Drug Abuse

Drug abuse is use of any substance until there is an adverse reaction on health or ability to function.

A person has receptors in their body and the receptors are stimulated when they are addicted. When they are no longer stimulated, they go through withdrawal. That’s the physical dependence but the hardest to treat is the psychological dependence (habituation; when the mind determines a need).

Dependence is just one of the many effects of drug abuse on a person.

Drug tolerance causes a chronic user to increase dose constantly to obtain an effect equal to the initial dose. Narcotic users need a constant increase in dose.

Cross tolerance is when a tolerance builds up to another drug that one is not consuming. If someone is developing a tolerance to heroin, there is a tolerance to ALL opiates.

Toxic range increases with tolerance but not as fast as the tolerance range.

Let’s say a person is taking 10mg of morphine for pain or abuse and a 30mg dose would kill them due to toxicity.

As time goes on, let’s say we increase the dose to 20mg so it continues to work. Interestingly the toxic dose goes up as well, not as fast, but goes up to 35mg.

Next week, let’s increase the dose to 30mg and the toxic range goes to 40mg.

Next week, we increase the dose to 40mg and the toxic range is now at 45mg. This is why heroin addicts eventually overdose, because they are getting very close to the toxic range. Interestingly, if you took that 40mg initially, you would die, but they wouldn’t.

Opiates (narcotics) effects

• Euphoria: exaggerated sense of feeling GOOD.
• Hallucination: sense perception not founded upon objective reality
• Psychological dependence
• Physical dependence
• Withdrawal stages

Morphine Withdrawal Effects

6-12 hours: anxiety, rhinorrhea (runny nose), lacrimation (tearing), diaphoresis (sweating), pyloerection (goosebumps), anorexia, nausea, diarrhea

48-72 hours: hyperactivity, restlessness, insomnia.

There’s nothing life threatening here. They can go cold turkey here with no physical harm. The psychological craving is the problem.

Opiate Withdrawal Comparisons

It depends how long the drug stays on the receptors.

• Meperidine: 3-5 days
• Morphine: 5-10 days
• Methadone: 10-14 days

The withdrawal is going to be the worse with meperidine because it comes off the receptors so fast.

Methadone Programs Benefits

Government funded/assisted rehab centers use Methadone due to this long acting action. If we don’t give it to them, they will go through withdrawal. Methadone decreases complications such as bacterial endocarditis, embolism, sepsis, hepatitis, and HIV.  They also decrease crime so they don’t try to steal to buy heroin.

Methadone maintenance: This is a government licensed program that patients are on every day. They can’t get it in pill form otherwise they would cheek it, crush it later and then shoot it up. They are given a liquid and they have to drink it down and wash it down and then talk to show the liquid is gone.

Methadone detoxification: Any doctor can detoxify a patient. They are weaned in 21 days.  However, they probably go right back on some other drug because the psychological dependence isn’t fixed.

Barbiturates

Even though it’s a depressant agent, the initial effect is excitement, just like alcohol. The later effects are depression, confusion, and decreased sensory perception.  There’s also psychological dependance and physical dependence.

Withdrawal includes: delirium, rebound excitement, orthostatic hypotension and seizures.  For these reasons, they CANNOT go cold turkey on barbiturates.

Benzodiazepines

Depressant effects
Psychological dependence
Physical dependence: withdrawal included rebound excitement and insomnia

Stimulants

Typically prescribed for weight loss or attention deficit. People continue to use it for increased alertness and self confidence. They love how they feel on it, even though it doesn’t work for weight loss anymore and they stay on it. Other effects are increased blood pressure and headache.

Psychological dependence.
Physical dependence: withdrawal tremor, exhaustion, disorientation, hallucinations and confusion.

Studies show that cocaine is the most addicting drug there is, probably due to a combination of factors including the act of snorting a drug, it being illegal and the high it gives.

Hallucinogens

LSD: profound experiences but they can be unpredictable.

Phencyclidine (PCP): Contributes to an unusual increase in strength and is the biggest problem for cops.  The taser gun was created as a way for controlling these people.

Marijuana (THC): impaired cognition and memory, teratogenicity (potential for birth defects).