The Drug Misuse
The causes of misuse: Availability of drugs. A vulnerable personality. Adverse social environment. Regular drug taking play a role. Determining misuse and dependence, it is unclear whether there is some specificity in the mechanisms which lead certain individuals to misuse particular substances.
1. Availability of drugs: People can misuse and become dependent on drugs by three routes: By taking drugs that can be bought legally without prescription. By taking drugs prescribed by the doctors. By taking drugs that can be obtained only from illicit sources( street drugs).
2. Personal factors: Those who misuse of drugs, they may live in disrupted families and have started taking drugs at young age associated with poor school record, truancy, or delinquency, associated with depression.
3. Social environment: The risk of drug misuse is greater in societies that condone drug use of one sort or another, within the group there may be social pressure for a young person to take the drugs to achieve status, there is also a link between drug misuse and unemployment and homelessness.
Adverse effects of drug misuse Drug misuse has many undesirable effects both for the individual and society.
1. Physical health Intravenous drug use pose particular health risks. local Vein thrombosis. Infection of injection site. Damage to arteries. Systemic Bacterial endocarditic. Hepatitis B and C. HIV infection.
2. Psychiatric changes There is a strong association between substance misuse and psychiatric co-morbidity, patient with substance misuse after have a diagnosis of personality disorder, depression and anxiety, patient who stimulants can experience depression subsequently. Patients with primary psychiatric disorder such as schizophrenia, bipolar disorder and sociopathic personality disorder frequently misuse alcohol and drugs.
3. Drugs misuse in pregnancy and puerperium Drug misuse in pregnancy increase the health risk to both mother and baby. When the drug taken in early pregnancy, there is a risk of increased rate of fetal abnormality. Opioids may decrease fetal growth. When the drug taken in late pregnancy, the fetus become dependent on them. After delivery the neonate may develop serious withdrawal effect.
4. social consequences 1. Chronic inloxication may affect behavior. 2. Illicit drugs are expensive, the user may cheat or steal to obtain money. 3. Drugs misusers may join company, they undergo antisocial or criminal activity.
Diagnosis of drug misuse 1. Physical signs, include needle tracks, thrombosis of veins, subcutaneous abscess or hepatitis. 2. Behavioral signs, behavioral changes may suggest drugs misuse, may neglect their appearance, isolate themselves. 3. Medical presentation: Some admitted that they dependent on drugs some present with cellulites, pneumonia, serum hepatitis or signs of accident.
4. Taking drug history: 1. Age of starting drug misuse. 2. Types and quantity of drugs taken. 3. Frequency of misuse and routes of administration. 4. Overdose. 5. Abstinence and relapse triggers. 6. System experienced when drugs unavailable. 7. Medical complications. 8. Psychiatric and forensic history
Laboratory diagnosis 1. Urine testing is commonly used. 2. Lab should be provided by a list of drugs for lab investigation.
Some Definitions: 1. Intoxication : short term psychological changes caused by psychoactive substance. 2. Abuse: long term effect of psychoactive substance. 3. Drug addiction: is a condition characterized by compulsive drug intake craving and seeking, despite negative consequences associated with drug use. 4. Dependence syndrome: psychological phenomena caused by repeated administration of psychoactive substance.
A person is dependent if he is: Take drug regularly. Experience unpleasant symptoms if discontinued, which makes stopping difficult. 5. withdrawal state: this can be physiological and or psychological condition refers to disturbed mental and physical functioning. 6. Tolerance: the need to increasing doses in order to produce the same effect.
المنشطات Stimulant drugs These drugs include: Amphetamine. Phenmetrazine. Methylphenidate. Cocaine Ecstasy ( mixtures of drugs)
Amphetamine have been largely abandon in medical practice, apart from their use for the hyperkinetic syndrome of childhood and for narcodepsy. Amphetamine sulphate is taken by mouth or by intravenous injection. Free-base Amphetamine( made by heating Amphetamine sulphate) is usually smoked and absorbed through the lung from which it is absorbed rapidly.
The psychomotor stimulant effects of Amphetamine are believed to result from thin ability to release and block the reuptake of dopamine and novadrenaline cocaine hydrochloride is taking by sniffing into the nose ( where it is absorbed through the nasal mucosa) or by injection. Free-base cocaine (crack) is usually smoked to give rapid and intense effect.
