Misuse of Medicines and Drugs PDF

MISUSE OF MEDICINES AND DRUGS NURUL AIN MOHD TAHIR, PHD, RPH FACULTY OF PHARMACY, UKM  LEARNING OBJECTIVES To be able to identify the most commonly abused drugs To understand about treatment options for drug abuse and dependence To understand the roles of pharmacy in th...

MISUSE OF MEDICINES AND DRUGS NURUL AIN MOHD TAHIR, PHD, RPH FACULTY OF PHARMACY, UKM  LEARNING OBJECTIVES To be able to identify the most commonly abused drugs To understand about treatment options for drug abuse and dependence To understand the roles of pharmacy in the management of drug abuse and dependence  DEFINITIONS Drug Misuse: The unintentional or inappropriate use of prescribed or over-the-counter drugs. Drug Abuse: The intentional and inappropriate use of a drug resulting in physical, emotional, financial, social, or intellectual consequences. Addiction: A chronic, and for many people, reoccurring disease characterized by compulsive drug seeking and use in spite of negative consequences that result from the prolonged effects of drugs in the brain. REASONS FOR DRUG ABUSE  REASONS FOR DRUG ABUSE 1. Experimentation Curiosity is a common reason to try drugs, especially among young people. Drugs also seen at time as tools for self- discovery. 2. Pleasure/Escape from boredom Drugs that are used to increase pleasure or to reduce boredom are reinforcing →The accompanying euphoria provides positive reinforcement. The drug user achieves some type of physical or social reward.  REASONS FOR DRUG ABUSE (CONT.) 3. Peer influence Many young people use drugs to gain peer acceptance or approval from their groups. Drugs are sometimes used to facilitate social interactions. Starting in early adolescence, influence of peers plays a relatively greater role than family as a socializing agent – however, positive family relationships may still deter drug abuse.  REASONS FOR DRUG ABUSE (CONT.) 4. Personality traits associated with drug abuse Low self-esteem Poor interpersonal skills Need for immediate gratification Rebelliousness Little tolerance for anxiety, frustration and depression Impulsivity Risk taking Low regard for personal health  REASONS FOR DRUG ABUSE (CONT.) 5. Desire to enhance performance in sports Examples of drugs abused among athletes: ❖ Anabolic steroids ❖ Human growth hormones ❖ Erythropoietin (EPO) ❖ Androstenedione ❖ Stimulants  DRUG DEPENDENCY Dependency is the need to take a drug for its pleasurable effects, the appearance of behavioral changes when drug use ceases, and the need to sustain a drug’s initial effects by increasing either the dosage or the frequency. Physical dependency is marked by withdrawal symptoms – the physical symptoms that appear after drug use ceases. People who are physically dependent on the drug need to take the drug to ward off withdrawal symptoms. Psychological dependency refers to one’s perceived need for a drug.  TOLERANCE Tolerance is defined as repeated exposure to the same dose of a psychoactive drug, resulting in a diminished effect, so that higher dosages than usual are required to achieve a similar response. Commonly occurs with depressant abuse (e.g. alcohol, opioids, benzodiazepines, barbiturates) stimulant abuse (e.g. cocaine, amphetamines)  TYPES OF DRUGS/ SUBSTANCES ABUSED  A class of drugs that are naturally derived from opium or produce effects like opium CNS depressants→ respiratory depressants, etc These are drugs which relieve pain and produce profound sleep or “narcosis” Medically, they are used as potent pain killers, cough depressants and as active components of anti-diarrheal preparation  Examples: Opium; Morphine; Heroine; Codeine; Synthethic opiates (pethidine, methadone, oxycodone, fentanyl). Administration Orally as pills, or chewed Inhaled by smoking Injected by a hypodermic needle Snorted  WITHDRAWAL SYMPTOMS Runny Constant Muscle Diarrhea Insomnia nose yawning aches & pain Nausea & Dysphoria Tearing Fever Perspiration vomiting  B. SEDATIVE-HYPNOTICS CNS depressants Types of sedative-hypnotic drugs include Barbiturates ✓Short-acting barbiturates – e.g. pentobarbital, secobarbital Benzodiazepines ✓A type of minor tranquilizer, used primarily to treat anxiety disorders ✓E.g. Valium, Xanax Others: Antihistamines; sedatives; anxiolytic, hypnotic; amnesiac  C. STIMULANTS These drugs increase activity levels and alter mood→ performance enhancers Major stimulants: Amphetamines E.g. methamphetamines (speed, crystal-meth/ice) Cocaine Snorting is the most common mode of intake  Minor stimulants OTC Sympathomimetics: E.g. cold, allergy and diet medications Caffeine-Like Drugs  D. HALLUCINOGENS Refers to drugs that have the potential to produce hallucinations; chemical that alter thoughts, feelings and perceptions. Examples: Serotonergic Hallucinogens: Lysergic acid diethylamine (LSD) and related compounds (i.e. mescaline, psilocybin) Phencyclidine (PCP) Methylene-dioxymethamphetamine (MDMA; Ecstasy)  SEROTONERGIC HALLUCINOGENS Drug Botanical Source Area Found Other Names LSD Synthethic, but derived from the Ergot native