Control of Drug Abuse and Misuse

WHAT ARE DRUGS?

Any substance other than food that is taken or administered
to induce a particular physiological changes in a body for
the treatment, cure, diagnosis, mitigation, prevention or
promotion of well-being. Agents used for the above
mentioned functions are also called medications or
medicines among other names.
 All medicines are drugs, but not all drugs are
medicines.
Some drugs are used for pleasure rather than
medicinal purposes. These drugs are not
medicines and are better called club drugs or
recreational drugs. They are illegal drugs and
mostly drug of addiction
Rational Use of Drugs/Medicines
“Patients receive medications
appropriate to their clinical needs,
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)
 Safe
 Effective
 Appropriate
 Economic
 Recommended
 Drug abuse and Misuse
Drug Abuse:
It is referred to consumption of any psychoactive substance
without medical or health care instruction.
Drug Misuse:
Inappropriate use of medications (either prescription or
nonprescription or OTC drugs).
Use of a legal prescription medications for a purpose other
than the prescribed reason or taking a non prescribed drug is
called a misuse of a drug.
Drug Misuse can include taking a drug in a manner or at a dose
not recommended by a health care professional. This can
happen when the person hopes to get a bigger or faster
therapeutic response from medications such as sleeping or
weight loss pills.
 Drug Misuse
 Drugmisuse refers to the use of a substance for
a purpose that is not consistent with legal or
medical guidelines, most often with
prescription medications. This could mean
taking more than what is prescribed, or taking
a medication that was not prescribed. Taking
medicines in very large quantities that are
dangerous to your health is also an example of
drug misuse.
Common Drugs Misuse
• Paracetamol
• Sleeping pills
• Antibiotics
• Benzodiazepines
• Non benzodiazepines
• Anti Rheumatic
• Barbiturates
 How to avoid misuse of drug?

• Talk to your Pharmacists about your medicine

• Don’t pass down drugs from one family or friends to another
• Complete your dosage regimen
• Receive medical advice from only healthcare Professionals.
• Avoid self-medication
 How drugs are misused
 According to the Institute for Safe Medication  Practices,
prescription drug misuse can include: taking the
incorrect dose; taking a dose at the wrong time;
forgetting to take a dose; stopping medicine too soon.
The FDA stresses that both misuse and abuse of
prescription drugs can be harmful and even life-
threatening.
 List of substances that are abused/misused

Common name Active agent Route of Effect on CNS Desired effect Unwanted
administration effects/harms

Lysergic acid Orally dissolved Hallucinogenic Hallucination, Panic attacks,

on the tongue detachment from psychosis,
reality tachycardia
Ethanol Drinks (wines, CNS depressant Relaxation, Aggressive mood,
spirits etc.) ↑social interaction diuresis, cirrhosis,
hypoglycemia
Caffeine Caffeine Orally in drinks CNS stimulant ↑ alertness % Diuresis,
stamina, combat insomnia, anxiety,
fatigue headaches
Cannabis Delta-9- Hashish (resin)/ CNS depressant Relaxation, Anxiety, sedation,
tetrahydrocannabi marijuana smoked enhances mood, tachycardia, lung
nol (THC) sociability disorder
 Continue…..

Ecstasy 3,4- Oral tablet esp. in CNS stimulation, Physical & mental Sweating,
methylenedioxyme parties hallucigenic stimulation, tachycardia,
thamfetamine sociability headache, dry
(MDMA) mouth
Heroin Diamorphine Vapor inhalation CNS depressant Euphoria, n/v, sweating,
after heating on detachment from drowsiness, resp.
foil/ I/V emotional distress depression hypoxia
Tobacco Nicotine Smoking/ chewing CNS stimulation Mood elevation, Cancers, CV
relaxation disorders, cough

Cocaine Cocaine Nasal CNS stimulation Euphoria, Cardiac toxicity,

hydrochloride administration, inj, ↑confidence palpitations
psychosis
Speed Amphetamine Nasal, oral I/V CNS stimulation Physical & mental Tachycardia, HTN,
stimulation, Paranoia,
 Drug Abuse
It is referred to consumption of any psychoactive substance without medical or
health care instruction.

