Transcript DRUGS OF ABUSE

DRUGS
OF
ABUSE
Reynaldo J. Lesaca, M.D.
CHEMICAL CLASS
AGENTS
Alcohol
Stimulants
Alcohol
Examples:
Amphetamine, crystal meth
Cocaine
Sympathomimetics
(incl. caffeine)
Examples:
Lysergic acid diethylamide
Cannabis
Phencyclidine
Hallucinogens
CHEMICAL CLASS
AGENTS
Opiates / Narcotics Examples: Morphine
Heroin
Phencyclidine
Inhalants / Aerosols Examples: Glue
Paint thinner
CHEMICAL CLASS
AGENTS
Gamma hydroxy butyrate
Sedative / Hypnotics
Examples:
Flunitrazepam
Barbiturates
Benzodiazepines
Hypnotics
Nicotine
Examples:
Cigarettes / cigars
DRUG ABUSE
Acute or chronic intake of any
substance that: (a) has no
recognized medical use, (b) is
used inappropriately in terms
of its medical indications or its
dose.
DEFINITIONS
DRUG ABUSE Acute or chronic intake of
any substance that: (a) has
no recognized medical use,
(b) is used inappropriately in
terms of its medical
indications or its dose.
DEFINITIONS
DRUG
DEPENDENCE
a) Psychological craving or desire for
continuous administration
of a drug to provide a
desired effect or to avoid
discomfort
DEFINITIONS
DRUG
A physiological state of
DEPENDENCE adaptation to a drug which
usually results in
b) Physical
development of tolerance
to drug effects and
withdrawal symptoms when
the drug is stopped.
* also called addiction
DEFINITIONS
TOLERANCE
The phenomenon in which
increasing doses of a drug
are needed to produce a
desired effect.
GENERAL COMMENTS
The effect which any drug of abuse
has on an individual depends on a
number of variables:
1. Dose (amount ingested,
injected, snifted, etc)
2. Potency and purity of the drug
3. Route of administration
GENERAL COMMENTS
4.Past experience of the user
5. Present circumstances
6. Personality and genetic
predisposition of user
7. Age of user
8. Clinical status of user
PHARMACOLOGY
Research data have demonstrated
that every drug of abuse increase
dopamine activity in the nucleus
accumbens of the brain; the
increased dopamine is suggested
to be associated with the pleasurable
effects produced by the drug.
ADVERSE EFFECTS
• Reactions are unpredictable and
depend on the potency and purity
of the drug taken
• Psychiatric reactions secondary
to drug abuse may occur more
readily in individuals already at
risk
ADVERSE EFFECTS
• Renal hepatic, cardiorespiratory,
neurological and gastrointestinal
complications as well as
encephalopathies can occur with
chronic abuse of specific agents.
• Intravenous users are at risk for
infection.
• Impurities in street drugs can cause
tissue and organ damage.
ADVERSE EFFECTS
• Psychological dependence can occur;
the drug becomes central to a
persons thoughts, emotions, and
activities resulting in craving.
• Physical dependence can occur, the
body adapts to the presence of the
drug and withdrawal symptoms occur
when the drug is stopped resulting in
addiction.
DETECTION OF DRUGS OF ABUSE
Factors affecting detection of a drug
in urine depend on:
- dose
- route of administration
- drug metabolism
- characteristics of screening and
confirmation assays
DETECTION OF DRUGS OF ABUSE
Characteristics of screening and
confirmation assays; for instance:
• Amphetamines in urine can be positive up to
5 days.
• Marijuana (THC) can be positive 2 – 4 days
after acute use and up to 1 – 3 months after
chronic use
DETECTION OF DRUGS OF ABUSE
Characteristics of screening and confirmation
assays; for instance:
• Cocaine in urine can be positive up to 1.5
days after I.V. use, for up to 1 week with
street doses used by different routes and for
up to 3 weeks after use of very high doses
• Heroin in urine can be positive for up to 1.5
days when administered parenterally or
intranasally.
TREATMENT
ACUTE
• The diagnosis of the type of substance
abused can be difficult in an ER when a
patient is floridly psychotic, intoxicated or
delirious. Blood and urine screens take
time, therefore diagnosis must include
mental status, physical and neurological
examination as well as a drug history,
whenever possible; collateral history
should also be sought.
TREATMENT
• In severe cases, monitor vitals and fluid
intake.
• Agitation can be treated conservatively by
taking with the patient and providing
reassurance until the drug wears off when
conservative approaches one in adequate
or if symptoms persists pharmacological
intervention should be considered.
TREATMENT
• Avoid low potency neuroleptics due to
anticholinergic effects, hypotension
and tachycardia
TREATMENT
LONG TERM
• The presence of comorbid psychiatric
disorders in substance abusers can
adversely influence outcome in
treatment of the substance abuse as
well as the psychiatric disorder.
Thank you!