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Why does the method of cocaine and stimulant administration make a difference in how a user is affected by this drug?
In your response, present one drug administered two different ways and describe how this has implications for the potency of the drug in the human body.
Use examples to substantiate your conclusions
Maisto, S.A., Galizio, M., & Connors, G. (2019). Drug Use and Abuse (8th ed.). Cengage.
Chapter 6: Cocaine, Amphetamines, and Related stimulants
Chapter 7: Nicotine
Chapter 8: Caffeine
Bremer, P.T., and Janda, K.D. (2017). Conjugate vaccine immunotherapy for substance use disorder. Pharmacological Review, 69(3), 298 -315.
Kosten, T.R., Domingo, C.B., Shorter, D, Orson, F., Green, G., Somoza, E., Sekerka, R., Leven, F.R., ariani, J., Stitzer, M., Tompkins, D.A., Rotrosen, J., Thakkar, V., Smoak, B., and Kampman, K. (2014). Vaccine for cocaine dependence: A randomized double-blind placebo-controlled efficacy trial. Drug and Alcohol Dependence, 140, 42 – 47.
Preston, J.D., O’Neal, J.H., & Talaga, M.C. (2013). Handbook of Clinical Psychopharmacology for Therapists (7th ed.). New Harbinger Publications, Inc.
Pharmacokinetics of Cocaine and the Stimulants
The stimulants and cocaine are administered through several different routes of administration. As we discussed in Module 2, the route of administration affects the speed at which the drug reaches its target and its potency. The characteristics and effects of simulants and cocaine are similar.
These substances are readily absorbed in the body; have short half-lives and relatively shorter detection time in urinalysis. The mechanism of action of these agents is their influence on systems involved with dopamine, norepinephrine and serotonin. Cocaine and amphetamines block reuptake of dopamine, norepinephrine, and serotonin. Amphetamines and methylphenidate also increase the release of dopamine and norepinephrine. Because of their dramatic impact on the monoamines, the long-term affect is to deplete monoamines. Long term users experience symptoms such as depression and lack of enjoyment in activities, a condition referred to as anhedonia. Although there is a withdrawal syndrome associated with cessation of the drugs, it is not as significant as the withdrawal from opiates and alcohol.
Vaccines for Substance Use Disorder
Over the past twenty years we have witnessed various forms of treatment for substance use disorder whose philosophy is embedded more in “harm reduction” as opposed to one of abstinence as the fundamental goal of treatment. As part of this shift in philosophy, the use of medications to treat aspects of substance use disorders has been adopted. There are several agents approved by the Food and Drug Administration (FDA) for the treatment of opioid dependence such as methadone, suboxone and naltrexone. There are agents approved by the FDA for the treatment of alcohol use disorder such as disulfiram, acamprosate and naltrexone. There are also practices deemed “off label” in which a prescriber will use a medication he or she believes may help someone with their substance use disorder but may not be officially approved by the FDA. All of these medications work by the same processes and specific sites that you were introduced to in Module Two.
There is another approach to using medications for the treatment of substance use disorders which doesn’t work at a specific site or target like the medications we identified above or at the sites that we have identified. Rather, these other agents work like vaccines, “attacking” the drug’s molecular composition itself. More specifically, the approach is referred to conjugate vaccine immunotherapy. For many substances such as those discussed in this module along with opiates, the drug’s molecule is too small to be detected by the bodies immune system. Coincidentally, the molecule is so small that it can pass through the blood brain barrier to reach its target in the brain. Immunization would involve the introduction of a protein that would bind (conjugate) to the drug molecule. This in turn provokes the body to produce and release antibodies to drug molecule. In doing so, the drug molecule is too large to pass through the blood barrier. By preventing the drug from reaching the brain, the pleasurable response to the drug has been diminished, and presumably, there is no incentive for the user to continue using the substance for which the vaccine was developed (Kosten et al., 2014). The first generation vaccines developed were those for nicotine and cocaine. Unfortunately, they did not provide meaningful results for FDA approval (Bremer & Janda, 2017). However, efforts in research and development in vaccines for a variety of substances continues.
For most individuals, the behavioral response to these agents is increased energy and a sense of vitality. However, the long-term consequence of the more potent of these agencies are disruption in mood and anhedonia. This is a group of agents whose route of administration is quite varied—highlighting the relationship between the way a drug is administered, its potency and the response of the user. Finally, the pharmacological harm reduction approach of conjugation vaccination is introduced. Although there are currently no FDA approved vaccination approaches, coincidentally, cocaine and nicotine have been two agents furthest along in research and development.