Commonly Used Medicine With The Potention For Misuse, Abuse or Addiction

Bibek Singh Mahat
Senior Pharmacist
7/1/2022
June 2022
bibekmahatsingh@gmail.com 1
7/1/2022 bibekmahatsingh@gmail.com 2
What is Drug Addiction ?
• Drug addiction, also called SUD (Substance Use Disorder) is a disease

that affects a person's brain and behavior
• It leads to an inability to control the use of a legal or illegal drug or
medication.
• Substances such as Alcohol, Marijuana And Nicotine also are
considered drugs.
• When you're addicted, you may continue using the drug despite the
harm it causes.
Major Symptoms of Drug Addiction ?
• Feeling that you have to use the drug regularly — daily or even
several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than
you intended !
• Making certain that you maintain a supply of the drug !
• Spending money on the drug, even though you can't afford it !
• Not meeting obligations and work responsibilities, cutting back on

social or recreational activities,
• Continuing to use the drug, even though you know it's causing
problems in your life or causing you physical or psychological harm,
• Doing things to get the drug that you normally wouldn't do, such as
stealing
• Driving / Doing other risky activities when you're under the influence
of the drug,
• Spending a Good Deal Of Time getting the drug, using the drug or
recovering from the effects of the drug,
• Failing in your attempts to stop using the drug,
• Experiencing withdrawal symptoms when you attempt to stop taking

the drug
Recognizing Unhealthy Drug User :
• Problems at school/ Campus/ or work — frequently missing school or work, a sudden
disinterest in school activities or work, or a drop in grades or work performance.
• Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
• Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — exaggerated efforts to bar family members from entering his or
her room or being secretive about where he or she goes with friends; drastic changes in
behavior and in relationships with family and friends.
• Money issues — sudden requests for money without a reasonable explanation; money
been stolen or items have disappeared from your home, indicating maybe they're being
sold to support drug use
Tolerance vs. Dependence vs. Addiction
• Long-term use of prescription opioids, even as prescribed by a
doctor, can cause some people to develop a TOLERANCE, which
means that they need higher and/or more frequent doses of the
drug to get the desired effects.
• DRUG DEPENDENCE occurs with repeated use, causing the neurons

to adapt so they only function normally in the presence of the drug.
The absence of the drug causes several physiological reactions.
• DRUG ADDICTION is a chronic disease characterized by compulsive,

or uncontrollable, drug seeking and use despite harmful
consequences and long-lasting changes in the brain.
Commonly Used Medicine With
The Potential For Misuse Or Addiction
KETAMINE INJECTION:
• What is Ketamine Hydrochloride and how is it used?
• Ketamine Hydrochloride is a prescription medicine used as a sedative for
diagnostic and surgical procedures.
 Sedative: A drug that calms a patient, easing agitation and permitting sleep.
 Sedatives generally work by modulating signals within the central nervous
system.
 Most sedatives also have addictive potential. For these reasons, sedatives should
be used under supervision and only as necessary.
• Ketamine Hydrochloride belongs to a class of drugs called General Anesthetics,
Systemic.
• FDA-Approved Ketamine FOR Depression Symptoms Management as well .
KETAMINE INJECTION:
• Ketamine Hydrochloride may cause serious side effects including:
• Hallucinations,
Hallucinations are sensory experiences that appear real but are created by your mind.
They can affect all five of your senses. For example, you might hear a voice that no one
else in the room can hear or see an image that isn't real.
• Unusual Thoughts,
• Increased Urination,
• Loss Of Bladder Control,
• Lightheadedness,
• Slow Heart Rate,
• Weak Or Shallow Breathing, And
• Jerky Movements That May Look Like Convulsions
KETAMINE INJECTION:
What are Opioids?
• Opioids are a class of drugs naturally found in the
opium poppy ( अ फम) plant.
• Some Prescription Opioids are made from the plant

directly, and others are made by scientists in labs using
the same chemical structure.
• Opioids are often used as medicines because they

