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Use and Abuse of Drugs


Over-the-counter drug. Any drug the may be legally ... Prescription drug. A drug that can only be sold in accordance with the orders of a physician (or ... – PowerPoint PPT presentation

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Title: Use and Abuse of Drugs

Use and Abuse of Drugs
Basic terminology of drugs and medicine Safe Use
of Medicine Factors Affecting Effects of Medicine
and Drugs Categories of Drugs Drugs of
Abuse Warning Signs of Dependence Drugs and the
Law Treatment
Some Definitions
  • Drug
  • Any non-food substance that, when taken into the
    body, has a physiological effect.
  • A substance need not be taken internally to be a
    drug. A skin ointment is still classified as a
    drug if it has a physiological effect.
  • Cosmetics, however, are not classified as drugs.
  • This definition includes alcohol, tobacco, some
    herbs, and some ingredients in foods (such as
  • Legally, herbs may not be classified as drugs,
    although this may be changed soon.
  • Over-the-counter drug
  • Any drug the may be legally purchased by anyone,
    without a prescription.

Some Definitions
  • Prescription
  • An order or recommendation from a physician (or
    other licensed professional) for a drug or other
    treatment or procedure. Usually a prescription is
    a written order.
  • Dentists and veteranarians write prescriptions
    within the limits of their professional practice.
  • In some states, pharmacists and some nurses can
    prescribe a limited set of medicines.
  • Prescription drug
  • A drug that can only be sold in accordance with
    the orders of a physician (or other licensed

Some Definitions
  • Controlled Substance
  • A drug or other substance for which sale or
    possession is restricted by law in some way.
  • Most drugs of abuse (not all) are controlled
    substances. Many poisons, explosives, and even
    materials that are ingredients for other
    dangerous materials may be controlled substances.
  • Many consumer products that can be abused,
    however, are not controlled substances. Gasoline,
    for example, is sometimes used as an inhalant
    drug but is not a controlled substance.
  • Street drug
  • Any drug, including legitimate medicine, that is
    obtained through imprper channels. The term
    derives from the idea of buying the substance on
    the street rather than in a legitimate drug

Some Definitions
  • Dependence
  • A condition of physiological or psychological
    need for a substance (or behavior), but not
    necessarily involving withdrawal effects if the
    substance becomes unavailable.
  • An insulin dependent diabetic is, by definition,
    dependent on insulin. However, the effects of not
    getting insulin are merely those of the absence
    of insulin, nothing more. Therefore, the person
    is dependent on but not addicted to insulin.
  • Addiction
  • A condition of dependence on a drug (or behavior)
    in which withdrawal symptoms occur if the
    substance (or behavior) becomes unavailable.
  • Addiction has nothing to do with any psychoactive
    effects of a drug, except to the extent that
    those effects are related to the withdrawal
  • In their Congressional testimony that tobacco
    was not addictive several executives of the
    major tobacco companies either committed perjury
    or were relying on a very different definition of
    addiction. They seemed to be re-defining
    addiction as having to do with alteration of
    thinking or other psychological effects.

Some Definitions
  • Tolerance
  • The amount of a substance required to produce a
    needed or desired effect. Tolerance tends to
    increase with use so more and more drug is needed
    to produce an effect.
  • Tolerance is found with drugs of abuse and with
    many medicines that must be used over a long
  • In the case of alcohol, a high initial tolerance
    is an indication of HIGHER risk of eventual
  • Half Life
  • The time needed for one half of the drug in a
    persons system to be removed.
  • Note that a half life of one day does NOT mean
    that all of the drug is removed in two days. It
    means that half is removed in one day, half of
    what remains will be gone after two days, and
    half of what remains after two days will be gone
    after three days, and so on. Thus, traces of a
    drug can often be detected in the blood or urine
    weeks or even months after the last use.
  • Therapeutic Dose
  • Lethal Dose
  • Synergy
  • Antagonism
  • Placebo Effect

Some Definitions
  • Therapeutic Dose
  • The amount of a drug needed to produce a specific
    therapeutic effect. The prescribed dose may vary
    according to the specific therapeutic effect
    desired, even for the same individual.
  • The therapeutic dose increases as tolerance
  • Lethal Dose
  • The amount of a drug that will cause death.
    Obviously, this is not an absolute quantity. It
    may vary from individual to individual or with
    other variables.
  • Therapeutic Index
  • The ratio of therapeutic dose to lethal dose.
  • Always a number between 0 and 1.
  • A low therapeutic index means a drug is
    relatively safe, aside from factors affecting
    specific individuals.
  • A high therapeutic index means a drug is very
    dangerous. There is not a great difference
    between the therapeutic dose and the lethal dose.
  • The development of tolerance means the
    therapeutic dose increases. However, it does not
    necessarily mean any change in the lethal dose.
    Therefore, tolerance means a person must take a
    dose that comes closer and closer to a lethal
    dose in order to get the desired effect.

