DRUGS OF

DEPENDENC
Y
BY PENINA CHEGE
• Drugs of dependency, also known as addictive substances, have the
potential to lead to physical and psychological dependence. They
often affect the central nervous system and can result in tolerance,
withdrawal symptoms, and compulsive drug-seeking behavior
• They include;
Opioids
CNS Stimulants
CNS depressants
Drugs that alter perception
Benzodiazepines and barbiturates
Inhalants
 1. OPIOIDS
• Examples: Morphine, Oxycodone, Heroin, Pethidine, methadone,
fentanyl, codeine, dihydrocodeine, tramadol.
• Mechanism of Action: Bind to opioid receptors in the brain and spinal
cord, producing analgesia and a sense of euphoria.
• Clinical Uses: Pain management, often prescribed for severe pain, post op
pain.
• Drug interactions: They augment function of antidepressants e.g(MAOIs)
• Opioid receptor Antagonists: Naloxone, Naltrexone.
• NB: Methadone and buprenorphine have very similar actions to
morphine, but are less sedating and longer acting. They can be used by
mouth to replace opioids when these drugs are being withdrawn in the
treatment of drug dependence
 Management of opioid dependence
• Refer to specialized addiction clinic (Rehab).
• Conduct assessment (to include two urine samples positive for opioids).
• Give maintenance treatment (e.g. full agonists such as methadone, or partial
agonists such as buprenorphine).
• Give antagonist treatment (e.g. naloxone).
• Provide detoxification regimens (e.g. lofexidine – to relieve withdrawal symptoms
• Give counselling/social support.
• Repeat urine testing to confirm use of methadone and not other drugs.
• Avoid prescriptions of other opioids/sedatives.
• Special ‘drug-free’ centers – concentrate on psychological and social support
through the acute and chronic abstinence phases, and are successful in some
patients.
 2. CNS STIMULANTS
• Examples: Cocaine, Amphetamines (e.g., Adderall, Methamphetamine),
Nicotine, Xanthines.
• Mechanism of Action: Increase dopamine levels in the brain, leading to
increased alertness and euphoria.
• Amphetamines and cocaine are abused for their stimulant properties
which are related to their action in blocking synaptic re-uptake of
dopamine, and to a lesser extent noradrenaline and serotonin
• Clinical Uses: Attention-deficit/hyperactivity disorder (ADHD), narcolepsy
(prescription amphetamines)
• Management: Currently, there are no specific drug treatments for cocaine
and amphetamine dependence. Counselling and social management of
patients have been shown to be of only modest benefit in maintaining
abstinence.
• Nicotine first stimulates the nicotinic receptors of autonomic ganglia and
then blocks them. Thus smoking can accelerate the heart via sympathetic
stimulation, or slow it by sympathetic block or parasympathetic
stimulation.
• Substitution of nicotine via skin patches or nicotine gum as part of a
smoking cessation programe significantly increases success rates
• Xanthines e.g Caffeine(Present in tea, coffee and colas) also act as
stimulants when taken in large amounts.
• In large doses, caffeine exerts an excitatory effect on the CNS that is
manifested by tremor, anxiety, irritability and restlessness, and
interference with sleep.
• Caffeine dependence Tolerance is low grade and dependence is not
clinically important.
3. CNS DEPRESSANTS
• Examples: Alcohol
• Mechanism of Action: Enhances the effect of GABA, leading to
sedation and relaxation.
• Ethyl alcohol is absorbed from the buccal, oesophageal, gastric and
intestinal mucosae
• Effects: CNS (Alcohol decreases concentration, judgement,
discrimination, and reasoning and increases self-confidence),
Gastritis, peptic ulceration, haematemesis, vasodilation,
convulsions(enhancement of sedative drugs, hypoglycemia.
• Medical Uses: As an antiseptic.
 Alcohol withdrawal
• Several features of acute withdrawal are due to autonomic overactivity,
including hypertension, sweating, tachycardia, tremor, anxiety, agitation,
mydriasis, anorexia and insomnia. Some patients also have seizures.
• Delirium tremens (acute disorientation, severe autonomic hyperactivity, and
hallucinations – which are usually visual) often follows after withdrawal
seizures and is a medical emergency.
• Management includes:
–Nursing in a quiet, evenly illuminated room
–Sedation (either clomethiazole or diazepam)
–Vitamin replacement with adequate thiamine(Pabrinex 1 and 2)
–Correction of fluid and electrolyte balance
–Psychiatric referral.
4. Drugs that alter perception
• Examples: Cannabis(marijuana), lysergic acid diethylamide (LSD),
phenylethylamines (e.g. mescaline, phencyclidine – angel dust – and
methylenedioxymethylamphetamine – MDMA or ‘ecstasy
The chemical compound in cannabis is Tetrahydrocannabinol (THC).
• Mechanism of Action: Binds to cannabinoid receptors, altering mood,
perception, and cognition.
• Psychedelics produce hallucinations (e.g. visual, somatic, olfactory)
and other changes in perception, e.g. feelings of dissociation and
altered perception of time
• Clinical Uses: Medical marijuana for certain conditions; recreational
use.
Withdrawal and management
• The most common features of cannabis withdrawal are anxiety,
irritability, anger or aggression, disturbed sleep/dreaming, depressed
mood and loss of appetite
• While classical hallucinogens like LSD are not associated with
addiction or withdrawal, dissociative hallucinogens like ketamine and
PCP are
• Symptoms of withdrawal include depression, loss of pleasure,
irritability, and anxiety
• Management of withdrawal includes detoxification e.g in Rehab,
psychotherapy, CBT and other non pharmacologic therapies.
5. Benzodiazepines and Barbiturates
• Examples: Diazepam, Alprazolam, Lorazepam, Phenobarbital,
Secobarbital.
• Mechanism of Action: Enhance the effect of the neurotransmitter
GABA, leading to sedation and relaxation.
• Clinical Uses: Anxiety disorders, insomnia, seizure disorders, sedation.
• Management of benzodiazepine withdrawal includes measures to
prevent the development of dependence, careful attention to
underlying medical conditions, medication consolidation and gradual
dosage reduction, accompanying psychological interventions
6. Inhalants
• Examples: Nitrous oxide, Glue, Aerosol sprays.
• Mechanism of Action: Produce a rapid, intense high by depressing
the central nervous system.
• Clinical Uses: None (used recreationally, often abused by inhalation).
• Symptoms of Inhalant withdrawal are typically mild(hand tremors,
irritability, excessive sweating, rapid heartbeat, headache, nausea,
vomiting), but the process can still be difficult. Addicted users are
advised to consult a doctor before quitting Inhalants or to complete the
withdrawal process at a drug treatment center.