5/7/2020
1
Lecture 16Drug Use and Abuse
1
Lecture 16
1. What is a Drug?
2. Types of Drugs
3. OTCs (Over the Counter Drugs)
4. Drug Abuse
5. Drug Effects
6. Drugs of Abuse
7. Confronting the Drug Problem
2
5/7/2020
2
What is a Drug?
3
What Is a Drug?
• Drug – a substance, other than food, that affects the
structure or function of the body through its chemical
action
4
5/7/2020
3
What is a Drug?Routes of Administration
• Oral - most drugs are taken orally…
5
What is a Drug?Routes of Administration
• Injection
– A hypodermic syringe used to deliver drug into the bloodstream by:
• Intravenous injection – into artery or vein
• Intramuscular injection – muscle (vaccinations)
• Subcutaneous injection – beneath the skin
6
5/7/2020
4
What is a Drug?Routes of Administration
• Inhalation - smoking or huffing (e.g. asthma medicine)
7
What is a Drug?Routes of Administration
• Application to mucous membranes
• Application to skin (topical application)
8
5/7/2020
5
Types of Drugs
9
Types of Drugs
Drugs are classified in several different ways…
1. Legal Drugs include:
– Medication prescribed by physicians
– Over-the-counter (OTC) medications
– Recreational (alcohol, tobacco)
– Herbal remedies
10
5/7/2020
6
Types of Drugs
2. Pharmaceutical Drugs - are developed for medical
purposes, whether over-the-counter or prescription
11
Types of Drugs
3. Illicit drugs - are unlawful to possess, manufacture, sell, or
use (cocaine, marijuana*, crystal meth, etc.), viewed as
harmful
12
*Legal in several states
5/7/2020
7
Types of Drugs
• Drug of Abuse - medical drug used for nonmedical (recreational) purposes, or a
drug that has no medical uses
• Substance - drug of abuse, a medication, or a toxin; the term is used
interchangeably with drug
13
14
Over-The-Counter (OTC)
Drugs
5/7/2020
8
Over-The-Counter (OTC)
• Facts
– Nonprescription medicine
– More than 1/3 of the time people self-treat
• How a prescription drug becomes an OTC drug
1) At least three years of prescription sales
2) Use has been relatively high
3) Adverse drug reactions are not significant
Over-The-Counter (OTC)
• Types of OTC drugs
1. Analgesics – pain relief, GRAS (Generally Recognized as Safe)* GRAE
(Generally Recognized as Effective)
5/7/2020
9
17
Over-The-Counter (OTC)
• Types of OTC drugs
2. Cold, cough, allergy, and asthma relievers
5/7/2020
10
Over-The-Counter (OTC)
• Types of OTC drugs
3. Sleeping Aids
Over-The-Counter (OTC)
• Types of OTC drugs
4. Dieting Aids
5/7/2020
11
The Over-the-Counter Drug Label
Over-The-Counter (OTC)
• Rules for proper OTC drug use:
1) Take as directed!!
2) Know what you are taking (e.g. Benadryl)
2) Know the effects
3) Reading warnings and cautions
4) Don’t use anything for more than 1 or 2 weeks
5) Be careful if you also take prescriptions (interactions)
6) Ask your pharmacist if you have questions
7) If you don’t need it, don’t take it!
5/7/2020
12
Misuse of OTCs
In 2008 A US Food and Drug Administration (FDA) advisory
panel recommended a ban on over-the-counter cough and
cold medicines for children younger than six.
Drug Abuse
24
5/7/2020
13
Using, Misusing, and Abusing Drugs
• Abuse often associated with illegal drugs, but
many people abuse and misuse legal drugs
– Drug Misuse – use for purpose not intended
– Drug Abuse – excessive use beyond acceptable
levels
– Misuse and Abuse - may lead to addiction
Who Uses?
Patterns of Illicit Drug Use
• A very complex issue!
• Rates of illicit drug use vary by age, gender, race and ethnicity, education, employment status, and geographical region
• Among Americans aged 12 or older, more than 47% report having used an illicit drug in their lifetime
• The most commonly used drugs are marijuana* and alcohol
26
5/7/2020
14
Illicit Drug Use by Age (12 and over)
27
Reasons Why 18 – 22 year-olds Use Illicit
Drugs or Controlled Prescription Drugs
5/7/2020
15
Who Uses?
Patterns of Illicit Drug Use
29
Drug Effects
30
5/7/2020
16
Drug Misuse and Abuse
• Characteristics of Drug/Substance abuse:
– Addiction - is the chronic relapsing brain disease characterized by
compulsive drug seeking and use, despite harmful consequences
– Tolerance - is reduced sensitivity to the effects of the drug
– Withdrawal Symptoms - uncomfortable feelings when drug use stops
31
32
5/7/2020
17
Why are Drugs (and other substances) Addictive?
• Most addictive drugs act on neurons in three brain
structures:
1. The Ventral Tegmental Area (VTA) in the midbrain
2. Nucleus Accumbens
3. Prefrontal Cortex
• The Pleasure and Reward Circuit
33
Pleasure and Reward Circuit
34
• Addictive psychoactive drugs activate and cause surge in levels of dopamineand associated feelings of pleasure
5/7/2020
18
Effects of Drugs on the Brain
• All or nearly all addictive drugs operate via the pleasure and reward
circuit
• Some also operate via additional mechanisms, i.e., the opioids which
block pain when the body undergoes stress
35
Drugs of Abuse
36
5/7/2020
19
Drugs of Abuse
Drugs of abuse are usually classified as:
–Stimulants
–Depressants
–Opioids
–Hallucinogens
– Inhalants
–Cannabinoids
37
Stimulants• Drugs that speed up activity in the brain and Sympathetic
Nervous System (SNS)
• “Fight-or-Flight” response - a physiological reaction that
occurs in response to a perceived threat to survival.
