Addiction Medicine Certificate Course by Muktaa Charitable Foundation Course Material by Dr Narayan Perumal Lecture conducted at Aga Khan Palace More material on Fullnasha.com

1. Dr. Narayan Nay Perumal
LET’S TALK ABOUT DRUGS….
Dr Mahajan’s De-Addiction Clinic
OLITO Multi-Speciality Clinic/ RAD Diagnostics
CLEAN ROOM
#ExBox
http://drnay.in

2. WHAT IS DRUGS?

3. TERMS

4. ADDICTIONARY
Abuse – Excessive use
Misuse – Inappropriate use
Use/High – Inebriation
Using – “in” Active Addiction
Recovering – stopped using
Clean = Sober
Substance – any drug including alcohol, prescription drugs
Multi-Addict or Polysubstance – uses more than one
substance

5. WHAT ARE THE DRUGS YOU
KNOW?

6. SOFT DRUG
Soft drugs are not thought to cause
physical addiction.
While they do not cause physical addiction,
some of them may still lead to psychological
dependence.
• Marijuana (Ganja)
• Hashish
• Mescaline
• Psilocybin
• LSD
• Ayahuasca
• Iboga
• DMT

7. HARD DRUG
Hard drugs are drugs that lead to
physical addiction.
• Opiates (Heroin, hydrocodone,
oxycodone, morphine)
• Benzodiazepine (Diazepine, Valium,
alprazolam, clonazepam)
• Flunitrazepam (Rufilin),
• Lorazepam(Ativan),
• methamphetamine (meth)
• Cocaine
• GHB
• Alcohol
• Nicotine

8. HARD DRUGS AND LEGALITY

9. CANNABINOIDS
• Cannabis is a genus of flowering plants which
produces THC (Tetra-Hydro-Cannabinol)
• Almost No OVERDOSE
• Almost No WITHDRAWL
• Psychologically or Habitually Addictive

10. EFFECTS OF THC

11. EFFECTS OF THC
• Effects = “High”
• Euphoria
• Stress reduction
• Increased sensuality
• Heightened Senses
• Increased Appetite =
Munchies
• Increased Libido
• General feeling of well being
• Joviality
• Increased Episodic Memory
• Altered Perception of Space
and Time = Time Shakes
• Tunnel Vision

12. EFFECTS OF THC
• Anxiety
• Introspection
• Paranoia
• Thought Abstraction (which
have no physical basis)
• Thought Aberration (away
from normal thinking)
Symptoms:
• Paranoid ideas
• Thought Broadcasting
• Irrational Thinking
• Hallucinations
• Social Withdrawal
• Aggression
• Depersonalization
• De-realization
• Paranoia

13. CONSUMPTION OF THC
Marijuana=
GANJA=
Maal=
Kalli=
Toke=
Mary Jane=
POT=
WEED
Rolling Paper
Joint

14. CONSUMPTION OF THC
HASH=
Hashish=
Bombay Black=
Manala Cream=
Manali=
Tola=

15. CONSUMPTION OF THC
Pot Cookies
Pot Brownies
Hash Cookies
Hash Cake

16. BHANG

17. VAPING

18. SHIVA’S INDIA

19. • Acute intoxication of cannabis usually resolves unremarkably
within 4-6 hours and is best managed by the following measures:
• Frequent reassurance and maintenance of a nonthreatening environment
• Minimal stimuli
• Use of a specifically assigned nurse to calm the patient
• Judicious use of benzodiazepines when significant anxiety is present.
• Lorazepam is used for acute marijuana-associated panic or anxiety
symptoms.
MANAGEMENT

20. EMERGENCY
• Treatment depends on the clinical presentation, the age of the patient, and
the presence of other legal or illicit substances.
• Immediate management should be supportive, including cardiovascular and
neurological monitoring, and placement in a quiet room.
• Gastric decontamination is rarely indicated, but may be considered in
children younger than 16 years with a large ingestion less than 2 hours
prior to presentation. OR in surgical emergencies
• Patients who are agitated, with psychosis, or with significant anxiety should
be treated with benzodiazepines.
• Lorazepam is used for acute marijuana-associated panic or anxiety
symptoms.
MANAGEMENT

21. Cannabis Withdrawal Syndrome
• Anxiety
• Irritability
• Depressed mood
• Restlessness
• Disturbed sleep
• G-I symptoms and decreased appetite.
Most symptoms begin during the first week of abstinence and resolve after a
few weeks.
MANAGEMENT

22. MANAGEMENT
DEPENDING ON SEVERITY OF WITHDRAWAL SYMPTOMS
(Bioavailability of THC differs from person to person with age, sex, weight etc. No
correlate has been found between impairment and usage)
• Nefazodone (450mg/day OD) - Improved anxiety
• Fluoxetine (20-40mg/day Morning) - Reduced cannabis use *
• Rimonabant (90 mg/day) - Attenuated effects of cannabis (Banned in US & UK)
• Entacapone (200mg/day) - Reduced craving
• Buspirone (60mg/day) - Reduced craving and irritability
• Lithium (500mg/day) - Reduced cannabis use
• Anti-psychotics for managing underlying thought disorders in long time cannabis abuse
• Divalproex, Bupropion, Naltrexone WORSENS withdrawals.

