Drug Abuse

General:

  • Substance use: is the use of drug that induces physiological, psychological and\or behavioral changes.

  • Substance abuse: when the usage cause maladaptive changes to patient’s life or causes a risk for patient well-being.

Examples:

  • Alcohol:

    • Most common abused drug is alcohol.

    • Alcohol is depressant.

    • First thing to do for a patient presented to ER with Alcohol intoxication, give thiamine B1

      • To prevent the onset or progression of Wernicke Korsakoff syndrome.

    • Scheduled Cholrdiazepoxide (benzodiazepine) in alcohol intoxication to prevent delirium.

 

  • Amphetamines & their derivatives:

    • Methyl amphetamine (crystal meth) high potential for abuse.

    • Amphetamine sulphate (fast acting).

    • Ectasy (white burger, white dove, dance drug) MDMA has a brief duration of effect.

    • Effect:

      • Short-term: Euphoriant, myardiasis, decreased appetite followed by fatigue and depression.

      • Long-term: Manic-like presentation and/or paranoid psychosis.

    • Withdrawal symptoms: anxiety, depression, tremor, increase appetite

      • Treat with SSRIs.

    • Death is caused by malignant hyperpyrexia and dehydration.

  • Cocaine:

    • Water-soluble hydrochloride salt (snorting) -> White powder.

    • Insoluble (crack) → smoked rapid and fast effect.

    • Effect:

      • Irritability, restlessness, paranoid ideation, and convulsions.

      • Persistent sniffing can cause nasal septal perforation.

    • Death is caused through MI, stokes, hyperthermia, and arrhythmias (even in people with normal coronary arteries).

  • Cannabis:

    • Other names (grass, pot, skunk, spliff, marijuana).

    • Effect:

      • Onset is within 10-30 min when smoked.

      • Exaggerate the pre-existing mood (depression, euphoria, or anxiety)

      • followed by increased appetite.

      • Red eye, increase the appetite, disturb the perception of time and place.

      • Amotivations syndrome (apathy and memory dysfunctions) with daily

      • usage.

      • Long-term use increases the risk of developing schizophrenia.

 

  • Opiates & Narcotics:

    • Cross-tolerance:

      • Using any of the other drugs in this class reduces withdrawal effects of one. ​

      • Effect:

        • Calming, slight euphoria, decrease physical discomfort, and flattening of emotional response.

      • Withdrawal effects usually subside after 7 days of abstinence.

      • Patients who cannot obtain opiate abstinence they may be on oral methadone for maintenance and withdrawal symptoms.

      • Patients have high mortality rate due to accidental overdose or blood-born

      • infections through sharing needles.

      • Overdose should be promptly managed with administering an opioid antagonist (Naloxone).

Amphetamines/ Cocaine withdrawal symptoms: depression, hyperphagaia,

and hypersomolence.

Consider cocaine toxicity in young patients with ischemic chest pain.

​​

  • Benzodiazepine:

    • Effect:

      • Behavioral disinhibiting, somnolence, sever sedation, respiratory depression.

    • Treat overdose with Flumazenil.

    • Intubate in case of respiratory depression.

    • Withdrawal symptoms:

      • Anxiety, insomnia, hyperactivity, seizure, and decreased appetite.

      • Treat with long-acting benzodiazepine: Clonazepam.

 

  • Drug-induced Psychosis:

    • Reported with amphetamines, cocaine, and hallucinogens (cannabis).

    • ICD-10 criteria for diagnosis of drug-induced psychosis requires:

      • These symptoms occur within 2 weeks and often within 2 days (48 hours) of the drug use

      • And symptoms should persist for more than 2 days but not more than 6 months.

    • Character:

      • Hallucinations (auditory or sensory)

      • Delusions

      • Psychomotor disturbances

      • Misidentification

Refrences:

  1. Kumar, Parveen J, and Michael L Clark. Kumar & Clark's Clinical Medicine. Print.

  2. Who.int,. 'WHO | Community Management Of Opioid Overdose'. N.p., 2015. Web. 18 Sept. 2015.

  3. Gloucestershire.gov.uk,. 'Reduce Alcohol - Mobile Subsite'. N.p., 2015. Web. 1 Oct. 2015.

  4. YouTube,. 'Substance Use Disorders - CRASH! USMLE Step 2 And 3'. N.p., 2015. Web. 11 Oct. 2015.

Written by:       Roaa Amer

Reviewed by:   Abdulrahman AlNasser 

                        Rawan Al-Tuwaijri

Format Editor:  Adel Yasky