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Substance use and misuse
- 1. SUBSTANCE USE AND MISUSE DR.AHLAM SUNDUS PHARM-D, M.PHIL. (MALAYSIA)
- 2. Rational use ofdrugs Safe Effective Appropriate Economic How are safety, efficacy, appropriateness and economic factors assessed?
- 3. Terminologies Drug use Drug misuse Drug abuse/ substance abuse Drug addiction/ drug dependence Drug dependence: “ a cluster of psychological, behavioral and cognitive phenomena of varying intensity in which the use of a psychoactive drug takes on high priority. The necessary descriptive characteristic are preoccupation with a desire to obtain and take the drug and persistent drug seeking behavior.” WHO.
- 4. List of substancesthat are misused Common name Active agent Route of administration Effect on CNS Desired effect Unwanted effects/harms Lysergic acid Orally dissolved on the tongue Hallucinogenic Hallucination, detachment from reality Panic attacks, psychosis, tachycardia Ethanol Drinks (wines, spirits etc.) CNS depressant Relaxation, ↑social interaction Aggressive mood, diuresis, cirrhosis, hypoglycemia Caffeine Caffeine Orally in drinks CNS stimulant ↑ alertness % stamina, combat fatigue Diuresis, insomnia, anxiety, headaches Cannabis Delta-9- tetrahydrocannabi nol (THC) Hashish (resin)/ marijuana smoked CNS depressant Relaxation, enhances mood, sociability Anxiety, sedation, tachycardia, lung disorder
- 5. Continue….. Ecstasy 3,4- methylenedioxyme thamfetamine (MDMA) Oral tabletesp. in parties CNS stimulation, hallucigenic Physical & mental stimulation, sociability Sweating, tachycardia, headache, dry mouth Heroin Diamorphine Vapor inhalation after heating on foil/ I/V CNS depressant Euphoria, detachment from emotional distress n/v, sweating, drowsiness, resp. depression hypoxia Tobacco Nicotine Smoking/ chewing CNS stimulation Mood elevation, relaxation Cancers, CV disorders, cough Cocaine Cocaine hydrochloride Nasal administration, inj, CNS stimulation Euphoria, ↑confidence Cardiac toxicity, palpitations psychosis Speed Amphetamine Nasal, oral I/V CNS stimulation Physical & mental stimulation, Tachycardia, HTN, Paranoia,
- 6. Factors Underlying Misuseof Drug Perceived benefits Pleasurable feelings Increased social interaction Alteration of person’s psychological condition Avoidance of withdrawal symptoms in drug dependents Availability an opportunity to try Legal status of drug Perceived benefits weighed up against risks
- 7. Adverse Impact ofDrug Misuse Type of drug Frequency/ dose Individual Circumstances Health problems Social problems Drug-related crime
- 8. Health Problems Individual Physical effects Psychological effects Damage to circulatory system, HI, HBV,HCV Society Blood-borne infections (needle sharing)
- 9. Social Problems Poverty Social deprivation Exclusion or failure in education Inability to obtain or sustain employment Spending of income on drugs Damage to relationship Homelessness
- 10. Drug-related Crime Criminalactivities for drug acquisition Robbery Drunk driving Violence associated with drunkenness Treatment has shown to reduce crime related to drug use
- 11. Control and Dependence Neurological control Person loses control over drug consumption Drug consumption controls the person Social deprivation
- 12. Withdrawal Stop usingsubstance Physical withdrawal effects (severe/ shorter duration) Psychological withdrawal effects (may not be easily observed/ long duration) Physical: seizures alcohol withdrawal palpitations, anxiety cocaine withdrawal insomnia nicotine withdrawal stomach cramps, influenza type symptoms opiate derivative Psychological: intense craving, emotional experiences, grief, inability to cope, altered mood, depression
- 13. Harms Relating toDrug Use and Dependence SIDE EFFECTS TOLERANCE DEPENDENCE WITHDRAWAL SYMPTOMS
- 14. Tolerance After chronicuse, the same amount of drug is insufficient to cause the desired effect and thus, more drug is used. A compensatory response. Drug Dose Normal Tolerance
- 15. Drugs/ Substances ofabuse Legal, over-the-counter - Includes drugs like alcohol and nicotine in cigarettes. Substances in beverages include caffeine. Nicotine gum and lozenges are medical products used to aid in smoking cessation in adults. Legal, prescription - includes drugs like methadone, oxycodone and Zolpidem, Barbiturates, Benzodiazepines, Amphetamine, Anti-depressants like alprazolam, midazolam Volatile substances - glue sniffing, light fuel, nail polish remover Illegal - includes drugs like Marijuana and Opiates (like heroin)
- 16. Strategies of controlof Drug Use & Dependence Primary Prevention Secondary Prevention Drug Education Social Support Detoxification Rehabilitation Harm reduction
- 17. Role of Pharmacistin Drug Dependence Extended opening hours Accessibility Expert advice Confidential service Network of service Job satisfaction
- 18. Needle and SyringeExchange Background Training HBV vaccination
- 19. NSE Procedure Supplyingclean, sterile, injecting equipment Exchange for used equipment Advice Check injecting site Referral Storage and disposal of used equipment Maintain supply Record keeping and audit
- 20. Use of Pharmacotherapy Substitute drug Non-substitute drug Harm reduction Benefits for individual and society Reduce crimes Reduce illegal drug usage
- 21. Role of Pharmacistin Provision of Pharmacotherapy Supervised consumption Confidentiality Contracts