Some Definitions
  • Synergy
  • When the effects of two substances taken in
    combination are greater than the sum of effects
    when they are taken separately.
  • The synergistic effects of barbiturates and
    alcohol can be lethal.
  • 11 3 (this equation is NOT, by itself, an
    adequate explanation for exam purposes)
  • Antagonism
  • When two substances tend to cancel the effects of
    each other or when one substance reduces the
    effects of the other.
  • For example, the effects of certain antibiotics
    may be reduced if taken with milk.
  • Placebo
  • A pill that is made to look like the real thing
    but which contains no pharmacologically active
  • Or
  • Any form of treatment (medical or otherwise) that
    is constructed to resemble a real treatment, but
    which, in fact, is not real and should have no
  • Placebo Effect
  • An effect from a pill or treatment the subject
    believes to be real, but which, in fact, is not

Suggested Rules for Safer Use of Medicines
  • Read the label
  • Read it twice and then think about what it says.
  • The label means the complete information sheet
    included inside the package, not just the label
    on the bottle.
  • Be especially sure you understand the dosage
    instructions and all contraindications.
  • Contraindications Any factor that indicates
    (point toward) an increased risk if the substance
    is used. Doctors often miss these or do not know
    about important factors in a patients life.
  • Discard leftovers
  • Medicines unnecessarily left in a medicine
    cabinet present a risk to children who may get
    into the cabinet.
  • Most medicines decay with time and may lose
    potency or become hazardous.

Suggested Rules for Safer Use of Medicines
  • Never Re-Package
  • Re-Packaging may expose the drug to moisture.
  • Re-Packaging risks misplacing the correct label.
  • The packaging a medicine comes in is designed to
    protect the medicine from decay.
  • Follow Physicians and Pharmacists Advice
  • These people have more knowledge and
    understanding of drug effects and interactions.
  • However, pay attention yourself and ALWAYS ASK if
    you think a mistake may be being made.
  • Never Share With Others
  • To do so is about the same as practicing medicine
    without a license,

Suggested Rules for Safer Use of Medicines
  • Store in a Cool, Dry Place
  • This will maximize the shelf life of the
  • A medicine cabinet in a bathroom is neither cool
    nor dry in most cases.
  • Report All Side-effects or Unexpected Effects
  • Your doctor should know if any effects warrant a
    change of prescription.
  • There are often alternative medicines that will
    have different effects.
  • Do Not Use Past Expiration Date
  • Obvious
  • Keep Away from Children
  • Children WILL get into everything, including you
    medicine, liquor, (and gun) cabinets.

Suggested Rules for Safer Use of Medicines
  • Do Not Describe a Pill to a Child as Candy
  • Obvious
  • Instruct Children to Never Take Medicine from
    Anyone Not Approved by the Parents
  • Obvious

Factors Affecting a Drugs Effects
  • Pharmacological Properties
  • What the drug does physiologically.
  • e.g. kills bacteria, blocks pain, etc.
  • Some properties can lead to abuse, others do not.
  • e.g. effects on brain often lead to abuse
  • Side effects
  • All pharmacological effects other than the one
    needed for medical purposes.
  • What is a side-effect in one patient may be an
    intended effect in another,

Factors Affecting a Drugs Effects
  • Dose-Response Curve
  • Could be or

Factors Affecting a Drugs Effects
  • Time Action Curve
  • Time between administration of the drug and its
    peak effect
  • Often it is the rate of change of level of a drug
    and not the total amount in the system that
    produces an effect, especially psychoactive
  • Effects of multiple dosages may be cumulative
  • Method of administration is very important here.

Factors Affecting a Drugs Effects
  • User Factors
  • Physical size
  • Amount of body fat
  • Physical conditioning
  • Other drugs being used
  • Pregnancy
  • Setting of Use
  • Expectation Effects

Categorization of Drugs
  • Categorization by Pharmacological Effects
  • e.g. antibiotic, pain blocker, anti-anxiety, etc.
  • Categorization Legally
  • Over the counter
  • Prescription
  • Narcotic
  • Controlled Substance

Categories of Drug That Are Abused
  • Opiates
  • Examples
  • Opium Morphine Heroin
  • Methadone Codeine Dilaudid
  • Percodan Demerol Darvon
  • Block pain, including psychological pain, induce
  • All derived from the Oriental Poppy or made
    synthetically to resemble chemicals derived from
    the poppy.

  • Cocaine Crack
  • Derived from Coca plant
  • Coca Cola really did once contain a coca based
    stimulant, but it was removed after 1906.
  • Amphetamines
  • Withdrawal effects can be very prolonged and
    dangerous, involving psychotic reactions and
    lasting up to a month.
  • Stimulant effects very dangerous to
    cardiovascular system.
  • Caffeine and Analogs of Caffeine
  • Found in coffee, cocoa, chocolate, and added to
    many soft drinks.
  • Completely legal, but addiction does occur.
  • Effects can be dangerous for persons with heart
  • Stimulents increases metabolic rate, and may
    cause feelings of euphoria when taken in
    strength, or feeling of alertness in smaller
    doses. Addiction, sudden death from cardiac
    arrest are risks. Withdrawal produces depression.