to Acid, many ergot fungus Europe others Ibogaine Iboga plant: Tabernanthe iboga Africa - Psilocybin Mushroom of genus Psilocybe, Throughout the Teonanacati Conocybe, Panaeolus, and world Stropharia Dimethyltryp- Virola tree: Virola calophylla and South America Ayahuasca, tamine (DMT) other species Yakee, Yopo Mescaline Peyote cactus: Lophophora Mexico and Peyote williamsi Southwest U.S. Lysergic acid Morning glory seeds: Rivea Throughout the Ololiuqui amine corymbosa, Ipomoea violacea world E. MARIJUANA/ CANNABIS Derived from the plant Cannabis sativa Primary psychoactive agent is delta-9- tetrahydrocannabinoid (THC) Works quickly and intensely when it is smoked Has been used to treat asthma, glaucoma, and multiple sclerosis; also to alleviate nausea and vomiting  F. ALCOHOL Alcohol produces a sedative effect in the CNS Affects every organ in the body – the brain, liver, GI tract, CV system, immune system. Frequently interacts with prescription medication – When alcohol is taken in combination with another sedating medicine, the CNS depressive effect is synergistic.  Alcoholism is a state of physical and physiological addiction to ethanol, a psychoactive substance. Major components of alcoholism: Craving Very impaired or loss of control Physical dependence Tolerance  G. INHALANTS Inhalants are volatile substances that elicit psychological or physiological changes when introduced into the body via lungs Types of inhalants: Volatile substances Aerosols: E.g. spray paints, deodorant, hair spray Toluene: a chemical found in some glues, paints, thinners, nail polishes Butane and propane: E.g. hair and paint sprays Gasoline Freon: used in a number of products including refrigerators, air- conditioners and airbrushes. Anesthetics: e.g. ether, chloroform, halothane and nitrous oxide SUBSTANCE ABUSE TREATMENT  PHARMACOLOGIC TREATMENT Treatment for opioid addiction Methadone Buprenorphine (Subutex/ Suboxone) Naltrexone Treatment for alcoholism Disulfiram Naltrexone Acamprosate  PSYCHOSOCIAL AND OTHER TREATMENTS Counseling and self-help groups Examples: Alcoholics Anonymous, Narcotics Anonymous Rehabilitation programs Short term residential treatment Long-term residential treatment  PSYCHOSOCIAL AND OTHER TREATMENTS Medical detoxification A medically supervised program to withdraw from drugs on which they are physically dependent. Support safe and effective discontinuation of drugs (for e.g. opiates) while minimizing withdrawals Usually lasts about 28 days as an inpatient or up to 12 weeks as an outpatient. Methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification.  PSYCHOSOCIAL AND OTHER TREATMENTS Symptomatic treatment of withdrawal: Can reduce some of the physical effects of withdrawal May be useful in situations where it is not possible to prescribe effective opioid substitution For example: Diarrhoea – loperamide Nausea and vomiting – metoclopramide/prochlorperazine Agitation and anxiety – diazepam Muscular pains and headaches – paracetamol, NSAIDs  ROLE OF PHARMACISTS As health care professionals, pharmacists are well placed to take a major role in the disease management of drug/ substance use disorders Responsibilities of pharmacists include I. Involvement in treatment of substance abuse II. Drug prevention III. Drug education  I. INVOLVEMENT IN TREATMENT OF SUBSTANCE ABUSE 1. Identifying patients who may be having problems with substance abuse. 2. Creating a list of substance abuse referral and treatment resources, and referring individuals with substance use disorders for proper evaluation and treatment. 3. Providing recommendations for the appropriate pharmacotherapeutic choices in individuals recovering from addiction disorders.  I. INVOLVEMENT IN TREATMENT OF SUBSTANCE ABUSE 4. Collaborating with other HCPs in the development of treatment options for drug detoxification protocols. 5. Involving patients and family members as partners in the development of their care or treatment plan. 6. Involvement in methadone maintenance and treatment programs – pharmacists prepare and dispense daily doses of methadone, perform documentation of the quantities dispensed, and supervised patients. 7. Involvement in needle and syringe exchange services.  II. DRUG PREVENTION 1. Participating in substance abuse education and prevention programs. 2. Working with local, state and federal authorities in controlling substance abuse (e.g. complying with controlled substance reporting regulations). 3. Discouraging prescribing practices that foster drug abuse behavior.  III. DRUG EDUCATION 1. Providing information and referral to support groups appropriate to the needs of people affected by substance abuse 2. Providing counselling to patients about the appropriate use of psychoactive substances including those recovering from substance dependency 3. Fostering the development of undergraduate pharmacy curriculum and continuing education programs on the topic of substance abuse 4. Providing substance abuse education to fellow pharmacists, other healthcare professionals and drug abuse counselors