23. GANJA PSYCHOSIS
Spiked/Laced – Adding substances
without the user’s knowledge

24. OPIODS
Opium (poppy tears) is the dried latex obtained from
the opium poppy

25. EFFECTS OF OPIOIDS
“आँख बंद,
मुंह खुला
…….गर्ुुला”
“CHEMICAL HOOKS”

26. EFFECTS OF OPIODS

27. CONSUMPTION OF OPIOIDS
Brown Sugar=
Brown=
Garad=
Smack
Heroin=
Purer form of
Brown Sugar

28. CONSUMPTION OF BROWN
SUGAR/ HEROIN
“Chasing” or
“Chasing the Dragon”
“Spot Chasing”
“Panni” or Foil
“Chaser”

29. CONSUMPTION OF BROWN
SUGAR
Brown + Distilled Water+ Inj. Avil+ Inj. Vit C
“Shooting/Shoot”
“Fixing/Fix”

30. CONSUMPTION OF BROWN
SUGAR
Smoking it –
“Loading” in cigarettes

31. WITHDRAWAL FROM BROWN SUGAR/ HEROIN
Increased sweating, lacrimation, rhinorrhoea, urinary frequency Diarrhoea,
abdominal cramps, nausea, vomiting Muscle spasm leading to headaches, back
aches, e.g. cramps, twitching, arthralgia Piloerection, pupillary dilatation,
elevated blood pressure, tachycardia Anxiety, irritability, dysphoria, disturbed
sleep, increased cravings for opioids
Do not Inject Naltrexone UNLESS IT’S A OVERDOSE
MANAGEMENT

32. MANAGEMENT

33. MANAGEMENT

34. MANAGEMENT

35. MANAGENENT

36. MANAGEMENT

37. HARM REDUCTION
• Needle Exchange Program
• Safe Injection Sites (SIS) or Drug Consumption Rooms (DCR)
• Opioid Replacement Therapy – Buprenorphine
• Methadone Clinic
• Heroin Maintenance Program
MANAGEMENT

38. • Clonidine (Tapering)
• Benzodiazepams
• NSAIDS
• Anti-Psychotics – Olanzapine
• Anti-Depressants – SSRI
• Injectable Tramadol Abuse reduce by 10% each day
TRAMADOL

39. MANAGEMENT

40. CODEINE

41. CODEINE

42. CODEINE

43. PRESCRIPTION MEDICINE ABUSE

44. EFFECTS

45. GLUE SNIFFING
Fevi-Bond
Paint Thinners/ Petrol/ Inhalants
“Huffing” “Bagging” “

46. • Slurred Speech
• Motor Incoordination
• Nausea, Vomitting
• Loss of Appetite
• Emotional Blunting
• Impaired Short Term Memory
EFFECTS

47. GLUE SNIFFING
NOT
A
GATEWAY
DRUG
BUT A
GET-AWAY
DRUG

48. COCAINE
Cocaine is a crystalline
alkaloid that is obtained from
the leaves of the coca plant.

49. • Stimulant of the Central Nervous System
• Increases Mental Alertness
• Feelings of well-being
• Momentary Euphoria
• Increased Energy
• Increased motor activity
• Increased feelings of competence
• Enhanced sensuality
• Restlessness
• Anxiety
• Paranoia
EFFECTS

50. EFFECTS
GLAMOUROUS
DRUG

51. CONSUMPTION OF COCAINE
Powder Cocaine=
Snow=
White=
Coca=
Coke
“Snorting”
“Lines”

52. CRACK COCAINE
Baking Soda +
Cocaine or
Lignocaine =
Crack Cocaine
“Free Basing”
• Smoked in Crack Pipes or Bongs
• More Addictive than Powder
• Effects Last Longer

53. CONSUMPTION OF COCAINE
“Freezing” – Applying cocaine to gums
“Coca-puff” – Cocaine in Cigarette

54. SPEED BALL
• Cocaine + Heroin
• Can be a cocktail of drugs
• Upper (Stimulant) + Downer (Depressant)
• Quick Tolerance
• Greater chances of Overdoses and deathIntravenous
Snorting/ Insufflation
Oral

55. MEPHEDRONE (MD)
Mephedrone is
a synthetic stimulant drug of
the amphetamine and cathinone classes.
MD, drone,M-CAT,[White Magic[
and meow meow

