A SHORT NOTE

ON

DRUG EDUCATION

FOR

HEALTH PROMOTION AND EDUCATION

STUDENTS
COURSE INSTRUCTOR
ISMAHEEL ADENIYI
FOREIGN LINKS COLLEGE OF HEALTH TECHNOLOGY,
MORO. IFE NORTH NIGERIA. STATE OF OSUN

C2019

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 CONCEPTS OF DRUG

Drug can be described as any substance which may have medicinal, intoxicating, performance
enhancing or other effects when taken or put into a human body or the body of another animal and is not
considered a food or exclusively a food. Although, there is no single, precise definition of drug, as there are
different meanings in drug control law, government regulations, medicine and colloquial usage.

In pharmacology, a drug is chemical substances used in the treatment, cure, prevention, or diagnosis
of diseases or used otherwise enhance physical or mental well- being. Drugs may be prescribed for a limited
duration, or on a regular basis for chronic disorder.

A drug refers to a substance that could bring about a change in the biological function through its
chemical action. It is also considered as a substance that modifies perceptions, cognition, mood, behaviour
and general functions. This could thus be considered as chemical modifiers of delivering tissues that could
be bring about physiological and behavioural change.

A drug can also be referred to as any substance other than food, that when inhaled, injected,
smoked, consumed, absorbed via a patch on the skin or dissolved under the tongue causes a physiological
change in the body.

CHARACTERISTICS OF DRUG

Drugs generally have the following characteristics properties:

-Dependent

-Withdrawal

-Tolerance

-Intoxication

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 DRUG

A drug is a substance which may have medicinal, intoxicating, performance enhancing or other
effects when taken or put it into a human body or the body of another animal and is not considered a food or
exclusively a food. Although, there is no single, precise definition of drug, as there are different meanings in
drug control law, government regulations, medicine and colloquial usage.

In pharmacology, a drug is chemical substances used in the treatment, cure, prevention, or diagnosis
of disease or used otherwise enhance physical or mental well-being. Drugs may be prescribed for a limited
duration, or on a regular basis for chronic disorders.

SOURCES OF DRUGS

The sources as highlighted as Sears and Winwood (1983) includes

1. VEGETABLE SOURCE: this is the oldest source of drugs. It includes the plant products like
leaves, root, seeds, flowers, fruits and barks. Resins and some oils are also obtained from vegetable
sources. Though this source is no very much in use nowadays, yet digitalis leaves still hold a place in
the management of heart failure. Example of digitalis is Digoxin. The most important active
principles extracted are alkaloids and glycosides.
(a) Alkaloids: these are active substances containing Nitrogen, Oxygen, Carbon, and Hydrogen are
used in extremely small doses. Alkaloids generally ends in ‘INE’ as indicated in these examples,
like atropine, (an alkaloid of belladonna), morphine (alkaloid of opium) and nicotin (an alkaloid
of tobacco).
(b) Glycosides or Glucosides: these are very potent vegetable substances in which glucose or some
other sugar play significant role in their formation. The names of glucoside usually terminate in
‘IN’, that is a glucoside.
2. MINERAL SOURCE: these are metallic compounds such as sodium chloride (common salt or
table salt), magnesium sulphate (Epsom salt) and ferrous gluconate. This mineral source includes
salt like sodium, potassium, magnesium, calcium and iron.
3. ANIMAL SOURCE: few products of animal origin are in use today and are of great important to
mankind. Examples of animal products includes: insulin, heparin, and Hyaluronidase (hylase). The
animal source generally applies to vaccine, hormones, gland extract, sera and other preparations
from animals.

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 4. SYNTHETIC SOURCE: This applies to drug formed or synthesized from simpler components of
natural substances in the chemical laboratories of pharmaceutical companies. Examples include
adrenalin which can be manufactured from the supra-renal gland. Other synthetic drugs include
hypotensive drugs, tranquillizers, antidepressants, sulphonamides, anticoagulants, hypoglycaemic
agents, etc.
5. ANTIBIOTIC SOURCE: these are anti microbial chemical substances produce either synthetically
of semi-synthetically from various moulds (fungi) and associated organisms, and which helps to
prevent the growth or even destroy other microorganisms. Examples includes: penicillin,
tetracycline, cephalosporin, streptomycin, nystatin, etc. Nystatin is of value in the treatment of
fungal infections.

DRUG EDUCATION

Drug education is the planned provision of information, resources, and skills relevant to living in a
world where psychoactive substances are widely available and commonly used for a variety of both medical
and non-medical purposes, some of which may lead to harms such as overdose, injury, infectious disease
(such as HIV or hepatitis C), or addiction.

BENEFITS OF DRUG EDUCATION

Planning includes developing strategies for helping children and young people engage with relevant
drug-related issues during opportunistic and brief contacts with them as well as during more structured
sessions. Drug education enables children, youth and adults to develop the knowledge, skills and attitudes to
appreciate the benefits of living healthily (which may or may not include the use of psychoactive
substances), promote responsibility towards the use of drugs and relate these to their own actions and those
of others, both now and in their future lives. It also provides opportunities for people to reflect on their own
and others' attitudes to various psychoactive substances, their use and the people who use them.

DRUG/SUBSTANCE ABUSE

Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user
consumes the substance in amounts or with methods which are harmful to themselves or others, and is a
form of substance-related disorder. Widely differing definitions of drug abuse are used in public health,

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medical and criminal justice contexts. In some cases criminal or anti-social behavior occurs when the person
is under the influence of a drug, and long term personality changes in individuals may occur as well. [2] In
addition to possible physical, social, and psychological harm, use of some drugs may also lead to criminal
penalties, although these vary widely depending on the local jurisdiction.[3]

Drugs most often associated with this term include: alcohol, barbiturates, benzodiazepines, cannabis,
cocaine, methaqualone, opioids and substituted amphetamines. The exact cause of substance abuse is not
clear, with theories including one of two: either a genetic disposition which is learned from others or a habit
which if addiction develops; it manifests itself as a chronic debilitating disease.

DRUG MISUSE

Drug misuse is a term used commonly when prescription medication with sedative, anxiolytic,
analgesic, or stimulant properties are used for mood alteration or intoxication ignoring the fact that overdose
of such medicines have serious adverse effects. It often involves drug diversion from the individual for
whom it was prescribed. Prescription misuse has been defined differently and rather inconsistently based on
status of drug prescription, the uses without a prescription, intentional use to achieve intoxicating effects,
route of administration, co-ingestion with alcohol, and the presence or absence of dependence symptoms.
Chronic use leads to a change in the central nervous system which means the patient has developed
tolerance to the medicine that more of the substance is needed in order to produce desired effects. When this
happens, any effort to stop or reduce the use of this substance would cause withdrawal symptoms to occur.

The rate of prescription drug abuse is fast overtaking illegal drug abuse in the community.
According to the National Institute of Drug Abuse, 7 million people were taking prescription drugs for
nonmedical use. Among 12th graders, prescription drug misuse is now second only to cannabis. "Nearly 1 in
12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of Oxytocin." Both of
these drugs contain opioids.

Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends,
illegally buying medications at school or work, and often "doctor shopping" to find multiple physicians to
prescribe the same medication, without knowledge of other prescribers.

