drug abuse and misuse 3rd

8/8/2019 Drug Abuse and Misuse 3rd

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Control of Drug Abuse andMisuse

Amjad HussainLecturer (Pharmacy Practice)

University College of PharmacyUniversity of the Punjab, Lahore.



TerminologyTerminology

Drug useDrug use consumption of psychoactive substances without medical or healthconsumption of psychoactive substances without medical or healthcare instructioncare instruction

Drug misuseDrug misuse drug use that is problematical and incur a significant risk of drug use that is problematical and incur a significant risk of harmharm

Drug abuseDrug abuse essentially same but less common nowessentially same but less common now

Drug user Drug user someone who participate in drug/substance usesomeone who participate in drug/substance use

Injectable drug usersInjectable drug users

Drug misuser Drug misuser someone who undertake drug use in such a way that issomeone who undertake drug use in such a way that isproblematical and incur a significant risk of harmproblematical and incur a significant risk of harm

Substance useSubstance use term used in place of drug to include non medicinalterm used in place of drug to include non medicinal

substances such as alcohol, nicotine.substances such as alcohol, nicotine.

Addiction; Addiction; According to WHO(1964), According to WHO(1964),

³Addiction is a state of periodic or chronic intoxication detrimental to³Addiction is a state of periodic or chronic intoxication detrimental toindividual and society which is characterized by an over whelming desireindividual and society which is characterized by an over whelming desireto continue taking the drug and obtaining it by any means´.to continue taking the drug and obtaining it by any means´.



Drug dependenceDrug dependence

Dependence refers to the compulsion toDependence refers to the compulsion tocontinue psychoactive substances andcontinue psychoactive substances anduser also feels ill when drug is suddenlyuser also feels ill when drug is suddenly

withdrawn.withdrawn. The mechanism of dependence consist of The mechanism of dependence consist of

1.1. Psychic dependence (compulsivePsychic dependence (compulsive

behavior, personal satisfaction)behavior, personal satisfaction)2.2. Physical dependence (altered physicalPhysical dependence (altered physical

state, withdrawal symptoms)state, withdrawal symptoms)



ToleranceTolerance

After chronic use, After chronic use,

the same amountthe same amount

of drug isof drug isinsufficient toinsufficient to

cause the desiredcause the desired

effect and thus,effect and thus,

more drug is used.more drug is used.

A compensatory A compensatory

response.response.

Drug Dose

Normal

Tolerance



Drugs/ Substances of abuse

Volatile substances (glue sniffing, light fuel, nailpolish remover etc)

Cannabis; (contain more than 50 cannabinoids,THC etc) most commonly used illicit drug.

Opioids; naturally occurring opiates & syntheticanalogues (heroin).

Routinely Prescribed drugs;(Barbiturates, Benzodiazepines, amphetamineetc)

Banned drugs(, cocaine)

Substances present in commonly used beverages(caffeine, nicotine, alcohol etc)



Etiology of Drug UseEtiology of Drug Use

There is no single cause of drug taking, but there areThere is no single cause of drug taking, but there aresome factors that can contributesome factors that can contribute

1.1. Family influence (family disruption)Family influence (family disruption)

2.2.Genetic influence (little only some in alcoholism)Genetic influence (little only some in alcoholism)3.3. Personality factors (anxiety, depression, emotionalPersonality factors (anxiety, depression, emotionalinstability, defensiveness, loss of control)instability, defensiveness, loss of control)

4.4. SocioSocio--cultural factors ( )cultural factors ( )

5.5. Availability (occur at high proportions in communities Availability (occur at high proportions in communities

with easy availability of drugs)with easy availability of drugs)6.6. Deviancy (peer group of pressures, community is doingDeviancy (peer group of pressures, community is doing

the same)the same)



Conti.Conti.

PsychoPsycho--social effectssocial effectsii) Pharmacological (elation, euphoria, anxiety, depression, loss of ) Pharmacological (elation, euphoria, anxiety, depression, loss of libido, memory loss, etc)libido, memory loss, etc)ii) Nonii) Non--pharmacological (taking drug & maintenance of supplypharmacological (taking drug & maintenance of supplybecome first priority, marital discard, family friction and workbecome first priority, marital discard, family friction and work

performance decline, aggressive behavior toward themselves)performance decline, aggressive behavior toward themselves) Miscellaneous factors;Miscellaneous factors;1.1. Broken/ unhappy family.Broken/ unhappy family.2.2. Not practicing religion.Not practicing religion.3.3. Use of psychoactive drugs, Alcohol or cigarettes by Parents.Use of psychoactive drugs, Alcohol or cigarettes by Parents.4.4. Drug use among friends.Drug use among friends.5.5. Involvement in political/protest movementsInvolvement in political/protest movements6.6. Lack of ambitions for future.Lack of ambitions for future.7.7. No extraNo extra--curricular activities.curricular activities.8.8. Regular cigarette use.Regular cigarette use.



