Chapter 18 New

Chapter 18: Substance Misuse and Abuse

Introduction  Substance abuse and misuse cost the United States billions of dollars annually in medical care, insurance and loss of productivity.  Even more important, however, are the lives lost or permanently impaired each year from injuries or medical emergencies related to substance abuse or misuse.

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Introduction (continued)

 Legal substances are among those most often misused or abused.  Such legal substances include—  Nicotine (found in tobacco products).  Alcohol (found in beer, wine and liquor).  Over-the-counter medications, such as aspirin, sleeping pills and diet pills.

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Introduction (continued)

 According to the National Vital Statistics Reports, over 40,000 Americans died as a result of drug- or alcohol-induced deaths in 2001.

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Activity  Define and discuss the following terms:  Substance misuse  Substance abuse  Drug  Medication  Dependency  Addiction  Tolerance

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Activity (continued)

 Define and discuss the following terms:  Overdose  Withdrawal  Synergistic effect

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Activity  Substance misuse  Substance abuse  Drug  Medication  Dependency  Addiction   Tolerance

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Activity (continued)

 Overdose  Withdrawal  Synergistic effect

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Misused and Abused Substances  Substances are categorized according to their effects on the body.  The six major categories of commonly misused and abused substances are—  Stimulants.  Depressants.  Hallucinogens.  Narcotics.  Inhalants.  Cannabis products.

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Stimulants  Stimulants are drugs that affect the central nervous system by increasing physical and mental activity.  The effects of stimulants include—  Temporary feelings of alertness and prevention of fatigue.  Appetite suppression.  Many stimulants are ingested as pills, but can be absorbed or inhaled.

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Stimulants  Amphetamines, dextroamphetamines and methamphetamines are stimulants.  Slangs are: uppers, bennies, black beauties, speed, crystal, meth, and crank  Cocaine is one of the most publicized and powerful stimulants.  A purer form of cocaine is known as crack.  Highly addictive and called rock and freebase rocks  The most common stimulants in America are legal:  Caffeine  Nicotine  Other stimulants are used for medical purposes.

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Hallucinogens  Hallucinogens, also known as psychedelics, are substances that affect mood, sensation, thought, emotion and self-awareness.  Hallucinogens sometimes cause what is called a bad trip.  A bad trip can involve intense fear, panic, paranoid delusions, vivid hallucinations, profound depression, tension and anxiety.  The victim may be irrational and feel threatened by any attempt others make to help.

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Hallucinogens (continued)

 Among the most widely abused hallucinogens are—  Lysergic acid diethylamide (LSD), also known as acid.  Psilocybin (mushrooms).  Phencyclidine (PCP), called angel dust.  Mescaline (peyote, buttons or mesc).  Most are ingested, PCP can be inhaled

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Depressants  Depressants are substances that affect the central nervous system by decreasing physical and mental activity.  Depressants are commonly used for medical purposes.  Relieve anxiety, promote sleep, depress respiration, relieve pain, relax muscles, impair coordination and judgment  Common depressants include—  Barbiturates.  Benzodiazepines.  Narcotics.  Alcohol.

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Depressants continued  Most are ingested or injected.  Alcohol is most widely used and abused substance in the U.S.  Causes many unhealthy consequences • Affect the brain causing lack of coordination, memory loss or apathy • Cause liver disease such as cirrhosis • Lead to psychological, family, social and work problems  Alcohol poisoning is caused when large amount is consumed in a short period of time. Resulting in LOC and if untreated DEATH 15

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Narcotics  Narcotics, derived from opium, are drugs that work on the central nervous system to relieve pain.  Are very powerful and highly addictive and are illegal without a prescription.  When taken in large amounts euphoria, stupor, coma or death can result.  The most common natural narcotics are morphine and codeine.  Most other narcotics, including heroin, are synthetic or semisynthetic.

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Narcotics continued  Heroin abuse is results in serious health conditions  Fatal overdose  Spontaneous abortion  Collapsed veins  HIV and Hep. B  Long Term  Infection or heart lining and valves, abscesses and liver diseases  Addiction

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Inhalants  Inhalants are substances inhaled to produce a mood-altering effect.  Inhalants also depress the central nervous system.  Inhalants include medical anesthetics, such as amyl nitrite and nitrous oxide (also known as laughing gas), as well as hydrocarbons, known as solvents.  Solvents are similar to alcohol they include • Toluene – found in glue • Butane – found in lighter fluid • Acetone – found in nail polish remover • Fuels such as gasoline and kerosene • Propellants – found in aerosol sprays

 Inhalant can damage heart, lungs, brain and liver 18

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Cannabis Products  Cannabis products, including marijuana, tetrahydrocannabinol, or (THC), and hashish, are all derived from the plant Cannabis sativa.  Marijuana is the most widely used illicit drug in the United States.  Marijuana, although illicit, has been used for some medicinal purposes to treat—  Nausea from chemotherapy.  Glaucoma.  Muscular weakness caused by multiple sclerosis.  Weight loss from cancer and AIDS. 19

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Cannabis Products (continued)

 The effects of marijuana include—  Feelings of elation.  Distorted perceptions of time and space.  Throat irritation.  Red eyes.  Rapid pulse.  Dizziness.  Increased appetite.