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 SIGNS AND SYMPTOMS

Depending on the actual compound, drug abuse including alcohol may lead to health problems,
social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides,
suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the
increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological
distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of
the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol
abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the USA approximately 30%
of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing
criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.[18]

Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles
mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some
cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged
psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also
occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable
drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after
cessation of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after
cessation of use.

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of
awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some
of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled
use than others.

FIVE PATTERNS OF DRUG USE THAT INDICATESA PROBLEM

1 ‘Hard’ Drug Use

“Hard” drugs, such as heroin, cocaine and methamphetamine, tend to be the most dangerous, both in
terms of their effects on health and behavior as well as the risk of addiction. While some individuals use

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these drugs recreationally, addiction can set in after just one use, setting into motion a rapid downward
spiral. Once a person has escalated to the use of hard drugs, they often engage in high-risk behavior, isolate
themselves from friends and family, and live “outside” society.

2 Frequent Drug Use

By itself, frequency of drug use is not the most accurate way to determine whether someone is
addicted. People who binge drink on weekends, for example, may have a serious problem even though they
don’t drink every day. However, frequent drug use can be an indicator of tolerance (needing more of a drug
to get the same high) and dependence. There is also a good chance that someone who uses drugs or alcohol
regularly will continue using and have difficulty quitting.

3 Early Drug Use

People who begin using drugs in early adolescence are highly vulnerable to drug problems in
adulthood. One study found that people who started drinking before age 15 were more likely to become
addicted to alcohol as adults than people who refrained from drinking until they were 18 or older. The
earlier a child uses drugs, the earlier they become addicted. Since their brains and bodies are still developing
during that time, the short- and long-term consequences may be particularly severe.

Unfortunately, drug use at an early age isn’t uncommon. In a survey of 10,000 teens, researchers
found that the median age for drug use is 14. Other studies have also linked teen substance abuse to stealing,
risky sexual behaviors, academic underachievement and other problems 

4 Solitary Drug Use 

Using alcohol or other drugs alone has been linked to addiction and other problems later in life. A
study found that teens who use alcohol, marijuana and cigarettes while alone are more likely to have drug
problems as young adults, are less likely to graduate from college and are more likely to report poor
physical health by age 23 than social drug users. Solitary users also earned lower grades and engaged in
violent or delinquent behavior more often. Solitary drug use among 8 th graders in the study was relatively
common, with 16 percent smoking cigarettes, 17 percent drinking alcohol and 4 percent using marijuana
while alone.

5 Escapist Drug Use

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 The reasons why someone uses drugs or alcohol can be as problematic as where, when or how. If a
person uses drugs to cope with stress, build self-esteem or medicate an underlying mental health disorder
such as depression or anxiety, they are at higher risk of eventually becoming addicted. Research has also
shown that the risk of drug use increases significantly when teens use substances to deal with stress or
boredom. In a CASA survey, high-stress teens were twice as likely to use drugs as low-stress teens, and
often-bored teens were 50 percent likelier to use drugs than other kids.

Many people drink a little too much on occasion or experiment with a substance once or twice. But
when these instances start to negatively impact your relationships, finances, career or home life, a pattern of
problematic drug use emerges. Whether it has been going on for a few weeks or a few years, these patterns
increase the risk of addiction and should not be ignored.

SIGNS OF DRUG ABUSE OR ADDICTION

For most people it hits them unaware; a parent, spouse or child with an apparent drug abuse
problem. For most it comes as a great shock. How did this happen in their house? How didn’t they notice?
Many people may have their suspicions, but still are not sure how to tell if their loved one is struggling with
drug addiction.

Now, not every case of substance use means an addiction. Addiction itself is a compilation of many factors.
Not all cases of use require a drug treatment program. These ten signs are indicators of what is possibly the
development of abuse to dependence. There are many ways to treat this. The most common course of action
is that of a drug rehab program, or support group. If your loved one is fitting the build of the behaviors
listed, chances are they could be treading the path to dependence. If you have questions about addiction and
abuse, the best way to get them answered is by contacting a rehabilitation program directly.

1. Loss of Interest – Apathy - Complacency: While this is not common it is a noticeable

characteristic. Someone who is normally quite active and involved in a number of things can lose
interest. Hobbies, talents, and skills that the individual normally enjoys, they will no longer seem
interested in. It isn’t that those things are no longer important to them. It is that their attention is
turned to feeding the impulse of their drug of choice. The individual will be apathetic towards things
they used to feel very strongly about. This includes anything of interest, including people.

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2. Physical Signs – Noticeable: When an individual uses drugs, there are a number of noticeable
physical signs that can be picked up on. Blood Shot (red) eyes, dilated pupils, sniffling, itching,
injection marks, puffy face, unusual skin color are all noticeable signs of use and abuse. If it is an
incessant occurrence chances are that the individual is using quite frequently. A person can go to
great lengths to hide these indicators as well. However, if complacency has set in, they may not be
so committed to hiding their use from others.
3. Change in Physical Appearance: Different than the subtle signs of drug use, a person consistently
abusing drugs and alcohol can undergo alterations to their physical appearance. This behavior can
suppress the appetite. An addict can experience rapid weight loss or gain. Eating habits and the time
of day when a person eats can rapidly change as well. Another area of noticing physical change is in
appearances. Once again complacency sets in. Someone who used to take a lot of pride in physical
appearance can change rapidly. If you notice a rapid change in physical appearance and in the
clothes they wear, chances are they may be struggling.
4. Discovering Drug Paraphernalia: Many drugs require articles to compliment use. Cigarette
wrapping papers, pipes, syringes, lighters, burnt spoons, bongs (glass or pottery made items used for
smoking marijuana), razor blades, and cutting surfaces (like mirrors or glass) are all common types
of paraphernalia that can be discovered. There are other items that are not considered paraphernalia
that can be indicators. One of them is eye clearing wash. Some drugs of abuse can cause blood shot
eyes and dilated pupils. The eye clearing wash is a quick fix it of eliminating this problem. Now
most people have eye wash, but an inordinate amount of the stuff is an indicator.
5. Rapid Mood Swings: When determining rapid mood swings you must take into consideration what
is normal for the individual. Someone who is usually calm and collected can be ultra-hyper and out
of control. Someone who is usually pleasant and upbeat can be miserably depressed. Also erratic
mood swings from one end of the spectrum to the other can also be caused by drug abuse. If these
things are strangely not the norm, chances are you might be dealing with substance use or a mental
health issue.
6. Reclusive and Private Behavior: Another behavioral issue that is common is one of a reclusive
nature. The behavior of substance use is very isolating. The person can have all the appearance of
hiding something, or being very private in their actions. Does the person spend a lot of time in their
room? Do they lock their room on leaving and entering? Do they seem bottled up when you ask
them questions? These are indicators that they may be hiding something, possibly substance abuse.