Harms Relating to Drug Use &

Dependence

Drug misuse follows epidemic rather thanendemic patterns.

Majors harms of drug use are

1. Social Problems2. 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 formingrelationships, exclusion from societyand homelessness.

Violence an aggression from alcoholand intoxication of CNS drugs aredetrimental to beauty of society.



Drug related crimes

There is well known link between drug useand crime.

Drug user is not only committing against

Control of Narcotic Substances Act butalso other crimes that impacts oncommunities and society.

Burglary to obtain money to get drugs,

robbery, violence, rape, drunk driving. Also these persons are at greater risk thannon-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 aremultifactorial.

But the use of sedative/hypnotics,stimulants, antidepressants,antihistamines etc put the drivers ongreater risk of accidents.

Studies have furnished evidence thatcannabis and heroin impair drivingperformance.



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 bestrong influence.

Restriction of supplies of problem drugs and thought prescribing canalso help.

Secondary prevention is aimed at people who use drug by discouragingfurther 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 overdoseprevention.

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 includingpractical advice and assistance e.g. about

provision of accommodation and usingpsychological tools such as motivationalinterviewing.

Pharmacist should be aware of need for

holistic approach to care using not onlypharmacological approach but non drugtreatment too.



Detoxification & Rehabilitation Detoxification refers to provision of treatment

to drug user to stop using it.

Rehabilitation involves detoxification followedby a period of social support and intensivepsychotherapy to facilitate sustained change.

Rehabilitation is provided within therapeuticcommunity where a drug user live for several

months. Here not only drug treatment is provided but

care is also given to his physical andpsychological health.



Harm reduction Include a range of interventions used to reduce

adverse consequences of drug use for those who stillwants to enjoy it.

Though it is viewed as official endorsement that it is allright 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, discouragingsharing 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 toapproach specialist agencies.

NSE involves supplying clean sterile injecting

equipment to injecting drug users in exchange forused equipment which is returned in sharp containerfor incineration.

Advise (not to share needle & proper disposal) andchecking for injecting site & referral to medicalservice if abscess is identified.



Legislation of Drug Misuse Control of narcotic substance act 1997.



Practical ManagementPractical Management(Use of Pharmacotherapy in Drug Dependence)(Use of Pharmacotherapy in Drug Dependence)

Pharmacotherapy alone can not stopPharmacotherapy alone can not stopsomeone using drugs but it can facilitatesomeone using drugs but it can facilitatechange in motivated people by providingchange in motivated people by providingbreathing space e.g. substitute therapy canbreathing space e.g. substitute therapy canprevent withdrawal symptoms.prevent withdrawal symptoms.

Pharmacotherapy removes the need toPharmacotherapy removes the need tocommit crime to obtain money for drugs,commit crime to obtain money for drugs,

thus has benefits for both individual andthus has benefits for both individual andsociety.society. The effects of substitute therapy are not The effects of substitute therapy are not

essentially the similar.essentially the similar.



Initial careInitial care

Include social care, hospital care,Include social care, hospital care,private care, general practice care,private care, general practice care,

and referral to other facilities.and referral to other facilities.

Before starting pharmacotherapy aBefore starting pharmacotherapy adetailed history, examination,detailed history, examination,

screening for HIV and hepatitis andscreening for HIV and hepatitis andassessment is done by the consultant.assessment is done by the consultant.



Opioid detoxificationOpioid detoxification

Without methadone (young, recent Without methadone (young, recent heroin smoke) Symptomatic treatment heroin smoke) Symptomatic treatment

Methadone treatment Methadone treatment



Long term careLong term care

Drug users may have several attempts to go backDrug users may have several attempts to go backbefore breaking out of the cycle.before breaking out of the cycle.

Short term goals (harm reduction, better health,Short term goals (harm reduction, better health,realization of need for change, improvement of self realization of need for change, improvement of self esteem).esteem).

Long term goals (a drug free life).Long term goals (a drug free life).

Care is provided through hospitals, communityCare is provided through hospitals, community

centers and rehabilitation centers.centers and rehabilitation centers. Therapy possibilities include family therapy,Therapy possibilities include family therapy,

cognitive therapy, behavior 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 withwhom drug users have regular contact. He can encourage the peopleto access drug services.



References Pharmaceutical practice by Winfield

and Richard 3rd edition.

Management of drug users in thecommunity by Roy Robertson.

Drug misuse a practical handbook for

GPs by Banks and Waller.

drug abuse and misuse 3rd

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