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Designer Drugs  These drugs are variations of other substances, such as narcotics and amphetamines.  The molecular structures of designer drugs include substances used for medical purposes that are modified by chemists.  When altered, the user can experience a variety of unpredictable and dangerous effects  Most common drug is methylenedioxymethamphertamine (MDMA) or ecstasy  Ecstasy is popular for the euphoric high • Other signals are: – Increase BP, Rapids HB, Profuse sweating, Paranoia, Sensory distortion, Erratic mood swings

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Anabolic Steroids  Anabolic steroids are sometimes used by athletes to enhance performance and increase muscle mass.  Their medical uses include stimulating weight gain.  Chronic use of anabolic steroids can lead to sterility, liver cancer and personality changes.  Steroid abuse by young people may also disrupt normal growth.

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Over-the-Counter Substances

 The most commonly misused and abused over-the-counter substances are aspirin, laxatives and nasal sprays.

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Over-the-Counter Substance (continued)

 Aspirin is used to relieve minor pain, reduce fever and treat heart disease.  Aspirin misuse can—  Cause inflammation of the stomach and small intestine.  Impair normal blood clotting.

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Over-the-Counter Substance (continued)

 Laxatives are used to relieve constipation.  Laxative misuse can cause uncontrolled diarrhea that may result in dehydration.  Laxative abuse is associated with attempted weight loss and eating disorders, such as anorexia nervosa and bulimia.

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Over-the-Counter Substance (continued)

 Antihistamines, such as decongestant nasal sprays, can help relieve the congestion of colds or hay fever.  If misused, they can cause physical dependency.  Used over a long period of time sprays can result in nose bleeds and changes in the lining of the nasal passages, eventually making it difficult to breathe without the spray

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Signals of Substance Misuse and Abuse  Signals of substance misuse and abuse are similar to those of other medical emergencies.  Signals of abuse or misuse include—  Moist or flushed skin.  Sweating, chills, nausea, vomiting.  Fever.  Headache.  Dizziness..  Rapid pulse, rapid breathing.  High blood pressure.  Chest pain. 27

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Signals of Substance Misuse and Abuse (continued)

 Respiratory distress, disruption of normal heart rhythm and even death can result from using a stimulant.  A victim of stimulant overdose may appear to be—  Very excited.  Restless.  Talkative.  Irritable.  Unconscious.

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Signals of Substance Misuse and Abuse (continued)

 Specific signals of hallucinogen abuse may include—  Sudden mood changes.  Flushed face.  Seeing or hearing something that is not present.  Anxiousness or being frightened.  Specific signals of depressant abuse include—  Drowsiness.  Confusion.

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Signals of Substance Misuse and Abuse (continued)

 Slurred speech.  Slow heart and breathing rates.  Poor coordination.

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Care for Substance Misuse and Abuse  Follow these general principles as you would for any poisoning:  Check the scene to make sure it is safe to help the person.  Do not approach if victim is behaving in a threatening manner.  Call 9–1–1, the local emergency number or the Poison Control Center.  Care for any life-threatening conditions.  Care for any other conditions you find.  Withdraw from the area if the victim becomes violent or threatening. 31

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Care for Substance Misuse and Abuse (continued)

 Look for clues.  Look for product or medicine containers, drug paraphernalia and signals of other medical conditions.  If you suspect that someone has taken a designer drug, tell EMS personnel.  After a substance abuse emergency, the victim may need additional support to overcome addiction.

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Preventing Substance Misuse and Abuse  Approaches vary, including educating people about substances and their effects on health and attempting to instill fear of penalties, which have not by themselves proved to be particularly effective.  To be effective, prevention efforts must address the various underlying factors of and approaches to substance abuse.

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Preventing Substance Misuse and Abuse (continued)

 The following factors may contribute to substance abuse:  A lack of parental supervision  The breakdown of traditional family structures  A wish to escape unpleasant surroundings and stressful situations  The widespread availability of substances  Peer pressure and the basic need to belong  Low self-esteem, including feelings of guilt and shame  Media glamorization  History of substance abuse 34

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Preventing Substance Misuse and Abuse (continued)

 Some poisonings from medicines occur when victims knowingly increase the dosage beyond what is directed.  The best way to prevent such misuse is to take medications only as prescribed.  On the other hand, many poisonings from medicines are not intentional.

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Preventing Substance Misuse and Abuse (continued)

 The following guidelines may help prevent unintentional misuse or overdose:  Read the product information and use only as directed.  Ask your physician or pharmacist about the intended use and side effects of prescriptions and over-the-counter medications. If you are taking more than one medication, check for possible interaction effects.  Never use another person’s prescribed medications.  Always keep medications in their appropriate, marked containers.  Destroy all out-of-date medications.  Always keep medications out of the reach of children. 36

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Closing  There are six major categories of substances that, when abused or misused, can produce a variety of signals.  You do not have to diagnose the condition to give care.  If you suspect that the victim’s condition is caused by substance misuse or abuse—  Give care for a poisoning emergency.  Call 9-1-1, the local emergency number or Poison Control Center personnel and follow their directions.  Call the police, if necessary.  Questions? 37

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