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Drugs of Abuse
Drug: is any substance/chemical other than food - taken to alter the way the body/mind functions Abuse: maladaptive pattern of drug use manifested by recurrent and significant adverse consequences related to repeated use of the drug(s) Latest study: 3 of 4 new HIV infections are drug-related ( CDC /Dr. Scott Holmberg, 2004+ )
Marijuana
Most commonly used illegal drug in USA Cannabis sativa: delta9-tetrahydrocannabinol (THC) Hashish (resin): higher concentration THC Grass, pot, weed, herb smoked, eaten Smoke: cancer-causing chemicals > tobacco smoke
Marijuana (cont)
Common effects:
euphoria, relaxation slowed reaction time distorted sensory perception impaired balance and coordination impaired learning, memory increased heart rate and appetite cough, frequent respiratory infections anxiety; panic attacks; psychosis possible mental health decline; addiction
Marijuana (cont)
Often first illegal drug used Increased risk of progressing to more powerful and dangerous drugs (cocaine, heroin) Risk for progressing to cocaine: 104 X higher with smoking marijuana at least once than never smoked marijuana
Stimulants:
Cocaine Amphetamine Methamphetamine
Stimulants (cont)
Cocaine:
Erythroxylum coca Crack, coke, snow, rock Smoked, injected, snorted, swallowed Intensity, duration of the drug's effects depend on how taken
Stimulants (cont)
Cocaine effect: Euphoria, energetic Increases T, HR, BP Abdominal pain, nausea Risk: heart attacks, respiratory failure, strokes, seizures Rare: sudden death on the first use of cocaine or unexpectedly afterwards
Stimulants (cont)
Cocaine 2009, 4.8 million Americans >=12 y.o. had abused cocaine in any form. Source: National Survey on
Drug Use and Health
1.6% of 8th graders 2.2% of 10th graders 9% of 12th graders had abused cocaine in any form
Stimulants (cont)
Amphetamines Acute intoxication: SNS stimulation
Stimulants (cont)
Methamphetamines
Meth, crank, ice, speed, crystal Injected, snorted, smoked, or eaten Powerful stimulant: increases alertness, pleasure decreases appetite Same toxic effects as cocaine:heart attacks, HBP, stroke Withdrawal: depression, abdominal cramps, and increased appetite Long-term effects: paranoia, hallucinations, weight loss, destruction of teeth, heart damage.
Opiates
Papaver somniferum Heroin: most commonly abused opiate Other:
methadone morphine codeine oxycodone fentanyl (China white) black tar (a potent form of
heroin)
Opiates (cont)
Heroin
Signs of intoxication:
Acute complications:
Club drugs:
MDMA: methylenedioxy-methamphetamine Ecstasy, Adam, clarity, Eve, lover's speed, peace, uppers Stimulant, hallucinogen Improve mood, maintain energy Long-term use: damage to the brain's ability to regulate sleep, pain, memory, emotions
4.5% of 12th graders had abused MDMA 0.5% of 8th graders, 0.6% of 10th graders, and 1.5% of 12th graders had abused Rohypnol 0.6% of 8th graders, 0.6% of 10th graders, and 1.4% of 12th graders had abused GHB 1.0% of 8th graders, 1.1% of 10th graders, and 1.6% of 12th graders had abused ketamine at least once in the year prior to their being surveyed.
Dissociative Drugs
Common effects: feelings of being separate from ones body and environment impaired motor function/anxiety tremors numbness memory loss nausea
special K, K anesthetic: orally or injected impair memory and attention higher doses:
amnesia paranoia hallucinations depression difficulty breathing
angel dust, boat, hog, love boat, peace pill usually, tobacco or marijuana cigarettes dipped into
PCP, then smoked similar effects to ketamine, stronger powerful anesthetic used in veterinary medicine anesthetic effects are so strong that you can break your arm but not feel any pain
Hallucinogens
Altered states of perception and feeling Hallucinations
Hallucinogens (cont)
LSD: Lysergic acid diethylamide
heaven Effects:
increased body T, HR, BP loss of appetite; sweating; sleeplessness; weakness, numbness, dizziness, tremors; impulsive behavior; rapid shifts in emotion flashbacks, Hallucinogen Persisting Perception Disorder
Hallucinogens (cont)
Mescaline
Psilocybin
Inhalants
Solvents (paint thinners, gasoline, glues); Gases (butane, propane, aerosol propellants, nitrous oxide); Nitrites (isoamyl, isobutyl, cyclohexyl) Laughing gas, poppers, snappers, whippe
Inhalants (cont)
Inhalants effects: varies by chemical
stimulation; loss of inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing/cramps; muscle weakness; depression; memory impairment; damage to cardiovascular and nervous systems; unconsciousness; sudden death
Inhalants (cont)
2009, 2.1 million Americans age 12 and older had abused inhalants. Source: National Survey on Drug Use
and Health
8.1% of 8th graders 5.7% of 10th graders 3.6% of 12th graders had abused inhalants at least
once in the year prior to being surveyed
ED management:
A, B, C
ED management (cont)
HT + agitation Benzodiazepine Phentolamine/Nitroprusside for HT urgencies DO NOT use beta blockers in suspected cocaine intoxication (unopposed alfa adrenergic HT)
ED management (cont)
Hypertermia (>104 F) Aggressive cooling measures Until T<100.4 May lead:
ED management (cont)
Respiratory depression/ comatose patient Bedside glucose Naloxone emirically/correct miosis 2nd dose, if no response Repeated doses/iv infusion NOT recommended: Flumazemil may induce seizures if co-ingestion of epileptogenic drugs/chronic BZD abuser
ED management (cont)
Seizures: Lorazepam/Diazepam Agitation: BZD / Haloperidol (PCP ingestion) Serotonin syndrome:
ED management (cont)
Indications for admission: CNS/respiratory depression Ventricular arrhythmia Opiate overdose requiring naloxone treatment Suspected opiate/ CNS depressant withdrawl Suicide attepmt/gesture without psychiatric clearance and appropriate follow up
Conclusion:
Drugs: very dangerous to the individual and the society Play a major role in other problems in the society e.g. HIV/AIDS, violence, passivity, etc Concerted efforts are needed by all Combined professional therapy techniques