2. Comparechoices in prescription and over-the-counter drugs, and identify actions thatwill maximize the benefit received from these drugs
1. Discussthe six categories of drugs and explain their routes of administration.
2. Comparechoices in prescription and over-the-counter drugs, and identify actions thatwill maximize the benefit received from these drugs.
3. Discussproper drug use and explain how hazardous drug interactions occur.
4. Discusspatterns of illicit drug use, including who uses illicit drugs and why.
5. Describethe use and abuse of controlled substances, including cocaine, amphetamines,marijuana, opiates, hallucinogens, designer drugs, inhalants, and steroids.
6. Profileillegal drug use in the United States, including frequency, financialimpact, arrests for drug offenses, and impact on the workplace.
7. Describethe signs of addiction.
OUTLINE
I. Drug Dynamics
A. Drugs work because they physicallyresemble chemicals produced naturally in the body and attach to the receptorsites for the natural chemicals.
B. There are six categories of drugs:
1. Prescription drugs are those drugs that canbe obtained only with the written prescription of a licensed physician.
2. Over-the-counter drugs can be purchased in pharmacies and discountstores.
3. Recreational drugs is a vague categorycontaining alcohol, tobacco, chocolate, and coffee.
4. Herbal preparations includes teas andpreparations of botanical origin.
5. Illicit or illegal drugs are generallyrecognized as harmful and have laws governing them.
6. Commercial preparations are perfumes,cosmetics, household cleaners, etc.
C. There are several routes of drugadministration. (See Figure 7.1)
1. Oral ingestion is the most common route.Effects are felt from 20 minutes to 1 hour after ingestion.
2. Injection involves use of a hypodermic needleto introduce a drug to the body.
a. Intravenous injection puts the drug directlyinto the vein, effects are felt
within 3 minutes.
3. Intramuscular injection results in slower absorption through muscletissue.
4. Subcutaneous injection puts the drug into thefat layer beneath the skin.
5. Inhalation refers to administration of drugsthrough the nostrils. Effects are
noticed within seconds and wear off fasterthan slower routes of administration.
6. Inunction introduces a chemical into the bodythrough the skin, such as nicotine patches.
7. Suppositories are absorbed through the rectalwalls.
II. Using, Misusing, and Abusing Drugs
A. Drug misuse is generally considered to be the use of a drug for apurpose for which it
was not intended. Drug abuse is the excessive use of any drug.
B. Addiction is continued involvement with a substance or activity despiteongoing negative consequences.
1. Diagnosis is usually based on severalcriteria:
a. Withdrawal or the physical and psychologicalsymptoms from stopping the drug.
b. An associated pattern of pathologicalbehavior.
c. Relapse or the tendency to return to thebehavior after quitting.
C. There are several universal signs ofaddiction:
1. Compulsion, characterized by obsession orexcessive preoccupation with the behavior.
2. Loss of control, or the inability to predictreliably whether an isolated occurrence of the behavior will be healthy ordamaging.
3. Negative consequences such as physicaldamage, legal trouble, financial problems, etc.
4. Denial, or the inability to perceive thebehavior, is self-destructive.
III. Prescription Drugs.
A. There are several common types ofprescription drugs:
1. Antibiotics are drugs used to fight bacterialinfections.
2. Sedatives are central nervous systemdepressants.
a. These drugs are usually included in the listof top selling prescription drugs.
3. Tranquilizers are another form of centralnervous system depressant.
4. Antidepressants are used to treat endogenousmajor clinical depression.
B. Generic drugs are medications sold undertheir chemical name rather than under a brand name.
IV. Over-the-Counter Drugs.
A. OTC drugs are non-prescription drugs we usein the course of self-diagnosis and self- medication.
B. There are criteria for prescription drugs tobecome OTC drugs:
1. The drug must have been marketed as aprescription drug for at least three years.
2. The use of the drug must have been relativelyhigh while a prescription drug.\
3. Adverse side effects must not be alarming andthe frequency of side effects should not have increased during the time thedrug was available to the public.
C. There are several types of OTC drugs.
1. Analgesics are pain relievers that come inmany forms.
a. Aspirin relieves pain by inhibiting thebody’s production of prostaglandins.
b. Acetaminophen is an aspirin substitute whichis also an antipyretic, but not anti-inflammatory.
c. Ibuprofen is another form of pain reliever.
d. Aleve is a new pain reliever with longerlasting effects.