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7. Rapid Change in What is Considered “Normal” For the individual: This is a notice in a rapid
change in daily routine. Cutting out on work, school, and home life are indicators of a change in
routine. This can stem from the behavior that is developed through a period of substance use. The
things that are considered “normal” daily activities take a back seat to the constant need to obtain
and use drugs of abuse. An increase in medical conditions is also indicator of abnormal behaviors.
Prescription drugs are a growing concern in society. Medical conditions are an easy way to obtain
prescriptions that are abused.
8. Erratic Behaviors: These can be the most noticeable traits of addiction. They are behaviors that are
not typical of the person. Excessive excitability or giddiness out of someone who is typically serious
is an example. These behaviors can become dangerous situations. This is typical with violent
behaviors caused by withdrawal. Some behaviors are magnified by substance use. A good example
of this is with depression or similar co-occurring disorder problems. The abuse of an addictive
substance can amplify the impact of something like depression. Such disorders like depression or
anxiety have also been shown to be strong influences in causing drug abuse. A brain struggling with
a mood disorder is more susceptible to the influences of drugs. Treatments have been developed that
focus on dual diagnosis and care for both mental health struggles and addictions
9. Additional Behaviors: There are additional behaviors to look for in drug using. One of which is
being overly sensitive about things. Particularly the subject of drugs, abuse, and similar topics.
Along with this sensitivity is defensiveness. Sensitivity and defensiveness are mechanisms used for
hiding the habit. This behavior can also result in an aggressive mood swing. Another defense used
by users is that of being argumentative. They will find a way to turn the emphasis away from their
problem and onto something else.
10. Sleep Habits: Substance use plays havoc on sleep habits. Someone who is struggling with addiction
and abuse can have completely erratic sleeping habits. If the person is keeping off hours, staying up
late, or overly sleeping, these are possible indicators. With some stimulants, the person must stay up
for lengthy amounts of time to maintain the high. This also can result in a crash and excessive sleep.
Depressant drugs also induce sleep. Erratic sleep habits are an indicator or potential of chemical
dependence.

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 WITHDRAWAL SYNDROME

A withdrawal syndrome, also called a discontinuation syndrome is a set of symptoms occurring

in discontinuation or dosage reduction of some types of medications. The risk of a discontinuation syndrome
occurring increases with dosage and length of use.

 Alcohol withdrawal syndrome, symptoms seen when an individual reduces or stops alcohol
consumption after periods of excessive alcohol intake
 Antidepressant discontinuation syndrome, a syndrome that can occur following the interruption,
dose reduction, or discontinuation of SSRI or SNRI medications
 Antipsychotic withdrawal syndrome or dopamine super sensitivity psychosis, symptoms seen when
an individual reduces or suddenly stops antipsychotics
 Benzodiazepine withdrawal syndrome, symptoms that appear when a long term user stops taking
benzodiazepines or reduces the dosage
 Cannabis withdrawal, a form of withdrawal associated with the substance cannabis
 Neonatal withdrawal, a withdrawal syndrome of infants, caused by administration of drugs or the
prenatal exposure to a substance
 Nicotine withdrawal, the effects felt by a person who is nicotine dependent and suddenly stops or
significantly reduces his or her nicotine intake
 Opioid withdrawal, symptoms seen cessation or rapid reduction of intake of opioid class drugs

Withdrawal syndrome occurs in drug and alcohol addicted individuals who discontinue or reduce the
use of their drug of choice. This process of eliminating drugs and alcohol from the body is known as
detoxification. Anxiety, insomnia, nausea, perspiration, body aches, and tremors are just a few of the
physical and psychological symptoms of drug and alcohol withdrawal that may occur during detoxification.

DESCRIPTION

When drug or alcohol consumption becomes chronic, the body adjusts to the constant presence of
the substance by changing its normal production of neurotransmitters. If drug and alcohol use suddenly
stops, the body and central nervous system react to the absence of the substance with an array of symptoms
known collectively as withdrawal syndrome.

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 Alcohol withdrawal
Alcohol withdrawal syndrome occurs in alcohol-dependent individuals who suddenly stop or
dramatically reduce their alcohol intake. The onset of the syndrome is likely to occur within a week, but
usually occurs within 24 hours of the individual's last drink, and is triggered when the central nervous
system attempts to adjust to the sudden absence of ethyl alcohol in the body. Symptoms may include
extreme anxiety, disorientation, hallucinations, sleep disorders, hand tremors, nausea, sweating, seizures,
and racing pulse. Delirium tremens(DTs) are an extreme example of withdrawal. In the worst cases,
untreated alcohol withdrawal syndrome can result in death. As many as two million Americans may
experience symptoms of alcohol withdrawal conditions each year.

Barbiturate withdrawal
Barbiturates are prescribed as anticonvulsants, sedatives, and general anesthetics. They can also
mimic some of the characteristics of alcohol intoxication (including euphoria, elation, and uninhibited
behavior), which make them candidates for abuse. Commonly abused barbiturates include amobarbital
(Amytal), pentobarbital (Nembutal), and sec barbital. These drugs depress the respiratory and nervous
system functions. Because abusers rapidly build up a tolerance to the effects of the drug, fatal overdose or
coma can easily occur. Symptoms of withdrawal syndrome appear 12-20 hours after the last dose; they
include anxiety, irritability, elevated heart and respiration rate, muscle pain, nausea, tremors, hallucinations,
confusion, and seizures. Death is a possibility if the condition is left untreated. Because barbiturates
decrease REM (rapid eye movement) sleep, during which dreaming takes place, withdrawal often results in
sleep disruptions such as nightmares, insomnia, or vivid dreaming.

Opiate withdrawal
Opiates are powerfully addictive analgesic drugs that deaden nerve pathways related to pain.
Abusers of propoxyphene (Darvon), meperidine (Demerol), Percocet (Oxycodone), heroin, morphine, and
other powerfully addictive opiates quickly build up a tolerance to the drugs and need progressively larger
doses to achieve the desired effect. Stopping or reducing the intake of the drug can cause severe withdrawal
symptoms, which begin six to eight hours after the last dosage. Symptoms are flu-like, and include gastro
intestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes.

Stimulant withdrawal
Use of stimulants, such as cocaine, crack, amphetamines, and methamphetamines, cause an increase
in neurotransmitters in the central nervous system and produce feelings of alertness and increased energy.
This initial rush" is followed by a longer period of neurotransmitter loss, characterized by depression,

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lethargy, and a craving form or stimulants sometimes called a rebound effect. When a stimulant dependent
individual abstains from stimulant use, withdrawal symptoms, including depression, fatigue, insomnia, and
loss of appetite, reflects this drop in neurotransmitter levels. Withdrawal typically takes one to two weeks.

THE IMPACT OF DRUGS ON SOCIETY

The negative consequences of drug abuse affect not only individuals who abuse drugs but also their
families and friends, various businesses, and government resources. Although, many of these effects cannot
be quantified.

The most obvious effects of drug abuse which are manifested in the individuals who abuse drugs
include ill health, sickness and, ultimately, death. Particularly devastating to an abuser's health is the
contraction of needle borne illnesses including hepatitis and HIV/AIDS through injection drug use.

Children of individuals who abuse drugs often are abused or neglected as a result of the individuals'
preoccupation with drugs. National-level studies have shown that parents who abuse drugs often put their
need to obtain and abuse drugs before the health and welfare of their children. Children whose parents and
other family members abuse drugs often are physically or emotionally abused and often lack proper
immunizations, medical care, dental care, and necessities such as food, water, and shelter. 

