MBBS curriculum

1. Drug Dependence and Abuse
Dr Nikita

3. Drug???? (WHO)
• Any substance used/ intended to be used
• To modify /explore
• Physiological systems/ Pathological states
• For the benefit of recipients.

4. Common substances abused

5. • Substance / drug – used interchangeably
• Three important terms
Substance INTOXICATION
Substance ABUSE
Substance DEPENDENCE

6. Substance Intoxication
• Unwanted physiological or psychological effects
• that cause maladaptive behaviour
On examination:
Clinically detectable adverse effects

7. SUBSTANCE ABUSE
• Excessive drug use
• Persistent/ sporadic
• Inconsistent with medical practice
• Recurrent and Significant adverse reactions
• Repeatedly in a period of 12 months
• No dependence

8. SUBSTANCE DEPENDENCE
• Cluster of behavioural, cognitive and physiological phenomenon
• Due to maladaptive pattern
• Components :
• Tolerance
• Withdrawal symptoms
when use is reduced/stopped
• Craving
• Despite persistent side effects

9. Two Terms
Drug ADDICTION Drug HABITUATION

10. •Drug Addiction
• PHYSICAL + psychological+ emotional dependency
•Drug Habituation psychological+ emotional dependency
+
ONLY

11. Trait Drug Addiction Drug Habituation
Compulsion to take drug Present
(may resort to crime to even acquire drug)
A psychological desire
But no compulsion
Dose Tendency to increase dose with
time
No such tendency
Dependence Mainly physical Psychological
Withdrawal symptoms Characteristic Symptoms+ None
Pre-occupation with
drug use
Important alternative pleasures given up No such thing
Time spent Activities to acquire the drug Not so
Persistent use despite
harmful effects
+++ -------
Harm Both to individual and society Minimal

12. Types of dependence
1. Morphine type
2. Barbiturate Type
3. Cocaine type
4. Cannabis type
5. Amphetamine type

13. • Drug Abusers Elbow
• Myositis ossificans resulting due to
• repeated needle punctures
• near the elbow in IV drug abusers
• Important autopsy findings

14. Withdrawal Symptoms
• Abstinence Syndrome
• Symptoms with physiological and cognitive components
• Occur when blood concentrations of a substance decline
• In an individual who had earlier maintained high levels

15. Salient features:
• h/o Repeated administration is necessary
• Opposite to the acute effects of the drugs
• Varies with the classes of the drugs

16. Typical withdrawal symptoms
• Start: 6 to 8 Hrs of stopping the drug
may be delayed (depends on the drug)
• Stages:
• 1st stage upto 12 hrs
• intense fear
• Chillness+ cold sensation
• Tachycardia++ sweating ++ lacrimation
• Myalgia
• yawning

17. • 2nd stage : 12- 24 hrs
• Increased bronchial secretions
• Dilated pupils
• Piloerection goose flesh
• Tremors
• Symptoms of 1st stage + 2nd stage  COLD TURKEY

18. • 3rd stage  24 hrs to 10 days
• Increased sleep
• Abdominal pain+++ cramps
All symptoms are maximal at 72 hrs
• Anorexia is present in all symptoms
• Newborns of addicted mothers  show withdrawal symptoms+++

19. Body packer ( Surgical mules)
• Illegal drugs
•  compressed into cylinders of 25 x12 mm
•  heat sealed in plastic film
•  wrapped again in multiple layers of latex
• (condoms, balloons, foil)
•  swallowed
•  drugs such as loperamide is taken
• (decrease gut motility)
• SMUGGLING

20. •  once they reach foreign country
•  take laxatives
•  retrieves the packets
• These packets may not burst
• But due to passive diffusion may have symptoms

22. Body stuffer Syndrome
• Persons arrested swallow illegal drugs
• For concealing the evidence
• Ears/ mouth/ vagina/rectum  “Body pushers”
• May not be well wrapped serious reactions
• Seen on X-ray/ CT

23. Volatile substance abuse
• Huffing - inhaling vapours from a cloth
• Bagging – inhaling and exhaling into a bag that has been filled
• Sniffing – from the neck of a container

25. Narcotic Drugs and Psychotropic Substance Act- 1985
• Latest amendment – 2014
• Prohibits a person to:
• Produce/Manufacture/cultivate
• Possess
• Sell
• Purchase
• Transport
• Store
• Consume
• Any narcotic drug/psychotropic substance

26. Punishment
• Based on the amount of substance kept
• Act has defined the small qty and commercial qty levels for each drug
• Small quantity Rs 10,000/ 1 year Imp
• > small but <commercial qty  Rs 1 Lakh- 2 lakh /10 years imp
• Amendment 2014
• relieved restrictions on important drugs like morphine
• used for pain and palliation

27. Designer drugs/ Party drugs
• Synthetic variations of well-known controlled drugs
• Eg: amphetamine, fentanyl, phencyclidine
• Similar pharmacological effects
• Molecularly different
• MLI cannot be picked up by common chemical tests
 so legally , no scientific evidence

28. Medicolegal Importance
• Contaminated currency and other objects
• Death usually as a result of > 1 drug
• Embolism
• Cirrhosis, HIV
• Homicide-criminal attempts to procure drug
• Increased suicide
• Trauma increased accidents
• Driving under influence- prohibited by s185 (b) of MVA,1988
• Mothers with abuse  children- SIDS

29. THANK YOU