Use and Abuse of Drugs

1
Use and Abuse of Drugs
Basic terminology of drugs and medicine Safe Use
of Medicine Factors Affecting Effects of Medicine
and Drugs Categories of Drugs Drugs of
Abuse Warning Signs of Dependence Drugs and the
Law Treatment
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Some Definitions

• Drug
• Any non-food substance that, when taken into the
  body, has a physiological effect.
• A substance need not be taken internally to be a
  drug. A skin ointment is still classified as a
  drug if it has a physiological effect.
• Cosmetics, however, are not classified as drugs.
• This definition includes alcohol, tobacco, some
  herbs, and some ingredients in foods (such as
  caffeine).
• Legally, herbs may not be classified as drugs,
  although this may be changed soon.
• Over-the-counter drug
• Any drug the may be legally purchased by anyone,
  without a prescription.

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Some Definitions

• Prescription
• An order or recommendation from a physician (or
  other licensed professional) for a drug or other
  treatment or procedure. Usually a prescription is
  a written order.
• Dentists and veteranarians write prescriptions
  within the limits of their professional practice.
• In some states, pharmacists and some nurses can
  prescribe a limited set of medicines.
• Prescription drug
• A drug that can only be sold in accordance with
  the orders of a physician (or other licensed
  professional).

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Some Definitions

• Controlled Substance
• A drug or other substance for which sale or
  possession is restricted by law in some way.
• Most drugs of abuse (not all) are controlled
  substances. Many poisons, explosives, and even
  materials that are ingredients for other
  dangerous materials may be controlled substances.
• Many consumer products that can be abused,
  however, are not controlled substances. Gasoline,
  for example, is sometimes used as an inhalant
  drug but is not a controlled substance.
• Street drug
• Any drug, including legitimate medicine, that is
  obtained through imprper channels. The term
  derives from the idea of buying the substance on
  the street rather than in a legitimate drug
  store.

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Some Definitions

• Dependence
• A condition of physiological or psychological
  need for a substance (or behavior), but not
  necessarily involving withdrawal effects if the
  substance becomes unavailable.
• An insulin dependent diabetic is, by definition,
  dependent on insulin. However, the effects of not
  getting insulin are merely those of the absence
  of insulin, nothing more. Therefore, the person
  is dependent on but not addicted to insulin.
• Addiction
• A condition of dependence on a drug (or behavior)
  in which withdrawal symptoms occur if the
  substance (or behavior) becomes unavailable.
• Addiction has nothing to do with any psychoactive
  effects of a drug, except to the extent that
  those effects are related to the withdrawal
  symptoms.
• In their Congressional testimony that tobacco
  was not addictive several executives of the
  major tobacco companies either committed perjury
  or were relying on a very different definition of
  addiction. They seemed to be re-defining
  addiction as having to do with alteration of
  thinking or other psychological effects.

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Some Definitions

• Tolerance
• The amount of a substance required to produce a
  needed or desired effect. Tolerance tends to
  increase with use so more and more drug is needed
  to produce an effect.
• Tolerance is found with drugs of abuse and with
  many medicines that must be used over a long
  period.
• In the case of alcohol, a high initial tolerance
  is an indication of HIGHER risk of eventual
  addiction.
• Half Life
• The time needed for one half of the drug in a
  persons system to be removed.
• Note that a half life of one day does NOT mean
  that all of the drug is removed in two days. It
  means that half is removed in one day, half of
  what remains will be gone after two days, and
  half of what remains after two days will be gone
  after three days, and so on. Thus, traces of a
  drug can often be detected in the blood or urine
  weeks or even months after the last use.
• Therapeutic Dose
• Lethal Dose
• Synergy
• Antagonism
• Placebo Effect

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Some Definitions

• Therapeutic Dose
• The amount of a drug needed to produce a specific
  therapeutic effect. The prescribed dose may vary
  according to the specific therapeutic effect
  desired, even for the same individual.
• The therapeutic dose increases as tolerance
  develops.
• Lethal Dose
• The amount of a drug that will cause death.
  Obviously, this is not an absolute quantity. It
  may vary from individual to individual or with
  other variables.
• Therapeutic Index
• The ratio of therapeutic dose to lethal dose.
• Always a number between 0 and 1.
• A low therapeutic index means a drug is
  relatively safe, aside from factors affecting
  specific individuals.
• A high therapeutic index means a drug is very
  dangerous. There is not a great difference
  between the therapeutic dose and the lethal dose.
• The development of tolerance means the
  therapeutic dose increases. However, it does not
  necessarily mean any change in the lethal dose.
  Therefore, tolerance means a person must take a
  dose that comes closer and closer to a lethal
  dose in order to get the desired effect.