The risk to children is even greater when their parents or guardians manufacture illicit drugs such as
methamphetamine. Methamphetamine abusers often produce the drug in their own homes and apartments,
using hazardous chemicals such as hydroid acid, iodine, and anhydrous ammonia. Children who inhabit
such homes often inhale dangerous chemical fumes and gases or ingest toxic chemicals or illicit drugs.
These children commonly test positive for methamphetamine and suffer from both short- and long-term
health consequences. Moreover, because many methamphetamine producers also abuse the drug, children
commonly suffer from neglect that leads to psychological and developmental problems. 

IMPACTS OF DRUG ABUSE ON HEALTH AND THE SOCIETY

Drug abuse is unwarranted, patterned consumption of any natural or synthetic substance or drug in
an unapproved quantity for performance enhancement and psychological effect for non-therapeutic, non-
medical use by an individual with methods neither approved nor supervised by medical professionals.

When drug abuse becomes a necessity for maintaining psychological and emotional equilibrium it is called
Drug Addiction. Drugs corrode the basic structure of a whole society, by affecting a cultured human society

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in all aspects including destabilizing families, reducing human productivity, corrupting trustworthy
governments and honest police, and demoraling law respecting citizens.

The trafficking of illicit drugs and hallucinogens is the largest illegal business in the world accounting for
about 8% of international trade, amounting to about $400 billion annually. Drugs corrode a whole society.
Robbery and violence connected with drug abuse have become a mundane affair and most commonly drug
consumers often appeal to felony or prostitution to satisfy their vice.
PSYCHOLOGICAL EFFECTS OF DRUG ABUSE
Euphoria and Illusion: Drugs would distort the normal perception capacity and functionality of the brain
and make a “pseudo” visualization and perception. It would create illusion and artificially make you feel
euphoric, excited or pleasurable.

Stress: Drugs would make you feel as if it is helping you in relaxation and forget about all the issues that
make you stressed. However, in reality, it is the opposite. Long-term use of drugs can cause a deep impact
on the way your brain works, and lead to increased anxiety and stress.
Anxiety and Depression: Feeling low after alcohol consumption is common. Some drugs would make you
feel depressed, while others make you depressed and anxious because of something that happened while you
were under its impact. People often use drugs as a way to overcome their depression, but in reality, the drug
use can often worsen these.
Mental illnesses: Scientists have showed that there is a link between drug use and serious mental illnesses
like schizophrenia, yet it’s still unclear whether serious drug use leads to mental illnesses. However, a
person having any chronic psychological illness has an increased chance of drug abuse.
HEALTH AND SEXUAL EFFECTS OF DRUG ABUSE / DRUG ADDICTION
Accidents and Injuries: Drug distorts your perception and thoughts and it would make you do unwarranted
acts that you would not do normally. Drugs can increase your chances of getting seriously injured or losing
your life through falls and road accidents and can even pose a threat or cause harm to others around you.
These effects include the following:

 Internal organs damage

 Risk of infectious diseases
 Sexual effects

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 SOCIAL EFFECTS OF DRUG ABUSE

 Safety
 Financial pressure and mounting debt
 Violence
 Homelessness
 Legal issues
 corruption

DRUGS AND CRIME

Drug abuse and addiction is associated with drug-related crimes. In several communities,
jurisdictions have reported that benzodiazepine misuse by criminal detainees has surpassed that of opiates.

Research carried out on drug-related crime found that drug misuse is associated with various crimes
that are in part related to the feelings of invincibility, which can become particularly pronounced with abuse.
Problematic crimes associated include shoplifting, property crime, drug dealing, violence and aggression
and driving whilst intoxicated.

Another research carried found that benzodiazepine users are more likely to be violent, more likely
to have been in contact with the police, and more likely to have been charged with criminal behavior than
those using opiates. Illicit benzodiazepines mostly originate from medical practitioners but leak onto the
illicit scene due to diversion and doctor shopping. Although only a very small number originate from thefts,
forged prescriptions, armed robberies, or ram raids, it is most often benzodiazepines, rather than opiates,
that are targeted in part because benzodiazepines are not usually locked in vaults and or do not have as strict
laws governing prescription and storage of many benzodiazepines. Diazepam accounts for most
benzodiazepine sought by forgery of prescriptions and through pharmacy burglary in Australia.

The relationship between drugs and crime is complex, and one question is whether drug use leads
people into criminal activity or whether those who use drugs are already predisposed to such activity. Many
illegal drug users commit no other kinds of crimes, and many persons who commit crimes never use illegal
drugs. However, at the most intense levels of drug use, drugs and crime are directly and highly correlated
and serious drug use can amplify and perpetuate preexisting criminal activity.

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There are essentially three types of crimes related to drugs:

 Use-Related crime: These are crimes that result from or involve individuals who ingest drugs, and
who commit crimes as a result of the effect the drug has on their thought processes and behavior.
 Economic-Related crime: These are crimes where an individual commits a crime in order to fund a
drug habit. These include theft and prostitution.
 System-Related crime: These are crimes that result from the structure of the drug system. They
include production, manufacture, transportation, and sale of drugs, as well as violence related to the
production or sale of drugs, such as a turf war. 

Those with a drug use dependency are more likely to be arrested for acquisitive crimes such as
burglary or shop theft, or for robbery and handling stolen goods -- crimes often related to “feeding the
habit.” For example, in 2004, 17% of state prisoners and 18% of federal inmates said they committed their
current offense to obtain money for drugs. There are also close links between drug use and women, men and
children who are involved in, or exploited by, the sex trade, many of whom are caught up in the criminal
justice system. However, there is evidence that drug use is both a pre-determining factor in such sexual
exploitation and a means of coping with it.

DRIVING WHILE INTOXICATED (DWI)

More than one million people are arrested annually for driving while intoxicated, which is the third
most commonly reported crime in various regions. Drinking and drugged driving is the number one cause of
death, injury and disability of young people under the age of 21, and nearly 40% of all traffic fatalities are
alcohol related. Every day 36 people die and approximately 700 are injured in motor vehicle crashes that
involve an alcohol-impaired driver. Drugs other than alcohol (e.g., marijuana and cocaine) are involved in
about 18% of motor vehicle driver deaths, often in combination with alcohol.

Many prescription drugs including Opioid pain relievers and benzodiazepines prescribed for anxiety
or sleep disorders come with warnings against the operation of machinery -- including motor vehicles -- for
a specified period of time after use. When prescription drugs are abused (taken without medical
supervision), impaired driving and other harmful reactions become much more likely.

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 JUVENILE CRIME

Four of every five children and teen arrestees in state juvenile justice systems are under the influence
of alcohol or drugs while committing their crimes, test positive for drugs, are arrested for committing an
alcohol or drug offense, admit having substance abuse and addiction problems, or share some combination
of these characteristics.

1.9 million of 2.4 million juvenile arrests had substance abuse and addiction involvement, while only 68,600
juveniles received substance abuse treatment.

ALCOHOL AND VIOLENCE IN COLLEGE

 Each year, more than 600,000 students between the ages of 18 and 24 are assaulted by another
student who has been drinking.
 95% of all violent crime on college campuses involves the use of alcohol by the assailant, victim or
both.
 90% of acquaintance rape and sexual assault on college campuses involves the use of alcohol by the
assailant, victim or both.

ALCOHOL, DRUGS AND DOMESTIC VIOLENCE

According to the Bureau of Justice Statistics, two-thirds of victims suffering violence by a current or
former spouse or partner report that the perpetrator had been drinking compared to less than one-third of
stranger victimizations. Among spouse victims, three out of four incidents reportedly involved an offender
who had been drinking.

