proper treatment of ADHD in childhood reduces amphetamine abuse later in life. Adult ADHD presents differently, with adults more likely to have attentional deficits. Methylphenidate, a reuptake inhibitor, is preferred over amphetamines due to lower addiction risk. Proper dosing and treatment for psychosis is crucial to prevent addiction.
While the differences between amphetamines and methamphetamines may seem minimal, the doses used in abuse settings versus clinical use play a significant role in addiction potential. ADHD patients who were appropriately treated during childhood have a lower rate of abusing amphetamines later in life compared to those who were not treated. Adult ADHD exists, but it presents differently than in children, with adults more likely to have attentional deficits rather than hyperactivity. Stimulant treatment can be beneficial for attention and behavior, but carries the risk of addiction if misused. Methylphenidate, which is a reuptake inhibitor, is generally preferred over amphetamines due to its lower risk of causing a euphoric response. When treating psychosis, it's important to block D2 receptors, but a slow and low dose of a D1 reuptake inhibitor like methylphenidate could still be beneficial.
Dopamine receptors in psychosis and methamphetamine use: Antipsychotics improve psychosis by blocking d2 receptors, enhancing D1 function. Excessive methamphetamine use harms health, but initial use may boost prefrontal cortex function.
In individuals with primary psychosis, positive symptoms are primarily driven by d2 receptors in the mesolimbic pathway and temporal lobe. Antipsychotics, which block these receptors, can improve the functioning of dopamine D1 receptors in the prefrontal cortex and anterior cingulate cortex, responsible for processing information and directing attention. However, if d2 receptors are not blocked, increasing dopaminergic tone with a dopaminergic stimulant can worsen positive psychotic symptoms. It's essential to carefully evaluate a patient's psychosis control before considering such treatment. Regarding methamphetamines, while they can improve prefrontal cortex function like stimulants, their excessive use is detrimental to overall health. Side effects include "meth mouth," hypertension, cardiac arrhythmias, kidney damage, and muscle wasting. The anhedonia experienced after methamphetamine use may last and improve with abstinence.
Recovering from methamphetamine addiction: a long and challenging process: Long-term treatment for methamphetamine addiction may involve antipsychotics, anxiolytics, and mood stabilizers, but their use should be cautious due to potential dopamine depletion. Education and support are crucial for a successful recovery.
The recovery process from methamphetamine addiction can take a long time and may result in a reduced ability to experience enjoyment. For those currently using meth and experiencing acute psychosis, initial treatment may involve gentle use of dopamine antagonists to calm them down, followed by supportive care to help them recover. Long-term treatment may include antipsychotics, anxiolytics, and mood stabilizers, but these should be used with caution due to the potential for underlying dopamine depletion. Evidence supports the use of antipsychotics and anxiolytics in treating methamphetamine-induced psychosis. The ideal treatment plan includes a partial program or day treatment with group therapy, family work, and regular attendance at 12-step meetings. It's important to educate patients about the long and potentially incomplete nature of the recovery process and encourage them to avoid using meth again to prevent worsening symptoms.
Synthetic drugs and marijuana's increased potency fueling drug crisis: Synthetic drugs and more potent marijuana can lead to psychosis, especially in vulnerable individuals. Effective treatment includes controlled environment and outpatient care, but resources and insurance coverage can be a barrier.
The drug crisis in the US is complex and multifaceted, with the emergence of more potent synthetic variants of classic drugs of abuse, such as cathinones and synthetic cannabinoids, making the situation even more dangerous. These synthetic drugs are significantly more potent than their natural counterparts and can lead to paranoid psychosis. Marijuana and hashish oil have also become more potent over the years, increasing the risk of psychosis, especially in individuals who are prone to primary psychotic illnesses like schizophrenia. The best evidence suggests that some drugs, including marijuana, amphetamines, and hallucinogens, can induce permanent psychosis in certain individuals. The ideal treatment for drug addiction involves a controlled environment for the first few weeks, followed by outpatient care and continued rehabilitation. However, insurance coverage and availability of resources can limit the effectiveness of this approach.
Drugs can cause temporary or permanent psychosis in some individuals: Some drugs, especially amphetamines and hallucinogens, can cause psychosis in users, with severity and length depending on drug use. Methamphetamine can lead to persistent psychosis, while LSD psychosis is usually temporary but can be long-term or broader spectrum.
Certain drugs, particularly amphetamines and certain hallucinogens, can cause temporary or permanent psychosis in some individuals due to their impact on dopamine levels and potential histological changes in the brain. The length and severity of these psychotic episodes depend on the duration and intensity of drug use. For instance, methamphetamine use can lead to persistent psychosis in 10-30% of users, while the psychosis caused by LSD or other hallucinogens is usually temporary but can sometimes result in long-term hallucinations or even broader spectrum psychosis. The exact cause of this broad spectrum psychosis is unclear - it may be due to a drug-induced tipping point for individuals with a genetic predisposition to psychosis, or the drug itself may be capable of producing psychosis in those with no predisposition. Recovering from substance abuse, such as alcohol, can also lead to changes in the brain, including the regrowth of dendritic spines and thickening of the cortex, which can improve neuron-to-neuron communication and help individuals maintain sobriety.
The Brain's Journey Back to Homeostasis: Through reducing noradrenergic overactivity, improving sleep, histological changes, psychotherapy, exercise, a healthy diet, and avoiding excessive internet use, the brain can gradually return to normal functioning and reduce the risk of cognitive decline.
The brain, after being pushed away from homeostasis due to substance use, can gradually return to more normal functioning through various means. This process involves the reduction of noradrenergic overactivity, improved sleep, and histological changes leading to normal monoamine production. Psychotherapy and exercise are essential in supporting this process, as they positively impact the brain and promote overall health. Additionally, maintaining a healthy diet, particularly transitioning from high processed foods to a more Mediterranean diet, can significantly improve brain health. Furthermore, individuals should be cautious of excessive use of short form video and other internet activities, as they can negatively impact the brain in a similar way to substance use. The combination of these healthy habits can help individuals change their brain for the better and reduce the risk of cognitive decline.
The Power and Potential Addiction of AI's Ability to Capture Our Attention: AI's advanced technology could impact child development, social interaction, and influence behavior and choices in profound ways. It's essential to be aware and set regulations for positive use.
As technology advances, particularly AI, its ability to capture and hold our attention is becoming increasingly powerful and potentially addictive. This could have significant implications for individuals, families, and society as a whole. For example, imagine a future where children are primarily interacting with AI instead of human caregivers. This could impact child development and social interaction in profound ways. Additionally, the algorithms used by AI are becoming increasingly sophisticated at targeting our interests, potentially influencing our behavior and choices in ways we may not even realize. It's important for us to be aware of this and take steps to maintain our independence and make wise choices. The potential benefits of AI are significant, but so are the risks. It's up to us as a society to set regulations and guidelines that will help ensure the technology is used in a positive and beneficial way. Ultimately, it's crucial that we educate ourselves and our children about AI and its potential impact on our lives.
Human and AI collaboration in chess: The combination of human and AI can be more powerful than relying on either alone. Be mindful of technology's impact on attention and prioritize real-life connections.
The combination of human and artificial intelligence can be more powerful than just relying on either one alone. This was illustrated in a study where the best chess player in the world, when paired with an AI, could almost beat another AI. As we move forward, it's important to consider how technology is vying for our attention and how we can make conscious choices about what we focus on. The potential for addictive behaviors towards technology is a growing concern, and it's crucial for mental health professionals and individuals to be mindful of their screen time and prioritize real-life connections with family and friends.