Drug abuse is a more repetitive and willful habit of taking drugs for the purpose of
pleasure, ecstasy and euphoria but does not include the repeated use of drugs for
therapeutic purposes. Drug abuse is mostly related to an individual’s intentions
or motivations. For example, let ’s say that a person knows that he will get a
pleasant or euphoric feeling by taking the drug, especially at higher doses than
prescribed. That is an example of drug abuse because the person is specifically
looking for that euphoric response. With time drug abuser gets addicted.
 Substanceabuse
 A maladaptive pattern of use of a substance

 Compulsive, excessive, and self-damaging use of drugs or substances

 Excessive use from a harmful drug (Overuse)
 psychoactive drugs or performance enhancing drugs for a non-therapeutic or non-medical
effect
Commonly Abused
Drugs
• Alcohol
• Cocaine
• Marijuana
• Nicotine
• Methamphetamine
• Morphine, etc.
 Terminologies commonly used in
Drug Abuse and Misuse
Substance:
Substance is sometimes used in place of drug to include
non-medical chemicals such as solvents like ethanol.
Drug User:
Drug user term is commonly used to refer someone who
participate in drug or substance use.
Drug Misuser:
Refers to someone under taking the drug use in such a way
that is problematical and presents a significant risk/ harm
related to its behavioral, social, physiological and
pathological conditions.
 Recreational Drug Use
 The use of a drug, usually psychoactive, with the intention of creating or enhancing
recreational experience.
 Often being considered to be also drug abuse, and it is often illegal.
 Also, it may overlap with other uses, such as medicinal (including self medication),
performance enhancement, and entheogenic (spiritual).
Responsible Drug Use
 A harm reduction strategy based on a belief that illegal recreational drug use can be
responsible in terms of reduced or eliminated risk of negative impact on the lives of
both the user and others.
 Drug Abuse and Misuse
Tolerance:
Need of a dose in higher amounts in order to achieve a therapeutic Normal
response. Tolerance may be developed due to saturation of drug
particles at the receptor site. After chronic use, the same amount of Tolerance
drug is insufficient to cause the desired effect and thus, more drug is
used.
Dependence: DRUG DOSE
A state characterized by sign and symptoms frequently the opposite of those
caused by the drug when it is withdrawn from use or when the dose of the
drug is abruptly lowered. 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.”
Addiction:
Addiction is a brain disorder characterized by compulsive drug using behavior
in which the person uses the drug for its personal satisfaction. Addiction is a
psychological and physical inability to stop consuming a chemical, drug,
activity, or substance.
 Drugs/ Substances of abuse
Most commonly abused OTC drugs are cough and cold remedies
containing Dextromethorphan .
 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 - Prescribed medicines including
painkillers, sleeping tablets, and cold remedies etc. drugs
lincluded in this category include methadone, oxycodone and
Zolpidem, Barbiturates, Benzodiazepines, Amphetamine,
Anti-depressants like alprazolam, midazolam.
 Volatile substances –glue sniffing, light fuel, nail polish
remover, aerosols, gases and volatile solvents such as Alcohol.
 Illegal - includes drugs Tobacco, Marijuana and Opiates
(like heroin) and Khat (a leaf that is chewed over several hours)
Factors Underlying Drug Abuse or Misuse
 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
 Legalstatus of drug
 Perceived benefits weighed up against risks
Control and Dependence
 Neurological control
 Person loses control over drug consumption
 Drug consumption controls the person
 Social deprivation

Identification of person upon drug abuse

 From appearance
 Body language
 Non communicable behavior
 They cover their body (Tight clothes)
 Fowl smell from body
 Reasons for using psychoactive drugs