Domestic violence also has an effect on other family members. A study in Massachusetts found that
children who witnessed abuse of their maternal caregiver were 50 % more likely to abuse drugs and/or
alcohol.

ALCOHOL, DRUGS AND CHILD ABUSE

Though there is no “cause” of abuse and no specific profile of abusers, many factors contribute and
make abuse more likely to occur. Pressures on the family, alcohol and drug abuse, and social isolation can
all lead to parental stress and increase the chances that a parent will strike out at their child.

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  Nearly 4 in 10 child victimizers reported that they had been drinking at the time of the crime.
Among drinkers, about half reported that they had been drinking for 6 hours or more preceding the
offense.
 A 1999 study by the National Center on Addiction and Substance Abuse found that children of
substance-abusing parents were almost three times likelier to be abused and more than four times
likelier to be neglected than children of parents who are not substance abusers.

STREET DRUGS AND PREGNANCY

A street drug (also called illegal or illicit drug) is a drug that is against the law to have or use. 

Street drugs are bad for you, and they’re bad for the baby. About 1 in 20 women (5 percent) take
street drugs during pregnancy. 

Street drugs include:

 Cocaine
 Ecstasy, methamphetamine and other club drugs
 Heroin
 Marijuana
 Prescription drugs that are abused

HOW CAN STREET DRUGS HARM YOUR PREGNANCY?

Using street drugs can cause problems for you before and during pregnancy, including:

 Not being able to get pregnant. This is called infertility.

 Problems with the placenta. The placenta grows in your uterus and supplies your baby with food and
oxygen through the umbilical cord.
 Preterm labor. This is labor that happens before 37 weeks of pregnancy.
 Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
 Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

Babies born to moms who use street drugs during pregnancy often have these complications: 

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  Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy. 
 Low birth weight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
 Smaller-than-normal head size (called reduced head circumference)
 Heart defects
 Birth defects. These are health conditions that are present at birth. Birth defects change the shape or
function of one or more parts of the body. They can cause problems in overall health, how the body
develops, or in how the body works.
 Infections, including hepatitis C and HIV. HIV is the virus that causes AIDS. These viruses often
affect people who share needles to inject street drugs. Moms can pass these infections to their baby
during pregnancy or at birth.
 Neonatal abstinence syndrome (also called NAS). This is a group of health conditions that a baby
can have if his mother uses addictive drugs during pregnancy. NAS can happen when a baby gets
addicted to a drug before birth and then goes through drug withdrawal after birth.

Babies born to moms who use drugs often have problems later in life, including:

 Learning and behavior problems

 Slower-than-normal growth
 Sudden infant death syndrome (also called SIDS). This is the unexplained death of a child while
sleeping.

It’s hard to know exactly how each street drug harms your pregnancy. This is because women who
use street drugs may use more than one drug and may have other unhealthy behaviors, too. For example,
they may smoke or drink alcohol.  They may not eat healthy meals. They may be more likely to get a
sexually transmitted disease. All of these can cause problems during pregnancy. 

DRUGS IN PREGNANCY

Drugs are used in over half of all pregnancies, and prevalence of use is increasing. The most
commonly used drugs include antiemetic, antacids, antihistamines, analgesics, antimicrobials, diuretics,
hypnotics, tranquilizers, and social and illicit drugs. Despite this trend, firm evidence-based guidelines for
drug use during pregnancy are still lacking.

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The information required by the FDA has 3 subsections:

 Pregnancy: Information relevant to the use of the drug in pregnant women (eg, dosing, fetal risks)
and information about whether there is a registry that collects and maintains data on how pregnant
women are affected
 Lactation: Information about using the drug while breastfeeding (eg, the amount of drug in breast
milk, potential effects on the breastfed child)
 Females and males of reproductive potential: Information about pregnancy testing, contraception,
and infertility as it relates to the drug

The pregnancy and lactation subsections each include 3 subheadings (risk summary, clinical
considerations, and data) that provide more detail.

EFFECTS OF DRUG USE DURING PREGNANCY

During pregnancy, drugs are often required to treat certain disorders. In general, when potential
benefit outweighs known risks, drugs may be considered for treatment of disorders during pregnancy.

Not all maternal drugs cross the placenta to the fetus. Drugs that cross the placenta may have a direct
toxic effect or a teratogenic effect. Drugs that do not cross the placenta may still harm the fetus by

 Constricting placental vessels and thus impairing gas and nutrient exchange
 Producing severe uterine hypertonia that results in anoxic injury
 Altering maternal physiology (eg, causing hypotension).

Drugs diffuse across the placenta similarly to the way they cross other epithelial barriers (Drug
Absorption). Whether and how quickly a drug crosses the placenta depend on the drug’s molecular weight,
extent of its binding to another substance (eg, carrier protein), area available for exchange across the
placental villi, and amount of drug metabolized by the placenta. Most drugs with certain molecular weight
readily cross the placenta and enter the fetal circulation. Substances with a high molecular weight (eg,
protein-bound drugs) usually do not cross the placenta. The exception is immune globulin G, which is
occasionally used to treat disorders such as fetal alloimmune thrombocytopenia. Generally, equilibration
between maternal blood and fetal tissues takes at least 30 to 60 min.

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A drug’s effect on the fetus is determined largely by fetal age at exposure, drug potency, and drug dosage.
Fetal age affects the type of drug effect:

 Before the 20th day after fertilization: Drugs given at this time typically have an all-or-nothing
effect, killing the embryo or not affecting it at all. Teratogenesis is unlikely during this stage.
 During organogenesis (between 20 and 56 days after fertilization): Teratogenesis is most likely
at this stage. Drugs reaching the embryo during this stage may result in spontaneous abortion, a
sublethal gross anatomic defect (true teratogenic effect), or covert embryopathy (a permanent subtle
metabolic or functional defect that may manifest later in life), or the drugs may have no measurable
effect.
 After organogenesis (in the 2nd and 3rd trimesters): Teratogenesis is unlikely, but drugs may
alter growth and function of normally formed fetal organs and tissues. As placental metabolism
increases, doses must be higher for fetal toxicity to occur.

Despite widespread concern about drug safety, exposure to therapeutic drugs accounts for only 2 to
3% of all fetal congenital malformations; most malformations result from genetic, environmental, or
unknown causes.

VACCINES DURING PREGNANCY

Immunization is as effective in women who are pregnant as in those who are not.

Influenza vaccine is recommended for all pregnant women in the 2nd or 3rd trimester during influenza
season.

Other vaccines should be reserved for situations in which the woman or fetus is at significant risk of
exposure to a hazardous infection and risk of adverse effects from the vaccine is low. Vaccinations for
cholera, hepatitis A and B, measles, mumps, plague, poliomyelitis, rabies, tetanus-diphtheria, typhoid, and
yellow fever may be given during pregnancy if risk of infection is substantial.

Live-virus vaccines should not be given to women who are or may be pregnant. Rubella vaccine, an
attenuated live-virus vaccine, may cause subclinical placental and fetal infection. However, no defects in
neonates have been attributed to rubella vaccine, and women vaccinated inadvertently during early
pregnancy need not be advised to terminate pregnancy based solely on theoretical risk from the vaccine.

