Drugs of Abuse2

7/30/2019 Drugs of Abuse2

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Drugs of Abuse


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Drugs of Abuse

Drug: is any substance/chemical other thanfood - taken to alter the way the body/mindfunctions

Abuse: maladaptive pattern of drug usemanifested by recurrent and significantadverse consequences related to repeateduse of the drug(s)

Latest study: 3 of 4 new HIV infections aredrug-related ( CDC /Dr. Scott Holmberg,2004+ )


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Marijuana

Most commonly usedillegal drug in USA

Cannabis sativa: delta-9-tetrahydrocannabinol

(THC) Hashish (resin): higher

concentration THC

Grass, pot, weed, herb

smoked, eaten Smoke: cancer-causing

chemicals > tobaccosmoke


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Marijuana (cont)

Common effects:

euphoria, relaxation

slowed reaction time

distorted sensory perception impaired balance and coordination

impaired learning, memory

increased heart rate and appetite

cough, frequent respiratory infections

anxiety; panic attacks; psychosis

possible mental health decline; addiction


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Marijuana (cont)

Often first illegal drug

used

Increased risk of

progressing to morepowerful and dangerous

drugs (cocaine, heroin)

Risk for progressing to

cocaine: 104 X higher

with smoking marijuana

at least once than never

smoked marijuana


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Stimulants:

Cocaine

Amphetamine

Methamphetamine


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Stimulants (cont)

Cocaine:

Erythroxylum coca

Crack, coke, snow, rock

Smoked, injected,snorted, swallowed

Intensity, duration of the

drug's effects depend onhow taken


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Stimulants (cont)

Cocaine effect:

Euphoria, energetic

Increases T, HR, BP

Abdominal pain, nausea

Risk: heart attacks, respiratory failure, strokes,

seizures

Rare: sudden death on the first use of cocaineor unexpectedly afterwards


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Stimulants (cont)

Cocaine

2009, 4.8 million Americans >=12 y.o. had

abused cocaine in any form. Source: National Survey onDrug Use and Health

The NIDA-funded 2010 Monitoring the Future

Study

1.6% of 8th graders

2.2% of 10th graders

9% of 12th graders had abused cocaine in any form
http://www.samhsa.gov/http://www.samhsa.gov/http://www.samhsa.gov/http://www.samhsa.gov/


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Stimulants (cont)

Amphetamines

Acute intoxication: SNS stimulation

tachycardia

hypertension

anorexia

Insomnia seizures


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Stimulants (cont)

Methamphetamines Meth, crank, ice, speed, crystal

Injected, snorted, smoked, or eaten

Powerful stimulant: increases alertness, pleasuredecreases appetite

Same toxic effects as cocaine:heart attacks, HBP,stroke

Withdrawal: depression, abdominal cramps, andincreased appetite

Long-term effects: paranoia, hallucinations, weightloss, destruction of teeth, heart damage.


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Opiates

Papaver somniferum

Heroin: most commonly

abused opiate

Other: methadone

morphine

codeine

oxycodone

fentanyl (China white)

black tar (a potent form ofheroin)


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Opiates (cont)

Heroin Signs of intoxication: decreased respiratory rate pinpoint pupils

Acute complications: noncardiogenic pulmonary edema respiratory failure

Complications of chronic use: primarily infectious: skin abscess, cellulitis

mycotic aneurysms, endocarditis talcosis HIV hepatitis


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Club drugs:

MDMA: methylenedioxy-methamphetamine

Ecstasy, Adam, clarity, Eve, lover's speed,

peace, uppers

Stimulant, hallucinogen

Improve mood, maintain energy

Long-term use: damage to the brain's ability to

regulate sleep, pain, memory, emotions


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Club drugs (cont)

Gamma-hydroxybutyrate GHB

Liquid XTC, G, blue nitro

Effects related to dose: mild relaxation to

coma/ death

Date-rape drug: tasteless, colorless, powerful

sedative


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Club drugs (cont)

Flunitrazepam:Rohypnol

forget-me pill, Mexican Valium, R2, roach,Roche, roofies, roofinol, rope, rophies

Sedative, date-rape drugEffects: low blood pressure dizziness

abdominal cramps confusion impaired memory


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Club drugs (cont)

The NIDA-funded 2010 Monitoring the Future

Study

2.4% of 8th graders, 4.7% of 10th graders, and

4.5% of 12th graders had abused MDMA 0.5% of 8th graders, 0.6% of 10th graders, and

1.5% of 12th graders had abused Rohypnol

0.6% of 8th graders, 0.6% of 10th graders, and

1.4% of 12th graders had abused GHB 1.0% of 8th graders, 1.1% of 10th graders, and

1.6% of 12th graders had abused ketamine at least

once in the year prior to their being surveyed.


