Drugs of Abuse

Drugs of Abuse
Drug: is any substance/chemical other than food - taken to alter the way the body/mind functions Abuse: maladaptive pattern of drug use manifested by recurrent and significant adverse consequences related to repeated use of the drug(s) Latest study: 3 of 4 new HIV infections are drug-related ( CDC /Dr. Scott Holmberg, 2004+ )

Marijuana
Most commonly used illegal drug in USA Cannabis sativa: delta9-tetrahydrocannabinol (THC) Hashish (resin): higher concentration THC Grass, pot, weed, herb smoked, eaten Smoke: cancer-causing chemicals > tobacco smoke

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

Marijuana (cont)
Often first illegal drug used Increased risk of progressing to more powerful and dangerous drugs (cocaine, heroin) Risk for progressing to cocaine: 104 X higher with smoking marijuana at least once than never smoked marijuana

Stimulants:
Cocaine Amphetamine Methamphetamine

Stimulants (cont)
Cocaine:
Erythroxylum coca Crack, coke, snow, rock Smoked, injected, snorted, swallowed Intensity, duration of the drug's effects depend on how taken

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 cocaine or unexpectedly afterwards

Stimulants (cont)
Cocaine 2009, 4.8 million Americans >=12 y.o. had abused cocaine in any form. Source: National Survey on
Drug 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

Stimulants (cont)
Amphetamines Acute intoxication: SNS stimulation

tachycardia hypertension anorexia Insomnia seizures

Stimulants (cont)
Methamphetamines
Meth, crank, ice, speed, crystal Injected, snorted, smoked, or eaten Powerful stimulant: increases alertness, pleasure decreases appetite Same toxic effects as cocaine:heart attacks, HBP, stroke Withdrawal: depression, abdominal cramps, and increased appetite Long-term effects: paranoia, hallucinations, weight loss, destruction of teeth, heart damage.

Opiates
Papaver somniferum Heroin: most commonly abused opiate Other:

methadone morphine codeine oxycodone fentanyl (China white) black tar (a potent form of
heroin)

Opiates (cont)
Heroin
Signs of intoxication:

decreased respiratory rate pinpoint pupils

Acute complications:

noncardiogenic pulmonary edema respiratory failure

primarily infectious: skin abscess, cellulitis mycotic aneurysms, endocarditis talcosis HIV hepatitis

Complications of chronic use:

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

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

Club drugs (cont)

Flunitrazepam: Rohypnol forget-me pill, Mexican Valium, R2, roach, Roche, roofies, roofinol, rope, rophies Sedative, date-rape drug Effects:

low blood pressure dizziness abdominal cramps confusion impaired memory

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.

Dissociative Drugs
Common effects: feelings of being separate from ones body and environment impaired motor function/anxiety tremors numbness memory loss nausea

Dissociative Drugs (cont)

Ketamine

special K, K anesthetic: orally or injected impair memory and attention higher doses:
amnesia paranoia hallucinations depression difficulty breathing

Dissociative Drugs (cont)

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

Dissociative Drugs (cont)

Phencyclidine effects:

analgesia psychosis aggression violence slurred speech loss of coordination hallucinations

Dissociative Drugs (cont)

Dextromethorphan (DXM)
Triple C Effects:
euphoria slurred speech confusion dizziness distorted visual perceptions

Cough, cold medications: Robotripping, Robo,

Hallucinogens
Altered states of perception and feeling Hallucinations

Hallucinogens (cont)
LSD: Lysergic acid diethylamide
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

acid, blotter, cubes, microdot yellow sunshine, blue

Hallucinogens (cont)
Mescaline

buttons, cactus, mesc, peyote swallowed, smoked

Psilocybin

magic mushrooms, purple passion, shrooms, little

smokeI swallowed effects: nervousness; paranoia; panic

Inhalants
Solvents (paint thinners, gasoline, glues); Gases (butane, propane, aerosol propellants, nitrous oxide); Nitrites (isoamyl, isobutyl, cyclohexyl) Laughing gas, poppers, snappers, whippe

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

Inhalants (cont)
2009, 2.1 million Americans age 12 and older had abused inhalants. Source: National Survey on Drug Use
and Health

The NIDA-funded 2010 Monitoring the Future Study

8.1% of 8th graders 5.7% of 10th graders 3.6% of 12th graders had abused inhalants at least
once in the year prior to being surveyed

ED management:
A, B, C

Treatment of grossly abnormal VS

ED management (cont)
HT + agitation Benzodiazepine Phentolamine/Nitroprusside for HT urgencies DO NOT use beta blockers in suspected cocaine intoxication (unopposed alfa adrenergic HT)

ED management (cont)
Hypertermia (>104 F) Aggressive cooling measures Until T<100.4 May lead:

rhabdomyolysis myoglobinuria renal failure death

ED management (cont)
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 epileptogenic drugs/chronic BZD abuser

ED management (cont)
Seizures: Lorazepam/Diazepam Agitation: BZD / Haloperidol (PCP ingestion) Serotonin syndrome:

mydriasis HT psychomotor agitation AMS (MDMA) Cyproheptadine

ED management (cont)
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 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.

Principles of Drug Addiction Treatment (cont)

Counselingindividual and/or groupand other behavioral therapies are the most commonly used forms of drug abuse treatment Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. An individuals treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.

Principles of Drug Addiction Treatment (cont)

Many drug-addicted individuals also have other mental disorders Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Treatment does not need to be voluntary to be effective. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

Principles of Drug Addiction 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-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

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, etc Concerted efforts are needed by all Combined professional therapy techniques