DRUGS OF ABUSE Reynaldo J. Lesaca, M.D. Reynaldo J. Lesaca, M.D.

CHEMICAL CLASSAGENTS Alcohol Stimulants Alcohol Examples: Amphetamine, crystal meth Cocaine Sympathomimetics (incl. caffeine) Hallucinogens Examples: Lysergic acid diethylamide Cannabis Phencyclidine

CHEMICAL CLASSAGENTS Opiates / Narcotics Examples: Morphine Heroin Phencyclidine Inhalants / Aerosols Examples: Glue Paint thinner

CHEMICAL CLASSAGENTS Gamma hydroxy butyrate Sedative / Hypnotics Examples: Flunitrazepam Barbiturates Benzodiazepines Hypnotics NicotineExamples: Cigarettes / cigars

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.

DEFINITIONS DRUG ABUSEAcute 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.

DEFINITIONS DRUG DEPENDENCE a) Psychologicalcraving or desire for continuous administration of a drug to provide a desired effect or to avoid discomfort

DEFINITIONS 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

DEFINITIONS TOLERANCEThe phenomenon in which increasing doses of a drug are needed to produce a desired effect.

GENERAL 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 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

PHARMACOLOGY 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 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 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 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 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 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 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.

TREATMENT ACUTE 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. TREATMENT

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

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. TREATMENT

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