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Some Definitions

• Synergy
• When the effects of two substances taken in
  combination are greater than the sum of effects
  when they are taken separately.
• The synergistic effects of barbiturates and
  alcohol can be lethal.
• 11 3 (this equation is NOT, by itself, an
  adequate explanation for exam purposes)
• Antagonism
• When two substances tend to cancel the effects of
  each other or when one substance reduces the
  effects of the other.
• For example, the effects of certain antibiotics
  may be reduced if taken with milk.
• Placebo
• A pill that is made to look like the real thing
  but which contains no pharmacologically active
  ingredient.
• Or
• Any form of treatment (medical or otherwise) that
  is constructed to resemble a real treatment, but
  which, in fact, is not real and should have no
  effect.
• Placebo Effect
• An effect from a pill or treatment the subject
  believes to be real, but which, in fact, is not
  real.

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Suggested Rules for Safer Use of Medicines

• Read the label
• Read it twice and then think about what it says.
• The label means the complete information sheet
  included inside the package, not just the label
  on the bottle.
• Be especially sure you understand the dosage
  instructions and all contraindications.
• Contraindications Any factor that indicates
  (point toward) an increased risk if the substance
  is used. Doctors often miss these or do not know
  about important factors in a patients life.
• Discard leftovers
• Medicines unnecessarily left in a medicine
  cabinet present a risk to children who may get
  into the cabinet.
• Most medicines decay with time and may lose
  potency or become hazardous.

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Suggested Rules for Safer Use of Medicines

• Never Re-Package
• Re-Packaging may expose the drug to moisture.
• Re-Packaging risks misplacing the correct label.
• The packaging a medicine comes in is designed to
  protect the medicine from decay.
• Follow Physicians and Pharmacists Advice
• These people have more knowledge and
  understanding of drug effects and interactions.
• However, pay attention yourself and ALWAYS ASK if
  you think a mistake may be being made.
• Never Share With Others
• To do so is about the same as practicing medicine
  without a license,

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Suggested Rules for Safer Use of Medicines

• Store in a Cool, Dry Place
• This will maximize the shelf life of the
  medicine.
• A medicine cabinet in a bathroom is neither cool
  nor dry in most cases.
• Report All Side-effects or Unexpected Effects
• Your doctor should know if any effects warrant a
  change of prescription.
• There are often alternative medicines that will
  have different effects.
• Do Not Use Past Expiration Date
• Obvious
• Keep Away from Children
• Children WILL get into everything, including you
  medicine, liquor, (and gun) cabinets.

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Suggested Rules for Safer Use of Medicines

• Do Not Describe a Pill to a Child as Candy
• Obvious
• Instruct Children to Never Take Medicine from
  Anyone Not Approved by the Parents
• Obvious

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Factors Affecting a Drugs Effects

• Pharmacological Properties
• What the drug does physiologically.
• e.g. kills bacteria, blocks pain, etc.
• Some properties can lead to abuse, others do not.
• e.g. effects on brain often lead to abuse
• Side effects
• All pharmacological effects other than the one
  needed for medical purposes.
• What is a side-effect in one patient may be an
  intended effect in another,

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Factors Affecting a Drugs Effects

• Dose-Response Curve
• Could be or

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Factors Affecting a Drugs Effects

• Time Action Curve
• Time between administration of the drug and its
  peak effect
• Often it is the rate of change of level of a drug
  and not the total amount in the system that
  produces an effect, especially psychoactive
  effects.
• Effects of multiple dosages may be cumulative
• Method of administration is very important here.

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Factors Affecting a Drugs Effects

• User Factors
• Physical size
• Amount of body fat
• Physical conditioning
• Other drugs being used
• Pregnancy
• Setting of Use
• Expectation Effects

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Categorization of Drugs

• Categorization by Pharmacological Effects
• e.g. antibiotic, pain blocker, anti-anxiety, etc.
• Categorization Legally
• Over the counter
• Prescription
• Narcotic
• Controlled Substance

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Categories of Drug That Are Abused

• Opiates
• Examples
• Opium Morphine Heroin
• Methadone Codeine Dilaudid
• Percodan Demerol Darvon
• Block pain, including psychological pain, induce
  sleep
• All derived from the Oriental Poppy or made
  synthetically to resemble chemicals derived from
  the poppy.

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Stimulants

• Cocaine Crack
• Derived from Coca plant
• Coca Cola really did once contain a coca based
  stimulant, but it was removed after 1906.
• Amphetamines
• Withdrawal effects can be very prolonged and
  dangerous, involving psychotic reactions and
  lasting up to a month.
• Stimulant effects very dangerous to
  cardiovascular system.
• Caffeine and Analogs of Caffeine
• Found in coffee, cocoa, chocolate, and added to
  many soft drinks.
• Completely legal, but addiction does occur.
• Effects can be dangerous for persons with heart
  disease.
• Stimulents increases metabolic rate, and may
  cause feelings of euphoria when taken in
  strength, or feeling of alertness in smaller
  doses. Addiction, sudden death from cardiac
  arrest are risks. Withdrawal produces depression.

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Anti-anxiety Drugs

• Valium Xanax Librium Quualude
• Useful for reducing anxiety but can be addictive.
• Withdrawal causes a state of agitation which can
  be very unpleasant.
• Most addictions are accidental.

