Substance Abuse and Misuse Exam 1

Public health

is the science of protecting and improving the health of people and their communities

Everyone should have a ____ and _____ opportunity to achieve good health and well-being.

fair and just

Social determinants of health (SDoH)

are the conditions in the environments where people are live that affect a wide range of health, functioning, and quality-of-life outcomes and risks

Socioecological Model and substance use

combination of factors that leads a person to use or misuse substances

Individual SEM

• physical and mental health

• trauma and resiliency

• social-emotional learning and skill

• perception of risk

• withdrawal symptom management

Interpersonal SEM

•Access to substances

•Family and friends’ attitudes and opinions towards substance use and pain management

•Acceptance of medication assisted treatment (MAT)

•Family history of substance use

Community SEM

•Prescriber's perception of risk and prescribing practices

•Drug disposal facilities

•Access to medically assisted treatment

•Access to naloxone and naloxone training

•Public health and harm reduction programming

Societal SEM

•Stigma towards people who use drugs

•Legislation that supports syringe service programs, MAT, and expansion of behavioral health services

•Polices that promote health equity

•Health insurance coverage for mental health and substance use treatment

•Naloxone protocol for pharmacies

public health understanding of stigma

the “co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised”

Why are switching to the wording substance disorder/misuse than substance abuser?

to reduce the stigma and judgment around substance misusers, can also help people receive medical care instead of punishment

Homeostasis

•The maintenance of internal stability or equilibrium of the body and its functions

Neuron

are responsible for conducting the homeostatic functions of the brain and other parts of the nervous system by receiving and sending information

neurotransmitter

are chemical messengers that transmit signals between neurons.

•Dendrites

are the receiving regions of a neuron’s cell body

Synapse

is the point of communication between one neuron and another

•Agonists:

substances or drugs that activate receptors

•Antagonists:

substances or drugs that attach to receptors and prevent them from being activated

•Central nervous system (CNS)

brain, spinal cord

Peripheral nervous system (PNS)

extremities, sensory

Limbic system

•Regulates emotional activities, memory, reward, and endocrine activity

•Output: Two types

autonomic and somatic

•Somatic

(control of voluntary muscles)

•Autonomic

(control of unconscious functions)

•Stimulants

produce wakefulness and a sense of energy and well-being

•Hallucinogens

produce altered perceptions

•Cannabinoids

produce feelings of euphoria, enhancement of sensory perception, difficulties in concentration and impairment of memory

•Depressants

slow nervous system activity

•Opioids or narcotics

produce a relaxed, dreamlike state

types of drug names

chemical

generic

brand

Routes of Administration

•Oral administration

•Insufflation (Snorting)

•Intravenous injection

•Subcutaneous and intramuscular injection

•Inhalation (Smoking)

oral

20-30min

safer, convient

inhalation

7-10sec

most efficient

snorting

3-15min

efficient

Intravenous Injection

15-30sec

efficient

Intramuscular injection

3-5 min

more rapid than Subcutaneous

Subcutaneous injection

5-7min

sustained effect

Addiction

is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences

three (3) basic processes that may occur with repeated drug use:

•Tolerance

•Physical dependence

•Psychological dependence (BEHAVIORAL)

Tolerance

•A phenomenon in which repeated exposure to the same dose of a drug results in a lesser effect

physical dependence

the occurrence of a withdrawal syndrome

Psychological Dependence

•Describes the emotional and mental processes associated with the development of, and recovery from, a substance use disorder or process addiction

•Also called behavioral dependence

Moral Model

•Oldest theory of addiction

•Drug use is a sign of irresponsible, sinful behavior, evil possession, moral failing, etc.

•Behavior is freely chosen à “these people” refuse to abide by ethical/legal/moral proscriptions of conduct

•Solution: Condemn substance users and send them to jail.

AA Model (spiritual disease)

•This model was put forward by the Alcoholics Anonymous movement in the mid 1930s

•Addiction is a physical, mental, and spiritual disease, and it is a “primary disease” rather than “secondary” to another condition.

•It is progressive, chronic, and incurable (one can be “recovering” but not be “recovered”)

Psychological Model

•The psychological model highlights psychological factors (coping mechanisms, underlying mental illness, learning history, cognition, etc.) involved in addiction

•Coping: Substance misuse is secondary to another mental illness or underlying problem (e.g., childhood trauma) and used for self-medication or coping.

•Cognition: People seek drugs because of their expectations about the way they will feel when they use substances (expectancies).

Biological/brain disease model

•Genetic predisposition

NDA and ASAM use these

Socio-cultural Model

•Highlights social/environmental factors such as cultural practices that influence use and abuse of substances

ex: access to substances, type introduced to, environment, acceptance among peers, norms

Multi-casual models

•Multi-causal models are more comprehensive and describe the complex interplay of multiple factors in the development (why the problem began) and maintenance (why the problem continues) of addiction.

Public Health Model

biopsychosocial model

•A multi-causal model that explains how biological, psychological, and social factors combine and interact to influence physical and mental health.

includes SDOH

Two classes of drug laws

regulatory and criminal

regulatory laws (written response)

Regulations of “legal” drugs for pharmaceutical companies.

Designed to control the production, distribution, and use of substances.

criminal laws (written response)

Criminalization of certain drugs for their use, possession, and sale.

Designed to deter use of illicit or harmful substances and reduce consequences.

Early issues leading to legislation (written response)

• Fraud medicines sold directly to the public with false therapeutic claims and were habit forming.

• Opium: Chinese workers brought it to US, there it was a sign of social status.

• 1848: Drug Importation Act required US customs to inspect entry of drugs.