56. MD
• Was available online, recently banned in July 2012
• Many spurious products available as MD locally

57. EFFECTS

58. MD EPIDEMIC

59. • EMERGENCY – NO KNOWN ANTIDOTE
• Supportive Care
• Antipsychotics
• Check for Hyperthermia
MANAGEMENT

60. SPASMOPROXYVON
Dicycloverine/dicyclomine
• Relieves GI muscle spasms
• nonselective smooth
muscle relaxation,
• anticholinergic side effects

61. • Supportive / Symptomatic Treatment
• Psychological Help
MANAGEMENT
Other Prescription Medicines Widely Abuse:
• Fentanyl
• Nitrosun
• Modafinil
• Ketamine

62. DARK WEB / DARK NET
MARKETPLACE
Dark Web - the part of the World
Wide Web that is only accessible
by means of special software,
allowing users and website
operators to remain anonymous
or untraceable.

63. PARTY DRUGS

64. ECSTACY
E=
XTC=
Ezee=
Contains MDMA
Empathogenic Drug

65. MDMA
• Psychedelic Amphetamine
• MDMA is used less frequently than other stimulants
• typically less than once per week
• Mixed with water and sipped
• Also called Molly
• “Entactogenic” - increased empathy or feelings of closeness with others
• increased empathy or feelings of closeness with others
• Visual Distortions
• Increased emotionality
• infantile ideas
• Increased self-confidence, sociability and feelings of communication being easy or simple

66. • Bruxism (grinding and clenching of the teeth)
• Dehydration
• Insomnia
• Tachycardia
• Erectile Dysfunction
• Trismus or Lock Jaw
• Teratogenic
EFFECTS

67. LSD

68. THE LSD EXPERIENCE
• also known as acid, is a psychedelic drug
• animated sensory experience of
senses, emotions, memories, time,
and awareness for 6 to 14 hours, depending on
dosage and tolerance
• within 30 to 90 minutes after ingestion, the user
may experience anything from subtle changes in
perception to overwhelming cognitive shifts.
• “TRIPS” – Psychedelic Experience
• Auditory Distortions
• Synaesthesia
• Additional spatial or temporal dimensions

69. LSD EFFECTS

70. CONSUMPTION
“Blots or Blotter”

71. CONSUMPTION
“Drops”
Cubes
Comes in “powers” – doses
400 micrograms
800 micrograms
1200 micrograms
1600 micrograms
Increasing does not
prolong the effect but
intensifies it.

72. CONSUMPTION
“Microdots”
“Gels”

73. MANAGEMENT
Chlorpromazine (CPZ) “cuts” or
Stops LSD trip
Deaths are due to anxiety attack
Or accidental deaths involving
high places or road traffics

74. MAGIC MUSHROOMS

75. DMT /AYAHUASCA
Extreme Hallucinogens
“Spirit Molecules”

76. EFFECTS

77. NDPS ACT The Narcotic Drugs and Psychotropic Substances Act,1985,
were enacted with stringent provisions to curb this menace. The Act envisages
a minimum term of 10 years imprisonment extendable to 20 years and fine of
Rs. 1 lakh extendable up to Rs. 2 lakhs for the offenders.
LAW & DRUGS

79. Drug Small quantity Commercial quantity
Amphetamine 2 grams (0.071 oz) 50 grams (1.8 oz)
Charas 100 grams (3.5 oz) 1 kilogram (2.2 lb)
Cocaine 2 grams (0.071 oz) 100 grams (3.5 oz)
Ganja 1 kilogram (2.2 lb) 20 kilograms (44 lb)
Heroin 5 grams (0.18 oz) 250 grams (8.8 oz)
LSD 2 milligrams (0.031 gr) 100 milligrams (1.5 gr)
Methadone 2 grams (0.071 oz) 50 grams (1.8 oz)
Morphine 5 grams (0.18 oz) 250 grams (8.8 oz)
Opium 25 grams (0.88 oz) 2.5 kilograms (5.5 lb)
LAW IN INDIA
Anyone who contravenes the NDPS Act will face punishment based on the quantity of the banned substance.
•involves a small quantity, with rigorous imprisonment for a term which may extend to 1 year, or with a fine which may extend
to ₹10,000 (US$160) or both;
•a quantity lesser than commercial quantity but greater than a small quantity, with rigorous imprisonment for a term which may extend to 10 years
and with fine which may extend to ₹1 lakh (US$1,600);
•a commercial quantity, with rigorous imprisonment for a term which shall not be less than 10 years but which may extend to 20 years and also a
fine which shall not be less than ₹1 lakh (US$1,600) but which may extend to ₹2 lakh
•Repeat offenses upto 30 years

80. DRUG COURTS