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An Overview of Drug Dependence. S. Casey Laizure, PharmD Associate Professor of Clinical Pharmacy University of Tennessee Memphis,TN. Commonly Abused Drugs. Alcohol Cigarettes Benzodiazepines and barbiturates Opiates Cocaine and other stimulants Hallucinogens Inhalants Marijuana.

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An overview of drug dependence

An Overview of Drug Dependence

S. Casey Laizure, PharmD

Associate Professor of Clinical Pharmacy

University of Tennessee

Memphis,TN


Commonly abused drugs
Commonly Abused Drugs

  • Alcohol

  • Cigarettes

  • Benzodiazepines and barbiturates

  • Opiates

  • Cocaine and other stimulants

  • Hallucinogens

  • Inhalants

  • Marijuana


Societal costs
Societal Costs

  • Lost productivity

  • Motor vehicle accidents

  • Medical costs

  • Crime

  • Legal drugs (alcohol and cigarettes) have the highest societal costs

  • Alcohol abuse and alcoholism cost society an estimated 148 billion dollars annually


Definition of terms
Definition of Terms

  • Drug misuse- inappropriate use of drug intended for therapeutic purpose

  • Drug abuse- use inconsistent with social norms with the intent of altering mood

  • Drug addiction or dependence- compulsive drug use

  • Physical dependence- abrupt discontinuation will cause withdrawal reaction


Definition of terms cont
Definition of Terms (cont.)

  • Drug tolerance- physiologic adaptation to drug effects

  • Withdrawal or abstinence syndrome- characteristic symptoms occurring after abrupt discontinuation

  • Alcohol dependence, alcohol addiction, and alcoholism are synonyms


Dsm iv criteria substance dependence
DSM-IV Criteria: Substance Dependence

3 must be present in last 12 months

  • Tolerance

  • Withdrawal

  • Substance taken in larger amounts or over longer period than intended

  • Persistent desire or unsuccessful efforts to decrease use

  • Significant time spent acquiring drug or recovering from its effects

  • Drug use displaces normal social, recreational, or work activities

  • Continued use despite negative consequences


Symptoms of alcohol intoxication
Symptoms of Alcohol Intoxication

  • Slurred speech

  • Ataxia

  • Sedation

  • Loquacity

  • Psychomotor retardation

  • Mood changes

  • Euphoria



Symptoms of opiate intoxication
Symptoms of Opiate Intoxication

  • Apathy

  • Slurred speech

  • Miosis (pathognomonic for mu agonists)

  • Constipation

  • Euphoria/Dysphoria

  • Psychomotor retardation


Symptoms of opiate withdrawal
Symptoms of Opiate Withdrawal

  • Lacrimation

  • Diarrhea

  • Rhinorrhea

  • Fever

  • Piloerection

  • Muscle aches

  • Diaphoresis

  • Mydriasis


Symptoms of cocaine intoxication
Symptoms of Cocaine Intoxication

  • Euphoria

  • Hypervigilance

  • Motor agitation

  • Tachycardia

  • Mydriasis

  • Loquacity

  • Grandiosity

  • Elevated blood pressure

  • Sweating

  • Nausea and vomiting

  • Cardiotoxicity

  • Seizures


Symptoms of cocaine withdrawal
Symptoms of Cocaine Withdrawal

  • Fatigue

  • Sleep disturbance

  • Anhedonia

  • Depression

  • Increased appetite


Treatment of intoxications
Treatment of Intoxications

  • All (supportive)

  • Benzodiazepines (flumazenil)

  • Alcohol (none)

  • Opiates (naloxone)

  • CNS stimulants (lorazepam/haloperidol)

  • Hallucinogens (lorazepam/haloperidol)


Alcohol detoxification
Alcohol Detoxification

  • GABA agonists used to prevent withdrawal

  • Commonly used medications

    • Chlordiazepoxide

    • Lorazepam

    • Phenobarbital


Alcohol detoxification1
Alcohol Detoxification

  • Vitamins

    • Alcoholics commonly thiamine and folate deficient

    • Megaloblastic anemia is a common finding

      • Thiamine 100 mg qday

      • Folic acid 1 mg qday

      • Multivitamin qday

    • Cyanocobalamin 100ug IM X 1


Alcohol detoxification2
Alcohol Detoxification

  • Other

    • Acetaminophen prn headache

    • Kaolin/pectin or aluminum hydroxide prn diarrhea

    • Magnesium hydroxide prn constipation

    • Promethazine IM or PO prn nausea and vomiting


Benzodiazepine detoxification
Benzodiazepine Detoxification

  • Carbamazepine

    • 200 mg b.i.d., Increase until level therapeutic, 8-12 ug/ml

  • PRNs

    • Vitamins

    • Lorazepam, clonazepam or other benzodiazepine if withdrawal symptoms cannot be controlled with carbamazepine


Opiate detoxification
Opiate Detoxification

  • Clonidine

    • Decreases sympathetic outflow from central nervous system

    • Monitor heart rate and blood pressure carefully

  • Methadone

    • If withdrawal symptoms not controlled by clonidine alone

    • Patient should not know methadone dose – crush tablets and mix in liquid


Opiate detoxification1
Opiate Detoxification

  • Other

    • Ibuprofen prn for increased temperature and muscle aches

    • Methocarbamol prn for muscle cramps

    • Kaolin/pectin prn for diarrhea

    • Promethazine IM or PO prn for nausea and vomiting


Cocaine detoxification
Cocaine Detoxification

  • No specific treatment


Treatment of drug dependence
Treatment of Drug Dependence

  • Behavioral (12 step)

    • first-step - admit they can't control drug use, that their life has become unmanageable

  • Cognitive

    • coping mechanisms to avoid drug seeking

  • Pharmacotherapy

    • Drugs to reduce craving


Pharmacotherapy for drug dependence
Pharmacotherapy For Drug Dependence

  • Use of pharmacotherapy should be accompanied by behavioral therapy and/or teaching of copping skills

  • Only alcohol dependence is commonly treated with adjunctive pharmacotherapy


Pharmacotherapy for alcohol dependence
Pharmacotherapy for Alcohol Dependence

  • Disulfiram

    • Aversive - N/V, palpitations, flushing, H/A, sweating, hypotension if alcohol consumed

    • Normal dose 250 – 500 mg per day

  • Naltrexone

    • Reduces drinking amount on relapse

    • Normal dose 50 mg per day


Pharmacotherapy for other drug dependencies
Pharmacotherapy For Other Drug Dependencies

  • Opiates

    • Naltrexone: an opiate antagonist that blocks the effects of exogenously administered opiates

  • Benzodiazepines

    • Carbamazepine in doses to achieve concentrations of 8-12 ug/mL

  • Cocaine

    • Desipramine

    • Bromocriptine to reduce craving


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