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Varicella vaccine is another attenuated live-virus vaccine that can potentially infect the fetus; risk is highest
between 13 wk and 22 wk gestation. This vaccine is contraindicated during pregnancy.

ANTIDEPRESSANTS DURING PREGNANCY

Antidepressants are commonly used during pregnancy because an estimated 7 to 23% of pregnant
women have perinatal depression. Physiologic and psychosocial changes during pregnancy can affect
depression (possibly worsening it) and possibly reduce the response to antidepressants. Ideally, a
multidisciplinary team that includes an obstetrician and a psychiatric specialist should manage depression
during pregnancy.

Pregnant women who are taking antidepressants should be asked about depressive symptoms at each
prenatal visit, and appropriate fetal testing should be done. It may include the following:

 A detailed evaluation of fetal anatomy during the 2nd trimester

 If a pregnant woman takes paroxetine, echocardiography to evaluate the fetus's heart because
paroxetine appears to increase the risk of congenital cardiac anomalies

Clinicians should consider tapering the dose of all antidepressants during the 3rd trimester to reduce
the risk of withdrawal symptoms in the neonate. However, the benefits of tapering must be carefully
balanced against the risk of symptom recurrence and postpartum depression. Postpartum depression is
common, often unrecognized, and should be treated promptly. Periodic visits with a psychiatrist and/or
social workers may be helpful.

SOCIAL AND ILLICIT DRUGS DURING PREGNANCY

Cigarette smoking is the most common addiction among pregnant women. Also, percentages of
women who smoke and of those who smoke heavily appear to be increasing. Only 20% of smokers quit
during pregnancy. Carbon monoxide and nicotine in cigarettes cause hypoxia and vasoconstriction,
increasing risk of the following:

 Spontaneous abortion (fetal loss or delivery < 20 wk)

 Fetal growth restriction
 Abruption placentae
 Placenta destruction

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  Premature rupture of the membranes
 Preterm birth
 Chorioamnionitis
 Stillbirth

Neonates whose mothers smoke are also more likely to have anencephaly, congenital heart defects,
orofacial clefts, sudden infant death syndrome, deficiencies in physical growth and intelligence, and
behavioral problems. Smoking cessation or limitation reduces risks.

Alcohol is the most commonly used teratogen. Drinking alcohol during pregnancy increases risk of
spontaneous abortion. Risk is probably related to amount of alcohol consumed, but no amount is known to
be risk-free. Regular drinking decreases birth weight by about 1 to 1.3 kg. Binge drinking in particular,
possibly as little as 45 mL of pure alcohol (equivalent to about 3 drinks) a day, can cause fetal alcohol
syndrome. This syndrome occurs in 2.2/1000 live births; it includes fetal growth restriction, facial and
cardiovascular defects, and neurologic dysfunction. It is a leading cause of intellectual disability and can
cause neonatal death due to failure to thrive.

Cocaine use has indirect fetal risks (eg, maternal stroke or death during pregnancy). Its use probably
also results in fetal vasoconstriction and hypoxia. Repeated use increases risk of the following:

 Spontaneous abortion
 Fetal growth restriction
 Abruptio placentae
 Preterm birth
 Stillbirth
 Congenital malformations (eg, CNS, GU, and skeletal malformations; isolated atresias)

Although marijuana’s main metabolite can cross the placenta, recreational use of marijuana use does not
consistently appear to increase risk of congenital malformations, fetal growth restriction, or postnatal
neurobehavioral abnormalities.

Hallucinogens may, depending on the drug, increase risk of the following:

 Spontaneous miscarriage

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  Premature delivery
 Withdrawal syndrome in the fetus or neonate

Hallucinogens include methylenedioxymethamphetamine (MDMA, or Ecstasy), rohypnol, ketamine,

methamphetamine, and LSD (lysergic acid diethylamide).

Whether consuming caffeine in large amounts can increase perinatal risk is unclear. Consuming
caffeine in small amounts (e.g., 1 cup of coffee/day) appears to pose little or no risk to the fetus, but some
data, which did not account for tobacco or alcohol use, suggest that consuming large amounts (>7 cups of
coffee/day) increases risk of stillbirths, preterm deliveries, low birth weight, and spontaneous abortions.
Decaffeinated beverages theoretically pose little risk to the fetus.

Use of aspartame (a dietary sugar substitute) during pregnancy is often questioned. The most
common metabolite of aspartame, phenylalanine, is concentrated in the fetus by active placental transport;
toxic levels may cause intellectual disability. However, when ingestion is within the usual range, fetal
phenylalanine levels are far below toxic levels. Thus, moderate ingestion of aspartame (eg, no more than 1
liter of diet soda per day) during pregnancy appears to pose little risk of fetal toxicity. However, in pregnant
women with phenylketonuria, intake of phenylalanine and thus aspartame is prohibited.

RISK FACTORS FOR DRUG ADDICTION AND ALCOHOLISM

People who have alcoholism or drug addiction are not "weak" or "immoral." They have a real
disease that's caused by a combination of factors, including genetics, environmental influences, and
behavior. As with heart disease and other medical conditions, by understanding the risk factors for
alcoholism and drug abuse, you can take steps to reduce your chances of developing one of these life-
threatening disorders.

ALCOHOLISM AND DRUG ADDICTION: RISK FACTORS

There is no single factor that determines whether a person will develop alcoholism or a drug addiction. A
person's overall risk for addiction is determined by their biological makeup, including genetics, and their
exposure to drugs and alcohol.

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Risk factors include:

 Genetics. Research shows that the risk for developing alcoholism or drug addiction can be inherited.
This means that if you have a family member with an addiction, you have a greater likelihood of
becoming an addict yourself.
 Age. Adolescents are at greater risk of drug abuse and addiction than the general population, due to
their inclination toward risky behavior as well as to their biological inheritance. Also, the younger a
person is when they start using drugs or alcohol, the more likely they are to develop a problem.
 The people you associate with. Your friends can be a huge influence on how much you drink, or if
you use drugs. This is especially true for young people. If you are frequently surrounded by drugs
and alcohol, you are more likely to use them, thus increasing your risk of becoming substance-
dependent.
 Stress. Many people turn to alcohol and drugs as a way of unwinding. However, if you are not
careful, your body may require more frequent use of these substances to help you relax, especially if
you have a genetic predisposition to addiction.
 Mental disorders. People with depression or anxiety disorders in particular are more likely to abuse
alcohol and drugs.
 The type of drug used. Drugs that are smoked or injected into a vein are more likely to cause
addiction because they produce a quick, powerful effect — they reach the brain sooner than drugs
that are taken by mouth. This rapid "high" also fades faster, causing the person to need more and
more of the substance to regain the pleasurable feelings.

ROUTES OF ADMINISTRATION OF DRUGS

A route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison
or other substance is taken into the body. Routes of administration of drugs are generally classified by the
location at which the substance is applied. Also, they can be classified based on where the target of action is.

