Substance Abuse Drugs of abuse Narcotic Non narcotic

Substance Abuse

Drugs of abuse Narcotic Non narcotic Sedatives Opium alkoloids Morphine Benzodiazepines Codeine Synthetic opiods Stimulants Amphetamine Heroin Methadone barbiturates Cocaine Hallucinogens Ecstasy LSD Cannabis

Causes of drug abuse n Availability Prescribed Dx ‘Street’ Dx n Vulnerable personality n Social pressures

Substance dependence 1. 2. 3. 4. 5. 6. Strong desire or compulsion to take Difficult to control intake Withdrawal state when stopped /reduced Persisting use despite harm Neglect of alternate pleasures Tolerance

Substance Dependence n Physiological Fast – Opioids Slow – Anxiolytics None- Cannabis Hallucinogens n Psychological Craving, dysphoria Due to conditioning

Harmful Consequences n Physical health Vein thrombosis , infection IV drug use HIV, hepatitis, endocarditis In pregnancy - fetal defects, growth, dependence n Psychiatric -anxiety -mood -psychotic n Social

Opioids Extract of Papaver somniferum n Used for >3500 years (poppy) n Used as medication/pleasure n Heroin 1. ‘chasing the dragon’ 2. Smoking 3. Intra venous (IV) n

n Opioids Act through 1. NAD cell firing on withdrawal NAD action 2. Act on endogenous opioid receptors n Effects – Euphoria, analgesia, drowsiness, constipation, LOA, libido n Dependence + Rapid tolerance & withdrawals – low mood, aches, Insomnia, pupils dilated, lacrimation

Dried resin of cannabis sativan has Tetrahydrocannabinol n n Effects – existing mood enhanced Psychomotor retardation (!!driving) slowed time sense, red conjunctiva, cough, dry mouth psychotic symptoms n Psychological dependence only n Withdrawal- LOA, insomnia, irritability

Nicotine abuse n Most active chemical in tobacco n Smoking- ‘largest cause of preventable premature death’ – Kills 1 in 3 smokers n In SL used as – cigarettes, cigars, tobacco leaves n Diseases caused-Cancers (Tar) – lung, GI renal, pharyngeal -Lung disease (irritants) -MI, Stroke ( CO, clotting) -Sexual -Impotence

n Action - of nicotine- Acts on Ach receptors (but these ) Has stimulant and depressant actions dopamine, Adrenaline, NAd, serotonin Reduces insulin - hyperglycaemic Effects Performance enhancement § Mood stabilizer (reduce anger) § Reduces appetite ; BMR Withdrawal Low mood, irritability, Low concentration, restlessness weight gain, impaired functioning §

Management of tobacco use

Pharmacotherapies used

Other substances n Stimulants – Amphetamines Psychosis, aggression Cocaine MDMA (ecstasy)- hallucinogenic too n Hallucinogens – LSD ‘Magic mushrooms’ n Hypnotics - benzodiazepines

Management of substance abuse n Identify & Assess n Manage acute intoxication n Detoxification Withdrawals – Dx of same group – e. g. Methadone for heroin Longer acting bezodiazepine n Advice & education – Harm reduction n Rehabilitation houses & groups

Thank you Dr Himalee Abeya