contain chemicals that relax the body and can relieve
pain.
• Prescription opioids are used mostly to treat moderate

to severe pain, though some opioids can be used to
treat coughing and diarrhea.
What are prescription opioids?
• What are common prescription opioids?
• Hydrocodone
• Oxycodone
• Oxymorphone
• Morphine
• Codeine
• Fentanyl
• Codeine
• Morphine
Opioids:
FENTANYL :
• Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50
to 100 times more potent.
• It is a prescription drug that is also made and used illegally.
• Like morphine, it is a medicine that is typically used to treat patients with
severe pain, especially after surgery.
• It is also sometimes used to treat patients with chronic pain who are
physically tolerant to other opioids.
• Tolerance occurs when you need a higher and/or more frequent amount
of a drug to get the desired effects.
Opioids:
Fentanyl's effects include
• extreme happiness
• drowsiness
• nausea
• confusion
• constipation
• sedation
• problems breathing
• unconsciousness
BUPRENORPHINE :
• Buprenorphine is an opioid used to treat OPIOID USE DISORDER (OUD), acute pain, and
chronic pain.
• It can be used under the tongue (sublingual), in the cheek (buccal), by injection), as a
skin patch (transdermal), or as an implant.
BUPRENORPHINE :
• Buprenorphine is highly effective medication to treat OUD.
• Yet, like other drugs that activate mu opioid receptors, it has the potential to be misused
• taken in some other way than the doctor prescribed (such as at a higher dose or for
longer duration) or taken without one's own prescription (i.e., via diversion).
• This concern led to safety restrictions, including the requirement of a waiver to

prescribe buprenorphine for OUD and limits on the number of patients whom providers
can treat using it. ( in REHABS)
• Such restrictions don't exist when using buprenorphine for the treatment of pain.
How do people misuse prescription opioids?
• Prescription opioids used for pain relief are generally safe when
taken for a short time and as prescribed by a doctor, but they
can be misused.
People misuse prescription opioids by:

o taking the medicine in a way or dose other than prescribed
o taking someone else's prescription medicine
o taking the medicine for the effect it causes-to get high
How do people misuse prescription opioids?
• When misusing a prescription opioid, a person can swallow the

medicine in its normal form.
• Sometimes people crush pills or open capsules, dissolve the
powder in water, and inject the liquid into a vein.
• Some also snort the powder.
Prescription Opioids and Heroin
• Prescription opioids and heroin are chemically similar and can produce a similar HIGH.
• Data showed that an estimated 4 to 6 % who misuse prescription opioids switch to heroin and
about 80 % of people who used heroin first misused prescription opioids.
• More recent data suggest that heroin is frequently the first opioid people use.
• In a study of those entering treatment for opioid use disorder, approximately one-third reported
heroin as the first opioid they used regularly to get high.
• This suggests that prescription opioid misuse is just one factor leading to
heroin use.
Prescription Opioids and Heroin
• America’s opioid crisis is so significant that lots of data and statistics
are available. Some of the most shocking impacts of opioid use are as
follows:
• 30% of people prescribed opioids admit to misusing them

• 100 people die every day from opioid overdoses
•86% of heroin users say they started on an opioid prescription

Amphetamine Sulfate
• This medication is used to treat Attention
Deficit Hyperactivity Disorder – ADHD.
• It belongs to a class of drugs known as

