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Drug Abuse

Drug Abuse


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Published by ARIF-UR-REHMAN

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Published by: ARIF-UR-REHMAN on Jan 27, 2009
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Definition of drug abuse
•Drug abuse is the nonmedical use of drugs or other chemicals for the purpose of changing mood or inducing euphoria •Drug abuse that results in the physical, mental, emotional, and social impairment of the user.

Classification of abused drug
•barbiturate-alcohol: •The opioid drugs: •Cocaine: •Cannabis: •Amphetamines: •Hallucinogen: lysergic acid diethylamide •Volatile organic solvents: •Tobacco:

Tolerance and dependence of drug
•Tolerance: Body adaptation to drugs & larger doses are required to produce the original effects

•Cross Tolerance:
Development of tolerance to one drug confers tolerance to another drug, e.g. barbiturates, alcohol & other sedatives/hypnotics

It is an adaptive state and has the following properties: 1. Need to continue to take a drug – pleasure & prevent withdrawal 2. Appearance of symptoms when abruptly suspended 3.Need to increase the dose to sustain the initial effects

Physical dependence: The body has adjusted to the presence of a drug to avoid withdrawal symptoms

The withdrawal symptoms is a abnormal and unwell physiological state if the dependent drug is stopped abruptly, it may be manifested yawn, flowing tears, fatigue, diarrhea, fear, shivering, nausea, vomiting, and others.

Withdrawal syndrome

Psychological Dependence:Strong desire to experience the effects of the drug repeatedly • Craving for a drug is the most common withdrawal symptom leading to continued self-administration & compulsive drug taking Psychological & physical dependences are not mutually exclusive

Methods of taking drugs
• Oral ingestion • Injection: intravenous(IV), intramuscular(IM), or subcutaneous(SC) • Inhaling smoke • Nasal sniffing

Heroin and other opioid drugs


•Heroin is derived from morphine. Pure heroin is a white powder with a bitter taste. • Usage: Injected Smoked Inhaled Snorted

• The opioids include opium and opium

derivatives. •The natural substance extracted from the opium poppy plant: morphine, codein, thebaine, paparerine, narcotine, narceine and many other alkaloids. •Synthesized opioids: heroin(diacetyl morphine), dihydrocodeine, pethidine, methadone, etorphine, and many more.

• Effects:

The opiates work by interacting with specific receptor sites in the brain and peripheral nervous system to inhibit the release of dopamine, norepinephrine, and other neurotransmitters. These opioid receptors are present in highest concentration in the limbic system(frontal and temporal cortex, amygdala, and hippocampus), thalamus, hypothalamus, and spinal cord.

Opioid receptors
•µ-opioid receptor •δ-opioid receptor •κ-opioid receptor

In acute poisoning, the signs and symptoms are headache, dizziness, contracted pupils, coma, slow respiration, and others.

• The chronic addiction may show emaciation, dirty, and signs of infection, such as pulmonary tuberculosis, myocarditis, hepatitis B, HIV, AIDS. the presence of injection marks.

A normal aortic valve is shown at the top to compare with an aortic valve at the bottom being destroyed by vegetations with infective endocarditis.

Mycobacterium tuberculosis infection of the lung has resulted in upper lung field granulomatous and cavitary disease.

Macronodular cirrhosis of the liver here has followed viral hepatitis infection, gross. Generally, this is most often occurs with hepatitis B, but can occur with hepatitis C.

In cases of suspected poisoning,

morphine should be looked for in the urine, blood, bile, brain, and contents of the alimentary tract.


• The barbiturates are a group of barbituric acid derivatives used in medicine as sedatives and hypnotics

• long-acting barbiturates< onset of action 2 hours and duration of action is 6 to 12 hours>: barbitone, phenobarbitone, phenytoin. • Intermediate-acting barbiturates<onset of action half to one hour and duration of action is 3 to 6 hours>: amytal, pentobarbitone, butobarbitone. • Short-acting barbiturates<duration of action is less than 3 hours>: secobarbital, thiopentone,

• Ultra short acting • onset of action is immediate and duration of action is about 5 to 10 minutes • Eg . Pentothal sodium, hexobaebital sodium.

Absortion, distribution and elimination
• They are rapidly absorbed from the gastrointestinal tract including the rectum and from the subcutaneous tissues. • They are concentrated in the liver for a short time and then evenly distributed in the body fluids. • They r partly destroyed in the liver and excreted in urine.

Signs and symptoms
• Acute poisoning may result from a single large dose or repeated small dose. • Usually the first symptom is drowsiness. • A short period of confusion,excitement,delirium and hallucinations is common. • Ataxia,vertigo,slurred speech, headache, paraesthesias, visual disturbance may occur.

• A stupor progressing to deep coma with loss of superficial and deep reflexes and gradual loss of painful stimuli occur. • The Babinski sign may become positive. • Respiration may be rapid and shallow or slow and laboured. • There is fall in cardiac output and an increase in cappilary permiability leading to an increase in extracellular fluid. • Progressive cardiovascular collapse evidenced by cyanosis, hypotension,weak rapid pulse and cold clammy skin occurs.

• The pupils are usually slightly contracted but react to light. • Decrease peristalsis may occur in deeply comatose patient • The urine may be scanty or suppressed and may contain sugar and albumin. • Incontinence of urine and faces may occur. • Blister on the skin, often on an area of erythema strongly suggest barbiturate poisoning.it occurs due to direct toxic action on the epidermis.

• Death may occur from respiratory failure and ventricular fibrillation in early stages and bronchopneumonia or irreversible anoxia with pulmonary edema in the later stages. • The combination of alcohol and barbiturates causes rapid death.

• Fatal dose. short acting: 1 to 2 gm medium acting: 2 to 3 gm long acting: 3 to 5 gm The lethal blood levels are : long acting :10 mg/ 100ml medium acting: 7mg/ 100ml short acting : 3 mg/ 100 ml

The amphetamines

• Amphetamines are synthetic amines that are

similar to the body’s own neurotransmitter, norepinephrine, and the hormone for emergencies, epinephrine(adrenalin). • The amphetamines generally cause an arousal or activating response, which means that they stimulate the central nervous system(CNS). • Symptoms commonly are teeth-grinding, confused and disorganized patterns of thought and behavior, compulsive repetition of meaningless acts, irritability, self-consciousness, suspiciousness, and fear.

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