3 main drug laws

1906 pure food and drugs act

1914 harrison act

18th amendment alcohol prohibition 1918

Pure Food and Drug Act 1906

• Administered within the United States Department of Agriculture

•Goal: Ensure that drugs are pure and honestly labeled

•Prohibited interstate commerce in misbranded and adulterated foods and drugs

Harrison Act of 1914

•Goal: Taxation of drugs to restrict commerce in opioids and cocaine to authorized physicians, pharmacists, and legitimate manufacturers

•Required those who “produce, import, manufacture, compound, deal in, dispense, or give away” certain drugs to register and pay a special tax

•Initially controlled opium and cocaine

Alcohol Prohibition 1918

• Temperance Movement: where drunkenness was seen as a threat to American families.

• Massachusetts and Maine were first to pass

• WWI: temporary wartime prohibition to save grain for food production

Purity and Safety Acts

Purity: 1912 Sherley Amendment: outlawed false claims

Safety: 1938 Food, Drug, Cosmetic Act: testing

Effectiveness and Other Acts

Effectiveness: Kefauver Harris Amendments: prove effectiveness

Other: Prescription Drug Marketing Act and FDA Modernization Act (guidelines)

What led to the weed tax act of 1937 (written response)

Harry Anslinger became the first drug czar, prohibitionist made films that depicted weed would make you go crazy, gateway drug theory, stigma, and stereotypes among Hispanic people, formed the Treasury Department

What led to the War on Drugs?

• Vietnam War: soldiers were known to be smoking weed and using other drugs.

• Public concern regarding soldiers returning

• if failed drug test had to stay in country to detox

• Nixon Era

• Operation Intercept: boarder shutdown, lasted 20 days

in 1971 congress passes the

Comprehensive Drug Abuse Prevention and Control Act

• creation of 5 schedules

• reduce weed penalties

• allowed “no-knock” searches

Schedule 1

•"High abuse potential with no accepted medical use; medications within this schedule may not be prescribed, dispensed, or administered"

ex: weed, LSD, MDMA

Schedule 2

•"High abuse potential with severe psychological or physical dependence; however, these medications have an accepted medical use and may be prescribed, dispensed, or administered"

ex: meth, fentanyl, morphine, oxy

Schedule 3

•"Intermediate abuse potential”

ex- steriod, ketamine, testoaterone

Schedule 4

•“Abuse potential less than Schedule III but more than Schedule V medications”

ex: tramadol

Schedule 5

"Medications with the least potential for abuse among the controlled substances."

Len Bias

22 basketball player at Maryland. Took a “dealer” quality version of the drug and caused his death

•1986 – Reagan signs the Anti-Drug Abuse act

•Creates mandatory minimum penalties (prison sentences) for drug offenses

2010 Fair Sentencing Act

•to address the disparity linked to the Anti-Drug Abuse Act of 1986

•Law changed sentencing disparity between crack and powder to 18:1 (from 100:1)

•Eliminated the 5-year mandatory minimum sentence for simple crack cocaine possession

Positive Impact of War on Drugs (written response)

• DEA international programs

• 10-15% of drugs seized each year

• deterrence of drug-related crimes

• made drug prices rise

• changed public perception

Negative Impact on War on Drugs (written response)

• 50,000 students denied financial aid due to past drug convictions

• voting limitations

• limit job opportunities

• disproportionally impacts certian populations

• increased media and public fear

• expensive

Why did war on drugs fail?

• too expensive

• ineffective

• increased stigma

• increased violence

• made drug use more dangerous

• increased overdose

• mass incarceration

reward and reinforcement of using drugs

regulated by dopamine which is the brains main driver of reward system

Ventral Tegmental Area (VTA)

regulates reward, learning, memory, and addiction behaviors through mediating dopamine (DA) release in downstream regions

treatment is best when it happens

early

comorbidity

•A condition where two or more illnesses occur in the same person, simultaneously or sequentially.

•Suggests interactions between the illnesses that affect the course and prognosis of both

Decriminalization

•Process through which the legislature removes criminal sanctions against a crime

•The drugs would remain illegal, but the legal system would not prosecute 

•The penalties would range from no penalties to a civil fine

•Offenders may be required to attend drug treatment

Legalization

The act of allowing something into law

Allows for the removal of all specific drug-related offenses from criminal law

Regulations are typically established to manage where and how the legal drug can be produced, sold, and consumed

Criminal or civil penalties may apply if production, sale or consumption occur outside of regulations

Portugal decriminalization

2001

•More than a 20 years later, drug use has remained about the same – but arrests, incarceration, disease, overdose and other harms are all down

Public Sentiment Changing in US

• sentiment in favor of reducing criminal penalties for drug possession is growing across the country

• 22 states decriminalized possession of small amounts of marijuana

• Vermont

Drug Courts

• •Highly specialized court process that functions within the existing Court structure to address charges associated with non-violent substance users.

• Courts help participants recover from substance use disorder with the aim of reducing future criminal activity.

Two contradictory models of Drug Courts

•Disease model = people with a SUD use drug compulsively – despite negative consequences

•Rational actor model = assumes people weigh the benefits of their actions against the potential consequences of those action

Why did the Oregon Decimalization not work

• covid hit

• fentanyl crisis

• did not have the infrastructure or resources to help drug users

• completed health assessment or fine of $100

• counties

Oregon and Therapeutic Psychedelics

Oregon allowed the supervised, therapeutic use of psilocybin

Oregon Decriminalization Advocates

• Measure 110 replaces criminal justice approach with public health approach.

• argues money should be put towards education and treatment

Oregon Decriminalization Opponents

• removes deterrent to trying drugs

• criminal penalties attached to drug possession leveraged to push people to treatment