2. Cough, cold, allergy and asthma relief arecommon OTC drugs.
a. Expectorants are formulated to loosen phlegm.
b. Antitussives are used to calm cough reflex.
c. Antihistamines are CNS depressants that dryup runny noses.
d. Decongestants are designed to reduce nasalstuffiness.
e. Anticholinergics reduce nasal secretions andtears
3. Stimulants heighten wakefulness, alertness,and reduce fatigue.
4. Sleeping aids induce drowsy feelings thatprecede sleep.
5. Dieting aids are designed to be appetitesuppressants.
a. Laxatives and diuretics have been used asdiet aids.
D. OTC drugs must be used as recommended to reduce theincidence of problems.
E. Drug interactions can be dangerous.
1. Synergism (potentiation) is an interaction of two or more drugs in whichthe
effects of the individual drugs are multiplied beyond what wouldnormally be
expected, i.e. 2+2=10.
a. It is most likely to occur with CNSdepressants.
b. It can occur with OTC drugs.
2. Antagonism is when drugs work at the samereceptor site so that one drug blocks
the action of the other.
3. Inhibition is when the effects of one drugare eliminated or reduced by the presence of another drug at the receptor site.
4. Intolerance occurs when drugs combine in thebody to produce extremely uncomfortable reactions, i.e. antabuse used to helpalcoholics give up drinking alcohol.
5. Cross-tolerance is when a person develops atolerance to one drug and shows similar tolerance to other selected drugs as aresult.
V. Illicit Drugs.
A. Illicit drugs are those drugs that areillegal to possess, produce, or sell.
B. In 2002, an estimated 19.5 million Americanswere current illicit drug users. Use hasbeen increasing among youth, especially marijuana use.
C. Illicit drug users come from all walks oflife.
1. In 2000, NIDA noted that 9.7% of the population age 12-17 reported usingan
illicit drug during the past year.
2. Drug use among college students has beenincreasing in recent years, but is generally lower than the population ofsimilar aged individuals (except alcohol). (see Table 7.1)
D. People who develop drug problems begin with the beliefthat they can control their use. Becausemany of these drugs have the ability to produce dependence quickly, this may bea foolish thought.
VI. Controlled Substances.
A. Drugs are classified into five “schedules” or categories. (See Table 7.2)
1. Schedule I has high potential for abuse,addiction, and no accepted medical use.
2. Schedule II has high potential for abuse and addictionand restricted medical use.
3. Schedule III has some potential for abuse and addictionand is currently accepted for medical use.
4. Schedule IV has low potential for abuse and addictionand is currently accepted for medical use.
5. Schedule V has the lowest potential for abuse andaddiction and is accepted for medical use.
6. Illegal drugs are either schedule I or II and aredivided into five representative categories:
a. Stimulants, including cocaine, crack,amphetamines, and
methamphetamines – crank and ice.
b. Marijuana and its derivatives, such ashashish.
c. Depressants, including opiates, barbituratesand alcohol.
d. Psychedelics and deliriant, including LSD,mescaline, psilocybin, PCP, inhalants.
e. Designer drugs, including MDMA also known asEcstasy, and Ketamine.
B. Cocaine is described by the NIDA as “the mostpowerful naturally occurring stimulant.”
1. It is a crystalline white alkaloid powderderived from leaves of the coca shrub.
2. Cocaine can be snorted, smoked (freebased),or injected.
3. Cocaine binds with receptor sites in the CNSand produces an intense pleasure that abates quickly, leaving the user with adesire to use again.
a. Cocaine is an anesthetic and a CNS stimulant.
b. There are many symptoms of increased dosageincluding irritability, paranoia, dramatic weight loss, convulsions, irregularheartbeat and eventual death from overdose that can cause stroke, heart attackor brain seizures.
c. Withdrawal symptoms include pervasivelong-term depression, loss of the ability to feel joy and many others. Sometimes these are permanent.