• Acceleration of heart and lung action
• Slowing of digestion
• Etc.
38
5/7/2020
20
Stimulants
• May stimulate movement, fidgeting, and talking, and
produce intense feelings of euphoria and create a sense of
well-being
• Examples:
– Cocaine
– Amphetamines
– MDMA (Ecstasy)
– Bath salts
– Caffeine
39
Depressants
• Slow down activity in the brain and sympathetic
nervous system
• Can be deadly if misused, especially when mixed
with alcohol
• CNS depressants carry a high risk of dependence
• Examples:– Barbiturates and hypnotics
– Anti-anxiety drugs
40
5/7/2020
21
Alcohol
41
Opiates and Opioids• Opiates – natural drugs obtained from the opium poppy
• Opioids – synthetic drugs that mimic the effects of opiates;
chemically manufactured
42
5/7/2020
22
Opiates and Opioids
• Currently prescribed as pain relievers, anesthetics,
antidiarrheal agents, and cough suppressants
• Produce feelings of pleasure and block the
sensation of pain
• Examples:
– Morphine
– Heroin
– Codeine
– Synthetic opioids (OxyContin, Vicodin, Demerol, Percocet, Percodan)
43
Opiates and Opioids
• With low doses opioid users experience:
– Euphoria
– Drowsiness
– Constriction of the pupils
– Slurred speech
– Slowed movement
– Impaired coordination, attention, and memory
• At high dosage users can experience depressed respiration,
loss of consciousness, coma, and death (overdose)
• Opioids have a high potential for dependence
44
5/7/2020
23
Hallucinogens
• Also known as psychedelics
• Alter perceptions and thinking in characteristic ways
• Intensify and distort visual and auditory perceptions and
produce hallucinations
• Examples:
– LSD (lysergic acid diethylamide)
– PCP (phencyclidine)
– Peyote
45
Inhalants
• Breathable chemical vapors that alter consciousness,
producing a state that resembles drunkenness
• Active ingredients are all powerful toxins and carcinogens
• The most significant negative effect for chronic users is
widespread and long-lasting brain damage
• Examples:
– Paint thinner, gasoline, glue, and spray-can propellant
46
5/7/2020
24
Cannabinoids• Marijuana is the most widely used illicit drug* in the United
States
– Derived from the hemp plant, Cannabis sativa
– Active ingredient is delta-9-tetrahydrocannabinol (THC)
– Use produces mild euphoria, sedation, lethargy, short-term memory
impairment, increase in appetite, distorted sensory perceptions,
distorted sense of time, impaired coordination, and an increase in
heart rate
• Researchers have found that THC impairs problem solving
and decision making
47
48
?
5/7/2020
25
49
Confronting
the Drug Problem
Approaches to the Drug Problem
1. Supply Reduction Strategies
2. Demand Reduction Strategies
3. Harm Reduction Strategies
50
5/7/2020
26
Approaches to the Drug Problem
1. Supply Reduction Strategies:
– Interdiction - interception of drugs before they get into
the country
51
Approaches to the Drug Problem
1. Supply Reduction Strategies:
– Pressure on supplying countries to suppress production
and exportation
52
5/7/2020
27
Approaches to the Drug Problem1. Supply Reduction Strategies:
– Prevent domestic production and selling via law
enforcement
53
Approaches to the Drug Problem
2. Demand Reduction Strategies - reducing the
public desire for illegal and illicit drugs.
– Incarceration for drug-related crimes (current users)
• Follow up incarceration with treatment
• Half the people in U.S. prisons meet the diagnostic
standards for substance use disorders
• Only 7–17% who need drug treatment receive it
54
5/7/2020
28
Approaches to the Drug Problem
2. Demand Reduction Strategies
– Prevention Strategies – EDUCATION!
1. Primary Prevention - educate entire population
(https://www.youtube.com/watch?v=GOnENVylxPI)
55
Approaches to the Drug Problem
2. Demand Reduction Strategies
– Prevention Strategies (i.e educate potential users)
2. Secondary Prevention - educate subgroups that are
at greatest risk for use or abuse
56
5/7/2020
29
Approaches to the Drug Problem
2. Demand Reduction Strategies
– Prevention Strategies (i.e educate potential users)
3. Tertiary Prevention – educate at-risk individuals rather
than groups
57
Approaches to the Drug Problem
2. Demand Reduction Strategies:– Drug treatment programs
• Narcotics Anonymous (NA)
• Treatment is more successful when the program lasts at least three
months
58
5/7/2020
30
Approaches to
the Drug Problem3. Harm Reduction Strategies - focus on reducing the harm
associated with drug use...
• Provide containers for needle and syringe disposal
• Make naloxone (Narcan) available in case of opioid overdoes
• Needle exchange programs
• Drug substitute programs (ex: methadone instead of heroin)
• Controlled availability
• Medicalization
• Decriminalization
59