Control of Drug Abuse and

Misuse

Amjad Hussain
Lecturer (Pharmacy Practice)
University College of Pharmacy
University of the Punjab, Lahore.
 Terminology
 Drug use consumption of psychoactive substances without medical or health
care instruction
 Drug misuse drug use that is problematical and incur a significant risk of
harm
 Drug abuse essentially same but less common now
 Drug user someone who participate in drug/substance use
 Injectable drug users
 Drug misuser someone who undertake drug use in such a way that is
problematical and incur a significant risk of harm
 Substance use term used in place of drug to include non medicinal
substances such as alcohol, nicotine.
 Addiction; According to WHO(1964),
“Addiction is a state of periodic or chronic intoxication detrimental to
individual and society which is characterized by an over whelming desire
to continue taking the drug and obtaining it by any means”.
 Drug dependence
 Dependence refers to the compulsion to
continue psychoactive substances and
user also feels ill when drug is suddenly
withdrawn.
 The mechanism of dependence consist of
1. Psychic dependence (compulsive
behavior, personal satisfaction)
2. Physical dependence (altered physical
state, withdrawal symptoms)
 Tolerance

 After chronic use,

the same amount of
Normal
drug is insufficient to
cause the desired
EFFECT

Tolerance effect and thus,

more drug is used.
 A compensatory

Drug Dose
response.
Drugs/ Substances of abuse
 Volatile substances (glue sniffing, light fuel, nail
polish remover etc)
 Cannabis; (contain more than 50 cannabinoids,
THC etc) most commonly used illicit drug.
 Opioids; naturally occurring opiates & synthetic
analogues (heroin).
 Routinely Prescribed drugs;
(Barbiturates, Benzodiazepines, amphetamine
etc)
 Banned drugs
(, cocaine)
 Substances present in commonly used beverages
(caffeine, nicotine, alcohol etc)
 Etiology of Drug Use
 There is no single cause of drug taking, but there are
some factors that can contribute
1. Family influence (family disruption)
2. Genetic influence (little only some in alcoholism)
3. Personality factors (anxiety, depression, emotional
instability, defensiveness, loss of control)
4. Socio-cultural factors ( )
5. Availability (occur at high proportions in communities
with easy availability of drugs)
6. Deviancy (peer group of pressures, community is doing
the same)
 Conti….
 Psycho-social effects
i) Pharmacological (elation, euphoria, anxiety, depression, loss of
libido, memory loss, etc)
ii) Non-pharmacological (taking drug & maintenance of supply
become first priority, marital discard, family friction and work
performance decline, aggressive behavior toward themselves)
 Miscellaneous factors;
1. Broken/ unhappy family.
2. Not practicing religion.
3. Use of psychoactive drugs, Alcohol or cigarettes by Parents.
4. Drug use among friends.
5. Involvement in political/protest movements
6. Lack of ambitions for future.
7. No extra-curricular activities.
8. Regular cigarette use.
 Harms Relating to Drug Use &
Dependence
Drug misuse follows epidemic rather than
endemic patterns.
Majors harms of drug use are
1. Social Problems
2. Drug related crimes
3. Drugs and unemployment/ Employment.
4. Drugs and accidents
5. Medical conditions related to drug use.
6. Legal requirements violations.
 Social Problems
Include poverty (social deprivation,
failure in education, unemployment,
spending on drugs), damage to family
relations, difficulties forming
relationships, exclusion from society
and homelessness.
Violence an aggression from alcohol
and intoxication of CNS drugs are
detrimental to beauty of society.
 Drug related crimes
There is well known link between drug use
and crime.
Drug user is not only committing against
Control of Narcotic Substances Act but
also other crimes that impacts on
communities and society.
Burglary to obtain money to get drugs,
robbery, violence, rape, drunk driving.
Also these persons are at greater risk than
non-drug users of being victim of crime.
 Drugs and unemployment/
Employment
Drug user are more likely be the
young unemployed people living in
areas of high social deprivation.
Doctors and nurse are more likely to
be at risk of drug dependence,
similarly publicans, actors etc are
prone to develop alcoholism.
 Drugs and accidents
The cause of traffic accidents are
multifactorial.
But the use of sedative/hypnotics,
stimulants, antidepressants,
antihistamines etc put the drivers on
greater risk of accidents.
Studies have furnished evidence that
cannabis and heroin impair driving
performance.
Strategies for Control of Drug
Use & Dependence
 Prevention
 Drug education
 Social support
 Detoxification
 Rehabilitation
 Harm reduction
 Prevention
 Primary prevention is concerned with preventing people from starting
to use drug.
 Target group include vulnerable groups such as school children, young
people who left education.
 It include warning of the harm, using health promotion and education
campaigns (exercise, diet, no smoking etc).
 GPs can play role by displaying material in waiting rooms and
spreading information by other means.
 Central to any educational campaign must be the establishment of
attitude that make drug use unfashionable, cultural attitude can be
strong influence.
 Restriction of supplies of problem drugs and thought prescribing can
also help.
 Secondary prevention is aimed at people who use drug by discouraging
further use.
 Education
 Drug education is a tool used in primary and
secondary prevention campaigns.
 It includes leaflets, booklets, videos and posters.
 DE may also benefit drug users to inform them about
long term risk associated and overdose prevention.
 DE is also a key part in harm reduction as to assist
them in minimizing risks from drug taking e.g. safe
injecting etc
 DE may be provided through teachers, young health
promotion workers, medical & nursing staff.
 Pharmacist may be asked to provide talks and should
can advice after proper consultation.
 Social support

