reference: PHARMACEUTICAL PRACTICE by A.J Winfield

1. SUBSTANCE USE AND
MISUSE
DR. AHLAM SUNDUS PHARM-D, M.PHIL. (MALAYSIA)

2. Rational use of drugs
 Safe
 Effective
 Appropriate
 Economic
 How are safety, efficacy, appropriateness and economic factors assessed?

3. Terminologies
 Drug use
 Drug misuse
 Drug abuse/ substance abuse
 Drug addiction/ drug dependence
Drug dependence:
“ a cluster of psychological, behavioral and cognitive phenomena of varying
intensity in which the use of a psychoactive drug takes on high priority. The
necessary descriptive characteristic are preoccupation with a desire to obtain
and take the drug and persistent drug seeking behavior.”
WHO.

4. List of substances that are misused
Common name Active agent Route of
administration
Effect on CNS Desired effect Unwanted
effects/harms
Lysergic acid Orally dissolved
on the tongue
Hallucinogenic Hallucination,
detachment from
reality
Panic attacks,
psychosis,
tachycardia
Ethanol Drinks (wines,
spirits etc.)
CNS depressant Relaxation,
↑social interaction
Aggressive mood,
diuresis, cirrhosis,
hypoglycemia
Caffeine Caffeine Orally in drinks CNS stimulant ↑ alertness %
stamina, combat
fatigue
Diuresis,
insomnia, anxiety,
headaches
Cannabis Delta-9-
tetrahydrocannabi
nol (THC)
Hashish (resin)/
marijuana smoked
CNS depressant Relaxation,
enhances mood,
sociability
Anxiety, sedation,
tachycardia, lung
disorder

5. Continue…..
Ecstasy 3,4-
methylenedioxyme
thamfetamine
(MDMA)
Oral tablet esp. in
parties
CNS stimulation,
hallucigenic
Physical & mental
stimulation,
sociability
Sweating,
tachycardia,
headache, dry
mouth
Heroin Diamorphine Vapor inhalation
after heating on
foil/ I/V
CNS depressant Euphoria,
detachment from
emotional distress
n/v, sweating,
drowsiness, resp.
depression hypoxia
Tobacco Nicotine Smoking/ chewing CNS stimulation Mood elevation,
relaxation
Cancers, CV
disorders, cough
Cocaine Cocaine
hydrochloride
Nasal
administration, inj,
CNS stimulation Euphoria,
↑confidence
Cardiac toxicity,
palpitations
psychosis
Speed Amphetamine Nasal, oral I/V CNS stimulation Physical & mental
stimulation,
Tachycardia, HTN,
Paranoia,

6. Factors Underlying Misuse of Drug
 Perceived benefits
 Pleasurable feelings
 Increased social interaction
 Alteration of person’s psychological condition
 Avoidance of withdrawal symptoms in drug dependents
 Availability an opportunity to try
 Legal status of drug
 Perceived benefits weighed up against risks

7. Adverse Impact of Drug Misuse
 Type of drug
 Frequency/ dose
 Individual
 Circumstances
Health problems
Social problems
Drug-related crime

8. Health Problems
 Individual
 Physical effects
 Psychological effects
 Damage to circulatory system, HI, HBV,HCV
 Society
 Blood-borne infections (needle sharing)

9. Social Problems
 Poverty
 Social deprivation
 Exclusion or failure in education
 Inability to obtain or sustain employment
 Spending of income on drugs
 Damage to relationship
 Homelessness

10. Drug-related Crime
 Criminal activities for drug acquisition
 Robbery
 Drunk driving
 Violence associated with drunkenness
Treatment has shown to reduce crime related to drug use

11. Control and Dependence
 Neurological control
 Person loses control over drug consumption
 Drug consumption controls the person
 Social deprivation

12. Withdrawal
 Stop using substance
 Physical withdrawal effects (severe/ shorter duration)
 Psychological withdrawal effects (may not be easily observed/ long duration)
 Physical: seizures alcohol withdrawal
palpitations, anxiety  cocaine withdrawal
insomnia  nicotine withdrawal
stomach cramps, influenza type symptoms  opiate derivative
 Psychological: intense craving, emotional experiences, grief, inability to cope, altered mood,
depression

13. Harms Relating to Drug Use and
Dependence
 SIDE EFFECTS
 TOLERANCE
 DEPENDENCE
 WITHDRAWAL
SYMPTOMS

14. Tolerance
 After chronic use, the
same amount of drug is
insufficient to cause the
desired effect and thus,
more drug is used.
 A compensatory
response.
Drug Dose
Normal
Tolerance

15. Drugs/ Substances of abuse
 Legal, over-the-counter - Includes drugs like alcohol and nicotine in
cigarettes. Substances in beverages include caffeine. Nicotine gum and
lozenges are medical products used to aid in smoking cessation in adults.
 Legal, prescription - includes drugs like methadone, oxycodone and
Zolpidem, Barbiturates, Benzodiazepines, Amphetamine, Anti-depressants like
alprazolam, midazolam
 Volatile substances - glue sniffing, light fuel, nail polish remover
 Illegal - includes drugs like Marijuana and Opiates (like heroin)

16. Strategies of control of Drug Use &
Dependence
 Primary Prevention
 Secondary Prevention
 Drug Education
 Social Support
 Detoxification
 Rehabilitation
 Harm reduction

17. Role of Pharmacist in Drug Dependence
 Extended opening hours
 Accessibility
 Expert advice
 Confidential service
 Network of service
 Job satisfaction

18. Needle and Syringe Exchange
 Background
 Training
 HBV vaccination

19. NSE Procedure
 Supplying clean, sterile, injecting equipment
 Exchange for used equipment
 Advice
 Check injecting site
 Referral
 Storage and disposal of used equipment
 Maintain supply
 Record keeping and audit

20. Use of Pharmacotherapy
 Substitute drug
 Non-substitute drug
 Harm reduction
 Benefits for individual and society
 Reduce crimes
 Reduce illegal drug usage

21. Role of Pharmacist in Provision of
Pharmacotherapy
 Supervised consumption
 Confidentiality
 Contracts