 To fulfill needs or desires

 For involvement in social circles
 For activation or hyperactivation
 Anabolic steroids to look beautiful
 To improvement of physical appearance
 For relaxation of stress
 Adverse impact of drug abuse
 Health problems
The use of psychoactive drug may leads to both physical and physiological
health problems. Alterations in Mood, Mental Cloudiness, Confusion,
Inability to Sleep or Excess Sleep, Alterations in behavior, Erratic Behavior,
Hygiene and appearance, Suicidal attempt, Addictions ( long term use )
and DEATH are the most commonly reported side effects of drug abuse.
Infecting drug use is associated with damage to circulatory system and
infection like Hepatitis B, C and AIDS.
 Social problems
Social problems may include poverty (due to spending of money on drugs),
social deprivation, damage to relationships, difficulty in forming relations
and exclusion or failure in education and homelessness.
 Drug-related crimes
Drug-related crimes includes Drunk driving, Violence associated with
drunkenness, Criminal activities for drug acquisition and Robbery Drug-
related crimes greatly effects the community and society on large scale.
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
Strategies of control of Drug Use &
Dependence
 Primary Prevention
 Secondary Prevention
 Drug Education
 Social Support
 Detoxification

 Rehabilitation

 Harm reduction
Role of Pharmacist in controlling drug
abuse
Pharmacist perform following necessary roles
in controlling drug abuse
Prevention from drug dependence
Identification of drug abusers
Counseling of drug abusers
Rehabilitation of drug abusers
 Role of Pharmacist in management of drug
dependence

 Pharmacistmanage drug dependence in

three processes:
 Primary prevention
 Secondary prevention
 Tertiary prevention
 Role of Pharmacist in management of
drug dependence
Primary prevention:
 Primary prevention is concerned with preventing people from
starting to use elicit drugs. Target groups include children,
school, college and university students and those children who
left their education. Discouraging bad habits like smoking.
Secondary prevention:
 It is aimed at people who use drug. Doing counseling and
discouraging further use
 Drug education and prevention campaigns
 Distributing drug leaflets, booklets, videos and posters
 Motivational interviewing
Role of Pharmacist in management of
drug dependence

Tertiary prevention:
 May include a detoxification process
followed by a period of social support and
intensive psychotherapy to facilitate
positive sustained change. It is applied on
drug abusers to support in shifting into
healthy life style.
 Pharmacist's contribution to the management
of drug misuse
 The scope of substance abuse–related responsibilities of
pharmacists varies greatly & is mainly divided into
 Prevention
 Education &
 Assistance

To support this proposal the following points are put forward:

 Community pharmacists should provide dispensing services to drug
addicts
 Thepharmacist should direct the enquirer to the appropriate expert
agency.
 Pharmacist's contribution to the management of drug misuse
Prevention
1. Participating in or contributing to the development of substance abuse prevention and assistance programs
within healthcare organizations.
2. Participating in public substance abuse education and prevention programs (e.g., in primary and secondary
schools, colleges, churches, and civic organizations) and stressing the potential adverse health consequences
of the misuse of legal drugs and the use of illegal drugs.
3. Opposing the sale of alcohol and tobacco products by pharmacists and in pharmacies.
4. Working with local, state, and federal authorities in controlling substance abuse, including i) participation in
state prescription drug monitoring programs, ii) participation in appropriate prescription disposal programs,
iii) controlled-substance reporting program , iv) and cooperating in investigations involving the misuse of
controlled substances.
5. Working with medical laboratories to (a) identify substances of abuse by using drug and poison control
information systems, (b) establish proper specimen collection procedures based on knowledge of the
pharmacokinetic properties of abused substances, and (c) select proper laboratory tests to detect the
suspected substances of abuse and to detect tampering of samples.
6. Discouraging prescribing practices that enables, promotes and fastens the drug abuse behavior (e.g.,
prescribing a larger quantity of pain medication than is clinically needed for treatment of short-term pain).
7. Collaborating with outpatient and ambulatory care providers to prevent substance abuse after discharge
Pharmacist's contribution to the management of drug misuse
Education
Pharmacists should participate in substance abuse education by performing the following activities:
1. Providing information and referral to support groups appropriate to the needs of people whose lives are
affected by their own or another person’s substance abuse or dependency.
2. Providing recommendations about the appropriate use of mood-altering substances to healthcare
providers and the public, including those persons recovering from substance dependency and their
caregivers.
3. Fostering the development of undergraduate and graduate college of pharmacy curricula and pharmacy
technician education on the topic of substance abuse prevention, education, and assistance.
4. Providing substance abuse education to fellow pharmacists, other healthcare professionals, and other
employees of their healthcare organization.
5. Instructing drug abuse counselors in drug treatment programs about the pharmacology of abused
substances and medications used for detoxification.
6. Promoting and providing alcohol risk-reduction education and activities.
7. Maintaining professional competency in substance abuse prevention, education, and assistance through
formal and informal continuing education.
8. Providing postgraduate training in addictions, pain management, and palliative care where feasible.
9. Conducting research on substance abuse and addiction.
10. Educating patients about the correct storage, handling, and disposal of prescription medications.
Pharmacist's contribution to the management of drug misuse
Assistance
Pharmacists should be involved in substance abuse assistance by performing the following activities
1. Assisting in the identification of patients, coworkers, and other individuals who may be having problems related to their
substance abuse, and referring them to the appropriate people for evaluation and treatment.
2. Participating in multidisciplinary efforts to support and care for the healthcare organization’s employees and patients who
are recovering from substance dependency.
3. Supporting and encouraging the recovery of health professionals with alcoholism or other drug addictions. Major elements of
an employer’s support program might include (a) being willing to hire or retain employees, (b) participating in monitoring
and reporting requirements associated with recovery or disciplinary contracts, (c) maintaining an environment supportive of
recovery, (d) establishing behavioral standards and norms among all employees that discourage the abuse of psychoactive
substances, including alcohol, and (e) participating in peer-assistance programs.
4. Collaborating with other healthcare providers in the development of the pharmacotherapeutic elements of drug
detoxification protocols.
5. Providing pharmaceutical care to patients being treated for substance abuse and dependency.
6. Maintaining knowledge of professional groups (e.g., state- and national-level pharmacist recovery networks) and other local,
state, and national organizations, programs, and resources available for preventing and treatin substance abuse (appendix).
7. Refusing to allow any student or employee, including health professionals, to work, practice, or be onsite for rotations
within the healthcare organization while his or her ability to safely perform his or her responsibilities is impaired by drugs,
including alcohol. The refusal should follow the organization’s policies and procedures, the principles of ethical and
responsible pharmacy practice, and statutory requirements. Practice should not be precluded after appropriate treatment
and monitoring, if approved by the treatment provider or contract monitor (or both, when applicable).
 Pharmacist's contribution to the management
of drug misuse
while dispensing controlled drugs to persons prescribed
these drugs in treatment for drug addiction. This
interaction in itself could provide an opportunity for
the provision of information on general healthcare and
specific advice on minimizing health risks associated
with substance misuse.
The health care professional should talk to a patient about
all of the warnings and precautions listed in the drug
label for the medication being prescribed. In addition, if a
medication guide is available, it will explain the risks of
the drug in plain language. The pharmacy will provide the
medication guide when a person picks up the
prescription.
 Pharmacist's contribution to the
management of drug misuse
FDA also recommends that patients be vigilant when it comes to
matters of their health. Reading information and asking questions
are good practices, though they are only the first steps. For instance,
individuals may not realize they are developing a drug abuse
problem with a prescription drug, especially if they were initially
using the drug as directed when they were patients. Health care
professionals should encourage patients to be aware of early signs of
drug abuse, which can include using the prescription more
frequently or at higher doses, but without medical direction to do so.
Using the drug compulsively or not being able to carry out normal
daily activities because of drug misuse are also signs of abuse. Finally,
health care professionals and pharmacists have a responsibility to
remind patients not to share their medications with friends or family.
Not only is this a dangerous practice health-wise, it is also illegal.