 Include non-medical intervention including

practical advice and assistance e.g. about
provision of accommodation and using
psychological tools such as motivational
interviewing.
 Pharmacist should be aware of need for
holistic approach to care using not only
pharmacological approach but non drug
treatment too.
Detoxification & Rehabilitation
 Detoxification refers to provision of treatment
to drug user to stop using it.
 Rehabilitation involves detoxification followed
by a period of social support and intensive
psychotherapy to facilitate sustained change.
 Rehabilitation is provided within therapeutic
community where a drug user live for several
months.
 Here not only drug treatment is provided but
care is also given to his physical and
psychological health.
 Harm reduction
 Include a range of interventions used to reduce
adverse consequences of drug use for those who still
wants to enjoy it.
 Though it is viewed as official endorsement that it is all
right to carry on drug use, but
 With the advent of AIDS epidemics it becomes
generally accepted as a useful therapeutic approach.
 Include safer injection techniques, NSE scheme,
cleaning of injection equipment, safe sex, discouraging
sharing of needle, methadone maintenance.
 Pharmacist are frequently involved in harm reduction
service.
Needle Exchange Service
 Is a harm reduction strategy
 NSE is was started in many countries as health
education campaign to avoid from the risk of blood
born diseases.
 Community Pharmacist may contribute in NSE program
especially for those who are reluctant to approach
specialist agencies.
 NSE involves supplying clean sterile injecting equipment
to injecting drug users in exchange for used equipment
which is returned in sharp container for incineration.
 Advise (not to share needle & proper disposal) and
checking for injecting site & referral to medical service
if abscess is identified.
 Legislation of Drug Misuse
 Control of narcotic substance act 1997.
Practical Management
(Use of Pharmacotherapy in Drug Dependence)

 Pharmacotherapy alone can not stop

someone using drugs but it can facilitate
change in motivated people by providing
breathing space e.g. substitute therapy can
prevent withdrawal symptoms.
 Pharmacotherapy removes the need to
commit crime to obtain money for drugs,
thus has benefits for both individual and
society.
 The effects of substitute therapy are not
essentially the similar.
 Initial care

 Include social care, hospital care,

private care, general practice care,
and referral to other facilities.
 Before starting pharmacotherapy a
detailed history, examination,
screening for HIV and hepatitis and
assessment is done by the consultant.
 Opioid detoxification

 Without methadone (young, recent

heroin smoke) Symptomatic treatment
 Methadone treatment
 Long term care
 Drug users may have several attempts to go back
before breaking out of the cycle.
 Short term goals (harm reduction, better health,
realization of need for change, improvement of self
esteem).
 Long term goals (a drug free life).
 Care is provided through hospitals, community
centers and rehabilitation centers.
 Therapy possibilities include family therapy,
cognitive therapy, behavior therapy.
Role of Community Pharmacist
in Drug Dependence
 Community pharmacists are ideally placed to
contribute to the care of drug users because of
several factors including
 Extended opening hours (weekends and evenings)
 Accessibility (within communities, no appointment required )
 Expert advise (trained healthcare professional are available)
 Discretion (confidential service no personal data is requested)
 Network of service (network of good practice developed by joint
training of GPs and Pharmacists)
 Job satisfaction Pharmacist is the only health professional with
whom drug users have regular contact. He can encourage the people
to access drug services.
 References
 “Pharmaceutical practice” by Winfield
and Richard 3rd edition.
 “Management of drug users in the
community” by Roy Robertson.
 “Drug misuse a practical handbook for
GPs” by Banks and Waller.