There are various routes by which drugs can be administered. Some drugs are approved for use
through more one route and are manufactured in different drug forms appropriate for those different routes.
Each routes of administered has distinct advantages and disadvantages. A drug is given by the
recommended route of administered will be therapeutic; if given by another route, it may be ineffective,
harmful, or even fatal. The following are the routes of administration:

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1. TOPICAL: This is the administration of drugs directly to the skin or eyes or ears. The therapeutic
effect of the drug only extends to the local area. For example, antibiotic ointment for a skin injury,
Timoptic eyes drops for glaucoma or antibiotic drops for an ear infection.
2. TRANSDERMAL: This differs from the tropical route in that the drug is applied to the skin, but the
therapeutic effect is felt systematically, not just at the site of administration. Drugs delivered by the
transdermal patch are worn on the skin and releases the drug slowly over one or more days,
providing a sustained therapeutic blood level. For example, Nicodern CQ patches to stop smoking.
3. ORAL: This is the most convenient route of administration and the one most commonly used. The
oral route involves placing the drug in the mouth and swallowing it. Tablets, capsules and liquid are
given orally. The drug is then absorbed from the stomach or small intestine into the blood. The oral
rout is routinely abbreviated as P.O. or p.o. meaning “per os” in Latin and through the mouth
medically. Oral routes have the following disadvantages:
(a) It cannot be used for patients who are unconscious or vomiting.
(b) Some drugs (e.g. penicillin) are inactivated by stomach acid and cannot be given orally.
(c) Some drugs (e.g. tetracycline) cannot be taken with certain foods and beverages because they
combine chemically to form an insoluble complex.
4. SUBLINGUAL AND BUCCAL: Sublingual administration involves placing the drug (usually in a
tablet form) in the pocket between the cheek and lower teeth on one side of the mouth and allowing
it slowly disintegrate. The tablet is not swallowed but the dissolve drug is absorbed quickly through
tongue and oral mucosa.
5. NASAL: This involves spraying drug into the nasal cavity. This is usually done topically to treat
allergy symptoms of nasal cavity. This is usually done topically to treat allergy symptoms of nasal
stuffiness. For example, Nasonex, a topical corticosteroid drug for inflammation.
6. INHALATION: This involves the inhaling of a drug that is in a gas, liquid, or powder form. The
drug is absorbed through the alveoli of the lungs. For example, an anesthetic gas.
7. NASOGASTRIC: This is accomplished with a nasogastric tube that is passed from the nose through
the esophagus and into the stomach. Any liquid drug that can be given by the oral route can be given
by this route.
8. GASTROSTOMY AND JEJUNOSTOMY: These routes use a surgically implanted feeding tube
to deliver drugs directly into the stomach (gastronomy) or jejunum (jejunostomy). Any liquid drug
that can be given orally can be given by these routes

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9. VAGINAL: This is used to treat vaginal infections by means of cream, ointments and suppositories.
For example, Monistat vaginal cream or suppositories for a yeast infection. Contraceptive foam are
inserted vaginally as well.
10. RECTAL: This routes is reserved for certain situations such as when the patient is vomiting are
unconscious, or the drug cannot be given by injection, for example, Tylemol suppositories for a
fever. Systematic absorption of a drug through the rectal route of administration is slow and often
unpredictable, so, this route is not used often. However, the rectal route is the preferred route when
drugs are administered topically to relieve constipation, for example, fleet enema or to treat
hemorrhoids, for example, Anusol cream or suppositories, or ulcerative colitis for example
proctoform HC aerosol foam.
11. PARENTERAL: This theoretically includes all routes of administration other than the oral route;
but in clinical usage, parenteral administration commonly includes these routes: intradermal,
subcutaneous, intramuscular and intravenous.
(a) Intradermal: This involves the use of a syringe to inject a liquid drug into the dermis, the layer of
skin just below the epidermis or skin surface. The needle is inserted at a 10-15 0 angles so that it does
not penetrate too deeply. The epidermis itselfis less than 1/20 inch thick; therefore, when an
intradermal injection is correctly positioned, the tip of the needle is still visible through the
epidermis. Intradermal administration is used for allergy scratch tests and for the manteaux text that
screen for tuberculosis.
(b) Subcutaneous: This involves using a syringe to inject a liquid drug into the subcutaneous tissue (the
fatty layer of tissue just beneath the dermis of the skin but above the muscle layer). The needle is
inserted at a 450 angle to reach the fatty subcutaneous tissue, but not penetrate into the muscle layer.
There are only a few blood vessels in this fatty layer, so drugs are absorbed more slowly than by the
intramuscular route. Examples of drug given through the subcutaneous route include insulin for
diabetes mellitus, allergy shots and heparin.
(c) Intramuscular: This involved the injection of a liquid drug into the belly (area of greatest mass) of
a muscle. The muscles of the body are well supplies with blood vessels, and drugs injected
intramuscularly are absorbed more quickly than wit subcutaneous administration. The needle is
inserted at 900angle to reach the muscle layer; intramuscular injection can also be classified as a
hypodermic injection. Examples of injection given intramuscularly include meperidine (Demerol)
for severe pain and penicillin for bacterial infection. Some liquid drugs, such as Valium (an anti-

27
 anxiety drug), can never be given by intramuscular injection because they are not water soluble and,
if injected would form precipitate particles in the muscle tissue.
(d) Intravenous: This involved the injection of a liquid drug in to a vain. A bag of intravenous fluid is
hung from an I.V. pump can be used to precisely regulate the amount of I.V. fluid given. The
therapeutic effect of a drug given intravenously is often seen immediately. Examples of drug given
intravenously include thiopental (Pentothal) for induction of general anesthesia, diazepam (valium)
to control continuous epileptic seizures, and most chemotherapy drugs. Intravenous administration
can be done in one of the following three ways:
(i) Bolus: The whole amount of a drug can be injected in a short period of time through a port
(rubber stopper) in the I.V. tubing by gently pushing on the plunger of the syringe. This is often
referred to as I.V. push.
(ii) I.V. Infusion: The drug can be injected into the fluid of a large I.V. bag and administered
continuously over several hours. This is known as I.V. drip.
(iii) I.V. Piggyback: The drug can be injected into a small I.V. bag of fluid that is then attached onto
an existing primary I.V. line. For some drug, the small I.B. bag already comes premixed.
12. OTHER ROUTES OF ADMINISTRATION: The following routes of administration are used less
frequently and only in special situations. They include:
(a) Central venous line: This route is used to continuously fluid or drugs to critically ill patients or to
administer chemotherapy drug to patients with cancer, inserted into a large vein, and advanced until
its tip is positioned in the superior vena cava.
(b) Endotracheal tube: This is used to administer drug through an endotracheal tube inserted through
the mouth the mouth in to the trachea. This route is especially useful if there is no established
intravenous access. The drug dose is absorbed through the lung tissue and into the blood. It is also
used to administer synthetic lung surfactant drug to treat respiratory distress syndrome in premature
infants.
(c) Implantable port: This is a special intravenous access device that is used to administer a
chemotherapy drug to treat cancer. The port is a thin metal or plastic reservoir that is placed in a
subcutaneous pocket of tissue. The reservoir is attached to a catheter that is threaded into the
patient’s superior vena cave.
(d) Intra-articular route: This route is used to administer a drug into a joint. For example,
corticosteroid drugs to decrease pain and inflammation.

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 (e) Intra-arterial route: This route is used to administer chemotherapy drug directly into the area of a
cancerous tumor.
(f) Intra-cardiac route: This route is only used during emergency resuscitation associated with cardiac
arrest.
(g) Intra-theca route: This is used to administer drug within the meninges around the spinal cord and
into the cerebrospinal fluid.
(h) Intra-peritoneal route: This is used to administer drug or fluid into the peritoneal cavity.
(i) Intra-vesico route: This is used to administer chemotherapy drug into bladder to treat bladder
cancer.
(j) Umbilical artery or vein: This route is accessible only in newborn infants before the umbilical cord
has dries. It is used to administer intravenous fluids and draw blood. It is generally not used to give
drugs.

