Other Substance Use Disorders
Other Substance Use Disorders
%
THC
time
https://www.drugabuse.gov/publications/drugfacts/marijuana
Synthetic
• Pharmaceutical preparation for research and
clinical purposes
• Some of them are
1. Dronabinol/ Marinol- 1985, oral FDA approved
(1st)
2. Cesamet/ Nabilone- more potent than THC
3. Cannador- capsule , 2:1 ( THC:CBD)
4. Nabiximols/ Sativex- oromucosal spray, 1:1
5. Epidiolex- 99% CBD, undergoing research, may
soon be in the market
Cannabis “raw materials”
cannabidiol oil
hashish (~2-20%)
hash oil, marijuana concentrate (40-80%) Photo Source: www.dea.gov and cureepilepsy.org
Route of Administration
• Inhalation (smoking, vaporizing)
– onset: immediate
– bioavailability: 20-37%
Source:http://www.doh.wa.gov/YouandYourFamily/Tobacco/OtherTobaccoProducts/ECigar
ettes
Source:http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm
Route of Administration
• Oral
– Onset: 30-60 minutes
– Bioavailability: 10-20%
• Oro-mucosal: similar to oral; highly variable
Source: www.containerstore.com
Source: www.dea.gov
Route of Administration
• Topical
– Onset: ? ~1-2h
– Bioavailability: ?
• Bypasses first pass
• Crossing aqueous layer is the rate limiting step,
then perfuses well
Threshold for
respiratory
depression
Partial Agonists:
Buprenorphine
Antagonists: Naltrexone,
naloxone
0
Drug
Dose
Physiological factors
• Four major subtypes of opioid receptors: μ, κ
, δ and Orphan receptor
• μ receptor causes:
• Analgesia,
• Euphoria,
• Respiratory depression,
• Drowsiness, Decreased ability to
concentrate
• Itching,
• Reduced blood pressure,
• Miosis
• constipation
• κ-opioid receptor
analgesia, sedation, Miosis,
dysphoria, Psychomimetic
symptoms
• δ-opioid receptor
analgesia, may also associated with mood
change
• Orphan receptor
now commonly designated OFQ/N- analgesic
and pro-nociceptive
Routes of Abuse
• Oral: Codeine containing cough syrups
(Corex, Dextropropoxyphene, phensidyl)
(spasmoproxyvon)
Raw opium (afim)
khus-khus, poppy
seeds
• Parenteral: Heroin , Morphine, Pethidine,
Buprenorphine(tidigesic,
norphine), Pentazocine (fortwin),
• Chasing: Heroin (brown sugar)
CLINICAL MANIFESTATIONS
• Analgesia
• Sedation
• Euphoria
• Dry skin, mouth, ⇩urine
• Constipation
• During overdose/intoxication- coma,
respiratory depression, pinpoint pupils
• May also frothing at mouth, fall in BP,
cardiac arrhythmias
•Withdrawal
• In less severe cases or early in withdrawal-
dysphoria, irritability, restlessness, and general
achiness; craving, anxiety, dysphoria, yawning,
perspiration, lacrimation, rhinorrhoea, and restless
and broken sleep
• In more severe cases or as the syndrome
progresses- dilated pupils,
piloerection/gooseflesh/cold turkey and hot and
cold flashes with visible diaphoresis
• In severe syndromes, the patient may also
experience nausea, vomiting, diarrhoea, fever
(usually low grade), and increased blood pressure,
pulse, and respiratory rate
Intoxication (overdose)
• medical emergency
• Ensure airway, clear secretions
• two approved opioid antagonists
(naloxone, nalmefene)
• Naloxone – 0.8 mg/70 kg body wt IV,
repeat if required
• Nalmefene – single dose 0.5 – 1 mg IV –
longer duration of action – prolonged
withdrawal
Withdrawal (detoxification)
• 3 medications approved: Methadone, LAAM,
and buprenorphine
• Other off label
1. Clonidine based
2. Clonidine-naltrexone for rapid Detoxification
3. Ultrarapid Detoxification
4. Tramadol based
Three FDA-approved medications are commonly used
to treat opioid addiction:
• Methadone – Prevents withdrawal symptoms and reduces cravings
in people addicted to opioids. It does not cause a euphoric feeling
once patients become tolerant to its effects. It is available only in
specially regulated clinics.
• Buprenorphine – Blocks the effects of other opioids, reduces or
eliminates withdrawal symptoms and reduces cravings.
Buprenorphine treatment (detoxification or maintenance) is
provided by specially trained and qualified physicians, nurse
practitioners and physician assistants (having received a waiver
from the Drug Enforcement Administration) in office-based
settings.
• Naltrexone – Blocks the effects of other opioids preventing the
feeling of euphoria. It is available from office-based providers in pill
form or monthly injection.
Inhalants
• Easily available
• Very cheap
• Highly addictive
• Causes many psychological and behavioral
problems
• Tip of the iceberg
INHALANTS-
CATEGORIE
S
• Synthetic cannabinoids
• Synthetic cathinones
Blue Silk
Cloud Nine
Ocean Snow
Lunar Wave
Vanilla Sky
Ivory Wave
White Lightning
Scarface
Purple Wave
Novel psychedelics or synthetic
LSD
25B-NBOMe / 25I-NBOMe
Synthetic opioids
Hallucinogens MPPP
phenethylamines, (1-Methyl-4-phenyl-4-propion
benzylphenethylamines oxypiperidine), dextrorphan,
(e.g. 2C-Bfly, Br-fly, Br-dragonfly); dezomorphin
(crocodile).
Prescription drugs
• Psychotropics
• Benzodiazpines ( alprazolam commonest-
similar withdrawal symptom as alcohol)
• Schedule X
• NDPS 1985 drugs
E-Cigarette-
Vaping
E-CigaretteComponents
1. Cartridge:
This holds the liquid solution called
e-liquid.
2. Automizer:
This is heating element that
allows vaporization.
3. Battery:
Largest part of E-Cigarette
usually lithium-ion and
rechargeable.
4. LED Light:
This glows when you inhale.
How it works?
E-Cigarette which is a
powered-battery device
●
convert liquid nicotine into
vapor with no fire and no
smoke.
● There is a battery, a
heating element and a
cartridge that holds the
nicotine and other liquid
flavoring.
Trend
• The prevalence of most drug use is increasing
• The age of onset is decreasing
• The gender gap is narrowing
• Vaping
Thank you