Anti-anxiety Drugs
  • Valium Xanax Librium Quualude
  • Useful for reducing anxiety but can be addictive.
  • Withdrawal causes a state of agitation which can
    be very unpleasant.
  • Most addictions are accidental.

  • Produces hallucinations of various kinds -
    seeing, hearing, feeling things that are not
  • PCP mescaline marijuana (THC) Hashhish
  • LSD MDMA Some Designer drugs
  • Some of these may be helpful in certain medical
    situation because of other effects.
  • THC - may be helpful in suppression of nausea and
    treatment of glaucoma.
  • May lead to brain damage when use is sustained
    over a long period.
  • It was once thought these drugs might help us
    understand mental illnesses involving alterations
    of perception, but this has not lead anywhere.

  • LSD
  • Very similar to hallucinogen, but involving an
    alteration of perception rather than actual
    hallucinations. (LSD produces both).
  • When Alice changes in size she is experiencing
    an alteration of perception.

  • Any drug of abuse that is taken by inhalation.
  • Cocaine is often taken by inhalation but is
    usually classified as a stimulant rather than as
    an inhalant.
  • Many involve substances that can readily be
    purchased by anyone.
  • Glue Spray Paint Amyl nitrate
  • Gasoline Butane Butyl nitrate
  • Solvent based correction fluid Nitrous oxide
  • Most of these chemicals are powerful solvents and
    will produce profound brain damage that is not
  • Many also expose the user to a risk of terrible
  • Gasoline and butane especially

  • Barbiturates (downers)
  • Essentially the opposite effects of stimulants.
  • Especially deadly in combination
  • barbiturates plus alcohol

Anabolic Steroids
  • Produce muscle growth, especially in combination
    with exercise
  • Also produce
  • increased risk of heart disease
  • liver damage
  • acne
  • aggressive, violent behavior
  • testicular atrophy in males
  • Breast development in males
  • sterility in males
  • Deepened voice in females
  • Beard development in females
  • Breast reduction in females
  • May be very helpful in certain medical
    circumstances (e.g.after chemotherapy)

Designer Drugs
  • Synthetic drugs made to mimic those of natural
  • May be much more potent.
  • May have different side-effects, however.
  • Many side-effects may be quite unexpected.
  • MDMA (Case of the Frozen Addict)
  • Ecstasy

Warning Signs of Drug Dependence
  • Many of the following may be signs of other
    problems as well.
  • Unexplained emotional withdrawal or distancing
  • Rebelliousness or irritability
  • Loss of interest in things
  • Decline in performance
  • Sudden change in social groups
  • Change in eating or sleeping habits
  • Borrowing or stealing

Drugs and the Law
  • For most of history
  • Drugs were legal
  • Drugs were poorly understood
  • Drugs were much less potent
  • Prior to 1906
  • In the US there were no laws governing drugs,
    either for medicine or abuse.
  • Heroin, invented in 1874 by a London chemist, was
    actually marketed as Bayer Heroin in 1898.
  • Addiction was noticed soon after
  • Bellevue Hospital had 149 heroin-related
    admissions in 1914.
  • Coca Cola contained a small amount of Coca
  • When they said Coke has the taste you never get
    tired of. they werent kidding! truthfully,
    however, that advertising slogan was not used
    back then

  • Pure Food and Drug Act - 1906
  • Prohibited importation of dangerous drugs
  • Required ingredients to be listed on label
  • 1909
  • Another law prohibited importation of opium, for
    smoking or non-medical purposes.
  • Actually the impetus behind this law was more
    anti-Chinese racism than real concern about
  • Harrison Narcotics Act - 1914
  • First Federal anti-narcotics act.
  • Prohibited sale of drugs through non-medical
  • Also regulated sales through medical channels
  • This and subsequent laws were not originally
    meant to regulate medical use but they were
    interpreted as such by law enforcement officials.
    Many doctors were intimidated into not
    prescribing such drugs.

The Prohibition Experiment
  • January 16, 1920 - 18th Amendment to Constitution
    became law.
  • It became difficult or illegal to obtain drugs
    and alcohol.
  • This led to the creation of an underground
    mechanism to supply these substances.
  • This was, in effect, the beginning of organized
    crime in America.
  • The ban on alcohol was almost universally
    ignored. Alcohol was even served regularly in the
    White House.
  • From 1930 until at least 1962, the majority
    opinion was that drug use (including alcohol) was
    immoral and could be stopped by harsh criminal
    penalties. Many people still believe that drugs
    and alcohol and immoral, but fewer and fewer
    believe that harsh penalties can be an effective
    deterrent. We are still building jails, however.
  • 1933 - The 20th Amendment repealed the 18th
  • Immediately thereafter there was a surge in hard
    alcohol abuse.
  • Today, however, alcohol is still widely abused
    but abuse patterns have shifted away from hard
    liquor and toward beer and wine.

  • Tobacco has always been legal and is declining in
    use. Alcohol abuse increased when it was illegal
    and eventually declined when it became legal.
    Drugs are illegal and are a continuing national
  • Discuss Does this suggest that legalization, in
    some form, might work to help reduce the problem
    of drugs?
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