DRUG ABUSE

Definition of drug abuse

•Drug abuse is the nonmedical use of drugs or
other chemicals for the purpose of changing
mood or inducing euphoria

•Drug abuse that results in the physical,

mental, emotional, and social impairment of
the user.
Classification of abused drug
•barbiturate-alcohol:
•The opioid drugs:
•Cocaine:
•Cannabis:
•Amphetamines:
•Hallucinogen: lysergic acid diethylamide
•Volatile organic solvents:
•Tobacco:
Tolerance and dependence of drug
•Tolerance: Body adaptation to drugs & larger
doses are required to produce the original effects

•Cross Tolerance:
Development of tolerance to one drug confers
tolerance to another drug, e.g. barbiturates,
alcohol & other sedatives/hypnotics
•Dependence:
It is an adaptive state and has the following
properties:

1. Need to continue to take a drug –

pleasure & prevent withdrawal

2. Appearance of symptoms when abruptly

suspended

3.Need to increase the dose to sustain the initial

effects
• Physical dependence:
The body has adjusted to the presence of a
drug to avoid withdrawal symptoms

The withdrawal symptoms is a abnormal and

unwell physiological state if the dependent
drug is stopped abruptly, it may be manifested
yawn, flowing tears, fatigue, diarrhea, fear,
shivering, nausea, vomiting, and others.
Withdrawal syndrome
Psychological Dependence:Strong desire to
experience the effects of the drug repeatedly

• Craving for a drug is the most common

withdrawal symptom leading to continued
self-administration & compulsive drug
taking

Psychological & physical dependences are

not mutually exclusive
Methods of taking drugs
• Oral ingestion
• Injection: intravenous(IV),
intramuscular(IM), or subcutaneous(SC)
• Inhaling smoke
• Nasal sniffing
Heroin and other opioid
drugs
Introduction
•Heroin is derived from morphine. Pure heroin is
a white powder with a bitter taste.
• Usage:
Injected
Smoked
Inhaled
Snorted
• The opioids include opium and opium
derivatives.
•The natural substance extracted from the opium
poppy plant: morphine, codein, thebaine,
paparerine, narcotine, narceine and many other
alkaloids.
•Synthesized opioids: heroin(diacetyl morphine),
dihydrocodeine, pethidine, methadone,
etorphine, and many more.
• Effects:

The opiates work by interacting with specific

receptor sites in the brain and peripheral nervous
system to inhibit the release of dopamine,
norepinephrine, and other neurotransmitters.
These opioid receptors are present in highest
concentration in the limbic system(frontal and
temporal cortex, amygdala, and hippocampus),
thalamus, hypothalamus, and spinal cord.
 Opioid receptors

•µ-opioid receptor
•δ-opioid receptor
•κ-opioid receptor
•In acute poisoning, the signs and
symptoms are headache, dizziness,
contracted pupils, coma, slow respiration,
and others.
• The chronic addiction may show
emaciation, dirty, and signs of infection,
such as pulmonary tuberculosis,
myocarditis, hepatitis B, HIV, AIDS.
the presence of injection marks.
A normal aortic valve is shown at the top to compare
with an aortic valve at the bottom being destroyed by
vegetations with infective endocarditis.
Mycobacterium
tuberculosis infection of
the lung has resulted in
upper lung field
granulomatous and
cavitary disease.
Macronodular cirrhosis of the liver here has followed viral
hepatitis infection, gross. Generally, this is most often
occurs with hepatitis B, but can occur with hepatitis C.
• In cases of suspected poisoning,
morphine should be looked for in
the urine, blood, bile, brain, and
contents of the alimentary tract.
Barbiturates
• The barbiturates are a group of barbituric acid
derivatives used in medicine as sedatives and
hypnotics
classification
• long-acting barbiturates< onset of action 2 hours
and duration of action is 6 to 12 hours>: barbitone,
phenobarbitone, phenytoin.
• Intermediate-acting barbiturates<onset of action
half to one hour and duration of action is 3 to 6
hours>: amytal, pentobarbitone, butobarbitone.
• Short-acting barbiturates<duration of action is less
than 3 hours>: secobarbital, thiopentone,
• Ultra short acting
• onset of action is immediate and duration
of action is about 5 to 10 minutes
• Eg . Pentothal sodium, hexobaebital
sodium.
 Absortion, distribution and
elimination
• They are rapidly absorbed from the
gastrointestinal tract including the rectum
and from the subcutaneous tissues.
• They are concentrated in the liver for a
short time and then evenly distributed in the
body fluids.
• They r partly destroyed in the liver and
excreted in urine.
 Signs and symptoms
• Acute poisoning may result from a single
large dose or repeated small dose.
• Usually the first symptom is drowsiness.
• A short period of
confusion,excitement,delirium and
hallucinations is common.
• Ataxia,vertigo,slurred speech, headache,
paraesthesias, visual disturbance may occur.
• A stupor progressing to deep coma with loss of superficial
and deep reflexes and gradual loss of painful stimuli occur.
• The Babinski sign may become positive.
• Respiration may be rapid and shallow or slow and
laboured.
• There is fall in cardiac output and an increase in cappilary
permiability leading to an increase in extracellular fluid.
• Progressive cardiovascular collapse evidenced by
cyanosis, hypotension,weak rapid pulse and cold clammy
skin occurs.
• The pupils are usually slightly contracted but react
to light.
• Decrease peristalsis may occur in deeply comatose
patient
• The urine may be scanty or suppressed and may
contain sugar and albumin.
• Incontinence of urine and faces may occur.
• Blister on the skin, often on an area of erythema
strongly suggest barbiturate poisoning.it occurs
due to direct toxic action on the epidermis.
• Death may occur from respiratory failure
and ventricular fibrillation in early stages
and bronchopneumonia or irreversible
anoxia with pulmonary edema in the later
stages.
• The combination of alcohol and barbiturates
causes rapid death.
• Fatal dose.
short acting: 1 to 2 gm
medium acting: 2 to 3 gm
long acting: 3 to 5 gm
The lethal blood levels are :
long acting :10 mg/ 100ml
medium acting: 7mg/ 100ml
short acting : 3 mg/ 100 ml
The amphetamines
• Amphetamines are synthetic amines that are
similar to the body’s own neurotransmitter,
norepinephrine, and the hormone for emergencies,
epinephrine(adrenalin).
• The amphetamines generally cause an arousal or
activating response, which means that they
stimulate the central nervous system(CNS).
• Symptoms commonly are teeth-grinding, confused
and disorganized patterns of thought and behavior,
compulsive repetition of meaningless acts,
irritability, self-consciousness, suspiciousness, and
fear.