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Hallucinogens

• Produces hallucinations of various kinds -
  seeing, hearing, feeling things that are not
  real.
• PCP mescaline marijuana (THC) Hashhish
• LSD MDMA Some Designer drugs
• Some of these may be helpful in certain medical
  situation because of other effects.
• THC - may be helpful in suppression of nausea and
  treatment of glaucoma.
• May lead to brain damage when use is sustained
  over a long period.
• It was once thought these drugs might help us
  understand mental illnesses involving alterations
  of perception, but this has not lead anywhere.

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Psychedelics

• LSD
• Very similar to hallucinogen, but involving an
  alteration of perception rather than actual
  hallucinations. (LSD produces both).
• When Alice changes in size she is experiencing
  an alteration of perception.

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Inhalants

• Any drug of abuse that is taken by inhalation.
• Cocaine is often taken by inhalation but is
  usually classified as a stimulant rather than as
  an inhalant.
• Many involve substances that can readily be
  purchased by anyone.
• Glue Spray Paint Amyl nitrate
• Gasoline Butane Butyl nitrate
• Solvent based correction fluid Nitrous oxide
• Most of these chemicals are powerful solvents and
  will produce profound brain damage that is not
  reversible.
• Many also expose the user to a risk of terrible
  accidents.
• Gasoline and butane especially

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Depressants

• Barbiturates (downers)
• Essentially the opposite effects of stimulants.
• Especially deadly in combination
• barbiturates plus alcohol

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Anabolic Steroids

• Produce muscle growth, especially in combination
  with exercise
• Also produce
• increased risk of heart disease
• liver damage
• acne
• aggressive, violent behavior
• testicular atrophy in males
• Breast development in males
• sterility in males
• Deepened voice in females
• Beard development in females
• Breast reduction in females
• May be very helpful in certain medical
  circumstances (e.g.after chemotherapy)

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Designer Drugs

• Synthetic drugs made to mimic those of natural
  origin.
• May be much more potent.
• May have different side-effects, however.
• Many side-effects may be quite unexpected.
• MDMA (Case of the Frozen Addict)
• Ecstasy

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Warning Signs of Drug Dependence

• Many of the following may be signs of other
  problems as well.
• Unexplained emotional withdrawal or distancing
• Rebelliousness or irritability
• Loss of interest in things
• Decline in performance
• Sudden change in social groups
• Change in eating or sleeping habits
• Borrowing or stealing

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Drugs and the Law

• For most of history
• Drugs were legal
• Drugs were poorly understood
• Drugs were much less potent
• Prior to 1906
• In the US there were no laws governing drugs,
  either for medicine or abuse.
• Heroin, invented in 1874 by a London chemist, was
  actually marketed as Bayer Heroin in 1898.
• Addiction was noticed soon after
• Bellevue Hospital had 149 heroin-related
  admissions in 1914.
• Coca Cola contained a small amount of Coca
• When they said Coke has the taste you never get
  tired of. they werent kidding! truthfully,
  however, that advertising slogan was not used
  back then

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• Pure Food and Drug Act - 1906
• Prohibited importation of dangerous drugs
• Required ingredients to be listed on label
• 1909
• Another law prohibited importation of opium, for
  smoking or non-medical purposes.
• Actually the impetus behind this law was more
  anti-Chinese racism than real concern about
  drugs.
• Harrison Narcotics Act - 1914
• First Federal anti-narcotics act.
• Prohibited sale of drugs through non-medical
  channels
• Also regulated sales through medical channels
• This and subsequent laws were not originally
  meant to regulate medical use but they were
  interpreted as such by law enforcement officials.
  Many doctors were intimidated into not
  prescribing such drugs.

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The Prohibition Experiment

• January 16, 1920 - 18th Amendment to Constitution
  became law.
• It became difficult or illegal to obtain drugs
  and alcohol.
• This led to the creation of an underground
  mechanism to supply these substances.
• This was, in effect, the beginning of organized
  crime in America.
• The ban on alcohol was almost universally
  ignored. Alcohol was even served regularly in the
  White House.
• From 1930 until at least 1962, the majority
  opinion was that drug use (including alcohol) was
  immoral and could be stopped by harsh criminal
  penalties. Many people still believe that drugs
  and alcohol and immoral, but fewer and fewer
  believe that harsh penalties can be an effective
  deterrent. We are still building jails, however.
• 1933 - The 20th Amendment repealed the 18th
  Amendment.
• Immediately thereafter there was a surge in hard
  alcohol abuse.
• Today, however, alcohol is still widely abused
  but abuse patterns have shifted away from hard
  liquor and toward beer and wine.

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Discussion

• Tobacco has always been legal and is declining in
  use. Alcohol abuse increased when it was illegal
  and eventually declined when it became legal.
  Drugs are illegal and are a continuing national
  problem.
• Discuss Does this suggest that legalization, in
  some form, might work to help reduce the problem
  of drugs?