4. Cocaine, when taken during pregnancy, cancause many birth defects needing extensive medical attention.
a. Some risks include small head, prematuredelivery, reduced birth weight,
increased irritability and subtle learningand cognitive deficits
b. Baby goes through withdrawal at birth, isunable to sleep or eat properly
c. They are able to respond normally to care andare difficult to console and comfort, negatively affecting social and emotionaldevelopment.
5. Freebase cocaine is a form of cocaine that ismore costly and more powerful than powder or chip forms.
a. It is converted to pure base by removing thehydrochloride salts and cutting agents.
b. It reaches the brain quickly causing anintense, short-lasting, high.
6. Crack is a form of cocaine that has beenprocessed using ammonia or sodium
bicarbonate and heat to remove thehydrochloride.
a. It is five times as powerful as cocaine.
b. Addiction is accelerated by the speed atwhich crack is absorbed through
the lungs.
7. Cocaine use affects society and theindividual.
C. Amphetamines stimulate the CNS.
1. Small doses can cause increased alertness, but there are many negativeside-
effects associated with prolonged use and high doses. Effects of use and
withdrawal symptoms are very similar to that of cocaine.
2. Therapeutic uses include treatment forobesity and hyperactivity.
D. There are several new generation stimulants, known asmethamphetamines.
1.Their effects last much longer than cocaine with their immediate effectsincluding irritability and anxiety;increased body temperature, heart rate, and blood pressure; and possible death.
2. Prolonged use of these drugs can cause fatallung and kidney damage.
E. Marijuana is derived from cannabis sativa or cannabis indica (hemp) plants.
1. The psychoactive substance in marijuana isTHC.
a. The THC levels have increased over the years,going from between 1 to 2
percent to between 4 and 6 percent.
b. Hashish is derived from the plant resin andcan contain up to 70% THC.
2. Marijuana can be smoked, ingested, or brewed.
a. The most noticeable effect of use is dilationof the eye’s blood vessels.
User also experiences coughing, dry mouthand throat, increased thirst
and appetite, lowered blood pressure,muscular weakness.
b. Anxiety or paranoia are negative reactions tothe drug.
c. Users may experience intensified reactions tovarious stimuli.
3. Studies on the long-term effects of marijuanahave been difficult to conduct due to the illegality of the drug.
a. Studies from other countries show damagesimilar to cigarette smoking.
b. The immune system is suspected to becompromised with this drug use.
c. Other long term effects include blood pressure changes, and impaired
memory function.
d. Pregnant women who smoke have higher risk forstillbirth, miscarriage, low birth weight babies, abnormalities of the nervoussystem, and other symptoms similar to fetal alcohol syndrome.
4. Marijuana has been used to help control theside-effects of chemotherapy and reduce the eye pressure of glaucoma, and forAIDS patients.
5. Marijuana use reduces a driver’s ability toreact and make quick decisions, contributing to auto accidents.
F. Opiates, also called narcotics, are allderived from the parent drug, opium, which comes from the poppy plant. Theyinclude opium, morphine, codeine, and heroin.
1. Opiates such as morphine and codeine arestill used today in medicine.
2. Opiates are powerful CNS depressants. Besides relieving pain they:
a. Lower heart rate, respiration and bloodpressure.
b. Cause weakness, dizziness, nausea, vomiting,euphoria, decreased sex drive, visual disturbances, and lack ofcoordination.
c. Symptoms of tolerance and withdrawal canoccur within three weeks of first use.
d. Withdrawal symptoms include an intense desireto use, yawning, a runny nose, sweating, crying, sleep disturbance, loss ofappetite, irritability, muscle tremors, nausea, abdominal cramps, vomiting,diarrhea, extreme anxiety, elevated blood pressure, rapid heartbeat andrespiration.
3. All opiate addictions follow the sameprogression as heroin.
4. Heroin and black tar heroin are illegalopiates.
a. Heroin use is on the rise because ofincreased availability.
b. Using heroin by injection can increase riskof getting AIDS.
c. The most common route of administration is“mainlining.”
5. Treatment programs for heroin addiction havenot been very successful.
a. Heroin withdrawal produces intense symptoms.
b. Methadone helps decrease the heroinwithdrawal symptoms.
c. The use of methadone is controversial becausecritics say the use is
replacing one addiction with another.