Epidemiology Amphetamine are probably the most commonly used stimulant in the UK although cocaine is more commonly used in USA. A survey in the USA estimated that (7%) of the population had used an Amphetamine at least once in their alive. The highest level of use was among those aged (15-28) of whom (9%) reported using Amphetamine at least once while (1%) described themselves as current users.
In the UK about (10-15%) of young people have tried Amphetamine by the age of (19). Most Amphetamine are now illicitly synthesized and used as a " street drug " known as speed or whiz Amphetamine taken orally or intravenously, can also be snorted ( taken like snuff). A pure form ( ice, it also can be smoked or injected it produce powerful effects.
Clinical effects: These drugs produce an elevation of mood, overactivity, overtalkativeness, insomnia, anorexia, dryness of mouth and nose, the pupils dilate, the pulse rate and blood pressure increase and with large doses there may be cardiac arrhythmia and circulatory collapse. Occasionally patients complain of an unusual feeling like insects under the skin.
Some complications of Amphetamine and cocaine misuse Medical Cardiovascular hypertension, stroke, arrhythmias, myocardial infarction. Infection abscesses, septicaemia, hepatitis, HIV. Obstetric Reduced fatal growth, miscarriage, premature labour, placental abruption. Others Weight loss, dental problems, epilepsy, general neglect. Psychiatric Anxiety, depression, antisocial behavior, paranoid psychosis.
Amphetamine induced psychosis Prolong use of high doses of Amphetamine may result in paranoid psychosis like paranoid schizophrenia. The features include persecutory delusions, auditory and visual hallucinations, hostile and aggressive behavior usually the condition subside in about a week, it is uncertain about the cause of this psychosis.
Tolerance and dependence From the epidemiology of Amphetamine use, it seems that many users do not progress to misuse and dependence, in more persistent users tolerance to Amphetamine leads to users taking higher doses of the drug, a withdrawal of varying severity follows cessation of Amphetamine use.
Dependence on stimulant drugs may be recognized from the history of overactivity and high spirits alternating with inactivity and depression. Whenever Amphetamine use a urine sample should be taken for analysis as soon as possible because these drugs are quickly eliminated.
Prevention Prevention of Amphetamine misuse depends on restriction of the drugs and careful prescribing by the doctors.
Treatment Treatment of acute overdose requires sedation and management of hyperpyrexia and cardiac arrhythmias. Most toxic symptoms including paranoid psychosis, resolve quickly when the drug stopped. An antipsychotic drug may be needed to control florid symptoms. Abstinence- require a full range of social and psychological interventions, benzodiazepines may be helpful together with antidepressants for the depressed mood.
Cocaine Cocaine is a central nervous stimulant, it's effect is similar to Amphetamine, it causes strong dependency. It block the re-uptake of dopamine into presynaptic terminals and consequently activation of physiological reward system. Cocaine administered by injection, by smoking and by sniffing into the nostril. Subject who misuse cocaine often misuse other drugs.
Epidemiology (12%) of Americans reported the use of cocaine. The highest rate of use was in those aged (18-25) years. Cocaine use in USA was associated with high level of violent crime. In the UK has increased over the last decade.
Clinical effects The psychological effects of cocaine include excitement, increased energy and euphoria, impaired judgment, grandiose thoughts, higher dose can cause visual and auditory hallucinations with aggressive behavior, higher dose causes a feeling as if insects are crawling under the skin (cocaine bugs).
The physical effects of cocaine include increase of pulse rate, increase of blood pressure, dilatation of pupil, cardiac arrhythmias, myocardial infarction, cerebral infarction, subarachnoid haemorrhage, seizures and respiratory arrest has been reported, miscarriage and premature labour.
Treatment Acute intoxication may require sedation with benzodiazepine. Or in sever cases with antipsychiditic agent such as haloperidol, seizures or hypertension should be managed as usual. Treatment of cocaine dependence may be sufficient to provide psychological and social support on an out-patient cases, chronic and strong users need more intensive management, one of the SSRI for depressed patients. Cognitive- behavioral approaches including relapse prevention produce better results.