DRUG CYCLE

Following drug administration, most drugs go through well-defined sequences of four steps before
being excreted from the body. These steps are known as the drug cycle. The steps are:

 Absorption from the site of administration.

 Distribution via the circulatory system.
 Metabolism.
 Excretion from the body.
Pharmacokinetic is the study of how drugs move through the body in the processes of absorption,
distribution, metabolism and excretion.
ABSORPTION: This involved the movement of a drug from the site of administration through
tissues and into the blood. For most drug forms absorption involves three steps which are:
(a) Disintegrate: Tablets, capsules, suppositories, etc. are drug forms that must first disintegrate before
they can be absorbed. This steps is omitted for drugs that are already in a liquid form or those that
are effervescent tablet that disintegrate outside the body in a glass of water before being swallowed.
(b) Dissolve: Once the drug is in liquid form, it dissolves in the surrounding body fluids (saliva, gastric,
juice, or tissue fluid).
(c) Absorb: From the body fluids, the drug passes through the walls of nearby capillaries and is
absorbed into the blood.

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DISTRIBUTION: Once a drug has been absorbed into the blood, it is distributed throughout the body via
the circulatory system. As a drug enter the blood, some of the drugs binds to circulating plasma proteins
such as albumin.

Drug molecules that are bound to plasma protein are essentially pharmacologically inactive as they
are carried through the blood. The other portion of the drug that did not bind to plasma proteins moves
through the circulatory system, passing through the walls of capillaries and into body tissues. As this portion
of the drug leaves the blood some of the bound drug is released by the plasma proteins so as to maintain
equilibrium of unbound drug in the blood. When a drug moves into body tissues, it comes in contact with a
cell membrane and exerts an effect by interacting with one or more receptor.

METABOLISM: This is the process is also known as biotransformation because the drug is gradually
transformed metabolized from its original active form to a less active or even inactive form. This process is
accomplished in the liver, the principal organ of metabolism by the action of liver enzymes. The initial
metabolism by the liver before it can enter the general circulation to exert a systemic effect.

Some drugs are actually administered in an inactive form and remain inactive until they are metabolized by
the liver. So, it is metabolite form of the drug that is active and actually exert to therapeutic effect. This type
of drug is classified as a pro-drug. A pro-drug is a form of the drug that comes before the active drug is
produced.

EXCRETION: This is necessary in getting rid of the body waste products (inactive drug metabolites) and
removing active drug that are not metabolized by the liver. The principal organ of drug excretion is the
kidney, although other organs are involved to a limited degree. The lungs excrete certain inhaled drugs each
time the patient exhales.

Also, trace amount of drugs are excreted in saliva, tears, sweat and breast milk. Poor renal function can
significantly prolong the effects of some drugs. Patients with renal disease and elderly patients with
decrease levels of kidney function due to aging are prescribe lower doses of drug to prevent toxic symptom
due to decreased rates of drug excretion.

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 DRUG CATEGORIES

Drug can be classified into different categories based on their chemical ingredient and their effect on
uses. They are:

STIMULANTS: These drugs speed up the body’s nervous system and create a feeling of energy. They are
also called “uppers” because of their ability to make you feel very awake. When the effects of a stimulant
wear off, the user is typically left with feeling of sickness and a loss of energy. The types of these drugs
include cocaine methamphetamines, cylert, amphetamines, Ritalin, etc.

INHALANTS: These are sniffed or huffed and give the users immediate results. Unfortunately, these
immediate results can also result in sudden mental damage deprived of oxygen, causing a rapid heartbeat.
Other effect include liver, lung and kidney problems affected sense of smell, difficulty walking and
confusion. These include glues, paint, thinner, gasoline, laughing gas, aerosol sprays.

CANNABINOID: These drugs result in feeling of euphoria, cause confusion and memory problems,
anxiety, a higher heart rate as well as staggering and poor reaction time. These include hashish, marijuana.

DEPRESSANTS: These drugs slow down activity in the central nervous system of your body. These drugs
are also called “downers” because they slow the body down and seem to give feeling of relaxation. They are
available as prescription drug to relieve stress and anger, although, drowsiness is often a side effect. The
relaxation felt from these drugs is not a healthy feeling for the body to experience. These are barbiturates,
benzodiazepines, flunitrazepam, gamma-hydroxybutyrate (GHB), methaqualone, alcohol, tranquillizers.

OPIOIDS AN MORPHINE DERIVATIVES: These drugs can cause drowsiness, confusion, nausea,
feeling of euphoria, respiratory complications and relieve pain. The types of these drugs are codeine,
fentanyl and fentanyl analogs, heroin, morphine, opium, oxycodone hydrochloride, hydrocodone bitertrate,
and acetaminophen.

ANABOLIC STEROIDS: Steroids are taken to improve physical performances as well as to enlarge
muscles and increase strength; Negativeeffects of steroid include baldness, cysts, oily hair and skin, acute
heart attack, stroke and change in voice. Hostility is also a frequently side effect of anabolic steroids they
are anadrol, oxandrin, durabolin, stanozol, dianabol.

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HALLUCINOGENS: These drugs change the mind and cause the appearance of things that are not really
there. Hallucinogens affect the body self-control, such as speed and movement, often bring about hostility.
Other negative effects of these drugs includes heart failure, increased heart rate, higher blood pressure and
changes in the body hormones. These includes lysergic acid diethylamide (LSD), mescaline, Psilocybin,
cannabis, magic mushrooms.

PRESCRIPTION DRUGS: These drugs can be very helpful when used properly and when under the
guidance of qualified physician. These drugs can be used as aids in surgery, to treat medical conditions and
while controlling various symptoms. However, misuse and abuse can be very dangerous. Types of these
drugs include opioids (codeine, oxycodone, and morphine), central nervous system depressants
(barbiturates, benzodiazepines), stimulants (dextroamphetamine, methylphenidates).

DRUG ACTION, EFFECT AND RESPONSE

Drug action refers to the biochemical or physiological mechanism by which a drug achieves or
produces a response in a living organism. It is the way or manner by which a drug achieves its purpose or
effect. Each drug is designed to work in different way. Atemicillin Combination Therapy (ACT) is designed
or produced to kill plasmodium by disturbing the free radicals.

A drug effect on the other hand is the observable consequences of the drug action. There are
different ways by which a particular drug works. There are different types of drug effects which include:

 Local effect: This is the effect of drug that is seen or observed within the vicinity of the application
of drug
 Systemic effect: This is the effect that is seen or observed at a location that is away from the point of
application
 Primary effect: This can be referred to as the effect of which a particular drug is used or
administered
 Secondary effect: This can also be referred to any other effects that can be attributed to a particular
drug of which is not the reason for which the drug is applied or administered. When the secondary
effect is not deleterious it is called side effect but when it is, it is called adverse effect
 Toxic effect: This is the effect that is due to over dosage of the drug or accumulation of the drug
after long period of taken the drug
 After effect: The effect that is seen or observed after a drug has been withdrawn.

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