G. Hallucinogen or psychedelic drugs alterfeelings, perceptions, and thoughts in the user.
1. The major receptor sites for these drugs are in area of the brain, knownas the
reticular formation, which interprets outside stimuli. (see Figure 7.4)
2. The mixing of sensory messages is calledsynesthesia.
3. LSD is a psychedelic drug once used bypsychiatrists to unlock secrets in the mind.
a. Even in small doses, LSD can producepsychological and physical effects.
b. LSD stimulates uterine contractions and cancause premature labor.
c. Euphoria is common, however sometimesdysphoria, a sense of evil and foreboding, occurs in many LSD users.
d. LSD produces illusions and can lead to “badtrips” which are related to set or setting.
4. Mescalineis derived from the peyote cactus and is used in religious
ceremonies of the Native American Church.
a. Mescaline has similar effects to LSD. Unlike LSD, mescaline is a powerful hallucinogen. It is also a CNS stimulant.
b. Street versions of mescaline are usuallysynthetic derivatives with names like DOM, STP, TMA, and MMDA. These can be toxic in small quantities.
5. Psilocybin is an active chemical found in a group of mushrooms causing an
effect similar to LSD.
6. PCP was developed as an anesthetic but wastoo unpredictable for medical use.
a. In small doses it produces feelings similarto strong CNS depressants.
b. Serious side-effects may occur with largerdoses. These include drastic drops in blood pressure, coma, muscular rigidity,violent outbursts, and possible convulsions and death.
c. Long-term effect of PCP use is unknown.
H. Designer drugs are easy to produce in homesand chemical laboratories. They are allillegal.
1. Called “Club Drugs”:Ecstasy, GHB, Special K,and Rohypnol are designer drugs.
2. Prior to 1989, these drugs were not includedin the drug laws. Now most states have look-alike laws that make designer drugsillegal.
3. Designer drug use can cause serious healthproblems and may result in death.
I. Inhalants are chemicals that produce vaporsthat, when inhaled, can cause hallucinations as well as create intoxicating andeuphoric effects.
1. Inhalants are generally used by people whocannot afford illicit drugs.
2. Amyl nitrite is often prescribed to relievechest pain in heart patients, but is used as an inhalant.
3. Nitrous oxide (laughing gas) is a commondental anesthesia and used as a propellant chemical in aerosol products such aswhipped topping.
4. Inhalants can produce many unhealthy sideeffects.
J. Steroids are ergogenic drugs used to enhanceathletic performance. Anabolic steroidsare artificial forms of testosterone that promote muscle growth andstrength. They are now a Schedule IIIdrug and use carries possibility of imprisonment and fines.
1. They have become popular in competitivebodybuilding.
2. Anabolic steroids produce a state ofeuphoria, diminished fatigue, and increased bulk and power.
3. There are many adverse side-effects,including becoming aggressive and violent (roid rage), acne, liver tumors,elevated cholesterol levels, hypertension, kidney disease, and immune systemdisorders.
a. Women may experience masculine changes:deeper voice, increased
facial and body hair, male patternbaldness, enlarged clitoris, decreased
breast size, and changes or absence ofmenstruation.
4. Steroid alternatives are being used moreoften. There are two common forms:
a. GHB is an illegal drug that is the primaryingredient of some of the
performance enhancing steroidalternatives.
b. Clenbuterol is a popular black-market steroidalternative used in other countries on animals, but with no approved use in theUS.
c. A newer supplement, androstenedione (andro),is currently being used by baseball players, although the NFL, NCAA, and InternationalOlympic Committee have banned it.
VII. Illegal Drug Use in the United States
A. The economic cost of illegal drug use in the U.S. is estimated to be about $160 billion. This includes the costs of prevention,treatment, healthcare, lost productivity, crime, and social welfare.
B. About half of this money is spent to combat crime.
C. NIDA estimates that 8.5 percent of all US workers use dangerous drugs onthe job.
1. Many employers have instituted drug testingto counteract the drug epidemic.
a. Critics say drug testing violates the rightsof employees.
b. Critics question the accuracy and thereliability of the tests.
D. There are several strategies proposed, todecrease the drug problem.
1. Scare tactics and total prohibition have beenineffective.
2. A multi-modal approach is to drug educationis needed.
3. Other strategiesinclude stricter border surveillance, longer prison sentences for drug dealers,increased government spending on prevention and law enforcemen
