Transcript Commonly Misused Substances

Commonly Misused
Substances
Substances
Commonly Used in an At-Risk Manner
Alcohol
•
Ethanol, methanol, isopropyl alcohol.
Sedative/Hypnotics/Anesthetics
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Benzodiazepines, barbiturates, anesthetics (Gammahydroxybutyrate (GHB),
ketamine).
Primarily used orally although ketamine may be injected.
Opioids
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Heroin, oxycodone, morphine, hydromorphone, methadone, fentanyl, codeine,
propoxyphene and others.
All of these substances maybe used orally, intranasally or by injection. Long acting
formulations and patches may be chewed.
Stimulants
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Amphetamines, cocaine, methamphetamine, ephedrine, phencyclidine,
methylphenidate.
All of these substances may be used orally, intranasally or by injection.
SAMHSA, 2005
Substances
Commonly Used in an At-Risk Manner
Hallucinogens
•
LSD, mescaline, psilocybin (mushrooms), phenylcyclidine (PCP), ecstasy,
methylenedioxymethamphetamine (MDMA).
Cannabis/Tetrahydrocannabinol (THC)
• Marijuana.
• Smoked, vaporized, oral.
Steroids
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Dianabol, nandrolone.
Typically by injection.
Volatile Substances
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Toluene, acetone, butane, fluorocarbons.
Inhaled (“Huffed”).
cntinue
SAMHSA, 2005
Sedative/Hypnotic/Anesthetic
Benzodiazepines, barbiturates, anesthetics (GHB, ketamine)
Signs/SXS of intoxication:
• Altered consciousness
• Ataxia
• Sexual dysfunction
• Death
• Confusion
• Slurred speech
• Stupor/coma
• Loss of coordination
• Dizziness
• Apnea
• Memory impairment
• Weight gain
• Paradoxical/uncharacteristic
behavior
• Incoordination
• Emotional lability
• Memory impairment
• Poor task completion
• Nystagmus with accommodation
• Insomnia
• Psychosis
• Headache
• Seizure
• Hypersensitivity to stimuli
Signs/SXS of chronic use:
• Loss of motivation
• Poor comprehension
• Development of tolerance
(barbiturates)
Signs/SXS of withdrawal:
• Severe anxiety
• Autonomic hyperactivity
If injected, Ketamine use may present with Signs/SXS common to injection drug use.
NIDA, 2008; Stark, 2009
Opioids
Heroin, oxycodone, morphine, hydromorphone, methadone,
fentanyl, codeine, propoxyphene
Signs/SXS of intoxication:
• Pinpoint pupils
• Respiratory depression
• Nausea/vomiting
• Bradycardia
• Constipation
• Coma
• Relaxed and/or euphoric state ("nodding“)
Signs/SXS of chronic use:
• Sexual dysfunction
• Amenorrhea
• Development of tolerance to euphoria/analgesia (but not to pupillary response)
Signs/SXS of withdrawal:
• Yawning
• Diaphoresis
• Diarrhea
• Autonomic hyperactivity
• Rhinorrhea
• Nausea/vomiting
• Tremor
• Malaise
• Lacrimation
• Myalgia
• Insomnia
• Anxiety
• Piloerection
• Abdominal cramps
• Dysphoria,
Signs/SXS related to route of administration:
Injection:
• Embolis
• Cellulitis
• Endocarditis
• HIV
• Abscesses
• Viral hepatitis
• Foreign body emboli
• Infections consequences of unsterile injection
• Fresh needle marks and scaring (track marks)
• Soft tissue necrosis (with injection of pill forms)
NIDA, 2008; Stark, 2009
Stimulants
Amphetamines, Cocaine, Ephedrine, Phencyclidine
Signs/SXS of intoxication:
• Hypertension
• Diaphoresis
• Fine tremor
• Muscle spasms
• Tachycardia
• Agitation
• Appetite suppression
• Chest pain
• Tachypnea
• Paranoia
• Hyperthermia
• Sexual dysfunction
• Mydriasis
• Brisk reflexes
• Formication
• Malnutrition
• Reduced fertility
• Development of tolerance
Signs/SXS of chronic use:
• Weight loss
Signs/SXS of withdrawal:
• Muscle pain/tremor
• Depression/irritability
• Intense persistent drug seeking behavior
• Hunger
• No specific withdrawal syndrome but cessation of use may be accompanied by fatigue/malaise
Signs/SXS related to route of administration:
Intranasal:
• Rhinorrhea
Inhaled:
• Bronchitis
• COPD/bronchiectasis
Injection:
• Septal perforation
• Eczema localize to nares
• Pneumonia
• Dry mouth with poor dentition
• Burns to the lips and fingers
• Embolis
• Abscess formation
•Infections consequences of unsterile injection
• Skin and soft tissue necrosis with chronic wound formation and adjacent or distant osteomyelitis
NIDA, 2008; Stark, 2009
Hallucinogens
LSD, Ecstasy, Mushrooms
Signs/SXS of intoxication:
• Tachycardia
• Nystagmus
• Nausea
• Paranoia
• Dry mouth
• Ataxia
• Mood lability
• Bruxism
• Hyperreflexia
• Vomiting
• Mydriasis
• Autonomic hyperactivity
• Visual/auditory
hallucinations
Signs/SXS of chronic use:
• Tolerance develops rapidly to LSD, flashbacks may occur long after heavy or prolonged use
Signs/SXS of withdrawal:
• No specific withdrawal syndrome
Medical Consequences:
• Rhabodomyolysis and acute renal failure with large doses, elevated liver enzymes
NIDA, 2008: Stark, 2009
Cannabis
Marijuana, tetrahydrocannabinol
Signs/SXS of intoxication:
• Euphoria
• Dry mouth
• Tachycardia
• Poor concentration
• Agitation
• Anxiety
• Hypertension with postural hypotension
• Hunger
• Memory impairment
• Toxic psychosis
• Reddened conjunctivae
• Paranoia
• Impaired manual dexterity
• Cough
• Chronic bronchitis
Signs/SXS of chronic use:
• Affect disorders
• Dental caries
Signs/SXS of withdrawal:
• No discrete withdrawal syndrome although cessation of use may be accompanied by disphoria or anxiety
• Restlessness and irritability
Smoked cannabis is a respiratory irritant. No specific consequences associated with oral or vaporized consumption.
NIDA, 2008; Stark, 2009
Volatile Substances
Signs/SXS of intoxication:
• Solvent smell
• Diarrhea
• Ataxia
• Nausea
• Sneezing
• Dysphoria
• Vomiting
• Coughing
• Disinhibition
• CNS depression
• Slurred speech
• Coma
• Burns
• Memory loss
• Delusions
• Respiratory problems
• Weight loss
• Psychosis
• Perioral eczema (glue sniffer’s rash)
• Poor concentration
Signs/SXS of chronic use:
• Nasal sores
• Fatigue
• Depression
Signs/SXS of withdrawal:
• Primarily psychological dependence
• HA Inhalation of volatile substances is associated with sudden death from
arrhythmia
• Drowsiness
• Chronic liver and renal failure
Stark, 2009