Drugs of Abuse Review

Drugs of Abuse: Comprehensive Study Notes

Introduction to Drugs of Abuse

  • Medications can be misused and abused, leading to immense costs at individual and societal levels.

  • Substance abuse is frequently associated with trauma, domestic and partner violence, mental illness, and suicide.

  • This section highlights key aspects of substance abuse, building on core concepts previously covered, with a focus on prevalence and practical implications.

Key Definitions and Concepts

  • Tolerance: The need for a progressively higher dose of the same medication to achieve the desired effect.

    • This phenomenon is not exclusive to drugs of abuse; it can occur with various prescribed pharmaceutical medications.

  • Cross-Tolerance: Occurs when a patient requires a higher dose of drug X due to prior use of drug Y.

    • Example: An individual with a history of opioid use (e.g., heroin) will require a significantly higher dose of morphine or its equivalent for pain management (inpatient setting) compared to an opioid-naive individual with the same injury.

  • Physical Dependence: Characterized by inherent withdrawal symptoms upon discontinuation of the medication or drug.

  • Psychological Dependence: Involves an overwhelming desire and craving that strongly motivates drug use, but does not necessarily include physical withdrawal symptoms.

  • Substance Use Disorder: This term has largely replaced

    • the older terms like "drug abuse" and "drug addiction" to reflect a more clinical and less stigmatizing perspective.

    • It is diagnosed based on criteria outlined in the DSM−5DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition).

    • The criteria cover impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal).

    • Severity ranges from mild to severe, depending on the number of criteria met.

Common Classes of Drugs of Abuse

  • Understanding different drug classes is crucial due to their varied mechanisms of action, effects, and withdrawal symptoms.

    • #### Opioids

      • Description: Depress the central nervous system, reducing pain and inducing euphoria.

      • Examples: Heroin, morphine, oxycodone, fentanyl.

      • Risks: High potential for physical dependence and life-threatening respiratory depression (overdose).

    • #### Stimulants

      • Description: Increase alertness, attention, and energy, often leading to feelings of euphoria and increased drive.

      • Examples: Cocaine, amphetamines (e.g., methamphetamine, Adderall), ecstasy (MDMA).

      • Risks: Cardiovascular complications, psychosis, severe depression during withdrawal.

    • #### Depressants

      • Description: Slow down brain activity, producing calming, sedative effects.

      • Examples: Alcohol, benzodiazepines (e.g., Xanax, Valium), barbiturates.

      • Risks: Respiratory depression, sedation, severe and potentially fatal withdrawal (seizures).

    • #### Hallucinogens

      • Description: Alter perception, thoughts, and feelings, causing distortions of reality.

      • Examples: LSD, psilocybin (magic mushrooms), DMT, PCP (dissociative).

      • Risks: "Bad trips," persistent perceptual changes (HPPD), psychological distress.

    • #### Cannabinoids

      • Description: Produce a range of effects including altered perception, relaxation, euphoria, and increased appetite.

      • Examples: Marijuana (THC).

      • Risks: Impaired cognitive function, potential