STIMULANTS.
• It can help increase your ability to pay

attention, stay focused on an activity, and
control behavior problems.
• It may also help you to organize your tasks and

improve listening skills.
Amphetamine Sulfate
• This medication is also used to treat a
certain sleeping disorder to help you stay
awake during the day.
• It may also be used along with a doctor-

approved, reduced-calorie diet to help
significantly overweight people lose weight.
Benzodiazepines:
• Benzodiazepines are a class of drugs primarily used for treating ANXIETY.
• Benzodiazepines appear to work by affecting neurotransmitters in the brain,

chemicals that nerves release in order to communicate with other nearby
nerves.
• One of these neurotransmitters is gamma-aminobutyric acid (GABA), a

neurotransmitter that suppresses the activity of nerves.
• Scientists believe that excessive activity of nerves may be the cause of anxiety
and other psychological disorders, and benzodiazepines reduce the activity
of nerves in the brain and spinal cord by enhancing the effects of GABA..
Benzodiazepines:
Benzodiazepines are used for treating:
• anxiety and panic
• seizures (convulsions) a sudden, uncontrolled electrical disturbance in the
brain
• insomnia or trouble sleeping.
Also used for:
• general anesthesia
• sedation prior to surgery or diagnostic procedures,
• muscle relaxation,
• alcohol withdrawal and drug-associated agitation,
• nausea and vomiting
• depression
Benzodiazepines:
• Although most benzodiazepines are used interchangeably, some are
most commonly used for certain conditions.
• Alprazolam, Chlordiazepoxide , Diazepam, Lorazepam, Midazolam are used for
anxiety disorders.
• Clonazepam, Lorazepam are used for seizure disorders.
• Estazolam, Flurazepam,Quazepam, Temazepam, triazolam are used for insomnia or
trouble sleeping.
• Midazolam, Lorazepam, Diazepam are used in anesthesia.
• Diazepam also is used for muscle relaxation.
• Chlordiazepoxide is used for alcohol withdrawal.
Benzodiazepines:
Benzodiazepines:
Benzodiazepines:
Benzodiazepines:
The most common side effects associated with benzodiazepines
are:
• Sedation,
• Dizziness,
• Weakness,
• Unsteadiness
• A Feeling Of Depression,
• Loss Of Orientation,
• Confusion,
• Irritability,
• Aggression,
Benzodiazepine Addiction:
Two serious concerns of benzodiazepine therapy are:
1. the potential for abuse (overdose) and
2. the development of physical dependence (addiction).
• Benzodiazepines are rarely the sole drug of abuse, and abusers usually
combine benzodiazepines with other drugs to increase the effect.
• For example, benzodiazepines are combined with certain opioids, a
class of strong prescription pain relievers, to enhance the euphoric
effects.
• Among abusers, diazepam (Valium) and alprazolam (Xanax) are most
popular due to their rapid onset.
Benzodiazepine Addiction:
Abusers are at higher risk for side effects including
• Confusion,
• Slurred Speech,
• Seizures Or Convulsions,
• Severe Drowsiness Or Coma,
• Shakiness,
• Slow Heartbeat,
• Difficulty Breathing, And
• Severe Weakness.
Barbiturates :
• A barbiturate is a drug that acts as a CNS depressant.
• Barbiturates are effective as anxiolytics, hypnotics and anticonvulsants

but have physical and psychological addiction potential as well as
overdose potential .
• Barbiturates, such as PHENOBARBITAL were long used as anxiolytics and
hypnotics
• Intermediate-acting barbiturates reduce time to fall asleep, increase
total sleep time, and reduce REM ( Rapid Eye Movement) sleep time.
Barbiturates :
• Barbiturates are classified based on the duration of action. Examples of
each class include:
• Ultra Short Acting (30 Minutes): Thiopentone, Methohexitone
• Short Acting (2 Hours): Hexobarbitone, Cyclobarbitone,

Pentobarbitone, Secobarbitone
• Intermediate Acting(3-6 Hours): Amobarbitone, Butabarbitone
• Long Acting (6 Hours): Phenobarbitone

