This document discusses drug abuse, misuse, and control. It begins by defining drug use, misuse, and abuse. It then discusses the definition of rational drug use according to the WHO. Over 50% of drugs are prescribed or used inappropriately. The document outlines various types of drug misuse and their effects. It discusses why people use psychoactive drugs and factors that influence drug choice. Adverse impacts of drug misuse are outlined. The roles of industries, prescribers, patients, and communities in drug misuse are examined. Withdrawal effects and pharmaceutical care approaches are summarized.

1. CONTROL OF DRUG ABUSE & MISUSE

2. TERMINOLOGY
 Drug use: is the term commonly used to refer to
the consumption of psychoactive substances
without medical or health care instruction.
 Drug misuse: refers to drug use that is
problematical and incurs significant risk of harm.
 Drug abuse: essentially refers to the same thing
but its use is less common in recent publications.
Substance is sometimes used in place of drug to
include non-medical chemicals such as solvents,
alcohol and nicotine.

3. DEFINITION OF RATIONAL USE
 “The rational use of drug requires that patients
receive medication appropriate to their clinical
need, in doses that meet their own individual
requirements, for an adequate period of time, and
at the lowest cost to them and their
community.”(WHO 1985)
 More than 50 % of all medications are prescribed,
dispensed or sold inappropriately and not in
accordance with the standard principles. (WHO
1992)
 50 %of patients fail to take their medication
correctly.

4. TYPES OF DRUG MISUSE:
 No drug need: e.g. minor upper respiratory viral
infections in children are treated with antibiotics.
 Wrong drug: e.g. many children with streptococcal
pharyngitis are not properly treated with narrow
spectrumpenicillins. Instead,tetracyclines(broad
spectrum antibiotics) are used.
 Ineffective drug:e.g. use of antimotility agents in acute
diarrhea.
 Unsafe drug: e.g. anabolic steroids for growth and
appetite stimulation of children and athletes, which
increase blood pressure & cholesterol, and cause heart
problems.

5. Underuse of available effective drugs: e.g.
underuse of ORS in diarrhea in children.
Incorrect use of drugs: e.g. one or two days’
supply of an antibiotic, rather than for the full course
of therapy.
Unnecessary expensive drugs: e.g. prescriber’s
individual monetary benefits seed for this problem, or
unnecessary use of a third-generation broad-
spectrum antibiotic, when a first line, narrow-
spectrum antibiotic is indicated.
Unlicensed drug prescribing: e.g. prescribing/use
of unregistered, unsafe drugs.

6. SUBSTANCES THAT ARE USED AND THEIR
EFFECTS

7. WHY DO PEOPLE USE PSYCHOACTIVE DRUGS
 Attainment of pleasureable feelings (e.g relaxation)
 Increased social interaction (e.g reduced
inhibitition)
 Alteration of the person’s psychological condition to
a more desirable state.
 Physical change (e.g anabolic steroids taken by
body builders)
 Avoidance of withdrawal symptoms in someone
who is dependant on drug.

8. CHOICE OF DRUG USED
The decision to use a drug may be influenced by
many things including:
 Availability and opportunity to try
 Legal status of the drug
 Perceived desired effects
 Perceived risks
 Specifically desired effects versus the risks as
weighed up and assessed by the individual
concerned.
 Acceptability of the drug or method of
administration to the individual.

9. ADVERSE IMPACT OF MISUSE OF DRUGS:
 Increased adverse drug reactions (ADRs)
 Use of non-sterile injections leads to transmission
of hepatitis and other blood borne diseases.
 Poor patient outcome
 Patient’s inappropriate reliance on the drugs
 Impact on cost
 Overuse of drugs causes excessive spending
offinancial resources by the patient.
 Expenditure on non-essential pharmaceuticals
like multi-vitamin products, cough mixtures, etc.

10. FACTORS UNDERLYING MISUSE OF DRUGS:
 The health system
 Unreliable supply
 Expired drugs
 Availability of inappropriate drug

11. Such influences result in lack of confidence of the
prescriber, and the prescriber feels obliged to provide
what is available, even if the drug is not correct for the
specific treatment.
Prescriber’s inadequate training.
Lack of objective drug information + drug information
provided by the medical representatives.
Profit may affect a prescriber’s choice if the
prescriber’s income is dependent on drug sales.