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Dissociative Drugs

Common effects:

feelings of being separate from ones body

and environment

impaired motor function/anxiety

tremors

numbness

memory loss

nausea


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Dissociative Drugs (cont)

Ketamine

special K, K

anesthetic: orally or injected

impair memory and attention higher doses:

amnesia

paranoia

hallucinations depression

difficulty breathing


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Phencyclidine (PCP) :

angel dust, boat, hog, love boat, peace pill

usually, tobacco or marijuana cigarettes dipped into

PCP, then smoked similar effects to ketamine, stronger

powerful anesthetic used in veterinary medicine

anesthetic effects are so strong that you can break

your arm but not feel any pain


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Phencyclidine effects:

analgesia

psychosis

aggression violence

slurred speech

loss of coordination

hallucinations


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Dextromethorphan (DXM)

Cough, cold medications: Robotripping, Robo,Triple C

Effects: euphoria

slurred speech

confusion

dizziness

distorted visual perceptions


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Hallucinogens

Altered states of

perception and feeling

Hallucinations


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Hallucinogens (cont)

LSD: Lysergic acid diethylamide acid, blotter, cubes, microdot yellow sunshine, blue

heaven

Effects: increased body T, HR, BP

loss of appetite;

sweating;

sleeplessness; weakness,

numbness, dizziness, tremors;

impulsive behavior;

rapid shifts in emotion

flashbacks, Hallucinogen Persisting Perception Disorder


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Hallucinogens (cont)

Mescaline

buttons, cactus, mesc, peyote

swallowed, smoked

Psilocybin magic mushrooms, purple passion, shrooms, little

smokeI

swallowed

effects: nervousness; paranoia; panic


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Inhalants

Solvents (paint thinners, gasoline, glues);

Gases (butane, propane, aerosol propellants,

nitrous oxide);

Nitrites (isoamyl, isobutyl, cyclohexyl)

Laughing gas, poppers, snappers, whippe


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Inhalants (cont)

Inhalants effects: varies by chemical

stimulation;

loss of inhibition;

headache;

nausea or vomiting;

slurred speech; loss of motor coordination;

wheezing/cramps;

muscle weakness;

depression; memory impairment;

damage to cardiovascular and nervous systems;

unconsciousness; sudden death


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Inhalants (cont)

2009, 2.1 million Americans age 12 and older

had abused inhalants. Source: National Survey on Drug Useand Health

The NIDA-funded 2010 Monitoring the FutureStudy

8.1% of 8th graders

5.7% of 10th graders

3.6% of 12th graders had abused inhalants at leastonce in the year prior to being surveyed


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ED management:

A, B, C

Treatment of grossly abnormal VS


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ED management (cont)

HT + agitation

Benzodiazepine

Phentolamine/Nitroprusside for HT urgencies

DO NOT use beta blockers in suspected

cocaine intoxication (unopposed alfa

adrenergic HT)


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Hypertermia (>104 F)

Aggressive cooling measures

Until T


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Respiratory depression/ comatose patient

Bedside glucose

Naloxone emirically/correct miosis

2nd dose, if no response

Repeated doses/iv infusion

NOT recommended: Flumazemil may induce

seizures if co-ingestion of epileptogenicdrugs/chronic BZD abuser


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Seizures: Lorazepam/Diazepam

Agitation: BZD / Haloperidol (PCP ingestion)

Serotonin syndrome:

mydriasis

HT

psychomotor agitation

AMS (MDMA) Cyproheptadine


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Indications for admission:

CNS/respiratory depression

Ventricular arrhythmia

Opiate overdose requiring naloxone treatment

Suspected opiate/ CNS depressant withdrawl

Suicide attepmt/gesture without psychiatric

clearance and appropriate follow up

Principles of Drug Addiction


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Treatment

Addiction is a complex but treatable disease

that affects brain function and behavior.

No single treatment is appropriate for

everyone.Treatment needs to be readily available.

Effective treatment attends to multiple needs

of the individual, not just his or her drug abuse.Remaining in treatment for an adequate period

of time is critical.


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Treatment (cont)

Counselingindividual and/or groupandother behavioral therapies are the mostcommonly used forms of drug abuse treatment

Medications are an important element oftreatment for many patients, especially whencombined with counseling and otherbehavioral therapies.

An individuals treatment and services planmust be assessed continually and modified asnecessary to ensure it meets his or herchanging needs.


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Treatment (cont)

Many drug-addicted individuals also haveother mental disorders

Medically assisted detoxification is only the

first stage of addiction treatment and by itselfdoes little to change long-term drug abuse.

Treatment does not need to be voluntary to beeffective.

Drug use during treatment must be monitoredcontinuously, as lapses during treatment dooccur.


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Treatment (cont)

Treatment programs should assess patients

for the presence of HIV/AIDS, hepatitis B and

C, tuberculosis and other infectious diseases,

as well as provide targeted risk-reductioncounseling to help patients modify or change

behaviors that place them at risk of contracting

or spreading infectious diseases.


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Conclusion:

Drugs: very dangerous to the individual and

the society

Play a major role in other problems in the

society e.g. HIV/AIDS, violence, passivity, etcConcerted efforts are needed by all

Combined professional therapy techniques


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Drugs of Abuse2

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