Barbiturates Addiction :
• Recreational users report that a barbiturate high gives them feelings of
relaxed contentment and euphoria
• Physical and psychological dependence may also develop with repeated
use.
• Chronic misuse of barbiturates is associated with significant morbidity.
One study found that 11% of males and 23% of females with a sedative-
hypnotic misuse die by suicide.
• Other effects of barbiturate intoxication include drowsiness lateral and
vertical nystagmus, slurred speech and ataxia, decreased anxiety, and
loss of inhibitions.
Barbiturates :
Methadone :
• Methadone, is a synthetic opioid agonist used for chronic pain and also for opioid
dependence.
• It is used to treat chronic pain, and it is also used to treat addiction to heroin or other
opioids.
• Prescribed for daily use, the medicine relieves cravings and removes withdrawal
symptoms.
• Detoxification using methadone can be accomplished in less than a month, or it may

be done gradually over as long as six months.
• While a single dose has a rapid effect, maximum effect can take up to five days of use.
• The pain-relieving effects last about six hours after a single dose.
Methadone :
Methadone :
• Methadone Abuse
• While Methadone is used as a way to curb addiction and reduce cravings, it
is a heavily-regulated drug.
• It is so regulated that patients who are prescribed Methadone in an
outpatient setting have to go to a clinic every day to be administered their
dose.
• It is a powerful Opiate with potentially addictive qualities.
• People who start using Methadone to overcome their Heroin addiction are
at a higher risk of abuse because they already have a history of Opioid
dependency
• Some addicts, in fact, prefer Methadone as their substance of choice.
• Any time someone uses more Methadone than they are prescribed, or uses
it without a prescription, they are abusing the medication
Other Drug Addiction in Nepal :
1. TRAMADOL
Tramadol belongs to a class of drugs known as opioid analgesics. It works in
the brain to change how your body feels and responds to pain.
2. FLUOXETINE
Fluoxetine is an antidepressant and belongs to a group of medicines known
as selective serotonin reuptake inhibitors (SSRIs). This medicine works by
increasing the activity of a chemical called serotonin in the brain.
3. COUGH SYRUPS
• Codeine phosphate, which is contained in cough preparations, is the main
drug that is abused. Cough preparation contains chlorpheniramine
maleate, an anti-histaminic, in addition to codeine phosphate, which
causes sedation.
1. TRAMADOL
2. FLUOXETINE
3. COUGH PREPARATIONS :
Note:
All the photos of Medicines for

illustrative purpose only .
Narcotic and psychotropic drug List of Nepal
Useful Articles and References :
Let us get united for ………
7/1/2022
Thank You …
bibekmahatsingh@gmail.com 51

Commonly Used Medicine With The Potention For Misuse, Abuse or Addiction

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Bibek Singh Mahat

• Drug addiction, also called SUD (Substance Use Disorder) is a disease

• Not meeting obligations and work responsibilities, cutting back on

• Failing in your attempts to stop using the drug,

• Experiencing withdrawal symptoms when you attempt to stop taking

• Neglected appearance — lack of interest in clothing, grooming or looks

• DRUG DEPENDENCE occurs with repeated use, causing the neurons

• DRUG ADDICTION is a chronic disease characterized by compulsive,

• Some Prescription Opioids are made from the plant

• Opioids are often used as medicines because they

• Prescription opioids are used mostly to treat moderate

• This concern led to safety restrictions, including the requirement of a waiver to

People misuse prescription opioids by:

• When misusing a prescription opioid, a person can swallow the

• 30% of people prescribed opioids admit to misusing them

•86% of heroin users say they started on an opioid prescription

• It belongs to a class of drugs known as

• It can help increase your ability to pay

• It may also help you to organize your tasks and

• It may also be used along with a doctor-

• Benzodiazepines appear to work by affecting neurotransmitters in the brain,

• One of these neurotransmitters is gamma-aminobutyric acid (GABA), a

• Barbiturates are effective as anxiolytics, hypnotics and anticonvulsants

• Ultra Short Acting (30 Minutes): Thiopentone, Methohexitone

• Short Acting (2 Hours): Hexobarbitone, Cyclobarbitone,

• Intermediate Acting(3-6 Hours): Amobarbitone, Butabarbitone

• Long Acting (6 Hours): Phenobarbitone

• Detoxification using methadone can be accomplished in less than a month, or it may

All the photos of Medicines for

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