drugs of abuse reynaldo j. lesaca, m.d. reynaldo j. lesaca, m.d

DRUGS DRUGS OF OFABUSEABUSE

Reynaldo J. Lesaca, M.D.Reynaldo J. Lesaca, M.D.

CHEMICAL CLASS AGENTS

Alcohol

Stimulants

Alcohol

Examples:

Amphetamine, crystal meth

Cocaine

Sympathomimetics

(incl. caffeine)

Hallucinogens Examples:

Lysergic acid diethylamide

Cannabis

Phencyclidine

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 ABUSEDRUG 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.

DEFINITIONSDEFINITIONS

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.

DEFINITIONSDEFINITIONS

DRUG DEPENDENCE

a) Psychological craving or desire for continuous administration of a drug to provide a desired effect or to avoid discomfort

DEFINITIONSDEFINITIONS

DRUG DEPENDENCE

b) Physical

A physiological state of adaptation to a drug which usually results in development of tolerance to drug effects and withdrawal symptoms when the drug is stopped.

* also called addiction

DEFINITIONSDEFINITIONS

TOLERANCE The phenomenon in which increasing doses of a drug are needed to produce a desired effect.

GENERAL COMMENTSGENERAL 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 COMMENTSGENERAL 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

PHARMACOLOGYPHARMACOLOGY 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 EFFECTSADVERSE 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 EFFECTSADVERSE 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 EFFECTSADVERSE 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 ABUSEDETECTION 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 ABUSEDETECTION 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 ABUSEDETECTION 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.

TREATMENTTREATMENTACUTE• 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.

• 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.

TREATMENTTREATMENT

• Avoid low potency neuroleptics due to anticholinergic effects, hypotension and tachycardia

TREATMENTTREATMENT

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.

TREATMENTTREATMENT

Thank you!Thank you!