12. PATIENT AND THE COMMUNITY:
An individual’s adherence to the treatment depends
upon:
 cultural beliefs (not believing on the health care
system, undergoing traditional treatment or using
strongallopathic medicines )
 Lack of communication skills
 Attitude of the prescriber
 Limited time available for counseling
 Shortage of printed information

13. ROLE OF INDUSTRIES:
 Industries often make misleading claims about their
products. Moreover, promotional activities by
medical representatives also lead to irrational
prescribing.

14. HOW TO AVOID DRUG MISUSE:
Improve patient information
 Patient education for using various dosage forms
(inhalers, nebulizers, suppositories, etc.)
 Use of printed materials
 Use of mass media
 Counseling (active, passive)

15. Role of the prescriber
 Prescribing from EDL(essential drug
list).
 Following standard treatment
guidelines.
 Using unbiased information for drug
use.
 Monitor patients for ADRs.

16. WITHDRAWAL
When a person stops using a substance they are
dependant on, they often experience withdrawal.
There are two types of withdrawal:
 Physical withdrawal effect
 Psychological withdrawal effect

17. PHYSICAL WITHDRAWAL EFFECT
These are physical signs and symptoms experienced
when the drug is removed like:
 Seizures in alcohol withdrawal
 Stomach cramps & severe influenza type
symptoms experienced in opiate withdrawal
 Palpitation & anxiety in cocaine withdrawal
 Insomnia in nicotine withdrawal
These effects can be severe and tend to be of shorter
duration that psychological effects

18. PSYCHOLOGICAL WITHDRAWAL EFFECT
 These are psychological disturbance experienced
when a drug is removed.
 These cannot be easily observed or measured in
the way like that physical withdrawal effects.
Psychological withdrawal effects include:
 Intense craving
 Intense emotional experience like unmasking of
grief, inability to cope, altered mood and
depression, which may be prolonged and severe.
It tend to be of long duration and contributes to
relapse back to drug use.

19. PHARMACEUTICAL CARE
Pharmaceutical care plan includes the role of
pharmacists in drug dependance at community and
hospital level.
1. Community Pharmacists:
Community pharmacists are ideally placed to
contribute to the care of drug users. In addition to
the health gains for the patient, there are several
advantages for drug users, the community and
pharmacists from providing care:
 Extended opening hours: most pharmacies are
open atleast part of the weekend and some
evenings, when specialist drugs services may be
closed.

20.  Accessibility
 Expert advice
 Discretion: pharmacies provide a confidential
service exchange
 Network of services
 Job satisfaction: pharmacist may be the only health
care professional with whom some drug users have
regular contact. Over time, improvements in health
can often be seen in people receiving substitute
therapies, bringing job satisfaction.
 Two most common services of community
pharmacist to prevent and reduce harm are needle
exchange and dispensing services.

21. 2. HOSPITAL PHARMACIST
Hospitals should have guidelines for the admission and
discharge of drug users to ensure that any ongoing
prescribing is continued. There should also be policies and
specialist support available to ensure treatment can be
initiated if a need is identified.
Hospital pharmacists may contribute to the formulation of such
guidelines. The includes:
 Admission: how to ensure safe continuation of substitute
prescribing with attention paid to acute and out of hours
admission.
 Discharge: how to ensure safe continuation of substitute
prescribing on discharge without a break in care or doubling
up of prescribing. Liason with a patients’s nominated
community pharmacist is important.

22.  Initiation of substitute therapy: for e.g if a heroin-
dependant person is admitted to a ward unplanned
via accident and emergency, it will be necessary to
control withdrawal symptoms that onset quickly.
 Appropriate referral to service provider:
guidance on identifying patients at particular risk
and rapid referral from hospital to primary care
services is recommended.

23. ROLE OF PHARMACOTHERAPY
 Evidence showed maintenance doses of substitute
drug treatment improve patient physical health and
mental health outcomes.
 Reduce drug related deaths.
 Improve social functioning.
All who receive pharmacotherapy, especially in the
early stages of treatment may not achieve complete
abstinence from illicit drug use. Ideally
maintainence therapy at an adequate dose may be
necessary, prior to planned detoxification and
aftercare. This maintenance stage may last for
many years.